Objective To explore the effect of tumor necrosis factor (TNF)-α inhibitors therapy on bone mineral density (BMD) in active rheumatoid arthritis (RA) patients with low bone mass.Methods Sixtytwo active RA patients with low bone mass were treated with a standard treatment of calcium carbonate 0.5 g/d and alfacalcidol 0.25 μg/d,and were divided into two groups.Patients of the control group were treated with methotrexate 10 mg per week,while patients of the experimental group were treated with combined recombinant human type Ⅱ tumor necrosis factor receptor-antibody fusion protein 50 mg per week or adalimumab 40 mg/2 week subcutaneously for 12 months with methotrexate.BMD of lumbar spine (L2-4),femoral neck,trochanter and Ward's triangle region by dual energy X-ray absorptiometry (DEXA),as well as the bone turnover markers serum C telopeptide of type-Ⅰ collagen (CTX-Ⅰ) and serum procollagen type-Ⅰ N propeptide (PINP) were measured by enzyme-linkedimmunosorbent assay (ELISA) in both groups at the baseline,treatment for six-month and twelve-month.T test and Chi-square test was used to process the data.Results ① After 6 months of treatment,the BMD of lumbar spine,femoral neck and trochanter in the group with TNF-α inhibitors were higher than the control group [(0.68±0.08) g/cm2 vs (0.65±0.06) g/cm2,t=2.269,P=0.027; (0.63±0.08) g/cm2 vs (0.58±0.09) g/cm2,t=2.111,P=0.040; (0.61±0.10) g/cm2 vs (0.56±0.07) g/cm2,t=2.203,P=0.032; respectively].And after 12 months,the BMD of all regions were significantly higher thanthe control group [spine,(0.68±0.07) g/cm2 vs (0.62±0.08) g/cm2,t=5.115,P=0.000; femoral neck,(0.63±0.08)g/cm2 vs (0.56±0.08) g/cm2,t=3.475,P=0.001; Ward's triangle region (0.60±0.08) g/cm2 vs (0.56±0.08) g/cm2,t=2.309,P=0.025; trochanter,(0.61±0.10) g/cm2 vs (0.53±0.08) g/cm2,t=3.254,P=0.002; respectively].② Compared to the baseline,BMD of lumbar spine was significantly decreased in the control group after 12 months.While in the group of TNF-α inhibitors,BMD of lumbar spine was increased[(0.66±0.08) g/cm2 vs (0.68±0.07)g/cm2,t=3.411,P=0.001].③ Compared to the baseline,CTX-Ⅰ,a marker of bone resorption was significantly decreased at 6 months and 12 months in the group with TNF-αinhibitors [6 months,(0.33±0.2) ng/ml vs (0.46±0.22) ng/ml,t=5.548,P＜0.01; 12 months,(0.31±0.21) ng/ml vs (0.46±0.22) ng/ml,t=5.974,P＜0.01],while this decline was not found in the control group.PINP,a marker of bone formation was stable in both 2 groups during the study.Conclusion In active RA patients with low bone mass,loss of BMD in the spine and hip can be arrested by the treatmentof TNF-α inhibitors.

Objective To analyze the clinical features,diagnosis and treatment of fibromyalgiav syndrome (FMS).Methods Retrospectively analyzed 52 cases of FMS treated in our hospital between July,2008 to July,2011,and its clinical features,laboratory examination results,treatment and prognosis were analyzed.Results The ratio of female and male patients was 9∶1 in 52 FMS patients.The diagnosis was delayed for four years in average.Pain of FMS was diffuse and tenderness was symmetrical.Fatigue and sleepdisorder were the most common symptoms.There were no specific laboratory tests for this condition.Symptoms of 21 patients (57％) were alleviated among 37 patients who received drug treatment only,and comparatively,the symptoms of 12 patents (80％) were alleviated among 15 patients who received combined drugs and non-drug treatment.Conclusion The incidence of FMS is high and its clinical features vary.Clinician should pay much attention to the disease.Because the study sample size is small,so further study is needed to demonstrate the superiority of the combined therapy.

Objective patients with pSS and 30 cases of healthv contrels.The streptavidin immunohistochemical staining was performed to detect the expression and distribution of MMP-9 and CD147 in labial salivary glands.Quantitative analysis was performed by image analysis software-image plus 5.0 at the site of positive expression of MMP-9 and CD147.The correlation between their expression and the infiltrating lymphocyte foci per 4 mm2 of labial gland was analyzed by SPSS software as well as the correlation between the expression of MMP-9 and CD 147 in the salivary glands of patients with pSS.Results MMP-9 was hiKhly expressed in labial salivary glands from 52 patients with pSS and 30 healthy controls,but the expression of MMP-9 in pSS was stronger compared with that of healthy controls(P<0.01).There was a significant positive correlation between lymphocyte foci score and up-regulated expression of MMP-9 in labial salivary glands from 52 patients with pSS(P<0.01).CD147 was highly expressed in labial salivary glands from 52 patients with pSS and 23 healthy controls，but over-expression of CD147 in PSS was more Drominent compared with that of controls(P<0.01).There was a significant positive correlation between lymphocyte foci score and up-regulated expression of CD147 in labial salivary glands from 52 patients with pSS(P<0.01).The expression of MMP-9 and CDl47 was detected in ductal and acinar epithelial cells,lymphocyte foci in pSS.There was linear correlation between the expression of MMP-9 and CDl47 in the salivary glands of patients with pSS(P<0.01).Conclusion The results of this study suggest that the abnormal expression of MMP-9 and CD 147 is involved in the pathogenesis of pSS and play a crucial role.The interaction of MMP-9 and CD147 may be one of theimportant mechanisms leading to labial salivary glands destruction found in pSS.

Objective To investigate the effects of recombinant human thioredox ( rhTrx) on primary cultured hepatocytes. Methods The cDNA coding hTrx was amplified by using RT-PCR. The objective protein was expressed in E. Coli. The activity of purified rhTrx protein was determined by IgM and insulin disulfide reduction assay. DNA synthesis was determined by 3H-TdR mixing assay to realize the proliferating roles of rhTrx in murine primary cultured hepatocytes. Cell viability was assessed by lactate dehydrogenase ( LDH) releasing assay. Results The cloning hTrx open reading frames cDNA was confirmed by sequence analysis. The soluble recombinant hTrx are expressed efficiently in the prokaryotic expression system. The recovery ratio was 23. 20% of total bacteria protein with a purity of the expressive protein of 96. 30%. The rhTrx had stronger IgM and insulin reduced activity compared with the controls (P

Objective To investigate the efficacy of liver transplantation for the treatment of polycystic liver disease.Methods The clinical data of 8 patients with polycystic liver disease who received liver transplantation at the Third Affiliated Hospital from September 2003 to July 2009 were retrospectively analyzed.All patients underwent modified piggyback liver transplantation with vena cava plasty,and 1 of the patients received simultaneons liver-kidney transplantation.Data including acute rejections,complications,graft functions and survival time of patients were recorded.Results Operation was successfully performed on all patients.The mean operation time,anhepatic phase and operative blood loss were (7.5 +2.8)hours (range,4-11 hours),(42 + 14)minutes (range,25-70 minutes) and (2250 ± 1850)ml (range,2000-6500 ml),respectively.One patient received liver retransplantation at 45 days after primary liver transplantation because of hepatic artery stenosis.Two patients died during perioperative period.One patient died of pulmonary infection and multiple organ disfunction syndrome (MODS) at 39 days after operation,and the other one died of MODS at 59 days after operation.The median follow-up time was 60 months (range,37-93 months).Six patients survived for more than 3 years,4 patients survived for more than 5 years and 2 patients survived for more than 7 years.No acute rejection of gratis was observed at the end of the follow up.Conclusion Liver transplantation is safe and effective for the treatment of polycystic liver disease.

Objective To investigate the occurrence and treatment of lamivudine resistance in immunocompromised chronic hepatitis B liver transplantation recipient. Methods From Oct 2003 to Mar 2005, 157 chronic hepatitis B liver recipients were analyzed retrospectively to investigate the occurrence and treatment of lamivudine resistant chronic hepatitis B. Results Ten (6. 37% ) cases developed resistance to lamivudine within 1 year after liver transplantation. These patients were treated subsequently with Adefovir dipivoxil or Entecavir. The mean reduction in HBV DNA levels at weeks 12,24,48 was(3. 85?0. 79)、(3. 27?0.84)、(3. 19?0.58) and 3,4,5 cases achieved HBV DNA

0.05). Compared with BHD group,HCC group had better liver function as assessed by Child-Pugh scores. Postoperatively, the period of artificial respiration was shorter in HCC group(P0.05). Elderly HCC patients meeting Milan criteria(n=12) had 1-,2-y overall and disease-free survival equivalent to patients exceeding Milan criteria (n=19).Conclusions Liver transplantation is safe and feasible in elderly patients. The prognosis of elderly patients with HCC after LT is comparable to those with benign hepatic disease. Milan criteria for selecting HCC patients for LT may be too restrictive and could be expanded in the elderly over sixty years of age.

Objective To investigate the indications, complication and survival of combined liver-kidney transplantation (CLKTs) after liver/kidney transplantation. Methods From Oct. 2003 to Dec. 2008, the clinical data of 3 patients who underwent CLKTs after liver/kidney transplantation were retrospectively followed up and literature was reviewed at our institution. The perioperative mortality, post-operative complications, survival were analyzed. Results The perioperative mortality of patients with CLKTs was 1/3. The postoperative complications: one patient with massive abdominal bleeding died of pulmonary infection, acute renal failure of graft, multiple organ failure on the 29th day after operation; 3 patients with pulmonary infection; no acute rejection of the graft. Two of 3 patients survived 56 months, 228 months from primary transplantation, respectively, while survived 40 months, 48 months from CLKTs, respectively. Conclusion CLKTs is only radical treatment method for patients with end-stage liver disease and end-stage kidney disease. CLKTs after liver/kidney transplantation were feasible.

Objective To analyze the clinical characteristics, risk factors, prevention, and treatments of de novo malignant tumors after orthotopic liver transplantation (OLT). Methods The clinical data of 4 patients with de novo malignant tumors out of the 726 patients undergoing OLT from October 2003 to December 2008 were analyzed. Results The morbidity of de novo malignant tumors after OLT was 0.6 % (4/726), and all of them were men. The 4 de novo malignant tumors were respectively diagnosed as acute myeloid leukaemia, gastric carcinoma, lung cancer, undifferentiated embryonal sarcoma of the liver. The age of patients during OLT was 42-57 years (mean 52 years). The age of patients' onset was 45-60 years (mean 53 years). The length was 6-38 months from liver transplantation to diagnosis of de novo malignant tumors (mean 31 months). All of the 4 patients died of tumor progression and multiple organ failure. The survival time was 12-48 months after OLT (mean 39.5 months), and that was 6-10 months after diagnosis of de novo malignant tumors (mean 8.5 months). Conclusion The incidence of de novo malignant tumors after OLT in China is lower than in abroad. The delayed diagnosis time is a main cause of death for patients with de novo malignant tumors after OLT. To think highly of precancerous lesions and high risk of factors, early diagnosis, and early treatment are the keys to improve the survival time.

Objective To compare the efficacy of percutaneous and endoscopic treatment for the biliary stricture(BS) after liver transplantation (LT).Methods The result of percutaneous transhepatic cholangiography (PTC) and drainage ( PTC group) and endoscopic retrograde cholangiopancreatography (ERCP group) for the BS in 132 post-LT patients were analyzed retrospectively.Ninety-nine patients received PTC treatment,and 59 patients received ERCP treatment,26 patients converted to PTC treatment because of the poor efficacy or failure of the ERCP treatment.The operation success rate,complication rate,cure rate and remission rate of the two groups were compared with X2 test.Results The BS types of PTC and ERCP group were different significantly( P ＜ 0.01 ),with more non-anostomotic stricture in PTC group and more anostomotic stricture in ERCP group.The operation success rate of PTC group was higher than of ERCP group( 100％ vs 97％ ) (P ＜0.01 ),and the complication rate of PTC group was lower than of ERCP group.The overall cure and remission rate of PTC and ERCP group were not different significantly(32.3％ vs 45.8％,94.9％ vs 88.1％ ) (P ＞0.05).The cure and remission rate of PTC and ERCP treatment for each subtype of BS were not different significantly ( P ＞ 0.05 ).Conclusions The efficacy of PTC treatment for the post-LT BS is equivalent to that of ERCP treatment.PTC can be considered the first-line option for the post-LT BS.