Volume 91  ·   Issue 11  ·  2011

In recent years, with the progress of clinical research on rheumatoid immune diseases, there is a deeper understanding of the treatment methods and strategies of these diseases at home and abroad. Especially through large sample, multi-center randomized controlled clinical trials, it has been proved that patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS) can achieve clinical remission.

The study found early evidence that artesunate in combination with existing anticancer drugs could potentially make each drug more effective than alone.They also found that breaking out of routine therapy can improve the level of success of therapy.The results of the in vitro study of human Cancer cells by Dr Wai Liu and Prof Angus Dalgleish of the University of London, St George, U.K., were recently published in the International Journal of Cancer.

In recent years, the diagnosis and treatment of rheumatoid arthritis (RA) have made gratifying progress. First, the detection of anti-cyclic citrulline polypeptide antibody in serology and the application of joint magnetic resonance and ultrasound in imaging have promoted the early diagnosis of RA; Secondly, the combination of biologics represented by tumor necrosis factor inhibitors and traditional disease-modifying antirheumatic drugs (DMARD) makes patients get better clinical and radiological remission [1].

biologics refers to medicines which are directly made by using microorganisms, microorganism metabolites, parasites and animal toxins, human or animal blood or tissue, or made by modern biotechnology and chemical methods, and are used for the prevention, treatment and diagnosis of human diseases.

The treatment of rheumatoid arthritis (RA) has made rapid progress in recent 10 years. The marketing and promotion of synthetic immunosuppressants and biologics have greatly improved the prognosis of the disease, but it has also brought confusion and controversy to doctors and patients. Because RA is a heterogeneous disease, some patients can spontaneously alleviate and may not need too active treatment, while others still have irreversible joint deformities despite receiving a lot of active treatment, and at the same time, they have to face the complications and adverse drug reactions caused by active treatment.

In view of the experience in the treatment of chronic diseases such as cardiovascular disease and diabetes, the concepts of treating to target and tight control have been extended to other medical specialties and other diseases.Among them, target treatment is a treatment concept, which makes the clinical treatment have a clear direction and goal, that is, once the disease is diagnosed, the induction treatment should be carried out towards the goal of complete remission, and even if complete remission cannot be achieved, it should be controlled at a low activity state as much as possible to prevent the disease from harming the body, which is called "target treatment" [1].

Objective To explore a minimally invasive technique with hydroxylapatite artificial bone to repair the orbital blowout fracture.Methods Twenty-one cases of orbital blowout fracture from March 2008 to April 2010 were enrolled.And the fractures were repaired with a bridge of hydroxylapatite artificial bone under a nasal endoscope.During a regular 6-month follow-up,anatomic and functional recovery was evaluated.Results There was neither postoperative visual loss nor infection in all cases.At 3 months postoperation,diplopia vanished completely (n = 17),remained in peripheral vision (n = 2),existed in primary ocular position (n = 2) and the deviation of eyeball (n = 1).At Month 3,diplopia in peripheral vision or in primary position and the deviation of eyeball showed no improvement.Compared with the uninjured side,enophthalmos:≤2 mm (n = 18),＞ 2 mm (n= 2) and ＞ 4 mm (n = 1).The passive traction test was positive in one case.On computed tomograph (CT) scanning,there was no bone dislocation or slippage in all cases.Conclusion The surgical efficacy is excellent.The technique of combining the advantages of endoscopic sinus approach and hydroxyapatite artificial bone is worth a wider popularization.

Objective To discuss the treatment effect of wedge resection and thermal cantery of pleura for patients with malignant pleural effusion (MPE) caused by lung cancer under VATS.Methods 37patients with MPE underwent wedge resection and thermal cautery of pleura under VATS,from June 2005 to December 2008.Postoperative tumor markers level was contrasted with the preoperative,and the control rate of pleural effusion and survival rate of the patients were compared with control group,including 25 patients undergoing intrapleural chemotherapeutics in the same period.Result In the group,the control rate of pleural effusion was 100%,but 60% in control group(P = 0.005).The 1 -year survival rate of the group and the control group was 78.38% and 60% respectively (P =0.003).CEA and CA-125 were descended obviously in postoperative day 7 in the group(P = 0.002) ;in control group,there were no significant change of CEA and CA 125 after treatment(P= 0.797).Conclusion Wedge resection and thermal cautery of pleura under VATS can reduce tumor burden of patients with MPE to the maximum,and control MPE effectively and improve the quality of life for lung cancer patients with MPE.

Objective To investigate the application and techniques of Ligasure in video-assisted thoracic pulmonary surgery.Methods Use Ligasure to dissect lung parenchyma,small pulmonary vessel and stop bleeding in 15 cases spontaneous pneumothorax and 20 cases peripheral single lung node who undertaken video-assisted thoracic surgery during October 2008 to June 2010.Result All the procedures were successful,no severe complications,as active bleeding,continuous air leak occurred.A period of 9.3months (2-18 months) follow-up of all patients shows no delayed bleeding or recurrence pneumothorax.Conclusion Ligasure is safe,easy to use.It can optimize operation and reduce the operation time.

Objective To observe the effects of remifentanil or esmolol on the stress responses during electric shock therapy in psychiatric patients.Methods Upon the approval of institutional Ethics Committee,Eighty psychiatric patients requiring electric shock therapy were randomly divided into 2 groups:esmolol group (Group E) and remifentanil group (Group R) (n = 40 each).The patients in Groups E and R were injected with esmolol 1 mg/kg or remifentanil 2 μg/kg respectively before induction of anesthesia.Electric shock therapy was performed after a disappearance of fasciculation.MAP (mean arterial pressure) and HR (heart rate) were recorded at the following time points:prior to anesthesia (T0),prior to electric shock therapy (T1) and at 1 min (T2),3 min (T3) & 5 min (T4) after electric shock therapy.Venous blood samples were collected at (T0) and (T4).The plasma levels of cortisol and norepinephrine were determined by enzyme-linked immunosorbent assay.Results The levels of MAP and HR at T2,T3 were significantly higher than those at TO in Group E (P ＜ 0.05).And the levels of cortisol and norepinephrine at T4 were significantly higher than those at TO in 2 groups (P ＜ 0.05).However,their levels were significantly higher in Group E than those in Group R (P ＞ 0.05).Conclusion In modified electric convulsive treatment, remifentanil is superior to esmolol in maintaining the stabilization of cardiovascular system and effectively inhibiting the stress responses.

Objective To evaluate the correlation of collateral circulation with prognosis in patients with acute cerebral infarction.Methods A total of 260 patients with acute ischemie stroke within 1 week of symptom onset underwent digital subtraction angiogram (DSA).The National Institutes of Health Stroke Scale (NIHSS) scores were obtained at admission.And the Modified Rankin scores (mRS) were assessed at a 3-month follow-up.The follow-up data were acquired through clinic visits or telephone interviews.Results Among them,86 were found to have intra- or extra-cranial culprit artery severe stenosis or occlusion.And 36(75.00%) in 48 patients had collateral arterial circulation while 11 (28.64%)in 38 patients posterior circulation.There were statistical differences in the NIHSS scores at admission and favorite clinical outcome (mRS≤2) at 3-month follow-up for patients with and without collateral circulation.Conclusion DSA is the golden standard for the assessment of collateral circulation in patients with severe cerebral artery stenosis or occlusion.The prognosis is better in stroke patients with collateral circulation.

Objective To investigate the distribution of atherosclerotic stenosis of cerebral arteries in Chinese patients suffered from cerebral infarction,and to determine if there are any factors correlating with intracranial and extracranial atherosclerosis.Methods For this study,we enrolled 428 consecutive inpatients with cerebral infarction,All patients were examined with transcranial Doppler ultrasonography (TCD) and carotid duplex ultrasound to detect atherosclerotic lesions in intracranial and extracranial cerebral arteries,some also were examined by magnetic resonance angiography (MRA) and/or digital subtraction angiography(DSA),they were all diagnosed as atherosclerotic cerebral artery stenosis.The patients were divided into three groups according to the different location of lesions,the frequency of risk factors of atherosclerosis and the demographic parameters were compared among these groups.Results 199 cases (46.5%) had only intracranial artery stenosis,129 cases (30.1%) had only extracranial artery stenosis,100 cases (23.4%) had both intracranial and extracranial stenosis (combine group).Compared with the other two groups,the levels of total cholesterol and low density lipoprotein-cholesterol of the intracranial artery group are both significantly higher(TC:P1 = 0.001,P2 = 0.000;LDL-C:P1 = 0.004,P2 = 0.039),the combine group had a significant higher ratio of male than that of the intracranial artery group (P =0.003),there were no any other atherosclerosis risk factors had association with the location of cerebral artery stenosis.Conclusion The occurrence of stenosis in intracranial arteries is more frequent than that in extracranil arteries in Chinese patients with cerebral infarction,and the lipid level is higher in the intracranial artery group,most risk factors of atherosclerosis may not be major determinants of location for cerebral atherosclerosis.

Objective To create a breast nodule estimation model based on grayscale and color Doppler ultrasonography using Logistic regression that can screen out the specific features for distinguishing breast malignancy from benignancy.Methods From July,2009 to May,2010,217 patients were enrolled in the study in peking university first hospital.Clinical data and ultrasonic features were evaluated in 219 breast nodules of 217 patients confirmed by surgical pathology.Logistic regression model was established to screen out significant ultrasonic indexes for differentiating breast malignancy from benignancy.A receiver operating characteristics curve was made to assess diagnostic value of the Logistic regression model.Correlation was analyzed between the Logistic regression model and surgical pathology.Results Logistic regression model:Logit(p) = - 16.884 + 0.037 × age + 3.228 × longitudinal-transverse axis ratio + 1.412 ×border + 2.663 × halo + 1.813 × microcalcicum + 1.157 × resistance index + 2.204 × enlarged axillary lymph node (x2 = 167.107,P =000).The areas of ROC curve for probability and identification of breast malignant and benign nodule were 0.948 and 0.882 respectively.Diagnostic sensitivity,specificity and accuracy were 91.6%,84.9% and 88.9%.Logistic regression model positively correlated with surgical pathology(r=0.768,P= 0.000).Conclusion Our Logistic regression model can effectively differentiate malignant breast nodules from benign and can identify the ultrasonic features associated with breast cancer.

Objective To compare the early clinical outcomes of primary total knee arthroplasty by a fixed-bearing versus mobile-beating prosthesis.Methods A total of 80 patients with osteoarthritis at our hospital from January 2008 to October 2008 were sequentially and randomly assigned into Group A (fixedbearing prosthesis) (40 knees) and Group B (mobile-bearing prosthesis) (40 knees).And the data of the range of motion (ROM),Knee Society Score (KSS) and Western Ontario MacMaster (WOMAC) were collected at pre-operation and 6,12 and 24 months post-operation respectively.Results The P values were as follows:KSS:0.754,0.802,0.561,0.764;HSS (Hospital for Special Surgery):0.737,0.361,0.254,0.330;WOMAC (Western Ontario and McMaster Universities) osteoarthritis index :0.976,0.557,0.946,0.818;ROM follow-up:0.519,0.646,0.175,0.276.No significant differences were found in clinical outcomes between two groups.Conclusion The fixed-bearing and mobile-bearing prostheses show no difference in clinical outcomes.

Objective To investigate whether the polymorphisms of WNT3A gene are associated with congenital scoliosis (CS) and its various clinical phenotypes in a Chinese Han population.Methods A total of 127 CS patients admitted into PUMC were enrolled into this case-control study between October 2005 and September 2007.There were 55 boys and 72 girls with a mean age of 12.90 years old.Another 127 scoliosis-free control subjects at the same hospital during the same study period were frequency-matched with regards to age (+3 years) and gender.Genomic DNA was extracted by QIAamp DNA Blood Mini Kit from peripheral blood leukocytes of each subject who had signed informed consent.Based on the genotypic data from the International HapMap project,the main functional single nucleotide polymorphisms (SNPs) were initially selected.The patients in the case group were classified into different clinical phenotypes according to vertebral defect type,location of deformity,extent of developmental disruption,combined rib malformations and neural canal deformity.The genotying of all selected SNPs was performed by SNPstream technology (Beckman Coulter SNPstream).All data of SNPs with polymorphism were processed by the association analysis based on a single SNP and between phenotypes and SNPs.And the pairwise linkage disequilibrium was calculated in the control population by Haploview 4.1 software.Results The SNP1 (rs964941) and SNP2(rs752107) of WNT3A were genotyped.There was no linkage disequilibrium between two SNPs.No association was observed between SNP1 and SNP2 genotypes or allele polymorphisms and risk of CS and various clinical phenotypes (P ＞ 0.05).Conclusions The genetic variants of WNT3A gene may not be associated with the susceptibility to CS and various clinical phenotypes of CS in Chinese Han population.

Objective To evaluate the modulation of RhoA/Rho kinase (ROCK) signaling pathway,a small Rho GTPase that is considered as an important modulator in inflammatory responses,on Toll-like receptor-2 mediated chemokine secretion in fibroblast-like synoviocytes (FLS)from rheumatoid arthritis (RA) patients.Methods The RhoA activity was measured by a pull-down assay.And the ROCK activity was assessed by Western blot.The secretion of chemokines was measured by ELISA (enzyme-linked immunosorbent assay).MTT test was used to detect the cellular viability.Results The stimulation of peptidoglycan(PG,5 mg/L) increased the levels of IL-8 (interleukin-8),RANTES (regulated upon activation normal T cell expressed & secreted) and MCP-2 (monocyte chemotactic protein-2)and boosted the activities of RhoA and ROCK versus the unstimulated RA FLS.And these effects of PG were suppressed by anti-TLR-2 monoclonal antibody.Inhibition of RhoA and ROCK with a specific inhibitor inhibited the secretion of IL-8,RANTES and MCP-2 in PG-induced RA FLS.Conclusion The present study provides novel evidence that the RhoA/ROCK signal pathway modulates the TLR-2-mediated secretion of chemokines in RA FLS.It suggests that the inhibition of RhoA/ROCK may be a new therapeutic approach for RA.

Objective To investigate the effect of mechanical stretch force on the morphologic and apoptotic changes of fibroblasts derived from the OPLL (ossification of posterior longitudinal ligaments)patients.Methods The third passage cells were collected and subjected to 10% elongations cyclic mechanical stretching for 6 h and 24 h with Flexerce114000TM strain unit.Their morphologic changes were observed and the post-stretching apoptotic rates quantified by flow cytometer.The gene expressions of alkaline phosphatase (ALP),collagen types Ⅰ (COL Ⅰ) and osteocalcin (OC) were examined.Results The treated cells were arranged along the vertical direction of force.Stretch force led to a slight increase of apoptosis rate at 6 h and a significant increase of apoptosis rate at 24 h.No significant difference in cellular senescence was observed between control group and treated group.The mRNA expressions of ALP,COL Ⅰand OC were positively up-regulated by cyclic stretch at 24 h.Conclusion Stretching force can affect the cellular morphology,promote the osteogenic differentiation and enhance the cellular apoptosis.

Objective To investigate the expression of CD133 and CD34 in different parts of glioblastoma and its margin and explore the invasive path of glioma stem cells within the tumor and surrounding tissue.Methods The surgical specimens were collected from the core of mass,junctional zones between tumor and peritumoral edematous areas and edematous areas in 52 patients with glioblastoma.Immunohistochemical cell staining and Western blot were employed to evaluate the expression of CD133 in different specimens while immunohistochemistry was used to detect the CD34-microvesel postforming.A correlation analysis was performed between them.Results The expression of CD133 was not detected in the control groups while the scores were 7.3 ± 1.4,5.2 ± 1.1,2.7 ± 1.0 in junctional zones,tumor cores and edematous areas with immunohistochemistry and 0.79 ± 0.03,0.38 ± 0.01,0.20 ± 0.04with Western blot respectively.There were significant differences between different groups (P ＜ 0.05).Under light microscope,the CD133-positive cells frequently forming perivascular pseudorosettes were dense in junctional zones and mostly clustered near the microvessels in tumor cores and scattered in edematous areas.At a high magnification (200 ×),the CD34-MVD(/HP) values were 31.3 ±4.0,21.8 ± 2.6,15.3 ±2.4,4.7 ± 1.5 respectively in junctional zones,tumor cores,edematous areas and control tissues.Significant differences were also found in these groups(P ＜ 0.05).The expression level of CD133-positive cell was positively correlated with the distribution of CD34-microvessels (r =0.948,P ＜ 0.05).Conclusion Glioma stem cells tend to assemble in the junctional zones where the microvessels are enriched.There is probably an intimate nourishing relationship with the microvessels.The distribution of glioma stem cells may be related with the invasiveness within glioblastoma.

A 46-year-old male was admitted to Peking Union Medical College Hospital on March 24, 2010 due to right temporal pain accompanied by diplopia for 4 months. Four months ago, the patient developed persistent severe pulsatile headache in right temporal region without obvious trigger, which gradually worsened with diplopia, hypoesthesia on right facial side, limited mouth opening, soreness and weakness in mandibular joint during chewing, accompanied by nausea and vomiting, non-jetting, without fever, abnormal limb movement, convulsions, etc.

A 14-year-old male was admitted to Peking Union Medical College Hospital on October 15, 2008 due to cough with subcutaneous nodules for 8 months, intermittent fever for 3 months and holding his breath for 2 weeks. The patient developed paroxysmal cough and coughed a small amount of white phlegm without inducement 8 months before admission. The local hospital gave cephalosporin antibiotics treatment for 1 week, but it was not effective, and red painful subcutaneous nodules in both lower limbs began to appear.