Volume 86  ·   Issue 35  ·  2006

In recent 20 years, with the deepening of the research on the pathogenesis and clinical research of rheumatism, the treatment methods are becoming more and more mature and standardized, and the complete remission rate of these diseases is also increasing. The concept that rheumatism is mostly "incurable disease" has become the past. However, due to the relatively lagging understanding of these diseases in China, there are still a large number of patients in clinic who have not been treated correctly in time, and therefore they are delayed or disabled, or even life-threatening. In fact, many clinical studies have proved that with standardized individualized treatment, most rheumatism diseases can be completely relieved. Clinicians should provide individualized treatment plan for each patient with both therapeutic effect and no obvious adverse reaction. In this paper, combined with the recent clinical research progress, the individualized treatment of several major rheumatism diseases is discussed.

Objective to investigate the molecular mechanism of characteristic changes after acute spinal cord injury (SCI). Methods Nine SD rats were randomly divided into 3 groups: SCI 8 h group (3 rats), 72 h group (3 rats) and control group (3 rats). The rat spinal cord contusion model was established by modified Allen's impingement method. The gene expression profiles of 13 200 rat genes were analyzed by cDNA microarray containing 13 200 rat genes at 8 h and 72 h after traumatic spinal cord injury. The expression levels of 12 genes were verified by RT-PCR. The expression levels of C/EBP δ gene were verified by immunohistochemistry and in situ hybridization. Results The expression of 52 genes in SCI 8 h showed significant changes, and the upregulated genes included transcription factors, early rapid response genes, oxidative stress, complement, pro-inflammatory and anti-inflammatory response genes, etc. The down-regulated genes included ion channel, synaptic and vesicle-associated proteins, neurofilament proteins, cytoskeleton-associated proteins and myelin-associated glycoproteins, etc. The expression of 44 genes in SCI 72 h showed significant changes, including growth factor, GTPase, oncogene, tumor suppressor gene, ubiquitin system-associated protein, etc. These genes played an important role in neuronal growth/differentiation/survival, repair and regeneration, etc. The results of RT-PCR validation of 12 genes were in agreement with those of microarray. Conclusion There were significant changes in the expression of many genes in the early stage of SCI. C/EBP δ is a gene highly expressed in injured spinal cord tissue, and may be an interventional target for treatment of SCI.

Objective to study the effect and mechanism of glucocorticoid on airway mucus excessive secretion in asthmatic mouse model.Methods Twenty-four BALB/c mice were randomly divided into control group,asthma group and asthma + dexamethasone group,8 mice in each group.The mice in each group were anesthetized 24h after the last challenge.Different specimens were collected to observe the total number of cells and eosinophils in bronchoalveolar lavage fluid (BALF). The changes of airway goblet cells were detected by AB-PAS staining.The mRNA of mucin gene MUC5AC and protein and interleukin-4 (IL-4) mRNA were detected by RT-PCR and immunohistochemical staining.Results Compared with the control group, the number of eosinophils and airway goblet cells in BALF was significantly increased in asthma group, but decreased significantly in asthma + dexamethasone group; MUC5AC mRNA (0.5341±0.0303), protein (0.1906±0.0008) and IL-4 mRNA (0.6265±0.0932) in lung tissues of asthma group were significantly higher than those of control group (0.1994±0.0128, 0.1194±0.0007 and 0.2389±0.0289, respectively) (P<0.01), and those of asthma + dexamethasone group (0.2729±0.0345, 0.1456±0.0003 and 0.2424±0.0260, respectively) were significantly higher than those of asthma group (P<0.05), but there was no significant difference between IL-4 mRNA and protein in asthma + dexamethasone group and control group (P>0.05), and MUC5AC mRNA and protein were significantly lower than those of control group (P<0.01). Conclusion Glucocorticoid can reduce lung inflammation in asthmatic mice, and may play a therapeutic role in airway mucus excessive secretion by downregulating the expression of MUC5AC and IL-4.

Objective to evaluate the short-term efficacy and safety of laparoscopic surgery for colorectal carcinoma. Methods the published prospective randomized controlled trials (RCTs) comparing the short-term clinical effects of laparoscopic surgery and open surgery for colorectal carcinoma were retrieved before December 2005. After screening according to the inclusion and exclusion criteria, the quality score was performed, and the short-term clinical effect index was extracted for meta-analysis. Results Nine RCTs were included in the meta-analysis, and the mean quality score was (7.6±0.6). The basic characteristics of patients in the laparoscopic surgery group and the open surgery group were balanced. Compared with the open surgery group, the incision length in the laparoscopic surgery group was reduced by 12 cm [95% CI (-13.51~ -10.49), P<0.01], and the bleeding volume was reduced by about 75ml [95% CI (-86.06~ -62.99), P<0.01], but the operation time was prolonged by 42 min [95% CI (32.18~52.50), P<0.01]. There were no statistical differences in the length of specimens, the positive rate of resection margin and the number of lymph nodes detected between the two groups. There were no statistical differences in the incidence of intraoperative complications, overall postoperative complications and specific complications between the two groups. The patients in the laparoscopic surgery group had less pain on the first day after operation [weighted mean difference WMD = -0.80, 95% CI (-1.26~ -0.34), P<0.34 Trauma to patients was also significantly reduced.

Objective to observe the effect of Ginkgo biloba extract (GBE) on the injury of hippocampal neurons and brain caused by N-methyl-D-aspartate (NMDA) receptor overactivation and to explore its possible mechanism.Methods The effect of GBE on excitotoxic injury of hippocampal neurons was evaluated by trypanosome blue staining and lactate dehydrogenase (LDH) assay, and the modulation effect of GBE on NMDA receptor activation current in rat hippocampal acute isolated neurons was observed by whole cell patch clamp recording. The protective effects of GBE on focal cerebral ischemic injury in rats were evaluated by Longa score, red tetrazole, neuronal nucleoprotein and microtubule associated protein-2 immunohistochemical staining, etc. The above interventional effects of GBE were compared with those of NMDA receptor specific antagonist MK-801. Results 150 μ g/ml GBE pretreatment could effectively protect hippocampal neurons exposed to NMDA + glycine, improve cell survival rate to 85.2% ± 5.2%, and reduce LDH leakage to 87 U/L ± 8 U/L, but this effect was weaker than that of MK-801 (P<0.05); The inward current (INMDA) induced by the joint action of NMDA and glycine was significantly inhibited by 0.1 mg/ml GBE, and the inhibition rate of 50 μ mol/L MK-801 was 78% ± 18%. The difference between the two groups was statistically significant (P<0.01). After washing with standard extracellular fluid, INMDA recovered to 91%±8% in GBE group, but not in MK-801 group (P<0.05). GBE pretreatment can effectively alleviate the focal cerebral ischemia injury in rats, and its protective effect is weaker than that of MK-801 (P<0.05), but there is no severe behavioral toxicity caused by MK-801 in rats. Conclusion GBE pretreatment can resist the toxic injury of hippocampal neurons caused by excessive activation of NMDA receptor and focal cerebral ischemia injury in rats, which may be related to antagonizing NMDA receptor. This protective effect and its binding ability to NMDA receptor are weaker than that of MK-801, and there is no behavioral toxicity, which makes anti-excitotoxic clinical intervention possible.

Objective to determine the anatomical position and composition of rectal lateral ligament and its relationship with middle rectal artery and pelvic plexus. Methods Total mesorectal resection (TME) was used to dissect 58 human hemipelvic specimens along the median sagittal plane to confirm the rectal lateral ligament. The distance between the midpoint of lateral ligament and the sacral promontory and the tip of coccyx was measured, and the lateral ligament was transversely cut for pathological examination. The pelvic plexus and middle rectal artery were dissected to determine the relationship between them and lateral ligament. Results The lateral ligament could be dissected in 58 hemipelvic specimens. The lateral ligament originated from the lateral part of the anterior edge of the second, third and fourth sacrum and connected to the posterolateral side of the rectum and the middle 1/3 of its mesangium. The distance between the midpoint of the right lateral ligament and the sacral promontory was (8.3 ± 1.6) cm, and the left side was (8.4 ± 1.4) cm; The distance between the midpoint of the right lateral ligament and the tip of the coccyx is (5.2 ± 1.4) cm, and the left side is (5.0 ± 1.3) cm. The width (cephaloanal diameter) of the right lateral ligament is (3.2 ± 0.4) cm, and the left side is (3.1 ± 0.4) cm. Histological examination shows that the lateral ligament is composed of loose connective tissue, the main components are fibrous tissue, adipose tissue, blood vessels, nerve bundles, etc. The middle rectal artery is found in the hemipelvis in 83% (48/58), and the artery passes through the lateral ligament in 47% (27/58). With the pelvic plexus as the boundary, the lateral ligament can be divided into two parts: the lateral side includes the branch of iliac vessel, the medial side includes the rectal branch from the pelvic plexus and the medial part of the middle rectal artery. Conclusion The lateral rectal ligament is a clear anatomical structure, mainly composed of loose connective tissue bridging the rectum and its mesangium posterolateral and the lateral part of the second, third and fourth sacral bodies. The distance between the lateral ligament and the tip of the coccyx is less than the distance from the sacral promontory. The lateral ligament contains the pelvic plexus and its rectal branch, the middle rectal artery or its branch, which is the entrance of blood vessels and nerves into the rectum

Objective to observe the effect of exogenous carbon monoxide (CO) on serum-induced neutrophil (PMN) apoptosis and nuclear factor (NF) κ B in patients with limb ischemia-reperfusion (IR). Methods Human peripheral blood PMN was isolated and cultured in 24-well culture plates and divided into 4 groups (n =16): control group, control + CO, IR and IR + CO groups. Cells in IR and IR + CO groups were incubated with serum of limb IR patients instead of culture medium, and the other two groups were incubated with serum of healthy volunteers. Cells in IR + CO group and control + CO group were incubated in air containing 0.025% CO and 5% CO2. Cells in control group and IR group were always incubated in air containing 5% CO2. The apoptosis rate of PMN was detected by flow cytometry, the ladder band was observed by PMN DNA electrophoresis, and the activity of NF-κ B in PMN nucleus was detected by electrophoretic mobility (EMSA). Results Compared with the control group, the percentage of PMN apoptosis was significantly reduced and the activity of NF-κ B was significantly enhanced in IR group; Compared with IR group, the percentage of PMN apoptosis was significantly increased, the activity of NF-κ B was significantly decreased, and the typical DNA ladder band appeared in IR + CO group. Conclusion Exogenous CO can improve the inhibition of serum-induced PMN apoptosis in limb IR patients, and its mechanism is related to the down-regulation of NF-κ B activity.

Objective to investigate the effect of risperidone on sleep EEG activity in patients with first-episode schizophrenia by polysomnography (PSG). Methods 25 patients were treated with PSG for 4 consecutive nights, including 1.2 mg of risperidone before going to bed on the third and fourth nights, and the changes of PSG after medication were observed. Results After taking risperidone, the total sleep time at night increased (baseline sleep value 378 min±30 min, 406 min±34 min after the third night, 427 min±31 min after the fourth night, F =34.762, P<0.01), and the sleep efficiency increased (baseline sleep value 86% ±10%, 90%±10% after the third night, 93%±12% after the fourth night, F =3.215, P<0.05), the wake time decreased (baseline sleep value 34 min±17 min, 23 min±15 min after the third night, 19 min±8 min after the fourth night, F =7.459, P<0.01), and the stage S1 decreased (baseline sleep value 22%±10%, 15%±9% after the third night, 18%±9% after the fourth night, F =4.12, P<0.05), S2

Objective to investigate the role of specific/non-specific neuroreactive autoantibodies in serum/cerebrospinal fluid (CSF) of patients with neuropsychiatric lupus (NPSLE) in the pathogenesis of NPSLE. Methods The serum and cerebrospinal fluid of 25 patients with NPSLE and 11 patients with systemic lupus erythematosus (SLE) with central nervous system (CNS) infection were collected, and the serum of 10 patients with SLE without neuropsychiatric involvement (non-NPSLE) were collected. Human laryngeal carcinoma epithelial cells (Hep-2) and monkey cerebellar tissue and peripheral nerve slices were used as antigen matrix to detect autoantibody fluorescence models. Results There was no significant difference in the positive rate of serum antinuclear antibody (ANA) between NPSLE group and SLE control group (P>0.05). The positive rate of ANA in CSF was 60% (15/25) in NPSLE group and 27% (3/11) in SLE infection control group (P<0.01). The positive rate of serum nerve tissue reactive antibody in PSLE group was significantly higher than that in SLE infected control group and non-NPSLE control group (P<0.001). Conclusion (1) The positive rate of CSF ANA in SLE patients is related to SLE activity and nervous system involvement, especially in severe cases, the higher titer can be seen; (2) The positive neural tissue reactive autoantibody in serum is related to the pathogenesis of NPSLE, and its production and pathogenesis need to be explored.

Objective to investigate the clinical characteristics of undifferentiated connective tissue disease (UCTD) developed into a definite autoimmune disease. Methods 1105 hospitalized cases were randomly selected, including 751 cases of systemic lupus erythematosus (SLE), 63 cases of systemic sclerosis (SSc), 103 cases of polymyositis/dermatomyositis (PM/DM), 159 cases of Sjogren's syndrome (pSS) and 29 cases of overlapping syndrome. Results 75 cases of SLE, 27 cases of SSc, 15 cases of PM/DM, 26 cases of pSS and 2 cases of overlapping syndrome, a total of 176 cases developed from UCTD after an average of 2~5 years. In 85.2% (23/27) of the patients developing SSc, Raynaud's phenomenon was the first symptom; The main manifestations of PM/DM were rash or facial edema in 40% (6/15) and 33.3% (5/15), respectively; Conclusion UCTD can develop into definite autoimmune diseases/diffuse connective tissue diseases, including SLE, SSc, pSS, PM/DM and overlapping syndrome. The outcome of UCTD is related to the clinical features at the onset.

Objective to compare enzyme-linked immunosorbent assay (ELISA), immunodubble diffusion (ID) and immunoblotting (IB) in the detection of anti-SSA/Ro antibodies, to evaluate the conformity of the three methods, and to improve the understanding of the relative molecular weight of 52 000 bands detected by IB. Methods The anti-SSA/Ro antibody levels of the following three groups were detected by ELISA, IB and ID: 122 serums from normal blood donors; 7736 serum samples were routinely tested in the laboratory; Results (1) All 122 serums of normal blood donors were negative for anti-SSA/Ro antibodies by ELISA, ID and IB; (2) In 7736 serum samples routinely tested in laboratory, the relative molecular mass of IB was 52,000 in 1085 cases. Among them, 92 samples were negative for antinuclear antibody and other anti-ENA antibodies. All patients in this group were negative by ID and ELISA; (3) In 166 cases of connective tissue disease, the positive rates of anti-SSA/Ro antibody detected by ELISA, ID and IB were 76.5% (127/166), 65.1% (108/166) and 49.4% (82/166), respectively; (4) In 166 samples of connective tissue disease, the coincidence rate of ELISA and ID was 88.6% (147/166), χ 2=17.1, P<0.001. The coincidence rate of ID and IB was 75.9% (126/166), χ 2=15.6, P<0.001. (5) The correlation coefficient of ELISA and ID was 0.828, P<0.001. Conclusion (1) The specificity of ELISA and ID is better than that of IB. (2) The specificity of IB is poor, but if ANA and anti-ENA bands are positive at the same time, the specificity will be significantly improved. (3) The sensitivity of ELISA is better than that of ID, and the sensitivity of ID is better than that of IB. (4) There is a significant positive correlation between ELISA and ID.

Objective to investigate the changes of serum matrix metalloproteinase (MMP) -3 concentration in patients with ankylosing spondylitis (AS) after treatment with two kinds of tumor necrosis factor inhibitors.Methods The serum concentration of MMP-3 was detected by enzyme-linked immunosorbent assay (ELISA) in 47 and 26 patients with active AS after treatment with Infliximab and recombinant human type Ⅱ tumor necrosis factor receptor-antibody fusion protein Etanercept respectively.Results After 6 weeks of Infliximab treatment, the serum MMP-3 levels were significantly decreased at 2, 6 and 10 weeks (P<0.01). There was a significant correlation between MMP-3 levels and erythrocyte sedimentation rate (ESR) at 2, 6 and 10 weeks (P<0.05). After 12 weeks of treatment with Etanercept, the serum MMP-3 levels decreased significantly at 1, 2, 4, 8 and 12 weeks (all P<0.01). The concentration of MMP-3 before treatment (0 weeks) was significantly correlated with ESR (r =0.74, P<0.01) and C-reactive protein CRP (r =0.72, P<0.01). At the end of treatment (12 weeks), there was also a significant correlation between the concentration of MMP-3 and ESR (r =0.43, P =0.029), but the correlation with CRP was not significant (r =0.37, P =0.061). Conclusion Infliximab and Etanercept can not only significantly reduce the objective indexes of ESR and CRP, but also significantly reduce the concentration of MMP-3 in peripheral serum of AS. MMP-3 is related to the onset and disease activity of AS, and MMP-3 may be a useful objective index to evaluate the disease activity of AS and the efficacy of antitumor necrosis factor inhibitors in the treatment of AS.

The patient, a 40-year-old female, was admitted to the hospital on June 28, 2000 due to low fever in April and numbness of limbs in March. In February 2000, she had no induced low fever, body temperature 37.2~37.8℃, accompanied by fatigue. In March 2000, she gradually developed numbness of limbs and limbs. Echocardiography showed moderate pericardial effusion, and abdominal B-ultrasound showed hepatosplenomegaly and ascites. Since the onset of the disease, her skin became dark, her weight lost 5kg, and her defecation and stool were normal. Skin rash, joint pain, dry mouth and eyes, etc. were denied. Past history: penicillin allergy, no special. Menstrual history was normal. Physical examination at admission: body temperature 37.3℃, blood pressure 130/75 mm Hg, heart rate 70 beats/min, clear mind, extensive pigmentation throughout the body, red warts were visible on the ring finger of the left hand. One swollen lymph node in both mandibles, 1 cm in diameter, medium quality, no tenderness.

With the development of modern advanced diagnosis and treatment technology and the widespread use of antibiotics and immunosuppressants, the clinical detection rate of Acinetobacter has increased year by year. This bacterium has become the main pathogen causing serious lethal nosocomial infections, often causing nosocomial pneumonia, bacteremia, urinary system infection, meningitis, soft tissue infection and intraabdominal infection, especially in patients in intensive care unit (ICU). Carbapenem antibiotics are the most widespread antibacterial drugs in use at present, with the strongest antibacterial activity and rapid bactericidal action. However, with the widespread use of this kind of drugs, bacteria have gradually appeared drug resistance. Since foreign scholars [1] first discovered Acinetobacter resistant to carbapenem antibiotics in 1991 and it is a multi-drug resistant strain, scholars have continuously reported [2, 3] Acinetobacter resistant to carbapenem antibiotics. Recently, [4, 5] acquired carbapenemase production has been reported in ICU and hematology wards. Therefore, the treatment of Acinetobacter infection is unavailable, the mortality rate is very high, and the clinical treatment is facing severe challenges. This paper reviews the mechanism of resistance of Acinetobacter to carbapenem antibiotics and the progress of treatment.

Inflammation is a self-response of human body to infection, antigen-antibody binding and mechanical damage. Moderate inflammation is beneficial to human body, but excessive or sustained inflammation can cause tissue damage and induce disease. Glucocorticoid (GC) can correct the dysregulation of inflammation response, and is often used in clinical practice to treat diseases caused by abnormal inflammation response such as rheumatoid arthritis, systemic lupus erythematosus, glomerulonephritis, multiple sclerosis, psoriasis, etc., mainly through its binding to glucocorticoid receptor (GR), and exerts its action through different ways. However, this pleiotropic effect can also produce adverse reactions, causing growth retardation, immunosuppression, hypertension, inhibition of wound repair, osteoporosis and metabolic disorders in children. Studying these mechanisms will help us to understand the different ways of pharmacological action and side effect, so as to develop more complete preparations.

Studies have shown that high sensitivity C-reactive protein (hsCRP) has a strong early warning effect on cardiovascular events, and has a positive correlation with atherosclerosis; The increase of glycated hemoglobin A1C (HbA1c) is also a clear risk factor for the development of atherosclerosis, and it is also an independent risk factor for cardiovascular disease and mortality in non-diabetic patients. HbA1c is associated with hyperglycemia, and hsCRP is associated with inflammation.

age-related macular degeneration (AMD) is a common cause of irreversible visual decline in the elderly, and AMD is the leading cause of blindness in the elderly in the United States. Cognitive impairment is common in the elderly, and can be caused by neurodegenerative diseases such as Alzheimer's disease and cerebrovascular diseases. Because both AMD and cognitive impairment are involved in neuronal degeneration, people have tried to find the association between them. It has been reported that AMD is associated with Alzheimer's disease in the elderly over 75 years old, but this correlation is significantly weakened after adjusting for factors such as smoking and atherosclerosis. There is no positive conclusion about the relationship between AMD and cognitive impairment at present. An epidemiological investigation of 2946 subjects in 11 centers by the age-related eye disease study (AREDS) research group found that advanced AMD with significant visual decline is positively correlated with cognitive impairment. the study was published recently in<Arch Ophthalmol, 2006, 124:537-543).

From January 1998 to October 2005, we made full use of the structural characteristics of Foley catheter to assist in carrying out non-stop open heart surgery, and the clinical results were satisfactory.

Iatrogenic arytenoid subluxation (AS) is rare, often caused by endotracheal intubation anesthesia or nasogastric tube insertion. Early diagnosis and treatment are extremely important, otherwise it can cause joint adhesion and fixation, and persistent hoarseness and may cause medical disputes. A total of 61 cases of AS were diagnosed and treated in the clinical acoustics clinic of otolaryngology department of the Second Affiliated Hospital of Zhejiang University School of Medicine from January 1993 to December 2004.

With the popularization of clinical standard guidelines for diagnosis and treatment of lung cancer and pulmonary tuberculosis, the diagnosis of lung mass before treatment has become a routine, especially the pathological diagnosis must be obtained before chemotherapy and radiotherapy. At present, the accuracy of commonly used imaging diagnosis such as chest radiography, chest CT and chest MRI is about 50% ~70%. positron emission tomography (PET) with high specificity and sensitivity has not been widely used in clinical practice because of its price. Percutaneous lung biopsy is still a common method for diagnosing lung mass [1]. Because of the shortcomings of the older generation CT, such as poor positioning accuracy, easy to be affected by patients' breathing, few traditional needles, low positive rate and easy to occur chest wall implant transfer, the clinical popularization and application of CT-guided percutaneous lung biopsy have been affected. The new generation of 64-slice spiral CT and the new generation of lung cutting biopsy needles have unique advantages in clinical operation, diagnostic accuracy and complication rate.

A 48-year-old male was admitted to the hospital on December 3, 2005 due to hematemesis twice in 4 years. The patient had initial hematemesis 4 years ago, combined with tarmaceous stool, which improved after hemostasis and drug treatment under internal gastroscopy, and similar symptoms occurred again 1 month ago, which improved after conservative treatment. The patient's spleen was enlarged 40 years ago, but there were no related symptoms such as fever and history of exposure to epidemic water in the epidemic area. Physical examination: varicose veins in the abdominal wall, no ascites and abdominal pain symptoms, no subcostal liver, 10cm subcostal spleen, slightly hard texture, no lower limb edema. Laboratory examination: blood routine showed that the blood three lines were decreased, including white blood cells 2.2×109/L, red blood cells 2.4×1012/L, hemoglobin 65g/L, platelet 5.6×109/L; Blood biochemistry showed normal liver function, normal coagulation indexes, normal virological indexes of hepatitis B and hepatitis C, and normal type IV collagen. Color Doppler ultrasound showed that the portal vein was widened by 2.5 cm, the splenic vein was widened by 2.2 cm, and there was a thrombosis attached to the wall. A huge aneurysm with a diameter of 4 cm was found next to the splenic vein, and the blood flow was suspected to have an arteriovenous fistula between the splenic vein and the splenic vein. Abdominal enhanced CT showed huge spleen, splenic aneurysm located in the middle segment of splenic artery, splenic arteriovenous fistula was unclear, upper gastrointestinal angiography showed esophageal varices, but gastric varices were not significant.