Tofacitinib for acute rheumatoid arthritis patients who have had an inadequate response to disease-modifying antirheumatic drug (DMARD): a systematic review and meta-analysis

The aim of this systematic review and meta-analysis is to assess the efficacy and safety of tofacitinib for the treatment of patients with acute rheumatoid arthritis (RA) who have had an inadequate response to disease-modifying antirheumatic drug (DMARD). Randomized controlled trials were searched in MEDLINE (1966–2013), Embase (1947–2013), the Cochrane Central Register of Controlled Trials (1948–2013), WHO International Clinical Trial Registration Platform (2004–2013), Clinical Trial.gov (1999–2013), and China Biology Medicine disc (1978–2013). The review included 10 studies involving 4,929 patients. A pooled analysis of six studies showed that tofacitinib had a superior effect over placebo (both with background therapy) at weeks 12 and 24. Also, the pooled results of three studies showed that tofacitinib monotherapy had a significantly greater effect over placebo. Compared to adalimumab, tofacitinib was found to be more efficacious as well. For safety, tofacitinib monotherapy had less serious adverse events (sAE) than placebo but not other adverse effects (oAE). In the comparison of tofacitinib and placebo both with background therapy, no difference in sAE and oAE were found. However, the quality of the evidence was quite low when evaluated using GRADE. Tofacitinib alone, or together with non-biologic DMARDs, was associated with more favorable remission in the signs and symptoms of RA than adalimumab or placebo. Also, tofacitinib monotherapy was safer than placebo with regards to reported sAE, but not oAE. However, the quality of evidence is exceedingly low; long-term, large-scale, and high-quality post-marketing research is suggested to further verify the conclusion.     

脑转移瘤低场MR诊断与鉴别诊断

目的:总结脑转移瘤低场MRI表现。材料与方法:分析经增强或手术病理证实的脑转移瘤13例。使用嘉恒公司0.35T扫描仪,行常规轴位、矢状位、冠状位加增强扫描。对肿瘤的部位,形态、大小、边界、信号、周围水肿等进行总结分析。结果:MR定位准确率100%。肿瘤大多呈圆形、椭圆形、结节状、环形。10例呈长T1长T2信号,3例呈等T1长T2信号。水肿呈不规则指状。多位于皮髓交界区,亦可见于脑干、小脑等部位。结论:脑转移瘤低场MRI表现经平扫加增强多具有特征性表现。基本能做出比较正确的诊断。     

超声指导下制备犬急性心肌缺血与心肌梗死模型

 目的 探讨超声实时定量指导下制备犬心肌缺血和心肌梗死模型.方法 选用杂种犬12只,麻醉后开胸,分离出前降支,结扎前二维超声测量前降支内径、多普勒测量冠脉内血流速度,部分结扎前降支后测量结扎点处血管内径及结扎点远端血流速度,定量评价狭窄程度,行常规超声检查、留取血生化标本;后完全结扎前降支,制备急性心肌梗死模型,行常规超声检查、留取血生化标本、行伊文思蓝与TTC染色.结果 12只犬均成功制备前降支部分狭窄与完全闭塞模型,轻度狭窄时的狭窄率控制在50%～75%,经常规超声心动图、血生化检查显示:前降支轻度狭窄时心肌酶轻度升高,心脏大小及心功能未见明显改变,前降支完全结扎后出现了心脏扩大、室壁运动障碍、心功能减低,心肌酶学指标明显升高.结论 超声可实时定量评价制备犬心肌缺血及心肌梗死模型,此方法直观、准确,重复性强,可控性好,成功率高.     

高中生的生活事件、社会支持对自我概念的影响

目的 探讨高中生生活事件和社会支持对自我概念的影响.方法 对247名高中生进行自我概念量表、青少年生活事件量表、领悟生活支持量表测试.结果 ①高一学生的教师支持显著好于高二学生(t=2.09,P＜0.05),男同学的身体自我概念显著好于女同学(t=2.6,P＜0.01).②生活事件与自我概念显著负相关,社会支持与自我概念显著正相关.③学习压力负向预测自我概念,家庭支持和朋友支持正向预测自我概念,朋友支持在学习压力和自我概念的关系中起调节作用.结论 生活事件中的学习压力对自我概念有负面影响,家庭支持和朋友支持对自我概念有正面影响,朋友支持可以缓解学习压力对自我概念的负面影响.     

Hepatitis B virus directly promotes collagen I expression of LX-2 cells without infection in vitro

Aim: To investigate direct effects of hepatitis B virus (HBV) on collagen type I in vitro. Methods: Collagen type I were measured after LX‐2 cell cultured with purified or serum HBV for 12, 24 and 48 h. Furthermore, evidence of HBV infection to LX‐2 were detected, and different inhibitors were used to identify pathways regulating collagen I expression. Results: The 3 × 10⁵ IU/mL purified/serum HBV increased collagen type I mRNA expression by 2.2‐/3.2‐ and 1.3‐/1.5‐fold at 24 and 48 h, respectively. Collagen type I protein in the supernatant of purified/serum HBV group also increased compared to the control group (408.0 ± 8.0/384.4 ± 6.8 vs 262.7 ± 15.7 ng/mL, P < 0.05). However, the 3 × 10⁷ IU/mL purified/serum HBV increased collagen type I expression similar to that of 3 × 10⁵ IU/mL, while 3 × 10³ IU/mL group showed no effect. Human HBV immunoglobulin alleviated HBV‐induced collagen I expression, but no evidence of HBV infection was found. Neutralization of transforming growth factor beta, tumor necrosis factor alpha, platelet‐derived growth factor, extracellular signal‐regulated kinase and TGF‐β receptor had no obvious inhibitory effects; only inhibition of p38 mitogen‐activated protein kinase decreased collagen type I mRNA expression by 0.5‐/0.4‐ and 0.4‐/0.3‐fold at 24 and 48 h, respectively. It reduced collagen type I protein in the purified/serum HBV group for 48 h (252.1 ± 14.1/251.7 ± 18.8 vs 403.9 ± 4.9/385.0 ± 4.2 ng/mL, P < 0.05). Conclusion: HBV directly promotes collagen type I expression of LX‐2 cells without infection in vitro.     

盆底神经肌肉电刺激治疗薄型子宫内膜患者的临床研究

目的 探讨盆底神经肌肉电刺激(PFNES)治疗,对于薄型子宫内膜(TE)患者子宫内膜厚度(ET)与血流灌注及妊娠情况的影响.方法 选择2016年5月至2018年5月,在四川大学华西第二医院生殖医学科与生殖内分泌科接受门诊治疗、有生育需求的96例T E患者为研究对象.根据其是否接受PFNES治疗,将其分为研究组(n=51...     

类风湿性关节炎大小鼠动物模型的研究进展

类风湿性关节炎(rheumatoid arthritis,RA)是一种常见的自身免疫性疾病,致残率高,其病理机制尚不明确.构建合适的尤其是与人RA发病相似的动物模型在研究RA的发病机制和临床治疗方面具有十分重要的意义.而所构建类风湿性关节炎模型所选择的大小鼠品系和方法很多,各种动物模型都有其各自的侧重点.现针对所报道的...     

Voxel-based assessment of gray and white matter volumes in Alzheimer's disease

Using the study-specific templates and optimized voxel-based morphometry (VBM), this study investigated abnormalities in gray and white matter to provide depiction of the concurrent structural changes in 13 patients with Alzheimer's disease (AD) compared with 14 age- and sex-matched normal controls. Consistent with previous studies, patients with AD exhibited significant gray matter volume reductions mainly in the hippocampus, parahippocampal gyrus, insula, superior/middle temporal gyrus, thalamus, cingulate gyrus, and superior/inferior parietal lobule. In addition, white matter volume reductions were found predominately in the temporal lobe, corpus callosum, and inferior longitudinal fasciculus. Furthermore, a number of additional white matter regions such as precentral gyrus, cingulate fasciculus, superior and inferior frontal gyrus, and sub-gyral in parietal lobe were also affected. The pattern of gray and white matter volume reductions helps us understand the underlying pathologic mechanisms in AD and potentially can be used as an imaging marker for the studies of AD in the future.     

盆底功能障碍性疾病患者阴道壁成纤维细胞受力后生物学功能的变化

目的:研究盆底功能障碍性疾病(PFD)阴道壁成纤维细胞在受力情况下,Ⅰ型胶原(colⅠ)、Ⅲ型胶原(colⅢ)、转化生长因子β1(TGF-β1)和基质金属蛋白酶-1(MMP-1)基因表达水平的变化,探讨其与PFD发病的关系。方法:选取2009年10月至2010年5月在河北医科大学第二医院妇产科接受手术治疗的12例PFD患者的阴道壁组织,用组织块法对阴道壁成纤维细胞进行原代培养,取2～5代稳定的传代阴道壁成纤维细胞,采用Flexcell-4000细胞柔性基底拉伸系统进行0.3Hz、12%、正弦波的拉伸应变加载实验,以未加载力的静态细胞作为对照组。用RT-PCR反应检测对照组及受力后4h、15h、24h colⅠ、colⅢ、TGF-β1、MMP-1基因的表达水平。结果:对照组colⅠmRNA的表达水平为1.178±0.071,受力后4h、15h、24h表达分别为1.092±0.038、1.198±0.031、1.120±0.098,不同时间colⅠmRNA水平比较,差异有统计学意义(P=0.035);对照组colⅢ表达为0.673±0.029,受力后4h、15h、24h分别为0.313±0.019、0.504±0.033、0.853±0.210,不同时间colⅢmRNA水平比较,差异有统计学意义(P=0.015);对照组TGF-β1表达为0.852±0.039,受力后4h、15h、24h分别为0.673±0.052、0.897±0.051、0.895±0.015,不同时间TGF-β1 mRNA水平比较,差异有统计学意义(P=0.0001)。对照组MMP-1表达为1.167±0.036,受力后4h、15h、24h表达分别为0.669±0.109、1.085±0.176、1.325±0.048,不同时间MMP-1 mRNA水平比较,差异有统计学意义(P=0.017)。随着加力时间的延长,目的基因的表达水平呈现先下降,再上升的趋势。结论:阴道壁成纤维细胞受到机械拉伸刺激后,其细胞外基质的合成代谢和分解代谢均呈旺盛状态,细胞外基质发生了重塑,这可能是导致PFD发生的重要原因。