Objective To investigate the role of RANKL/RANK/OPG system in bone metabolism of ankylosing spondylitis (AS) by detecting bone mineral density, bone metabolism factors such as osteoprotegerin (OPG), soluble receptor activator of nuclear factors-κB ligand (sRANKL) and the expression of membrane-bound (mb) RANKL in the peripheral blood T lymphocytes. Methods Bone mineral density of AS patients were measured by dual-energy X-ray absorptiometry (DEXA) and serum levels of OPG, sRANKL,tartrate resistant acid phosphatase 5b (TRACP-5b) and bone alkaline phosphatase (BALP) were determined by enzyme-linked immunosorbent assay (ELISA). The percentages of CD4+/RANKL+ and CD8+/RANKL+ in the peripheral blood were detected with flow cytometry. T-test, x2-test were used for statisical analysis. Results ① The incidence of osteopenia and osteoporosis in AS was 47% and 37% respectively. ② Serum RANKL,TRACP-5b levels and RANKL/OPG ratio were higher in AS patients than those in normal controls (P<0.05).But there was no significant difference in OPG and BALP between AS patients and normal controls. ③There were positive linear correlation between serum levels of RANKL and OPG, sRANKL and TRACP-5b, OPG and TRACP-5b in AS (P<0.01). ④ The prevalence of CD4+/RANKL+ cells in the peripheral blood of AS patients was significantly higher than that in the normal controls (P<0.05). Conclusion There is a high incidence of bone loss in AS patients. Increased bone resorbtion is the feature of bone metabolism in AS.RANKL/RANK/OPG system may play an important role. The imbalance of RANKL/RANK/OPG system may be one of the bone loss mechanisms of AS. CD4 + T lymphocyte may play an important role in osteoclasts differentiation and bone resorption in AS by up-regulating the expression of RANKL.

Objective To investigate the changes and significance of Th1/Th2 cytokines in ankylosing spondyhtis (AS).Metbotis Serum and synovial fluid levels of TNF-α,IL.17.IL-10 and IL-4 were detected by en-zyme linked immunosorbent assay(ELISA)in AS cases.Results The serun levels of TNF-α,IL-17 and IL-10 were significantly higher,while the serum level of IL-4 Was significantly lower in AS group than in normal group.The levels of TNF-α.IL-17 and IL-4 in synovial fluid were significantly higher than in serum.Conclusion Disequilibrium exists in Th1/Th2 cytokine network of AS.and there is a strong predominance of Th1.

Objective:To investigate the clinical characteristics, treatment and prognosis of primary vitreoretinal lymphoma (PVRL) diagnosed and treated in our hospital during the past 10 years.Methods:A retrospective clinical study. From 2011 to 2021, 126 eyes of 67 patients with PVRL who were diagnosed and treated in Department of Ophthalmology, Eye-ENT Hospital, Fudan University were included in the study. Among them, there were 23 males (34.3%, 23/67) and 44 females (65.7%, 44/67); the average age was 57.1 years. There were 59 cases with both eyes (88.1%, 59/67) and 8 cases with one eye (11.9%, 8/67). At the initial eye diagnosis, 22 cases had a clear history of primary central nervous system lymphoma (PCNSL); 5 cases were found to have intracranial lesions by head imaging examination; 40 cases had no central nervous system involvement. Twenty cases were treated with glucocorticoids due to misdiagnosed uveitis. All patients received intravitreal injection of methotrexate (IVM) treatment. The treatment regimen was twice a week in the induction period for 2 weeks, once a week in the consolidation period for 1 month, and once a month in the maintenance period. Patients with PCNSL or both eyes received concurrent systemic chemotherapy (chemotherapy), and some in combination with radiation therapy to the brain (radiotherapy). The mean follow-up time was 39.3 months. The clinical manifestations, treatment and prognosis of the patients were retrospectively analyzed. The visual acuity before and after treatment was compared by t test. Results:Among the 22 cases with a clear history of PCNSL at the initial eye diagnosis, the average time from intracranial diagnosis to eye diagnosis was 22.9 months. Among the 40 cases without central nervous system involvement at first, 14 cases (20.9%, 14/67) developed central nervous system lesions during follow-up period. The mean time from ocular diagnosis to intracranial diagnosis was 9.9 months. Among the 126 eyes, 42 eyes (33.3%, 42/126) had anterior segment inflammation. vitreous inflammation type, retinal type, and vitreous retinal type were 58 (46.0%, 58/126), 7 (5.6%, 7/126), and 61 (48.4%, 61/126) eyes, and 9 of them (7.1%, 9/126) had optic nerve involvement at the same time. Patients received an average of 12 IVM treatments. IVM combined with systemic chemotherapy in 59 cases (88.1%, 59/67), of which 16 cases were combined with brain radiotherapy. All patients achieved complete remission after completing the treatment cycle (100.0%, 67/67). After treatment, 21 eyes (16.7%, 21/126) had ocular recurrence; 22 (32.8%, 22/67) had intracranial recurrence; 8 cases (11.9%, 8/67) died. The mean progression-free survival of patients was 23.7 months; the mean survival time was 43.6 months; the 5-year overall survival rate was 72.5%.Conclusions:The manifestations of PVRL are complex and diverse, and most of them are accompanied by involvement of the central nervous system. It can be divided into vitreitis type, retinal type and vitreoretinal type, and the optic nerve can be involved at the same time; IVM combined with systemic treatment can completely relieve the disease.