SUMMARY Regenerationofbonetissue,aswellasothertissues,requiresinvolvementandinteraction of cells,scaffolds and relevant growth factors,among which growth factors play a crucial role in maintai-ning the stability of microenvironment.Nel-like-type 1 molecule (NELL-1 ),a novel growth factor in tis-sue engineering,has been studied intensively in recent years.Researches mainly covered gene and pro-tein structure and their expression profiling,biological function,molecular mechanisms and disease rele-vance.NELL-1 expressed in embryonic tissue is essential for growth and development of bone tissue. NELL-1 presents excellent abilities of inducing bone and cartilage regeneration,especially with high spe-cificity to chondrocyte lineage.Compared with classic osteogenic growth factor bone morphogenetic pro-tein 2 (BMP-2),the process of osteogenesis interacted with NELL-1 exhibits stronger specificity,higher bone density and fewerside effects.Furthermore,a recent study shows synergistic effects of NELL-1 and BMP-2.NELL-1 enhances the osteogenic reaction induced by BMP-2 of cells and notably declines in-flammation response caused by BMP-2.This review evaluates the current research progress of the function and application of NELL-1 by the systematic method of evidence-based medicine.

Objective Thymoma is associated with autoimmune diseases. We retrospectively analyzed the clinical characteristics of thymoma complicated systemic lupus erythematosus (SLE). Methods Patients were from Qilu Hospital Shandong University between June 2004 and June 2014, and satisfied classification criteria of American College of Rheumatology (ACR) classification criteria 1997 for SLE. Thymoma was diagnosed by chest CT scan. Results Nine cases were of thymoma complicated with SLE, with the male:female ratio of 1∶8. The age of SLE onset was (48±19) years, age of thymoma discovery was (47±19) years. The follow-up period was 3 to 10 years. Three cases (33%) were benign thymoma and underwent thymectomy and verified by histopa-thology test. One case presented thymoma 9 years after SLE, 5 cases (56%) presented SLE and thymoma simultaneously, 3 cases (33%) presented SLE after thymectomy. Clinical manifestations of SLE included 4(44%) skin lesions, 8(89%) polyarthritis, 5(56%) nephritis, 3(33%) leukocytopenia, 3(33%) throm-bocytopenia, 2 (22%) of interstitial pneumonia, 4 (44%) pleural effusion, no neuropsychiatric systemic lupus erythematosus. Nine cases (100%) were ANA positive, 7 (78%) were anti-dsDNA positive. Conclusion SLE complicated thymoma usually occurs in relatively older age, tend to present with multi-systemic presentations, and high percentage of anti-dsDNA positivity.

Objective To investigate the olfactory function in patients with systemic lupus erythematosus (SLE) and to explore factors that may influence it.Methods The Connecticut Chemosensory Clinical Research Center (CCCRC) test was carried out in SLE patients and healthy controls for olfactory function testing.ELISA method was used to detect anti-ribosomal P protein antibody in the serum.The statistical methods used in this study including t test,ANOVA,LSD-t test,Pearson correlation analysis,multiple linear regression analysis,andx2 test.Results ① The CCCRC scores of the active,inactive group and healthy controls were compared,the difference was statistical significant (F=26.52,P=0.01).CCCRC score in active SLE group (62±16) was lower than that of the inactive group (80±13) the and the normal control group (83±12) (P＜0.01),while there was no statistical significant difference between the inactive group and the normal controls (P=0.226).② CCCRC score was lower in 16 ARPA positive SLE patients (61±17) than 49 negative patients (74±16) (t=2.681,P=0.009).③ In addition,CCCRC score showed a negative correlation with ARPA serum concentration (r=-0.327,P=0.008).There was no significant correlation between CCCRC score and disease course (r=0.141,P＞0.05).④ Multiple linear regression analysis indicated that CCCRC score was associated with age and ARPA.Conclusion SLE patients have olfactory dysfunction and the dys-function is associated with age and ARPA.

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.

Objective We reported a case of osteogenesis imperfecta (OI) concurrent with ankylosing spondylitis (AS) and reviewed the literature to investigate the Musculoskeletal manifestations of OI.Methods A 27 years old male patient was admitted to department of rheumatology,Qilu hospital with complaints of left hip and low back pain accompanied with morning stiffness.He had pain and gradual limitation in range of motion of the spine for 2 years and symptomatic exacerbation nearly 8 months.His mother,aunt,daughter and son suffered from OI as well.Clinical examinations revealed blue sclera but hearing and teeth were normal.He had typical AS appearance and severe deformities of left hip joint.His erythrocyte sedimentation rate (ESR) was 32 mm/1 h,C-reactive protein (CRP) was 9.00 mg/L,and human leukocyte antigen (HLA)-B27 was positive.Magnetic resonance imaging (MRI) scanning of sacroiliac joint was consistent with spondyloarthropathies and avascular necrosis of left femoral head.After being treated with daily 99Te methylenediphonate intravenously,oral risedronate 5 mg and diclofenac sodium and sulfasalazine,his condition was improved.Results OI was an autosomal dominant hereditary disease defined by bone frailty due to abnormal synthesis of type Ⅰ collagen in bone matrix.It affects the entire skeleton,predisposing the patient to frequent non-traumatic fractures,causing pain,skeletal deformity,and disability.Conclusion OI patients have many musculoskeletal manifestations,such as arthralgia and deformities and should be considered in the differential diagnosis by rheumatologist.

Objective: To evaluate the current status and related factors of influenza vaccination among health care workers (HCWs) in tertiary hospitals of Xining city after the implementation of the free influenza vaccination policy. Methods: In August 2018, the cluster sampling method was used to select four medical institutions in Xining that had previously conducted investigations and interventions. All HCWs(excluding logistic staff) in each medical institution were included in the study. A total of 3 260 valid respondents were included. Questionnaires were used to collect the demographic characteristics, influenza and influenza vaccination awareness, implementation of free policy in the influenza epidemic season from 2017 to 2018, influenza vaccination status, awareness of influenza vaccination schedule and free policy. The multivariate logistic regression model was used to analyze related factors of influenza vaccination. Results: The age of respondents was (31.41±5.00) years. The influenza vaccination rate was 6.80% (226/3 260) in 2017-2018 influenza epidemic season. After controlling for related factors, the awareness of the influenza vaccination schedule (OR=17.05, 95%CI: 5.86-49.59), vaccination frequency (OR=8.22, 95%CI: 2.98-22.61) and the free policy (OR=3.15, 95%CI: 1.49-6.67) had higher vaccination rate. Conclusion The influenza vaccination rate of HCWs in tertiary hospitals of Xining city was low. Increasing the awareness of the vaccination schedule, frequency and free policy may promote the influenza vaccination rate of HCWs.