Objective To explore preliminarily the role of the E2 subunit of pymvate dehydrogenase (PDC-E2) modified by xenobiotics (e.g.2-octynic acid,2-OA) in the pathogenesis of primary biliary cirrhosis (PBC).Methods Patients of PBC (102 cases),primary sclerosing cholangitis (PSC,34 cases) and healthy controls (HC,50 cases) were selected.The anti-PDC-E2,anti-2-OA and anti-lipoic acid (LA) antibody in the peripheral blood of the 3 groups were tested by enzyme linked immunosorbent assay (ELISA).By inhibitive ELISA (iELISA),30 of the 102 PBC patients with anti-PDC-E2 antibody but without anti-2-OA antibody were selected to detect whether there was any new epitope on the PEC-E2 conjugated with 2-OA.The chi-square test and Fisher exact test were taken to analyze the enumeration data.The two-tailed unpaired t test with Welch's correction was used to compare the measurement data.Spearman rank correlation analysis was also employed for proper test.Results The positive rate of anti-PDC-E2,anti-LA and anti-2-OA antibody in PBC patients was 94.1％(96/102),73.5％(73/102) and 53.9％(55/102) respectively,all of which were statistically significantly higher than those in healthy controls group but were of no significant difference between PSC and healthy controls group.There was no significant relevance between the levels of Anti-LA and anti-2-OA antibody in the PBC group (r=-0.065,P=0.520).The iELISA results showed that the antibody,which only identified the epitopes on 2-OA-PDC-E2 induced by the 2-OA conjugation with PDC-E2,existed in 40％(12/30) of the PBC patients,and more interestingly,this antibody was predominantly appeared in PBC patients at their early clinical stage.Conclusion There are anti-LA antibody and anti-2-OA antibody in PBC patients,which have shown no significant association with each other.It is very likely that new antigenic conformational epitopes on PDC-E2 modified by 2-OA would emerge,which might led to the immune response in the individuals who are susceptible to PBC,and thus contribute for the breaking of PDC-E2 immune tolerance,and PBC occurrence finally.

Aim To study the effects of amitriptyline(Ami)on focal cerebral ischemia-reperfusion injury in rats.Methods An animal model of focal cerebral ischemia-reperfusion injury was induced by the middle cerebral artery occlusion(MCAO) by reversibly inserting a nylon thread method.The rats were decapitated after ischemia for 1 hour and reperfusion for 2 hours.The infarct volumes were determined using a 2,3,5-tri-phenyl tetrazolium chloride(TTC) staining and assessed by image analysis system.The neurologic deficit status were evaluated on 0~5 grade scale.The levels of dopamine(DA),norepinephrine(NE),serotonin(5-HT) and its metabolic product~hydroxyindole acetic acid(5-HIAA) in cortex and striatum were measured by fluoro-spectrophotometry.Results Ami treatment exhibited a remarkable reduction in infarct volume and neurologic deficit scores.The monoamines content of cortex and striatum had a significant increase compared with ischemia-reperfusion group.Conclusion Amitriptyline has protective effect on cerebral ischemia-reperfusion injury in rats.The mechanism might be related to reducing the release of NE,DA and 5-HT during cerebral ischemia-reperfusion,attenuating or inhibiting of the neurotoxic effects of monoamine neurotransmitters.

Objective To investigate the clinical characteristics of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (MPO-AAV) with pulmonary injury and the relationship between pulmonary injury and ANCA against light chain of MPO (LCMPO-ANCA).Methods A total of 195 patients with newly diagnosed primary active MPO-AAV were recruited in this prospective study.Indirect immunofiuorescence assay was used to detect peri-nuclear ANCA (p-ANCA).Immunoblotting and ELISA were used to detect myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA).Clinical features of patients with both positive p-ANCA and MPO-ANCA were collected.Disease activity was evaluated by Birmingham Vasculitis Activity Score-version 3 (BVAS-V3) Recombinant light chain of MPO was used to coat substrate of LCMPO-ANCA by ELISA.The clinical characteristics of pulmonary injury and its correlation with serum levels of p-ANCA,MPO-ANCA and LCMPO-ANCA were explored.Results All 195 patients (64 male and 131 female),consisted of 191 patients (98.0％) with microscopic polyangiitis,3 patients (1.5％) with granulomatosis with polyangiitis,and 1 (0.5％) with eosinophilic granulomatosis with polyangiitis including 64 men and 131 women.Their mean age was (63.2 ±13.5) years old.The level of MPO-ANCA had a positive correlation with general BVAS-V3 (r =0.193,P =0.007) in all patients,and the level of LCMPO-ANCA was positively related with the pulmonary BVAS-V3 (r =0.228,P =0.001).As for multiple systemic damages,the incidence of lung involvement was 60.51％(118/195),which ranked second to renal involvement (71.80％,140/195).The most common pulmonary injuries represented as pulmonary infiltration of 80.51％ (95/118),pleural effusion / pleurisy of 41.53％(49/118),pulmonary nodule or cavity of 22.03％ (26/118).Compared with those without lung involvement,the patients with pulmonary injuries were older [(66.39 ± 10.70) years old vs (58.30 ±15.72) years old;t =4.277,P =0.001],had a shorter course of disease [2.00(1.00,10.50) months vs 3.00(1.00,3.50) months;t =-2.283,P=0.024],and higher scores of general BVAS-V3 (18.21 ±6.08 vs 15.18 ± 5.64;t =3.501,P =0.001).Also,in the patients with pulmonary lesions,the positive rate of LCMPO-ANCA was significantly higher (35.59％ vs 6.49％;x2 =21.569,P ＜ 0.001),and the level of LCMPO-ANCA was significantly higher (0.377 ±0.229 vs 0.285 ±0.079;t =3.399,P =0.001)than those without lung involvement.The pulmonary BVAS-V3 in the patients with LCMPO-ANCA was significantly higher than that in the patients without LCMPO-ANCA (4.34 ± 2.10 vs 2.59 ± 2.52;t =4.301,P ＜ 0.001),whereas the pulmonary BVAS-V3 was not correlated with LCMPO-ANCA (r =0.035,P =0.708) in patients with lung injuries.Conclusion Pulmonary injury was relatively common and insidious in patients with MPO-AAV.To monitor ANCA level is necessary in patients with pulmonary injury.LCMPO-ANCA might play an important role in the pathogenesis of pulmonary lesions in AAV.

OBJECTIVE: To study the risk factors for severe acute pancreatitis (SAP) complicated by pancreatic encephalopathy (PE). METHODS: Clinical data from 255 patients with SAP from January 2005 to December 2006 were reviewed. Thirty-one SAP patients had PE, and 224 SAP patients did not. Clinical characteristics of SAP patients in both PE group and non-PE group were analyzed. RESULTS: Ranson scale and the incidence rates of acute respiratory distress syndrome (ARDS), renal failure, hypoproteinemia, hypocalcemia and hyperglycosemia in PE group were higher than those in non-PE group (P<0.05). There were no significant differences in acute physiology and chronic health evaluation II and CT severity index scales, the activities of amylase and lipase, the incidence rate of liver function failure, the infection rate and the operability between the PE group and the non-PE group (P>0.05). Multivariate logistic regression analysis showed that ARDS and hyperglycosemia were high risk factors. Cure rate in PE group was higher than that in non-PE group. CONCLUSION: Nosogenesis of PE is the result of multiple factors. ARDS and hyperglycosemia may be the high risk factors for PE.

Objective To test the level of cell factor interleukin (IL)-21,CXCL13 in the plasma of patients with rheumatoid arthritis (RA),and to analyze the relationship between Follicular helper T cells(Tfh)and clinic features and discuss the possible immunological pathogenesis of RA.Methods The Tfh cells were obtained from patients and healthy controls (NC) and detected by Flow cytometery.While the levels of IL-21,CXCL13 in patients and NC were measured by ELISA tests.Those analysis were performed by student's t-test,one-way ANOVA,SNK-q test,Chi-square test,Spearman's correlation and multiple linear regression.Results The expression of CD4+CXCR5+ICOS+ cells (Tfh) in PBMCs of RA was significantly higher than normal controls (3.0±1.2 vs 1.1±0.4,P＜0.01).Meanwhile,the three RA groups of patients were divided to low,moderate and high disease activity groups,and the results showed that the expression of Tfh were increased accordingly (1.8±0.7,2.5±0.6,4.0±1.2).The expression of Tfh in the three groups were all significantly higher than that of controls (P＜0.01).There was a positive correlation between Tfh and DAS28,ESR,CRP,TJC,and bone erosion,RF and anti-CCP respectively.The expression of Tfh in those patients who had bone destruction was higher than those with no or mild bone destructions (2.7±1.1vs 3.4±1.3).The expression of Tfh in patients with un-treated RA patients,when compared to those RA patients who were treated appropriately and those who were not treated appropriately,was decreased significantly.The expression of Tfh in appropriately treated RA patients was lower than that without appropriately treatment.The level of IL-21,CXCL13 was decreased in patients with RA in the order of high,moderate,low disease activity and NC.Conclusion The expression of Tfh and the levels of IL-21,CXCL13 are increased significantly,and are closely related to disease activity and bone ersions.The expression of Tfh is decreased after relevant treatment.These results indicate that the abnormality of Tfh may play an important role in the pathogenesis of RA.

Objective To explore the value of 64-row helical CT multi-phase enhancement scan combined with angiography (CTA)in the diagnosis of pulmonary mass.Methods Two hundred and sixty-five patients with pulmonary mass confirmed by pa-thology were checked,analyzed the CT sign of multi-phase enhancement scan and the blood supply of pulmonary mass displayed by CTA.Results Lung cancer was mainly supplied by bronchial arteries,some by body arteries,the feeding arteries display rate of lung cancer group was significantly higher than that of benign disease group(P <0.05).CT enhancement peak value of lung cancer group was significantly higher than that of tuberculoma group,inflammatory pseudotumor group and hamartoma group(P <0.05), but no significant difference between hemanginoma group(P >0.05).Enhancement dynamic curves of lung cancer group was differ-ent from benign lesion groups:Lung cancer without obvious enhancement in pulmonary artery phase,CT value increased rapidly in aorta phase,120 s reached peak,and declined slowly in delay phase;CT value of tuberculoma was increased slowly without obvious peak;CT value of inflammatory increased gradually in pulmonary artery phase,90 s reached the peak;hamartoma was no obvious enhancement;Hemangioma enhanced rapidly after strengthening in the pulmonary artery phase,reached the peak at about 15 s,and then decreased slowly.Conclusion 64-row helical CT multi-phase enhancement scan combined with angiography have important clinical value,which can differentiate malignant mass from benign ones.

Objective To explore the relationship between the respiratory disturbance index (RDI) detected by cardiopulmonary coupling (CPC) and all parameters of polysomnography (PSG), and to analyze the correlation of the two different analytical techniques for the interpretation of sleep breathing events.Methods In this case-control study, the patients′ CPC and PSG were simultaneously recorded at the Sleep Clinic at Changzheng Hospital from Janunary 2016 to December 2016.Effective recordings were obtained from 292 patients (male/female: 173/119).According to PSG, these patients were divided into two groups: obstructive sleep apnea hyponea syndrome (OSAHS) group (n=173, aged (50.1±13.3) years) and non-OSAHS group (n=119, aged (50.5±11.7) years).All the PSG parameters and the RDI detected by CPC were compared between the two groups.Pearson correlation was used to analyze the relationship between the CPC-RDI and polysomnography parameters, and Bland-Altman chart was used to test the correlation of the two methods.The receiver operator characteristic curve was used to research the value of CPC-RDI in diagnosis of OSAHS.Results The OSAHS group showed higher levels of total sleep time (TST, (445.94±82.64) min), apnea times ((108.16±35.70)/h), hypopnea rate ((55.62±17.44)/h), apnea hyponea index (AHI, (22.78±20.73)/h), Epworth Sleeping Scale (ESS) scores ((11.21±5.30) scores), CPC-RDI ((32.98±22.19)/h) compared with the non-OSAHS group ((417.21±96.10) min,t=2.730;(7.89±5.41)/h,t=30.384;(11.05±2.23)/h, t=27.709;(5.51±3.11)/h,t=9.014;(7.61±2.29)scores,t=6.973;(11.16±8.63)/h,t=10.205, all P<0.01), and a significant decrease in N1 latency ((14.79±9.29) min vs (18.18±8.98)min, t=-3.106), N3% ((6.53±4.95)% vs(8.83±7.29)%,t=-3.212) and the lowest oxygen saturation (SaO2;(77.91±12.21)% vs(92.72±5.17)%, t=-12.479, all P<0.05 respectively).Pearson correlation analysis indicated that RDI was positively correlated with TST, N2 sleeping time, N3 sleeping time, AHI, microarousals index, leg movements index, and ESS scores (P<0.01 respectively).Remarkably, the correlation between CPC-RDI and PSG-AHI was excellent (r=0.801, P<0.01), and CPC-RDI was negatively correlated with lowest SaO2 (r=-0.765, P<0.01).Bland-Altman showed that the points in the limits of agreement accounted for more than 95% of all points.If CPC-RDI is higher than 18.95, the subjects were more likely with OSAHS.The sensitivity was 62.9% and the specificity was 88.7%.In addition, the enhanced low-frequency coupling parameters in the CPC analysis technique can clearly analyze the central respiratory rhythm disturbance.Conclusions CPC technology is an effective assessment technology to diagnose sleep-disordered breathing, and correlates well with AHI detected by traditional PSG.It shows the advantage of screening for central sleep apnea.

Objective To investigate the expression of CD55 and myeloperoxidase (MPO) on neutrophils in patients with MPO-specific anti-neutrophil cytoplasmic antibody associated vasculitis(MPO-AAV), and analyze the relationship between the expression and clinical manifestation.Methods Forty untreated patients with active MPO-AAV (patient group) and 30 healthy volunteers (control group) were enrolled in this study.The CD55 on neutrophils and both membrane and cytoplasmic MPO were detected by flow cytometry.Serum fragment-from the activated complement factor B(Ba) and MPO were measured by ELISA.The clinical activity of vasculitis was valued by Birmingham vasculitis activity score-version 3(BVAS-V3).The significance of laboratory data was evaluated by Spearman correlation test and multivariate linear regression analysis.Results (1)The mean fluorescence intensity(MFI) of CD55 expressed on neutrophils was significantly higher than that in control group[4 068.6±2 306.0 vs 2 999.5±1 504.9,P=0.033].Similar results of serum MPO and Ba in patient group were found compared to controls [500.0(381.0, 612.7) IU/L vs 286.9(225.5, 329.1) IU/L,P<0.001;35.2(25.2, 79.5) ng/L vs 18.0(15.0, 28.0) ng/L,P<0.001], respectively.However, MIF of cytoplasmic MPO in patients was significantly lower than that of control group(1 577.1±1 175.9 vs 3 105.3±2 323.0,P=0.003).(2) In patient group, cytoplasmic intensity of MPO was negatively associated with the serum levels of MPO(r=-0.710,P<0.001) and Ba (r=-0.589,P=0.001).Moreover, serum MPO was positively associated with serum Ba(r=0.691,P<0.001).Membrane intensity of CD55 on neutrophils was positively correlated with patient age (r=0.514, P=0.001), C reactive protein (r=0.376, P=0.018), peripheral neutrophils count (r=0.485, P=0.001) and BVAS-V3 (r=0.484, P=0.002), whereas negative correlation between membrane CD55 and disease duration was seen (r=-0.403,P=0.01).(3) The result of multiple linear regression analysis showed there was statistically significant positive correlation between MFI of CD55 expressed on neutrophils and BVAS-V3 (β=0.001,P=0.027).Conclusions In MPO-AAV,CD55 expression on neutrophils is markedly enhanced, which is one of the independent risk factors related to disease activity.It might protect neutrophils from attacking AAV, CD55 expression on neutrophils is markedly enhanced, which is one of the independent risk factors related to disease activity.It might protect neutrophils from attacking by complement alternative pathway.Activated neutrophils release more MPO and lysosome to intensify the inflammation reaction and aggravate the disease.Thus CD55 might become a new potential target for the treatment of this disease in the future.

Objective To measure the morphological parameters of the acromion with CT and to analyze their match with the hook plate. Methods From October 2009 to February 2010,spiral CT scanning (with Somatom Emotion16) and three-dimensional reconstruction of bilateral shoulders were conducted in 61 Chinese subjects.They were 24 men and 37 women,aged from 20 to 83 years (average,45.2 years).The thickness,length and width of the acromion were measured and the subacromial shape was observed with software of the CT system to analyze the match between the hook plate and the acromion.Results The mean thickness of the acromion was 0.85 ± 0.13 cm in all subjects,0.94 ± 0.12 cm in males and 0.79 ± 0.10 cm in fe males,with a significant difference between males and females ( t =2.382,P =0.202).The mean acromion length was 2.08 ± 0.20 cm in all subjects,2.09 ± 0.21 cm in males and 2.06 ± 0.18 cm in females,with no significant difference between males and females( t =1.541,P =0.129).The mean acromion width was 3.81 ± 0.52 cm in all subjects,4.34 ± 0.32 cm in males and 3.47 ± 0.25 cm in females,with a significant difference between males and females ( t =2.296, P =0.025 ). Conclusions The acromial morphology varies significantly between genders in Chinese population,particularly in the thickness and width.It is,therefore,necessary to modify the morphological parameters of the hook plate to match better the gender difference in Chinese population.It is optimal that the hook plate should allow individualized pre-moulding to enhance its therapeutic efficacy.

ObjectiveTo investigate the clinical characteristics and predisposing factors of systemic lupus erythematosus(SLE) with sepsis.MethodsTwenty-one SLE patients with sepsis admitted to our hospital between 2005-2010 were reviewed in this study.The other 21 inpatients with active SLE in our hospital in the same period were randomly selected as controls.Clinical and laboratory documents of these patients were comparatively analyzed.Results The peak body temperature [ (39.4±0.6) vs (37.2±0.4) ℃,t=13.403,P=0.000],the hyperpyrexia (T≥39 ℃) incidence (71％ vs 5％,X2=19.788,P=0.000),the white blood cell (WBC) counts[(10.2±4.6) vs(6.2±2.5)×109/L,t=3.469,P=0.001)] and neutrophils in the peripheral blood [(8.3±4.5) vs(4.5±2.1)×109/L,t=3.559,P=0.001 ],the C-reactive protein(CRP) level [ (74±59) vs (5±4) mg/L,t=5.398,P=0.000 ] and lactate dehydrogenase (LDH) level[ (444±343) vs ( 225±144) U/L,t=5.398,P=0.000] in the sepsis group were significantly higher than those in the control group.It was noticeable that CRP in the sepsis group was 15 to 20 times higher than that in the control group.The level of serum albumin[ (29±9) vs(35±7) g/L,t=2.688,P=0.011 ],the maintenance dosage of hydroxychloroquine [(0.11±0.08) vs(0.17±0.09) g/d,t=2.331,P=0.025],the frequency of autoantibodies against SSA (38％ vs 71％,X2=4.709,P=0.03) or SSB(0 vs 43％,X2=11.455,P=0.001) in the sepsis group were significantly lower than those in the control group.Correlation analysis showed that,in the sepsis group,the SLE disease activity index (SLEDAI) had significant positive association with SLE duration (r=0.514,P=0.017),the WBC count (r=0.552,P=0.010) and neutrophils count(r=0.545,P=0.011 ),respectively.The neutrophil count correlated positively with the LDH(r=0.482,P=0.032) and CRP(r=0.606,P=0.022).These correlations were not statistically significant in the control group.ConclusionSepsis should be considered when SLE patients have hyperpyrexia,high levels of WBC and neutrophils,markedly elevated LDH and CRP level,especially when the CRP increases ten times higher than the normal limit.SLE activity and sepsis might affect each other,and this may be more evident in patients with longer disease duration.Hypoalbuminemia and negative autoantibody to SSA or SSB are likely to be the risk factors for SLE to develop sepsis while hydroxcyhloroquine may be protective against sepsis.