Objective:To investigate the safety and efficacy of J-valve transapical catheter aortic Valve replacement(TA-TAVI) in the early treatment of aortic stenosis with low coronary ostium.Methods:From January 2020 to April 2022, 20 patients with aortic stenosis with coronary opening height ≤10 mm who underwent TA-TAVI treatment in the Valve Surgery Center of Beijing Anzhen Hospital Affiliated to Capital Medical University were enrolled retrospectively. All patients underwent preoperative imaging screening, and 5 patients underwent preoperative coronary artery protection: The height of coronary artery opening was less than 5 mm in 3 cases. 2 cases had stent stenosis & LT after coronary artery stenting 50%, and the position of the coronary artery opening was less than 8mm. The postoperative complications, mortality and cardiac function prognosis of TA-TAVI were analyzed.Results:There were 5 males and 15 females. The average age of the whole group was(73.00±6.20) years. Transthoracic echocardiography showed that all patients had severe aortic valve stenosis, and 85% of the patients had NYHA grade Ⅲ-Ⅳ, and 80% of the patients had aortic valve stenosis with insufficiency. The mean height of left coronary artery opening was(9.07±3.70) mm. RCA(11.39±3.00) mm; The opening height of coronary artery was ≤5 mm in 3 cases(left 7.5%), 5-8 mm in 5 cases(12.5%), and 8-10mm in 16 cases(40.0%). Mean aortic sinus(valsalva) diameter: Left(30.06±5.90) mm; Right(28.50±5.68) mm; Non(29.96±6.15) mm. J-valve Valve was successfully implanted through apical catheter in all patients, most of whom were size 23. CPB was performed in 2 patients at the same time, permanent pacemaker was inserted in 2 patients, and moderate or above perivalvular leakage was found in 0 patients. All patients had TNI( P=0.12) and MYO( P=0.03) before and 24 hours after operation. None of the 5 patients underwent coronary artery stenting. None of the 5 patients died within 30 days after the operation. Ta-tavi is effective 30 days after operation, with low complication rate and good prognosis of cardiac function. Conclusion:J-valve transapical catheter aortic Valve replacement is safe and effective in the treatment of aortic stenosis with low coronary ostium.

2019年1月至2020年12月，我中心使用术中虚拟影像融合技术辅助指导完成15例各类介入瓣膜手术，包括心脏主动脉瓣手术6例、二尖瓣3例、三尖瓣4例、肺动脉瓣2例，介入瓣膜手术入路涵盖股动脉途径、心尖途径、股静脉途径和右心房等常见入路途径。术前常规使用门控全心动周期心脏三维CT扫描获取心脏三维的解剖信息，使用Valve-ASSIST软件包对CT血管造影图像进行分析，术中将三维CT数据正确地投射到二维荧光成像上。对重建后的三维图像使用专用工作站的图像融合软件进行2D实时透视图像与3D进行叠加，并进行实时校对，完成2D-3D影像实时融合。然后在虚拟影像融合技术的辅助下完成手术。术中全部成功完成术前三维CT扫描影像和术中透视二维影像融合重建，虚拟影像随着术中透视角度和手术介入导管床的移动而自动移动，实时指导介入瓣膜手术的进行，置入成功率100%。术中无介入瓣膜移位，无严重并发症，术后患者恢复良好，全部顺利出院。虚拟影像融合技术可以方便术中心脏解剖定位，缩短手术时间，进一步提高介入瓣膜手术安全性。

Objectives. Polymyalgia Rheumatica (PMR) is a common inflammatory disease in elderly persons whose pathogenesis is unclear. We aimed to explore the pathogenetic features of PMR and find a new therapeutic strategy. Methods. We included 11 patients with PMR and 20 age-matched and sex-matched healthy controls (HC) in this study. The disease features were described. The gene expression profiles were analyzed in peripheral blood mononuclear cells (PBMCs) by RNA sequencing and were confirmed by RT-PCR. We also tested gene expression profiles in five patients with PMR after tofacitinib therapy. Results. Patients with PMR experienced pain with high disease activity scores. The gene expression of PBMCs in patients with PMR differed from that in HC by RNA sequencing. GO and KEGG analysis demonstrated that inflammatory response and cytokine-cytokine receptor interaction were the most remarkable pathways. There were markedly expanded IL6R, IL1B, IL1R1, JAK2, TLR2, TLR4, TLR8, CCR1, CR1, S100A8, S100A12, and IL17RA expressions. Those genes may trigger the JAK signaling. Furthermore, tofacitinib, a pan JAK inhibitor, effectively treated five patients with PMR, leading to clinical remission and a significant decrease in inflammatory genes. Conclusions. Many inflammatory genes associated with JAK signaling were increased in patients with PMR, suggesting an important role of JAK signaling in PMR disease development. JAK inhibitors may effectively treat PMR. Keywords: Polymyalgia Rheumatica, Inflammatory pathway, JAK signaling

总结2019年4月至10月期间使用J-Valve介入瓣膜成功完成介入瓣中瓣技术治疗3例三尖瓣生物瓣膜毁损的临床经验。经本院伦理委员会批准, 术前评估提示外科常规开胸体外循环手术中/高危风险, EuroSCORE Ⅱ评分为19.50%～25.45%。手术成功率100%, 1例术中输送器撤离时出现瓣膜轻度移位, 同时置入第2枚瓣膜。围手术期无死亡, 无脑血管事件, 无介入瓣移位或脱落。术后抗凝方案使用华法林抗凝6个月, 6个月后改为口服阿司匹林100 mg/天。定期复查超声心动图监测心脏功能、瓣膜流速和反流情况。术后随访26～32个月, 无死亡事件, 无脑血管事件, 无感染性心内膜炎等不良事件。术后患者自觉症状明显改善, 心功能分级≤Ⅱ级。肋间切口右心房穿刺使用J-Valve介入瓣中瓣技术可成功治疗三尖瓣生物瓣毁损, 为再次开胸手术风险高的患者提供了相对安全可行的选择。

To the Editor: Rheumatoid arthritis (RA) is a chronic autoimmune disorder not only characterized by joint symptoms but also extra-articular and systemic manifestations.[1] Traditionally, the evaluations of RA had centered on laboratory measures of inflammation and clinician-generated assessments. However, patient-reported outcomes (PROs) are recommended by several guidelines to assess disease progression. PROs also can contribute to reduce discrepancies between physicians’ evaluation and patients’ own judgment on disease status and their importance on disease management and physician-patient communication has been identified during the past decennia.[2] However, it is uncertain whether the awareness has promoted the usage and reporting of PRO measures in RA-related research and clinical practice in Chinese population. Thus, this study systematically reviewed the PRO measures collected in recent researches and summarized the PRO results among Chinese RA population. To capture the most recent publications focusing on PRO measures among Chinese adult RA patients, we conducted a systematic review using PubMed, Cochrane Library, Wanfang, China National Knowledge Infrastructure, and China Science and Technology Journal database on January, 2019 to identify articles from January 1st, 2016 to December 31th, 2018. The search strategies are presented in Supplementary Appendix A, https://links.lww.com/CM9/A618. Literatures were included if they contained any Chinese RA patients (age ≥18 years) and reported any PRO results. Articles were excluded if they: (1) were not in English or Chinese; (2) were animals or in vitro models/studies; (3) were reviews, letters, editorials, commentaries, protocols, or guidelines; (4) were duplicates in the same population; (5) were not separately reported the PRO results for Chinese RA patients; (6) were validation studies focusing on psychometric properties of PRO measures; (7) focused on Chinese medicine not recommended in the guidelines for diagnosis and treatment of RA based on combination of disease and syndrome.[3] Articles with less than 50 Chinese RA patients were excluded to obtain stable statistical results. And journal articles in Chinese language that were not published in “core journals” listed by the Peking University (2018 edition) were also excluded to further ensure study quality. An initial assessment was made by scanning all titles and abstracts according to the inclusion and exclusion criteria. Full-text screening was conducted independently by two reviewers on potentially relevant articles for eligibility. Discrepancies were resolved by discussion between the two reviewers. The full items included in the standard data extraction sheet are listed in Supplementary Appendix B, https://links.lww.com/CM9/A618. All outcomes reported by patients were recorded. Composite indices were also recorded if comprised of any patient-reported component. Thus, the study included American College of Rheumatology (ACR) response criteria, European League Against Rheumatism (EULAR) response criteria, clinical disease activity index, disease activity score (DAS), and simplified disease activity index. DAS would be included only if the inclusion of patient-reported global health/patient global assessment (PGA) was clearly specified. PROs were classified into a number of health domains according to prior publication[4] and EULAR outcome library website (http://oml.eular.org). They were classified into “others” if no pre-specified domain was appropriate. For composite indices, the patient-reported component would be further classified into the specific health domain if presented separately. The characteristics of identified articles were described. Frequencies and percentages were calculated for composite indices, health domains, and PRO measures. Meta-analysis was conducted to summarize the results of guideline recommended or frequently reported PRO measures at several pre-specified time-points.[4] A description of imputation for missing data is provided in Supplementary Appendix C, https://links.lww.com/CM9/A618. Heterogeneity test was performed using the Chi-squared test and the magnitude of heterogeneity was measured by I2. If P ≥ 0.1, or P < 0.1 and I2 ≤ 50%, A fixed effect model was used; if P < 0.1 and I2 > 50%, a random effect model was used for meta-analysis. All analyses were performed in Microsoft Excel and Stata version 15. Among 7591 identified articles, a total of 166 articles (71 interventional studies including randomized controlled trials and non-randomized clinical trials, 95 observational studies including cross-sectional studies, case-control studies, prospective cohorts, retrospective cohorts, and case-series) with 28,462 subjects of interests were included in final analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart is shown as Supplementary Figure 1, https://links.lww.com/CM9/A618. Details of patients’ characteristics are listed in Supplementary Table 1, https://links.lww.com/CM9/A618. Supplementary file, https://links.lww.com/CM9/A619 gives characteristics of each article included in our final analysis. Of the 166 articles, 103 distinct PRO measures were reported, of which 27 were composite indices and the other 76 PRO measures spread across 15 health domains. The average number of PRO measures per article was 3.4 ± 2.3 (min: 1, max: 11). Pain visual analog scale (VAS) (n = 61, 36.7%), morning stiffness duration (MSD) (n = 54, 32.5%), Health Assessment Questionnaire (HAQ) (n = 47, 28.3%) were the most frequently reported PRO measures. A total of 102 (61.4%) articles reported at least one composite index. Among 27 distinct composite indices reported in all articles, DAS28-erythrocyte sedimentation rate was the most frequently reported one (n = 41, 24.7%). Details of composite indices are shown in Supplementary Table 2, https://links.lww.com/CM9/A618. Among the 15 health domains characterized by 76 PRO measures, pain, physical function, and morning stiffness were reported most frequently (reported by >30% articles). While PGA, quality of life (QoL), and psychological status were relatively frequently reported (reported by >15% articles). PRO measures were classified into health domains as Supplementary Table 3, https://links.lww.com/CM9/A618. Pain was evaluated most frequently (n = 70, 42.2%), and was measured mostly by pain VAS (n = 61, 87.1% of 70). Function was reported by 66 (39.8%) publications, and the most frequently implemented tool was HAQ (n = 47, 71.2% of 66). Morning stiffness was assessed in 54 (32.5%) studies and was more likely to be assessed in interventional ones compared to observational ones (49.3% vs. 20.0%). All articles focusing on this domain described MSD. PGA was reported relatively frequently (n = 29, 17.5%), which was evaluated predominantly using PGA VAS (n = 22, 75.9% of 29). QoL was mentioned by 29 (17.5%) publications and assessed by Medical Outcomes Study Short Form 36-Item (SF-36) as the most (n = 19, 65.5% of 29). Psychological status was also reported by more than 15% articles (n = 27, 16.3%). Psychological status was measured by 16 distinct tools, in which self-rating anxiety scale and self-rating depression scale (SDS) were used most frequently (n = 9, 33.3% of 27). The remaining health domains were infrequently reported (reported by <10% articles). Fatigue was assessed by 15 (9.0%) articles, mostly using fatigue VAS (n = 7, 46.7% of 15). Sleep disturbance (n = 9, 5.4%) and coping (n = 8, 4.8%) were only evaluated by observational studies. As the PRO results, at baseline, the mean pain VAS (scale: 0–10 cm) was 5.6 (95% confidence interval [CI]: 5.2–6.0). Among 15 studies reported the means and standard deviations of baseline HAQ (scale: 0–3), RA patients were scored 1.4 (95% CI: 1.0–1.9) on average. The mean MSD (mins) at baseline was 92.1 (95% CI: 79.3–105.0). The mean PGA VAS (scale: 0–10 cm) was 5.8 with a 95% CI of 5.2 to 6.3 at baseline. Regarding QoL, the mean SF-36 total score (scale: 0–100) was 47.2 (95% CI: 41.1–53.3) at baseline. The average baseline score of European Quality of Life – 5 Dimensions (scale: 0–1) was 0.7 (P = 0.785, I2 = 0.0%). Fatigue VAS (scale: 0–10 cm) was 4.9 (95% CI: 3.9–5.9) at baseline on average. Details of baseline and longitudinal PRO results are shown in Supplementary Tables 4 and 5, https://links.lww.com/CM9/A618, respectively. In general, the health domains and PRO tools were selected following the guidelines.[2] Pain, function, morning stiffness, and PGA were the four most frequently reported health domains in our study, which covered the core set PRO domains recommended by the ACR and were consistent with systematic reviews exploring PROs in other countries.[4] It was also noticed that within above domains, the utilization of PRO tools was relatively homogeneous. However, domains that were not recommended by guidelines were underreported and the selection of PRO tools was heterogeneous. For example, fatigue and sleep disturbance were both assessed in less than 10% articles, although they were common problems among patients.[5] Heterogeneity was most evident in the psychological status domain, in which a total of 16 different PRO tools were implemented and eight tools were used only once. The health domains and PRO tools reported in interventional studies were generally consistent with the guidelines comparing with observational studies. The majority of baseline health status among Chinese RA patients is comparable to that of patients from other countries although improvements are still needed. In conclusion, most health domains and PRO tools reported in studies related to Chinese RA patients are consistent with the guidelines and majority of baseline PRO levels among Chinese RA patients are comparable to other countries. Further studies and educations need to be conducted to increase the awareness and standardization the usage of PRO in daily clinical practice and streamline the usage of PRO tools. Conflicts of interest None.

Objectives: To initially clarify the efficacy and tolerability of nintedanib in patients with idiopathic-inflammatory-myopathy-related interstitial lung disease (IIM-ILD). Methods: A retrospective, real-world analysis was conducted in IIM-ILD patients who regularly received outpatient visit or hospitalization from January 2018 to March 2020 in three centers. And the patients were divided into two groups depending on presence or absence of nintedanib therapy. Comparisons, Kaplan-Meier survival analysis and propensity score matching were made to identify difference in time to death from any cause, incidence of rapidly progressive interstitial lung disease (RP-ILD) and comorbidity of pulmonary infection between the two groups. The following logistic regression analyses and Cox proportional-hazard regression analyses were used to verify the therapeutic value of nintedanib as well as clinical significance of other factors. Adverse events were descriptively recorded. Results: Thirty-six patients receiving nintedanib therapy and 115 patients without use of nintedanib were included. Before and after propensity score matching, the primary comparisons revealed better survival (P = 0.015, P = 0016, respectively) and lower incidence of RP-ILD (P = 0.017, P = 0.014, respectively) in patients with nintedanib therapy. Logistic regression analysis identified that disease activity (P < 0.001), percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%, P = 0.036), nintedanib therapy (P = 0.004, OR value = 0.072) and amyopathic dermatomyositis (ADM, P = 0.012) were significantly correlated with RP-ILD. Cox proportional hazards regression analysis suggested that disease activity (P < 0.001), anti-MDA5 antibody (P < 0.001) and nintedanib therapy (P = 0.013, HR value=0.268) were significantly associated with survival of IIM-ILD patients. Similar results can also be seen in analyses after propensity score matching. In the 36 patients with nintedanib therapy, diarrhea was the most common adverse event (44.4%) and hepatic insufficiency contributed to most dosage reduction (44.4% of nine patients) or therapy discontinuation (60.0% of five patients). Conclusions: Nintedanib was found to reduce incidence of RP-ILD and improve survival in IIM-ILD patients in a real-world setting. Anti-MDA5 antibody could be taken as a risk factor for unfavorable outcome. ADM was significantly correlated with occurrence of RP-ILD. In addition to the most frequent diarrhea, hepatic insufficiency was closely related to dosage reduction or therapy discontinuation.

Abstract Background Interstitial lung disease (ILD) is a common and frequently fatal extra-muscular complication in patients with idiopathic inflammatory myopathy (IIM), and is refractory to the conventional immunosuppressive medications. Nintedanib has previously been proven to be effective and tolerable in idiopathic pulmonary fibrosis, systemic-sclerosis-related ILD, etc. However, the efficacy and safety of nintedanib in idiopathic-inflammatory-myopathy-related ILD (IIM-ILD) remain unknown. The purpose of this study was to initially explore the efficacy and tolerability of nintedanib in IIM-ILD patients. Methods A real-world analysis was conducted to explore the efficacy and tolerability of nintedanib in IIM-ILD patients who regularly received outpatient visit or hospitalization from January 2018 to October 2019 in one medical center. The primary end point was occurrence of rapid progression of interstitial lung disease (RP-ILD) in the follow-up. And time to death from any cause, complication of pulmonary infection and difference in immunosuppressive regimen were taken as secondary end points in this study. Adverse events were descriptively recorded. Results 22 patients receiving nintedanib therapy and 82 patients under conventional medications were included. After propensity score matching, the primary comparison revealed that better survival (P = 0.036) and prominently less RP-ILD (P = 0.031) in patients with nintedanib therapy. Logistic regression analysis identified that disease activity (P = 0.032), anti-PM-Scl75 antibody (P = 0.027) and nintedanib therapy (P = 0.023, OR value = 0.063) were significantly correlated with RP-ILD. Cox proportional hazards regression analysis demonstrated that disease activity (P = 0.007), anti-MDA5 antibody (P = 0.004) and nintedanib therapy (P = 0.027, HR value = 0.190) were significantly associated with survival of IIM-ILD patients. Similar results can also be seen in analyses before propensity score matching. In the 22 patients with nintedanib therapy, diarrhea was the most common adverse event (54.5%) and hepatic insufficiency contributed to most dosage reduction (50%) or therapy discontinuation (50%). Conclusion Nintedanib therapy might reduce incidence of RP-ILD and improve survival in IIM-ILD patients. Anti-PM-Scl75 and anti-MDA5 antibodies could predict RP-ILD and survival respectively. In addition to the most frequent diarrhea, hepatic insufficiency was closely related to dosage reduction or therapy discontinuation. Trial registration: ISRCTN.com, ISRCTN 10507540. Retrospectively registered.

Objective:To compare the effect of different transcatheter valve types on conduction disturbances after transcatheter aortic valve implantation.Methods:From January 2018 to July 2019, 97 patients with valvular heart disease were treated by transcatheter aortic valve implantation (TAVI) at Beijing Anzhen Hospital, Capital Medical University. According to the transcatheter valve type, patients were divided into Venus-A group (52 cases) and J-Valve group (45 cases). Incidences of conduction disturbances and permanent pacemaker implantation events were analyzed.Results:There was no significant difference of the incidence of conduction disturbances and permanent pacemaker implantation events between Venus-A group and J-Valve group [48.1% (25/52) vs. 53.3%(24/45), 11.5% (6/52) vs. 6.7%(3/45)] ( P=0.61, 0.50). There was also no significant difference between aortic stenosis and aortic regurgitation in J-Valve group [43.8%(7/16) vs. 58.6%(17/29), 6.3%(1/16) vs. 6.9%(2/29)] ( P=0.34, 1.00). Conclusion:There is no significant difference between Venus-A group and J-Valve group on the incidence of conduction disturbances and permanent pacemaker implantation.

目的总结分析经导管主动脉瓣植入术/置换术（TAVI/TAVR）人工瓣膜滑脱的危险因素及处理经验。方法回顾性分析本中心自2017年9月至2019年5月行TAVI手术131例患者的临床资料。经心尖入路62例,经股动脉入路69例。结果 131例中4例患者术中出现人工瓣膜滑脱,2例为经股动脉入路,2例为经心尖入路。4例患者平均年龄（77±9）岁,最大年龄85岁,女性1例,占25%。术前评估方法选择、术中瓣膜位置高、同轴性不佳等因素是引起TAVI术中瓣膜滑脱的危险因素。结论瓣膜滑脱亦是TAVI术中严重的并发症,合理有效的处理可避免开胸。

Objective To explore the clinic results of our new designed transcatheter valve in valve for the mitral biopro-thesis deterioration.Methods Mitral bioprothesis deterioration patients with high risk for the routine bypass surgery got con-sent.After general anesthesia in the hybrid operation the left ventricle apical puncture was performed with guidance of 3D echo and X-ray.The retro-preset J Valve system was guided into the left atrium and the mitral bioprothesis with the beating heart . Results There were total 9 cases between Jan 2019 to Mar 2019 which had STS score above 6-8.The mitral bioprothesis in-cluded Hancock valve 3 cases, Perimount valve 3 cases, Epic valve 2 cases, Baxiter valve 1 case.The mitral bioprosthesis size included 27 for 6 cases and 25 for 3 cases.The successful implant rate was 100％, mortality rate 0, and all the patients recov-ered well without any main complications.The mean tran-valular pressure was only(8 ±2) mmHg (1 mmHg=0.133 kPa). Conclusion This innovative mitral valve in valve technique with retro-preset J Valve system got very good clinic results and worthy of deep research.

Objective. Iguratimod, a novel disease-modifying anti-rheumatic drug for the treatment of rheumatoid arthritis, has been approved in China and Japan. Here, we aimed to find whether iguratimod can inhibit the aggressive behavior and promote apoptosis of rheumatoid fibroblast-like synoviocytes (RA-FLSs). Methods. The proliferation of RA-FLSs was assessed by 5-ethynyl-2′-deoxyuridine test and Cell Counting Kit-8. Migration and invasion were determined by the wound test and a transwell assay. Apoptosis was tested by flow cytometry. The mRNA expression of matrix metalloproteinases (MMPs) and proinflammatory cytokines in RA-FLSs were measured by quantitative PCR and ELISA. To gain insight into the molecular signaling mechanisms, we determined the effect of iguratimod on the activation of mitogen-activated protein kinases (MAPK) signaling pathways by the cellular thermal shift assay (CETSA) and western blot. Results. Iguratimod treatment significantly reduced the proliferation, migration, and invasive capacities of RA-FLSs in a dose-dependent manner in vitro. MMP-1, MMP-3, MMP-9, Interleukin-6 (IL-6), and monocyte chemoattractant protein-1 mRNA and protein levels were all decreased after treatment with iguratimod. Furthermore, tumor necrosis factor-alpha- (TNF-α-) induced expression of phosphorylated c-Jun N-terminal kinases (JNK) and P38 MAPK were inhibited by iguratimod. Additionally, iguratimod promoted the apoptosis of RA-FLSs. Most importantly, iguratimod was shown to directly interact with JNK and P38 protein by CETSA assay. Moreover, activating transcription factor 2 (ATF-2), a substrate of both JNK and P38, was suppressed by iguratimod. Conclusions. Our findings suggested that the therapeutic effects of iguratimod on RA might be, in part, due to targeting the aggressive behavior and apoptosis of RA-FLSs.

患者 男,23岁.因“口角歪斜、口齿不清伴低热3d”于2018年5月7日收住本院.3d前患者无明显诱因下出现口角歪斜,口齿不清,右上肢无力,伴发热,体温最高38.2℃,无畏寒、寒战、咳嗽、咳痰、皮疹及关节痛,来本院急诊,查WBC 12.8×109/L,中性粒细胞82.2％.头颅CT检查示:两侧大脑半球多发低密度灶(图1),建议MRI进一步检查.急诊拟“脑栓塞、血管炎、神经系统受累?中枢神经系统感染?”收住入院.

系统性红斑狼疮（ SLE）是一种系统性自身免疫性疾病，其具体发病机制不明。 SLE患者体内存在T细胞亚群比例失衡及细胞因子紊乱。 T 辅助细胞22（ T helper 22， Th22）是一种新的独立T细胞亚群，以分泌白细胞介素（ in-terleukin， IL）22为主，不表达IL-17或IFN-γ，参与机体免疫调节。已有研究显示，其在银屑病［1］等疾病中发挥重要作用。而Th22及IL-22在SLE患者是否存在异常及其与狼疮活动和器官损害的关系尚未得到确认。本研究通过检测SLE患者及健康对照者血浆Th22及IL-22水平，探讨其在SLE发病机制中的作用。

Objective:To explore the clinical efficacy and changes of inflammatory factors of methotrexate combined with total glucosides of peony(TGP)in the treatment of juvenile idiopathic arthritis. Methods:Sixty cases of juvenile idiopathic arthritis patients were randomly divided into a methotrexate group,a TGP group and a combined group(methotrexate combined with total glucosides of peony),twenty cases in each. Clinical indicators and inlfammatory factors of the three groups were observed respectively before treatment,three and six months after treatment.Results:After 6-month treatment,the improvement of clinical symptoms,indexes of disease activity(erythrocyte sedimentation rate,C-reactive protein)and clinical disease activity index(CDAI) score in the combined group was better than that in the methotrexate group and the TGP group(P< 0.05). IL-1,IL-17,TNF-α,MMP-3 and MMP-14 in the serum signiifcantly decreased(P< 0.05),positively correlated with CDAI score.At the same time,after 6 months of treatment,the scores of synovitis and bone marrow edema of the combined group were signiifcantly lower than those in the methotrexate group and TGP group(P< 0.05). Conclusion:TGP combined with methotrexate in treatment of juvenile idiopathic arthritis is better than the single use of methotrexate or TGP.At the same time,the levels of IL-1,IL-17,TNF-α,MMP-3 and MMP-14 in peripheral blood may be used as a marker for the judgment of the activity of juvenile idiopathic arthritis.

Objective To analyze abnormal characteristics of mitral valve (MV) caused by rheumatic and degenerative mitral valvedisease in virtue of the real-time three-dimensional transesophageal echocardiography(RT3DTEE) and quantitative analysis software.Methods Sixty patients underwent RT3DTEE study:21 patients with rheumatic valvular disease(RHD) studied intraoperatively(9 severe mitral stenosis,6 severe mitral regurgitation,6 severe mitral stenosis couple with regurgitation ) and 20 patients with normal MV who were used as controlsubjects(NS).TomTec-Arena 1.0-4D MV-Assessment 2.3 software was used to measure parameters of annular dimensions and geometry,[eafletsurface area and so on.Results Compared with NS,the diameter between anterior and posterior(AP) of RIID increased,however,the commissural width (CW)didn't change.Parameters of AP,CW,annulus circumference(AC) and annulus area(AA) of degenerative mitral valve disease(DMVD) increased obviously,the spherical index instead didn't change,the original "saddle" shapebecame flat.The impact on mitral valve leaflets is difference between RHD and DMVD.The anterior instead of posterior leaflet arena and length became larger of the group MS and MS&MI.However,the group of DMVD has increased leaflet area of anterior as well as posterior.Posterior leaflet angle is significantly increased in the group of MS&MI.The angle,between the DAP and plane of aortic valve annular (Angle AAo-AP),were magnified in both RHD and DMVD.From the automatic dynamic analysis,the parameters of annular displacement(max),annulus area fraction(2D)decreased considerably in RHD group.Conclusion RHD has relatively mild impact on annular of MV,but the lesions of mitral valve leaflet and chordae tendineae limit the movement of bicuspid valve an nular.The dilated and flattened annular of DMVD still has the "saddle" shape.

Objective:This study set out to analysis structural characteristics of mitral valve (MV) caused by chronic secondary mitral regurgitation by means of the real-time three-dimensional transesophageal echocardiography (RT3DTEE) and quantitative analysis software.Methods:Forty patients underwent RT3DTEE study:20 patients with chronic secondary mitral regurgitation and 20 patients with normal MV used as control subjects(CS).TomTec-Arena 1.0-4D MV-Assessment 2.3 software was used to measure parameters of annular dimensions and geometry,leaflet surface area and so on.Results:There is a Significant difference between CSMR and CS group that the left ventricular end-diastolic diameter of CSMR significantly increased (P ＜0.01).Compared with CS group,the parameters include AP diameter,AL-PM diameter,Annulus circumference,Annulus area had increased (P ＜ 0.05),however,the Sphericity index and Non-planar Angle had no statistical difference.The Annular Height of CSMR decreased (P ＜ 0.05).AHCWR,namely the ratio of Annular Height to Commissural Width,is generally accepted as an index which reflects the degree of mitral valve annular nonplanar.The CSMR group had smaller AHCWR(P ＜0.05).There is no difference between two groups in anterior leaflet area,diameter of anterior annular to closure line length,but posterior leaflet area and diameter of posterior annular to closure line length were increased significantly(P ＜ 0.05).Parameters of posterior leaflet angle,anterior closure line length (3D),posterior closure line length had no statistical difference between groups,besides Angle AAo-AP,the angle constituted by AP diameter and aortic annular planar,had increased in CSMR group.From the automatic dynamic analysis,the parameters of Annular Displacement (max),Annulus Area Fraction (2D) decreased considerably in CSMR group(P ＜ 0.05).Conclusion:MV annular became Dilated and flattened,accompanied by expanded left ventricular in CSMR secondary to severe aortic insufficiency,and systolic MV closing forces decreased.

Tabia was a very popular construction material with high mechanical strength, great tenacity and good impermeability, which was widely used in ancient China. It is one of the greatest inventions of ancient China. Organic additives, such as sticky rice, egg white and sugar, were believed to be added to some tabia, according to many ancient documents. However, the detection of these organic additives is not easy, because the soil and pigments in tabia can interfere with the analytical observations. In this paper, a simple and economical method to detect sticky rice composition in tabia is presented. Starch, the main component of sticky rice, can be extracted by acetic acid aqueous solution, using a microporous membrane filter and an ultrafiltration method to get rid of the interference of soil particles and pigment, and finally it can be detected by an iodine–starch chromogenic reaction. A number of ancient Chinese tabia samples were analysed using this method and starch was found, which proved that sticky rice was added during the preparation process of tabia.

The present study describes the case of an 18-year-old adolescent male exhibiting acute lymphocytic leukemia (ALL), complicated by the onset of the symptom of sacroiliitis mimicking spondyloarthritis. Atypical features including an enlarged spleen, poor effects of non-steroidal anti-inflammatory drug therapy, low levels of hemoglobin, a low platelet count, a low neutrophil count and increased levels of monocytes, indicated the possibility of hematological malignancy. Bone marrow examination confirmed the diagnosis of ALL. The patient received chemotherapy and the symptoms were dramatically relieved. To the best of our knowledge, the current study reports the second published case of a patient with ALL presenting with sacroiliitis. Sacroiliitis as an onset manifestation of ALL may result in misdiagnosis, therefore, a differential diagnosis is essential when atypical features are present.

The activated NF-κB signaling pathway plays an important role in pathogenesis of primary Sjögren's syndrome (pSS). The inhibitor of κB (IκB) kinase (IKK) family such as IKKα, IKKβ, IKKγ, and IKKε, is required for this signaling. Our aim was to investigate the role of IKKα/β/γ/ε in patients with untreated pSS. In minor salivary glands from pSS patients, phosphorylated IKKε (pIKKε), pIκBα, and pNF-κB p65 (p-p65) were highly expressed in ductal epithelium and infiltrating mononuclear cells by immunohistochemistry, compared to healthy individuals. pIKKα/β and pIKKγ were both negative. And pIKKε positively related to expression of p-p65. Furthermore, pIKKε and p-p65 expression significantly correlated with biopsy focus score and overall disease activity. Meanwhile, in peripheral blood mononuclear cells from pSS patients, pIKKε, total IKKε, pIKKα/β, and p-p65 were significantly increased by western blot, compared to healthy controls. However, there was no difference in IKKγ and IκBα between pSS patients and healthy individuals. These results demonstrated an abnormality of IKKε, IκBα, and NF-κB in pSS, suggesting a potential target of treatment for pSS based on the downregulation of IKKε expression and deregulation of NF-κB pathway.

Interleukin‐22 (IL‐22) and IL‐22‐producing T helper (Th) cells are involved in the pathogenesis of autoimmune diseases. However, the roles of IL‐22 and IL‐22‐producing T helper cells in systemic lupus erythematosus (SLE) remain unclear. Plasma levels of IL‐22 were measured in 41 patients with SLE (19 new‐onset and 22 relapsing patients) and 20 healthy controls by enzyme‐linked immunosorbent assay (ELISA). Meanwhile, the percentages of CD4+IFN‐γ+ (Th1), CD4+IL‐17+ (Th17) and CD4+IFN‐γ−IL‐17− IL‐22+ (Th22) cells in peripheral lymphocytes were determined by flow cytometry, and plasma IL‐22 autoantibodies were detected by ELISA in 19 new‐onset SLE patients and 20 healthy controls. Plasma IL‐22 levels in new‐onset SLE patients were significantly decreased compared with relapsing SLE patients and healthy controls. After treatment with prednisone and hydroxychloroquine, the levels of plasma IL‐22 in new‐onset SLE patients were obviously increased but still lower than healthy controls. There was a positive correlation between plasma IL‐22 levels and the percentages of Th22 cells, but not Th1 and Th17 cells. Moreover, plasma IL‐22 levels as well as peripheral Th17 and Th22 cells correlated with SLE disease activity index (SLEDAI) scores and erythrocyte sedimentation rate (ESR). High frequencies of plasma IL‐22 autoantibodies were detected in new‐onset SLE patients. However, IL‐22 levels did not correlate with IL‐22 autoantibody. Decreased plasma IL‐22 levels and correlation with Th22 cells may be distinct features in new‐onset SLE. Moreover, IL‐22 and Th22 cell correlated with SLE disease activity.