Systemic lupus erythematosus (SLE) is a multisystem disorder which can affect the gastrointestinal (GI) system. Although GI symptoms can manifest in 50% of patients with SLE, these have barely been reviewed due to difficulty in identifying different causes. This study aims to clarify clinical characteristics, diagnosis and treatment of the four major SLE-related GI system complications: protein-losing enteropathy (PLE), intestinal pseudo-obstruction (IPO), hepatic involvement and pancreatitis. It is a systematic review using MEDLINE and EMBASE databases and the major search terms were SLE, PLE, IPO, hepatitis and pancreatitis. A total of 125 articles were chosen for our study. SLE-related PLE was characterized by edema and hypoalbuminemia, with Technetium 99m labeled human albumin scintigraphy (Tc HAS) and alpha-1-antitrypsin fecal clearance test commonly used as diagnostic test. The most common site of protein leakage was the small intestine and the least common site was the stomach. More than half of SLE-related IPO patients had ureterohydronephrosis, and sometimes they manifested as interstitial cystitis and hepatobiliary dilatation. Lupus hepatitis and SLE accompanied by autoimmune hepatitis (SLE-AIH overlap) shared similar clinical manifestations but had different autoantibodies and histopathological features, and positive anti-ribosome P antibody highly indicated the diagnosis of lupus hepatitis. Lupus pancreatitis was usually accompanied by high SLE activity with a relatively high mortality rate. Early diagnosis and timely intervention were crucial, and administration of corticosteroids and immunosuppressants was effective for most of the patients.
Pulmonary fibrosis, a progressive chronic disease with a high mortality rate, has limited treatment options. Currently, lung transplantation remains the only effective treatment. Here we report that a small RNA, HJT-sRNA-m7, from a Chinese herbal medicine Hong Jing Tian (HJT, Rhodiola crenulata can effectively reduce the expressions of fibrotic hallmark genes and proteins both in alveolar in vitro and in mouse lung tissues in vivo. We also discovered over one hundred oil-soluble chemicals from HJT decoctions, most of which are found in lipid extracts from other Chinese herbals decoctions, including Pu Gong Ying (PGY, Taraxacum mongolicum), Chuan Xin Lian (CXL, Andrographis paniculata), and Jin Yin Hua (JYH, lonicera japonica or Honeysuckle). We identified the active component in these decoctions as two forms of phosphocholines, PC (18:0/18:2) and PC (16:0/18:2). These PCs potentially could form liposomes with small RNAs to enter human alveolar and gastric cells. Our experimental results suggest an unprecendent lipid complex route through which botanic small RNA can enter human bodies. Our results provide an innovative treatment strategy for oral delivery of siRNAs as therapeutic medication.
Objective This study aimed to identify the clinical characteristics and prognostic factors of systemic lupus erythematosus with transverse myelitis (SLE-TM) in a relatively large patient series. Methods This retrospective study considered 45 SLE-TM individuals treated as inpatients and outpatients at Peking Union Medical College Hospital between 1993 and 2018. SLE-TM patients were compared with 180 controls, and SLE-TM patients with neuromyelitis optica spectrum disorder (NMOSD) were compared to those without NMOSD. Results Compared to controls, the SLE-TM group frequently had a fever and had a significantly higher positive rate of anticardiolipin and lupus anticoagulant. Among the 45 patients, 22 met the NMOSD criteria. Compared to non-NMOSD patients, NMOSD patients had a lower incidence of rash ( p = 0.023), serositis ( p = 0.042) and renal disorder ( p = 0.073); a lower prevalence of decreased complement ( p = 0.083); and lower rates of positive anti-dsDNA ( p = 0.074) and anti-Sm ( p = 0.042). Among 22 SLE-TM patients with NMOSD, 18 underwent aquaporin 4 antibody testing, with 11 showing positive results. Out of the 45 patients, 39 were given methylprednisolone pulse treatment. After treatment, 32 patients had lower-limb muscle strength recovery (recovered group), whereas 13 had no change and persistent severe neurological deficits (non-recovered group). Compared to the recovered group, the non-recovered group were younger ( p = 0.002), had a higher likelihood of having a fever ( p = 0.020), initial severe myelitis ( p < 0.001), long spinal segment involvement ( p = 0.017) and higher C-reactive protein levels ( p = 0.020). Methylprednisolone pulse given within two weeks of onset was more frequent in the recovered group than in the non-recovered group ( p = 0.082). Conclusions Disease characteristics differed between SLE-TM patients with and without NMOSD. SLE and NMOSD tended to be co-morbidities. Initial severe neurological impairment, extensive spinal cord lesions, hyper-inflammation and delayed steroid impulse treatment could be predictors of poor outcome for SLE-TM.
Objective This study aims to exhibit the prognosis, both mortality and morbidity, of patients with systemic lupus erythematosus (SLE) in a single-center cohort in China. Methods A cohort of Chinese SLE patients were recruited from April 2009 to February 2010, and followed up regularly in clinic at Peking Union Medical College Hospital (PUMCH). Data for baseline, follow-up, and survival were collected, including demography, manifestations, activity, the Systemic Lupus International Collaborating/American College of Rheumatology (SLICC/ACR) Damage Index (SDI), and medications. The Kaplan-Meier method was adopted for survival analysis. Predicting and risk factors for both mortality and morbidity were evaluated by the Cox proportional hazard model. Associated factors were analyzed by the logistic regression model. Results A total of 260 patients were included at entry. The one-, three-, and five-year survival rates were 98.4%, 95.5%, and 93.8%. The proportion of patients with organ damage increased from 13.4% at baseline to 28.4% at year 6. Regression analysis showed that organ damage led to higher mortality, and organ-involved flare was associated with more future damage. Time from onset to diagnosis > 1 year, nephropathy and severe organ involvement were potential prognostic factors. Furthermore, onset age > 50 and previous organ damage were predictors for further damage. Conclusion Organ damage, severe organ involvement, and prolonged remission could be targets for the management of Chinese SLE patients to further reduce mortality. Early diagnosis, paying more attention to severe organ involvement, and preventing organ-involved flares and new organ damage would be crucially important in the future for Chinese SLE patients.
Oesophageal cancer is one of the most common cancers worldwide. Currently, the tumour, node, metastasis (TNM) staging system is the primary method for determining its extent and prognosis, however, data suggest this system does not predict prognosis accurately. Research has, therefore, concentrated on searching for specific biomarkers. Paxillin has been shown to play an important role in controlling cell spread and migration. Its over-expression is considered to correlate with the prognosis of some types of cancers, however, the relationship between paxillin expression and clinical outcome in oesophageal cancer has not been investigated. This study determined the expression of paxillin by immunohistochemistry on the tissue microarray of 100 oesophageal squamous cell cancer patients followed up for a mean of 55 months. Paxillin was over-expressed in tumours in 27/100 cases, compared with 6/100 cases for adjacent non-tumoural cells. No correlation occurred between expression of paxillin and overall patient survival, hence paxillin is not an effective prognostic marker in these patients.
SummaryThe objective of this study was to investigate the effects of thalidomide (THD) on interstitial lung fibrosis (ILF). In vitro, human fetal lung fibroblast (HFL-F) to myofibroblast (MF) trans-differentiation was induced by transforming growth factor (TGF)-b1. The effects of THD on transdifferentiation process or differentiated MF were evaluated by measuring hydroxyproline (HYP) content by alkaline hydrolysis colorimetry, a-smooth muscle actin (a-SMA) protein by Western blot and a-SMA and procollagen III mRNA expressions by semi-quantitative reverse transcriptionpolymerase chain reaction; in vivo, a mouse model of ILF was generated by daily subcutaneous injection of bleomycin (BLM) in female C3H mice. Gastric perfusion of THD began 1 week prior to injection and lasted for 8 weeks. Lung specimens were harvested at different time-points (1, 4, 6 and 8 weeks) for pathology and immunohistochemistry examination. The HYP content, a-SMA and pro-collagen III mRNA expressions were also assessed. THD inhibited the up-regulation of HYP protein, pro-collagen III mRNA and a-SMA protein induced by TGF-b1 in HFL-F cells, and additionally inhibited pro-collagen III mRNA expression on trans-differentiated MF. THD reduced HYP synthesis in the lung tissues of BLM-treated mice at week 4, and slightly reduced the numbers of a-SMA-positive cells. THD had an effect on ILF models both in vitro and in vivo.
The aims of this study were to utilize multi‐channel electrogastrography (MEGG) and power spectra analysis of Heart Rate Variability (HRV) to investigate the effects of test meal on MEGG and autonomic nervous system (ANS) function in patients with gastroesophageal reflux disease (GERD). Methods: Sixteen patients with the diagnosis of GERD were enrolled in this study (11 M, 5 F, mean age: 47 yrs) and 16 healthy subjects (HS) matched for age and gender were recruited as control (11 M, 5 F, mean age: 47 yrs). MEGG was recorded simultaneously with the electrocardiogram (ECG) recording for 30 min in the fasting state and 60 min after a standard test meal (450 Kcal). MEGG parameters included dominant frequency (DF), dominant power (DP), the normal percentage of 2–4 cpm gastric slow waves (%N) and the percentage of slow wave coupling (%SWC). ANS parameters included sympathovagal balance LF/HF Ratio, mainly sympathetic activity LF and vagal activity HF. Results: (1) Compared with fasting state, test meal significantly increased the DF but decreased the %N and %SWC in both GERD patients and HS in the 1st 30 min and 2nd 30 min fed state (P < 0.05). DP was not significantly altered by test meal in both groups in fed state. However, there is no significant difference between 1st 30 min and 2nd 30 min fed state for DF, %N and %SWC. 2) Compared with fasting state, test meal significantly increased the LF/HF ratio and LF but decreased the HF in both groups in the 1st 30 min after meal (P < 0.05), however, the increase of LF/HF ratio and LF but decrease of HF were still present in HS whereas absent in patients with GERD in the 2nd 30 min fed state. There is no significant difference between 1st 30 min and 2nd 30 min fed state for those ANS parameters. (3) There was no significant difference between GERD patients and HS in any of those MEGG and ANS parameters neither in fasting state nor in fed state. (4) There was no significant correlation between MEGG parameters and ANS parameters neither in fasting state nor in fed state in both groups. Conclusions: Both patients with GERD and HS may have similar response to test meal in MEGG test. GERD patients could not maintain the response to test meal longer in ANS test suggests that GERD patients may have impaired ANS regulation to test meal.
Previous studies have shown that patients with functional dyspepsia (FD) had significantly lower percentage of slow wave coupling (%SWC) in fasting state. The aim of this study was to utilize MEGG and ANS test to investigate the difference of MEGG parameters and ANS parameters between different subtypes of FD patients and healthy subjects (HS). Methods: Sixty‐two patients with the diagnosis of FD were enrolled in this study (16 M, 46 F, mean age: 43 years) and divided into dysmotility‐like FD group (15 M, 35 F, mean age: 42 years) and ulcer‐like FD group (1 M, 11 F, mean age: 46 years) based on Rome II criteria. 50 HS were recruited as control (25 M, 25 F, mean age: 44 years). MEGG were recorded simultaneously with the electrocardiogram (ECG) recording for 30 min in the fasting state and 60 min after a standard 450 Kcal test meal. MEGG parameters included dominant frequency (DF), normal percentage of 2–4 cpm gastric slow waves (%N) and %SWC. ANS parameters included sympathovagal balance LF/HF Ratio, mainly sympathetic activity LF and vagal activity HF. Results: (1) Compared with HS, %SWC was significantly lower in ulcer‐like FD group in fasting state (P < 0.05) but not in fed state. No significant difference of %SWC was shown between dysmotility‐like FD group and HS either in fasting state or in fed state. There was no significant difference between the two FD groups and HS in DF and %N neither in fasting state nor in fed state. (2) Compared with HS, LF/HF ratio and LF were significantly lower and HF was significantly higher in fasting state in dysmotility‐like FD group (P < 0.05), this difference was abolished by test meal in the 1st 30 min fed state and the lower LF and higher HF were present in the 2nd 30 min fed state again in dysmotility‐like FD group. There was no significant difference between ulcer‐like FD group and HS in any of those ANS parameters either in fasting state or in fed state. Conclusions: Gastric slow wave coupling was abnormal in patients with ulcer‐like FD. Patients with dysmotility‐like FD had abnormal ANS function in fasting state and test meal could only correct the abnormal ANS for short time, which suggest that different subtypes of FD may have different patterns in ANS test.
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