Meta-analysis: compared with anti-CCP and rheumatoid factor, could anti-MCV be the next biomarker in the rheumatoid arthritis classification criteria?

Background Previous reviews of the diagnosis for rheumatoid arthritis (RA) have not compared anti-mutated citrullinated vimentin (MCV) with anti-cyclic citrullinated peptide (CCP) and rheumatoid factor (RF) in respect of sensitivity, specificity and the area under the curve (AUC) against disease controls for differential diagnosis. This meta-analysis aims to evaluate the value of anti-MCV in the diagnosis for RA, the combined sensitivity of anti-MCV and anti-CCP, and certain clinical characteristics related to the performance of anti-MCV. Methods Medline, Embase, Cochrane Library and Web of Science were searched for articles published up to 25 August 2018. A total of 33 studies including 6044 RA patients and 5094 healthy or disease controls achieved inclusive criteria. QUADAS-2 was applied to evaluate the quality of the included studies. The bivariate random effects model was employed in primary data synthesis to evaluate the diagnostic performance. Results The sensitivity of anti-MCV, anti-CCP and RF in RA diagnosis against a disease control group was 0.71, 0.71, 0.77, with the specificity of 0.89, 0.95, 0.73, and the AUC of the SROC of 0.89, 0.95, 0.82, respectively. The predesign of the primary study and diagnostic criteria were statistically significant as sources of heterogeneity. Anti-MCV and anti-CCP tests demonstrated a sensitivity of 0.77 when performed in parallel, with a sensitivity of 0.60 when performed in series; whereas, the combination of anti-MCV and RF presented a sensitivity of 0.64 when used in series. Conclusions Anti-MCV demonstrates comparable diagnostic value to anti-CCP and RF, thus it can be an effective diagnostic marker for RA and may be written into the next authoritative criteria.

Expression of S100B protein levels in serum and cerebrospinal fluid with different forms of neuropsychiatric systemic lupus erythematosus.

The aim of this study is to determine S100B protein levels in serum and cerebrospinal fluid (CSF) in patients with different forms of neruopsychiatric systemic lupus erythematosus (NPSLE). There were 157 SLE patients (65 with and 92 without NPSLE, and 20 patients without rheumatic diseases served as controls) recruited in the present study. Serum and CSF S100B protein levels were measured by ELISA assay. Serum S100B protein levels in patients with NPSLE (0.179 +/- 0.095 microg/l) were significantly higher than the levels in patients without NPSLE (0.110 +/- 0.091 microg/l; p < 0.001) and in controls (0.103 +/- 0.065 microg/l; p = 0.005). Thus, the differences in serum levels between non-NPSLE patients and controls had no statistical significance. The serum and CSF S100B protein contents in patients with organic brain syndrome, seizures, cerebral vascular accident, and psychosis were significantly higher than those in controls (all p < 0.001). However, there was no significant difference in serum and CSF S100B protein levels among patients with headache, patients with neuropathy, and controls. In conclusion, serum and CSF S100B levels were raised in NPSLE, especially concerning patients with organic brain syndrome, seizures, cerebral vascular accident, and psychosis. The results obtained imply that S100B protein is possibly an available and complementary biochemical marker within evaluation of NPSLE and deserves further study.

[Comparison of different vehicles for nebulized salbutamol in treatment of bronchial asthma exacerbations: a Meta-analysis].

OBJECTIVE: To assess the efficacy of two vehicles for nebulized salbutamol in treatment of asthma exacerbations with Meta-analysis. METHODS: All relevant randomized controlled clinical trials (RCT) with isotonic magnesium sulphate and saline as vehicles for inhaled salbutamol in treatment of asthma exacerbations were searched. A Meta-analysis was performed to evaluate the results of the two therapies. RESULT: Five relevant RCTs from literature were collected and total 219 cases were included for analysis. The meta-analysis indicated that the significant improvements were obtained from isotonic magnesium sulphate as a vehicle for nebulized salbutamol, in comparison with saline [pooled standardized mean difference (SMD)=0.55(95% CI 0.28 - 0.83), P <0.001]. By further subgroup analysis, this change was properly significant in the subgroup of severe patients with their baseline FEV1% <30% [FEV1 weighted mean difference (WMD)=0.72 L(95% CI 0.30 L - 1.14 L), P <0.01]. The pooled results of vital signs between two vehicles did not demonstrate statistical significance. Overall, the risk of admission to hospital was not statistically reduced in patients using magnesium sulphate, who presented to the emergency department with an asthma exacerbation [pooled RR=0.64(95% CI 0.38 - 1.08), P >0.05]. CONCLUSION: Compared with saline,the use of isotonic magnesium sulfate as an adjuvant to nebulize salbutamol is a beneficial therapy with improving spirometric airway function in the severe asthma exacerbation.

[Clinical significance of CD4+CD25+ T cells in peripheral blood of patients in systemic lupus erythematosus].

OBJECTIVE: To investigate the expressions of C(4)D(+)CD(25)(+) T cells in the peripheral blood of patients with systemic lupus erythematosus (SLE) and to identify the relationship between the levels of CD(4)(+)CD(25)(+) T cells and the disease activity and progression of SLE. METHODS: Fifty-three SLE patients were enrolled in the study. Flow-cytometric assay was employed for detection of CD(4)(+)CD(25)(+) T cells and CD(4)(+)CD(25)(bright) T cells were defined according to fluorescence intensity of CD(25) expression exceeding 100. Meanwhile, correlation analysis was performed between their expression and the scores of SLE disease active index (SLEDAI), C(3), dsDNA and antinuclear antibody titles. RESULTS: The levels of peripheral blood CD(4)(+)CD(25)(+) T cells in SLE were (7.84 +/- 1.85)%, which were significantly lower than those in a group of healthy control [(9.18 +/- 2.01)%, P < 0.05]. The levels of CD(4)(+)CD(25)(+) T cells in a group of active SLE [(6.72 +/- 1.16)%] were higher than those in a group of stable SLE [(8.57 +/- 1.91)%, P < 0.01]. There was no difference between the active and stable groups of SLE in peripheral blood CD(4)(+)CD(25)(bright) T cells [(0.85 +/- 0.24)% vs (0.91 +/- 0.25)%, P = 0.686], but they were significantly lower than those in the group of healthy controls [(1.43 +/- 1.08)%, P < 0.01]. With the reduction of the SLEDAI scores in SLE patients after relevant treatment, the levels of peripheral blood CD(4)(+)CD(25)(bright) T cells did not change. No correlation was found between the levels of CD(4)(+)CD(25)(bright) T cells and SLEDAI scores, antinuclear antibody titles, dsDNA and C(3), respectively (rho = -0.188, P = 0.178; rho = -0.216, P = 0.121; rho = 0.082, P = 0.560; rho = 0.010, P = 0.944). CONCLUSION: The reduction of CD(4)(+)CD(25)(+) T cells in peripheral blood may participate in the pathogenesis of SLE.

[The expression of transforming growth factor beta-1 in rat model of chronic obstructive pulmonary disease and the effects of early drugs intervention].

OBJECTIVE: To evaluate the expression of transforming growth factor beta-1(TGF-beta1) and the effects of early drugs intervention of chronic obstructive pulmonary disease(COPD) in rat model. METHODS: The COPD rat model (group B) was established by intratracheal instillation of lipopolysaccharide twice and daily exposure to cigarette smoking. Drug intervention groups received dongchongxiacao orally daily from the three days before the experiment (group C) and erythromycin by intraperitoneal injection since the third week (group D)and inhalation of budesonide since the forth week (group E). At the end of 10 weeks, all 40 rats including normal control (group A) were assessed for lung resistance (RL) and dynamic lung compliance (Cdyn). The expression of TGF-beta1 gene and protein were also observed by immunohistochemistry and semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), respectively. RESULTS: The changes of pathology and pathophysiology in rat COPD model were similar to those of human COPD. There was a significant increase in the smooth muscle and collagen thickness in the airway wall of the group B in comparison with that of the group A. RL in group B was significantly higher than that in group A (P<0.01), while it was inhibited by early drugs intervention (P<0.01). Cdyn was decreased in group B as compared with that in group A, which was limited by erythromycin and budesonide intervention (P<0.01). The relative content for TGF-beta1 was significantly increased in the epithelial cells of the bronchi, endothelial cells of the pulmonary small vessel and alveolar macrophages of COPD group as compared with those of normal controls (P<0.01).The relative contents for TGF-beta1 in the epithelial of bronchi in group D and group E were significantly lower than that in group B, but not found in group C. There was no difference between group D and group E. There were statistical positive relationships between the RL and the relative content for TGF-beta1 in the bronchial epithelial cells, between the RL and the mRNA level of TGF-beta1 in the lung tissue (P<0.01 approximately 0.05). CONCLUSION: This rat COPD model could be helpful to obtain more information about airway remodeling. TGF-beta1 may play an important role during the process of airway remodeling, and could be influenced by early drugs intervention such as budesonide and erythromycin, which may imply their potency in the treatment of COPD. But there is not same phenomenon found in dongchongxiacao group.