Objective:To investigate the therapeutic efficacy of Golimumab in the treatment of children with refractory juvenile dermatomyositis(JDM).Methods:The clinical data of a child diagnosed with JDM in the Department of Allergy, Immunology and Rheumatology of Guangzhou Women and Children′s Medical Center in February 2019 were collected.The treatment effect was studied and literature review was conducted.Results:The patient was a 7-year-old boy with subacute onset of the disease.The illness protracted, and main manifestations included skin rashes, limb weakness, and swallowing dysfunction.Physical examination showed heliotropic rashes, Gottron papules, positive Gower, proximal limb muscle strength grade Ⅲ-Ⅳ, distal limb muscle strength grade Ⅳ, and a choking cough when swallowing fluid food.Laboratory tests revealed alanine aminotransferase (ALT) of 36 U/L, aspartate aminotransferase (AST) of 115 U/L, alkaline phosphatase of 69 U/L, lactate dehydrogenase of 941 U/L, creatine kinase of 974 U/L, hypersensitive C-reactive protein of 26 mg/L and an erythrocyte sedimentation rate (ESR) of 52 mm/1 h. Antinuclear antibody spectra were negative.Electromyography suggested myogenic damage.Thigh magnetic resonance imaging indicated diffuse abnormal signal shadows in the subcutaneous fat, muscles and muscle spaces of both hips, thighs and knee joints.The child was diagnosed with JDM, and given standardized treatment of Methylprednisolone, intravenous immunoglobulin, Methotrexate and Hydroxychloroquine sulfate.However, after the treatment, the facial rashes were still red, proximal limb muscle strength and swallowing dysfunction did not improve, the choking cough symptom still existed, and a Cushing face appeared.Recheck results showed ALT of 24 U/L, AST of 32 U/L, alkaline phosphatase of 56 U/L, lactate dehydrogenase of 216 U/L, creatine kinase of 527 U/L, hypersensitive C-reactive protein of 8 mg/L and an ESR of 15 mm/1 h. Refractory JDM was considered.After negotiating with the patient′s family members, they agreed to treat the patient with Golimumab 50 mg by subcutaneous injection once a month.Then tapered prednisone gradually, stopped Hydroxychloroquine sulfate tablets and continued to give the patient oral Methotrexate.After two doses of Golimumab 50 mg, proximal limb muscle strength and swallowing function improved markedly.After the third subcutaneous injection of Golimumab, proximal limb muscle strength improved to grade Ⅳ-Ⅴ, and he was able to go up and down stairs, squat and stand up after squatting.Besides, dysphagia and the choking cough disappeared, and skin rashes improved.Recheck results suggested a normal ESR and creatine kinase levels.Magnetic resonance imaging of thighs indicated no muscle inflammation.Conclusions:Golimumab works well in the treatment of refractory JDM and can effectively improve muscle strength.Therefore, it can be used as a treatment option for refractory JDM.

Objective To investigate the epidemic strains of biological type, drug resistance, and the basic clinical characteristics of haemophilus influenzae(Hi)isolated from hospitalized adults with lower respiratory tract infection in Chengdu area.Methods A prospective cross-sectional study was conducted to analyze the biological typing,capsular genes detected by PCR technique,and drug resistance tested by drug sensitive test of Hi epidemic strains isolated from the sputum of adults aged above 18 years who were hospitalized in two tertiary hospitals of west Sichuan in China.Results The positive rate of pathogenic bacteria in adults aged above 18 years who were hospitalized in the two hospitals was 46.71%(15 447/33 069)between November 2013 and October 2014.The positive rate of Hi isolated from the sputum of 100 adults with lower respiratory tract infection was 0.31%(101/33 069).The constituent ratio of Hi in lower respiratory tract infection pathogens was 0.65%(101/15 447).The Hi were all undifferentiated type detected by PCR,and the biological typing of Hi were typeⅠ(42.57%),Ⅳ(29.7%),Ⅱ(15.84%),Ⅲ(9.9%),Ⅶ(1.98%), and Ⅵ(0.9%).The diseases of Hi positive were acute phase of chronic obstructive pulmonary disease(59%), pneumonia(35%), and bronchitis(6%), in which community acquired infection was 55%.The rate of β-lactamase enzyme production was 38.61%.The frequencice of β-lactamase -nonproducing-ampicillin-resistant(BLNAR)strains was 2.97%,and of intermediary strains was 4.95%(5/101).The drug resistance rate of amoxicillin and clavulafiate was 2.97%.The drug resistance rate of cefuroxime was 12.87%, and intermediary rate was 12.87%.The drug resistance rate of cefaclor was 29.7%,and intermediary rate was 8.91%.The drug resistance rate of cefotaxime and ofloxacin was 6.93%and 1.99%.There were no obvious statistical differences between the drug resistance rates of the two hospitals.Conclusions The Hi epidemic strains isolated from the sputum of adults with lower respiratory tract infection were all undifferentiated type,and the common biological types were Ⅰ,Ⅳ,Ⅱ, andⅢ in west Sichuan in China.It should pay attention to the BLNAR strains and ofloxacin-resistant strains.

Objective To study the effect and mechanism of down-regulating Silt2/Robo 1 signaling pathway on rabbit iliac artery after angioplasty restenosis. Methods The 30 male New Zealand white rabbits were divided randomly into 3 groups , namely the blank group , the control group , and the experimental group , 10 rabbits in each group. Hign-fat feeding , the rabbits were produced endothelial denudation of iliac artery stenosis model. Another 4 weeks of feeding , percutaneous balloon angioplasty was performed. Then R5 antibody was injected into the abdominal cavity. After 4 weeks of feeding ,angiography again. The results of angiography was analysied by image workstation. The concentrations of Slit2 and Robo1 was detected by ELISA. The iliac artery tissue examined by HE staining. Results The rabbit iliac artery after angioplasty restenosis animal model was set up successfully. Compared with the control group and the experimental group , the serum concentration of Slit2 and Robo1 were significantly higher (P < 0.01) than the blank group. But in the experimental group, the Slit2 and Robo1 serum concentrations were significantly lower than those in the control group (P < 0.05) after R5 antibody intervention. The area ratio stenosis and diameter stenosis rate of iliac artery were reduced that confirmed by angiography. Conclusion The expression of Slit2/Robo1 was significantly higher in the rabbit model of vascular restenosis. R5 antibody can effectively inhibit the expression of Slit2/Robo1. Down regulation of Slit2/Robo1 signaling pathway in the treatment of restenosis after angioplasty in rabbits.

Aim To explore the protective effects of LPPC ( procyanidins extracted from the litchi pericarp) on cardiomyocyte apoptosis in septic rats and its mech-anisms. Methods The rats were randomly divided in-to 5 groups, and were given orally the drug for two weeks continuously. The control group ( control) and sepsis model group ( LPS ) were given distilled water once a day. LPPC low, medium and high dose groups were given LPPC 50 , 100 , 200 mg · kg-1 · d-1 re-spectively which were prepared freshly every day. After the treatment, sepsis animal models were established. Except for the control group, other groups were injec-ted LPS (lipopolysacchride, 10mg·kg-1) intraperito-neally to induce acute sepsis model. 4hrs later, rat se-rum was collected, isoenzyme ( CK-MB ) , lactate de-hydrogenase ( LDH ) and activity of aspertate amin-otransferase ( AST/GOT) were detected. Then rat car-diac tissue was obtained and cardiac tissue malondial-dehyde ( MDA ) , total antioxidant capacity ( T-AOC ) and reduced glutathione ( GSH ) content were deter-mined. TUNEL staining was performed to analyze the apoptosis of myocardial cells. Cleaved caspase-3 and TNF alpha protein expressions were analyzed by West-ern blot. Results Compared with the control group ( control) , serum of sepsis model group rats CK-MB, LDH, AST/GOT and cardiac tissue MDA content were significantly increased (P<0. 01). At the same time, the activity of cardiac tissue T-AOC and GSH de-creased obviously ( P<0. 01 ) . The apoptotic myocar-dial cells increased significantly ( P<0. 01 ) , and the expression level of cleaved caspase-3 and TNF alpha decreased obviously ( P <0. 01 ) . LPPC pretreatment significantly decreased the serum CK-MB, LDH, AST/GOT and tissue MDA content, increased tissue T AOC and GSH activity, attenuated apoptosis of rat myocardi-al cells significantly, and decreased expression level of cleaved caspase-3 and TNF alpha. Conclusion LPPC pretreatment can significantly attenuate rat myocardial cell apoptosis induced by sepsis, and the underlying mechanisms may be related to its anti-oxidative effects.

Objective To investigate the effects of whole grain-bean mixed staple food on intestinal microecology,anthropometric,and metabolic parameters of obese people.Methods Totally 87 obese people were divided with random number table into whole grain-bean mixed staple food group (test group) and refined grains staple food group (control group).Body weight (BW),body mass index (BMI),waist circumference (WC),hip circumference (HC),waist/hip ratio (WHR),fasting plasma glucose (FPG),triglyceride (TG),total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),and colony count of intestinal flora (bacillus bifidus,lactobacillus,clostridium perfringens,enterobacteria,enterococcus,bacteroides) were measured at baseline and 3 months after intervention.Results Ten people were excluded from this research,6 in the test group and 4 in the control group.Mter 3 months of dietary intervention,BW,BMI,WC,HC,and WHR were significantly lower in the test group than in the control group [(69.45 ± 7.07) kgvs.(72.42 ±5.79) kg,P=0.000; (26.08 ±1.48) kg/m2 vs.(27.27 ±0.81) kg/m2,P=0.000; (82.48±9.30) cm vs.(86.96±4.93) cm,P =0.000; (90.08 ±6.57) cm vs.(92.42 ±6.67) cm,P =0.000; 0.92 ±0.11vs.0.95 ±0.10,P =0.003].The levels of FPG,TC,and LDL-C in the test group were significantly lower than those in the control group [(4.92 ± 0.75) mmoL/L vs.(5.41 ± 1.21) mmoL/L,P=0.037; (3.85±1.13) mmoL/L vs.(4.38 ±1.26) mmoL/L,P=0.046; (3.55 ±1.04) mmoL/L vs.(4.16 ± 1.40) rnmoL/L,P =0.033] ; the level of HDL-C in the test group was significantly higher than that in the control group [(1.13 ± 0.37) mmoL/L vs.(0.92 ± 0.26) mmoL/L,P =0.004].The colony counts of intestinal bacillus bifidus,lactobacillus,and bacteroides in the test group were significantly higher than in the control group [(7.94 ± 0.58) lg CFU/g vs.(6.95 ± 0.38) lg CFU/g,P =0.000 ; (7.67 ± 0.46) lg CFU/g vs.(6.96 ± 0.57) lg CFU/g,P =0.000 ; (5.53 ± 0.44) lg CFU/g vs.(4.80 ±0.23) lg CFU/g,P =0.000],while the colony count of clostridium perfringens was significantly lower than in the control group [(4.40 ± 0.49) lg CFU/g vs.(5.11 ± 0.63) lg CFU/g,P =0.000].Conclusions In obese people,whole grain-bean mixed staple food can improve anthropometric parameters,some lipid metabolic parameters,and intestinal flora.The underlying mechanism may involve promoting the survival and proliferation of probiotics,thereby improving glucose and lipid metabolism.

Aim To study the mechanisms of the pro-tective effect of procyanidin B2 ( PCB2 ) on the myocar-dial cell apoptosis induced by lipopolysaccharide ( LPS) . Methods Using the primary culture rat myo-cardial cells, myocardial cell injury model was induced by LPS. PCB2 low, medium and high dose groups, were cultured with 6. 25 , 12. 5 , 25. 0 μmol · L-1 PCB2 respectively in DMEM medium for 24 h continu-ously. Myocardial cell survival rate was determined by MTT colorimetric method. Cardiacmyocyte NOX activi-ty was determined by lucigen chemiluminescence meth-od . Western blot analysis was used to detect myocardi-al NADPH oxidase p47phox expression. TUNEL method was used to detect apoptosis and flow cytometry was used to determine the content of myocardial cells ROS. Results Compared with control group, the cell dam-age induced by LPS group myocardial cell survival rate significantly decreased ( P <0. 01 ) , and myocardial cell NOX activity, p47phox expression, apoptotic cell number and ROS content were significantly increased (P<0. 01). PCB2 low, medium and high dose groups cell survival rates were significantly elevated, myocar-dial cell NOX activity and p47phox expression, apoptotic cell number and the ROS content decreased significant-ly in a dose-dependent manner ( P <0. 01 ) . Conclu-sion PCB2 protects myocardial cell apoptosis induced by LPS via inhibiting the expression of NADPH oxidase activation, p47phox expression and reactive oxygen spe-cies generation.

OBJECTIVETo assess the feasibility and safety of using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum.

METHODSA total of 136 patients undergoing artificial heart pacemaker implantation with active fixation pacing leads were randomized into two groups to receive conventional right ventricular outflow tract pacing (CRVOTP) or modified right ventricular outflow tract pacing (MRVOTP). The electrode lead wire core was modeled in a double-curved three-dimensional shape in CRVOTP group and in a J-shaped bend in MRVOTP group before fixation at the right ventricular outflow tract septum.

RESULTSRight ventricular outflow tract septum pacing was achieved successfully in all the patients. None of patients experienced serious complications. No significant differences were found between the two groups in the number of times of electrode fixation, pacing thresholds, impedance, R wave height or QRS wave width during the operation, but MRVOTP was associated with a reduced time of X -ray exposure and operation (P<0.05) due to the convenience in electrode modeling and in passing the leads through the tricuspid annulus and the direct access to the right ventricular outflow tract septum. Postoperative follow-up of the patients showed no incidence of active fixation pacing lead dislocation and comparable pacing thresholds of the ventricular electrodes, impedance, R wave height and QRS wave width between the two groups.

CONCLUTIONSUsing the modified active fixation pacing leads model to pace the right ventricular outflow tract septum can reduce the time of X -ray exposure and operation with a low probability of lead damage.

Objective To assess the feasibility and safety of using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum. Methods A total of 136 patients undergoing artificial heart pacemaker implantation with active fixation pacing leads were randomized into two groups to receive conventional right ventricular outflow tract pacing (CRVOTP) or modified right ventricular outflow tract pacing (MRVOTP). The electrode lead wire core was modeled in a double-curved three-dimensional shape in CRVOTP group and in a J-shaped bend in MRVOTP group before fixation at the right ventricular outflow tract septum. Results Right ventricular outflow tract septum pacing was achieved successfully in all the patients. None of patients experienced serious complications. No significant differences were found between the two groups in the number of times of electrode fixation, pacing thresholds, impedance, R wave height or QRS wave width during the operation, but MRVOTP was associated with a reduced time of X-ray exposure and operation (P<0.05) due to the convenience in electrode modeling and in passing the leads through the tricuspid annulus and the direct access to the right ventricular outflow tract septum. Postoperative follow-up of the patients showed no incidence of active fixation pacing lead dislocation and comparable pacing thresholds of the ventricular electrodes, impedance, R wave height and QRS wave width between the two groups. Conclusion Using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum can reduce the time of X-ray exposure and operation with a low probability of lead damage.

Objective To assess the feasibility and safety of using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum. Methods A total of 136 patients undergoing artificial heart pacemaker implantation with active fixation pacing leads were randomized into two groups to receive conventional right ventricular outflow tract pacing (CRVOTP) or modified right ventricular outflow tract pacing (MRVOTP). The electrode lead wire core was modeled in a double-curved three-dimensional shape in CRVOTP group and in a J-shaped bend in MRVOTP group before fixation at the right ventricular outflow tract septum. Results Right ventricular outflow tract septum pacing was achieved successfully in all the patients. None of patients experienced serious complications. No significant differences were found between the two groups in the number of times of electrode fixation, pacing thresholds, impedance, R wave height or QRS wave width during the operation, but MRVOTP was associated with a reduced time of X-ray exposure and operation (P<0.05) due to the convenience in electrode modeling and in passing the leads through the tricuspid annulus and the direct access to the right ventricular outflow tract septum. Postoperative follow-up of the patients showed no incidence of active fixation pacing lead dislocation and comparable pacing thresholds of the ventricular electrodes, impedance, R wave height and QRS wave width between the two groups. Conclusion Using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum can reduce the time of X-ray exposure and operation with a low probability of lead damage.

Objective To study the effects of adjusted proportional macronutrient intake on serum uric acid,blood lipids,renal function,and nutritional status of patients with gout and overweight.Methods Sixtyseven patients with gout and overweight were randomized into high protein group and low purine group for 6 months.Each patient had had at least one gouty attacks during the six months before enrollment.Dietary recommendations consisted of calorie restriction to 6276 kJ per day with 40％ derived from carbohydrate,30％ from protein,and 30％ from fat,and the refined carbohydrates were replaced with complex ones and saturated fats with mono-and polyunsaturated ones.High protein group didn't limit purine intake.The two dietary consisted of isoenergetic (6276 kJ).Dietary of low purine group consisted of 60％ derived from carbohydrate,10％ from protein,and 30％ from fat,and limited of parine ＜ 150 mg/d.At onset and 6 months after intervention,fasting blood samples were taken for determination of uric acid(UA),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting plasma glucose(FBG),serum creatinine(SCr),blood urea nitrogen(BUN),albumin(ALB),total protein(TP),and hemoglobin(Hb);the number of gout attacks was recorded.Results Sixty-one persons completed the study.Dietary measures resulted in weight loss[(65.75 ± 3.26)vs(69.31 ± 7.78)kg,P =0.043)and a decrease in the frequency of sixmonth gout attacks(17 vs 28,P =0.000).After the trial,compared to low-purine group,UA[(420.25 ±36.78)vs(466.81 ±41.97)μmol/L,P=0.000],TC[(5.69±0.46)vs(6.49±1.04)mmol/L,P=0.007),TG[(2.15 ±0.54)vs(3.13 ±0.62)mmol/L,P =0.000]and FBG[(5.63 ±0.82)vs(6.49 ±0.64)mmol/L,P =0.000]decreased significantly in the high protein group.There were no significant differences in LDL-C[(3.55 ±0.80)vs(3.73 ±0.72)mmol/L,P =0.445],SCr[(96.63 ± 16.97)vs(94.28 ±13.35)μmol/L,P =0.597],and BUN[(4.89 ± 1.25)vs(4.46 ± 1.21)mmol/L,P =0.208]between two groups.HDL-C[(1.24±0.22)vs(0.89±0.26)mmol/L,P=0.000],ALB[(41.56±5.37)vs(37.08±5.94)mmol/L,P=0.014],TP(72.97 ±5.41)vs(67.27±7.87)g/L,P=0.005],and Hb[(142.86±12.31)vs(114.25 ± 12.98)g/L,P =0.001]increased significantly in the high protein group.Gouty attacks were reduced and decreased by 48.48％ and 22.22％ in high protein group and low purine group,respectively.The differences between the two group was statistically significant(P =0.000)Conclusion Change in proportional macronutrient intake is helpful to reduce body weight and thus is beneficial for lowering UA,improving lipid metabolism and nutritional status,and decreasing the frequency of gout attacks.