2017 Vol. 8, No. 4-5

Editorials
Abstract:
Rheumatology is still a relatively young specialty of medical science in China. Despite decades of development, the number of rheumatologists nationwide is still far less than what is needed by the enormous population of patients suffering from rheumatic diseases. Moreover, the clinical competence of rheumatologists is varied considerably in different regions in China. Since the field of rheumatology is advancing internationally with a great speed, we need to expand further our understanding of rheumatology, in order to accordingly boost the progress of rheumatology in China, and to satisfy the huge unmet clinical need.
Abstract:
Inflammatory bowel diseases, including ulcerative colitis and Crohn's disease, are chronic nonspecific inflammatory diseases of bowels whose etiology is not clear. Anti-tumor necrosis factor(TNF)-α monoclonal antibody is one of the representative biological agents used for the treatment of Crohn's disease. The "2017 revised Consensus on the Anti-TNF-α Monoclonal Antibody Therapy of Inflammatory Bowel Disease" will be published in current issue. From reviewing the new consensus, the author discussed some key points of anti-TNF-α monoclonal antibody therapy in Crohn's disease, hoping to improve clinical practice of anti-TNF-α monoclonal antibody therapy in Crohn's disease.
Specialist Forum
Abstract:
With the development of combined antiretroviral therapy(cART), the quality of life and life expectancy of the human immunodeficiency virus(HIV) infected adults have been significantly elevated. However, there still remains a small amount of HIV infected adults who could not regain a satisfactory amount of CD4+ T cells(< 500 cells/μl) even with long-term cART treatment and complete viral suppression. These infected individuals with incomplete immune reconstitution are more likely to acquire an opportunistic infection and have a higher mortality rate than infected individuals with complete immune reconstitution. One of the most important mechanisms behind incomplete immune reconstitution is the existence of abnormal immune activation. Among the studies of interventions on immune activation in HIV infected adults, an in vitro experiment and a clinical trial have indicated that Tripterygium wilfordii Hook F(TwHF) could suppress the abnormal immune activation, and may improve the immune reconstitution state in patients with incomplete immune reconstitution.
Abstract:
Rheaumatoid arthritis is a common autoimmune disease, manifested as continuing swelling and tenderness of the involved joints, deformation and disabled function of joints in serious cases. High frequency ultrasound can not only identify structures and surrounding soft tissue of the joints, but also detect synovial vessels of inflamed joints. Thus, it plays an important role in the diagnosis and follow-up of rheaumatoid arthritis. This article reviewed in detail about the application of grey scale ultrasound, color Doppler ultrasound, contrast enhanced ultrasound, and ultrasound-guided interventional therapy in rheaumotoid arthritis.
Abstract:
Rheumatoid arthritis(RA) is a chronic autoimmune disorder that could affect small joint of hands and feet. Major joints such as hip, knee and shoulder could also be affected at the late stage of the progression. With chronic inflammation of the synovium, RA can cause joint pain and swelling, as well as destruction of cartilage, which leads to joint deformity and disability. Artificial joint replacement is a surgical intervention that uses prosthetic joints to replace the damaged joints with pain, deformity and loss of range of motion due to trauma or disease. It has been applied in clinical practice for decades. This article summarizes the indications, contraindications, surgical procedures, perioperative management and complications of prosthetic joint replacement for RA patients.
Abstract:
Anti-Müllerian hormone(AMH) is a dimeric glycoprotein secreted by follicular granulosa cell and sertoli cell. AMH inhibits the recruitment and growth of follicles in female, and adjusts the function of leydig cells in male. Serum AMH level is a potential marker for ovarian reserve. At present, the article elaborated its clinical application:the level of serum AMH can be used to evaluate ovarian reserve, to predict ovarian response during assisted reproductive process, to evaluate ovarian reserve of cancer patients, to diagnose polycystic ovary syndrome, premature ovarian failure and predictive menopause. There are few studies on the detection methods and reference intervals. With the development of detection technology, AMH has become more widely used in clinical medicine. The physiology, clinical application, assay methods and reference intervals of AMH are discussed in this article.
Opinion
Abstract:
The in-depth study of tumors and the evolution of gene detection techniques in the level of clinical application have promoted the comprehensive treatment of tumors from the age of refining anatomic staging, and precisely evaluating anatomic tumor burden, to the age of analyzing the biological feature, and developing target medicine. The panel of the American Joint Committee on Cancer(AJCC), for the first time, in the 8th edition of breast cancer staging system, built the prognostic staging system based on estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor receptor-2(HER-2), histologic grade(G), and multi-gene expression panels. The principle that the prognostic staging system is more recommended will be a revo-lution in the history of the war between human and cancer. The evolution of cancer staging system from anatomic level to micropathologic and multigenetic level shows that the cancer treatment has stepped into classification-based treatment from population-based treatment. This evolution will promote the arrival of personalized treatment.
Original Contributions
Abstract:
  Objective  The aim of our study was to detect the positive incidence and analyze the clinical significance of anti-PUF60 antibody in Chinese patients with idiopathic inflammatory myopathy(IIM).  Methods  This study involved, from October 1989 to August 2016, 388 IIM patients (including 275 patients with dermatomyositis(DM), 76 patients with polymyositis(PM), and 37 patients with myositis overlap syndrome), 211 patients with control diseases (including 28 patients with noninflammatory neuromuscular disease(NMD), 104 patients with systemic lupus erythematosus(SLE), and 79 patients with Sj gren's syndrome(SS)) as disease controls, and 167 healthy adults as healthy controls(HCs). Enzyme-linked immunosorbent assay(ELISA) was developed to detect serum anti-PUF60 antibody, and immunoblotting analyses were performed to validate the ELISA results. The results of two groups were compared using unpaired Mann-Whitney U test, and the relevance was analyzed using Spearman correlation analysis.  Results   Anti-PUF60 antibody was detected in 11.6%(45/388) of patients with IIM, 17.3%(18/104) of patients with SLE, and 10.1%(8/79) of patients with SS, and the antibody positive rates were significantly higher than that of HCs(P < 0.001, P < 0.001, and P=0.009, respectively). In IIM subgroups, anti-PUF60 antibody presented in 11.3%(31/275) of DM patients and 21.6%(8/37) of patients with myositis overlap syndrome, and the antibody positive rates were significantly higher than that of HCs(P=0.001 and P < 0.001, respectively). The clinical associations of anti-PUF60 antibody in different groups of immune disease were varied. Classical DM patients with anti-PUF60 antibody had lower prevalence of currently known myositis antibodies(P=0.018) and higher prevalence of mechanic's hands(P=0.046). While, the prevalence of anti-PUF60 antibody was particularly higher in the clinically amyopathic dermatomyositisc(CADM), subgroup and associated with the incidence of skin ulcer(P=0.029). As for other rheumatic diseases, in SS patients, anti-PUF60 antibody was significantly associated with higher prevalence of cutaneous manifestation, rheumatoid factor, and antibodies against SSB and RNP; in SLE patients, it is related to higher incidence of younger onset, alopecia, hypocomplementemia, elevated CD5+CD19+B-cell subpopulations, and antibodies against dsDNA, Sm and SSB.   Conclusions   Anti-PUF60 antibody can be detected in Chinese patients with DM, myositis-overlap syndrome, SLE and SS; and it is associated with distinct clinical features in different rheumatic diseases. This finding indicates that anti-PUF60 antibody is associated with different pathogenesis processes in different systemic rheumatic diseases.
Abstract:
  Objective  The aim was to evaluate the clinical efficacy of total hip arthroplasty(THA) in the treatment of ankylosing spondylitis(AS) involving hip joint.  Methods  A retrospective analysis of 23 patients(30 hips) with AS undergoing THA during the period from July 2015 to August 2016 was performed in the department of Joint Suegery, Changhai Hospital, Shanghai. All patients were male, with a mean age of (42.2±12.9)years(ranging from 23 to 65 years). The mean disease duration was (20.2±8.4)years(ranging from 5 to 46 years), and the mean body mass index was (21.6±3.7)kg/m2(ranging from 16.4 to 30.1 kg/m2). For all patients, a posterolateral approach was used to implant the biological prosthesis. The BASFI questionnaire was used to assess the AS functional status. Harris hip scoring system was applied to evaluate the clinical results. The range of motion(ROM) of the hip, BASFI score, and Harris score were compared pre- and post-operatively.   Results   All patients were followed up for an average of (15.1±3.2)months(ranging from 10 to 21 months); and the hip function was improved markedly after surgery. At the final follow up, the flexion-extension ROM of the hip improved from (44.3±39.6)° to (93.2±19.7)°; the total ROM improved from (64.8±54.8)° to (179.5±25.1)°; the mean value of Harris hip score improved from 39.2±17.2 to 87.5±4.5, with 10 cases rated as excellent and 19 cases as good(the rate of excellent or good result was 96.7%); the mean value of BASFI score decreased from 6.4±2.3 to 2.2±0.9. These differences were all statistically significant(P < 0.001). At the final follow up, all of the locations of the prosthesis were evaluated with X-ray, which showed no signs of aseptic loosening and dislocation of the hip prosthesis. According to Brooker grading system, only 2 hips were classified as GradeⅠ, and no hips were classified as GradeⅡ, Ⅲ, or Ⅳ.  Conclusion  THA is an effective method in treating AS involving the hip joint to relieve unbearable pains and reconstruct the hip function, which can greatly improve the life quality of AS patients.
Abstract:
  Objective  The aim of this study was to investigate the expression of non-B lymphocyte immunoglobulin G(non B-IgG) in bladder cancer and its role in the biological behavior of cancerous cells.  Methods  The expression of non B-IgG proteins in bladder cancer tissue of 89 cases (study group, aged 37-89 years, median age (68.0±4.3)) and normal bladder tissue of 7 cases(control group) was detected by immunohistochemistry. There were 47 cases of high histological grades, and 42 cases of low grades. The non B-IgG protein and mRNA in bladder cancer cell lines were detected by Western blot and RT-PCR, respectively. After knocking down the expression of IgG in bladder cancer cells, we investigated the migratory and invasive abilities of bladdercancer cells by Transwell and Matrigel assays.  Results  The rate of positive expression of non B-IgG in bladder cancertissues was higher than that in normal tissues; and the expression of IgG was correlated with tumor size, histological grade and reoccurrence(P < 0.05). However, the expression of non B-IgG had no relation with age, sex, and tumor number(P>0.05). Western blot and RT-PCR results also showed that nonB-IgG was expressed in bladder cancer cells. After knocking down IgG expression, the ability of migration and invasion of bladder cancer cells was inhibited.  Conclusions  Non B-IgG was over-expressed in bladder cancer tissues, promoting migration and invasion of cancer cells, which indicated that IgG might be a potential therapeutic target of bladder cancer.
Abstract:
  Objective  The aim of our study was to analyze clinical features of neuropsychiatric lupus erythematosus(NPLE)with normal cerebrospinal fluid, in order to improve the diagnosis of NPLE.  Methods  From January 2013 to December 2016, a total of 95 patients diagnosed with NPLE at Peking Union Medical College Hospital were included in our study. Results of the first time exam of cerebrospinal fluid after hospitalization were collected. Cerebrospinal fluid was normal in 18 cases(study group) and abnormal(including any abnormalities in pressure, cell number or protein) in 77 cases(control group). Gender, age, symptoms, mode of onset, involved system, inflammatory markers, magnetic resonance imaging(MRI) findings, dsDNA, treatment, and length of hospitalization were analyzed statistically. Age distribution, systemic lupus erythematosus(SLE) course, treatment, and results of MRI of the 18 patients with NPLE and normal cerebrospinal fluid were further descriptively analyzed.  Results  Ten of the 18 patients with normal cerebrospinal fluid and 10 of the 77 cases with abnormal cerebrospinal fluid started with mental symptoms. There were significant differences between the two groups(55.6% vs. 13.0%, P < 0.05). Twelve of the study group and 20 of the control group had relapse of NPLE(66.7% vs. 26.0%, P < 0.05). There was no significant difference between the two groups in gender, age, involved system, inflammatory indicators, MRI results, double stranded DNA, treatment, and length of hospitalization(P>0.05). Sixteen of 18 cases of the study group were women at reproductive age(88.9%); 9 occurred in the first year of SLE(50.0%); 17 were initiated from inadequate medication(94.4%); 9 patients with normal MRI findings presented abnormal CSF examination 48 hours later.  Conclusion  SLE patients with onset of mental symptoms and medical history of NPLE, even with normal cerebrospinal fluid exam, should perform MRI and repeated cerebrospinal fluid exams to avoid the misdiagnosis of NPLE.
Abstract:
  Objective  Our study aimed to establish a potential way of fourier transform infrared(FTIR) spectra to diagnose malignant tumors.  Methods  Ovarian cancer cell subclones with high(A-H) or low(A-L) malignant potential were confirmed by Matrigel invasive/migratory assay in vitro and the tumor xenograft model in vivo. FTIR spectra of cells was recorded and analyzed in the region from 600 cm-1 to 4000 cm-1.  Results  A-Hcells were confirmed to have higher invasive and migratory activities in vitro compared with A-L cells(2.211±0.256 vs. 0.149±0.097, P=0.0003; 2.412±0.298 vs. 0.337±0.079, P=0.0005).A-H-derived tumors were significantly larger than A-L-derived tumors(2.42 cm±0.43 cm vs. 0.63 cm±0.22 cm, P < 0.0001). Significant spectral differences between A-H and A-L cells were observed in the band intensity of 1086 cm-1 and 1240 cm-1(0.359±0.014 vs. 0.323±0.018, P=0.020; 0.343±0.010 vs. 0.317±0.012, P=0.021), as well as in that of 1655 cm-1(1.710±0.024 vs. 1.640±0.017, P=0.045), 2925 cm-1(0.669±0.025 vs.0.613±0.016, P=0.034) and 2853 cm-1(0.397±0.008 vs. 0.376±0.010, P=0.039), which indicated higher amounts and synthesis of nucleic acids, proteins and lipids in A-H cells. The amount of secondary protein structures of β-sheet and turns in A-H was higher than that in A-L(22.50±0.54 vs. 21.30±0.50, P=0.037; 50.00±1.12 vs. 47.70±0.76, P=0.029). The amount of random coil component of protein in A-H was lower than that in A-L(8.50±0.82 vs. 11.50±1.32, P=0.011).  Conclusions  FTIR quickly provides important and reliable information about heterogeneous ovarian cancerous cells on the difference in molecular components and structures. The findings of this study demonstrate the potential use of infrared spectroscopy in differentiating ovarian tumors at different developing stages.
Abstract:
IgG4-related disease(IgG4-RD) is a chronic autoimmune disease implicating multiple organs and tissues. Its pathological characteristics are infiltration of lymphocytes and IgG4-positive plasma cells in the implicated organs. Pulmonary involvement reportedly varies. Here we reported a case of IgG4-RD with the onset of cough and dyspnea, presenting with multiple lesions. The pulmonary involvement was manifested as diffuse nodules in lungs that dissolved after glucocorticoid therapy.
Review
Abstract:
Primary biliary cholangitis(PBC) is an autoimmune disease characterized by the liver damage. The pathogenesis of PBC is not fully understood currently, and many factors are involved. The cellular immunity mediated by CD8+ T cells plays an important role in the immune dysregulation of PBC, which is related to the injury of biliary epithelial cells. This review is mainly about the regulation of CD8+ T cells that involves several mechanisms, and the function of this group of cells in the liver damage of PBC patients.
Abstract:
Tuberous sclerosis complex(TSC) is an autosomal dominant genetic disease involving multiple organs and systems. It can involve all organs and systems in the body. Nodular sclerosis is often manifested as skin lesions and visceral benign tumors, as well as a small number of highly malignant tumors, such as subependymal giant cell astrocytoma(SEGA), renal cell carcinoma and so on. There is growing evidence that microRNAs(miRNAs) are closely related to TSC related diseases and act as oncogenes or tumor suppressor genes. This paper reviews the progress of study on miRNA in several diseases related to tuberous sclerosis complex.
Abstract:
The role that Musashi-2(Msi-2) protein plays in maintaining the undifferentiated status and self-renewal ability of stem cells has been a hot issue since its discovery. In recent years, it has been confirmed that Msi-2 plays a key role in the development and progression of malignant tumors. The existing study is not limited to Msi-2's function in promoting the development of malignant tumor. The use of Msi-2 in the diagnosis of malignant tumors, and its value in individual treatment have become increasingly prominent. We will review the role of Msi-2 in the development of malignant tumors and its latest research progress as a diagnostic and therapeutic target.
Abstract:
Transfusion related acute lung injury (TRALI) is a leading cause of transfusion related death. It is helpful to prevent and cure TRALI by understanding the potential mechanism of TRALI. Based on causative factors, it is divided into antibody mediated TRALI and non-antibody mediated TRALI; the former is caused by the passively infused endogenous antibodies, and the latter is mediated by the soluble molecules andcellular components from blood products.This review focuses on mechanisms of non-antibody mediated TRALI which include biological response modifiers accumulating during storage of red blood cells (RBCs) and platelets (PLTs), as well as changes in morphology and function of aged PLTs and RBCs, and the current research progress, so as to provide theoretical direction for clinical practice.
Abstract:
PTEN gene is one of the most important tumor suppressor gene, which acts through a unique protein phosphatase and lipid phosphates activity. PTEN protein has a wide distribution, complex biological function, and a variety of regulation modes, which can regulate the cell morphology, proliferation, differentiation, adhesion and migration through a variety of signaling pathways. With the further study of PTEN, it is found that the gene is closely related to the digestive process of many kinds of digestive organs, and may be a potential target for the reversing and treatment of fibrosis.
Clinical Research and Evidence Based Medicine
Abstract:
Real-world evidence is defined as information on health care that is derived from multiple sources outside typical clinical research settings. The essential difference between real-world evidence and evidence from traditionally randomized clinical trial is the setting where data is collected, but not the study method or design. Real-world evidence has a better external validity and research efficiency when compared to evidence from traditionally randomized clinical trials, and thus is widely used in the assessment of the safety and efficacy of a medical product, in the analysis of clinical practice, etc. In recent years, increasing importance has been attached to real-world research in the context of rapid development of information technology and growing need for clinical evidence, suggesting its good prospects in the future.
Clinical Case Analysis
Abstract:
Castleman disease and POEMS syndrome are both rare diseases, and there is a close relationship between each other. A#60hough these two diseases have been investigated for decades, a comprehensive understanding of renal manifestations is still lacking. We reported a 44-year-old man who suffered from refractory ascites initially, and then developed renal insufficiency and lower limb edema. Physical examination at admission indicated mu#60iple hemangioma in the zone of neck and chest. There was a significant elevation in inflammatory indices and serum vascular endothelial growth factor, while the monoclonal protein was negative. The lymph node biopsy showed Castleman disease; and the skin biopsy showed glomeruloid hemangioma. Renal biopsy demonstrated endotheliopathy and tubular-interstitial injury. He was diagnosed with Castleman disease; and after the treatment with high dose glucocorticoid and immunosuppressants, the disease had been relieved rapidly and the renal function returned normal.
Case Report
Abstract:
Familial Mediterranean fever (FMF) is a kind of genetic autoinflammatory diseases, characterized with periodic fever, abdominal pain, arthritis and serositis. FMF is commonly seen in Mediterranean area and the onset of disease is mostly before 20 years old. Here we report a Chinese FMF patient who presented with typical syndromes after adulthood. The clinical manifestations, laboratory results, genetic mutations and therapeutic responses are presented and discussed in detail.
2017, 8(4-5): 201-201.
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Xinnian Ba
2017, 8(4-5): 202-203. doi: 10.3969/j.issn.1674-9081.2017.05.001
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2017, 8(4-5): 234-234.
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2017, 8(4-5): 239-243. doi: 10.3969/j.issn.1674-9081.2017.05.009
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2017, 8(4-5): 250-250.
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2017, 8(4-5): 257-257.
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