Objective:To study the clinical and immunological features of two case of rare antisynthetase syndrome (ASS), so as to improve the level of diagnosis and treatment.Methods:Two cases with rare antisynthetase syndrome admitted to the First Affiliated Hospital of Zhengzhou University from July 2020 to August 2022 were collected.Results:The two rare ASS were anti-Zo antibody and anti-Ha antibody positive patients, both of which had interstitial lung disease (ILD) as the main clinical manifestation and positive anti-Ro52 antibody. Two rare antisynthetase autoantibodies manifested cytoplasmic ANA indirect immunofluorescence (IIF) staining pattern, but it is different from the cytoplasmic dense speckled pattern of several common ASS antibodies. After treatment with glucocorticoids and immunosuppressants, case 1 died of respiratory failure due to a long course of disease and late diagnosis, the lung lesions of case 2 improved significantly.Conclusion:When encountering the cytoplasmic ANA fluorescent pattern in ILD patients, especially with anti-Ro52 antibody, it is necessary to screen more myositis specific antibodies to rule out the possibility of rare ASS.

Intracranial atherosclerosis has been regard as the most common cause of ischemic stroke.The information of the types and degree of vascular wall lesions is important basis for the diagnosis and treatment of ischemic stroke.High-resolution MR vessel wall imaging can directly display the lumen and wall of intracranial vessels,evaluate the characteristics of atherosclerotic plaque qualitatively and quantitatively,including intra-plaque hemorrhage,plaque enhancement,and plaque distribution.Thus,high-resolution MR vessel wall imaging may play an important role in risk stratification,pathogenesis,treatment and prognosis evaluation in ischemic stroke patients.This review summarizes the progress of high-resolution MRI vessel wall imaging in the evaluation of intracranial atherosclerosis,especially the pathogenesis of plaque features and treatment-related information.

OBJECTIVE To investigate the clinical efficacy and safety of rituximab （RTX） followed by belimumab （BLM） in patients with severe systemic lupus erythematosus（SSLE）. METHODS Nine SSLE patients， who were treated with RTX followed by BLM for more than 6 months in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Zhengzhou University from October 2020 to June 2021， were enrolled. Baseline clinical data of patients， laboratory examination results and basic treatment status at weeks 0， 4， 12， and 24 of medication were collected retrospectively. The patients’ systemic lupus erythematosus disease activity index （SLEDAI） score， glucocorticoid dosage and serological indicators （complement C3， complement C4， serum albumin， and 24-hour urine protein quantification） level were analyzed. At the same time， the occurrence of adverse drug reaction was collected. RESULTS All 9 patients completed more than 24 weeks of RTX followed by BLM therapy. All patients suffered from renal impairment， of which 7 （77.8%） had renal pathology support， 3（33.3%） had blood system damage and 2 （22.2%） had nervous system damage. During treatment， with the prolongation of treatment time， the SLEDAI score， 24- hour urinary protein quantification， and glucocorticoid dosage of patients showed a significant downward trend， and ultimately decreased to the normal index level （P＜0.05）； serum albumin， complement C3 and complement C4 all showed a significant upward trend， eventually rose to the normal index level （P＜0.05）. During treatment and follow-up， 1 patient developed herpes zoster， 1 patient developed upper respiratory tract virus infection， and 1 patient developed urinary system bacterial infection. All patients recovered after symptomatic treatment. CONCLUSIONS In sequential use of RTX followed by BLM for SSLE， early administration of RTX can quickly stabilizethe condition， significantly alleviate clinical symptoms， and gradually normalize specific serological indicators； subsequent administration of BLM can reduce the type and dosage of basic treatment drugs； there is no increase in the incidence of adverse drug reactions.

Objective To investigate the serum levels of dickkopf-related protein 1 (DKK1) and sclerostin (SOST) in patients with axial spondyloarthritis treated with selective cyclo-oxygenase 2 inhibitor and its relation to clinical efficacy.Methods A randomized double-blind controlled trial with axial spondyloarthritis (ax-SpA) was carried out in our hospital.The data from patients in a single center was collected and analyzed.Serum DKK1 and SOST levels were measured by enzyme-linked immuno sorbent assay (ELISA)method before and after 12 weeks treatment,then correlation analysis were conducted for DKK1 and SOST levels with erythrocyte sedimentation rate (ESR),C reactive protein (CRP),Bath ankylosing spondylitis disease activity index (BASDAI),Bath ankylosing spondylitis functional index (BASFI) and SPARCC of the sacroiliac joint inflammation score.Chi-square tests were used for analyzing of categorical data.Fisher exact tests were performed when the expected frequencies were less than 5.Two independent samples t-test was used to compare the difference between groups.Single sample t-test was used to ompare the differences between data before and after treatment.Pearson or Spearman correlation was used for correlation analysis.Results After 12 weeks of treatment,a total of 116 patients completed the follow-up,including 57 cases of imrecoxib group and 59 cases of the celecoxib group.There were no statistically significant difference between the two groups (P＞0.05).The level of serum DKK1 was significantly increased after treatment [(393±137) pg/ml,vs (542±274)pg/ml,P＜0.05].The serum level of SOST increased significantly [(39±19) pg/ml vs (57±36) pg/ml,t=5.814,P＞0.05],too.The difference between the two groups was not statistically significant (P＞0.05).Spearman correlation analysis showed that serum DKK1 was positively correlated with serum SOST (r=0.226,P=0.015).A significantcorrelation was found between SOST level and ESR,CRP,finger to floor distance,left and fight lumbar side flexion and Schober's test (ESR:r=-0.379,P＜0.01;r=-0.309,P=0.001;r=-0.225,P=0.015;r=0.185,P=0.047;r=0.247,P=0.008;r=0.214,P=0.021).Conclusion Imrecoxib and celecoxib have similar efficacy on relieving the signs and symptoms of patients with ax-SpA.Short-term application of selective COX-2 inhibitors can increase DKK1 and SOST and possibly delay radiographic progression.

Objective To investigate the sleep quality of patients with systemic lupus erythematosus (SLE) and to analyze its influencing factors. Methods A total of 156 patients with SLE who were treated in the Rheumatology Department of the First Affiliated Hospital of Zhengzhou University from October 2016 to January 2017 were selected as the research objects by convenience sampling method. All the participants were investigated by general information questionnaire, Pittsburgh sleep quality index (PSQI) scale and systemic lupus erythematosus disease activity index (SLEDAI). The influencing factors of patients' sleep quality was analyzed by single factor analysis and multiple linear regression analysis. Results The score of PSQI scale of SLE patients was (10.04±5.83). It was reported that 62.23% of patients had poor sleep quality. The main reason for night sleep disturbance were easy to wake up at night, night frequent urination and sensory heat. Single factor analysis showed that there was significant difference in total sleep quality among SLE patients with different age, education level, number of hospitalization, course of the disease, daily average dose of glucocorticoid and disease activity index (P< 0.05). Multiple linear regression analysis showed that age, course of the disease, daily average dose of glucocorticoid and disease activity index were the influencing factors of SLE patients' sleep quality (P<0.01). Conclusions The results indicate that sleep quality of SLE patients is influenced by age, course of disease, daily average dose of glucocorticoids and disease activity index. Medical staff should pay attention to patients' sleep problems and give sleep nursing interventions on the basis of treatment in order to improve the sleep quality and life quality of SLE patients.

Objective:To evaluate the changes of quality of life in patients with axial spondyloarthritis (ax-SpA) after treatment with non-steroidal anti-inflammatory drugs (NSAIDs) by the 36-item Short Form Health Survey (SF-36).Methods: 120 patients diagnosed with ax-SpA were collected in the first Affiliated Hospital of Zhengzhou University from October 2014 to September 2015.They all agreed to be treated with the special drugs and assessed by special scale.Then they all signed the agreement.In the 3 months,double-blind,parallel controlled trial patients were randomized to 200 mg twice daily (bid) imrecoxib,or 200 mg twice daily (bid) celecoxib.They were assessed for the changes of quality of life at enrollment and after three months of NSAIDs therapy by the SF-36 of Chinese edition.The correlation between quality of life and erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),Bath Ankylosing Spondylitis Disease Activity Index (BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI),Spondylo Arthritis Research Consortium of Canada (SPARCC) was analyzed.Results: A total of 116 ax-SpA patients completed the study and 4 patients were lost to follow-up.We used the SF-36 scale to assess the quality of life in patients with ax-SpA before and after 3 months,NSAIDs treatment.The treatment effects were not statistically significant difference between the two drugs (P>0.05).After all the patients were treated with NSAIDs for 3 months,there was statistically significant difference (P<0.05) of the physical functioning,role-physical,bodily pain,general health,social functioning,role-emotional;and there was no statistically significant difference (P>0.05) of vitality and mental health.The positively significant correlations had been identified between BASDAI and PF,RP,BP,GH,VT,SF,RE (P<0.05),while no significant correlation was found between BASDAI and MH (P>0.05).A positively significant correlation had been identified between BASFI and PF,RP,BP,GH,SF,RE,MH (P<0.05),while no significant correlation was found between BASFI and VT (P>0.05).The ESR was positively correlated with SF,RE (P<0.05);and CRP was positively correlated with SF,MH (P<0.05);and SPARCC was positively correlated with PF (P<0.05).BASDAI and BASFI were the important influence factors of PF (P<0.05);and BASDAI was the important influence factor of BP,GH,VT,RE(P<0.05);BASFI was the important influence factor of RP,SF,MH(P<0.05).Conclusion: Non-steroidal anti-inflammatory drugs can improve the quality of life of the ax-SpA patients.Imrecoxib and celecoxib have the equivalent curative effect.SF36 scale is suitable for the assessment of the quality of life in patients with ax-SpA.

Objective To acquire the prevalence and molecular identification data on Syphacia muris and provide reference for the revision of national standard. Methods 923 batches of 5199 SPF animals ( including one batch of 5 monkeys, 3 batches of 25 mini?pigs, 28 batches of 55 rabbits, 13 batches of 248 hamsters, 37 batches of 198 guinea pigs, 93 batches of 459 rats, 742 batches of 4179 mice, 5 batches of 25 chickens and one batch of 5 ducks) and 145 batches of 1389 clean animals ( including one batch of 3 rabbits, 4 batches of 31 hamsters, 16 batches of 157 guinea pigs, 32 batches of 268 rats and 92 batches of 930 mice ) came from 50 different manufactures in China. Direct microscopy real?time dynamic video recording techniques in combination with morphological identification method were applied to screen the Syphacia muris infestation. A multiple polymerase chain reaction ( multiple?PCR ) testing of the isolate based on amplification of the conserved portions of the Syphacia muris internal transcribed spacer (ITS), 28S ribosomal RNA (28S rRNA), NADH dehydrogenase subunits 1 (nad1) and cytochrome c oxidase subunit 1 (cox1) genes, and the molecular sequencing of the multiple?PCR amplicons was used to confirm the Syphacia muris infection. Results Syphacia muris eggs, larvae and adults were detected by using direct microscopy real?time dynamic video recording technique. Syphacia muris were detected based on the morphology and size of ovum, larvae, and female and male adult worms. Multiple?PCR and sequencing were performed to identify ITS, 28S rRNA, nad1 and cox1 genes of DNA extracted from the single egg, larva and adult parasite Syphacia muris. This approach allowed the specific identification with no amplicon being amplified from heterogeneous DNA samples, and sequencing confirmed the identity of the amplified sequences. Molecular characterization by multiple?PCR amplification and sequencing of the ITS, 28S rRNA, nad1 and cox1 genes demonstrated the presence of Syphacia muris. Multiple?PCR followed by sequencing confirmed 285 of 5199 SPF and 135 of 1389 clean animal samples classified as positive by using direct microscopy real?time dynamic video recording technique in the study as containing Syphacia muris?specific DNA. Comparison of the partial sequences of the ITS, 28S rRNA, nad1 and cox1 genes revealed 100% similarity amongst Syphacia muris from different animals. The prevalence of Syphacia muris infection in SPF and clean animals were 5?5% (285/5199) and 9?7% (135/1389), respectively. Conclusions Direct microscopy real?time dynamic video recording technique, multiple?PCR and sequencing can be used to rapidly detect and accurately identify Syphacia muris. The zoonotic nature of Syphacia muris can be regard as a public health alter, hence the good quality control of animal has an important role in protecting human health and safeguarding people safety. This is the first molecular identification and infection investigation of Syphacia muris in SPF and clean animals in China.

Objective To analyze the clinical characteristics of respiratory involvement in relapsing polychondritis(RPC). Methods The clinical data of 38 patients with respiratory (larynx, trachea and bronchus) involvement in RPC were retrospectively analyzed. Results The incidence of respiratory involvement in patients with RPC was 51.35%(38/74), and the most common symptoms were cough, wheezing, chest tightness and dyspnea. The incidences of erythrocyte sedimentation rate (ESR) increasing, C- reactive protein (CRP) increasing, fibrinogen increasing, D- dimer increased and rheumatoid factor (RF) positive in patients with respiratory involvement were significantly higher than those in patients without respiratory involvement: 47.37% (18/38) vs. 30.56% (11/36), 52.63% (20/38) vs. 33.33% (12/36), 31.58% (12/38) vs. 25.00% (9/36), 21.05% (8/38) vs. 13.89% (5/36) and 36.84%(14/38) vs. 5.56% (2/36), and there were statistical differences (P<0.05). CT was the main method to discover the respiratory involvement, and MRI could detect early cartilage inflammation lesions. Laryngoscope and bronchoscope could early detect mucosa and cartilage damage. Pathology was given priority to lymphocytes and neutrophils infiltration. Some patients had epithelium metaplasia and even canceration. Primary treatment methods were glucocorticoids combined with immunosuppressant. Airway stenosis and infection was the main factors influencing the prognosis of patients. Conclusions The respiratory involvement is not uncommon in RPC, and early CT, MRI, laryngoscope and bronchoscope examination is an important means of early diagnosis.Early glucocorticoid combined immunosuppressive therapy is the key to achieve good prognosis.

Objective To investigate the incidence and correlative factors of metabolic syndrome (MS) in patients with systemic lupus erythematosus (SLE).Methods A total of 116 SLE patients and 115 controls were enrolled into the study.The incidence of MS,SLE disease activity index(SLEDAI) of patients with SLE combined with MS (MS-SLE) and patients without MS (n-MS-SLE),lupus characteristics,cumulative glucocorticoids,administration dose of glucocorticoids and hydroxychloroquine were compared between SLE group and the control group.Results The incidence of MS of SLE group was obviously higher than that of the control ( 34.48％ vs 14.78％,P ＜ 0.05 ).The ratios of patients with lower HDL-C,higher TG and higher blood pressure in SLE group ( 50.86％,56.03％,46.55％ ) were higher than those in the controls ( 34.78％,16.52％,20.00％,all P ＜ 0.05 ).MS-SLE group had significantly higher mean waist circumference,BMI,systolic blood pressure and diastolic blood pressure and lower HDL-C than n-MS-SLE group (all P ＜0.05 ).No significant difference was found regarding duration of disease,renal involvement,ESR,C-reactive protein,high-sensitivity C-reactive protein,SLEDAI,cumulative and current glucocorticoids use in MS-SLE group and n-MS-SLE group.The ratio of patients taking hydroxychloroquine in n-MS-SLE group was higher than that of MS-SLE group (46.05％ vs 15.00％,P＜0.05).Conclusions Patients with SLE has a higher incidence rate of MS.Hydroxychloroquine may reduce their MS incidence.

Objecfive To investigate the clinical characteristics,treatment and prognosis of autoimmune diseases associated and non-autoimmune diseases associated hemophagocytic syndrome.Methotis Clinical records of 15 cases witll secondary hemophagocytic syndrome'were collected and the relations with treatment and prognosis was analyze.The similarities and differences between autoimmune disease associated bemophagocytic syndrome (group A)and non-autoimmune disease associated hemophagocytic syndrome (group B)were compared.Fisher exact test,t test and Willcoxen test were used for statistical analysis.Results Both groups had fever,bleeding,jaundice,hepatosplenomegaly,and arthralgia,skin rash and positive of autoantibodies in group A were discovered specifically.But in group B,the patients with icterus were mo common(38% vs 100%,p=0.018).There was no significant difference in their laboratory data and prognosis when compared between the two groups(P>0.05).The patients who received corticosteroids and IVIG and/or immunosuppressive agents had better prognosis(P<0.05).Conclusion Except for icterus there is no significant difference in clinical features and laboratory data among autoimmune disease associated hemophagocytic syndrome and other secondary hemophagocytic syndrome.And the therapy with corticosteroids combined with IVIG and/or immunosupprcssive agents is effective.