Anti-C1q antibodies in systemic lupus erythematosus

OBJECTIVE

Anti-C1q has been associated with systemic lupus erythematosus (SLE) and lupus nephritis in previous studies. We studied anti-C1q specificity for SLE (vs rheumatic disease controls) and the association with SLE manifestations in an international multicenter study.

METHODS

Information and blood samples were obtained in a cross-sectional study from patients with SLE (n = 308) and other rheumatologic diseases (n = 389) from 25 clinical sites (84% female, 68% Caucasian, 17% African descent, 8% Asian, 7% other). IgG anti-C1q against the collagen-like region was measured by ELISA.

RESULTS

Prevalence of anti-C1q was 28% (86/308) in patients with SLE and 13% (49/389) in controls (OR = 2.7, 95% CI: 1.8-4, p < 0.001). Anti-C1q was associated with proteinuria (OR = 3.0, 95% CI: 1.7-5.1, p < 0.001), red cell casts (OR = 2.6, 95% CI: 1.2-5.4, p = 0.015), anti-dsDNA (OR = 3.4, 95% CI: 1.9-6.1, p < 0.001) and anti-Smith (OR = 2.8, 95% CI: 1.5-5.0, p = 0.01). Anti-C1q was independently associated with renal involvement after adjustment for demographics, ANA, anti-dsDNA and low complement (OR = 2.3, 95% CI: 1.3-4.2, p < 0.01). Simultaneously positive anti-C1q, anti-dsDNA and low complement was strongly associated with renal involvement (OR = 14.9, 95% CI: 5.8-38.4, p < 0.01).

CONCLUSIONS

Anti-C1q was more common in patients with SLE and those of Asian race/ethnicity. We confirmed a significant association of anti-C1q with renal involvement, independent of demographics and other serologies. Anti-C1q in combination with anti-dsDNA and low complement was the strongest serological association with renal involvement. These data support the usefulness of anti-C1q in SLE, especially in lupus nephritis.

A mechanism study on propofol's action on middle latency auditory evoked potential by neurons in ventral partition of medial geniculate body in rats

OBJECTIVES

To investigate the effect of propofol on the middle latency auditory evoked potentials (MLAEP) by neurons in the ventral partition of medial geniculate body (MGBv) in rats and study their mechanism.

MATERIALS AND METHODS

Sprague-Dawley (SD) rats were randomly divided into 7 groups (n = 6): group normal saline (NS), group intralipid (I), and groups of different concentrations of propofol (5.6, 16.8, 56, 168, 560 µmol/L) (P1-P5). These animals were anesthetized with ether, tracheostomized, and mechanically ventilated. After anesthesia, rats were paralyzed with vecuronium and fixed. A recording needle electrode with drugs was inserted into MGBv by means of stereotaxis. After injection of 0.2 µl propofol, normal saline or intralipid, correct insertion was verified by MLAEP response to standard sound. MLAEP including amplitudes and latencies of N0, P0, Na, Pa, and Nb waves were recorded. To identify which ion channel could be impacted by propofol, SD rats were divided into Ni2+ plus propofol (A1 group), Cd2+ plus propofol (A2 group), 4-AP plus propofol (A3 grouop), and TTX plus propofol (A4 group). The changes of MLAEP were recorded between injecting 4 ion channel blockers and propofol. Whole-cell patch clamp technique was used to confirm these variations.

RESULTS

There was no significant changes in all waves of MLAEP in MGBv after drug administration as compared with the baselins before injection in group NS, I, P1, and P2. The latency of Na, Pa, and Nb wave was significantly prolonged and the amplitude of Pa wave was decreased after injection as compared with the baseline in group P3, P4, and P5. The latency of Na, Pa, and Nb waves was significantly longer and the amplitude of Pa wave was significantly lower in group P3, P4, and P5 than in group NS and I. With TTX, amplitudes were decreased in wave Na-Pa. After given propofol, waves were unchanged in Na-Pa and latency was increased in Na, Pa, and Nb. With Cd2+, latency was unchanged in Na, Pa, and Nb as well as amplitudes decreasing in Na-Pa. Nevertheless, after given Ni2+ and 4-AP, every wave of MLAEP had no changes. After injected propofol, amplitudes were decreased in wave Na-Pa and latency was increased in Na, Pa, and Nb. The results of patch clamp showed 56 µmol/L, 168 µmol/L and 560 µmol/L propofol inhibited the persistent sodium currents and high voltaged activated calcium currents in the brain slices of rats.

CONCLUSIONS

Propofol in 56 µmol/L, 168 µmol/L and 560 µmol/L can inhibit MLAEP in MGBv of rats in a dose-dependent manner and these changes may be caused by blocking the ion channel of persistent sodium currents and high voltaged activated calcium currents.

Evaluation of the therapeutic effect of treatment with intra-articular hyaluronic acid in knees for Kashin-Beck disease: a meta-analysis

OBJECTIVE

To assess the efficacy and safety of intra-articular hyaluronic acid (IAHA) injection in knee joints of patients with Kashin-Beck disease (KBD).

METHODS

We searched nine electronic databases as well as unpublished data from inception until November 30th 2013 using a combination of search terms for KBD and hyaluronic acid (HA). For dichotomous data, odds ratios (OR) and 95% confidence intervals (CI) were estimated. For continuous data, standard mean difference (SMD) was used for outcomes pooled on the difference scale using a "random-effects" or "fixed-effects" model. We also compared the mean and standard deviation of cytokine levels in post-treatment.

RESULTS

The seven eligible trials included 954 IAHA and 495 control patients. The methodological quality of included trials was low. The overall effectiveness of the IAHA group and control group were 93.7% and 62.9%, respectively. IAHA group resulted in very large treatment effects compared to pre-treatment values in 12 months, with SMD values ranging from 1.19-2.64 (all P < 0.05). Compared to controls, SMDs in IAHA group ranged from 0.19-0.64 at 1 week to 1 month (all P > 0.05) and 0.68-1.47 at 2 months to 12 months (all P < 0.05). There was significant improved of HA, cluster of differentiation44 (CD44), keratan sulfate (KS), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and nitric oxide (NO) contents in serum compared with that in the post-treatment and healthy control in non-KBD area (all P < 0.05).

CONCLUSION

IAHA for the treatment of KBD was safe and efficacious at 12 months with low and transient adverse reactions. However, more high-quality randomized controlled trials (RCTs) are needed to confirm its therapeutic effect.

Mechanism of ulinastatin protection against lung injury caused by lower limb ischemia-reperfusion

AIM

The aim of this paper was to investigate the mechanism of ulinastatin's protection of lung from injury caused by lower limb ischemia-reperfusion in a rat model.

METHODS

Male, Sprague-Dawley rats were divided into three groups: saline control (CON), lung injury group, caused by lower limb ischemia-reperfusion (LIR) by rubber band ligation of the lower limbs for 3 h, followed by reperfusion for 3 h and lung injury with ulinastatin pretreatment intravenously before ligation (UTI). Carotid arterial blood was drawn 3 h postreperfusion for gas analysis, and alveolar lavage of one lung was performed. Rats were then sacrificed and lungs were taken for pathological examination and to detect phosphorylated and total p38, JNK, ERK levels. Inflammatory cell count and cytokines TNF-α, IL-1, IL-6 were measured from the lavage fluid.

RESULTS

There was significant inflammatory cell infiltration, hemorrhaging, and edema of the lung in the LIR group, all of which were reduced significantly in the UTI group. Oxygenation index in the LIR was lower than the CON while it was higher in the UTI than the LIR group. Compared to the CON group, white blood cell count in the alveolar lavage fluid from LIR group was increased, while this is lower in the UTI. Lavage fluid TNF-α, IL-β, and IL-6 levels were higher in the LIR group than the CON group, and were significantly lower in the UTI than the LIR. LIR group exhibited increased phosphorylated ERK, JNK and p38; UTI group rats also had enhanced p-ERK levels, but had decreased p-p38 and p-JNK.

CONCLUSION

Ulinastatin pre-treatment reduces lung injury caused by lower limb ischemia-reperfusion via a mechanism that may involve inhibition of inflammatory cytokine production via p-JNK and p-p38 pathways.

Chronic urticaria in Chinese population: a hospital-based multicenter epidemiological study

BACKGROUND

The epidemiologic profiles of chronic urticaria (CU) vary considerably among regions, and few such data are available from China.

METHODS

We performed a multicenter open questionnaire investigation about the clinical and laboratory features of CU, defined as recurrent wheals with/without angioedema lasting for ≥6 weeks, among 3027 patients.

RESULTS

Female preponderance was observed (female/male ratio, 1.46 : 1). The mean age at diagnosis was 34.7 ± 13.8 years, and the mean disease duration was 18.5 ± 46.1 months (range, 1.5-127 months). Patients were classified as having chronic spontaneous urticaria (CSU, 61.0% of patients), physical urticaria (PU, 26.2%), or other urticaria types (OU, 2.3%). Nocturnal attacks were reported by 60% of cases. The Urticaria Activity Score (UAS) in patients with CSU was 3.8 ± 1.4. The mean Dermatology Life Quality Index was 7.3 ± 3.4 (range 0-30). Induction or exacerbation of wheals with alcohol drinking was reported by 55.7% of patients. Chronic hepatitis B was less prevalent in our CU patients compared with the general Chinese population (2.7% vs 7%). Positive autologous serum skin tests (ASSTs) were observed in 66.9% of patients. Patients with positive ASST had higher UAS, greater angioedema frequencies, longer disease durations, and poorer QoL compared with patients with negative ASST (P < 0.05).

CONCLUSION

In this Chinese population, CU usually affected youth, and CSU was the most common subtype. Autoreactivity and alcohol consumption were the top two triggers for CU, whereas latent infectious and chronic inflammatory diseases were not as common as in previous reports.

Exploring the FDA adverse event reporting system to generate hypotheses for monitoring of disease characteristics

The US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) is a database for postmarketing drug safety monitoring and influences changes in FDA safety guidance documents such as drug labels. The number of cases in the FAERS has rapidly increased with the improvement of submission methods and data standards and thus has become an important resource for regulatory science. Although the FAERS has been predominantly used for safety signal detection, this study explored its utility for disease characteristics.

Population genetic structure and geographical differentiation of burbot (Lota lota) in China

The burbot (Lota lota Linnaeus, 1758) is the only freshwater species of the family Gadidae. There is a long-standing controversy about taxonomic status of the burbot from the Amur River basin. It is necessary to investigate population genetic structure and geographical differentiation among burbot populations from the Irtysh River basin and Amur River basin by mitochondrial DNA nucleotide sequence analysis. A 572 bp segment of cytochrome b and 425 bp segment of control region gene were sequenced from 4 populations. The results showed that there was lower genetic diversity of burbot in China and highly significant genetic difference between populations in the Amur Riverbasin (P < 0.01). Demographic analysis indicated that the burbot from the Amur River basin experienced population expansion (Cytb: F(s) = -0.912 (P = 0.287), D = -0.399 (P = 0.375); CR: F(s) = -4.771 (P = 0.015), D = -1.523 (P = 0.03 )). The data of 4 populations in China combining with the published data representing the Eurasian and North American burbot, revealed three distinct phylogenetic lineages (labelled EB, NA, Amur).

Dual role of chloroquine in liver ischemia reperfusion injury: reduction of liver damage in early phase, but aggravation in late phase

The anti-malaria drug chloroquine is well known as autophagy inhibitor. Chloroquine has also been used as anti-inflammatory drugs to treat inflammatory diseases. We hypothesized that chloroquine could have a dual effect in liver ischemia/reperfusion (I/R) injury: chloroquine on the one hand could protect the liver against I/R injury via inhibition of inflammatory response, but on the other hand could aggravate liver I/R injury through inhibition of autophagy. Rats (n=6 per group) were pre-treated with chloroquine (60 mg/kg, i.p.) 1 h before warm ischemia, and they were continuously subjected to a daily chloroquine injection for up to 2 days. Rats were killed 0.5, 6, 24 and 48 h after reperfusion. At the early phase (i.e., 0–6 h after reperfusion), chloroquine treatment ameliorated liver I/R injury, as indicated by lower serum aminotransferase levels, lower hepatic inflammatory cytokines and fewer histopathologic changes. In contrast, chloroquine worsened liver injury at the late phase of reperfusion (i.e., 24–48 h after reperfusion). The mechanism of protective action of chloroquine appeared to involve its ability to modulate mitogen-activated protein kinase activation, reduce high-mobility group box 1 release and inflammatory cytokines production, whereas chloroquine worsened liver injury via inhibition of autophagy and induction of hepatic apoptosis at the late phase. In conclusion, chloroquine prevents ischemic liver damage at the early phase, but aggravates liver damage at the late phase in liver I/R injury. This dual role of chloroquine should be considered when using chloroquine as an inhibitor of inflammation or autophagy in I/R injury.

Erythrocyte sedimentation rate is a predictor of renal and overall SLE disease activity

OBJECTIVE

Our aim was to assess whether erythrocyte sedimentation rate (ESR) levels correlate with the level of disease activity at each visit and whether a change in ESR could be useful in predicting changes in disease activity.

METHODS

Thousands of visits in a prospective systemic lupus erythematosus (SLE) cohort were analyzed to assess the association of ESR and level of disease activity. We explored whether ESR was cross-sectionally associated with disease activity, whether changes in ESR were associated with changes in disease activity, and whether changes in ESR predicted future changes in disease activity. Visits when patients had cancer, infection, pregnancy or were in renal failure were excluded.

RESULTS

After adjusting for confounding factors, mild (25-50 mm/h), moderate (51-75 mm/h), and marked (>75 mm/h) elevations in ESR levels at a given visit correlated with the SELENA-SLEDAI, the Physician Global Assessment (PGA), fatigue, renal, joint, rash, serositis, hematological visual analogue scale (VAS), hematuria and proteinuria (p<0.0001) levels at that visit. A change in ESR between two visits was highly correlated with a concurrent change in PGA, renal, fatigue and joint VAS (p<0.0001). There was no statistically significant correlation between change in ESR between two visits and change in disease activity at a future visit. The subgroup analysis of patients who do not have anti-dsDNA and low complement levels as a feature of their disease showed ESR to be positively associated with SLEDAI, PGA, renal and joint VAS at that visit (p<0.0001), but there were few significant associations between changes in ESR and changes in disease activity.

CONCLUSION

ESR is associated with disease activity in SLE measured by the SELENA-SLEDAI, the PGA, and with organ-specific activity including serositis, rash, joint, renal and hematological VAS. Grouping baseline ESR into four levels does associate with both global and organ-specific disease activity. A change in ESR between two visits was highly correlated with a change in PGA, renal, fatigue and joint VAS. In patients without anti-dsDNA and low complement levels, ESR was positively associated with SLEDAI, PGA, renal and joint VAS at the same visit. Until more specific biomarkers are validated, serial ESR does have some utility in following disease activity in SLE.

Predictors of corticosteroid tapering in SLE patients: the Hopkins Lupus Cohort

Purpose

Organ damage in systemic lupus erythematosus (SLE) patients is highly associated with the use of corticosteroids. Doses of prednisone below 6 mg daily are associated with reduced organ damage. We now report on the largest prospective cohort study of predictors of prednisone tapering in SLE patients.

Methods

A total of 866 SLE patients (91% female, 50% Caucasian, 43% African-American, mean age 43 years) who consented for the Hopkins Lupus Cohort from 1987 through 2009 were included. The analysis was based on patient visits in which the previously prescribed dose of prednisone was 5 mg/day. We then examined the proportion of times the patient’s dose was reduced to below 5 mg/day (“tapering”). Among those patients who tapered and were followed for at least one year thereafter, we examined the proportion whose prednisone dose remained below 5 mg/day for at least one year (“Successful tapering”). Rates of tapering and successful tapering were calculated for patient subsets based on demographic and clinical characteristics.

Result

The analyses showed that Caucasians, younger patients, patients with a higher level of education, lower disease activity, or absence of urine protein were more likely to have a prednisone taper. However, successful tapering was not dependent on age, ethnicity, or education. As expected, successful tapering was more frequent in those with lower disease activity. Successful tapering was achieved more often after the year 2000.

Conclusion

Our study suggests that successful tapering of prednisone below 5 mg has increased since the year 2000, which may reflect the greater knowledge of the long-term harm of even low-dose chronic corticosteroid use. Caucasians, younger age, higher level of education, and absence of proteinuria predicted tapering, but not successful tapering. Ongoing cutaneous or arthritis activity were associated with unsuccessful tapering. Lack of disease activity, as expected, was the only major clinical variable that significantly predicted successful tapering.

Radiofrequency ablation for liver metastasis from gastric cancer

AIMS

Several studies have reported the benefit of hepatic resection for metastatic tumor from gastric cancer. However, the value of treatment with radiofrequency ablation (RFA) has not been clearly defined.

METHODS

Between Jan 2002 and Dec 2007, 21 patients with primary gastric cancer were diagnosed with synchronous or metachronous liver metastases. All patients were treated with RFA, and the complication, survival, and recurrence rates were assessed.

RESULTS

The postoperative complication rate was 5% (1/21), with no mortality. The median actuarial survival time was 14 months. The 1-yr, 2-yr, 3-yr, and 5-yr survival rates after RFA were 70%, 11%, 5%, and 3%, respectively. With a median follow-up time of 19 months, local recurrence at the RFA site was 19% (4/21). Solitary metastasis had significantly longer survival than multiple lesions after RFA (22 vs 10 months, P = 0.004).

CONCLUSIONS

RFA provides a minimally invasive and safe modality of treatment patients with liver metastasis from gastric cancer. Patients with solitary liver lesion were considered appropriate candidates for RFA.