Objective To determine whether thalidomide can maintain remission after discontinuing the treatment of etanercept in ankylosing spondylitis (AS). Methods One hundred and five patients with active AS treated with etanercept 50 rag/week for 12 weeks and attained an ASAS20 response at week 12. They were randomly assigned to receive thalidomide 150mg/night, sulfasalazine (SASP) 2.0 g/d, or non-steroidal anti-inflammatory durgs (NSAIDs) only. All patients were followed monthly for BASDAI, BASFI, PGA and spinal pain VAS. A Kaplan-Meier survival analysis was used to calculate the probability of a relapse. Results One hundred patients completed the follow-up. Thirty patients were treated with thalidomide, 33 patients with SASP and 37 patients with NSAIDs only. The mean follow-up time was 5.1 months and the longest time was 12 months. At the end of the follow-up, the percentage of patients who maintained remission in the thalidomide group was 40%, much higher than SASP group (15%) and NSAIDs group 11% (P=0.0265 and 0.0053 respectively). No difference was found between the remission rate of SASP and NSAIDs only group (P=0.5881). Conclusion Thalidomide can successfully maintain remission of AS after discontinue etanercept treatment.

Objective To evaluate the application value of the micro movement sensitive mattress sleep monitoring system(MSMSMS) in the diagnosis of children with obstructive sleep apnea syndrome (OSAS).Methods One hundred and twenty-nine children aged from 3 to 14 years who visited the sleep center of Beijing Children's Hospital Affiliated to Capital Medical University from June 2013 to June 2015 due to sleep snoring were enrolled.Children with acute respiratory infection,cranial facial abnormalities,chronic lung diseases and neuromuscular diseases were excluded.According to the criteria,36 children were diagnosed as OSAS with average age of (7.3 ± 2.5) years,including 28 males and 8 females.Ninety-three non-OSAS children were recruited with average age of (6.3 ± 2.3) years,including 61 males and 32 females.Subjects were monitored with polysomnography(PSG) and MSMSMS simultaneously.Apnea/hypopnea index (AHI) ＞ 5 or obstructive apnea index (OAI) ＞ 1 were used to define whether OSAS existed.The consistency between MSMSMS and PSG in the diagnosis of OSAS and the determination of sleep efficiency were compared.Results The Kappa consistency coefficient of MSMSMS and PSG in the diagnosis of OSAS was 0.70(95％ CI:0.57-0.84),Z =7.99,P ＜ 0.000 1,which indicated the consistency between PSG and MSMSMS was good.The consistency of sleep efficiency of MSMSMS and PSG were compared.Bland-Altman results showed that there were 3％ (5/129 cases)points out of 95％ consistency bound and the interclass correlation coefficient (ICC) was 0.69 which indicated the consistency of 2 methods was good in determination of sleep efficiency.MSMSMS was able to detect respiratory event that was associated with sub-cortical arousals with no electroencephalogram arousal or blood oxygen reduction.Conclusions There is an adequate consistency between MSMSMS and PSG in the diagnosis of children with OSAS and determination of sleep efficiency.The MSMSMS has an advantage in detection of sub-cortical arousals and respiratory event.

ObjectiveTo evaluate the efficacy of etanercept in the treatment of active ankylosing spondylitis ( AS) with enthesitis and explore an easy and accurate scoring method.MethodsWe designed this 12-week double-blind,placebo-controlled,randomized clinical study in active AS patients.The first part was a 6-week placebo-controlled period that patients received etanercept or placebo,followed by a 6-week open-label period that all patients received etanercept. At week 0,2,4,6,8,10,12,the scores of enthesitis were recorded.The primary efficacy endpoint was the Mander Index in the two groups. We compared the Maastricht AS Enthesis Score ( MASFS) index,Spondyloarthritis Research Consortium of Canada ( SPARCC) index,Berlin index and San Francisco index with the Mander Index. Results A total of 127 patients were included with 92 in the etanercept group and 35 in the placebo group.In etanercept group there were 25,41,47 patients without enthesitis at week 2,4,6 separately. At week 12,more than 70％ patients' enthesitis in two groups turned negative.The primary endpoint,as the Mander Index at week 6,was achieved by 0(0,2) score in the etanercept group compared with 1 (0,3) score in the placebo group (P =0.0286). Among the four Indexes.the San Francisco Index was the one most COrrelated with the Mander Index.Conclusion Etanercept can improve the symptoms of enthesitis fast and significantly. In clinics,the San Francisco Index is easier to operate and more accurate for assessment.

Objective To observe before and after surgery plasma vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-β1) content changes in the children with congenital heart disease(CHD) combined severe pulmonary arterial hypertension(PAH),and to explore the relationship with the pulmonary artery pressure.Methods Sixty cases patients with CHD in the First Hospital of Hebei Medical University from June 2014 to January 2015 were selected,including 30 cases left to right shunt CHD with severe PHD,30 cases no PHD.The content of serum VEGF,TGF-β1,parallel echocardiographic estimates pulmonary artery mean pressure(PAMP) of all children were detected with preoperative and postoperative 24 h,7 d and 30d.Results PAMP of children with severe PAH before surgery was (60.29±8.48) mmHg and (48.36±5.25)mmHg of postoperative 24 h,(28.21±3.29) mmHg of 7 d after surgery,(25.21±2.09) mmHg of 30 d after surgery,the difference was statistically significant (F within the grouP=39.86,P＜0.001),and compared with no PHD group,the difference was significant ((14.26±1.78) mmHg,(14.30±1.92) mmHg,(13.31±1.02)mmHg;F between groups=46.01,P＜0.001).The levels of VEGF and TGF-β1 in severe PHD group were (808.90±41.37) ng/L and (1156.96±83.68) ng/L of before operation,(620.21±30.30) ng/L and (906.20±65.11) ng/L of postoperative 24 h,(454.49±21.48) ng/L and (826.23±35.11) ng/L of postoperative 7 d,(454.49±21.48) ng/L and (806.49±29.48) ng/L of postoperative 30 d,the differences were significant (Fwithin the grouP=43.73,P＜0.001;F within the grouP=65.41,P＜0.001),compared with no PHD group,the differences were significant (VEGF:(379.25±20.21) ng/L,(380.05±19.98) ng/L,(380.05±19.98) ng/L,F between groups =54.09,P＜0.001;TGF-β1:(728.56±29.93) ng/L,(728.11±25.26) ng/L,(727.05±24.99) ng/L,F between groups=83.05,P＜0.001).Conclusion Plasma VEGF and TGF-β1 level has correlation with pulmonary artery pressure,the severity evaluation of pulmonary hypertension and surgical curative effect has a certain significance.After surgery,severe PAH is still exist in a certain period in children with pulmonary hypertension,sufficient attention should be paid to strengthening treatment and follow-up.

Objective To evaluate the therapeutic effect and safety of the rituximab in the treatment of severe rheumatoid arthritis (RA). Methods A total 22 severe RA patients with DAS28＞5.1 were treated with rituximab 500～1000 mg/24week, or placebo/24 week, along with methotrexate (MTX) 10～25 mg/week.Chi-square test was adapted for statistical analysis if the results met the data criteria for the analysis. Rank conversion analysis was used to test the results if the data did not satisfy the Chi-square test. Results Twenty-two patients (93% were females with the median age of 50 yd and the average MTX dosage was 17.6 mg/week ) completed the treatment. The proportion of ACR 20 responders at 72 week was 80%, 60%,57% respectively. Other secondary efficacy endpoints showed that rituximab could provide substantial benefits to patients with RA by reducing clinical signs and disease activity score. The most frequently occurred adverse event was upper respiratory tract infection. Tne second most frequent adverse events were reduction of lymphocytes and elevation of liver enzymes. Most treatment-related adverse events were mild to moderate in severity. Conclusion Rituximab has demonstrated to be effective and is well tolerated by patients in the treatment of active RA.

Objective To investigate the role of myeloid dendritic cells(mDC)in the pathogenesis of ankylosing spondylitis (AS),and to study the mechanism of tumour necrosis factor (TNF)-α blocker on the treatment of AS by counting the number of mDC before and after the treatment.Methods Peripheral blood from 21 AS patients treated with 50 mg rhTNFR-Fc and 15 AS patients treated with placebo were investigated at week 0,week 2 and week 6 in a randomized,double-blind,placebo-controlled trial.Three-color flow cytometry analysis was used to investigate the change of the number of mDC before and after the treatment.And their correlation with the clinical parameters was analyzed.Results MHC Class Ⅰ positive mDC(Lin-/CD11c+/HLA-abc+)in AS patients was slightly less than in healthy controls (not statistically significant).No significant change in MHC Class Ⅰ mDC number was observed after drug treatment.The number of MHC Class Ⅱ mDC cells was not correlated with clinical parameters.Conclusion The treatment with rhTNFR-Fc in AS induces a significant upregnlation of MHC-Ⅱ DC.

Objective To evaluate the effect of red yeast rice on chemokines of collagen-induced arthritis in rats. Methods Rat arthritis was induced by injecting bovine type Ⅱ collagen(BⅡC)to Wistar rats.The rats were randomly divided into six groups including the normal control group,the CIA control group which were treated with normal saline,ibuprofen group,large dose red yeast rice group,moderate dose of red yeast rice group and small dose of red yeast rice group.Mice were sacrificed after 48 days of immune injection and their venous blood were collected. The effect of cytokines and chemokinos on CIA was measured by ELISA.Results Red yeast rice significantly degraded the expression of TNF-α,IL-6 compared with the model groups,the difference was significantly different(P＜0.05).The degree of IL-8 decrease was more evident in the high dose of Red yeast rice group and moderate dose of Red yeast rice group than that of the model group(P＜0.05).Red yeast rice could significantly degrad the expression of MCP-1,R.ANTES and IP10 in serum of CIA rats(P＜0.05).Conclusion The mechanism of anti-inflammatory action of red yeast rice is related to the inhibition of inflammatory factors.

Objective To assess the value of multi-slice spiral CTA in the diagnosis of iliac vein compression syndrome(IVCS)and secondary thrombosis.Methods The CTA data of 80 controls and 31 patients with IVCS conformed by DSA were retrospectively studied.The inner diameters of the compressed iliac vein in two groups were measured and compression ratios were calculated.The data were compared using t test and Wilcoxon test.The findings of CTA were compared with that of DSA and the accuracy of CTA was analyzed.Results For the control group,the inner diameters of left iliac vein in female group(7.0±2.5)mm were significantly less than that in male group(8.1±2.5)mm(t=2.42,P＜0.05).For the control group,the inner diameters of left iliac vein was(7.6±2.0)mm,and the compression ratios were 0 to 65.41%(median 27.65%).The compression ratios were no statistical differences between male group(0 to 61.36%,median 26.82%)and female group(0 to 65.41%,median 28.75%)(Z=-0.59,P＞0.05).For the patients group,the inner diameters of compression iliac vein was(2.7±1.1)mm.The compression ratios were 55.18% to 100%(median 76.12%).Both inner diameters and compression ratios were statistically different between the control and patients group(t=12.78,P＜0.05;Z=-8.18,P＜0.05).Fifteen of 31 cases with IVCS were accompanied with deep vein thrombosis.The left iliac veins were compress in 28 cases,while right iliac veins were compressed in 2 cases.The left and right iliac common veins were compressed by the left and right jliac common arteries in one case.The results of CTA were consistent with that of DSA in all cases.Conclusions CTA can not only measure the inner diameters of iliae vein compression and calculate compression ratios,but also demonstrate secondary thrombosis clearly.CTA is an effective examination in diagnosis of IVCS and secondary thrombosis.

ObjectiveTo evaluate the efficacy and safety of etanercept 50 mg once-weekly treatment of Chinese patients with active ankylosing spondylitis ( AS).Methods Four hundred patients with active AS,enrolled in six medical centers,were randomly divided into either the treatment group or the placebo group in a 3∶1 ratio.The total length of the study was 12 weeks.The first 6-week period was a double-blind placebo controlled treatment period and the second 6-week period was an open-labeled treatment period.During the first 6-week period,300 patients in the treatment group received once-weekly subcutaneous injection of etanercept (50 mg),whereas the 100 patients in the placebo group received placebo injection.During the second 6-week period,patients in both groups received etanercept (50 mg once weekly subcutaneous injection).The primary end point was the percentage of patients achieving the Assessments in Ankylosing Spondylitis (ASAS) 20％ response ( ASAS 20 ) at week 6.Other outcome measures included the percentage of patients achieving ASAS 5/6,partial remission and Bath AS disease activity index 50 ( BASDAI 50) responses at week 12.ResultsA total of 381 patients completed the trial,including 285 patients in the etanercept group and 96 patients in the placebo group.At week 2,the percentage of patients achieving ASAS 20 in the etanercept group was 55.7％,whereas the placebo group was only 17.0％ ( P ＜ 0.001 ).At week 6,77.5％ of patients in the etanercept group achieved ASAS 20 as compared with 32.3％ in the placebo group ( P ＜ 0.001 ).At the end of 12 weeks,the percentage of patients in the etanercept group achieving the ASAS 20 was 89.5％.Improvements of other measures were also significant in the etanercept group.Etanercept was well tolerated and no malignancy and life-threatening events were observed in this study.Most adverse events observed were mild injection-site reactions.ConclusionEtanercept 50 mg weekly treatment of Chinese patients with active ankylosing spondylitis is convenient,fast-acting,highly effective,and well tolerated.

This study was aimed to explore five Chinese medicine components or ingredients from Qu-Shi Hua-Y u Decoction (QSHYD) with uniform design method and screen ingredients assembling of Chinese medicine BZL pre-scription in order to verify its therapeutic effect on experimental fatty liver rats. High-fat diet was used in the estab-lishment of fatty liver rat models. Five effective ingredients (i.e., chlorogenic acid, geniposide, curcumin, polydatin and polysaccharide of Atractylodes macrocephala Koidz) of QSHYD were used as study subjects. Uniform design was applied in the grouping design. The intragastric administration was given for four weeks. The screening index was the content of liver triglyceride (TG). The ingredients assembling of Chinese medicine BZL prescription was screened through uniform design and regression analysis. The same fatty liver animal model was used in the comparison be-tween QSHYD and rosiglitazone. The TG content in liver tissues of rats and serum ALT activity were detected. The pathological changes of liver tissues were observed (HE stain and oil red O stain) with Ridit analysis to verify its therapeutic effect. The results showed that through screening, the regression equation was Y = 15.083X1 + 5.321X2- 5.186X3 - 16.157X4 + 9.35X5 + 17.667X3X4 - 8.422X1X2 - 6.617X3X5 + 16.571 (X1: chlorogenic acid, X2:polydatin, X3: polysaccharide of Atractylodes macrocephala Koidz, X4: geniposide, X5: curcumin). According to this equation, the best TG reducing effect occurred when the chlorogenic acid (X1), polysaccharide of Atractylodes macrocephala Koidz (X3), and geniposide (X4) were the maximum dosage. It showed that the best combination in inhibiting TG content in liver tissues was X3, X4 and X1 (i.e. BLZ prescription). Among fatty liver rat mod-els induced with same high-fat diet, the screened Chinese medicine ingredient BZL prescription can obviously reduce its TG content in liver tissues and serum ALT activity ( P < 0 . 01 ) . It obviously improved the fatty degen-eration of rat's liver. It was concluded that ingredients assembling of Chinese medicine BZL prescription screened through uniform design can obviously prevent and treat fat deposition and injury of the liver among rat models induced by high-fat diet .