Accommodation of the human eye ian extremely complex and dynamiprocess,which iaccomplished by the interaction between the central nervousystem and variouoculastructurethaare relevanto accommodation.Varioumechanismof accommodation have been puforward since the beginning of the 19th century,among which Helmhohz'theory ithe mosfamous.However,iistill challenged by othetheories.So far,the mechanism of accommodation hanobeen fully understood.The mosdirecmethod to study accommodation ito observe changein the biometry of the oculastructureduring accommodation,which ialso the mosobjective interpretation of accommodative mechanisms.The rapid developmenof imaging technologiein regardto ophthalmology makethipossible.Thiarticle aimto describe the use of variouimaging technologiein oculaaccommodative studiein vivo from the perspective of morphology.

We describe a case of systemic sclerosis (SSc) complicated with portal hypertensive ascites which did not improve with diuretics and ascitic drainage. When corticosteroid added, her ascites diminished dramatically. Though portal hypertension can be imputed to other causes, such as polycystic liver in this case, it can occur in limited SSc with positive anti-centromere antibody and respond to corticosteroid treatment.
Adrenal Cortex Hormones ; therapeutic use ; Aged ; Female ; Humans ; Hypertension, Portal ; diagnostic imaging ; drug therapy ; Radiography ; Scleroderma, Systemic ; diagnostic imaging ; drug therapy

Objective To investigate the feasibility,efficacy and safety of high dose chemotherapy (HDC)and autologous peripheral blood stem cell transplantation(PBSCT)with CD34~+ cell selection in patients with severe primary Sjgren's syndrome(pSS).Methods Three patients with persistent and severe pSS de- spite of glucocorticoid and immunosuppressive treatment were enrolled from 1999.All patients underwent high dose chemotherapy and peripheral blood stem cell infusion with CD34~+ cell selection.Autologous hematopoietic stem cells were mobilized with 2～3 g/m~2 CTX(total dosage,infused in two days)and 5?g/kg granulocyte colony stimulating factor(G-CSF),enriched with CD34~+ cell selection by CliniMACS,and reinfused after con- ditioning with 200 mg/kg CTX and 90 mg/kg swine antithymocyte globulin or 200 mg/kg CTX and total body irradiation of 4 Gy.Results One patient got complete remission after 2 times of mobilization,so no condi- tioning and transplantation were given.Other 2 patients completed the mobilization and leukapheresis proce dures successfully,and proceeded to receive conditioning and transplantation.All patients had rapid hematopoi- etic reconstitution.Three patients were followed up for 48 months,60 months and 18 months,respectively.All patients were free from abnormal activity of B lymphocytes.The titer of antibody decreased and anti-SSB anti- bodies of 2 patients turned to negative.Aggregation of focal lymphocytes in labial gland disappeared in 1 pa- tient after PBSCT.Improvement of pulmonary dysfunction and reversibility of interstitial pulmonary fibrosis fol- lowing hematopoietic stem cell transplantation were observed in 2 patients.Conclusion The abnormal activity of B lymphocytes in pSS patients can be controlled successfully with PBSCT.High close chemotherapy followed by peripheral blood stem cell transplantation with CD34~+ cell selection is feasible and safe.

OBJECTIVETo investigate the dynamic changes of lymphocyte subsets before and after autologous hemopoietic stem cell transplantation (HSCT) in severe/refractory autoimmune disease (AID) and study the post-transplantation immunological reconstitution in AID.

METHODSThirteen patients with severe/refractory AID who registered for HSCT from April 2003 to April 2005 in Peking Union Medical College Hospital, including 8 patients with systemic lupus erythematosus, 4 patients with rheumatoid arthritis, and 1 patient with primary Sjögren's syndrome (pSS) were enrolled in this study. Blood samples were collected before/after mobilization, before conditioning, and 2 weeks, 1 month, 3 months, 6 months, 12 months, and 18 months post-transplantation. Lymphocyte subsets were tested by flow cytometry as follows: T cell (CD3 +), B cell (CD19 +), natural killer (CD3-CD16 + CD56 +), Th (CD3 + CD4 +), Tc (CD3 + CD8 +), naïve T (CD4 + CD45RA), memory T (CD4 + CD45RO), and CD4/CD8 ratio.

RESULTSLymphocyte subsets for SLE patients were severely abnormal compared to normal or RA patients (both P < 0.01). B cell reconstituted to normal level within 18 months, meanwhile NK and T cell remained low. The repopulations of Th and naive T cell were delayed, which caused the up-side-down of CD4/CD8 ratio and low level of naYve T cell percentage for a relatively long time.

CONCLUSIONSLymphocyte subsets abnormality in SLE patients are more severe than in RA patients. Although most autoimmune T/B cell in the grafts and patients can be effectively removed after transplantation, nonmyeloablative conditioning may be a risk for the relapse of AID. The long-term inhibition of CD4 + T cell may be related with the relief of AID after transplantation.

Arthritis, Rheumatoid ; blood ; immunology ; therapy ; Hematopoietic Stem Cell Transplantation ; Humans ; Lupus Erythematosus, Systemic ; blood ; immunology ; therapy ; Lymphocyte Subsets ; immunology ; pathology ; Sjogren's Syndrome ; immunology ; therapy

Objective To observe the effects of ritodrine hydrochloride,phloroglucinol and magnesium sulfate on serum sex hormones and fetal protection effect in patients with threatened abortion after 20 gestational weeks.Methods Patients with threatened abortion(after 20 gestational weeks)underwent fetal protection treatment were retrospectively enrolled.According to cohort method,they were divided into group A(ritodrine hydrochloride injection 100 mg+5％glucose injection 500 mL for intravenous drip,continued infusion after uterine contraction inhibition for 12-18 h,oral ritodrine hydrochloride tablets),group B(of phloroglucinol injection 40 mg+5％glucose injection 500 mL for intravenous drip,drug withdrawal after uterine contraction inhibition)and group C(magnesium sulfate injection 20 mL+5％glucose injection 100 mL,magnesium sulfate injection 40 mL+5％glucose injection 500 mL for intravenous drip after rapid intravenous drip,continued infusion after uterine contraction inhibition for 12 h).The onset time,disappearance time of uterine contraction,levels of serum sex hormones[progesterone(P),estradiol(E2),human chorionic gonadotrophin β-subunit(β-hCG)],adverse drug reactions and response rate of fetal protection in the three groups were observed.Results There were 40 cases in group A,38 cases in group B and 42 cases in group C.The onset time in group A,group B and group C were(1.71±0.34),(2.29±0.23)and(4.51±1.12)h,and the difference was statistically significant(P＜0.05).The disappearance time of uterine contraction in groups A,B and C were(1.34±0.32),(2.24±0.26)and(2.36±0.28)d,and the difference between group B and group A,between group C and group A were statistically significant(all P＜0.05).After 3 d of treatment,levels of serum P in group A,group B and group C were(78.64±10.34),(69.35±10.52)and(68.76±11.13)ng·mL-1;E2 levels were(672.25±85.63),(623.25±92.31)and(624.12±93.65)pg·mL-1;β-hCG levels were(6.95×104±1 258.65),(6.75×104±1 274.43)and(6.70×104±1 327.59)mU·mL-1;the difference between group B and group A,between group C and group A were statistically significant(all P＜0.05).The incidence rates of palpitation in groups A,B and C were 25.00％,0 and 9.52％,the difference between group A and group B was statistically significant(P＜0.05).The incidence rates of headache in groups A,B and C were 2.50％,2.63％and 26.19％;the difference between group A and group C,and between group B and group C was statistically significant(P＜0.05).The incidence rates of fatigue in groups A,B and C were 5.00％,0 and 19.05％,and the difference between group B and group C was statistically significant(P＜0.05).The incidence rates of gastrointestinal discomfort were 5.00％,0 and 11.90％,and the difference between group B and group C was statistically significant(all P＜0.05).The response rates of fetal protection in groups A,B and C were 92.50％,94.74％and 73.81％,and the difference between group A and group C,between group B and group C was statistically significant(all P＜0.05).Conclusion The onset time of ritodrine hydrochloride is short,which can be the first choice for disease control.Phloroglucinol is comparable to ritodrine hydrochloride in terms of fetal protection effect,which has better advantages in adverse drug reactions.Clinically,phloroglucinol can be considered for patients with poor tolerance to ritodrine hydrochloride.

OBJECTIVETo evaluate the feasibility, efficacy, and safety of high dose immunosuppressive therapy (HDIT) and autologous hemopoietic stem cell transplantation (HSCT) with CD34+ cell selection in patients with severe, refractory autoimmune diseases.

METHODSTwenty-six patients with persistent systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), primary Sjögren's syndrome (pSS), or systemic sclerosis (SSc) who had been treated unsuccessfully with conventional treatment were enrolled in the trial in Peking Union Medical College Hospital from September 1999 to June 2004. The patients received HDIT with 200 mg/kg cyclophosphamide followed by an infusion of autologous stem cells that were CD34 selected. Disease activity, adverse effect, hemopoietic and immune reconstitution, and time to recurrence of disease were monitored.

RESULTSOverall treatment related mortality was 7.7% (2/26) with 1 patient died of cytomegalovirus infection and another of severe pneumonia. Relapse occurred in 3 SLE patients (17.6%) in 37, 26, and 19 months posttransplantation respectively, and 1 RA patient in 15 months posttransplantation. SLE Disease Activity Index (SLEDAI) scores of SLE survivors decreased significantly (P < 0.01). RA patients recorded a drop of Disease Activity Score 28 (DAS 28). The pSS patient remained symptoms free up to now, more than 50 months after the transplantation.

CONCLUSIONHSCT can be performed relative safely in patients with severe autoimmune disease. Short-term effect of HSCT is promising. However treatment related mortality and relapse were observed in a subset of patients.

Adolescent ; Adult ; Antigens, CD34 ; analysis ; Arthritis, Rheumatoid ; immunology ; therapy ; Autoimmune Diseases ; immunology ; therapy ; Cyclophosphamide ; administration & dosage ; therapeutic use ; Dose-Response Relationship, Drug ; Female ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Lupus Erythematosus, Systemic ; immunology ; therapy ; Male ; Pilot Projects ; Recurrence ; Sjogren's Syndrome ; immunology ; therapy ; Transplantation Conditioning ; Transplantation, Autologous

To study the effects of Smad4 on liver fibrosis and hepatocarcinogenesis in mice treated with CCl(4)/ethanol. The wild-type mice (Smad4 +/+) and the Smad4 knockout mice (Smad4 +/-) were injected subcutaneously with carbon tetrachloride(CCl(4))/ethanol twice a week for twenty weeks. The expression of Smad4, TGFbeta1, Smad2, Smad3, Smad6, TIMP1, MMP2 and MMP9 was detected by RT-PCR. In the cirrhotic liver, the expression of Smad4 mRNA was significantly higher than that in the normal liver. Comparing with wild-type mice (Smad4 +/+), the TGFbeta1-Smad4 signaling was markedly attenuated in the Smad4 knockout mice (Smad4 +/-). After induction by CCl(4)/ethanol, the hepatic fibrosis in the Smad4 knockout mice (Smad4 +/-) was obviously alleviated compared with the wild-type mice (Smad4 +/+), and the incidence rate of hepatocarcinogenesis of the former was also lower than that of the latter(32.0% vs 41.9%). These results indicate that knocking out Smad4 can delay the progression of liver fibrosis and liver cancer.
Animals ; Carbon Tetrachloride ; administration & dosage ; Disease Models, Animal ; Ethanol ; administration & dosage ; Female ; Liver Cirrhosis, Experimental ; chemically induced ; metabolism ; pathology ; Liver Neoplasms, Experimental ; chemically induced ; metabolism ; pathology ; Male ; Mice ; Mice, Knockout ; RNA, Messenger ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Signal Transduction ; Smad Proteins ; genetics ; metabolism ; Smad4 Protein ; genetics ; metabolism ; Tissue Inhibitor of Metalloproteinase-1 ; genetics ; metabolism ; Transforming Growth Factor beta1 ; genetics ; metabolism

OBJECTIVETo evaluate the feasibility and safety of peripheral CD34+ cell mobilization in patients with severe autoimmune disease.

METHODSForty-two patients underwent a total of 46 mobilizations by the regimen of cyclophosphamide 2-3 g/m2+ recombinant human granulocyte colony stimulating factor (rhG-CSF) 5 microg x kg(-1) x d(-1). The positive selection of CD34+ cell was performed through the CliniMACS.

RESULTSIn 8.1 +/- 2. 3 days after administration of cyclophosphamide, the peripheral white blood cell and mononuclear cell (MNC) decreased to the lowest level. In 3.7 +/- 1.6 days after injection of rhG-CSF, the peripheral absolute MNC and CD34+ cell counts were 0.95 x 10(9)/L and 0.035 x 10(9)/L, respectively. After 2.4 +/- 0.6 times of leukapheresis, there gained 4.46 x 10(8)/kg of MNC and 5.26 x 10(6)/kg of CD34+, respectively. After mobilization, the underlying diseases were ameliorated more or less. In systemic lupus erythematosus (SLE) patients, SLE Disease Activity Index (SLEDAI) decreased from a median of 17 to 3 (P < 0.01). In rheumatic arthritis patients, an American College of Rheumatology criteria for 20% (ACR20) response was achieved in all five patients. Totally, 17.4% of patients whose absolute neutrophil count < 0.5 x 10(9)/L suffered infection, and 31.0% of patients had bone pain after the injection of rhG-CSF. Two patients suffered severe complications, one with acute renal failure and recovered by hemodialysis, the other died of thrombotic thrombocytopenic purpura. Failed mobilization occurred in three patients.

CONCLUSIONSSufficient CD34+ cells can be mobilized by low dose of cyclophosphamide and rhG-CSF. CD34+ cell mobilization for treatment of severe autoimmune disease not only is appropriate in both effectiveness and safety but ameliorates disease also.

Adolescent ; Adult ; Antigens, CD ; blood ; Antigens, CD34 ; blood ; Autoimmune Diseases ; therapy ; Cyclophosphamide ; pharmacology ; therapeutic use ; Female ; Hematopoietic Stem Cell Mobilization ; methods ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; immunology ; Humans ; Leukapheresis ; methods ; Leukocyte Count ; Leukocytes ; drug effects ; Leukocytes, Mononuclear ; drug effects ; Male ; Middle Aged ; Young Adult

Arthritis, Psoriatic ; Cardiovascular Diseases/etiology* ; Cardiovascular System ; Humans