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 clinical efficacy and safety between spleen total resection splenectomy and spleen partial splenectomy in the treatment of patients with traumatic spleen rupture.Methods:84 cases of patients with traumatic spleen rupture from March 2013 to March 2016 were selected and divided into two groups.42 cases in the spleen total resection group were treated with spleen total resection,while the other 42 cases in the spleen partial nephrectomy group were treated with spleen partial splenectomy.The operative effect,the levels of platelet count,serum IgA,IgG,IgM,CD3 +,CD4 +,CD8 +,CD4 + / CD8 + levels before and after treatment,the incidence of complications were compared between two groups.Results:The intraoperative blood loss,exhaust time,length of hospital stay of spleen partial nephrectomy group were shorter than those of the spleen total resection group,but the operation time of research group was longer than that of the spleen total resection group (P＜0.05).The platelet count,CD8+ of spleen partial nephrectomy group were lower than those of the spleen total resection group (P＜0.05).The IgA,IgG,IgM,CD3+,CD4+,CD8+,CD4+/CD8+ of spleen partial nephrectomy group were significantly higher than those of the spleen total resection group (P＜0.05).The incidence rate of complications in the spleen partial nephrectomy group was lower than that of the spleen total resection group (P＜0.05).Conclusion:Spleen partial splenectomy was more effective than spleen total resection in the treatment of traumatic splenic rupture,which had little effect on the platelet and immune function.

Objective To understand the features of immunoglobulin G4-related diseases and to improve its diagnosis and treatment.Methods The clinical data of 20 cases discharged from our hospital were analyzed retrospectively.Results Twenty cases with IgG4 related diseases were reviewed retrospectively.IgG4-related diseasesis more prevalent in male than in female (14∶6),and the mean age was 58 years.Pancreas and bile ducts were the most commonly affected organs,2 and more than 2 organs were involved in 17 patients.All patients had significantly elevated serum immunoglobulin G4.Histopathological findings included diffuse tissue fibrosis with extensive lymphoplasmacytes infiltration.On immunohistochemical staining,the ratio of IgG4-positive plasma cells to IgG-positive plasma cells was higher than 40％.One patient deceased and one patient was left untreated,other patients responded well to the treatment.Conclusion There is no characteristic clinical symptoms for IgG4-related diseases,and serum immunoglobulin G4 is the essential diagnostic method in suspected cases.IgG4-related diseases can be well controlled with prompt use of glucocorticosteroid.

Objective To observe the effects of Qizhi Zhoufei Granules on IL-8, TNF-αand ET-1 in serum and bronchoalveolar lavage fluid (BALF) of chronic obstructive pulmonary disease (COPD) model rats, and to study its mechanism of preventing and treating COPD. Methods Wistar rats were randomly divided into blank group, model group, positive control group, Qizhi low-dose group, Qizhi medium-dose group and Qizhi high-dose group. The COPD model was established by smoking and infusing lipopolysaccharide (LPS). After 15 days, the rats were given the drugs by orally taking once a day. On the 43rd day, the change of IL-8, TNF-α and ET-1 content in serum and BALF were measured by radio-immunity assay. Results Compared with the blank group, the level of IL-8, TNF-α and ET-1 in serum and BALF were considerably raised in model group (P<0.05). Whereas compared with the model group, the level of TNF-αin serum of Qizhi high-dose group was remarkably lowered (P<0.05), the level of IL-8 in serum of Qizhi low-dose group and Qizhi high-dose group was remarkably lowered (P<0.05), the level of TNF-αin BALF of Qizhi medium-dose group was remarkably lowered (P<0.05), the level of IL-8 in BALF of Qizhi low-, medium- and high-dose group was remarkably lowered (P<0.05), and the level of ET-1 in BALF of Qizhi high-dose group and Qizhi medium-dose group was remarkably lowered (P<0.05). Conclusion Qizhi Zhoufei Granules have protective effect on lung tissue of COPD rats, and can adjust the content of IL-8, TNF-α and ET-1, which may be one of its mechanisms of intervening occurrence and development of COPD.

Base on the clinical characteristics of septic arthritis in a group of systemic lupus erythematosus patients,this study has found out that high systemic lupus erythematosus disease activity index,leucopenia,high cumulative dose of glucocorticoid,methylprednisolone intravenous pulse therapy and joint cavity puncture were closely correlated with septic arthritis.Once septic arthritis is suspected,culture specimens should be collected and appropriate antibiotics are suggested immediately.Also,surgical drainage is a very useful approach.

Objective To investigate the correlation between toll-like receptor 9 (TLR9) gene 2848G/A polymorphism and primary antineutrophil cytoplasmic antibodies (ANCA) associated small vasculitis (AAV). Methods A case-control study was performed among 135 patients diagnosed with AAV and 140 disease-free control and we test the serum biochemical parameter. Polymorphism was analyzed by polymerase chain restricted fragments length polymorphism. As for statistic method, according to the character of data, we performed t-test, chi-square test, Spearman grade related analysis and one-way ANOVA. Results ① The frequencies of AA, GG, GA genotype of TLR9 2848 in AAV patients were 14.07%, 38.52%, and 47.71%, respectively; ② Significant increase in IgM was observed in AA genotype than GG+GA genotype in AAV patients (F=4.561, P<0.05). ③ There was no significant difference between AI and CI in AA, GA and GG genotype in AAV patients (F=2.115, 0.760, P>0.05). Conclusion AA, GA and GG genotypes are detected in TLR9 2848G/A in patients with AAV in Guangxi, without significant correlation with susceptibility to primary AAV in Guangxi.

Objective:To investigate high mobility group protein 1(HMGB1), tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels and their clinical significance in elderly patients with viral pneumonia.Methods:One hundred and sixty elderly patients with viral pneumonia admitted to the Sixth Hospital Affiliated to Anhui Medical University were enrolled as research subjects.In addition, 40 elderly people who underwent regular physical examination were considered as the control group.Patients with viral pneumonia were divided into the low-risk group, middle-risk group and high-risk group according to CURB-65 scores and pneumonia severity index(PSI)scores.HMGB1, TNF-α and IL-6 levels were compared between different groups.The correlations of CURB-65 scores and PSI scores with HMGB1, TNF-α, IL-6 levels were analyzed.Multivariate Logistic regression analysis was used to examine influencing factors for the severity of viral pneumonia in elderly patients.Results:HMGB1, TNF-α and IL-6 levels were higher in research subjects than in the control group.As the severity of viral pneumonia increased, so did HMGB1, TNF-α and IL-6 levels(all P<0.05). HMGB1, TNF-α and IL-6 levels in the severe viral pneumonia group were significantly higher than those in the non-severe viral pneumonia group( P<0.05). HMGB1, TNF-α and IL-6 levels were positively correlated with CURB-65 scores and PSI scores(CURB-65 score: r=0.463, 0.392 and 0.497, P=0.015, 0.003 and 0.025; PSI score: r=0.596, 0.515 and 0.381, P=0.007, 0.011 and 0.009). HMGB1, TNF-α and IL-6 levels were influencing factors for the severity of viral pneumonia in elderly patients( OR=1.344, 1.422 and 1.351, P=0.006, 0.015 and 0.009). Conclusions:HMGB1, TNF-α and IL-6 levels are closely correlated with the severity of viral pneumonia and are helpful for early assessment of viral pneumonia.

Objective:To evaluate the effects of rocuronium on limb ischemia-reperfusion injury in the patients undergoing total knee arthroplasty.Methods:Ninety patients of both sexes, aged 50-80 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with body mass index<30 kg/cm 2, scheduled for elective unilateral knee arthroplasty under general anesthesia combined with femoral nerve block from January 2019 to October 2019, were divided into 3 groups ( n=30 each) using a random number table method: normal saline group (group S), rocuronium 0.6 mg/kg group (group RL) and rocuronium 1.2 mg/kg group (group RH). Anesthesia was induced by intravenous injection of midazolam, etomidate, sufentanil and rocuronium 0.6 mg/kg (group RL) or 1.2 mg/kg (group RH) or equal volume of normal saline (group S). Mechanical ventilation was performed after placement of laryngeal mask to maintain P ETCO 2 35-45 mmHg.Femoral nerve block was performed under ultrasound guidance.Anesthesia was maintained by inhaling 1% sevoflurane and intravenous infusion of propofol and remifentanil to maintain entropy index at 40-60 during operation.Patient-controlled intravenous analgesia was performed with sufentanil after surgery to maintain visual analogue scale score ≤ 4 points.When visual analogue scale score was > 4, flurbiprofen axetil 100 mg was intravenously injected.The vastus medialis muscle at the edge of the incision was obtained at 60 min after inflation to determine the expression of dystrophin by immunohistochemistry.Arterial blood samples were collected immediately after inflation of the tourniquet, at 60 min after inflation, and at 5 and 30 min after deflation for determination of the serum malondialdehyde (MDA) concentrations by the thiobarbituric acid method.The effective pressing times of the analgesic pump and consumption of sufentanil and flurbiprofen axetil were recorded within 48 h after operation.The occurrence of responses to tourniquet and residual muscle relaxation during recovery from anesthesia, the first postoperative off-bed time and postoperative length of hospital stay were recorded.The thigh girth was measured before operation and at 24 and 48 h after operation, and the difference after and before operation was calculated.The range of motion of knees of the operated limb and tourniquet-related complications in the early postoperative period (3 days) and in the long-term postoperative period (3 months) were recorded. Results:Compared with group S, the expression of dystrophin in skeletal muscle was significantly up-regulated, the concentration of serum MDA was decreased at 30 min after deflation, and the difference in thigh girth at 24 and 48 h after operation was decreased in group RH, and the range of motion of knees was significantly increased at 3 days and 3 months after operation, and the first postoperative off-bed time was shortened in group RH and group RL ( P<0.05). Compared with group RL, the range of motion of knees was significantly increased at 3 days and 3 months after operation, and the first postoperative off-bed time was shortened in group RH ( P<0.05). There was no significant difference in the incidence of responses to tourniquet, postoperative length of hospital stay, effective pressing times of the analgesic pump, postoperative consumption of sufentanil and flurbiprofen axetil, and the incidence of tourniquet-related complications in the early and long-term postoperative periods among the three groups ( P>0.05). No residual muscle relaxation was found during recovery from anesthesia in three groups. Conclusion:Rocuronium 1.2 mg/kg can reduce limb ischemia-reperfusion injury in the patients undergoing total knee arthroplasty.

Metabolomics,a hot field of research of life science in recent years,is to analyze endogenous smallmolecule metabolites in biological samples for an overall understanding of the characteristics of metabolic disorders.A growing number of studies have confirmed the application of metabolomics for clinical diagnosis and treatment of diseases."Metabolic fingerprint" of biological fluids can be employed for disease prevention,timely diagnosis,accurate treatment,prognostic assessment and drug discovery.Clinical metabolomics is to measure low-molecule-weight metabolites' alterations of individuals in response to physiological stressors,disease processes,or drug therapy,aiming to discover potential biomarkers and drug targets.Coronary artery disease (CAD) is characterized as complex molecular events.Metabolic disturbances are involved in CAD progression.The application of metabolomics to CAD is an emerging field.Advances in metabolomics improve our knowledge on CAD in early diagnosis,prognostic prediction,and personalized therapy.

Objective:To study the diagnosis and treatment of osteoporotic fractures in the elderly in two third Grade A hospitals in Shenyang and Dalian, and to provide scientific basis for prevention and treatment of osteoporotic fractures in Dalian and Shenyang.Methods:Patients of osteoporotic fractures over 60 years old from January 2015 to December 2015 in the Second Hospital of Dalian Medical University and the People′s Hospital of Liaoning Province were chosen, and the basic characteristics, fracture site, the number of fracture site, diagnosis treatment and secondary prevention of osteoporosis fractures of them were analyzed.Results:Among the patients of osteoporotic fractures over 60 years old in the hospitals of Shenyang and Dalian, women were more than men ( P = 0.00). The predilection sites of elderly osteoporotic fractures in two hospitals were both followed by the hip, spine, ulnar and radial distal, proximal humerus. The rates respectively were 38.26%(295/771), 34.63% (267/771), 9.34%(72/771), 5.71%(44/771). The rate of fracture-again was 10.89%(84/771). The rates of in-hospital diagnosis, in-hospital treatment and treatment of discharged medical advice among osteoporosis were 13.88%(107/771), 24.64%(190/771) and 18.81%(145/771). There were 0.65% (5/771) patients who had diagnosis of osteoporosis, basic osteoporosis treatment (vitamin D 3 and calcium) and anti-osteoporosis treatment in both in-hospital and discharged medical advice. Conclusions:The rates of in-hospital diagnosis, in-hospital osteoporosis treatment and anti-osteoporosis treatment in discharged medical advice are both very low in the two third Grade A hospitals. The secondary prevention of osteoporosis fractures in the elderly has not been taken attention, and the situation of prevention and treatment are serious.