[The characteristics of non-alcoholic fatty liver disease and its associated factors in patients with rheumatoid arthritis]

Objective: To investigate the characteristics of non-alcoholic fatty liver disease (NAFLD) and its associated factors in rheumatoid arthritis (RA) patients. Methods: This cross-sectional study recruited 385 RA patients [including 72 (18.7%) male and 313 (81.3%) female] who received abdominal sonographic examination from August 2015 to May 2021 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. There were 28 RA patients at 16-29 years old and 32, 80, 121, 99, 25 at 30-39, 40-49, 50-59, 60-69, ≥ 70 years old, respectively. Demographic and clinical data were collected including age, gender, history of alcohol consumption, disease duration, body mass index (BMI), waist circumference, blood pressure, RA disease activity indicators and previous medications. Logistic regression analyses were used to identify the associated factors of NAFLD in RA patients. Results: The prevalence of NAFLD was 24.2% (93/385) in RA patients, 26.3% (21/80) in 40-49 age group and 33.1% (40/121) in 50-59 age group. There were 22.1% (85/385) and 3.6% (14/385) RA patients with overweight and obese, in which the prevalence of NAFLD was 45.9% (39/85) and 78.6% (11/14) respectively, which was 2.6 folds and 4.5 folds that of RA patients with normal BMI. Although there was no significant difference of age, gender and RA disease activity indicators between RA patients with or without NAFLD, those with NAFLD had higher proportions of metabolic diseases including obese (11.8% vs. 1.0%), central obesity (47.3% vs. 16.8%), hypertension (45.2% vs. 29.8%) and type 2 diabetes mellitus (24.7% vs. 12.0%), consistent with higher levels of total cholesterol [(5.33±1.31) mmol/L vs. (4.73±1.12) mmol/L], triglyceride [(1.51±1.08) mmol/L vs. (0.98±0.54) mmol/L] and low-density lipoprotein cholesterol [(3.37±0.97) mmol/L vs. (2.97±0.78) mmol/L, all P<0.05]. Multivariate logistic regression analysis showed that BMI (OR=1.314) and triglyceride (OR=1.809) were the independent factors positively associated with NAFLD in RA patients. Conclusion: NAFLD is a common comorbidity in RA patients, especially in those with middle-aged, overweight or obese, which is associated with high BMI or high triglyceride. Screening and management of NAFLD in RA patients especially those with overweight, obese or dyslipidemia should be emphasized.

[WU Xu's experience of sequential therapy for peripheral facial paralysis]

The paper introduces professor WU Xu 's experience of sequential therapy for peripheral facial paralysis. The sequential therapy refers to a staging treatment, but not rigidly adheres to it. With this therapy, the acupuncture- moxibustion regimen is modified flexibly in line with the specific symptoms of illness. At the acute phase of peripheral facial paralysis, warm acupuncture at Wangu (GB 12) is predominated and electroacupuncture is not recommended at the acupoints on the face. At the recovery phase, warm acupuncture at Zusanli (ST 36) is the main therapy and electroacupuncture is applied to the acupoints on the face appropriately. Besides, for the intractable case, the tapping technique with plum-blossom needle or skin needle should be combined and exerted in the local affected region. At the sequelae phase, in order to shorten the duration of illness, depending on the different types of facial paralysis, i.e. stiffness type, spasmodic type and flaccid type, the corresponding needling techniques are provided, i.e. bloodletting and moxibustion, strong stimulation with contralateral acupuncture and the technique for promoting the governor vessel and warming up yang.

[The characteristics and associated factors of functional limitation in patients with rheumatoid arthritis]

Objective: To investigate the characteristics of functional limitation and associated factors in patients with rheumatoid arthritis (RA). Methods: Consecutive patients with RA were recruited from August 2015 to June 2019 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. Demographic and clinical characteristics including age, gender, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) of pain, clinical disease activity index (CDAI), modified total Sharp score were collected. Physical function was assessed by the Stanford health assessment questionnaire disability index (HAQ-DI).Ordered logistic regression was used to analyze the related factors of HAQ-DI. Results: A total of 643 RA patients were finally recruited including 114 males and 529 females with mean age (49.7±12.9) years. There were 399 (62.1%) patients having different degrees of functional limitation, who were classified as mild (293, 45.6%), moderate (73, 11.4%) and severe (33, 5.1%). The prevalence of functional limitation was positively correlated with age and disease activity. The most restricted activity was walking [43.5% (280/643)], followed by gripping [36.1% (232/643)], reaching [35.5% (228/643)], daily activities [33.4% (215/643)], hygiene [33.0% (212/643)], dressing and grooming [29.7% (191/643)] and arising [29.1% (187/643)], and the last eating [18.4% (118/643)]. Multivariate ordered logistic regression analysis showed that age (OR=1.019, 95%CI 1.004-1.035),pain VAS (OR=1.820, 95%CI 1.616-2.050), ESR (OR=1.009, 95%CI 1.001-1.017), CDAI (OR=1.080, 95%CI 1.059-1.102) and modified total Sharp score (OR=1.010, 95%CI 1.004-1.015) were associated factors of functional limitation. Conclusion: The majority RA patients have functional limitation. Age, pain and active disease are independent associated factors. Therefore, target treatment and control of pain should be emphasized in RA patients.

Traditional Chinese Eight Brocade Exercise Prescription for Ankylosing Spondylitis: A Quantitative Synthesis

INTRODUCTION

The aim of this research was to assess the safety and effectiveness of traditional Chinese Eight Brocade exercise for ankylosing spondylitis (AS).

METHODS

A literature search was conducted using twelve databases (Web of Science, EBSCO, AMED, SCOPUS, CINAHL, MEDLINE, EMBASE, DBPIA, KoreaMed Synapse, Oriental Medicine Advanced Searching Integrated System, Chinese Wan Fang, and China National Knowledge Infrastructure) from inception to June 2019. We only included randomized controlled trials (RCTs) regarding traditional Chinese Eight Brocade exercise for AS. For statistical analysis, we adopted a quantitative analysis using the RevMan 5.3 statistical software.

RESULTS

Five eligible RCTs involving 308 participants were included in the systematic review. The meta-analysis showed superior effects of traditional Chinese Eight Brocade exercise plus NSAIDs therapy on response rate, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), inflammatory indicators, and bone mineral density when compared with NSAIDs therapy alone (p < 0.05). Moreover, when used alone, traditional Chinese Eight Brocade exercise significantly improved fatigue, intensity of morning stiffness domains, and duration of morning stiffness domains of BASDAI scores in comparison to waiting list controls (p < 0.05).

CONCLUSION

Traditional Chinese Eight Brocade exercise could improve physical function and reduce disease activity and inflammatory indicators in AS patients. However, the level of evidence was low because of the high risk of bias. Further rigorously designed RCTs are warranted before it can be recommended.

[Preliminary study on reading speed test with IReST for normally-sighted young Chinese readers]

Objective: To assess the reading speed of normally-sighted young Chinese with the International Reading Speed Texts (IReST) Chinese version, and evaluate the normal range of the texts, the equivalence of the ten different texts and the potential clinical value. Methods: Evaluation of diagnostic techniques. Participants aged 18 to 35 years old with junior high school or above education and best corrected visual acuity no less than 0.6 were recruited. Best corrected visions of both eyes and binocular vision were tested, and ocular and nervous system diseases were excluded with slit-lamp microscope and funduscope. All the ten texts were read aloud at a distance of 40cm one by one according to a random sequence for each participant. Reading speeds were calculated based on the reading time measured with a stopwatch and number of characters read correctly. The procedure was repeated once again a week later. Data were collected with Epidata and further analyzed with R software. Data accorded with normal distribution and homogeneity of variance were compared by t-test, or by rank sum test. Results: One hundred and three volunteers aged (26.0±2.8) years old participated in the survey. Among them, 66% were female, 96.1% had college education, 53.4% wear glasses in daily life. The best corrected vision of both distance and near were 1.0 (decimal). For the first test, average reading speed for all the participants and texts was (295±51) characters/min,much faster than the normal range provided by the reading cards. No significant difference was found between different texts, and the biggest variance between texts was 11 characters/min(P>0.05). The average reading speed of the second test was (315±53) characters/min, which was faster than the first one (P<0.05) . No statistic relationship was found between reading speed and age, education level or wearing of glasses. However, women read faster than men, and significant difference was found between male and female volunteers in 5 texts during the first test. Conclusions: Normally-sighted young Chinese readers read faster than the normal range provided by IReST cards. There is significant variance of reading speed between different individuals. Although learning effect due to the repeated tests should be considered, the ten texts are of favorable consistency. IReST can be a useful tool for assessing reading performance, especially for comparing results before and after interventions with different texts. (Chin J Ophthalmol, 2018, 54: 120-124).

[Variation of Locations of Baliao Acupoints in 290 Volunteer Subjects Analyzed by Using Computed Tomography-aided Three-dimensional Reconstruction Technique]

OBJECTIVE

To observe the variation of sacral vertebrates and foramen involving the bilateral Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33) and Xialiao (BL 34, Baliao acupoints), so as to provide an anatomic basis of acupoint needling in clinical practice.

METHODS

A total of 290 patients[161 men and 129 women, mean age and standard devia-tion, (63.6±13.3)years old and (59.5±13.3) years old, respectively] with intact pelvic structure were recruited in the present study. Computed tomography (CT) scans of intact pelves were taken using a SOMATOM Definition AS 128 and the acquired signals were imported into Siemens Syngo Inspace platform for 3 D reconstruction, followed by identification, classification and analysis of the variation of sacral foramen (Baliao acupoint).

RESULTS

The total variation rate of posterior sacral foramen (Baliao acupoint) was 20.34%(59/290). The detected three types of variation were sacral vertebrae number variation (4 sacral vertebraes, 6 sacral vertebraes), fusion variant (lumbosacral fusion, sacrococcygeal fusion, lumbosacral & sacrococcygeal fusion, and lumbosacral fusion & S 4 variation) and mixed type.

CONCLUSIONS

Variations of sacral vertebrae including the number and fusion exist in the human body, suggesting an increase of the difficulty of acupoint needling. Since posterior iliac spine does not change generally, it is recommended to be used as a reference point for locating the Baliao acupoint.

[Location of disease: acupoint view from the angle of clinic]

Doctor WANG Zhi-zhong in the Southern Song Dynasty proposed the acupoint view of "location of disease", which explained the connotation of acupoints from the angle of clinic. Its meaning included two levels, one level meant pathological change on the body surface, that was the location of acupuncture diagnosis-treatment, and the other one indicated that the body surface which was the reflecting point of pathological change on the distal area or inside the body was the location of acupuncture diagnosis-treatment. The specific connotations of clinical acupoints were: location of pathogenic factors or reflection of pathogenic factors, regularity between acupoints un- der disease and specific organ, morphological differences and positioning variability after acupoints under disease, and acupoints examination, diagnosis and treatment.

Combustion smoke exposure induces up-regulated expression of vascular endothelial growth factor, aquaporin 4, nitric oxide synthases and vascular permeability in the retina of adult rats

Retinal cells respond to various experimental stimuli including hypoxia, yet it remains to be investigated whether they react to smoke inhalation. We show here that retinal cells in rats, notably the ganglion cells, Müller cells, astrocytes and blood vessels responded vigorously to a smoke challenge. The major changes included up-regulated expression of vascular endothelial growth factor (VEGF), aquaporin 4 (AQP4) and nitric oxide synthase (NOS). VEGF expression was localized in the ganglion cells, Müller cells, astrocytes and associated blood vessels. AQP4 was markedly enhanced in both astrocytes and Müller cells. Increase in vascular permeability after smoke exposure was evidenced by extravasation of serum derived rhodamine isothiocyanate which was internalized by Müller cells and ganglion cells. The tracer leakage was attenuated by aminoguanidine and N(G)-nitro-L-arginine methyl ester (L-NAME) treatment which suppressed retinal tissue NOS and nitric oxide (NO) levels concomitantly. It is suggested that VEGF, AQP4 and NO are involved in increased vascular permeability following acute smoke exposure in which hypoxia was ultimately implicated as shown by blood gases analysis. NOS inhibitors effectively reduced the vascular leakage and hence may ameliorate possible retinal edema in smoke inhalation.

Seroprevalence of Helicobacter pylori infection in patients with hepatitis B

Helicobacter pylori infection has been investigated extensively in immunocompromised hosts, such as those with acquired immunodeficiency syndrome (AIDS) and organ transplant recipients. However, few reports on H. pylori prevalence in individuals with chronic HBV infection are available. The aim of this serological study is to investigate H. pylori prevalence in patients with hepatitis B. Ninety-six consecutive hospitalised patients with chronic hepatitis B were studied, together with 104 age-matched healthy individuals of similar socioeconomic status and with no evidence of hepatitis B virus infection or liver diseases. Serum samples from both groups were tested for specific IgG antibodies to H. pylori, using enzyme-linked immunosorbent assay (ELISA). Of the 96 patients with hepatitis B, 55 (57.3%) were positive for serum IgG anti-H. pylori, significantly greater than in the control group of 104, where 44 (42.3%) were positive (P < 0.05). In addition, the seroprevalence of H. pylori in the 45 patients who were positive for hepatitis B envelope antigen (HBeAg) and/or HBV-DNA was 75.6% (34), compared to 41.2% (21) in the 51 patients who were negative (P < 0.005). An increase in H. pylori prevalence is present in patients with chronic hepatitis B. Further study is needed to determine whether eradication of H. pylori will benefit these patients.

Targeting behavior of hepatic artery injected temperature sensitive liposomal adriamycin on tumor-bearing rats

Temperature sensitive liposomal Adriamycin (LADM) was injected into the hepatic artery of rats bearing implanted hepatic tumors. Two hours after the injection, the liver was heated at 42 degrees C and maintained for six minutes at that temperature using local hyperthermia. Blood samples were taken at regular intervals until 8 hours after injection, at which time the animals were sacrificed and the drug distribution in the tissues was examined. Results indicate that the Adriamycin was released from the liposome, with the drug concentration in circulation peaking at 30 minutes after heating. High drug levels (25.2 micrograms/g of wet tissue) in the tumor and high tumor/liver Adriamycin level ratios (TLAR; 4.1) were found. The drug levels and the TLAR of the liposomal Adriamycin injection combined with heating (LADM H) were significantly different from those of the same dose of aqueous Adriamycin with heating (ADM H) or aqueous Adriamycin (ADM) and LADM without heating. The experiment shows that the LADM is cleared from the liver slowly, and when hyperthermia treatment at phase-transition temperature of the liposome is performed, the drug level in an implanted hepatic tumor is increased, and in the parenchyma is decreased. The results imply that targeting the hepatic tumor in this way may be an effective therapeutic method, and the drug release from the liposome may be controlled externally. This method appears promising for clinical practice.

[Basic study on hepatic artery chemoembolization and tumor selective drug targeting by temperature-sensitive liposome with local hyperthermia]

Temperature-sensitive liposome entrapping adriamycin (L-ADM) was administered into the hepatic artery of hepatic tumor-bearing rats. The embolization of the hepatic artery with liposome and bio-distribution of ADM were examined. ADM concentration in blood showed a peak at 30 min after local heating on tumor (the heating had been performed for 6 min at 41-42 degrees C 2 hr. after injection). The value at the peak was about 3 times higher than that just before heating. ADM administered in liposomal form showed a high accumulative property to tumor with heating; ADM concentration in tumor 8 hr. after administration of ADM in liposomal form was about 5 times higher than that in liver and about 30 times higher than that in the heart, and about 20 times higher than that in tumor after administration in free form.

[Studies on the stability and some other important physical properties of polysaccharides polyphase liposome (PPL)]

The stability and some other important physical properties of PPL were investigated by means of electron microscopy and MPV-TAS experiments. The results are rated as follows: Good integrity of liposome homogeneity of its particle size were reached, and at 100 degrees C PPL was found to undergo sterilization without causing changes of its shape and encapsulation efficiency for 1 h. Also, the distribution of PPL particle size and the regularity of the change of PPL particle in size were determined by Coulter counter. Using this method, the kinetic equation of coalescence of polyphase liposome and the activation energy for coalescence were obtained, and through these results the stability of PPL is elucidated.