Objective To compare the clinical features and treatment between elderly onset rheumatoid arthritis(EORA)and young onset rheumatoid arthritis(YORA).Methods The EORA patients (n=60)and the YORA patients (n =90)were compared regarding sex ratio,activity of pathogenetic condition,disease severity,extra-articular manifestations,complications,laboratory indexes,and therapeutic schedules.Results The female/male ratio was 36/24(1.50 ∶ 1.0)in group EORA,and 69/21(3.3 ∶ 1.0)in group YORA,with higher female/male ratio in in group YORA.The frequency of morning stiffness,proximal interphalangeal joint involvement and metacarpophalangeal joint involvement were lower in group EORA(53.3 ％,46.676％ and 61.67 ％) than in group YORA (72.2 ％,77.8 ％,81.11％) (x2 =5.521,15.385,6.960,P =0.018,0.000,0.008 respectively).Large joints involvement at onset of rheumatoid arthritis was higher in group EORA(38.33 ％)than in group YORA(18.89 ％)(x2=6.960,P=0.008).The joint swollen and tender counts were comparatively less (16.51 ± 7.34) and (15.92 ± 8.44) in group EORA than in group YORA(22.46 ± 7.58) and (23.8 ± 8.93) (t =5.080、5.740,all P =0.000) respectively.The accumulated disease activity score(DAS28)was higher in group EORA(5.86± 1.57)than in YORA(4.92± 1.64) (t=3.360,P =0.001).HAQ score was lower in group EORA(0.83 ± 0.85)than in group YORA (1.16±0.91) (t=2.43,P =0.02).Comorbid conditions such as osteoarthritis,osteoporosis,cardiovascular disease and chronic renal insufficiency were more frequent in group EORA (51.7 ％,31.7 ％,18.3 ％ and 15.00％)than in group YORA(27.8％,15.6％,5.6％ and 4.4％)(x2 =11.722,5.445,6.168,5.067,P=0.001,0.020,0.013,0.024).The positive rate of RF were more higher in YORA(70.00％)than in group EORA (48.33％)(x2 =7.126 P=0.008).The synthetic or biologic traditional DMARDs (disease modifying antirheumatic drugs)were widely used in group YORA(78.9％ and 31.1％)than in group EORA(40.0％ and 10.0％)(x2 =14.940,9.153,P =0.000,0.002).The more frequently used program with glucocorticoids hormonal therapy was received in group EORA(38.3 ％)than in group YORA(20.00 ％)(x2 =6.092 P=0.014) Conclusions EORA patients differs from YORA patients in many of ways,including a more balanced gender distribution,atypical presentation at onset of disease,more frequent involvement of large joints,seronegativity in a higher percentage,and less frequent positivity of anti CCP-antibody,which makes diagnosis more difficult in the earlier period.Therapy of EORA with DMARDs should be instituted based on disease activity,if there is no contraindication.

[ ABSTRACT] AIM:To establish the insulin resistance rat model for evaluating the correlation of omentin-1 level and insulin resistance.METHODS: SPF male Wistar rats ( n =30 ) were randomly divided into normal control group (NC, n=15) and high-fat diet group (HF, n=15).The rats in NC group were fed with basic diet.The insulin resistant model was established by feeding the rats with high-fat diet in HF group.After 10 weeks, 5 rats in each group were as-sessed by the technique of hyperinsulinaemic-euglycaemic clamp.After the insulin resistant model was successfully estab-lished, the body weight and fasting blood glucose were detected.The concentration of fasting serum omentin-1 was analyzed by ELISA.Fasting serum insulin was measured by radioimmunoassay.RESULTS: No difference of fasting blood glucose between the 2 groups was observed.The level of fasting serum insulin in HF group was significantly higher than that in NC group ( P <0.05 ) .The level of serum omentin-1 in HF group were significantly decreased compared with NC group (P<0.01).Pearson’s correlation analysis showed that negative correlations between serum omentin-1 and fasting serum insulin (r=-0.654,P<0.01), serum omentin-1 and free fatty acid (r=-0.446, P<0.05) was found.CONCLU-SION:In rats, serum omentin-1 level began to decrease at insulin resistance stage.As serum omentin-1 level decreased, the basal insulin level increased, indicating that decreased serum omentin-1 level may be an early factor of IR, diabetes and cardiovascular diseases.

By feeding rats with high-fat diet insulin resistant models were induced.Some of the models were treated with intragastric administration of curcumin,then the effects were evaluated by hyperinsulinaemic-euglycaemic clamp technique.Curcumin reduced the level of serum resistin and the expression of resistin mRNA in adipose tissue,and thus ameliorated insulin resistance in rats.

Objective To examine the effect of labouring in water on analgesia of vaginal delivery.Methods From June 2009 to February 2011,38 women who had volunteered to deliver in water in the obstetrical department were set as the observation group,another 70 women who chose vaginal delivery were named as the control group in the corresponding period.The items of labor pain,satisfaction with the birth experience,length of labor and neonatal outcomes were compared.Results The pain level of the observation group after labouring in water decreased compared with that before immersion in water.The delivery course was not influenced with a high rate of vaginal delivery.Conclusions Labouring in water can alleviate delivery pain,increase rate of vaginal delivery with no influence on delivery course and outcome of mothers and infants.It is a safe and effective analgesia method which should be widely applied.

Objective To investigate the distribution patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT),and explore its correlation with diabetic retinopathy (DR) stages and systemic factors.Methods A total of 135 patients (242 eyes) with type 2 diabetes were included in this retrospective study.There were 75 males (138 eyes) and 60 females (104 eyes),the ages were from 29 to 83 years,with an average age of (5 8.8± 11.1) years.The general information such as height,weight,smoking history and blood glucose [such as glycosylated hemoglobin (HbA1 c)],blood pressure,blood lipid,24 hours urine protein and other examinations were collected.The diagnosis of DR and DME were made,and the staging of DR and typing of DME were performed based on fundus color imaging and OCT.DR were divided into mild nonproliferative DR (NPDR),moderate NPDR,severe NPDR and proliferative DR (PDR).DME were categorizedinto 4 types including sponge-like retinal swelling (SME),cystoid macular edema (CME),serous retinal detachment (SRD) and posterior hyaloid traction (PHT).The correlation between DME types and DR staging were analyzed by x2 test and Fisher exact test.Multivariate logistic regression analysis was used to analyze the correlation between DME types and systemic factors.Results In 242 DR eyes the proportions of mild,moderate,severe NPDR and PDR were 30.99％,32.64％,23.14％ and 13.23％,respectively.There were 199 eyes (82.23％) with DME.There were statistically significant differences in the proportion of DME in different stages of DR (x2=21.077,P＜0.01).In the 199 eyes with DME,There were 165 eyes (68.18％) of SME,22 eyes (9.09％) of CME,7 eyes (2.89％) of SRD and 5 eyes (2.07％) of PHT.The distribution of DME patterns in different stages of DR was statistically significant (x2=156.273,P＜0.01).Logistic regression analysis showed that the duration of diabetes,HbA1c and macroalbummuria were independent risk factors for DME [odds ratio (OR)=1.090,1.510,4.123;P＜0.05],and were also independent for SME (OR=1.092,1.445,3.942;P＜0.05);HbA1c wasanindependentriskfactorforSRD(OR=2.337,P＜0.05).Canclusions There are differences in the distribution of different DME types in each stage of DR.The duration of diabetes,HbA 1c and macroalbuminuria were independent risk factors for DME and SME,and macroalbuminuria and HbA1c for CME and SRD.

Newcastle disease virus-like particles (NDV VLPs) are composed of matrix protein (M) as the skeleton,with the insertion of hemagglutinin-neuraminidase and/or fusion protein.NDV VLPs are reported to be immunogenic and can induce specific humoral and cellular immune responses.However,its relationship with innate immunity remains elusive.Dendritic cells (DCs) are a group of specialized antigen presenting cells,which are crucial in connecting innate immunity and adaptive immunity.In this study,NDV VLPs and murine DCs were used to investigate the connection between NDV VLPs and innate immunity.The DC maturation induced by NDV VLPs (M+ HN) was evaluated.The results showed that NDV VLPs could be effectively taken up by DC and presented to naive T cells.NDV VLPs-induced DC significantly up-regulated the expression of MHC Ⅱ and costimulatory molecules on DC surface,and subsequently promoted the secretion of proinflammatory cytokines.This experiments also showed that different assembled NDV VLPs induced significant stimulating ability in cytokine levels.In summary,NDV VLPs can induce DC maturation,which gives insights to better understanding of VLPs-mediated innate immunity and provide information in selecting preferred NDV VLPs candidate.

Objective To evaluate the safety of heparin used in plasma exchange (PE) and molecular absorbent recirculating system (MARS) for hepatic failure. Methods 8 databases were electronically searched including CNKI,CBM,WANFANG,VIP,PubMed,Web of Science,Cochrane and EMBASE.Two researchers individually performed the literature screening,data extraction and evaluation of risk of bias.Random or fixed effect model based on the result of the test of heterogeneity were chosento synthesize the datausing RevMan 5.3 software. Results 6 eligible studies with 863 patientswere included. Compared to omitting of heparin, the heparin PE could increase the probability of circuit clotting, hemorrhage in puncture point, puncture hematoma (RR = 6.05, 95% CI:2.00-18.30, P=0.001;RR=10.80,95% CI:4.78-24.37,P<0.05;RR=6.34,95% CI:1.13-35.53,P=0.04),but the probability of circuit blocking and other adverse reactions are not influenced(RR=5.61,95% CI:0.99-31.89,P=0.05;RR = 1.17,95% CI: 0.73-1.86, P=0.51). As for the treatment with MARS, heparin could increase the chance bleeding death (RR =12.04, 95% CI:1.69-85.66, P=0.01), but had no obvious effect on circuit clotting. Conclusion When curing the hepatic failure,heparin PE can increase the probability of circuit clotting, hemorrhage in puncture point and puncture hematoma, and heparin MARSE can increase the probability of bleeding death. On the contrary, no-heparin PE and MARSE will be safer in treatment of hepatic failure.

Objective:To investigate the effect of fluorofenidone on renal interstitial fibrosis in rats with unilateral ureteral obstruction (UUO) and to observe the effect of fluorofenidone on the expressions of collagen type Ⅰ (Col Ⅰ),collagen type Ⅲ (Col Ⅲ),α-smooth muscle actin (α-SMA),connective tissue growth factor (CTGF),platelet derived growth factor (PDGF) in the renal tissues of UUO rats.Methods:Male Sprague-Dawley (SD) rats were randomly divided into a sham-operated group,a UUO group,and a flurofenidone group (n=5).UUO model was induced by ligating the left ureter in rats.The rats were treated with 125 mg/(kg.d) fluorofenidone by gastric gavage in the fluorofenidone group at 24 h before the operation,and the rats were treated with the identical dose of 0.5％ sodium carboxyl methyl cellulose (CMC-Na) in the other 2 groups.The rats were sacrificed at 14 days after UUO.Pathological changes of the renal tissue were observed by HE and Masson staining,the mRNA expressions of Col Ⅰ,Col Ⅲ,α-SMA,PDGF and CTGF were detected by real-time PCR,and the protein expressions of Col Ⅰ,Col Ⅲ,PDGF and CTGF were detected by immunohistochemical staining.Results:The renal interstitial damage index,relative collagen area and mRNA and protein expressions of Col Ⅰ and Col Ⅲ in the renal tissues of the rats in the UUO group significantly increased (P＜0.05),and fluorofenidone could reduce these indexes (P＜0.05).Compared with the sham-operated group,the protein expressions ofα-SMA,PDGF,CTGF and the mRNA expressions of PDGF and CTGF in the renal tissues of the rats in the UUO group were increased,but fluorofenidone could decrease the protein expressions of α-SMA,PDGF,CTGF and the mRNA expressions of PDGF and CTGF (P＜0.05).Conclusion:Fluorofenidone (125 mg/kg·d) could attenuate renal interstitial fibrosis through inhibition offibroblast proliferation,myofibroblastic activation,PDGF and CTGF expression.

Objective To analyze the infiltration abundance of macrophage M2 in breast cancer tissues and explore the correlation between VSIG4 and macrophage M2 and the potential mechanism of regulating the invasion and migration of breast cancer patients. Methods We downloaded the RNA-seq data of TCGA-BRCA and assessed the infiltration abundance of immune cells in the samples by CIBERSORT, and established a prognostic risk prediction model. Then, we analyzed the effect of macrophage M2 and VSIG4 on the prognosis of breast cancer patients. In addition, we analyzed the signaling pathway associated with VSIG4 by gene set enrichment analysis and predicted its upstream regulation of miRNA. Results The infiltration abundance of macrophage M2, age, PR status and pathological stage were involved in the establishment of risk prediction model, and the model had a good prediction performance (AUC=0.816). High infiltration of macrophage M2 (HR=1.35, P < 0.05) and high expression of VSIG4 (HR=1.4, P=0.039) suggested poor prognosis of breast cancer patients. VSIG4 could be regulated by upstream miR-29a-3p and significantly correlated with Toll-like receptor, cell adhesion, production and release of cytokine. Conclusion VSIG4 is significantly associated with breast cancer patients' prognosis and infiltration of macrophage M2, regulated by the upstream miR-29a-3p and promotes the invasion and migration of breast cancer cells. It can be used as a potential prognostic marker for breast cancer.

Objective:To investigate the clinical features and long-term prognosis of pediatric acute lymphoblastic leukemia (ALL) with renal involvement as the initial manifestation, thus enhancing the diagnostic and therapeutic efficacy.Methods:Twenty-four cases of pediatric ALL with renal involvement as the initial manifestation treated in the First Affiliated Hospital of Zhengzhou University from March 2013 to March 2019 were analyzed retrospectively, and their clinical characteristics were analyzed.According to renal imaging examination findings, they were divided into abnormal group and normal group.The differences in clinical features between the two groups were compared, and the cumulative survival rate was evaluated by Kaplan-Meier method.Results:Among 1 030 newly treated cases of pediatric ALL, 24 cases(2.33%) had renal involvement as the initial manifestation, involving 20 males and 4 females, with a male/female ratio of 5∶1 and the median age of 4.3 years (1.3-14.0 years). There were 16 cases of superficial lymph node enlargement and 21 cases of hepatosplenomegaly.Immature cells in peripheral blood were found in 15 cases.Nine cases were examined with abnormal renal imaging, involving 8 cases returned normal after chemotherapy, and 1 died of renal failure.At the end of follow-up on August 1, 2020, there were 9 cases of bone marrow relapse, 11 survival cases, 10 death cases and 3 cases of loss to follow-up.There were no significant differences in the sex, age, immunophenotype, organ infiltration and urinary protein between the two groups (all P>0.05). The proportion of high creatinine level and intramedullary recurrence rate in the abnormal group were significantly higher than those in the normal group [55.6%(5/9 cases) vs.0(0/15 cases), P=0.003; 66.7%(6/9 cases) vs.20.0%(3/15 cases), P=0.036]. The survival analysis indicated that the 3-year cumulative survival in the abnormal group was significantly lower than that of normal group (17.3% vs.72.7%, χ2=4.047, P< 0.05). Conclusions:For children with unexplained renal involvement as the initial manifestation, clinicians should consider the possibility of leukemic renal infiltration or nephrogenic lymphoma.Physical examinations of the liver, spleen and lymph nodes, morphological analysis of peripheral blood cells, bone marrow examination and renal biopsy are important to make a definite diagnosis in time.Children with imaging abnormalities caused by leukemic renal infiltration are more likely to relapse and have a lower survival rate, which may be a poor prognostic factor for ALL.