Objective To investigate the clinical manifestations of coexistent rheumatoid arthritis(RA)and systemic lupus erythematosus(SLE)(Rhupus syndrome).Methods Clinical data from a patient with Rhupus syndrome were analyzed combined with literature review.Results The patient was a middle-aged female,who presented with features of RA and developed features of SLE 7 years later.Renal involvement in common cases is rare but presented in our patient with severe renal dysfunction.The patient showed part remission with glucocorticosteroids and cyclophosphamide therapy.Conclusion Rhupus syndrome is a rare condition sharing features of RA and SLE.These patients present with features of one disease but later on develop features of another.Glucocorticosteroids and immune suppressors are effective.Appreciation of these patients with rhupus is important since their therapy and outcome differ from those having RA or SLE alone.

Objective To observe liver functional lesion caused by combination chemotherapy containing or not containing oxaliplatin. Methods Data from 42 patients with liver functional lesion caused by chemotherapy between March 2005 and October 2007 were analyzed. All patients were diagnosed through histology or cytology detection and received chemotherapy only. Different drugs were. admitted,based on different tumors. Before chemotherapy, each patient had normal liver function without liver lesions such as liver metastasis, Hepatitis B and C, hepatic cirrhosis, etc. Furthermore, 22 received FOLFOX-4 in containing oxaliplatin group while the remaining 20 received chemotherapy excluding oxaliplatin. When liver functional lesion without the influence of any liver protectant was first observed, ALT, AST, TBIL, DBIL, IBIL, ALP, GGT and the WHO criteria of liver toxicity were analyzed. T test and Wilcoxon rank sum test were used for data analysis. Results All together 90 cycles, median 2.14 cycles, were given. According to WHO criteria of liver toxicity, 13 cases were in grade O, 21 in grade Ⅰ, 7 in grade Ⅱ, and 1 in grade Ⅲ. ALT and AST were significantly high after chemotherapy(P <0.05). Moreover, ALT and AST were significantly higher in containing oxaliplatin group than non oxaliplatin group after chemotherapy(P <0.05). Chemotherapy had no influence on bilirubin. The population distribution of accumulative chemotherapy cycles and WHO criteria of liver toxicity was similar between two groups. Conclusion Before the intervention of liver protectant, combination chemotherapy containing oxaliplatin is more likely to have liver functional lesion than other chemotherapy without oxaliplatin. It mainly presents an increase in transaminase.

HepG2 cells were pre-incubated with insulin (Ins 0,1,0. 1,0.01 μol/L) and dexamethasone ( Dex 0,3,0. 3,0.03 μol/L) alone or together for 24 h to induce insulin resistance (IR) in vitro, the resistant level was estimated by glucose consumption, the optimal model of insulin resitance was chosen, and at the same time its lasting time of resistance was determined. In order to investigate the effects and mechanisms of mifepristone on in sulin-resistant HepG2 cells induced by insulin and dexamethasone, mifepristone and pioglitazone were adminis tered 24 h after the optimal model of insulin-resistant HepG2 cells was established. The glucose consumption, in tracellular concentrations of glucose, glycogen, ATP, and free fatty acid (FFA) in each group were detected. The expression of InsR-mRNA and GR-mRNA was detected by semi-quantitative reverse transcription and polymerase chain reaction (SqRT-PCR). Results revealed that pretreatment with insulin (0. 1 μmol/L) and dexamethasone (0.3 (μol/L) for 24 h caused optimal insulin resistance of HepG2 cells which lasted for 36 h. Compared with control group, the glucose consumption, intracellular glucose, glycogen, ATP contents and the level of InsR-mRNA in model cells decreased while FFAs concentrations and GR-mRNA increased. However, the tendency of insulin resistant HepG2 cells was obviously attenuated by pioglitazone at the concentration of 0. 2 mmol/L and mifepris tone at 200μmol/L and 20 μol/L while mifepristone at 2 μol/L had no effect on insulin-resistant cells. The findings indicated that mifepristone at 200 μol/L and 20 μol/L improved the insulin resistance via modulating intracellular glucolipid metabolism and the expression of InsR-mRNA and GR-mRNA.

Objective To isolate and culture bone marrow mesenchymal stem cells (BMSCs) from patients with rheumatoid arthritis (RA) and examine their biological characteristics. Methods MSCs were isolated from bone marrow of RA patients and purified by density gradient centrifugation and cultured in vitro. The morphology, immunophenotype, and proliferative; property of BMSC and colony forming unit-fibroblast (CFU-F) were measured and analyzed. Results The culture expanded cells from RA patients presented a typical fibroblast-like morphology. Ceils were positive for SH2 (CD105), CD71, and CD44, but negative for CD45. Their proliferative capacity and CFU-F number were similar to those of BMSCs from healthy donors. Conclusion In respect to morphology, immuno-phenotype, proliferative property and colony forming unit-fibroblast (CFU-F), MSCs from bone marrow of RA patients are not different from those of MSCs isolated from bone marrow of normal donors. MSCs from the bone marrow of RA patients have the potential for clinical application.

Objective Endothelial microparticles (EMPs) are direct indicator of endothelial cell activation or apoptosis,and may also reflect endothelial inflammation,increased coagulation,and vascular tone.The aim of this study is to investigate whether EMPs would be able to evaluate systemic involvement and be a new indicator of disease activity in Beh(c)et's disease (BD).Methods Thirty-nine consecutive BD patients (who fulfilled the modified International Study Group on BD in 1990 or International Criteria for BD in 2006) and 67 age and sex-matched healthy controls were enrolled (Including 37 patients with hypertension and 30 healthy subjects).The plasma levels of EMPs were measured by flow cytometry utilizing specific labels for endothelial MPs (CD31+ and CD42b-).The measurement data of each group were expressed as-x±s,and the comparison data betwen groups were analyzed by independent sample t test and analysis of variance,Spearman/Pearson correlation analysis,P＜0.05 was statistically significant.Results The levels of circulating EMPs (CD31 + and CI42b-) were significantly elevated in the case group compared with the healthy control group and hypertension (F=6.845,P＜0.05).Moreover,BD patients plasma EMPs were positively correlated with active BD (r=0.802,P＜0.05).Vascular involvement in BD patients was higher than in patients without vascular EMPs,t=4.707,P＜0.05.Gastrointestinal involvement in BD patients was more frequent than that in patients without Gastrointestinal involvement,t=2.673,P＜0.05.Conclusion Levels of circulating EMPs are elevatedd in BD patients and correlated with disease activity in BD.Elevated EMPs may be a potential indicator to predict disease activity of BD.The plasma level of EMPs is increased,which indicats increased risk of vascular and digestive tract involvement in BD.

Objective To analyze the clinical features and treatment of connective tissue disease (CTD) complicated with acquired hemophilia A (AHA).Methods A retrospective analysis of 8 cases of CTD [5 cases of systemic lupus erythematosus (SLE),2 cases of Sj(o)gren's syndrome (SS),1 case of rheumatoid arthritis (RA)] related to clinical manifestations,diagnostic methods,treatment options and outcomes.Results At the onset of AHA,active disease was shown in 7 patients with CTD,and 5 cases had bleeding symptoms in different parts.There were 3 cases of anti-phospholipid syndrome in 5 cases of SLE,2 of which had thrombosis.In 8 patients,the activated partial thromboplastin time (APTF) was prolonged by 1.7 to 3.times,FⅧ∶ C was 9.2％ to 21％ (50％ to 150％),and the factor Ⅷ inhibitor titer was increased by 7.6 to 56 BU/m1 (Bethesda method).Seven patients were treated with sufficient hormones,immunosuppressive agents,human immunoglobulin (IVIG),and blood products.Five patients had clinically improved bleeding tendency and APIT,and one patient was ineffective.Conclusion CTD is easy to combine with AHA.Glucocorticoid combined with immunosuppressive agent can effectively treat CTD-related AHA.For refractory patients,rituximab can be an alternative.

Objective:To analyze the clinical features of patients with cardic involvement in eosinophilic granulomatosis with polyangiitis (EGPA), and to enhance the understanding.Methods:We retrospectively reviewed the clinical data of 16 patients with EGPA with cardiac involvement in Bethune hospital of Shan-xi from Jan 2012 to Jun 2019. T test, rank sum test and χ2 test were used for statistical analysis. Results:16 patients with cardiac involvement. There were 11 males and 9 female. The age of 16 patients with cardiac involvement ranged from 14 to 82 years old, and the average age of onset was (58±14) years. Compared with patients without cardiac invo-lvement was (41±15) years, the difference between the two groups was statistically significant ( t=3.230 , P<0.01). The analysis suggested that age was related to whether or not cardiac involvement. Cardiac related clinical symptoms occurred in 4 patients (25%). One patient presented with cardiac involvement as the initial symptom. The other 12 patients presented abnormal electrocardiogram (ECG), cardiac ultrasound or cardiac magnetic resonance imaging (MRI), including 10 patients (62%) with abnormal ECG, 13 patients (81%) with abnormal cardiac ultrasound examination, and1patient with cardiac MRI suggesting endocarditis. Among 16 patients with EGPA cardiac involvement, 14 presented with pulmonary involvement, 10 cases with nasal involvement, 9 cases with perip-heral neurological involvement, 9 cases with skin involvement, 6 cases with gastrointestinal involvement, 2 cases with kidney damage. Eosinophils (EO) were increased in all 16 patients, with a median value of 2.46 (1.49, 3.94) ×10 9/L, and EO was associated with cardiac involvement. Analysis of perinuclear anti-neutrophil cytoplasmic antibo-dies (pANCA) positive rate showed that only 2 of the 16 patients were positive. There was statistically significant difference ( P=0.017) compared with the group without cardiac involvement (8 patients were positive). All 16 patients were treated with glucocorticoid, 12 patients received immunosuppressive therapy, and 10 patients were treated with cyclophosphamide. During the ollow-up, 1 case died of heart failure, 1 case died of cerebral hemorrhage, 3 cases were lost to follow-up, and the other 11 cases were all stable after discharge. Conclusion:EGPA patients have a high incidence of cardiac involvement, and all cardiac stru-ctures can be involved, and most cardic involvement happens in ANCA negative patients. Cardiac involvement is one of the factors with poor prognosis.

Objective:To investigate the clinical value of multiparameteric quantitative ultrasound combined with a non-invasive prediction model for assessing high-risk steatohepatitis.Methods:One hundred and ninety-four cases with metabolic-associated fatty liver disease (MAFLD) who underwent liver biopsy in Huashan Hospital, Fudan University, from June 2021 to September 2022 were selected. Shear wave elastography (SWE), shear wave dispersion (SWD) imaging, and attenuation imaging (ATI) examinations were conducted in all patients before biopsy. High-risk steatohepatitis was defined as a total activity score of ≥4 in patients with steatohepatitis, hepatocellular ballooning, and liver lobular inflammation based on pathological hepatic steatosis, inflammatory activity, and fibrosis scoring system (SAF), and fibrosis stage≥F2. Binary logistic regression analysis was used to identify the factors influencing high-risk steatohepatitis. A predictive model for diagnosing high-risk steatohepatitis was constructed using R language. The DeLong test was used to compare the area under the curve between groups. Measurement data was compared between groups using the t-test or rank-sum test, and count data were compared between groups using the χ2 test. Results:There were 46 cases (23.7%) with high-risk steatohepatitis. The quantitative ultrasound parameters included elastic modulus ( OR=2.958, 95% CI: 1.889-4.883, P<0.001), dispersion coefficient ( OR=1.786, 95% CI: 1.424-2.292, P<0.001) and attenuation coefficient ( OR=42.642, 95% CI: 3.463-640.451, P=0.004). Serological indexes of fasting blood glucose ( OR=1.196, 95% CI: 1.048-1.392, P=0.011), alanine aminotransferase ( OR=1.012, 95% CI: 1.006-1.019, P<0.001), aspartate aminotransferase ( OR=1.027, 95% CI: 1.014-1.042, P<0.001), γ-glutamyl transferase ( OR=1.008, 95% CI: 1.001-1.017, P=0.041) and HDL cholesterol ( OR=0.087, 95% CI: 0.016-0.404, P=0.003) were the factors influencing its progression. The AUCs of elastic modulus, dispersion coefficient, attenuation coefficient, multiparametric ultrasound model, serological index model, and ultrasound combined with serology model for the diagnosis of high-risk steatohepatitis were 0.764, 0.758, 0.634, 0.786, 0.773 and 0.825, respectively. The results of the DeLong test showed that the ultrasound combined with the serological model was significantly better than the serological index model and the elastic modulus, dispersion coefficient, and attenuation coefficient alone ( P=0.024, 0.027, 0.038 and <0.001). Conclusion:The combination of multiparametric quantitative ultrasound is helpful for the non-invasive diagnosis of high-risk steatohepatitis and possesses great clinical significance.