Objective To investigate the role of IP-10 in the pathogenesis of ankylosing spondylitis (AS). Methods The peripheral blood monocytic cells (PBMC) were collected from 39 AS patients, and the mRNA expression of IP-10, IFN-? and IL-4 were measured by semi-quantitive RT-PCR with G3PDH as the internal control. Results The mRNA expression levels of IP-10, IFN-? and IL-4 as well as the rate of IFN-?/IL-4 were elevated in the PBMC of AS patients compared with the healthy controls (P

Objective To investigate the role of proteoglycan autoimmunity in the pathogenesis of rheumatoid arthritis (RA). Methods Human Aggrecan G1 domain cDNA was cloned from human cartilage, and recombinant aggrecan G1 domain (rAG1) protein was synthesized in a Baculovirus expression system. Synovial fluid monocytes from RA patients were stimulated with rAG1. Harvested cells' radioactivity was quantified in a ?-scentillation counter and the stimulation index (SI) was calculated. Cells with SI over 3 were taken as rAG1 specific T cells. Three well-characterized AG1-specific T cell lines were injected intraperitoneally into 8 SCID Beige mice. At the same time, rAG1 was injected intraarticularly into left knees of these mice. On day 8, mice were sacrificed and histological examination of the knee joints was performed. Results Human rAG1 specific T cell lines were generated from synovial fluid of RA patients. Most of these cells were CD4~+CD8~- T cells secreting Th1 cytokine (interferon-?). A pronounced capsular and synovial infiltration of mononuclear cells with early synovitis and cartilage erosion was observed in some left knees of the mice treated with rAG1-specific T cells. Conclusion Human rG1-autoreactive T cells injected intraperitoneally have homed to left knee where its epitope rAG1 was injected, and they participated in the development of inflammatory arthropathy.

Objective To set up rodent ankylosing spondylitis model. Methods Recombinant natively folded versican G1 domain(VG1) and FCA were injected into BALB/c mice to induce spondylitis and sacroiliitis. Spondylitis and sacroiliitis were determined by pathological examination. Results It was shown that immunity to recombinant VG1 resulted in spondylitis in the lumbar spine and sacroiliitis in 35 0% and 12 5% mice respectively. Accumulation of mononuclear cells was observed in spinal ligaments adjacent to the intervertebral disc, the intervertebral disc and the sacroiliac joints. No clinical peripheral arthritis was observed. Conclusion These observations suggest that immunity to human VG1 is involved in the induction of experimental spondylitis and sacroiliitis in BALB/c mice, which will do some help to probe the pathogenesis of human ankylosing spondylitis

Objective To investigate the long term efficacy and safety of thalidomide in the treatment of refractory ankylosing spondylitis.Methods A total of 232 patients with refractory ankylosing spondylitis were recruited into open study using thaiidomide at a dose of 150 mg/d, bath ankylosing spondylitis disease activity index ( BASDAI) , spinal pain score and thaiidomide related side effects were observed regularly.Results From the third month, BASDAI and spine pain score decreased significantly when compared with those of the base line ( P < 0.05).Such improvement became more obvious as time went on.A total of 148 patients (63.8% ) got >50% improvement in BASDAI and spine pain score, and 76 cases (32.8% ) reported absence of spine pain.The major side effects were drowsiness, constipation, dry mouth, dizziness and dandruff.Thirty two patients (13.8% ) withdrew from the study because of adverse events.Most of the adverse effects disappeared as thaiidomide was stopped.Conclusion Long term thaiidomide is effective and safe for treating resistant ankylosing spondylitis and it has cumulative effect as duration prolongs.

Objective To investigate whether unfolded protein response (UPR) plays a role in the pathogenesis of spondyloarthritis (SpA),and to assess UPR-related gene expression in SpA and other arthritis patients.Methods Eighteen patients with SpA,12 with rheumatoid arthritis (RA) and 6 with osteoarthritis (OA) were recruited.Macrophages were isolated from synovial fluid samples by immunomagnetic separation.The expression of UPR-regulated genes,including binding immunoglobulin protein (BiP),glucose-regulated protein 94 (GRP94),C/EBP homologous protein (CHOP),growth arrested and DNA damage-inducible 34 (GADD34),X-box binding protein 1 (XBP-1) and endoplasmic reticulum DnaJ homolog 4 (ERdj4),was tested by real time polymerase chain reaction (PCR).Results Compared with macrophages in OA patients,the expression of BiP and GRP94 mRNA [(6.06 ± 2.08) × 10-2 vs (1.11 ±0.72) × 10-2 for BiP mRNA,11.80(7.30-38.40) × 10-3 vs 1.27(1.02-4.18) × 10-3 for GRP94 mRNA,both P values ＜0.01] was significantly increased in macrophages in SpA patients.XBP1 mRNA was up-regulated [(12.70 ± 5.20) × 10-3 vs (4.14 ± 2.56) × 10-3,p ＜ 0.01] in SpA group as well.UPR-regulated gene expression in SpA patients with HLA-B27 positive or HLA-B27 negative was similar.However,none of UPR-regulated genes showed different expression between the SpA group and RA group except for GADD34 mRNA [7.30 (5.56-15.40) × 10-3 vs 21.30 (12.20-27.60) × 10-3,P =0.009].Conclusions Our data suggest that UPR possibly participates in the pathogenesis of SpA,although the relationship between HLA-B27 and UPR still needs further investigation.

Objective To study the prediction value of C-reactive protein (CRP) level to ankylosing spondylitis disease activity score (ASDAS),the most widely used activity score in ankylosing spondylitis (AS).Methods A total of 386 patients with AS were enrolled and divided into 2 groups by CRP≥3.5 mg/L (n =266) and CRP ＜ 3.5 mg/L(n =120).ASDAS-CRP was evaluated in patients with CRP below the normal range (3.5 mg/L) in different subgroups.Three methods were used to test the consistency between ASDAS-CRP and ASDAS-erythrocyte sedimentation rate (ESR).Results The ASDAS-CRP showed a good correlation with the ASDAS-ESR when CRP level was ≥ 3.5 mg/L (r =0.899,P =0.000).In the group of CRP ＜ 3.5 mg/L,ASDAS-ESR showed better consistency with ASDAS-CRP when CRP level was below 1.5 mg/L(intra-class correlation coefficient 0.902;kappa coefficient 0.70).By the evaluation of variant gradient matrix,CRP 1.5 mg/L coincided with disease activity states.Conclusion There is good consistency between ASDAS-CRP and ASDAS-ESR.When CRP level is below the normal range,1.5 mg/L could be a cut-off value to calculate the optimal ASDAS-CRP score.

Objective:To investigate the metabolic response of different load of nutrition and recombinant human growth hormone(rhGH)after major abdominal surgery. Methods:32 patients were randomly divided into three groups as fellows:Group A : low calorie load,83.68 kJ/(kg?d);Group B: low calorie load combined with rhGH,83.68 kJ/(kg?d) and rhGH 4 U/d from d1-7 after operation;Group C :high calorie load combined with rhGH,125.52 kJ/(kg?d) and rhGH 4 U/d from d1-7 after operation.The levels of serum albumin and prealbumin and the excretion of urea nitrogen in urine were measured.after operation. Results:On day 8 after operation,the level of prealbumin in group B and C were higher than in group A(P

Objective To improve the understanding of severe anaphylactic reactions to infliximab retreatment. Methods Delayed hypersensitivity to infliximab in two patients with ankylosing spondylitis who had previously received infliximab and resumed after discontinuation over 4 years were reported and the related literatures were reviewed. Results Two patients ( 1 male, 1 female ) who were diagnosised with ankylosing spondylitis for more than 10 years, both individuals had received infliximab treatment during a clinical trial approximately 4-5 years prior to further therapy. On day 6 after subsequent infusion, one patient had pruritic skin rash covering her whole body, followed by flustered, dyspnea, hypotension and anaphylactic shock, she was successfully treated with epinephrine and glucocorticoid. Another patient experienced a skin rash and itching 9 days after reinfusion, he was successfully treated with antihistaminics.Conclusion A distant infliximab retreatment is associated with high rates of reinfusion reactions, including fever, urticaria, myalgia, arthralgia,even hypotension, dyspnea, laryngeal edema and anaphylactic shock.We recommend careful monitoring of those patients who receive infliximab retreatment, particularly after a lengthy interval.

Objective To compare the effect of intra-articular injection of recombinant human tumor necrosis factor-Fc (rhTNFR:Fc) in the treatment of knee arthritis in spondyloarthritis (SPA) with that in rheumatoid arthritis (RA).Methods The subjects included in this study were SpA and RA patients with knee arthritis without deformity,moderate or severe bone erosion and obvious joint space narrowing in radiography,who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study.All subjects received one dose of 25 mg rhTNFR:Fc injected to the target knee joints after synovial fluid being drawn away before injection.They were followed up for four weeks after injection.The primary end-point was the 4-week change in the moditied hospital for special surgery (HSS) knee score for the target knee.The secondary end-point were the 4-week change in patients assessment of the knee,and investigators assessment of knee,pain VAS of the knee joint when walking or standing,the range of knee inflexion,circumference of the knee cross section,synovium thickness detected by ultrasound in the part of the thickest synovium in the suprapatellar bursa.Paired t test,independed t test and Wilcoxon test were used for statistical analysis.Results Twenty-seven SpA patients and fifteen RA patients were included in the trial.The modified HSS knee score for the SpA group was 66±14 at baseline,86±11 (P＜0.05) at follow-up,and for the RA group,the score was 64±13 at baseline,80±9 (P＜0.05) at follow-up.24.2％ (16.5％-41.9％) improve-ment on the modified HSS knee score was achieved in the SpA group,while 22.2％ (15.3％-37.7％) improvement on the modified HSS knee score was achieved in the RA group (P＞0.05).31.8％ (9.3％-57.3％) improvement on the synovium thickness was achieved in the SpA group,while 1.5％ (-19.3％-25.5％) improvement on the synovium thickness was achieved in the RA group (P＜0.05).Adverse events were observed in six patients in SpA group and two patients in RA group.No serious adverse events had been observed.Conclusion Single intra-articular rhTNFR:Fc injection is an effective and safe therapeutic option for knee arthritis in both SpA and RA patients.This treatment may relieve knee synovitis in SpA patients more effectively than in RA patients.

Objective To evaluate the clinical value of pulmonary embolism severity index (PESI) in non high-risk acute pulmonary thromboembolism (APTE) patients treated with sequential anticoagulation.Methods Non high-risk APTE patients treated with sequential anticoagulation were divided into two groups according to PESI:high-value group and low-value group.Prognosis and treatment response was compared between two groups.Results There were 82 cases in high-value group,and 76 cases in low-value group.The rate of adverse events in high-value group was significantly higher than that in low-value group [23.2％(19/82) vs.7.9％ (6/76)] (x2 =5.0698,P =0.009),and 30 days cumulative hazard was also significantly higher than that in low-value group (P ＜ 0.05).The sensitivity of predicting adverse events by PESI was 76.0％,specificity was 52.6％,positive predicting value was 64.6％,and negative predicting value was 65.9％.The mortality in high-value group was significantly higher than that in low-value group [9.8％(8/82) vs.1.3％ (1/76)] (P =0.022).After 30 days of anticoagulation,the pulmonary artery systolic pressure,internal diameter of right ventricle in high-value group was significantly higher than that in low-value group [(39.4 ± 8.1) mm Hg (1 mm Hg =0.133 kPa) vs.(27.2 ± 5.5) mm Hg,(33.0 ± 7.8) mm vs.(21.7 ± 4.6) mm] (P =0.034,0.021),and arterial oxygen partial pressure was significantly lower than that in low-value group[(75.15 ± 12.41) mm Hg vs.(86.36 ± 9.22) mm Hg](P=0.016).Conclusions PESI can effectively predict short-term prognosis of non high-risk APTE patients treated with sequential anticoagulation.At least some of these patients might need treatment other than sequential anticoagulation.