Objective To investigate the incidence,pathogens and clinical features of nosocomial infections in patients with ac-tive rheumatoid arthritis (RA).Methods A total of 2 452 active RA patients were reviewed and analyzed retrospectively in Shanghai hospitals between January 2009 and February 2011.The demographic and clinical characteristics were described.Re-sults A total of 721 episodes of infection were found in 503 patients (20.51%).About 40.97% of the infections were of respir-atory tract,22.35% of urinary tract,and 8.58% of skin and soft tissues.Major pathogens were bacteria (623,86.40%),in-cluding E.coli (226,31.35%),P .aeruginosa (40,5.55%),A.baumannii (48,5.42%),Enterococcus (144,16.25%), methicillin-resistant Staphylococcus aureus (15, 2.08%), methicillin-resistant coagulase-negative Staphylococcus (7, 0.97%).The other pathogens included fungi (74,10.26%),herpes zoster (16,2.21%),and Mycobacterium tuberculosis (8,1.10%).Conclusions Nosocomial infection is mainly seen in respiratory and urinary tracts,usually associated with E.co-li,P .aeruginosa,A.baumanii,methicillin-resistant Staphylococcus and Enterococcus .

Objective:To investigate the serum Vitamin A(sVit A) levels in Behcet′s disease(BD)and other rheumatological diseases.Methods: sVit A concentration was measured in BD(including 3 subtypes of eye BD,intestinal BD,and vascular BD),rheumatoid arthritis(RA),systemic lupus erythematosus(SLE),ankylosing spondylitis(AS),primary Sjogren′s syndrome(pSS) and adult onset Still disease(AOSD)and compared with healthy controls(HC).Results: The patients enrolled in this study was according with the epidemiological features;BD patients including its subtypes of eye BD,intestinal BD,and vascular BD patients all had a lower concentration of sVit A than HC(P<0.05),no statistical differences between the subtypes;RA,SLE,AS,pSS and AOSD had a lower concentration of sVit A than HC(P<0.05).Conclusion: Decreased serum Vit A levels might account for a common pathogenesis of various rheumatic diseases.

The repair of articular cartilage defects has been a dif ficult problem. Presently cartilaginous autograft and allograft, periosteal and perichondral graft and transplantation of chondrocytes had been widely applied t o repair cartilaginous defects. The application of tissue engineering might be a method of hope. This article reviewed the progression of cartilage transplantation and the tissue engineering.

OBJECTIVE To strengthen management of nosocomial infections in comprehensive intensive care unit so as to enhance medical treatment quality.METHODS Nosocomial infection administration department constituted the management institutions and standards of nosocomial infections with supervising,implementing targets monitoring.Comprehensive intensive care unit instituted several groups of nosocomial infection management and fulfiled the precautions and control measures.RESULTS By means of interventions and prophylaxes,the occurrence of nosocomial infection in comprehensive intensive care unit decreased.CONCLUSIONS It ensures for medical treatment quality and safe by strengthening the management of nosocomial infections.

Objective To analyze the clinical features,and prognosis of the interstitial lung disease (ILD) in patients with dermatomyositis (DM) and polymyositis (PM) by chest X-ray,chest high-resolution CT scan (HRCT) and pulmonary lung function.Methods Thirty-three patients hospitalized with DM/PM associated ILD were retrospectively analyzed.Results Thirty-three patients with ILD were confirmed by HRCT.Abnormal pulmonary function tests were available in 82% of patients.Clinical-imaging analysis revealed that the pathological features of ILD were non-specific interstitial pneumonia (NSIP,57%) and unusual interstitial pneumonia (UIP,25%).UIP types showed a poor prognosis and high mortality (70%).Conclusion This study shows that HRCT is more sensitive for the diagnosis of ILD than lung function tests and chest X-ray.Combined HRCT and chest X-ray with lung function tests and blood gas analysis have shown that the major pathological types of ILD are NSIP and UIP,in which UIP are associated with high mortality and poor prognosis.

Objective To evaluate the therapeutic effect of etanercept in patients with Behcet's disease (BD). Methods Twenty six patients with active BD were eligible for anti-TNF-α treatment, which failed previously to commonly used drugs. All the patients were stopped previous therapy and treated with etanercept 25 mg twice a week. The clinical responses and laboratory parameters were evaluated at the baseline, week 2, 4, 8, 12 and 24, and week 12 of etanercept withdrawal. Results Etanercept was effective in several clinical lesions and lab. parameters at all time points. Especially at week 2, including oral ulcers, genital ulcers, erythema nodosum, pseudofolliculitis and swollen joints (P<0.01). Two of four cases of uveitis were contro-lled with addition of topical corticosteroids; The ileocecal junction ulcer of 1 patient healed after 2 months etanercept therapy; four cases of epididymitis reached complete remission at week 4. ESR(P=0.012) and CRP (P=0.013) were also rapidly decreased at week 2. Most patients were relapsed at week 12 of etanercept withdrawal compared with baseline except for swollen joints (0.65±1.09 vs 0.31±0.60, P<0.01) after etanercept withdrawal, in which the typical rebound was CRP from (481±312) mg/L to (549±267) mg/L (P=0.013).Conclusion Etanereept has rapid efficacy onset for most of the mucocutaneous disorders and possibly effective for arthritis, ophthalmitis, epididymitis and colonic ulcer of BD.

Objective To analyze the characteristics of Behcet's disease (BD) with intestinal lesions to provides further reference for the diagnosis and treatment.Methods Four hundred and one cases of BD patients' data were collected including basic data,colonoscopy report,pathology diagnosis and hematologic examination.Statistical description of intestinal lesions was applied and analyzed for the differences between the locations and blood examinations of intestinal lesions.Results Within these 401 BD patients,88 (21.95 ％) with intestinal lesions.Intestinal ulcerations,including both active and inactive phase,appeared in 52 cases (12.97％) mostly founded in ileocecum,in which 62.86％ (22/ 401,5.49％ of all BD patients) without the abdominal discomfort.Compared with inactive phase,the active phase intestinal BD patients have higher inflammation indexes with C reactive protein (CRP) increased of statistical significance (P =0.028).Thirty-three cases (8.23 ％) with adenomas were founded,including tubular adenoma,serrated adenoma and villous adenoma.Mostly occurred in rectum,sigmoid colon,especially the sigmoid colon rectum junction.Adenomas were seen in eider patients with statistical significance compared to BD patients without intestinal lesion or with intestinal ulceration (P =0.022,0.000),and exhibited elder changes of lab tests,such as increas in aspartate aminotransferase (AST),gamma-glutamyl transferase (GGT) and uric acid (UA).In addition,2 cases of melanosis coli and 1 case of caecal diverticulum were also founded.Conclusions BD patients with intestinal ulcer or adenoma takes a fairly high ratio,and most intestinal BD and BD with adenoma patients did not complaint related symptoms,so colonoscopy as a screening method for diagnosis and treatment of BD is necessary.

Objective To improve the knowledge of intestinal Behcet's disease.Methods From October 2012 to January 2014,36 patients with intestinal Behcet's disease were collected.The general information of the patients,manifestation of Behcet's disease,digestive symptoms,lab findings,imaging findings,endoscopic examination results,treatment and prognosis of Behcet's disease were analyzed.Chi square test and Fisher exact probability test were performed for count data analysis.Single factor and multi factors of efficacy were analyzed by Logistic regression analysis.Results Among 36 patients with Behcet's disease (male 19 and female 17),the mean onset age was 26.5 years old and the average course of disease was (8.2±6.8) years.Symptoms of digestive system of 91.7％ (33/36) patients showed up later than system manifestations of Behcet's disease appeared.All 36 patients had oral ulcer.The rates of genital ulcers,skin diseases,inflammation and joint disease were 63.9％ (23/36),58.3％ (21/36),25.0％ (9/36) and 25.0％ (9/36),respectively.The main symptoms of digestive system were abdominal pain,diarrhea,bloating and hemafecia,of which abdominal pain was the predominant symptom and the incidence rate was 75.0％ (27/36).Gastrointestinal bleeding,intestinal perforation,intestinal obstruction and arteriovenous fistula were the common complications of Behcet's disease and the incidence rates were 36.1％ (13/36),2.8％ (1/36),2.8％ (1/36) and 2.8％ (1/36),respectively.Among patients with ocular lesions,male patients were more than female patients (male six and female three),and the difference was statistically significant (x2 =0.111,P＜0.05).Erythrocyte sedimentation rate increased in 55.6％ (20/36) patients.C-reactive protein was positive in 27.8％ (10/36) patients.Nine patients received computed tomography (CT) examination,there were five cases with thickened bowel wall and one case with proliferative lesions at ileocecal valve.Ileocecum was the predilection site,and accounted for 36.1％ of the disease (13/36).Endoscopic appearance was mainly ulcers.Pathological examination indicated non-specific acute and chronic gastrointestinal mucosal inflammation and the formation of inflammatory granulation tissue.Twerty-two patients received sulfasalazine (SASP) treatment and 24 patients accepted glucocorticoid therapy.After Behcet's disease recurrence,five patients received combined immunosuppressive therapy,five patients received immunosuppressive therapy and tumor necrosis factor (TNF) antagonist treatment,and nine patients received TNF antagonist treatment.All the patients treated together with proton pump inhibitor (PPI).Twelve patients without glucocorticoid treatment took thalidomide and immunosuppressive therapy.The efficacy was good in patients with immunosuppressive therapy or TNF antagonist treatment and the recurrence rate was low (r=3.984,P ＜ 0.05).Conclusions Most patients with intestinal Behcet' s disease are young adults.Symptoms of digestive system show up later than system manifestations of Behcet's disease appeared.Ileocecum is the predilection site of digestive system.The common endoscopic appearance is ulcers.Corticosteroids and sulfasalazine are the main therapy,which could be much more effective when combined with tumor necrosis factor antagonists or immunosuppressive therapy.

Background: The side effects of glucocorticoid in treatment of systemic lupus erythematosus (SLE) have been the focus of debate, and our preliminary study indicates that ginsenosides can enhance the efficacy of dexamethasone. Objective: To observe the effects of ginsenosides combined with prednisone in SLE patients. Design, setting, participants and interventions: A total of 60 SLE patients from Department of Rheumatology and Immunology, Changhai Hospital, Second Military Medical University, were randomly divided into treatment group and control group, with 30 patients in each group. Patients in the treatment group were given routine treatment with prednisone plus ginsenosides, while those in the control group were given routine treatment with prednisone plus placebo. They were all treated for 3 months. Main outcome measures: After three-month treatment, syndrome score in traditional Chinese medicine (TCM), total response rate and symptom improvement rate were measured and evaluated. Results: Twenty-eight cases in treatment group and twenty-seven cases in control group were included in analysis. The total response rates in the treatment group and control group were 89.28% and 66.67% respectively, and there was a significant difference between the two groups (P<0.05). After treatment, the TCM syndrome scores in the two groups were lower than those before treatment (P<0.01), and prednisone plus ginsenosides was better in decreasing the TCM syndrome score than prednisone plus placebo (P<0.05). The symptoms were improved in the treatment group as compared with the control group (P<0.05). Conclusion: Prednisone combined with ginsenosides can increase the clinical effective rate and improve the clinical symptoms of SLE patients.

Objective Using an in vivo adeno-associated virus(AAV)-mediated gene transfer technique,this study was designed to evaluate the protective effects of human osteoprotegerin(OPG)transgene against joint destruction in collagen induced arthritis(CIA)model.MethodsAfter CIA was established in the Sprague-Dawley rats,the experimental animals were treated with PBS or rAAV-EGFP or rAAV-hOPG (100μl/d)intra-articular injection 25 days after arthritis induction for 10 days.Paraffin-embedded joints were then analyzed histologically.The joint destruction was evaluated by Larsen Score.The protein expression of OPG,IL-1,MMP-3 was identified by enzyme-linked immunosorbent assay(ELISA).Results Suecessful trans-gene expression was confirmed by the detection of OPG by ELISA and positive fluorescence of the frozen joint section. Image analysis revealed that the expression of OPG significantly protected against joint destruction by 30% compared with the CIA group. Conclusion OPG gene transfer mediated by rAAV effectively protects against bone destruction induced by CIA model. Those data suggest that gene transferring using rAAV-OPG may be a feasible and effective therapeutic approach to treat or prevent joint destruction in inflammatory arthritis.