Gout in primary total knee arthroplasty: Prevalent but not independently associated with complications

BackgroundGout is a common synovial pathology, but its prevalence in patients undergoing total knee arthroplasty (TKA) and potential association with complications such as periprosthetic infection (PJI) and revision are unknown.MethodsMedicare data from 2009 to 2013 was retrospectively reviewed using PearlDiver. All patients 65 years of age or older and undergoing primary TKA with at least 3 years of pre-TKA records were included. The prevalence of gout was based on ICD-9 codes. Univariable associations of gout with PJI and revision at 1 year were assessed using odds ratios with 95% confidence intrervals (C.I.). To control for potential confounding, patients with a history of gout were matched on age, gender, smoking history, and Elixhauser Comorbidity Index (ECI) to patients without gout and associations reassessed.ResultsThe prevalence of gout in Medicare patients undergoing primary TKA was 5.7%. On univariable analysis, patients with a history of gout were more likely to develop PJI (O.R., 1.58; 95% C.I., 1.45–1.72) and undergo revision (O.R., 1.33; 95% C.I., 1.25–1.41) at 1 year. After matching for confounders, a history of gout was no longer associated with developing PJI (O.R., 0.98; 95% C.I., 0.90–1.06) or undergoing revision (O.R., 0.94; 95% C.I., 0.89–1.00) at 1 year.ConclusionsGout is a relatively common pathology in patients undergoing TKA. While gout is associated with increased complications, this appears to be driven by confounding through its association with other medical comorbidities. Gout does not appear to be an independent risk factor for complications following TKA.     

Elevated Serum Homocysteine Levels Were Not Correlated with Serum Uric Acid Levels,but with Decreased Renal Function in Gouty Patients

Hyperhomocysteinemia is one of the important factors of the cardiovascular disease, and gout is well known to be associated with cardiovascular disease. There are a few reports on the serum homocysteine (Hcy) levels in patients with gout, however, the results showed discrepancies. In this study, we measured Hcy levels in patients with gout and examined factors associated with the levels of serum Hcy. Ninety-one male patients with gout and 97 age-matched healthy male controls were enrolled in the study. Serum uric acid levels were not significantly different between gout and healthy control groups. However, serum Hcy levels were significantly higher in patients with gout compared to controls (13.96±4.05 µM/L vs 12.67±3.52 µM/L, P=0.035). In gout group, patients with 1-2 stages of chronic kidney disease (CKD) had significantly lower serum Hcy than those with 3-5 stages of CKD (13.15±3.46 µM/L vs 17.45±4.68 µM/L, P<0.001). Multivariate linear analysis revealed an inverse association between serum Hcy and estimated glomerular filtration rate (eGFR) (β=-0.107, P<0.001). In conclusion, serum Hcy was elevated in male patients with gout. Hyperhomocysteinemia was not correlated with serum uric acid, but it was inversely associated with impaired renal function.

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痛风患者血尿酸和炎性因子水平变化及相关性分析

目的 探讨痛风患者血尿酸水平以及炎性因子C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平的变化,并对其进行相关性分析。方法 选择2018年5月~2019年2月我院收治的52例痛风患者作为患者组,选取同期52名健康受试者作为对照组。检测两组受试者的血尿酸及CRP、IL-6、TNF-α的水平;采用Pearson相关分析评估血尿酸与炎性因子水平的相关性;采用ROC曲线法评估CRP、IL-6、TNF-α联合血尿酸对痛风诊断的曲线下方面积（AUC）、灵敏度和特异性。结果 患者组血尿酸、CRP、IL-6、TNF-α水平均高于对照组,差异具有统计学意义（P＜0.05）。血尿酸与CRP（r=0.193,P=0.050）、IL-6（r=0.225,P=0.021）、TNF-α（r=0.342,P=0.000）的水平均呈正相关关系。CRP、IL-6、TNF-α联合血尿酸水平诊断痛风的AUC面积分别为0.824（灵敏度为86.30%,特异性为67.30%）、0.811（灵敏度为80.40%,特异性为73.10%）、0.989（灵敏度为100.00%,特异性为96.20%）。结论 痛风患者升高的血尿酸水平可能与循环中的炎性因子密切相关,且炎性因子的水平对于痛风的诊断具有一定的指导意义。     

Immunochemical and Ultrastructural Characterization of Serum Proteins Associated with Monosodium Urate Crystals (MSU) in Synovial Fluid Cells from Patients with Gout

Immunoelectron microscopic (IEM) analysis of the surface coats of intracellular and extracellular monosodium urate (MSU) crystals in synovial fluid (SF) in gouty arthritis was performed using the ferritin-bridge method. Cells from patients with acute gout were fixed in 1% glutaraldehyde containing 0.05% saponin to permeabilize membranes for access of immunochemicals to intracellular antigens. Intracellular MSU crystals were observed in phagosomes of greater than 75% of both polymorphonuclear (PMNs) and mononuclear cells. Coating of crystals with IgG was more prominent than with IgM or IgA. Other proteins such as C3, and fibrinogen were also found to a lesser extent. Albumin was not detected in appreciable amounts on MSU crystals. Extracellular crystals also showed IgG to be bound more prominently than other proteins. The various proteins, shown here for the first time to be clearly associated with intracellular crystals by EM, and other materials associated with MSU crystals May-Jun influence the phlogistic properties of these crystals.     

SBP1和Caspase-3在人乳腺癌组织中的表达及意义

目的观察人乳腺癌组织中硒结合蛋白1（SBPl）和凋亡调节蛋白（Caspase-3）的表达,探讨SBPl和Cas-pase-3在乳腺癌发生、发展过程中的作用及其相互关系。方法用免疫组织化学ABC法检测乳腺癌中SBPl和Caspase-3的表达水平,并与癌旁相对正常组织、乳腺良性病变组织进行比较分析。结果SBP1、Caspase．3在癌旁相对正常乳腺组织中的阳性表达率为100％、86．6％;在乳腺良性病变组织的阳性表达率为93.3％、73．3％;在乳腺癌组织的阳性表达率为82．1％、57．1％。乳腺癌组织中SBP1和Caspase．3的表达水平均明显低于癌旁相对正常组织和乳腺良性病变组织。乳腺癌组织中SBPl与Caspase-3的表达呈正相关。结论乳腺癌组织中SBP1和Caspase-3的表达下调,提示SBPl可能通过促进肿瘤细胞的凋亡来抑制肿瘤的增殖,为进一步对硒诱导SBPl治疗乳腺癌的作用研究提供基础。     

前列腺癌组织中Apaf-1和Caspase-9表达及临床意义

目的检测凋亡蛋白酶活化因子-1(Apaf-1)和细胞凋亡蛋白酶-9(Caspase-9)在前列腺癌(prostatic carcinoma,PCa)和良性前列腺增生(benign prostatic hyperplasia,BPH)中的表达,探讨Apaf-1、Caspase-9表达与PCa临床病理特征的关系。方法采用免疫组化SP法检测45例PCa和60例BPH组织中Apaf-1和Caspase-9蛋白的表达。结果 PCa组中Apaf-1和Caspase-9的阳性率明显低于BPH组,差异有统计学意义(P<0.05);Apaf-1和Caspase-9的表达与患者年龄及远处转移无关,与病理分级及临床分期相关(P<0.05)。结论 Apaf-1和Caspase-9在PCa组织中低表达,二者呈正相关(rs=0.645,P<0.01),Apaf-1和Caspase-9可能与PCa的发生、发展密切相关。     

凋亡抑制蛋白c-IAP1和Caspase-3在喉癌中表达的研究

喉癌是耳鼻咽喉外科常见的肿瘤之一,其逐年增加的发病率和死亡率严重威胁着患者的健康,其中以鳞状细胞癌（约90%）为主,其次是腺癌。凋亡抑制蛋白c-IAP1和天冬氨酸特异性半胱氨酸蛋白酶3的表达与喉癌的发展变化关系密切。本文将凋亡抑制蛋白c-IAP1和Caspase-3在喉癌中的表达作用进行了系统综述。     

黄芩素调控 NLRP3 / Caspase-1 通路对牙周炎大鼠牙槽骨吸收的影响

目的 探索黄芩素调控核苷酸结合寡聚化结构域样受体蛋白 3 ( nucleotide-binding oligomerization domain-like receptor protein 3, NLRP3) / 半胱氨酸天冬氨酸蛋白酶 1 ( cysteine aspartate protease 1, Caspase1) 通路对牙周炎大鼠牙槽骨吸收的影响。 方法 将 40 只牙周炎大鼠随机分为模型组、 黄芩素组、 激活剂 组、 黄芩素 + 激活剂组, 另取 10 只正常作为对照组。 检测大鼠釉牙骨质界到牙槽嵴顶 (CEJ-AC) 的距离、 血清中白细胞介素-6 (IL-6)、 转化生长因子-β (TGF-β) 含量以及牙周组织病理变化、 IL-6、 TGF-β 阳性 表达和 NLRP3、 Caspase-1 蛋白表达。 结果 模型组大鼠 CEJ-AC、 NLRP3、 Caspase-1、 IL-6、 TGF-β 水平及 阳性表达水平以及蛋白表达水平均升高 (P< 0. 05); 经黄芩素干预后, 各项指标均降低 (P< 0. 05); 引入 激活剂明显削弱了黄芩素对牙周炎大鼠的抗炎作用。 结论 黄芩素通过抑制 NLRP3 / Caspase-1 通路减轻炎性反应, 控制牙槽骨吸收。     

High Incidence of Spontaneous Ig-Producing Lymphocytes in Peripheral Blood and Synovial Fluid of Patients with Active Seropositive Rheumatoid Arthritis

Numbers of in vitro spontaneous IgG, IgM and IgA plaque-forming cells (PFC) as assessed by a modification of the protein A haemolytic plaque assay were determined in the blood and synovial fluid of patients with seropositive rheumatoid arthritis (RA) and compared with those of control groups. The total numbers of PFC were significantly higher in the peripheral blood of patients with active seropositive RA than in that of normal controls. In addition, most B lymphocytes in the synovial fluid of patients with active seropositive RA were active immunoglobulin (Ig) producers, whereas synovial fluid lymphocytes from patients with inactive seropositive RA and seronegative arthritis were not. In general, IgA PFC were relatively high in blood, whereas IgG PFC dominated in the synovial fluid. IgM PFC appear to be relatively low in blood and synovial fluid. However, a relative increase of IgG PFC was noted in the peripheral blood of patients with active RA. To test for polyclonality of the increased Ig synthesis, we tested the sera of patients and controls for the presence of polyclonal antibodies against sheep erythrocytes (SRBC) and SRBC modified by fluorescein isothiocyanate (FITC) and trinitrophenyl (TNP). No differences were observed with SRBC and TNP-SRBC agglutinin titres between patients and controls, but patients with RA had higher titres of FITC-SRBC agglutinins than normal sera. This finding supports the concept of a polyclonal nature of antibody production in RA patients.     

Serum Cystatin C is a Potential Endogenous Marker for the Estimation of Renal Function in Male Gout Patients with Renal Impairment

Serum creatinine level is the most commonly used indices for assessment of glomerular filtration rate (GFR), even though these indices have been shown to have some limitations in clinical practice. We investigated the diagnostic efficacy of serum cystatin C compared to that of serum creatinine levels and identified the relating factors associated with changes in serum cystatin C levels in gout patients with renal impairment. A total of 68 gouty patients with renal impairment were enrolled in this study. Diagnostic efficacy of serum cystatin C levels was evaluated through non-parametric receiver operating characteristic (ROC) analysis. The risk factors for changes in serum cystatin C levels were confirmed using multivariate regression analysis. With 24-hr urine creatinine clearance (Ccr) as the reference for GFR, 1/cystatin C (r=0.702, P<0.001) showed a significantly higher correlation with Ccr than 1/creatinine (r=0.665, P<0.001). Multivariate correlation analysis demonstrated that the clinical parameters for increased serum cystatin C are a higher stage of chronic kidney disease, older age, use of allopurinol, and lower high density lipoprotein-cholesterol. The area under the curve (AUC) at ROC plots identified that of serum cystatin C was significantly greater than that of serum creatinine (AUC 0.804 of cystatin C and AUC 0.745 of creatinine). The study suggests that serum cystatin C is a reliable endogenous marker for the assessment of renal function or GFR in gout patients with renal impairment.     

仙茅苷对血管性痴呆模型大鼠海马区Caspase-3、PARP-1和雌激素受体表达的作用

目的:研究仙茅苷对血管性痴呆(VD)模型大鼠海马区Caspase-3、PARP-1和雌激素受体(ER)表达的作用.方法:确立SD大鼠对照组后,用构建的血管性痴呆模型大鼠随机分成模型组、药物仙茅苷低(24 mg/kg)和高剂量(72 mg/kg)组(予以仙茅苷灌胃4周),每组8只.用药结束后,按设计用Morris水迷宫测试大鼠空间学习记忆功能;流式细胞术分析海马区神经细胞元凋亡;Caspase-3、PARP-1和ER蛋白水平用Western Blot测定;Caspase-3、PARP-1和ER mRNA表达用Realtime PCR检测.结果:Morris水迷宫试验结果显示,药物组和模型组大鼠逃避潜伏期均明显延长(P ＜0.05～0.01),模型组大鼠更明显(P＜0.01);药物组和模型组大鼠空间探索距离百分比均降低(P ＜0.05 ～0.01),模型组大鼠降更明显(P＜0.01).与对照组比较,药物组和模型组大鼠海马神经细胞凋亡率显著提高(P＜0.01),模型组大鼠更明显(P＜0.01).与对照组比较,模型组的Caspase-3、PARP-1蛋白和mRNA表达均增加(P＜0.05);与模型组相比,仙茅苷各剂量组可见ER表达增加(P＜0.05),Caspase-3和PARP-1表达降低(P＜0.05).与对照组比较,模型组的Caspase-3和PARP-1表达增加(P＜0.01),而ER未见明显变化(P＞0.05);与模型组相比,仙茅苷各剂量组ER表达均增加(P＜0.01),Caspase-3和PARP-1表达不明显(P＞0.05),但不同剂量仙茅苷组间未见明显差异(P＞0.05).结论:结果表明仙茅苷具有改善血管性模型大鼠空认知功能的作用是通过抑制海马区神经细胞凋亡,下调Caspase-3和PARP-1表达,上调海马ER表达实现的.     

Immunoelectronmicroscopic Characterization of Intracellular Inclusions in Synovial Fluid Cells of Patients with Rheumatoid Arthritis

Qualitative immunoelectronmicroscopic (IEM) analysis of intracellular inclusions in synovial fluid (SF) cells in rheumatoid arthritis (RA) was performed using the peroxidase-antiperoxidase (PAP) method. Cells from patients with chronic RA were fixed in glutaral-dehyde containing 0.05% saponin to permeabilize membranes before immunologic treatments. Intracellular inclusions of IgG, IgM, and C3 were observed in vacuoles of greater than 75% of both polymorpho-nuclear leukocytes (PMNs) and mononuclear phago-cytic cells. IgA-and fibrinogen-containing inclusions were less frequent. Intracellular staining for albumin was minimal. Other membranous, vesicular, and granular unstained materials of potential importance were also often present in the same vacuoles. Stained inclusions were clearly distinct from lipid bodies, which were negative for immunostaining. Control samples had only occasional, scattered and weak stain that was easily recognizable as nonspecific and thus established the specificity of the reactions. A few lymphocytes in 2 patients showed positive staining for IgG in vacuoles. Extracellular staining of clumps of immunoglobulins, C3, and fibrinogen was also present. The various materials phagocytized by the different SF cells may be important in perpetuation of joint inflammation.     

类风湿关节炎患者关节滑膜液淋巴细胞活化标志的表达及意义

目的:研究类风湿关节炎(rheumatoidarthritis,RA)患者关节滑膜液淋巴细胞活化标志CD69、CD25、CD71、HLA-DR的表达,探讨其在RA致病中的作用。方法:采用流式细胞仪检测RA患者关节滑膜液淋巴细胞活化标志CD69、CD25、CD71、HLA-DR的表达,并设立正常对照组。结果:RA患者关节滑膜液表达CD25和CD71的淋巴细胞与正常对照组相比明显增多(P<0.01);而表达CD69和HLA-DR的淋巴细胞,与正常对照组相比差异无显著性(P>0.05)。结论:关节滑膜液淋巴细胞活化标志的表达增高,在RA发病机制中起着重要的作用。     

肺癌患者血清MIC-1升高的临床价值

目的 研究巨噬细胞抑制因子-1（MIC-1）血清水平在肺癌诊断中的临床应用价值.方法 采用双抗体夹心ELISA法检测256例肺癌患者、44例肺良性疾病患者及229例正常对照人群血清MIC-1浓度,采用电化学发光免疫分析仪及化学发光免疫分析仪分别检测肺癌患者血清CEA、CA125、NSE、CYFRA21-1和SCC浓度.结果 肺癌组患者血清中MIC-1浓度显著高于正常对照组（P＜0.001）和肺良性疾病组（P ＜0.001）;根据ROC曲线和正常人群的MIC-1血清水平,设1000pg/mL为诊断肺癌的临界值,MIC-1检测肺癌的敏感性和特异性分别为69.5％和96.5％;在不同病理类型中,血清MIC-1对小细胞癌的诊断敏感性高于鳞癌和腺癌,低分化组患者血清MIC-1水平明显高于高分化＋中分化组（P＜0.05）;MIC-1诊断肺癌的敏感性优于已有标志物CEA、CA125、NSE、SCC和CYFRA21-1;在肺癌早期（I期和II期）阶段,MIC-1诊断敏感性优于五种标志物的联合诊断（I期：66.7％vs 50.0％,II期：72.7％ vs 69.0％）;六种标志物联合诊断则能使I期和II期肺癌诊断敏感性分别提高至77.1％和85.5％.结论 本研究在较大样本量中证实MIC-1在肺癌诊断中的临床应用价值,提示其可能成为比较理想的肺癌诊断及筛查标志物.     

GSTT1 Gene Deletion Is Associated with Lung Cancer in Mexican Patients

Glutathione S-transferase (GST) is a dimeric detoxifying isoenzyme, involved in the deactivation of carcinogens, several tobacco-derived carcinogens, and xenobiotics. It catalyzes the reduction of glutathione to its thioester; thus, deficiency in GST activity due to homozygous deletion of the GSTT1 gene (null genotype) may play a role in the induction of lung cancer by smoking.We studied the distribution of GSTT1 gene deletion in peripheral blood DNA samples from 178 healthy controls (41 nonsmokers, 63 passive smokers and 74 smokers) and 52 lung cancer patients. Comparisons between groups showed that there was an increased lung cancer risk for individuals with the GSTT1 null genotype. Cancer patients showed significant differences when compared with controls: nonsmokers, passive smokers, and smokers. Twenty-one percent of lung cancer patients carried the deletion versus 2% among nonsmokers not exposed to passive smoking, 6% among passive smokers, and 5% among smokers. Thus, there is a significant association between this genotype and the possibility to risk of developing lung cancer.     

PD-1-Expressing SARS-CoV-2-Specific CD8+ T Cells Are Not Exhausted,but Functional in Patients with COVID-19

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Platelet Markers Correlate with Glycemic Indices in Diabetic,but Not Diabetic-Myelodysplastic Patients with Normal Platelet Count

To investigate the role of IκBα promoter polymorphisms in the development of Behçet’s disease, eighty-six patients with Behçet''s disease and 120 healthy controls were enrolled in this study. The IκBα; -881A/G, -826C/T, -550A/T, -519C/T, and -297C/T polymorphisms were measured by the method of polymerase chain reaction/ restriction fragment length polymorphism. This study demonstrated that the genotype frequencies of IκBα -826C/T and -826T/T were significantly higher in the patients with Behçet''s disease than in the controls. Both in the dominant and in the recessive models, the patients with Behçet''s disease have higher frequencies of the IκBα -826T containing genotype than the controls. The allele frequency of IκBα -826T was significantly increased in the patients with Behçet’s disease. The frequencies of the IκBα -881A -826T -550A -519C -297C and IκBα -881A -826T -550A -519T -297C haplotypes were significantly higher in the patients with Behçet–s disease than in the controls. In contrast, the haplotype frequency of IκBα -881A -826C -550A -519C -297C in the patients with Behçet’s disease was significantly decreased. This study also revealed that the Behçet’s disease patients with IκBα -826T/T have higher prevalence of skin lesions than those without IκBα -826T/T. In summary, the IκBα -826T allele, IκBα -881A -826T -550A -519C -297C and IκBα -881A -826T -550A -519T -297C haplotypes might be associated with susceptibility to Behçet’s disease. The IκBα -826T/T genotype was related to the development of skin lesions in the patients with Behçet''s disease.     

肺癌患者血清TK1检测的临床意义

目的:探讨肿瘤标志物胸苷激酶1(TK1)在肺癌患者血清中的水平及对肺癌的诊断价值.方法:检测43例肺癌患者、38例健康对照者血清TK1、CYFRA21-1、NSE的水平.TK1测定采用免疫印迹增强化学发光法,CYFRA21-1及NSE(neuro specific enolase)测定使用免疫放射分析.结果:肺癌组血清...     

骨性关节炎患者关节囊滑液MMP-3、PGE2检测的临床意义

目的：探讨基质金属蛋白酶-3（MMP-3）、前列腺素E2（PGE2）在骨性关节炎（OA）发生与发展中的作用,及关节液MMP-3、PGE2检测对诊断OA的临床价值。方法：通过检测36例OA膝关节和25例正常膝关节囊滑液中MMP-3、PGE2的含量情况。结果：MMP-3含量OA组为（152.5±41.8）ng/ml,对照组为（87.9±15.2）ng/ml,OA组明显高于对照组（P〈0.01）;PGE2含量OA组为（40.2±10.6）ng/L,对照组为（26.5±6.3）ng/L,OA组亦明显高于对照组（P〈0.01）。OA组、对照组关节液中MMP-3含量和PGE2含量的相关性经线性相关分析,两者密切相关（P〈0.01）。结论：OA组关节液中MMP-3和PGE2含量均明显高于对照组（均P〈0.01）,并且MMP-3含量和PGE2含量的相关性,经线性相关分析两者密切相关（P〈0.01）。表明MMP-3、PGE2共同参与了OA病程的发生、发展。因此,临床可通过检测关节液中MMP-3和PGE2的含量,作为早期诊断OA的重要指标。     

Influenza Virus Infection but Not H1N1 Influenza Virus Immunization Is Associated with Changes in Peripheral Blood NK Cell Subset Levels

The innate immune system constitutes the first line of defense against viral agents, and NK cells seem to have an important protective role during the early phases of influenza virus infections. We decided to assess the levels of NK and NKT lymphocytes and the expression levels of different membrane receptors (NKp44, NKp46, NKG2A, killer cell immune-like receptor [KIR] 3DL1/DS1, KIR2DL1/DS1, and CD161) in peripheral blood samples of patients with influenza (n = 17) and healthy individuals immunized against this virus (seasonal and [H1N1]pdm2009 influenza vaccines; n = 15 and 12, respectively). Blood samples were obtained from all individuals, and NK and NKT cell subsets were analyzed by multiparametric flow cytometry. We found that the patients with severe influenza (n = 9) showed significant increases in the percentages of NKp46⁺ NKp44⁺ NK cells and the proportions of NK and NKT lymphocytes expressing KIR2DL1 and KIR3DL1 and reductions in the percentages of NKp46⁺ NKp44⁻ NK cells compared to those in the healthy controls (n = 27). In contrast, influenza immunization, against either the seasonal or the pandemic H1N1 virus, was not associated with important changes in the levels of NK and NKT lymphocytes or the expression levels of the different receptors by these cells. Our data suggest that severe influenza is associated with important and complex alterations on NK cells, which might contribute to the pathogenesis of this condition.