Objective:To study the chemical constituents of the methylene chloride of Rubus chingii Hu..Methods:Chromatography on silica gel column,Sephadex LH-20 column,and recrystallization technique were used to isolate and purify the compounds.Spectroscopy methods including EI-MS,ES-MS,1H-NMR,13CNMR,HMQC,and HMBC were used to elucidate the structures of compounds.Results:Ten compounds were obtained and 9 compounds were identified as:hexacosanol(Ⅰ),?-sitosterol(Ⅱ),4-hydro-3-methlbenzal acid(Ⅲ),4-hydrobenzal dehyde(Ⅳ),oleanolic acid(Ⅴ),stigmast-5-en-3-ol,oleate(Ⅵ),1H-2-indenone,2,4,5,6,7,7a-hexahydro-3-(1-methylethyl)-7a-methyl(Ⅷ),4-hydroxy-3-methoxybenzoic acide(Ⅸ),and liballinol(Ⅹ).Conclusion:Compounds Ⅰ,Ⅲ,Ⅳ,Ⅵ,Ⅷ,and Ⅹhave been obtained from Rubus chingii for the first time.

A 54-year-old man was admitted to the Department of Rheumatology in Peking Union Medic.al College Hospital due to polyarthritis.back pain and multiple subcutaneous masses.He had symmetrical polyarthritis at onset.which was diagnosed as theumatoid arthritis.His follow-up and treatment were irregular.Back pain and multiple subcutaneous masses developed 2 year ago.Erythrocyte sedimentation rate and C-reac.tive protein were elevated.Rheumatoid fac.tor and Anti-cylic citrullinated peptide antibody were positive.No evidence of infection or malignancy was detected.Chest CT suggested pulmonary fibrosis and osteolytic lesions of stemum.Spinal MRI showed paravertebral soft tissue.Biopsy of the soft tissue suggested the pathologic.al finding of a theumatoid nodule.The patient was diagnosed as theumatoid arthritis complic.ated with multiple theumatoid bursal cysts.Combination therapy of methylprednisolone (40mg/d) and cyclophosphamide (0.4g/w) lead to a rapid improvement of clinical symptoms and laboratory parameters.The patient was still in remission at 6-month follow-up.

Objective To investigate the clinical features of patients with systemic lupus erythematosus (SLE) complicating with hepatitis B virus (HBV) infection.Methods The medical records of 40 inpatients with SLE complicating with HBV infection and 60 SLE inpatients without HBV infection were analyzed retrospectively.Chi-square test and t test were used for statistical analysis.Results Forty patients with SLE complicating with HBV infection were included,including 4 men and 36 women,with the mean age of (32±13) yr.Twenty-three patients suffered from chronic HBV hepatitis,5 patients were serological HBsAg carriers,12 patients with HBV occult infection.Twenty-one patients had mild liver dysfunction,presented mainly as increased ALT,2 patients presented with severe liver function abnormality.The main types of lupus rlephritis were Class Ⅳ and Class Ⅴ,2 patients complicating with HBV-associated glomerulonephritis.Compared with the control group,patients with SLE complicating with HBV infection had a significantly higher prevalence of fever,liver involvement,renal lesion,thrombocytopenia and cytomegalovirus infection respectively.One patient with severe liver abnormality had poor prognosis.Conclusion More attention should be paid to the clinical features of SLE complicating with HBV infection.Patients with SLE complicating with HBV infection have a significantly higher prevalence of fever,liver involvement,renal lesion,thrombocytopenia and cytomegalovirus infection respectively.Patients with SLE complicating with HBV infection may suffer from HBV-associated glomerulonephritis.Severe liver abnormality predicts poor prognosis.Anti-HBV drugs should be prescribed for SLE patients with serological positive HBsAg while immunosuppressive agents are used.

Objective To improve the understanding of autoimmune disease related panereatitis by analyzing their clinical features.Methods The clinical features were analyzed retrospectively in 28 autoimmune disease related pancreatitis cases from Peking Union Medical College Hospital(PUMCH),according to the associated autoimmune diseases.Results (1)The average age was(40.0±16.1)years,and the ratio of male to female patients Was 1:6.There were 24 acute and 4 chronic pancreatitis in the 28 cases.(2)The common related autoimmune diseases were systemic lupus erythematosus(20/28)and Sjogren's syndrome(6/28).(3)The characteristics of the autoimmune diseases was multi-system involvement,such as hematologic system,kidney,liver,etc.(4)Clinical features of those acute pancreatitis shown that no distinct trigger exist for acute pancreatitis.and the radiological changing Was not prominent.(5)In laboratory examination,an obvious increase of CA199 coaid be seen,paralleling the severity of pancreatitis.(6)Glucocorticoids or immunosuppressors was effective,and the mortality rate of acute pancreatitis cases was 33.3%.ConclusionsAutoimmune disease related pancreatitis is dominant with acute pancreatitis and females is common,which may reflect the activity of autoimmune diseases.Autoimmune disease related acute pancreatitis has a high mortality rate.Glucocorticoids and/or immunosuppressors may be useful to relieve the pancreatitis.

Objective To study the clinic manifest-rations, mechanism, diagnosis and treatment of pulmonary arterial hypertention (PAH) in systemic lupus erythamatosus (SLE). Methods The clinic symptoms, laboratory tests. Doppler tests of patients who were diagnosed with PAH and SLE during last five years were analyze retrospectively. Results Anti-RNP antibody's prevalence rate was high. The presence of pulmonary arterial perssure (PAP) was not related to SLE disease active index (SLEDAI). Those who had PAP higher than 45 mm Hg were prone to have Raynaud's phenomenon PAH had no association to auto-antibodies and other systemic lesions. There were no differences in clinic features, auto-antibodies and other examinations between those with kidney injure and without kidney injure. Conclusion PAH may develop insidiously in SLE, so early diagnosis and prompt treatment of PAH can improve the prognosis.

Objective To evaluate the effects of four agents including cyclophosphomide,thalidomide,total glucosides of peony (TGP) and simvastatin on cell-proliferation and endothlin-1 secretion of human endothelial cells (ECs).Methods EA.by926 cells were cultured until confluence WSS achieved,then incubated separately for 24 h.48 h and 72 h with various concentration of these four agents.The proliferation of ECs waft detected with 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium-bromide (MTT).The amount of endothlin-1 in supernatants of ECs was determined with enzyme linked immunosorbent assay.Results (1)Cyclophosphomide,TGP and simvastatin inhibited ECs proliferation in a dose dependent manner at 72 h (P＜0.05).(2)Cyclophosphomide (50-2000 μmol/L) and simvastatin (5-10 μmol/L) decreased endothlin-1 secretion but not in dose dependent manner. Conclusion Cyclophosphomide.TGP and simvastatin can inhibit ECs proliferation.Cyelophosphomide and simvastatin can decrease endothlin-1 secretion of human ECs.

Objective To analyze the clinical characteristics and prognosis of ANCA associated microvasculitis patients with gastrointestinal tract hemorrhage. Methods A retrospective analysis was conducted in 8 ANCA associated microvasculitis patients with gastrointestinal tract hemorrhage admitted to our hospital from May 1987 to May 2007. The statistical treatment is Kaplan-Meier. Results This group contained 4 male and 4 female patients. The average age was (39±20) years. The time from the onset of their disease to gastrointestinal bleeding was (8 ±8) months. Wegener's granulomatosis was the most common disease.Hematochezia(7/8 ) was the most common clinical manifestation and the distal small bowel (5/8) was the most common involved site. After the diagnosis was confirmed, methylprednisolone bolus therapy was used in 2 patients and 1～2 mg·kg-1·d-1 prednisone in 6 patients. Surgical operations were performed for 3 patients.However, 5 patients died. The prognosis was poor with the average survival time of (373±108) days. The mean survival time was (46 ±10) days after bleeding. Conclusion ANCA associated microvasculitis with gastrointestinal tract hemorrhage is rare. Early diagnosis and treatment could improve the prognosis.

Objective: To investigate the epidemiological characteristics of hand, foot and mouth disease ( HFMD ) in Zhejiang Province, so as to provide insights into HFMD control. Methods: The incidence of HFMD in Zhejiang Province from 2016 to 2019 was collected from National Notifiable Disease Reporting System. The temporal distribution, human distribution, regional distribution and pathogenic typing of HFMD were descriptively analyzed in Zhejiang Province from 2016 to 2019. Results: Totally 642 305 cases with HFMD were reported in Zhejiang Province from 2016 to 2019, including 121 severe cases and 9 fatal cases. The annual incidence of HFMD was 335.88/105, 147.76/105, 435.63/105 and 221.77/105, respectively. The incidence of HFMD peaked from May to July each year, and the three highest annual incidence included Ningbo, Jinhua and Wenzhou cities, while the lowest annual incidence was seen in Zhoushan City. The HFMD cases were predominantly found in children at ages of 1 to 5 years ( 537 738 cases, 83.72% ), and in children living at home ( 419 408 cases, 65.30% ). The average annual incidence of HFMD was higher in males than in females ( 328.23/105 vs. 239.99/105; P<0.05). The dominant pathogens gradually shifted from enterovirus 71 ( EV71 ) to Coxsachievirus A16 ( CA16 ), and other enteroviruses remained as the main pathogenic subtypes. Conclusions The incidence HFMD was high in summer and autumn in Zhejiang Province from 2016 to 2019. Children living at home are at a high risk of HFMD, and CA16 type gradually became the dominant pathogen of HFMD.

Objective To investigate the clinical features of macrophage activation syndrome (MAS) associated with systemic lupus erythematosus (SLE).Method The clinical data of 15 patients with SLE-induced MAS diagnosed in Peking Union Medical College Hospital from July 2011 to December 2014 were retrospectively analyzed.Results Fourteen patients were female.The average age was 28.07.When MAS occurred,the average duration of SLE was 20.47 months,and the average SLE disease activity index (SLEDAI) was 18.4.All 15 patients developed fever,hematocytopenia and impaired liver function in the course of MAS,while patients with splenomegaly,coagulation disorders and neuropsychiatric symptoms were 11,14 and 8,respectively.All 15 patients presented leukocpenia and thrombocytopenia.Hypofibrinogenemia,elevated ferritin and hemophagocytosis in bone marrow were respectively observed in 7,11 and 12 patients.Glucocorticoids were used in all patients,among whom eight received pulse methylprednisolone therapy.Thirteen patients were treated with immunosuppressants,including cyclosporine A,tacrolimus,cyclophosphamide and mycophemolate mofetil.Complete remission was achieved in 14 patients.One patient died of MAS.Conclusions In patients with SLE,MAS was most commonly seen in young females with short SLE duration and active disease.Fever,splenomegaly,hematocytopenia,coagulation disorders and liver damage are the most remarkable clinical manifestations.Early diagnosis and intensive therapy are the key parts to improve clinical outcome.

Pulmonary arterial hypertension(PAH) is one of the most severe complications of systemic lupus erythematosus(SLE).Recent studies emphasized the role of T and B lymphocytes in the pathogenesis of PAH.Rituximab (RTX),not only targeting at B lymphocytes,but also been proven to affect T cells,thus could be a potential treatment for SLE-PAH.