The alterations induced in gut microbiota by tacrolimus may affect immune function and organ transplantation. Mice were treated with high-dose tacrolimus for 14 days. The fecal microbiota were analyzed by pyrosequencing the 16S rRNA genes, and the effect on metabolism was predicted using the sequence data. The subgroups of T cells in the serum, gut-associated lymphoid tissue, and draining lymph nodes were determined by flow cytometry. Tacrolimus treatment significantly altered the relative abundance of Allobaculum, Bacteroides, and Lactobacillus and CD4 CD25 FoxP3 regulatory T cells in the colonic mucosa and the circulation. These were significantly increased after either tacrolimus treatment or treatment by fecal microbiota transfer from tacrolimus-treated donors. Further, treatment with low-dose tacrolimus plus fecal microbiota transfer from high-dose tacrolimus-altered mice increased skin allograft survival rate in a skin transplantation model. Thus, high-dose tacrolimus alters the compositions and taxa of the gut microbiota. Administration of these conditioned gut microbiota plus low-dose tacrolimus resulted in regulation of colonic and systemic immune responses and an increased allograft survival rate. This study demonstrated a new strategy for controlling allograft rejection by combining an immunosuppressive agent with gut microbiome transplantation.

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BackgroundIn past decades, treatment of rheumatoid arthritis (RA) has advanced greatly, driven largely by the advent of new medications and treat-to-target (T2T) strategy, but the secular trends in the activity and remission of RA over past years and the efficacy of T2T strategy are not fully validated in large population in real life practice.Objectives:To investigate the trends in the activity of RA over past 8 years and evaluate the value of T2T strategy in daily practice.Methods:All the medical records of RA patients from 2009 to 2016 were retrospectively reviewed. Disease activity scores at obtained visits were measured by DAS28-CRP, DAS28-ESR, SDAI and CDAI. To display trends over years, both mean and time-adjusted methods were applied in calculation of annual disease activity and remission rate. Disease activity and remission rate were also compared before and after the year of 2011 when application of T2T strategy was initiated in our center. Furthermore, a sub-cohort study including T2T and non-T2T period groups was conducted with outcome of cumulative percentage of remission and time to achieve first remission during the first year follow-up.Results:In total, 1,001 patients with 6,944 clinical visits were included. Over eight-year period, significant improvements were witnessed in disease activity and remission rate, measured by all four indices (p<0.0001). More patients achieved lower disease activity and higher remission rates after T2T adherence in 2011 compared to those in the years of 2009 and 2010 (P<0.0001). Moreover, sub-cohort study revealed that more patients (49.3%>73.2% vs. 19.1%>34.5%, OR=2.4-3.0) achieved remission with a shorter median time compared with the non-T2T period group (p<0.0001), particularly in DAS28-CRP (21 vs. >52 weeks), DAS28-ESR (37 vs. >52 weeks).Figure 1 Trends in disease activity scores over 8 years by four indices in mean and adjusted mean (AM) methods. (A) Trends based on DAS28-CRP and DAS28-ESR in two methods (B) Trends based on SDAI and CDAI in two methodsConclusions:Over past 8 years, the RA activity has substantially decreased and T2T strategy was directly attributable to the favorable changes in clinical practice.References:[1] Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet 2010;376:1094-108.[2] Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomized controlled trial. Lancet 2004;364(9430):263-9.[3] Verstappen SM, Jacobs JW, van der Veen MJ, Heurkens AH, Schenk Y, ter Borg EJ, et al. Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial). Ann Rheum Dis 2007;66(11):1443-9.[4] Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Kerstens PJ, et al. DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis. Ann Rheum Dis 2010;69(1):65-9.Acknowledgements:We wou...

BACKGROUND AND PURPOSE:Orbital SFT is a rare tumor, often misdiagnosed as orbital schwannoma preoperatively but with different prognosis and treatment. Our aim was to evaluate MR imaging features that might distinguish orbital SFT from schwannoma.

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Background and purpose Dermatomyositis (DM) with anti‐nuclear matrix protein‐2 (NXP‐2) antibodies usually shows multifocal ischaemic lesions in muscle. Here, we aimed to investigate the microarteriopathy underlying muscle ischaemia in anti‐NXP‐2‐positive DM. Methods A total of 16 patients diagnosed with anti‐NXP‐2‐positive DM were investigated by muscle biopsy. A total of 13 patients with DM with other myositis‐specific antibodies and 11 normal controls were included for comparison. Immunofluorescence assays were performed to localize endothelial cells, smooth muscle cells and pericytes, and to determine lesions in myofibers and microvessels by vascular endothelial growth factor and myxovirus resistance protein A (MxA). Electron microscopy was carried out to assess ultrastructure alterations. Results Subcutaneous edema, severe muscle weakness and dysphagia together with elevated creatine kinase, D‐dimer and triglyceride levels, and decreased albumin levels were found in anti‐NXP‐2‐positive DM. Muscle ischaemia included regional muscle edema, perifascicular atrophy, microinfarcts and focal punched‐out vacuoles. The density of arterioles was higher in anti‐NXP‐2‐positive DM (P ＜ 0.05). Perimysial arterioles with thickened vascular wall, thrombosis and lipid accumulation were found in the vascular wall of diseased perimysial arterioles. The frequency of diseased arterioles and thrombosis was higher in anti‐NXP‐2‐positive DM (P < 0.05). Sarcoplasmic vascular endothelial growth factor and MxA expression was observed in multifocal ischaemic lesions. MxA was present in endothelial and smooth muscle cells of the diseased arterioles and pericytes. Electron microscopy confirmed damaged capillaries and tubuloreticular structures. Conclusions Our research suggested that perimysial arterioles were most commonly involved in anti‐NXP‐2‐positive DM, which led to muscle ischaemia.

BackgroundTreat-to-target strategy, aiming at clinical remission, has greatly improved the prognosis of RA. However, the ultrasonographic subclinical synovitis was correlated with bone erosion and disease flare.ObjectivesThe aim of this study was to evaluate whether deeper clinical remission (DAS28(ESR) ≤1.98) reflects the better control of subclinical synovitis.Methods126 RA patients in clinical remission were enrolled in the study. Disease activity and ultrasongraphy were evaluated at baseline, and every 3 months during a 12-month follow-up. The relationship between the extent of clinical remission, flare and ultrasonographic features was analyzed.ResultsIn 126 RA patients, 76 achieved deep clinical remission and 50 achieved mild clinical remission. In all, 54 (42.9%) patients relapsed at average of 6.8±3.3 months during follow-up. Patients in deep remission possessed not only lower risk to relapse (30.3% vs. 62.0%, P<0.01), but also longer duration of remission before relapse (8.1±3.3 vs. 5.9±3.1 months, P<0.05). Besides, applying DAS28(ESR) <1.895 to predict ultrasonographic remission defined as negativity of both PD and SH was highly accurate (P<0.001). Subclinical PD synovitis at baseline was an independent risk factor for predicting relapse in RA patients achieved clinical remission (OR 8.8 [95% CI 2.7–28.4]).ConclusionsSubclinical synovitis was common in RA patients even in deep clinical remission. The deeper the clinical remission, the milder the subclinical synovitis, and the lower risk to relapse. Therefore, achieving deeper clinical remission, which reflected better control of subclinical synovitis and less tendency to flare, could be an optimized treatment target of RA.ReferencesSmolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014;73: 492–509.Hetland ML, Jensen DV, Krogh NS. Monitoring patients with rheumatoid arthritis in routine care: experiences from a treat-to-target strategy using the DANBIO registry. Clin Exp Rheumatol. 2014;32:S-141–6.Molenaar ET, Voskuyl AE, Dinant HJ, Bezemer PD, Boers M, Dijkmans BA. Progression of radiologic damage in patients with rheumatoid arthritis in clinical remission. Arthritis Rheum 2004;50:36–42.Tanaka Y, Hiratai S, Kubo S, et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. Ann Rheum Dis 2015;74:389–95.Geng Y, Han J, Deng X, Zhang Z. Presence of power Doppler synovitis in rheumatoid arthritis patients with synthetic and/or biological disease-modifying anti-rheumatic drug-induced clinical remission: experience from a Chinese cohort. Clin Rheumatol 2014;33:1061–6.Nguyen H, Ruyssen-Witrand A, Gandjbakhch F, Constantin A, Foltz V, Cantagrel A. Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and...

Objective/BackgroundThis report presents a superior mesenteric artery (SMA) embolism managed by percutaneous mechanical thrombectomy (PMT).MethodsA 61 year old woman diagnosed with SMA embolism was admitted. Emboli were found in the middle and distal segments of the SMA on abdominal computed tomography angiography. Under local anaesthesia, a 6 F Rotarex system was used to remove the emboli via left brachial artery access. Emboli were successfully removed and patency was restored to the SMA and its branches.ResultsPost-operatively, the patient's symptoms were significantly relieved. No post-operative complications were observed and no discomfort was documented during follow-up.ConclusionEndovascular treatment of SMA embolism using PMT is a feasible and alternative option.