Venous thromboembolism risk in rheumatoid arthritis patients: a systematic review and updated meta-analysis.

OBJECTIVE: Rheumatoid arthritis (RA) patients are prone to develop thromboembolic complications due to the chronic inflammatory nature of RA. Only one systematic review and meta-analysis has attempted to evaluate venous thromboembolism risk in RA patients. However, this review has become outdated due to the recent publication of several high-quality retrospective cohort studies. The aim of the study was to evaluate the risks of deep vein thrombosis, pulmonary embolism, and overall venous thromboembolism event incidence in RA patients. MATERIALS AND METHODS: Five databases (Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE) were systematically searched according to PRISMA guidelines for eligible studies. With the available literature, we conducted a random-effect meta-analysis to evaluate odds ratios of deep vein thrombosis, pulmonary embolism, and venous thromboembolism incidence in RA patients and healthy controls. RESULTS: We found 12 eligible studies detailing 272,884 RA patients and 2,280,454 age and sex-matched healthy controls. Meta-analysis revealed elevated risks for deep vein thrombosis (Odd's ratio: 2.25), pulmonary embolism (2.15), and overall venous thromboembolism incidence (2.23) in RA patients. CONCLUSIONS: This meta-analysis provides evidence concerning the elevated risks of deep vein thrombosis, pulmonary embolism, and venous thromboembolism in RA patients. The findings herein may aid in developing clinical awareness and assisting best practice guideline development for RA patients with thromboembolic complications.

Study on diagnostic value of P1NP and ß-CTX in bone metastasis of patients with breast cancer and the correlation between them.

OBJECTIVE: This study aimed to investigate the diagnostic value of the total amino-terminal propeptide of type 1 procollagen (P1NP) and C-terminal telopeptide of ß-I collagen (ß-CTX) in bone metastasis of patients with breast cancer and the correlation between them. PATIENTS AND METHODS: The medical records of 73 patients were retrospectively analyzed. These patients with breast cancer were treated in Oncology, General Surgery, and Orthopedic Departments in The Third People's Hospital of Qingdao from March 2014 to April 2017, including 40 patients with bone metastasis (bone metastasis group) and 33 patients with no bone metastasis (non-bone metastasis group). Other 40 healthy people who received physical examination in the same period were selected as the control group. The expression of P1NP and ß-CTX in plasma were detected by the Enzyme-linked immunosorbent assay, and the correlation between them was analyzed. RESULTS: There were significant differences in P1NP and ß-CTX concentrations among the three groups (p<0.05). The concentrations of P1NP in the control group and the non-bone metastasis group were significantly lower than that in the bone metastasis group (p<0.05); the concentrations of ß-CTX in the control group and the non-bone metastasis group were significantly lower than that in the bone metastasis group (p<0.05). P1NP: AUC=0.852, sensitivity: 72.5%, specificity: 93.9%, CUT OFF=66.44. ß-CTX: AUC=0.883, sensitivity: 85.0%, specificity: 84.8%, CUT OFF=69.8. Joint detection: AUC=0.952, sensitivity: 84.8%, specificity: 99.5%, CUT OFF=99.5. The results of the concentrations of P1NP and ß-CTX in the bone metastasis group detected by the Pearson correlation analysis showed that their concentrations were positively correlated in the bone metastasis group (r=0.764, p<0.05). CONCLUSIONS: P1NP and ß-CTX in plasma have a high diagnostic value for bone metastasis of breast cancer and have important significance in the diagnosis of bone metastasis and disease monitoring.

[Preoperative dynamic contrast-enhanced MRI can reduce the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma].

Objective: To investigate the value of preoperative dynamic contrast-enhanced MRI in reducing the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma. Methods: Seventy-two patients with early non-mass breast carcinoma received ultrasonographic and mammographic examination and subsequently underwent dynamic contrast-enhanced MRI examination before breast conserving surgery. The control group consisted of 74 patients who had early non-mass breast carcinoma. They only received ultrasonographic and mammographic examination and didn't undergo contrast-enhanced MRI examination. The comparison of the rate of tumor-positive resection margins between two groups was performed. The MRI findings that had the significant influence on the rate of tumor-positive resection margins were analyzed using Logistic regression model. Results: In 28 patients (28/72, 38.9%), dynamic contrast-enhanced MRI could correct or supplement the ultrasonographic and mammographic findings and resulted in the reasonable change of surgical program. The preoperative MRI examination group (n=30) had lower rate of tumor-positive resection margins than control group for invasive ductal carcinoma (23.3% vs 40.0%, P=0.02), but there was no significant difference (21.4% vs 26.9%, P=0.10) between two groups for ductal carcinoma in situ (n=28). The preoperative MRI examination group (n=14) had lower rate of tumor-positive resection margins than control group for the other pathologic types of breast carcinoma (14.3% vs 38.9%, P=0.02). The statistical analysis on the basis of Logistic regression model showed that some main MRI findings, including change surrounding the tumor, distance between tumor and nipple and tumor size, had the significant influence on the rate of tumor-positive resection margins. Conclusion: Preoperative dynamic contrast-enhanced MRI significantly increased the accuracy of resection margins evaluation, and greatly reduced the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma.

Right arm injection of contrast medium reduces venous artifacts in head and neck multislice spiral computed tomography angiography.

OBJECTIVE: We tested whether injection of contrast medium via right or left arm would affect venous artifacts on head and neck multislice spiral computed tomography (CT) angiography. PATIENTS AND METHODS: 326 patients were enrolled. Each patient was injected with 10 ml of contrast medium at 5 ml/sec. Time of peak contrast value plus an additional 1 sec was defined as delay time. Another 40 ml of contrast medium were injected with the same injection speed. The scanning area ranged from the aortic arch to the top of the head. Left and right forearms were used for intravenous injections of contrast medium in, respectively, 151 and 175 patients. Comparative analyses of image quality included determining contrast medium residues remaining in the superior vena cava, brachiocephalic vein, or subclavian vein, and comparisons of quality of three-dimensional CT angiography. RESULTS: In 75% of head and neck angiographies, the delay time of the common carotid artery ranged from 16 to 22 sec. In 60% of the images, the quality was graded as excellent, with the left arm injection resulting in delay time of > 23 sec and the right arm delay time of > 18 sec. The CT imaging quality after contrast injections via left or right arms was statistically significant (p < 0.05). The image quality after right arm injection was better than after left arm injection. CONCLUSIONS: Intravenous injection of contrast medium via right arm reduces artifacts from contrast medium residues and improves the image quality of head and neck CT angiography.

Histogenesis of hemopoietic bone marrow in adult mice.

Based on the concept that the hierarchy of regulatory genes may specify mammalian development, we attempted to evaluate how morphological and functional phenotypes of hemopoietic bone marrow develop in murine models. From studies of local irradiation, s.c. implantation of bone with or without marrow, and renal subcapsular implantation of marrow plugs or bone without marrow, we identified four sequential (necrotic, clearing, stromal proliferating, and hemopoiesis-recovering) responses in the early phase of the reconstruction of hemopoietic marrow that spatially and temporally proceeded in this restricted order. In addition, characteristic hexagonal sinuses were found to participate in the development of hemopoietic marrow in the early phase. The development of hexagonally arranged sinuses seems to coincide with the formation of abundant osseous trabeculae and to precede the appearance of colony-forming units in culture (CFU-C) and spleen colony-forming units (CFU-S). These findings are discussed from the point of the hierarchy of regulation.

Effects of juzen-taiho-toh (TJ-48), a traditional Oriental medicine, on hematopoietic recovery from radiation injury in mice.

Effects of Juzen-taiho-toh (TJ-48) on the recovery of hemopoietic systems from radiation injury are analyzed. Female C57BL/6N mice (6-8 weeks old) were irradiated at doses of 1, 2, 3, 5, or 7 Gy from a 60Co source. After irradiation, the mice were given TJ-48 (1.25 g in 100 ml drinking water). Seven days after irradiation, the mice were sacrificed, and bone marrow (both femurs), thymus, spleen, and peripheral blood counts were made. The bone marrow cells were used for fibroblast colony-forming unit (CFU-f), spleen colony-forming unit (CFU-S), granulocyte-macrophage colony-forming unit (CFU-GM), erythroid colony-forming unit (CFU-E), and erythroid burst-forming unit (BFU-E) assays. No difference was observed between the experimental and control groups except for CFU-S counts. In the assay for day-14 CFU-S, the mice injected with TJ-48-treated bone marrow cells showed better general condition (including increased body weight) and heavier spleens with larger and more numerous colonies. The effect of TJ-48 does not seem to be elicited via the hemopoietic microenvironment, because mice that had been given TJ-48 before irradiation at 8 Gy and then injected with syngeneic bone marrow cells did not show enhanced day-14 CFU-S counts. These results suggest that TJ-48 manifests a radioprotective effect by increasing the number and size of day-14 CFU-S.

Development of donor-derived thymic lymphomas after allogeneic bone marrow transplantation in AKR/J mice.

The transplantation of bone marrow cells from BALB/c (but not C57BL/6 and C3H/HeN) mice was observed to lead to the development of thymic lymphomas (leukemias) in AKR/J mice. Two leukemic cell lines, CAK1.3 and CAK4.4, were established from the primary culture of two thymic lymphoma, and surface phenotypes of these cell lines found to be H-2d and Thy-1.2+, indicating that these lymphoma cells are derived from BALB/c donor bone marrow cells. Further analyses of surface markers revealed that CAK1.3 is L3T4+ Lyt2+ IL2R-, whereas CAK4.4 is L3T4- Lyt2- IL2R+. Both CAK1.3 and CAK4.4 were transplantable into BALB/c but not AKR/J mice, further indicating that these cells are of BALB/c bone marrow donor origin. The cells were found to produce XC+-ecotropic viruses, but xenotropic and mink cell focus-forming viruses were undetectable. Inasmuch as thymic lymphomas are derived from bone marrow cells of leukemia-resistant BALB/c strain of mice under the allogeneic environment of leukemia-prone AKR/J mice, this animal model may serve as a useful tool not only for the analysis of leukemic relapse after bone marrow transplantation but also for elucidation of the mechanism of leukemogenesis.