Correlation of Hematological Indices and Acute-Phase Reactants in Rheumatoid Arthritis Patients on Disease-Modifying Antirheumatic Drugs: A Retrospective Cohort Analysis.

Acute-phase markers are often used to evaluate the disease activity of rheumatoid arthritis (RA). Occasionally, the serum levels of acute-phase reactants remain normal in patients with obvious inflamed joints. Hematological indices derived from complete blood counts have been shown to correlate with disease activity. This provides a potential practical implementation in daily practice. Only a few studies have evaluated the relation between hematological indices and novel RA treatment (i.e., biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs); no research has examined the changes in hematological indices in RA treatments longitudinally. We conducted a retrospective study involving 273 RA patients with b/tsDMARD treatment and followed them for at least a year. Baseline, 3-month, and 6-month lab data were collected. The results indicated a reduction in the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) post-treatment. Higher baseline PLRs and SIIs were associated with a more significant reduction in ESR at three months (η2 = 0.03/0.13, p = 0.21/0.023). NLR and SII correlated with CRP moderately at three months (r = 0.373/0.394, p < 0.001/< 0.001). A correlation comparison showed that the correlation of NLR and PLR with CRP differs during different periods (p = 0.037/0.004). Subgroup analysis revealed that the time effect on correlation is related to treatment with Janus kinase inhibitor and anti-interleukin-6 but not antitumor necrosis factors.

Acute Vision Loss as the Initial Manifestation of Granulomatosis with Polyangiitis Involving the Orbital Apex.

Granulomatosis with polyangiitis (GPA) is a systemic autoimmune disease consisting of necrotizing granulomatosis of the respiratory tract, necrotizing vasculitis, and necrotizing glomerulonephritis. It is under the category of ANCA-associated vasculitis, which involves small vessels. The nose, sinus, and ear were the most affected sites besides lung and kidney in localized form. They might precede other disease manifestations before progressing to the systemic form. Our patient presented with an intractable headache, followed by acute vision loss. His symptoms deteriorated regardless of antibiotic treatment for paranasal sinusitis. The sequential CT/MRI images showed the inflammatory raid of the orbital apex and cavernous sinus within days. The sinus biopsy and elevated PR3-anti-neutrophil cytoplasmic antibody led us to the diagnosis of GPA. Fortunately, the patient's vision improved gradually after steroid and immunosuppressant treatment.

Autologous stem cell transplantation in a patient with systemic sclerosis-associated interstitial lung disease in Taiwan.

BACKGROUND: Systemic sclerosis (SSc), characterized by fibrosis of the skin and other organs, is a devastating systemic autoimmune disease. Lung involvement is frequent in SSc and contributes to the high rate of mortality. OBJECTIVE: To describe the first case report of SSc and interstitial lung disease (ILD) receiving autologous hematopoietic stem cell transplantation (ASCT) in Taiwan. METHODS: Case report. RESULTS: A 51-year-old man presented with rapid skin thickening and shortness of breath. Early progressive SSc-associated ILD was diagnosed. Because his lung function rapidly declined and his skin disease progressed, he received ASCT with satisfactory treatment responses in both skin thickness and lung function. In addition, lung imaging analysis showed remarkable improvements in ILD after treatment. CONCLUSIONS: We suggest that ASCT can be considered in selected patients with early, rapidly progressive SSc associated with ILD.

Combined aerobic and resistance training improves physical and executive functions in women with systemic lupus erythematosus.

OBJECTIVES: Exercise is considered as an adjuvant therapeutic modality to alleviate symptoms of several rheumatic diseases. However, data regarding the benefits of exercise to patients with systemic lupus erythematosus (SLE) are relatively scant. METHODS: This study aimed to assess the effects of regular, moderate-intensity, aerobic exercise combined with resistance training on women with SLE who had no regular exercise. Patients were recruited and allocated into either the exercise or control group by their willingness. Patients in the exercise group (n = 12) underwent 12 weeks of combined exercise (five days per week), whereas those in the control group (n = 11) maintained their usual lifestyle. RESULTS: At baseline, there were no between-group differences in body composition, disease activity, two-kilometer walking test, and executive function test. After the combined exercise intervention for 12 weeks, significant improvements of both fitness index and reaction time to the stimuli in the go/no-go test were observed in the exercise group, but not in the control group. The disease activities in both study groups did not change significantly at the end of the study period. CONCLUSION: Our results suggest that regular moderate-intensity aerobic exercise combined with resistance training improves the physical and executive functions of SLE patients without exacerbating disease activity.

Faculty development program for general medicine in Taiwan: Past, present, and future.

General medical training programs are aimed at promoting competency in general practice skills with a holistic perspective of patient-centered medicine for the new generation of physicians. The faculty development program was implemented to promote learning and application of the six core competencies established by the Accreditation Council for Graduate Medical Education. This article describes the implementation and outcome of the current faculty development program. Additional assessment tools of the faculty development program are recommended to evaluate different perspectives of outcome. Our experience suggests that OSTEs are a realistic and well-received approach for faculty development that merits further investigation. According to the clinical instructors' response, our faculty development program effectively increased familiarity with various teaching and assessment skills needed to teach PGY 1 residents and ACGME competencies, and these clinical instructors also then subsequently applied these skills.

An investigation of the effects of inlet channel geometry on electrokinetic instabilities.

Numerical and experimental investigations are performed to examine the feasibility of inducing electrokinetic instability (EKI) phenomena in two-channel junctions containing two aqueous electrolytes with a 10:1 conductivity ratio via the application of a low-intensity DC electrical field. A deep microchannel with 700 microm in depth and 100 microm in width was designed, fabricated and used in this investigation. The results show that when the species streams are injected such that the conductivity gradient between them is perpendicular to the DC electrical driving field, an EKI effect can only be induced by applying a high electrical field intensity of 0.54 V/cm. However, when the potentials applied to the reservoirs of the microchip are switched such that the conductivity gradient is not perpendicular to the electrical field, flow instability can be achieved by applying a lower electrical field intensity.

Fabrication of UV epoxy resin masters for the replication of PDMS-based microchips.

This paper presents two methods for the fabrication of UV epoxy resin masters for the replication of PDMS-based microfluidic chips. In the first method, the epoxy resin master is fabricated from a negative glass template manufactured using conventional lithography and wet etching techniques. However, in the second method, the master is produced simply by exposing a layer of UV epoxy resin coated on a glass substrate. Although the first method enables the replication of multiple PDMS structures from a single master, the latter method avoids the requirement for a wet chemical etching process and enables the epoxy master to be produced in 40 min or less. The experimental results show that the epoxy resin masters enable the mass production of PDMS replicas with highly precise geometrical tolerances. A series of electrokinetic focusing experiments are performed using PDMS microchips replicated from the current epoxy resin masters. The experimental results obtained for the width of the electrokinetically-focused sample stream under different focusing ratios are found to be in good agreement with the theoretical predictions. The sample handling characteristics of the microfluidic chips are also investigated. It is shown that the sample flow can be electrokinetically pre-focused into a narrow stream and then guided to the desired outlet port by applying a simple voltage control model. Finally, it is demonstrated that through an appropriate alignment of the sample flow and the conductivity gradient, the electrokinetic instability phenomenon can be induced at a relatively low electrical field strength of 0.35 kV/cm.

Sample flow switching techniques on microfluidic chips.

This paper presents an experimental investigation into electrokinetically focused flow injection for bio-analytical applications. A novel microfluidic device for microfluidic sample handling is presented. The microfluidic chip is fabricated on glass substrates using conventional photolithographic and chemical etching processes and is bonded using a high-temperature fusion method. The proposed valve-less device is capable not only of directing a single sample flow to a specified output port, but also of driving multiple samples to separate outlet channels or even to a single outlet to facilitate sample mixing. The experimental results confirm that the sample flow can be electrokinetically pre-focused into a narrow stream and guided to the desired outlet port by means of a simple control voltage model. The microchip presented within this paper has considerable potential for use in a variety of applications, including high-throughput chemical analysis, cell fusion, fraction collection, sample mixing, and many other applications within the micro-total-analysis systems field.

Multiple injection techniques for microfluidic sample handling.

This paper presents an experimental and numerical investigation into electrokinetic focusing flow injection for bioanalytical applications on 1 x N (i.e., 1 sample inlet port and N outlet ports) and M x N (i.e., M sample inlet ports and N outlet ports) microfluidic chips. A novel device is presented which integrates two important microfluidic phenomena, namely electrokinetic focusing and valveless flow switching within multiported microchannels. The study proposes a voltage control model which achieves electrokinetic focusing in a prefocusing sample injection system and which allows the volume of the sample to be controlled. Using the developed methods, the study shows how the sample may be prefocused electrokinetically into a narrow stream prior to being injected continuously into specified outlet ports. The microfluidic chips presented within this paper possess an exciting potential for use in a variety of techniques, including high-throughput chemical analysis, cell fusion, fraction collection, fast sample mixing, and many other applications within the micrototalanalysis systems field.