Volume 89  ·   Issue 27  ·  2009

Chinese Medical Journal published a number of papers on the basic and clinical research of rheumatoid arthritis in this issue, and the editorial department invited the author to write a review article. However, after careful consideration, the significance of these papers can be understood and evaluated by readers, and the current domestic understanding of this disease and the existing clinical problems deserve more attention.

Objective To obtain the mimotope recognized by anti-keratin antibody (AKA) by screening a phage random peptide library and evaluate its diagnostic value. Methods IgG was purified from AKA positive pooled serum of rheumatoid arthritis (RA) patients by 33.3% ( NH4)2SO4 ( AKA measured with indirect immunofluorescence). Then the antibody was used as the ligand for biopanning of a 12-mer phage random peptide library. The serum of patients with RA, SLE and normal people were detected with the positive clone by indirect ELISA. Results After 4 rounds of screening, the peptide of mimotope associated with RA was acquired. The diagnostic specificity, positive predictive value and Youden's index were 95.6%, 90% and 155.6% respectively. Its amino acid sequence was QSESAGPTTSRR This sequence was similar to 137-148 amino acid sequence of human filaggrin. Conclusion The RA-associated peptide is acquired by screening a phage random peptide library using polyclonal AKA of RA patients. It may be a specific diagnostic tool of RA.

Objective To identify interleukin-17 (IL-17)-producing CD8 positive T cells from patients with rheumatoid arthritis (RA), and investigate its cytokines as well as their correlations. Methods Peripheral blood got from 39 RA patients and 40 healthy donors. Flow cytometry was used to analyze the subsets of T cells in peripheral blood from these 39 RA patients and 27 healthy donors. Ⅱ-17, IL-6, and IL-23 levels in sera of all these people were tested by ELISA. Results The median of CD8+IL-17+ T cellsfrom RA patients was 2. 7% (95% confidence internal was 1.55%-3. 74% );the median of these cells from healthy controls was 1.61% (95% confidence internal was 1.25%-2.61% ). CD8+IL-17+T cells elevated significantly in RA(P<0.05 ). As the production of CD8+IL-17+T ceils, the IL-17 levels in sera of RA patients and healthy controls were (429±502) ng/L and ( 13±30) ng/L respectively. The IL-17 level in RA is higher than that in healthy people (P<0.01 ). Meanwhile, to constitute CD8+IL-17+T cell polarizing condition, IL-23 and IL-6 in sera of RA were (157.83+ 27.07 )ng/L and (32. 67+34. 50)×ng/L individually. These two cytokines in healthy controls were (21.97±3. 52) ng/L and (1.82±1.51 ) ng/L severally. IL-6 and IL-23 increased clearly in peripheral blood of RA patients as compared with healthy donors (P<0.01 ). Conclusions This study suggested that elevated CD8+ IL-17+ T ceils which involved in IL-17 secretion may depend on increased IL-6 and IL-23 in peripheral blood of rheumatoid arthritis.

Objective To evaluate the inhibitory effect of blockade of Rho kinase upon mediating the secretion of proinflammatory cytokine in monocytic cells from rheumatoid arthritis (RA)patients. Methods Synovial fluid (SF) monocytic cells and peripheral blood monocytes (PB) from active RA patients were treated with TNFα or LPS respectively in the presence or absence of a specific ROK inhibitor, Y27632. ROK activity was assessed by Western blot and cytokine secretion measured by ELISA. Results Elevated ROK activity was found in synovial fluid monocytic cells from active RA patients.ROK activity was correlated with DAS, an index of disease activity of RA patients. ROK inhibitor Y27632 reduced the secretion of TNFα, IL-1β and IL-6 in RA SF monocytic cells, but had no effect upon the secretion of IL-10, an anti-inflammatory cytokine. Conclusion The present study provides novel evidence that ROK mediates the secretion of proinflammatory cytokines in monocytic cells from RA synovial fluids,suggesting a critical role of ROK in macrophage-mediated synovial inflammation of RA. Thus inhibition of ROK may be a new therapeutic target for RA.

Objective To investigate the efficacy and safety of Infliximab(IFX) plus methotrexate (MTX) combination therapy in patients with rheumatoid arthritis (RA). Methods Prospectively observe refractory RA patients who were treated with combination therapy of MTX and IFX. IFX was infused at the dosage of 3 mg/kg, in week O, 2, 6, and then every 8 weeks. During treatment, clinical variables, disease activity and adverse effects were eva]uated.Results After treatment,69.8%,52.4%,29.5%and 7.2%RA patients achieyed ACR20.ACR50,ACR70 and ACR90 respectively.111ere Were significant statistical differences in the changes of swollen;oint counts,tender joint counts,VAS scale,patient's global assessment.and physician'8 global assessment before and after therapy.Conclusion Infliximab plus MTX achieved significant efficacy and safety in refractory RA patients.

Objective To investigate the value of 64-detector spiral computed tomography versus MRI in the assessment of fight ventricular function. Methods Thirty healthy volunteers ( 15 males, 15 females, 48±24 years) underwent 64-detector spiral computed tomography CT and breath-hold MRI. With semiautomatic contour detection software, the parameters of end-diastolic volume, end-systolic volume,stroke volume and ejection fraction were determined from short-axis CT reformations (MPR) created at every 5% of RR-intervaL The results from CT were compared with those from MRI using Pearson correlation test and Biand-Altruan plot. Results The CT values of mean end-diastolic volume (146±27) ml, end-systolic volume (70±20) ml, stroke volume (75±12) ml and ejection fraction (52%±5% )correlated well with those by MRI [146±25 ml(r=0.959), 66±17 ml(r=0.914),80±15 ml(r=0.706),55%±7%(r=0. 612) ]. A strong correlation between MSCT and MRI was also found in the Bland-Altman plot. Conclusion 64-detector spiral CT can accurately assess the right ventricular function. It is a valuable method for evaluating cardiac function.

Objective To assess the prognosis of thymectomy in treatment of ocular myastbenia gravis (OMG) and relevant influencing factors. Methods A total of 135 OMG patients were included. The clinical course and the prognosis were reviewed in 65 patients with thymectomy and in 70 with medication. We compared the rate of relapse and conversion into generalized myasthenia gravis (GMG)between two different treatments for OMG by Kaplan-Meier analysis. An analysis of COX regression model was employed to compare gender, age, duration of prethymectomy, acetylcholine receptor antibody (AChR Ab), anti-titin antibody (Titin Ab), thymus pathology and postthymeetomy prednisene. The rates of relapse and conversion in OMG with thymomas or non-thymomas and with Titin Ab positive or negative afterthymectomy were farther investigated. Results The median follow-up was 62 months. The effective rate was 72.3% in the thymectomy group and 34.3% in the medication group (P<0.01). The COX regression analysis revealed that the prognosis was statistically independent of Titin Ab ( P<0.05), thymus pathology (P<0.05) and prednisene treatment (P<0.05). The rate of relapse ( Log-Rank, P<0.05) and the rateof conversion ( Log-Rank, P<0.05) were smaller in the thymectomy group than in the medication groups.The rates of relapse and conversion in OMG with Titin Ab positive or thymomas were higher than OMG with Titin Ab negative or non-thymomas (Log-Rank, P<0.05). Conclusion As an effective and safe treatment for OMG, thymectomy can relieve the symptoms and prevent the progression of OMG to GMG.

Objective To assess the value of ProSeal-LMA(laryngeal mask airway) during hip replacement operation. Methods Sixty patients undergoing hip replacement operation were randomly divided into two groups with 30 cases in each. ProSeaI-LMA was applied in Group I and normal endotracheal tube in Group Ⅱ. The parameters of heart rate ( HR), mean arterial blood pressure ( MAP), partial pressure of carbon dioxide in end expiratory gas (PetCO2) and airway pressure (Paw) were monitored and recorded in both groups at time points of before and after placing ProSeai-LMA or tracheal tube, body turning-over, skin incision and extubating of ProSeaI-LMA or tracheal tube. And also the cases with airway complications were reported. Results There was no significant changes of HR and MAP in Group I at time points of placing and extracting ProSeaI-LMA (P>0.05). However, there was significant difference of HR and MAP in Group Ⅱ at time points of placing and extracting tracheal tube ( P<0.05), And it was significantly higher than that in Group I at the same time point (P<0.05). No significant difference of these parameters was observed at other time points (P>0.05). And also PetCO2 and Paw were not changed significantly between two groups at time points of before and after body turning over (P>0.05). Conclusion ProSeaI-LMA can be applied in hip replacement operation because of its simple handling, lesser effects upon respiration and circulation and fewer post-operative complications.

Objective To investigate the effect of long-term sevoflurane anesthesia on markers of myocardial damage or toxicity. Methods Forty adult patients scheduled for upper abdominal surgery with general anesthesia for 4 hours or more were randomly divided into Group S and PR ( n=20 each). After anesthesia induction, patients of Group S were maintained with only sevoflurane, and patients of Group PR with target-controlled infusion of propofol 2-4μg/ml and remifentanil 4-8 ng/ml. Anesthesia was titrated to control blood pressure and heart rate change at less than 20 percent of baseline values. Blood samples were draw at pre-induetion,4 h and 24 h post-induction respectively. Serum level of cardiac treponin I, ereatine kinase MB and myoglobin were analyzed. Results There were no significant changes of troponin I, creatine kinase MB and myoglobin in Group S between pre-inductian and 4 h or 24 h pest-induction ( P>0.05 ). And there was also no significant differences as compared with Group PR (P>0.05). Conclusion At the concentration range of 1.6%-3%, long-term sevoflurane anesthesia does not cause detectable changes of markers of myocardial damage or toxicity.

Objectve To evaluate the effects of different glucocorticoids upon blood glucose during surgery under general anesthesia. Methods Thirty ( ASA Ⅰ/Ⅱ) patients scheduled for surgery under combined intravenous-inhalational anesthesia were randomly divided into 3 groups: dexamethasone group (Group D), methylprednisolone group (Group M) and normal saline group (Group S). Patients received dexamethasone, 10 mg Ⅳ (Group D), or methylprednisolone, 120 mg Ⅳ (Group M), or normal saline,10 wi Ⅳ (Group S) at pre-induction. Arterial blood was collected preoperatively, and at 60, 120, 180 win post-injection to analyze the blood glucose. Results As compared to baseline, blood glucose increased significantly in Group D at 60, 120, 180 rain post-injection (P<0.01). In Group M, blood glucose increased significantly at 180 win post-injection (P<0.01). In Group S, blood glucose increased significantly at 60, 120, 180 win post-injection respectively (P<0.01). Comparison among these three groups indicated that differences between Group D and Group M(P=0.01) or Group S ( P<0.05) were significant at 120 win post-injection. The difference between Group D and Group M was significant at 180 rain post-injection (P<0.05). Conclusion The blood glucose often increases significantly during surgery under general anesthesia. Use of glucocorticoids may aggravate hyperglycemia, so that close monitoring and control are quite important. Methylprednisolone has less effect upon blood glucose than dexamethasone.

Objective To probe clinical value of percutaneous ethanol ablation (PEA) in complicated renal carcinoma. Methods 10 cases complicated renal carcinoma patients with 16 lesions ranged from 1.7-8.4 cm totally, renal cancer in 7 cases, renal hamartoma in 3 cases,enderwent CT guided pereutaneous ethanol ablation(PEA) by local anesthesia. Plain and contrast CT scan was adopted to evaluate clinical effect and make follow-up. Results Each patient accepted 2 times PEA in average with follow-up time ranged from 2 to 26 months averaged in 18 months. No recurrence was seen in 1 ease isolated renal patient unfortunately with renal cancer through 1 year and 9 months follow-up after 2 times PEA. The other isolated renal cancer patient died of acute renal failure after 4 times PEA. Lesions were fully ablated in 2 cases renal cancer patients with low back pain and blood urine and symptoms disappeared after PEA accordingly. Other 3 cases renal cancer patients went through 1 year and 6 months,2 years and 2 months,and 1 year follow-up respectively. 1 case died of distant metastasis and 2 cases kept stabilization evaluated by CT scan. Hemorrhage within lesions disappeared in 2 cases renal hamartoma after just one time PEA, which keptstabilization through lycar, 1 year and 10 months follow-up respactively. 1 case hamartoma patient gave up treatment after 2 times PEA. No complications including urinary fistula, hemorrage, intestinal perforation and needle track implantation were seen in all patients. Conclusion CT guided PEA is a microinvasive, positive curative effect and faculative method in treating complicated renal carcinomas. But for isolated renal pa tientwith renal cancer,PEA should be performed cautiously.

Objective To analyze the selection of surgical methods for lumbar disc herniation with low back and leg pain and degenerative lumbar Medic endplate changes and their different postoperative therapeutic effects. Methods All 30 cases of single segment lumbar disc herniation accompanied by Modie endplate changes operated at our hospital using simple discectomy or decompressions with interbedy fusion from January 2005 to January 2008 were retrospectively identified. There were 18 males and 12 females with an average age of 38. 5 years old ( 26-53 years old) and an average follow-up of 21 months (4-40 months). Results Discectomy alone group included 15 cases. The average score of Japanese Orthopedics Association (JOA) and visual analysis scale (VAS) of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 13.2 (5-17 ), 6.8 (4-10), 4.8(1-8) and 19.8(14-24), 4.8(2-10), 1.2(0-6) respectively. The average improvement rate of JOA was 41.9%. The difference of VAS of lower extremity radieular pain between pre and post-operation was 3.7 on average.Among these 15 cases, Medic I, Ⅱ and Ⅰ/Ⅱ mixed-type was 5, 9, and 1 respectively. Decompression with interbody fusion group included 15 eases. VAS of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 12.9(5-17),7.0(4-10),4.9(1-8) and 22.6(19-28),2. 8 (2-8 ) and 1.3 (0-6) respectively. The average improvement rate of JOA was 63.4%. The differences of VAS of lower extremity radicular pain and low back pain between pre and post-operation were 4. 3 and 3.6 on average respectively. Among these cases, Medic Ⅰ,Ⅱ and Ⅰ/Ⅱ mixed-type was 6, 8,and 1 respectively. Comparing the VAS of low back pain, JOA average score and the improvement rate of JOA score of two groups at pre-operation and post-operation, statistical analysis showed that decompression with interbedy fusion group was superior to simple diseectomy group. Conclusion For lumbar disc herniation with degenerative Medic endplate changes, who suffered more from low back pain than lower extremity radicular pain, discectomy alone and decompression with interbody fusion could both improve the degree of lower extremity radicular pain, but discectomy alone is less likely to improve the degree of low back pain and function score than the latter. So the maneuver of lumbar decompression with fusion is a better choice.

Objective To investigate the association between brain-derived neurotrophic factor (BDNF) gene polymorphism and bipolar disorder. Methods Single nucleotide polymorphisms rs6265 and rs11030101 in BDNF gene were detected and compared between 228 patients with bipolar disorder and 361 healthy controls. Results The genotypes, alleles and combinative genotype of BDNF gene single nucleotide polymorphism rs6265 and rs11030101 did not show significant differences between two groups. There were also no significant differences in genotypes and combinative genotypes between diagnostic subtypes, genders and on-set age of bipolar disorder and controls. Conclusion This study did not found that BDNF gene single nucleotide polymorphism rs6265 and rs11030101 are associated with bipolar disorders.

Objective To assess cardiac twist in dilated cardiomyopathy (DCM) patients using echocardiography velocity vector imaging (VVI) and to explore the clinical application value of VVI in evaluating cardiac twist. Methods Thirty-three normal subjects and 30 DCM patients were enrolled.Echocardiographs of parasternal left ventricle basal, papillary muscle level and apical short axis plane, apical four-, two-chamber plane were obtained respectively. Systolic maximal rotation degree, peak rotation velocity, circumferential strain (CS), time to peak rotation velocity (TPRV), peak un-rotation velocity of end diastole and end isovolumic relaxation period in subendocardium were measured by WI software.Results (1) In the normal group, left ventricle performed systolic wring motion with counterclockwise rotation at the apex and clockwise rotation at the base as seen from the apex, while with transient counterclockwise rotation at the base and clockwise rotation at the apex in isovolumic relaxation period. The papillary level rotation form was not constant. For the dominant rotation action of the apex, the whole cardiac twist form wag counterclockwise.(2)Compared with the control group,4 DCM patients cardiac twist pattern changed:two showed both counterclockwise rotation of the base and the apIex,one represented botll clockwise rotation of the base and the apex.another performed the base rotated counterelockwise and the apex rotated elockwise.(3)All rotation and twist parameters of other 26 DCM patients decreased.especially at the apical level:LVtw:7.34°±3.65°VS 17.01°±4.81°,LVtor:(0.09±0.04)°/mm vs(0.23±0.06)°/mm,torsion rate:(60.23±23.67)°/s vs(148.24±56.23)°/s,untwisting rate(0.37±0.19)%/m VS(0.59±0.33%)/m,basal CS:(-8.09±2.73)%VS(-19.49±5.51)%(P=0.013),apical CS:(-8.94±5.90)%VS(-27.49±9.53)%(P=0.000),basal rotation angle:(-3.60±2.38)°VS(-6.28±3.05)°(P=0.014),apical rotation angle:(5.80±3.55)°VS(11.02±3.33)°(P=0.001).(4)The apical TPRV in DCM group were longer than the control group represented rotational dyssynchrony in DCM patients(400.26 ms±70.15ms vs 328.13 ms±66.95 ins,P=0.008).LVtw correlated positively well with EF (r=0.489,P<0.05).Conclusion (1)Cardiac twist function wag diffusely impaired in DCM patients and it contributed to the global cardiac dysfunction.(2)Cardiac twist pattern changed in some of DCM pailents.(3)VVI Can objectively reflect cardiac twist function in DCM patients.

Objective To study the effectiveness of retinoic acid on induction of osteoporotic ratstreated by either alendronate or Qianggu capsules and co-administration. Methods Sixty-five female SD rats were treated with retinoic acid 80 mg·kg-1·d-1by gastric lavage for 15 days. Then 5 rats were confirmed cases of esteoporosis and the remaining 60 were randomly divided into 4 groups 15 each: (1) control group with NS 8 ml·kg-1·w-1; (2) alendronate group with alendronate 40 mg·kg-1·w-1; (3) qianggu group with Qianggu capsules 90 mg·kg-1·d-1; (4) co-medicated group with alendronate 40 mg·kg-1w-1 and Qianggu capsules 90 mg·kg-1d-1. Five rats in each group were sacrificed at week 2, 4 and 6 respectively to carry out the biomechanic tests, histopsthologic examination and bony callus volume calculation.Results Biomechanical properties of femur changed significantly after the treatment by alendronate or Qianggu capsules and co-medication as compared with that of NS after 4 weeks (P<0.05);the bony callus were larger when treated by alendronate (P<0.05) and smaller by Qianggu capsules (P> 0.05); the bone trabecula formed and rebuilding were slower by alendronate and quicker by Qianggu capsules. Conclusion Alendronate or Qianggu capsules and co-medication can improve biomechanieal properties of femur by retinoic acid on induction of esteoporotic rats. Qianggu capsules can improve bone union.

Depressive disorder is a common psychiatric disease, its lifetime prevalence is 12%-17% [1], and its heritability is 40%-50% [2]. Foreign studies have shown that brain-derived neurotrophic factor (BDNF) plays an important role in the genetic research of depressive disorder [3].

In sudden accidents, a large number of injured people often appear, that is, mass wounded people (mass wounded people). The injuries caused also have the characteristics of diversified injuries, mixed minor and severe injuries, and the coexistence of simple injuries and compound injuries, which greatly increases the difficulty of treatment [1]. Understanding the injury characteristics of mass wounded people is of great significance for improving the success rate of treatment. We summarize the rescue of personnel organized by our hospital to Wenchuan earthquake-stricken areas, and the analysis and report are as follows.

A 44-year-old female was admitted to hospital on March 10, 2008 due to fatigue for 3 months, headache and edema for 1 month. The patient developed fatigue without inducement 3 months ago, and her activity tolerance decreased. Hemoglobin decreased in other hospitals, and the hemorrhoid sedimentation rate (ESR) was 118 mm, /1 h. Considering "iron deficiency anemia", the fatigue slightly improved after iron supplementation treatment (hemoglobin unknown). The symptoms worsened in the past month, headache, dizziness, anorexia, nausea, accompanied by low fever, and body temperature 37-38℃.

Innate immunity is directly related to whether or not infection occurs and the outcome after onset. The cornea itself has no blood vessels, so the corneal innate immunity may play a more important role in corneal infection and inflammation. Although some progress has been made in related research, the research on its regulation by exogenous intervention has not yet started, and these are precisely the key to prevent and control corneal infection. Glucocorticoid (GC) is one of the most commonly used and effective drugs for the treatment of ocular surface immune and inflammatory diseases at present, and it is used in almost all inflammatory diseases of the anterior segment of the eye [1].