OBJECTIVE To investigate the efficacy and safety of the interleukin-1 （IL-1） receptor antagonist anakinra in the treatment of refractory adult onset Still’s disease （AOSD）， and provide more real-world evidence and practical experience for the treatment of AOSD with this drug. METHODS A retrospective analysis was conducted on the diagnosis and treatment process of a patient with AOSD complicated with dermatomyositis who received anakinra； systematically searched for relevant literature on the treatment of AOSD with anakinra in Chinese and English databases such as CNKI， PubMed， Medline， etc.， and conduct literature review on its efficacy and safety. RESULTS The patient in this case had poor treatment with multiple traditional drugs and was considered to have AOSD combined with dermatomyositis. After being admitted to the hospital and treated with a combination therapy of anakinra and glucocorticoids for several days， the patient’s clinical symptoms and inflammatory indicators significantly improved， and no serious adverse drug reactions occurred. Pharmacists designed specialized pharmaceutical monitoring pathways and conduct regular follow-up after discharge. After discharge， the patient took medication regularly， and the condition was maintained and relieved； during this period， there was redness and swelling at the injection site which resolved on its own without any other obvious discomfort. Literature review showed that anakinra could increase the response rate and remission rate of AOSD patients， and significantly reduce the dosage of glucocorticoids； adverse events were mainly injection site reactions， with a low overall risk of infection and good safety； however， there was a significant difference in the treatment course， and there was currently no unified plan. CONCLUSIONS Anakinra is an efficient and safe biological agent for treating AOSD， which can rapidly induce and maintain disease remission. For AOSD patients， clinical consideration may be given to using IL-1 antagonists to reduce glucocorticoid dependence， while strengthening long-term medication monitoring.

Systemic lupus erythematosus(SLE)is an autoimmune disease with unknown etiology and pathogenesis, and is characterized by multiple organ involvement and the production of autoantibodies.Late-onset SLE means that clinical symptoms first occur after 50 years of age, often without typical skin lesions and implicating fewer target organs.It exhibits low disease activity, a high degree of cumulative damage, high rates of comorbidity and mortality, and abnormal immunological profiles, which make its diagnosis difficult.Due to the physiological state and disease characteristics in the elderly, the treatment is slightly different from that for SLE.This article reviews the clinical features, diagnosis and treatment of late-onset SLE to provide a basis for accurate diagnosis and treatment.

Objective To investigate the expression and clinical pathological correlation of STAT3 and E-cadherin in esophageal squamous cell carcinoma,as well as the effect of the process in the transformation of epithelial mesenchymal transition of esophageal squamous cell carcinoma.Methods The 50 cases of esophageal squamous cell carcinoma tissues and corresponding adjacent tissues,to detect the expression of STAT3 and E-cadherin expression by RT-qPCR method in carcinoma and adjacent normal tissue expression that differential expression in mRNA level,analyzed its relationship with clinical pathological characteristics between patients;the expression of STAT3 and E-cadherin was detected by Western blotting in 4 cases of esophageal squamous cell carcinoma by simple random sampling.The author detected the expression of STAT3 and E-cadherin in three strains of esophageal squamous cell carcinoma cell lines using RT-qPCR and Western blotting,in which a high expression strains were transfected by STAT3 small interfering RNA screening,as the experimental group,using double stranded nonsense RNA transfection as the control group,detected the changes of expression level of STAT3 and E-cadherin.Detected cell migration and invasion by cell scratch test and Transwell cell invasion test in the experimental group.Measurement data were expressed by ((x) ± s),and the t test was used comparison between groups.Results In 50 cases of esophageal carcinoma,the relative expression of STAT3 was 1.87 ± 0.71,E-cadherin was 0.63 ± 0.28,in paracancerous tissue STAT3 was 0.56 ± 0.45,E-cadherin was 2.01 ± 0.68;analysis of clinical pathological features of esophageal squamous cell carcinoma showed relatively high expression of E-cadherin as relatively low expression levels of STAT3,related to the depth and lymph node metastasis in carcinoma tissues (P ＜ 0.05).Among which 4 cases were selected,the expression of STAT3 in cancer tissues higher than in corresponding adjacent normal tissues,0.28 ± 0.06 vs 0.05 ± 0.02,P ＜ 0.05,and the expression of E-cadherin in cancer tissues was significantly lower than that in adjacent normal tissues,0.27 ± 0.07,0.59 ± 0.09,P ＜ 0.05.The high expression of EC109 from carcinoma cell lines was as experimentation of esophageal squamous cell,RT-qPCR results showed that the expression of STAT3 was significantly decreased in small interfering RNA transfection group than the control group 0.85 ± 0.24 vs 3.01 ± 0.20,P ＜ 0.05,while up-regulation of E-cadherin protein expression,2.69 ± 0.29 vs 0.36 ± 0.16,P ＜ 0.05;Western blotting detection,compared with the control group,the expression of STAT3 protein was successfully inhibited after transfection of STAT3 small interference RNA fragment (0.09 ±0.04 vs 0.32 ±0.18,P ＜ 0.05),while the expression of E-cadherin was up-regulated in EC109 cells (0.75 ±0.11 vs 0.15 ±0.05,P ＜0.05).After downregulation of STAT3 expression,cell scratch test and transwell cell invasion test showed that the migration and the number ofinvasion cell number of STAT3 small interfering RNA transfection group in esophageal squamous carcinoma cell line EC109 compared with the control transfected double-stranded non-sense RNA group were decreased,so the downregulation of STAT3 expression after migration,invasion ability were weakened (P ＜ 0.05).Conclusion In esophageal squamous cell carcinoma,STAT3 transcription factor can mediate E-cadherin expression and affect epithelial mesenchymal transition phenotype,thereby affecting tumor migration and invasion.

Objective To analyze the quality of life (QOL) of mothers of children with cerebral palsy and it's influencing factors.Methods The QOL of 123 children with cerebral palsy and their mothers was assessed a 36-item short form health survey (SF-36) and basic questionnaires combined with interviews.The factors influencing QOL were analyzed with t-tests and one way analysis of variance,and multiple regression analysis was used to determine the main influencing factors.Results Scores on all of the SF-36 items were much lower for mothers of children with cerebral palsy than for mothers of normal children.Average scores in the domains of emotional health,general health and vitality were the lowest (55.28,60.49 and 65.26 respectively).Correlation analysis showed that general health,physical function and role emotions were positively correlated with the child's age.All domains except pain were negatively correlated with the child's condition.Social functioning was positively correlated with the mother's age.The general health,role emotional,social function,and mental health scores were all negatively correlated with the mother's education level.Univariate analysis showed that the child's age and condition,the mother's education level and occupation,and the father's occupation all significantly predicted the mother's QOL.Multivariate regression analysis confirmed that the child's age and the father's occupation had significant predictive power.Conclusions The QOL of the mother of a child with cerebral palsy is mainly influenced by the child's age and condition,the mother's education level and occupation,and the father's occupation.Comprehensive and effective measures should be taken to improve the QOL of mothers of children with cerebral palsy and to improve the efficacy of rehabilitation for children with cerebral palsy.

Based on its years of experiences,Shenzhen began to openly enroll medical school graduates nationwide since 2010 for standardized residents training.This started the brand new training of resident physicians,which enjoys unreserved policy and budget support from the government.Thanks to training support from a number of medical schools and teaching hospitals with prime resources in the country,training quality is maintained at a high level.As one of the first cities in practicing the standardized residents training,Shenzhen has made an initial success.But the management system and standardized training model still need further improvement and further exploration to improve the training program in the city.

Objective To investigate the effects of photodynamic reaction on cytokines production of HaCat keratinocytes treated with 5-aminolevulinic acid (ALA). Methods The HaCat cells were cocultured in vitro with different concentrations of ALA. Three hours later PpIX levels in HaCat cells were detected, and phtotodynamic reaction was induced by 632.8 nm laser radiation on cells. The cell death was analyzed using a flow cytometer to evaluate reactive intensity. The cytokines contents in supernatant were determined, including interleukin (IL)- lα, IL-6, basic fibroblast growth factor (bFGF), endothelin (ET)-1 and tumor necrosis factor (TNF)-α. Results Different cellular PpIX levels and cell death rates were seen according to ALA concentrations. The cell death rate did not exceed 10% and showed a positive linear relationship with ALA concentration (P＜0.05), when the later was at 0.0-1.6 mmol/L interval. The levels of IL-1α, bFGF and TNF-α increased as ALA concentration ascended at this interval (P＜0.05). No significant correlation was found between ALA concentration and IL-6 or ET-1 level (P＞0.05). Conclusion The photodynamic reactive intensity could be enhanced by increasing ALA concentration. And at certain scope, higher reactive grade might induce higher levels of keratinocyte-derived cytokines.

Objective To study the effects of exogenous double-stranded DNA antigen on the immunophenotypic changes of dendritic cells (DCs) derived from stem cells in mouse bone marrow. Methods LinCD117 (c-kit)+ hemopoietic stem cells were obtained from the bone marrow of C57 mice by magnetic affinity cell sorting. Some cytokines, including granulocyte-macrophage colony-stimulating factor, interleukin-4, tumor necrosis factor-α and so on, were used to enhance the proliferation or differentiation of stem cells to obtain mature, semimature and immature DCs. The double stranded DNA of kinetoplast (kDNA) was isolated from Trypanosoma equiperdum, and added to the culture media to pulse DCs. The immunophenotypic and morphologic features of DCs were analyzed by using flow cytometry and laser confocal microscopy respectively. Results The expression rates of CD117 and CD11c in DCs showed no significant changes after kDNA pulse compared with those before the pulse. In unpulsed immature, semi-mature and mature DCs, the expression rate was 11.42% ± 2.56%, 27.08% ± 5.29% and 44.63% ± 10.37% for MHC Ⅱ, 8.54% ± 2.01%, 31.35% ± 6.40% and52.96% ± 10.34% for CD80, 10.22% ± 3.47%, 32.15% ± 6.83% and 64.72% ± 9.68% for CD86, respectively.After pulse with the kDNA antigen, the expression rate increased by 15.63%, 9.66% and 4.12% (t = 6.21,4.35, 2.82, P < 0.05) for MHC Ⅱ, by 9.63%, 7.09% and 4.09% for CD80, by 13.16%, 9.75% and 3.10% for CD86, respectively in immature, semi-mature and mature DCs, respectively. The increase of expression rate of these membrane antigens in decreasing order was observed in immature DCs, semi-mature DCs and mature DCs. Conclusions The exogenous DNA antigen could enhance the maturation of bone marrow-derived DCs,likely by upregulating the expression of certain immunophenotypic membrane proteins, and the lower the maturity degree, the more liable the DCs to be affected by the antigen.

Objective To observe the vaccination reactions and immunogenicity of the application of lyophilized Vero cell rabies vaccine without adjuvant in a way of low-dose intradermal injection for post-exposure group. Methods Conducting post-exposure immunization for 256 persons with the class Ⅱ level exposure to rabies. Based on a randomized, single-blind principle, all subjects were divided into intradermal injection (ID) group (n= 128),injected 0.1 ml for each site in accordance with 0,3,7,28,90 d,2 sites,2 sites,2sites,1 site,1 site respectively, and intramuscular injection(IM) group(n= 128) in accordance with 0,3,7,14,28 d in full-volume (0.5ml) PVRV Deltoid injection. The local and systemic vaccination reactions were observed for the different injection ways. The indirect sandwich ELISA assay was used to analyze the antibody levels. Results For the intradermal injection group, the incidence rates for local redness and swelling, induration, pain, itch were 1.27%, 0.29% ,0.49% ,11.43% respectively,for the intramuscular group, the incidence rates were 1.09% ,0. 16% ,2. 81% ,1.41% respectively. From the point of systemic reactions,the incidence rates of fever,rash,headache,fatigue and weakness were 0.31 % ,0. 16% ,0. 31 % , 1.09% respectively in the intradermal injection group,and the rates were 0.31% ,0.31% ,0.63% , 1.09% respectively in intramuscular group. All the adverse effects often occurred following the 1st,2nd injection. The seroconversion rates for intradermal injection and intramuscular were 94.53% ,95.31% following 14 d immunization respectively,the rates were 96. 83% ,97.64% following 42 d immunization respectively. For the post-exposure group,no statistical difference in significance was found between the two seroconversion rates. Conclusion For the application of domestic lyophilized Vero cell rabies vaccine,its adverse reactions are mild,and immunogenicity is good.

Objective To investigate the effect of δ-aminolevulinic acid(ALA)-induced photodynamic reaction on biological characteristics of skin fibroblasts.Methods Human skin fihroblasts were isolated from the foreskin of children and cultured in the presence of 0.5 to 5.0 mmol/L ALA;three hours later,they were irradiated with 632.8 am laser followed by additional 12-hour culture.Then,MTI"assay and flow cytometry were used to measure the proliferation and apoptosis of cells.The levels of matrix metallopmteinase(MMP)1,-2 and-3 and hydroxyproline in the culture supematant of irradiated cells were determined by avidinbiotin complex-based ELISA and alkaline hydrolysis-based method,respectively.Results With the rise of ALA concentration from 0.5 to 5.0 mmol/L.the proliferation level of fibroblasts expressed as the absor-bance at 570 nm dropped from 0.45±0.05 to 0.32±0.04.and cell death rate increased from 6.4%±2.0% to 29.6%±2.2%.Meanwhile,the contents of MMP-1,-2 and -3 increased at the early stage,but decreased at the late stage,whereas the hydroxyproline level showed an inverse tendency during the increase of ALA concentration from 0.5 to 5.0 mmol/L.Conclusions Proper intensity of photodynamic reaction induced by ALA could enhance the secretion of MMP and inhibit the synthesis of collagen by skin fibroblasts,however,high concentration of ALA may exert an inverse effect.

< 0.05; 8.9% vs 0.1%, x2 = 8.23, P< 0.05). Conclusion Low concentration (0.1%) of DMSO could enhance the effect of ALA-PDT on HaCaT cells.