BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and joint destruction. Iguratimod (IGU) is a novel conventional synthetic disease-modifying antirheumatic drugs (csDMARD) with good efficacy and safety for the treatment of active RA in China and Japan. However, the long-term effects of IGU on the progression of bone destruction or radiographic progression in patients with active RA remain unknown. We aimed to investigate the efficacy and safety of iguratimod (IGU), a combination of methotrexate (MTX) and IGU, and IGU in patients with active rheumatoid arthritis (RA) who were naïve to MTX. METHODS: This multicenter, double-blind, randomized, non-inferiority clinical trial was conducted at 28 centers for over 52 weeks in China. In total, 911 patients were randomized (1:1:1) to receive MTX monotherapy (10-15 mg weekly, n = 293), IGU monotherapy (25 mg twice daily, n = 297), or IGU + MTX (10-15 mg weekly for MTX and 25 mg twice daily for IGU, n = 305) for 52 weeks. The patients' clinical characteristics, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), disease activity score in 28 joints-C-reactive protein (DAS28-CRP) level, and disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) were assessed at baseline. The primary endpoints were the proportion of patients with ≥20% improvement according to the American College of Rheumatology (ACR20) response and changes in the van der Heijde-modified total Sharp score (vdH-mTSS) at week 52. RESULTS: The proportions of patients achieving an ACR20 response at week 52 were 77.44%, 77.05 %, and 65.87% for IGU monotherapy, IGU + MTX, and MTX monotherapy, respectively. The non-inferiority of IGU monotherapy to MTX monotherapy was established with the ACR20 (11.57%; 95% confidence interval [CI], 4.35-18.79%; P <0.001) and vdH-mTSS (-0.37; 95% CI, -1.22-0.47; P = 0.022). IGU monotherapy was also superior to MTX monotherapy in terms of ACR20 ( P = 0.002) but not the vdH-mTSS. The superiority of IGU + MTX over MTX monotherapy was confirmed in terms of the ACR20 (11.18%; 95% CI, 3.99-18.37%; P = 0.003), but not in the vdH-mTSS (-0.68; 95% CI, -1.46-0.11; P = 0.091). However, the difference in the incidence rates of adverse events was not statistically significant. CONCLUSIONS: IGU monotherapy/IGU + MTX showed a more favorable clinical response than did MTX monotherapy. IGU may have some clinical benefits over MTX in terms of radiographic progression, implying that IGU may be considered as an initial therapeutic option for patients with active RA. TRIAL REGISTRATION https://classic.clinicaltrials.gov/ , NCT01548001.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Antirheumatic Agents/therapeutic use* ; Arthritis, Rheumatoid/drug therapy* ; Chromones/adverse effects* ; Double-Blind Method ; Drug Therapy, Combination ; Methotrexate/adverse effects* ; Treatment Outcome ; Sulfonamides

Objective:To identify the risk factors of heart failure in elderly patients with hip fracture by Meta-analysis.Methods:The clinical studies on perioperative heart failure in elderly patients with hip fracture were searched by computer in Pubmed, EMbase, Cochrane Library, Medline, Web of Science, CNKI, CBM, Wanfang and VIP database. The retrieval period was from the establishment of the databases to October 2021. The literature screening, data extraction and quality evaluation were completed by two researchers, and the selected literature were statistically analyzed by RevMan5.3 software.Results:A total of 17 articles were included in this study, involving 1 76 611 patients and 24 related risk factors. Cardiac history ( OR= 4.47, 95% CI 3.56-5.62), positive balance of perioperative inflow and outflow ( OR=5.99, 95% CI 3.30-10.87), anemia ( OR= 3.78, 95% CI 2.50-5.69), and the number of complications >4 ( OR=6.21, 95% CI 3.71-10.38), electrolyte disorder ( OR=7.40, 95% CI 3.77-14.54), preoperative cognitive impairment ( OR=3.60, 95% CI 1.39-9.31) and American Society of Anesthesiologists (ASA) grade ≥ 3 ( OR= 4.73, 95% CI 2.73-8.12) were statistically significant risk factors ( P<0.05). Conclusions:Cardiac history, positive balance of perioperative inflow and outflow, anemia, number of complications >4, electrolyte disorder, preoperative cognitive impairment and ASA grade ≥3 were the risk factors of perioperative heart failure in elderly patients with hip fracture.

This study was aimed to analyze the content variations of chemical constituents produced in fresh Radix Rehmanniae (Xian-Di-Huang) after processing into Radix Rehmanniae Recens (Sheng-Di-Huang) and Radix Rehmanniae Preparata (Shu-Di-Huang). HPLC was used in the study of preparing Xian-Di-Huang into Sheng-Di-Huang, and the processing into Shu-Di-Huang. The contents of two newly produced chemical components, which were 2,3-dihydro-3,5-dihydroxy-6-methyl-4H-pyran-4-one (DDMP) and 5-hydryoxymethyl-furfural (5-HMF). The contents of both chemical components were determined in Sheng-Di-Huang and Shu-Di-Huang bought from the market. The Zorbax SB-C18 column (250 mm í 4.6 mm, 5 μm) was used. The mobile phase was methanol-wa-ter (5:95). The flow rate was 1.0 mL·min-1. The detection wavelength was set at 280 nm. The results showed that no DDMP or 5-HMF was detected in Xian-Di-Huang. However, after processing, DDMP and 5-HMF can be de-tected in both Sheng-Di-Huang and Shu-Di-Huang. The content in Shu-Di-Huang was higher than that in Sheng-Di-Huang. Both contents in Shu-Di-Huang were gradually increased along with processing time. The con-tent reached to the highest level after processing for 24 h and 32 h, respectively. And then, the content decreased. Both DDMP and 5-HMF were detected from three batches of Sheng-Di-Huang and ten batches of Shu-Di-Huang bought from the market. The content of 5-HMF was higher in Shu-Di-Huang than in Sheng-Di-Huang. There was no obvious difference in the content of DDMP between Sheng-Di-Huang and Shu-Di-Huang. It was concluded that DDMP and 5-HMF were produced in the processing Sheng-Di-Huang and Shu-Di-Huang. The contents were gradually increased along with the prolonging of processing time. There was obvious difference in the content of 5-HMF in Shu-Di-Huang and Sheng-Di-Huang.

Objective To construct a lentivirus vector for RNA interference targeting myosin Va gene and to observe its effect on motility and migration of human pulmonary giant cell carcinoma PG cells. Methods Based on the efficient target sequence for myosin Va RNAi, two pairs of oligo DNA containing myosin Va RNAi target sequence or scramble sequence were synthesized and inserted into pSuper vector, followed by sequence analysis. The expressing cassette H1 promoter-shM5A/shCON from the recombinant pSuper plasmid was then transferred to the lentivirus vector plenti4, and the recombinant lentivirus was packaged. PG cells were transduced with the packaged lentivirus and the positive cells were screened by zeocin selection. RT-PCR was performed to determine the myosin Va RNAi efficiency in zeocin-resistant PG cells, and wounding assay and Boyden chamber assay were utilized to examine the capabilities of motility and migration in myosin Va RNAi PG cells. Results Restriction enzyme digestion and sequencing confirmed the successful construction of the lentivirus vector containing myosin Va RNAi target or scramble sequence. RT-PCR result showed that myosin Va mRNA levels were remarkably reduced in lentivirus-based myosin Va RNAi PG cells. The abilities of motility and migration were also significantly inhibited in lentivirus-based myosin Va RNAi PG cells, as demonstrated in wounding assay and Boyden chamber assay.Conclusion Myosin Va RNAi lentivirus vector was successfully constructed and efficiently repressed myosin Va expression in PG cells. Repression of myosin Va by RNAi led to the inhibition of PG cells motility and migration, indicating that there might exist correlation between the expression of myosin Va and cancer progression.

BACKGROUND: The biomechanical property(BP) of the bone is decided by its geometric structure and component material. Merely pursuing increase of the bone mineral density(BMD) might lead to deterioration of bone BP.However at present, some researohes on therapeutic action on osteoporosis emphasize excessively medical influence to BMD, and the change in the holistic BP of the bone in osteoporotic zone and its mechanism still need to investigate deeply.OBJECTIVE: To probe into the action and its mechanism of "the kidney tonifying compound of the Traditional Chinese Medical (TCM) "on BP of cortical bone in ovariectomized osteoporotic model rats.DESIGN: Completely randomized controlled experiment based on experimental animals.SETTING: Laboratory of Biomedical Engineering, Luoyang Hospital and Institute of Traditional Chinese Orthopedics and Traumatology in Henan Province.MATERIALS: The experiment was completed from November 2000 to July 2001 at Research Laboratory of Biomedical Engineering,Luoyang Institute of Traditional Chinese Orthopedics and Traumatology of Henan Province. The healthy Wistar female rats aged 10 months,weighing(350±20) g.METHODS: Fifty Whistar female rats aged 10 months were randomly divided into 5 groups: the normal, model, premarin-treated, xianling gubao-treated and migu capsule-treated with 10 in each group. The normal group was only given sham operation and the other four groups were ovariectomized. The rats after operation were fed normally for ninety days.Since the 91st day after operation,the rats had been given the medicines for 90 days and then killed. The thighbones were taken out,then BMD,femoral geometry sizes and BP were determined.MAIN OUTCOME MEASURES: ① The primary sequel was the comparison of the parameters of femoral BP. ② The secondary sequel was the changes in parameters of femoral geometric structure, area of cortical bone and BMD of every midsectional fomur.RESULTS: Femoral BP worsened significantly,its mechanical intensity reduced,its external diameter diminished,cortical bone area decreased and femoral BMD lowered in osteoporotic model rats. In comparison with the above,in "the kidney tonifying compound ofTCM " groups(migu capsule group and xianling gubao group) femoral BP raised significantly, its mechanical intensity advanced,its external diameter augmented,cortical bone area aggrandized and femoral BMD enhanced.CONCLUSION: "The kidney tonifying compound of TCM" can improve BP of the cortical bone(thighbone) in ovariectomized osteoporosis rats. Its primary mechanism of action is that the TCM compound prescription could enhance"the mechanism of biomechanical response and regulation"(MBRR) of macrostructure of cortical bone,consequently increase femoral external diameter,aggrandize cortical bone area and enhance BMD in ovariectomized rats.

The TLC UV scanning assay for tanshinone IIA and cryptotanshinone in Yangxuezhitong pills was built up.Their wave lengths were 260 nm and 255 nm respectively.The regressive equation and coefficient of corelation were Y=40.48+5526.90X,r=0.9995 and Y=-12.91+5640.48X,r=0.9999 respectively.The recovery ratio of cryptotanshinone was(?)=102.62%.This me- thod is simple and convenient,and elicits accurate and reproduceable results.

Objective To set up the quality standard of Wanbile Wan. Method s Fructus Psoraleae, Radix Puerariae, Radix paeoniae Alba and Radix Glycyrrhiza e Preparatae in Wanbile Wan were identified by TLC .Isopsoralen was determined b y TLC scanning. The chromatographic conditions were: high performance silica gel G plate as lamellated plate, n- hexane - ethyl acetate (8 ∶ 2)being the exp ander, serrated scanning with single- wavelength reflection, beam stricture of 0.4? 0.4 mm, linear parameter SX=3 and scanning wavelength at 300 nm. Results The TLC spots were highly specific, clear and concentrated without interferen ce of the presence of negative controls. Isopsoralen showed a good linearity wit hin the range of 0.064～ 1.536 ? g, r=0.9980, average recovery rate was 100.7 % , and RSD was 2.0% .Conclusion This method can be used for the quality co ntrol of Wanbile Wan.