According to the consensus criteria of antiphospholipid syndrome (APS),the diagnosis of APS requires the persistent presence of antiphospholipid antibodies (aPLs),indicating the critical role of aPLs in the diagnosis of APS.During the last decade,great efforts have been made to improve the laboratory detection and standardization of aPLs testing.Unfortunately,the heterogeneous nature of aPLs,lacking of standardization in aPLs test,and significant inter-laboratory variation have hampered the clinical application of aPLs test.In this commentary,the clinical application and standardization of aPLs test are focused on,and how to establish the standardization system in aPLs test in order to improve the performance of aPLs test in clinical practice are discussed.

Antiphospholipid antibodies (APLs) are important for the diagnosis of antiphospholipid syndrome (APS),especially for predicting the risk of thrombosis and pathological pregnancy.However,the heterogeneity of antiphospholipid antibodies,lacking of standardization and significant interlaboratory variation binder the clinical application of APLs and better understanding of APS diagnosis and treatment.Therefore,it is urgent to establish a standardize system for antiphospholipid antibodies test and to improve the performance of the test and perform well-designed clinical evaluation.

ObjectiveTo evaluate and improve the quality of autoantibodies testing in China.Methods 102 laboratories participated voluntarily in the survey of the quality of autoantibodies testing in October 2009 and received a total of 15 samples from Japan MBL company including 5 different assays:antinuclear antibody ( ANA),anti-double strain DNA (dsDNA) antibody,anti-extractable nuclear antigen (ENA) antibody,anti-mitochondrial antibody ( AMA),anti-smooth muscle antibody ( ASMA ) and anti-cyclic citrollinated peptide (CCP) antibodies.There were 3 samples for each assay.The samples were detected by routine methods.The results were reported with qualitive results (for all),titer (for ANA,antidsDNA antibody and AMA/ASMA),patterns (for ANA) and methods.At the same time,MBL company also distributed the samples to the laborotories in the other areas,Greece,Italy,Japan,Korea,Portugue and China Taiwan,respectively.The results from the other areas were analyzed by MBL company.The results from China were analyzed in our laborotories.The distribution of samples and analysis of testing results was double-blinded.Descriptive analysis were performed with Excel.Only descriptive analysis of the qualitiveresult,positive rate (laboratories that all three results were right/laboratories that took part in the relevant autoantibody detection) were done,and quantity results were set as reference.Results According to the standard results from the analysis of MBL company the rate of satisfied results of ANA,anti-dsDNA antibody,AMA,ASMA,anti-ENA antibody and anti-CCP were 80.8％ ( 80/99 ),81.2％ ( 78/96 ),86.3％ (44/51),76.3％ (29/38),95.9％ (93/97) and 93.1％ (67/72),respectively.The accuracy rate of the titer for ANA was low and related results of sample 901 and 902 were 12.7％ (11/79) and 7.6％ (6/79),respectively.Also a considerable discrepancy was found in the results of anti-CCP among different laboratories using different commercial kits.The ranges of sample 921 and 923 were 10.0-419.0 U/ml and 15.3-418.5 U/ml,respectively.Conclusions The accuracy rates of the rate of satisfied results among ANA,anti-dsDNA antibody,AMA,and ASMA were lower than 90％,however,it's satisfed that the rate is higher than 90％ in anti-ENA antibody and anti-CCP.Internal quality control of ANA titer,AMA and ASMA,and external quality assurance of anti-CCP should be improved.

Objective To explore the differentially expressed genes in peripheral blood mononuclear cells of patients with primary biliary cirrhosis and compare it with healthy controls.Methods Peripheral blood mononuclear cells were isolated from 9 primary biliary cirrhosis patients and 9 age and sex matched healthy controls.Total RNA was extracted from peripheral blood mononuclear cells and analyzed by human genome oligonucleotide microarrays (22K).The differences of gene expression and signaling pathway of patients and healthy controls were compared.Results Seventy-nine genes differentially expressed in primary biliary cirrhosis were identified by microarray analysis,in which 21 were up-regulated and 58 were downregulated.The genes were further categorized into 27 signaling pathways,in which 6 pathways were involved in immune regulation and apoptosis:natural killer cell mediated cytotoxicity pathway,toll-like receptor signaling pathway,antigen processing and presentation pathway,cytokine-cytokine receptor interaction pathway,T cell receptor signaling pathway and apoptosis pathway.Conclusion This study has identified that some genes are different in transcription expression in the primary biliary cirrhosis patients.It may provide new clues for the pathogenesis and biomarker studies.

Objective To assess regional cerebrovascular reactivity (CVR) and cognition impairment of subcortical ischemic vascular disease (SIVD). To show whether CVR affects cognitive impairment of SIVD patients. Methods Arterial spin-labeling (ASL) by MR image was applied in measuring regional cerebral blood flow (rCBF) of frontal lobe, temporal lobe, parietal lobe, occipital lobes after 5% CO2 inhalation, and the CVR was demonstrated by increase rate of rCBF in all the subject areas. Results (1)The patients with SIVD had reduced CVR in cortex of frontal lobes, white matter of frontal lobes, temporal lobes and occipital lobes(P < 0.05). (2) CVR in the SIVD patients with cognitive impairment decreased in frontal cortex and white matter when compared with the patients without cognitive impairment(P < 0.01). Conclusion These results showed that CVR decreased significantly in cortical gray matter and white matter in elderly patients with SIVD. Also the reduction of CVR in the frontal cortex and white matter was associated with cognitive impairment.

Objective Matrix-assisted laser desorption ionization-time of might-mass spectrometry (MALDI-TOF-MS) was utilized to analyze the protein fingerprint in brain-gut interaction of irritable bowel syndrome (IBS) model rats' colon, so as to find the clues for IBS. Methods Fourteen healthy male adult Wistar rats were selected and divided into a control and a chronic and acute stress ( CAS) group. Colon motility, visceral sensation and behavior changes of rats were detected to evaluate the model. MALDI-TOF-MS was used to observe the overall view of protein in colon so as to study whether there are abnormalities of protein levels in IBS. Results As compared with those in the control group, the number of fecal pellets [ (6. 00 ± 1. 69 ) pellets/1 h vs ( 1. 14 ± 0. 69 ) pellets/1 h, P < 0. 01 ] and frequency of abdominal contraction induced by colorectal distention (CRD) increased, while the amount of weight gain [ (298. 88 ± 18.61)gvs (348. 00±12. 44)g, P<0.01] and consumption of sucrose solutions [ (13. 63 ± 1. 69) ml/1 h vs (19.00±3.06) ml/1 h, P<0.05] decreased in the CAS group (P <0. 05). As far as protein/peptide quality different peak was concerned, CAS rats had 12 different peaks compared with the control rats. The different proteins could be divided into 4 types, which were related to iron secretion, protein synthesis, G protein system and immunity. The protein levels of the model group were higher than those in the control group (P < 0. 05). Conclusions The CAS rats integrate the major characteristics of IBS such as altered colon motility, higher visceral hypersensitivity and psychiatric disorder and can mimic the brain-gut interaction of IBS partly. The detection of differential proteins provides reference for the pathogenesis and treatment of IBS.

Objective: To investigate the ratios of peripheral blood CD4+CD25+,CD4+CD8+ regulative T cells of systemic lupus erythematosus(SLE) patients, and explore the association with disease active stage,nephropathy,serum anti-ds-DNA antibody,and both IgG and C3 levels. Methods: The percentage of CD4+CD25+T cells and CD4+CD8+T cells of peripheral blood from patients with systemic lupus erythematosus(SLE)(30 females and 7 males),30 rheumatism controls and 30 normal individuals were measured by flowcytometry. Results: Patients with active disease had statisitically lower levels of CD4+CD25+T cells than did normal controls(P

Objectives To investigate the ratios of peripheral blood CD4+CD8+ and CD4+CD25+ regulative T cells, and explore the association with hepatic damnification and anti-AMA-M2 antibodies.Methods The percentage of CD4+CD8+T cells and CD4+CD25+T cells in peripheral blood from patients with primary biliary cirrhosis(PBC) (n=27)、26 patients with other hepatic desease、30 normal individuals were measured by flowcytometry.Results Patients with PBC had statistically higher levels of CD4+CD25+T cells than the patients with other hepatic disease (P

Objective To detect the value of autoantibedy profile in primary biliary cirrhosis (PBC). Methods 96 serum samples of patients with primiary biliary cirrhosis, 100 serum samples of other antoimmune disease and 49 serum samples of healthy were tested for anti- M2, anti-3E(BPO), anti-Sp100,anti-PML,anti-gp210,anti-LKM-1 ,anti-LC-1 ,anti-SLA/LP by EUROLine. Results The positive of the anti-M2,anti-BPO, anti-Sp100, anti-PML and anti-gp210 for PBC was 76. 0%, 84.4%, 32. 3%, 28. 1% and 35.4% ,respectively. The positive of the anti-M2, anti-BPO, anti-Sp100, anti-PML and anti-gp210 for other autoimmune disease was 13.0% ,9. 0% ,3.0% ,2.0% and 1. 0%, respectively. The sensitivity of the anti-M2 for PBC was 76. 0% ,with specificity of 87. 0%. The sensitivity of the anti-BPO for PBC was 84. 4%, with specificity of 91.0% ;the sensitivity of the anti-Sp100 for PBC was 32. 3%, with specificity of 97.0%. The sensitivity of the anti-PML for PBC was 28. 1% ,with specificity of 98.0%. The sensitivity of the anti-gp210 for PBC was 35.4%, with specificity of 99. 0% . Anti-LKM-1, anti-LC-1, anti-SLA/LP positive patients with PBC were not detected;the incidence rate of liver function failure in anti-gp210 positive serum higher than anti-gp210 negative serum (χ2 = 11.17, P < 0. 01). Conclusions Multiple autoantibedies can be detected in the sera of PBC patients. The detection of autoantibody profile is useful for the diagnosis and differential diagnosis of PBC, and may he helpful for therapy and prognosis of PBC.

Objective To describe the immunological characteristics of refractory primary biliary cirrhosis compared with the typical patients for more than 1 year's administration of UDCA.Methods Sixty patients treated with UDCA for more than 1 year in our clinic were enrolled into this study.According to the response to UDCA by Paris criteria,patients were divided into refractory group (23 patients) and typical groups (37 patients).The recent peripheral lymphocyte subsets and cytokines of the two groups were tested and analyzed.One-way ANOVA and t test were used for statistical analysis.Results ① One-year treatment after diagnosis,there were no differences between the two groups in the distribution of peripheral lymphocytic subsets,meanwhile,the two groups had higher percentage of B cells,CD4+T cells,CD4+CD28+T cells and CD8+ CD28-T cells than healthy controls respectively.② The serum levels of IL-6 [(0.8±0.9) pg/ml vs (0.3±0.4) pg/ml] and HGF were higher in the refractory group than other groups.Conclusion During the plateau phase,refractory PBC patients have higher serum levels of IL-6 and HGF,which probably suggest that the refractory PBC patients may have severe immunologic disturbance in vivo.