The clinical data of a child with refractory systemic juvenile idiopathic arthritis (sJIA) who was admitted to the Children′s Hospital, Zhejiang University School of Medicine in October 2023 were analyzed, and literature review was conducted.The patient was a 9-year-old boy, who was admitted due to recurrent fever, accompanied by rash and joint pain for more than 4 years.Four years ago, he was diagnosed with macrophage activation syndrome and sJIA.In the past 4 years, the condition recurred 3 times under treatment with glucocorticoids, Cyclosporine, and Methotrexate.He previously experienced allergic shock after 5 minutes of infusion of Tocilizumab.Due to Tocilizumab allergy, he was treated with Janus kinase inhibitors, but the disease still recurred.After informed consent was obtained from the guardian, 240 mg of Tocilizumab was administrated for desensitization once every 2 weeks and the process went smoothly.The patient has been followed up for more than 6 months and no allergic reactions had occurred.The condition was well controlled, and the Prednisone acetate tablet had been reduced to 2.5 mg orally once a day.At present, there are 10 patients undergoing desensitization treatment both domestically and internationally, including 2 males and 8 females, aged between 2.5 and 54.0 years.All of them have achieved a success in desensitization.Therefore, Tocilizumab desensitization therapy is of great significance for patients who are allergic to biologics in clinical practice.

The clinical data of a child with refractory systemic juvenile idiopathic arthritis (sJIA) who was admitted to the Children′s Hospital, Zhejiang University School of Medicine in October 2023 were analyzed, and literature review was conducted.The patient was a 9-year-old boy, who was admitted due to recurrent fever, accompanied by rash and joint pain for more than 4 years.Four years ago, he was diagnosed with macrophage activation syndrome and sJIA.In the past 4 years, the condition recurred 3 times under treatment with glucocorticoids, Cyclosporine, and Methotrexate.He previously experienced allergic shock after 5 minutes of infusion of Tocilizumab.Due to Tocilizumab allergy, he was treated with Janus kinase inhibitors, but the disease still recurred.After informed consent was obtained from the guardian, 240 mg of Tocilizumab was administrated for desensitization once every 2 weeks and the process went smoothly.The patient has been followed up for more than 6 months and no allergic reactions had occurred.The condition was well controlled, and the Prednisone acetate tablet had been reduced to 2.5 mg orally once a day.At present, there are 10 patients undergoing desensitization treatment both domestically and internationally, including 2 males and 8 females, aged between 2.5 and 54.0 years.All of them have achieved a success in desensitization.Therefore, Tocilizumab desensitization therapy is of great significance for patients who are allergic to biologics in clinical practice.

Objective:To investigate the factors influencing postpartum depression (PPD) in elderly multipara undergoing repeat cesarean section.Methods:A convenience sampling method was used to select 160 elderly multipara who underwent repeat cesarean section and completed follow-up at the Department of Obstetrics, First Affiliated Hospital of Zhengzhou University, from June 2021 to June 2023. The Edinburgh Postnatal Depression Scale (EPDS) was employed to assess PPD incidence, classifying participants into PPD and non-PPD groups. Binary Logistic regression analysis was conducted to identify factors influencing PPD.Results:The incidence of PPD among the 160 elderly multipara was 33.13%. Binary Logistic regression analysis indicated that monthly household income, postpartum sleep disturbances, and newborn weight were influencing factors for PPD in elderly multipara undergoing repeat cesarean section.Conclusions:Monthly household income, postpartum sleep disturbances, and newborn weight are significant factors influencing the occurrence of PPD in elderly multipara undergoing repeat cesarean section.

Objective:To investigate the factors influencing postpartum depression (PPD) in elderly multipara undergoing repeat cesarean section.Methods:A convenience sampling method was used to select 160 elderly multipara who underwent repeat cesarean section and completed follow-up at the Department of Obstetrics, First Affiliated Hospital of Zhengzhou University, from June 2021 to June 2023. The Edinburgh Postnatal Depression Scale (EPDS) was employed to assess PPD incidence, classifying participants into PPD and non-PPD groups. Binary Logistic regression analysis was conducted to identify factors influencing PPD.Results:The incidence of PPD among the 160 elderly multipara was 33.13%. Binary Logistic regression analysis indicated that monthly household income, postpartum sleep disturbances, and newborn weight were influencing factors for PPD in elderly multipara undergoing repeat cesarean section.Conclusions:Monthly household income, postpartum sleep disturbances, and newborn weight are significant factors influencing the occurrence of PPD in elderly multipara undergoing repeat cesarean section.

OBJECTIVETo evaluate the efficacy and safety of humanized anti-IL-6 receptor monoclonal antibody (tocilizumab) in treatment of systemic juvenile idiopathic arthritis (sJIA).

METHODSThirteen sJIA patients admitted between December 2015 and November 2016 and received tocilizumab treatment were enrolled in the study. The complete blood count (CBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6) and ferritin levels were measured; American College of Rheumatology Pediatric(ACR Pedi)30/50/70/90 scores were assessed; and the use of glucocorticosteroid and adverse events were documented.

RESULTSCompared with the baseline levels, the CRP and ESR at d3 were decreased (all<0.05); hemoglobin was increased and platelet was decreased at week 2 (all<0.05), ferritin decreased at week 4, white blood cell (WBC) decreased at week 8 after treatment with tocilizumab (all<0.05). The level of IL-6 was rising at d3 and week 2 and descending at week 4, but no significant difference was observed compared with the baseline level (all>0.05). All 13 patients achieved ACR Pedi 30 remission at week 4, 61.5% achieved ACR Pedi 90 remission and glucocorticosteroids were withdrawn at week 20. Twenty two adverse events occurred, and infection accounted for 54.5% (12/22); no severe adverse reactions were observed during 20-week follow-up.

CONCLUSIONSTocilizumab is safe and effective in treatment of sJIA, with decreasing inflammation, improving disease activity and reducing glucocorticosteroid use.

Objective To evaluate the clinical and radiological results of Phlios plate and Multiloc nail in treatment of proximal humerus fractures.Methods From February 2013 to December 2015,data of 37 cases of proximal humerus fractures who were treated by reduction and fixation using Phlios plate or Multiloc nail were retrospectively analyzed.In group one (Phlios plate),there were 10 males and 8 females,with an average age of 56.3±5.8 years,including 7 cases of Neer 2-part surgical neck fracture,6 cases of Neer 3-part fracture,4 cases of Neer 4-part fracture,and 1 case of fracture-dislocation.In group two (Multiloc nail),there were 8 males and 11 females,with an average age of 57.2±7.4 years,including 8 cases of Neer 2-part surgical neck fracture,9 cases of Neer 3-part fracture,1 case of Neer 4-part fracture,and 1 case of fracture-dislocation.Operation time,range of motion of shoulder joint,visual analogue scale (VAS) pain score,American Shoulder & Elbow Surgeon (ASES) score and ConstantMurley score were collected.Results All 37 patients were followed up for an average period of 15.5 months (range,12-36 months).The average bone healing time were 2.5±0.5 months (range,2-3 months)and 2.2±0.5 months (range,1.5-3 months) in the plate and nail group respectively.At the latest follow-up,average VAS score was 0.4±0.6 (range,0-2),the ASES score aver aged 85.4±6.8 points (range,73-96),Constant-Murley score averaged 83.4±7.3 points (range,71-94),and external rotation averaged 30.8°±10.0° (range,10°-50°) in plate group,while average VAS score was 0.2±0.4 (range,0-1),ASES score averaged 89.7± 5.6 points (range,80-98),Constant-Murley score averaged 88.5±6.8 points (range,76-98),and external rotation averaged 40.3°± 7.9° (range,20°-50°) in the intramedullary nailing group.One case had partial necrosis of humeral head in the plate group,while 1 case suffered absorption of the greater tuberosity in the nail group,with the complication rate of 5.6％ (1/18) and 5.3％ (1/19) respectively,without significant difference.The internal and external rotation degrees,ASES and Constant-Murley scores were better in nail group than those in plate group for 2-part fractures,while the forward elevation and abduction degrees were similar.Conclusion Similar results were achieved for the treatment of proximal humeral fractures by Phlios plate and Multiloc nail.The Multiloc nailing group had achieved superior outcomes in Neer-2-part proximal humeral fractures.

OBJECTIVETo investigate the serum levels of Th1/Th2 cytokines in children with non-systemic juvenile onset idiopathic arthritis (non-SOJIA).

METHODSClinical data of 41 children with non-SOJIA, including 11 cases of polyarthritis, 10 cases of oligoarthritis and 20 cases of enthesitis related JIA (ERA), admitted in Children's Hospital of Zhejiang University School of Medicine during November 2012 and May 2015 were retrospectively analyzed. Serum levels of Th1/Th2 cytokines including IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ were measured by flow cytometry in patients with non-SOJIA, and compared with those in patients with SOJIA (SOJIA group, n=85) and healthy children (control group, n=202); their correlations with erythrocyte sedimentation rate and C reactive protein and CRP were analyzed.

RESULTSCompared with the healthy control group, serum levels of IL-2, IL-6 and IFN-γ were significantly increased in patients with non-SOJIA (2.9 vs. 2.6 pg/mL, 9.9 vs. 6.4 pg/mL, 6.3 vs. 5.1 pg/mL, allP<0.05),while levels of TNF-α and IL-10 were significantly decreased (2.7 vs. 3.9 pg/mL, 2.9 vs. 7.1 pg/mL, both P<0.01). Compared with the SOJIA group, serum levels of IL-6 and IL-10 were significantly decreased in patients with non-SOJIA (9.9 vs. 33.5 pg/mL, 2.9 vs. 4.1 pg/mL, both P<0.01), while levels of IL-4 and IL-10 were significantly increased (3.1 vs. 2.3 pg/mL, 6.3 vs. 4.4 pg/mL, both P<0.05). Serum levels of IL-6 in patients with polyarthritis or ERA were higher than that in patients with oligoarthritis (12.7 and 11.0 vs. 4.2 pg/mL, both P<0.05). A positive correlation of IL-6 or TNF-α level with C reactive protein was observed in patients with ERA.

CONCLUSIONSThe results indicate that Th1/Th2 imbalance and Th1 predominance may exist in children with non-SOJIA; and IL-6 may be involved in the pathogenesis of non-SOJIA children with polyarthritis.

The diagnosis and treatment characteristics of head-wind sha in She medicine were analyzed and summarized. By visiting She-nationality villages and towns in Zhejiang province and Fujian province and interviewing hundreds of doctors of She medicine, the sha diagnosis, sha differentiation, experience and theory of treatment were arranged, and a comprehensive summary on theory and application of head-wind sha in She medicine such as pathogeny, name of disease, mechanism, diagnosis, differential diagnosis and treatment was made. It is believed that the methods of diagnosis and treatment in She medicine for head-wind sha could effectively enhance curative effect, safety and patients' quality of life, and the further research should be carried out.
Acupuncture Therapy ; China ; ethnology ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Headache Disorders ; diagnosis ; drug therapy ; ethnology ; therapy ; Humans

OBJECTIVETo study the changes in microtubule motor protein expression in the spinal cord and sciatic nerve of rats exposed to carbon disulfide, and to investigate the possible molecular mechanism of changes in axonal transport in carbon disulfide-induced peripheral neuropathy.

METHODSHealthy adult male Wistar rats were randomly divided into one control group and three experimental groups (10 rats per group). The rats in experimental groups were intoxicated by gavage of carbon disulfide at a dose of 200, 400, or 600 mg/kg 6 times a week for 6 consecutive weeks, while the rats in control group were given the same volume of corn oil by gavage. Animals were sacrificed after exposure, with nerve tissue separated. The levels of dynein, dynactin, and kinesin in the spinal cord and sciatic nerve were determined by Western blot.

RESULTSThe content of dynein, dynactin, and kinesin in the sciatic nerve decreased significantly under exposure to carbon disulfide. The levels of dynein in the sciatic nerve were reduced by 23.47% and 33.34% at exposure doses of 400 and 600 mg/kg, respectively. The levels of dynactin in the sciatic nerve of the three experimental groups were reduced by 19.91%, 24.23%, and 41.30%, respectively. The level of kinesin was reduced by 25.98%under exposure to 600 mg/kg carbon disulfide. All the differences were statistically significant (P < 0.01). As compared with the control group, the 600 mg/kg group experienced a 28.24% decrease in level of dynactin in the spinal cord (P < 0.01), but no significant change was observed in the level of dynein or kinesin.

CONCLUSIONCarbon disulfide has an impact on microtubule motor protein expression in nerve tissues, which might be involved in the development of carbon disulfide-induced peripheral neuropathy.

Animals ; Axonal Transport ; drug effects ; physiology ; Carbon Disulfide ; toxicity ; Dynactin Complex ; Male ; Microtubule-Associated Proteins ; metabolism ; Nerve Tissue ; metabolism ; Peripheral Nervous System Diseases ; chemically induced ; metabolism ; Rats, Wistar ; Sciatic Nerve ; metabolism ; Spinal Cord ; metabolism

Objective To explore the roles of B lymphocyte and plasma cell in liver allograft re-jection to find the evidences of humoral factor participating in the rejection. Methods Immunohisto-chemical inspection of C4d, CD20+ B lymphocytes and CD138+ plasma cells were performed in 34 liver biopsy specimens from 25 patients with hepatic injury and their preoperative specimens. Then we ob-served the variances of the above parameters in the liver biopsy specimens and the differences of them with different hepatic injuries. We further observed the relation of the presence of CD20+ B lympho-cytes and CD138+ plasma cells to C4d positivity. Meanwhile, we compared the difficulties of clinical therapy with different presences of CD20+ B lymphocytes and CD138+ plasma cells in the liver biopsy specimens. Results The positive ratios of CD20+B lymphocytes and CD138+ plasma cells were signif-icantly higher in the acute rejection group than in the non-rejection group(P<0. 05 and P<0. 01).The positive ratios of CD20+ B lymphocytes were markedly higher in the chronic rejection group than in the non-rejection group(P<0. 05). There was no difference in CD138+ plasma cells between the 2 groups. The degrees of hepatic injury could not influence the positive ratioes of CD138+ plasma, but the positive ratioes of CD20+ B lymphocytes in the heavy hepatic injury groups was higher than in the slight hepatic injury groups(P<0. 05). CD20+ B lymphocytes and CD138+ plasma cells presented fol-lowing C4d(P<0. 01 and P<0. 05). The effective power of steroid in the all-positive group was obvi-ously lower than in the all-negative group(P<0. 05). Conclusion Humoral immune may participate in some liver allograft rejection. It would be more favorable for observing and prewarning the humoral re-jection by finding CD20, CD138 and C4d by immunohistochemical staining in liver biopsy specimens with hepatic injury after liver transplantation. It would be helpful for choosing the therapeutic regi-mens of liver allograft rejection.