Objective To investigate the clinical features of macrophage activation syndrome (MAS) associated with systemic lupus erythematosus (SLE).Method The clinical data of 15 patients with SLE-induced MAS diagnosed in Peking Union Medical College Hospital from July 2011 to December 2014 were retrospectively analyzed.Results Fourteen patients were female.The average age was 28.07.When MAS occurred,the average duration of SLE was 20.47 months,and the average SLE disease activity index (SLEDAI) was 18.4.All 15 patients developed fever,hematocytopenia and impaired liver function in the course of MAS,while patients with splenomegaly,coagulation disorders and neuropsychiatric symptoms were 11,14 and 8,respectively.All 15 patients presented leukocpenia and thrombocytopenia.Hypofibrinogenemia,elevated ferritin and hemophagocytosis in bone marrow were respectively observed in 7,11 and 12 patients.Glucocorticoids were used in all patients,among whom eight received pulse methylprednisolone therapy.Thirteen patients were treated with immunosuppressants,including cyclosporine A,tacrolimus,cyclophosphamide and mycophemolate mofetil.Complete remission was achieved in 14 patients.One patient died of MAS.Conclusions In patients with SLE,MAS was most commonly seen in young females with short SLE duration and active disease.Fever,splenomegaly,hematocytopenia,coagulation disorders and liver damage are the most remarkable clinical manifestations.Early diagnosis and intensive therapy are the key parts to improve clinical outcome.

Objective To investigate the effect of treatment and restoration of residual dental root and crown in the elderly. Methods A total of 68 elderly patients with 202 residual roots and 47 residual crowns was treated.Radiography was taken to find out the length of residual roots and the status of treatment. A comprehensive treatment plan was made for each case, including restoration, extraction and endodontic treatment, etc. The restoration and the periodontal health of abutment teeth were followed up for 1 5 to 3 years consecutively. Results In endodontically treated teeth, the success rates of anterior 109, bicuspid 74, molar 26, were 92 3% 94 5%. In 87 post core crowns, 1 root cracked, 7 teeth mobility was 2 0 3 0 , all of which were the abutment teeth of removable dentures and single tooth. Maybe it was the impact of load heavy and occlusal trauma. In 64 post core fixed bridges, 6 ceramic broken was the impact of occlusal trauma. The function of restorations was good, with no root caries. Periodontitis was mainly in the abutment teeth and single tooth. Failure rate of restorative was 5 5% 7 7%. Conclusions Comprehensive treatments and restorations for residual root and crowns in the elderly would improve periodontal health and chewing function.

A 54-year-old man was admitted to the Department of Rheumatology in Peking Union Medic.al College Hospital due to polyarthritis.back pain and multiple subcutaneous masses.He had symmetrical polyarthritis at onset.which was diagnosed as theumatoid arthritis.His follow-up and treatment were irregular.Back pain and multiple subcutaneous masses developed 2 year ago.Erythrocyte sedimentation rate and C-reac.tive protein were elevated.Rheumatoid fac.tor and Anti-cylic citrullinated peptide antibody were positive.No evidence of infection or malignancy was detected.Chest CT suggested pulmonary fibrosis and osteolytic lesions of stemum.Spinal MRI showed paravertebral soft tissue.Biopsy of the soft tissue suggested the pathologic.al finding of a theumatoid nodule.The patient was diagnosed as theumatoid arthritis complic.ated with multiple theumatoid bursal cysts.Combination therapy of methylprednisolone (40mg/d) and cyclophosphamide (0.4g/w) lead to a rapid improvement of clinical symptoms and laboratory parameters.The patient was still in remission at 6-month follow-up.

Objective To discuss the clinical value of D-dimer(DD) testing in diagnosis of patients with deep vein thrombosis(DVT) of the lower extremity.Methods An analysis retrospectively was made on the changes of DD testing in 106 cases of DVT at different periods after onset and different clinical stages of DVT,and DD testing in 99 patients with primary deep venous insufficiency(PDVI) as control group.(Results) DD was higher in the acute stage of DVT,and gradually decreased with time in chronic DVT,and was negative in the patients with PDVI;the positive rate was up to 85.7% in the distal DVT.Conclusions The DD testing can be used as one of the methods for diagnosis,prediction and prognosis of acute DVT,especially for diagnosis of distal DVT.

Objective To analyze the clinical data of diagnosis and treatment of Wegener' s granulomatosis (WG) in order to understand the nature of this disease. Methods The clinical data including clinical manifestations,laboratory findings imaging features,pathological changes and efficacy of treatment of 34 patients with WG admitted from January 2002 to March 2012 were analyzed.Results Of the 34 patients,male to female ratio was 18 to 16,and the average age subjected to WG onset was (45 ± 15)years old ranged from 18 to 81 years old.The average duration before the diagnosis confirmed was ( 140 ±72) mouths,while 29.4％ was diagnosed within 3 months. The presenting symptoms included initial involvements in lung (41.1％),nose (38.2％ ),eyes ( 11.7％ ),ear (8.8％ ) and constitutional symptoms such as fever (26.4％ ). Throughout the whole disease course,the incidence of systemic impairments were as follows:lung (76.4％),nose (73.5％),kidney (67.6),eyes (58.5％),ear (47.0％),nervous system (41.1％),oral ulcer (20.5％ ).Of laboratory findings,C - ANCA/PR3 -ANCA was positive in 61.7％ patients,P - ANCA/MPO - ANCA positive in 20.5％ patients,ANCA negative in 11.7％ patients,P- ANCA positive with MPO- ANCA negative in one patient (2.9 ％ ) and C -ANCA positive with PR3 and MPO positive in one patient (2.9％ ).Of imaging findings,nodules or masses were most commonly observed (34％), followed by fibrotic lesions (20.5％ ), cavitations ( 17.6％ )、opacities ( 17.6％ ).Typically pathological triad ( vasculitis,necross and granuloma formation)was found in one patient ( 4.3％ ),while two pathological changes of the triad occurred in 10 patients (43.4％). Pulmonary infection was highly prevalent (50％), and of them,20.5％ patients were misdiagnosed as tuberculosis,malignancy or abscess.After admission,high dose of corticosteroids and cyclophosphamide were administered as bolus and maintenance therapy. Plasma exchange,intravenous immunoglobulin,and rituximab were added for refractory cases and optimal response were obtained in most cases.Conclusions Wegeners granulomatosis is a clinically complicated entity and sometimes can have progression,leading to misdiagnosis. Early and prompt use of steroids and cyclophosphamide may confer good therapeutic efficacy and avoid life -threatening complications.

ObjectiveTo investigate the effect of bone marrow-derived mesenchymal stem cells (MSCs) on gene and protein expression of toll-like receptor, TLR2/4 of the rat alveolus macrophages so as to discuss the effect of MSCs transplantation on the early inflammatory mediators and the regulatory mechanism of the inflammatory cascade.MethodsThe alveolus macrophages were randomly divided into the PBS control group (n = 24), MSCs control group (n = 24), lipopolysaccharide (LPS) control group (n=24) and LPS + MSCs treatment group (n =24).All groups were taken time-points of 1, 3,6, 12 hours.Positive cell rate of MSCs with surface mark and the expression level of TLR2/4 protein on macrophage were detected by flow cytometry.The mRNA level of TLR2/4 expression on macrophage was detected by RT-PCR and the concentrations of TNF-o in cell culture supernatants by ELISA at the different time points.ResultsCompared with the PBS control group and MSCs control group, TLR2/4 mRNA and protein levels were significantly up-regulated, markedly increased at one hour and peaked at 12 hours (P ＜0.01) and the TNF-α concentrations in cell culture supernatants were significantly up-regulated and peaked at 6 hours in the LPS control group (P ＜ 0.01).Compared with the LPS control group, mRNA and protein level of TLR2/4 and TNF-o concentrations in the cell culture supernatants of the LPS + MSCs group were markedly down-regulated (P ＜ 0.01).ConclusionsWith LPS stimulation, TLR2/4 mRNA and protein expressions as well as TNF-αt concentration increase, when the peak of the TNF-αt concentration appears slightly earlier, indicating that there may be a positive feedback loop between TLR2/4 expression and TNF-ot.MSCs can significantly reduce TLR2/4 mRNA and protein expressions as well as TNF-α concentration after LPS stimulation, indicating that MSCs can break up the positive feedback loop.

Objective To investigate the expression of Smac/DIABLO, XIAP mRNA in acute pancreatitis (AP) and the relationship with the severity in rats.Methods Fifty-four SD rats were randomly divided into three groups:sham-operation (SO) group, acute edematous pancreatitis (AEP) group and acute necrotizing pancreatitis (ANP) group.The models of AEP and ANP were induced by retrograde injection of 1％ and 3.5％ sodium deoxycholate into the pancreaticobiliary duct respectively.The specimens of pancreatic tissue at 3 h, 6 h, 12 h were collected, pathological changes of the pancreas were observed, apeptosis in pancreas were detected by TUNEL method and the expression of Smac/DIABLO, XIAP mRNA were analyzed by real-time PCR.Results Pathological changes of the pancreas confirmed the establishment of AEP and ANP.Apeptosis indexes in SO group, AEP group and ANP group were 0.67±0.82, 6.62 ±0.78 and 4.70 ±0.82, and the differences were significant (P< 0.05).The expression of Smac/DIABLO mRNA of AEP group increased with time, while the expression of ANP group decreased with time.Compared with SO group, Smac/DIABLO mRNA expressions at 6 h in AEP and ANP group were 2.41 ± 0.92 and 1.47± 0.53, and the differences were significant (P<0.05).By contrast, the expressions of XIAP mRNA in AEP group decreased with time,while the expressions in ANP group increased with time.The expressionsof XIAP mRNA at 6 h in AEP and ANP group were 5.51 ± 1.07 and 6.99 ± 1.00, and the differences were significant (P<0.05).Conclusions In acute pancreatitis, the expression of Smac/DIABLO mRNA was consistent with the apoptosis of pancreatic acinar cells, but not consistent with the severity of pancreatitis.The expression of XIAP mRNA was consistent with the severity of pancreatitis.Smac/DIABLO, XIAP mRNA is associated with regulation of apoptosis.

Objective To detect anti-M3 receptor antibodies in primary Sj(o)gren's syndrome(pSS)patients and to explore its association with clinical manifestations.Methods Anti-M3 antibodies were tested in 70 patients with pSS,50 patients with systemic lupus erythematosus(SLE)and 76 normal controls with ELISA and Western blot.The correlation between anti-M3 antibodies and other clinical manifestations was analyzed.Results (1)The positive rate of anti-M3 antibodies in pSS Was 47.14% using ELISA and 60.00% using Western blot in SLE 4.00% using ELISA and 12.00% using Western blot and in normal controls 14.47% using ELISA and 15.79% using Western blot.(2)The incidence of sehirmer test,tear break-up time(BUT),whole saliva flow rate,punctate epithelial erosions(PEE)on the corneas and external eye examination were not significantly different between the anti-M3 positive and negative groups.(3)The incidences of IgG,rheumatoid factor,SSB and fluorescence index(FI)＞3 were higher in the positive group than in the negative group using EUSA.Conclusion The positive rate of anti-M3 antibodies is higher in pSS than in SLE and normal controls and in some degree it has correlation with the lesion in salivary gland.

Objective To understand the Oncomelania hupensis distribution and infection status in the schistosomiasis sur?veillance sites of Yunnan Province,so as to provide the evidence for making the control and prevention measures. Methods Eighteen administrative villages were selected as the surveillance sites where the schistosomiasis endemic was serious in 18 epi?demic counties,one village for one county. The snail status was investigated with the systematic sampling and environmental sampling methods,and the infection status of the snails was detected by a microscope and loop?mediated isothermal amplifica?tion(LAMP). The surveillance database was established and descriptively analyzed. Results In 2015,the total surveillance ar?ea was 1 826.55 hm2,and the area with snails was 55.03 hm2,that was reduced by 57.70% as compared to that in 2013,and by 40.63% as compared to that in 2014. No new snail area was discovered,and also no schistosome infected snails were discovered. Totally 718 532 frames were surveyed,and the occurrence rate of frames with snails was 0.45% and the density of living snails was 0.013 9 snail/0.1 m2. In the endemic controlled areas,the snail area and density of living snails were both the highest. The snails concentrated on the environments of paddy field,ditch,bottomland,small reservoir,and dry land,and the vegetations of rice,dry crop,weed and wood. The snail area,occurrence rate of frames with snails,total number of snails and number of liv?ing snails all showed a downward trend. No infected snails were found for three years. Conclusions The Oncomelania hupensis snails have been effectively controlled in the national schistosomiasis surveillance sites of Yunnan Province. However,the com?prehensive snail control measures still should be continually strengthened in order to consolidate the achivements.

Objective To explore the prevalence and independent influencing factors of arthritis in Chinese patients with systemic sclerosis(SSc).Methods A total of 248 SSc patients were enrolled in this prospective cross-sectional study in Peking Union Medical College Hospital.Demographic,clinical and laboratory data were compared in arthritis group and non-arthritis group.Results Of 248 Chinese SSc patients,mean age of onset was (37.1 ± 13.7) years old and disease duration was (7.4 ± 5.2) years.Overall prevalence of arthritis was 41.1％ (102/248).The presence of arthralgia(95.1％ vs 15.1％),muscle weakness(38.2％ vs 24.7％),short of breath (60.8％ vs 45.2％),and intestinal lung disease (64.7％ vs 49.3％) occurred more frequently in patients with arthritis than those without arthritis (P ＜0.05).The elevation of C reactive protein,anti-Sm and anti-cyclic citrullinated peptide were more common in arthritis group than in non-arthritis group(61.4％ vs 43.9％,11.4％ vs 2.5％ and 28.1％ vs 2/16,respectively).There were no obvious differences in the Rodnan score,digital ulcers,pulmonary arterial hypertension,and six-minute walk test between two groups(P ＞ 0.05).Conclusion This study reveals the significant prevalence of arthritis in a large cohort of SSc patients in China.Compared to non-arthritis patients,the SSc patients with arthritis have a more severe inflammation reaction and a higher rate of intestinal lung disease.