Objective Analyzing polymyositis (PM) and dermatomyositis (DM) cases that had respiratory failure at the initial presentation in order to get a better understanding of their clinical features. Methods Eight PM or DM patients with respiratory failure as their first symptom were included in this study. Their clinical manifestation, laboratory and radiology changes and prognosis were analyzed retrospectively. Results In 8 patients, respiratory failure occurred before skin and muscle symptom for about two weeks to 3 month. Pulmonary interstitial disease was revealed by chest X ray and CT. Pulse methylprednisonlone was used combined with anti-infection and ameliorating respiratory function treatment. Five of the patients became deteriorated and 3 died of respiratory failure despite of the treatment, while the other 3 improved but one died of respiratory failure 6 months later. Conclusion About 5%~30% patients with PM and DM have lung damage. Pulmonary changes may occur before skin and muscle symptoms in 4% patients. Such patients have abrupt onsets and their disease progresses quickly with high mortality despite of corticosteroids therapy.

Objective To identify the clinical differences between central nervous system (CNS) infection and neuropsychiatric lupus in patients with systemic lupus erythematosus (SLE). Method Clinical manifestations, lab test results and prognosis of 12 SLE patients complicated with CNS infections, hospitalized in Nanjing Drum Tower Hospital in the past four years, were reviewed and compared with those of 15 concomi-tantly treated patients with central neuropsychiatric lupus (NPL). Two-indenpendent samples t test, Mann-whitney test and Fisher exact test were used for statistical analysis. Results 83% of SLE patients with CNS infections were female and the average disease onset age was (37±4) years. As compared to neuro-psychiatric lupus patients (the control group), those patients with CNS infections (infection group) had lower lupus disease activity (SLEDAI score 14.3±1.6 vs 6.4±1.2, P<0.01) and took higher dose of corticosteroids [average prednisone dose (28.3±2.5) vs (8.4±3.0) mg/d, P<0.01 ] and more immunosuppressives agents (83% vs 33%, P<0.05) before the occurrence of CNS symptoms. Headache and fever were more common in the infection group (100% vs 46.7% and 91.7% vs 20%, both P<0.01) and simultaneously higher serum albumin levels [(34.2±1.2) g/L vs (29.9±1.6) g/L] were detected in those patients compared to the NPL patients (P<0.05). Cerebrospinal fluid examination showed that agents for a long time but without strong evidence of lupus disease activity, CNS infection should be considered at the appearance of headache and fever, and timely cerebrospinal fluid examination is required for the diagnosis.

Objective To evaluate the role of rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (ACCP) and anti-keratin antibody (AKA) in patients with rheumatoid arthritis (RA).Methods Serum levels of RF, ACCP and AKA were examined in 82 RA and 56 non-RA patients and their sensitivity and specificity for the diagnosis of RA were exmined. Statistical analysis was performed to test the association between ACCP/AKA and number of tender joints and swollen joints, ESR, CRP, disease activity score (DAS) or Ritchie's articular index (RAI). Results ROC curve was performed for each single auto-antibody and various combinations of any two of the above antibodies. The area under the ROC curve was over 0.5 (P<0.05). The specificity of ACCP and AKA was 91.1% and 92.9% respectively. RF, ACCP and AKA were all sensitive markers for the diagnosis of RA and the sensitivity could be as high as 95.1% when one of these markers was positive. There were statistical differences in the number of swollen joints, ESR and DAS between ACCP positive group and ACCP negative group (P<0.05) and statistical significant difference was observed in tender joint count, swollen joint count, ESR and DAS between AKA positive and negative groups (P<0.05). Conclusion Combined test of ACCP, RF and AKA is useful in routine RA diagnosis.ACCP and AKA may be clinical markers for predicting disease activity and prognosis.

Objective To explore the therapeutic effects and mechanisms of umbilical cord mesenchymal stem cells(UC-MSCs)implantation on knee osteoarthritis(OA)in rabbits. Methods The healthy adult New Zealand rabbits were divided into control group(n=4),OA model group(n=4),and treatment group(n= 4).OA model was induced by 4% papain injection(0.1 ml/kg for 2 times),and treatment group were treated with UC-MSCs implantation(1 ml,1×105/L).At 2 weeks after papain injection for preparation of osteoarthritis model,rabbits knee joints were examined by MRI,and synchrony serum levels of IL-6 and-8,MMP-3 and-13 were tested.At 3 weeks after papain injection for OA,1×106/L 1 ml UC-MSCs were injected into articular cavity in treatment group,and normal saline was injected into articular cavity in blank control group and OA model group.At 2 weeks and 4 weeks after the treatment,serum levels of IL-6 and IL-8,MMP-3 and MMP-13 were tested respectively.At 4 weeks after the treatment,knee joints were reexamined again by MRI.After this,the rabbits were sacrificed and synovium and articular cartilage were taken out for HE and immunohistochemistry examination.Serum levels of IL-6 and IL-8,MMP-3 and MMP-13 were tested by ELISA method. Results The levels of inflammatory cytokines such as IL-6,IL-8,MMP-3,MMP-13 were significantly higher in model group 〔(44.7 ± 14.5)μg/L,(7.6 ± 2.5)μg/L,(16.5 ± 4.3)μg/L,(4.50 ± 1.20)μg/L〕and in treatment group 〔(43.9 ± 15.2)μg/L,(9.8 ± 2.9μg/L),(18.3 ± 4.9) μg/L,(4.80 ± 1.80)μg/L〕than in control group〔(20.8 ± 11.2)μg/L,(1.2 ± 0.6)μg/L,(2.8 ± 0.9) μg/L,(0.02 ± 0.02)μg/L〕(all P < 0.05).The levels of IL-6,IL-8,MMP-3,MMP-13 were significantly lower after UC-MSCs treatment〔(23.8 ± 11.4)μg/L,(2.4 ± 1.3)μg/L,(10.5 ± 3.4)μg/L,(0.50 ± 0.20)μg/L〕than before treatment(all P<0.05).Based on magnetic resonance imaging,the treatment group versus model group showed an improved coarse cartilage surface,thickened subchondral bone and synovium,and decreased volume of joints effusion.Pathological finding showed lower levels of inflammatory reaction in cartilage and synovium in the treatment group versus model group.Immunohistochemistry showed lower levels of IL-6 and MMP-13(all P<0.05). Conclusions The inflammatory response of cartilage and synovial tissue induces OA progress,and the inflammation factors play a significant role in OA progress.UC-MSCs could protect cartilage and synovial membrane of joints and inhibit the inflammatory response.Therefore,this study provides new therapy method for OA.