2 in B27 positive groups and X = l. 58

The repair of articular cartilage defects has been a dif ficult problem. Presently cartilaginous autograft and allograft, periosteal and perichondral graft and transplantation of chondrocytes had been widely applied t o repair cartilaginous defects. The application of tissue engineering might be a method of hope. This article reviewed the progression of cartilage transplantation and the tissue engineering.

Objective:To study the changes of serum IL 1?,IL 6,IL 8,TNF ? and sIL 2R and its relationship with disease activity in adult Still disease patients.Methods:Serum levels of IL 1?,IL 6,IL 8,TNF ? and sIL 2R were assessed by ELISA in 18 adult Still disease patients before and one month after treatment with prednisone.Results: Active adult Still disease patients had significant elevated erythrocyte sedimentation rate (ESR) and serum levels of C reactive protein (CRP),IL 1?,IL 6,IL 8,TNF ? and sIL 2R.After one month treatment with prednisone,ESR and serum levels of CRP,IL 6,TNF ? and sIL 2R significantly decreased.There was a significant correlation between ESR values and serum IL 6,TNF ? and sIL 2R levels,and between serum CRP levels and IL 6,TNF ? and sIL 2R levels.Serum IgG,IgA and IgM levels in active adult Still disease patients were similar to those in healthy controls.Conclusion: There are no changes in serum immunoglobulins but significant increases of serum IL 1?,IL 6,IL 8,TNF ? and sIL 2R levels in active adult Still disease.Serum levels of IL 6,TNF ? and sIL 2R are related to the activity of adult Still disease.

Objective To evaluate the therapeutic effect of etanercept in patients with Behcet's disease (BD). Methods Twenty six patients with active BD were eligible for anti-TNF-α treatment, which failed previously to commonly used drugs. All the patients were stopped previous therapy and treated with etanercept 25 mg twice a week. The clinical responses and laboratory parameters were evaluated at the baseline, week 2, 4, 8, 12 and 24, and week 12 of etanercept withdrawal. Results Etanercept was effective in several clinical lesions and lab. parameters at all time points. Especially at week 2, including oral ulcers, genital ulcers, erythema nodosum, pseudofolliculitis and swollen joints (P<0.01). Two of four cases of uveitis were contro-lled with addition of topical corticosteroids; The ileocecal junction ulcer of 1 patient healed after 2 months etanercept therapy; four cases of epididymitis reached complete remission at week 4. ESR(P=0.012) and CRP (P=0.013) were also rapidly decreased at week 2. Most patients were relapsed at week 12 of etanercept withdrawal compared with baseline except for swollen joints (0.65±1.09 vs 0.31±0.60, P<0.01) after etanercept withdrawal, in which the typical rebound was CRP from (481±312) mg/L to (549±267) mg/L (P=0.013).Conclusion Etanereept has rapid efficacy onset for most of the mucocutaneous disorders and possibly effective for arthritis, ophthalmitis, epididymitis and colonic ulcer of BD.

Objective To analyze the clinical features,and prognosis of the interstitial lung disease (ILD) in patients with dermatomyositis (DM) and polymyositis (PM) by chest X-ray,chest high-resolution CT scan (HRCT) and pulmonary lung function.Methods Thirty-three patients hospitalized with DM/PM associated ILD were retrospectively analyzed.Results Thirty-three patients with ILD were confirmed by HRCT.Abnormal pulmonary function tests were available in 82% of patients.Clinical-imaging analysis revealed that the pathological features of ILD were non-specific interstitial pneumonia (NSIP,57%) and unusual interstitial pneumonia (UIP,25%).UIP types showed a poor prognosis and high mortality (70%).Conclusion This study shows that HRCT is more sensitive for the diagnosis of ILD than lung function tests and chest X-ray.Combined HRCT and chest X-ray with lung function tests and blood gas analysis have shown that the major pathological types of ILD are NSIP and UIP,in which UIP are associated with high mortality and poor prognosis.

Objective To demonstrate the change in peripheral blood T lymphocyte subgroup and cytokines of Beh?et′s disease (BD). Methods T lymphocyte subgroup was detected by flow cytometry and serum interleukin (IL)-8, sIL-2R, IL-1?, IL-2, IL-6 and TNF-? were assayed by RIA. Results CD4, CD4/CD8, NK of BD decreased evidently and CD8 incrdased. Serum IL-8, sIL-2R increased compared to normal controls. Change of IL-2, IL-6, tumor necrosing factor (TNF)-? , IL-1? showed no statistical significance compared to normal group. Conclusion Change in peripheral blood T lymphocyte subgroup and serum IL-8, sIL-2R can be one of the activity index of BD.

Objective:To study the causes of misdiagnosis of patients with POEMS syndrome and to discuss the clues for its early diagnosis.Methods:The clinical and laboratory data of 26 inpatients with POEMS syndrome,who were treated in Changhai hospital over the last decade,were retrospectively analyzed.Results:The misdiagnosis rate of our group was 100%. The misdiagnosis was made in(3.31?0.97)hospitals and in(3.31?0.93)clinical departments;the misdiagnosis period was (19.42?10.86)months and it had been misdiagnosed as 18 other diseases.The initial symptoms included polyneuropathy in 21 (80.8%)cases,edema of lower extremity in 22(84.6%)cases,and body weight loss in 8(30.8%)cases.The typical clinical symptoms included polyneuropathy in 26(100%)cases and organomegaly in 24(92.3%).Two cases had newly-identified uterine hypertrophy,one had adrenal gland hypertrophy,and one had gastric wall thickening mimicking advanced gastric cancer.Hypothyroidism,impotence,skin pigmentation and sclerosis occurred in 76.9%(20/26),60%(6/10),92.3%(24/ 26)and 65.4%(17/26)cases,respectively.Monoclonal plasma cell proliferation was documented in 18(81.8%);M proteins were positive in 14(63.6%)cases by serum immunofixation,and only 2(9.1%)cases also positive by serum protein electrophoresis.One patient was positive of M protein by urine immunofixation and one had abnormal infiltration of plasma cells in the gastric wall.Lymph node biopsy were performed in 8 patients and 3 were found to have Castleman disease;the other 5 cases had lymphocyte infiltration,with 3 complicated with plasma cell proliferation.Nerve biopsy in 4 cases all revealed axonal degeneration and one patient complicated with demyelination.Bone marrow biopsy in 5 cases revealed plasmacytosis in 2 cases and myeloma in one.Excessive radioactivity resorption was found in 10 of the 16 cases(62.5%)and abnormal plasma cells were detected in 2 cases by bone aspiration guided by radioisotope bone scan.Conclusion:Misdiagnosis of POEMS syndrome is very common.Polyneuropathy,edema of lower extremity and body weight loss are the common early symptoms of POEMS syndrome. Early diagnosis can be made by having an intimate knowledge of the progression of the disease and by detecting M protein through various approaches.

BACKGROUND: The association of tumor necrosis factor alpha (TNF-α) gene polymorphisms with the onset and development of ankylosing spondylitis (AS) has been the focus of studies on AS in the field of genetics.OBJECTIVE: To explore the association of the polymophisms of TNF-α promoter gene at positions-308 and -238 with AS susceptibility and clinical pathological changes.DESIGN: A case-control study.SETTING:The Rheumatic Immunology Department of Changhai Hospital of the Second Military Medical University of Chinese PLA.PARTICIPANTS: Totally, 108 AS patients were recruited from Rheumatic Immunology Department of Changhai Hospital, Second Military Medical University of Chinese PLA from January 1999 to December 2003 ,they had no kinship. The ratio of men to women was 5.3: 1. They aged from 13 to 71 (30-± 12) years old, and AS was divided into Ⅰ- Ⅳ radiographic stages according to the sacro-iliac joint damage. A total of 100 healthy controls were randomly selected from the blood donators(Shanghai Hospital) who were aged from 19 -56 (33 ±9) years old, and the ratio of men to women was 4.9: 1. Informed consent was obtained from all the subjects.ti-coagulated with EDTA. Polymerase chain reaction amplification and purification of the TNF-α promoter region was made and the sequence of polymerase chain reaction products was examined and displayed by Chromas 1.62 softcorresponding radiographic stage of sacro-iliac joint damage was assessed to investigate the influence of gene polymorphisms on AS.MAIN OUTCOME MEASURES: DNA direct sequencing method was used to detect -238 and -308 allele phenotypes for investigating the association with clinical presentations.G and -238G/A allele was 98.1% (106 cases) and1. 9% (2 cases) respectively in AS group and 95.0% (95 cases) and 5.0% (5 cases) respecquency of TNF-α promoter gene at positions -308. 1.1(G/G) and - 308.1.2(G/A) alleles was 82.4% (89 cases) and 17.6% (192 cases) respectively in AS group, which was not significantly different compared respectively with 85.0% (85 cases) and 14.0% (14 cases) of the control of sacro-iliac joint damage and the frequency of TNF-α promoter gene at the position of - 308 (G/G) and (G/A): AS patients with(G/G) phenotype who were confirmed of radiographic stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ were observed in 3/35/40/11cases,compared with (G/A) phenotype of 1/12/6/0 cases.The difference was statistically significant (χ2GMH = 4.77, P ＜ 0.05 ).CONCLUSION: Our data suggest that the polymorphisms of TNF-α promoter gene at positions of - 238 and - 308 allele has no association with AS susceptibility, but the polymorphisms of TNF - α promoter gene at the position of -308 might exert great influence on AS according to the radiographic stage of sacro-iliac joint damage.

ObjectiveTo investigate the expression and significance of CD28- cells, CD4+ and CD8+T lymphocytes in the peripheral blood and synovial fluid in patients with rheumatoid arthritis ( RA ). Methods The expression of CD28, CD4+, CD8+ T lymphocytes and inducible co-stimulator(ICOS) in the peripheral blood and synovial fluid in 45 patients with RA were detected by three-color flow cytometry. Independent sample's t test was used for statistical analysis between the two groups. ResultsSynovial fluid CD4+CD28+ICOS+, CD4+CD28- ICOS+ , CD8 + CD28 + , CD8 + CD28 + 1COS+ T lymphocytes were significantly increased than the peripheral blood in RA patients[(36±19)％ vs (15±8)％, t=-4.234, P＜0.01; (2.1±2.2)％ vs (0.6±1.4)％, t=-3.143, P＜0.01; (62±15)％ vs (47±18)％, t=-2.885, P＜0.01; (9±9)％ vs (3±3)％,t=-2.131, P＜0.05], Synovial fluid CD8+CD28-T lymphoc-ytes were significantly reduced than the peripheral blood[(38±15)％ vs (54±18)％, t=2.975, P＜0.01], Synovial fluid CD8+ CD28-ICOS+, CD4+CD28+and CD4+ CD28- T lymphocytes had no significant difference than the peripheral blood (P＞0.05). Compared with peripheral blood in the same patients with RA, CD4+CD28+ ICOS+, CD8+ CD28+ T lymphocyteswere significantly increased[(38±18)％ vs (16±10)％, t=-4.065, P＜0.01 ; (61±16)％ vs (41±21)％, t=-4.065,P＜0.01], CD8+CD28-T was significantly reduced[(39±16)％ vs (59±21)％, t=2.949, P＜0.01]. The level of CD4+ CD28-, CD8+ CD28-, CD28-ICOS+ T lymphocytes in the active and remission patients with RA was not significantly different (P＞0.05). ConclusionSynovial fluid CD28T lymphocyte subsets disturbance and the abnormal expression of ICOS in patients with RA may play important roles in the mechanism of joint damage.

Objective To detect mutations in the PTPN11 gene in a family with LEOPARD syndrome (LS).Methods Clinical data were collected from a 7-year-old boy patient with LS.Peripheral blood was obtained from the patient,both of his parents,and 50 healthy controls.All the exons and their flanking sequences of the PTPN11 gene were amplified by PCR followed by direct DNA sequencing.Results A heterozygous missense mutation c.836A ＞ G,which resulted in a substitution of TAT by TGT at codon 279,was found in exon 7 of the PTPN11 gene in the patient.No mutation was detected in the unaffected parents or healthy controls.Conclusion The missense mutation c.836A ＞ G may be the cause of the phenotype of LS in this family.