[A clinical analysis of dermatomyositis with interstitial lung disease in 20 patients].

OBJECTIVE: To investigate the clinical features of the patients with dermatomyositis (DM) complicated with interstitial lung disease (ILD). METHODS: The clinical manifestations and the laboratory data of the 20 patients with DM complicated with ILD were retrospectively analyzed. RESULTS: Among 169 DM patients, 20(11.8%) were founded with ILD and 4 had no complaint of respiratory system. The ratio of male to female was 1:2.33. The level of serum creatine kinase (CK) was elevated in 11 cases. Anti-Jo-1 antibody was positive in 4 cases. Bilateral infiltrates including ground-glass attenuation, interlobular septal thickening and reticular opacities were found by chest high resolution computed tomography. The impairment of lung function was manifested as the decreased diffusion capacity for carbon monoxide of the lung (D(L)CO) and restricted ventilatory function abnormalities. Fifteen cases showed hypoxemia or respiratory failure by arterial blood gas analysis. All patients were treated with glucocorticoid and/or immunosuppressive agents. Totally, 14 patients had improved, while 2 patients with no improvement and 4 patients died with a mortality of 20%. CONCLUSIONS: DM complicated with ILD which is easily missed has a high morbidity and mortality. The understanding of DM complicated with ILD should be enhanced, thus early diagnosis and intervention could be performed for better prognosis.

Targeting 4-1BB for tumor immunotherapy from bench to bedside.

Immune dysfunction has been proposed as a factor that may contribute to disease progression. Emerging evidence suggests that immunotherapy aims to abolish cancer progression by modulating the balance of the tumor microenvironment. 4-1BB (also known as CD137 and TNFRS9), a member of tumor necrosis factor receptor superfamily, has been validated as an extremely attractive and promising target for immunotherapy due to the upregulated expression in the tumor environment and its involvement in tumor progression. More importantly, 4-1BB-based immunotherapy approaches have manifested powerful antitumor effects in clinical trials targeting 4-1BB alone or in combination with other immune checkpoints. In this review, we will summarize the structure and expression of 4-1BB and its ligand, discuss the role of 4-1BB in the microenvironment and tumor progression, and update the development of drugs targeting 4-1BB. The purpose of the review is to furnish a comprehensive overview of the potential of 4-1BB as an immunotherapeutic target and to discuss recent advances and prospects for 4-1BB in cancer therapy.

Changes in the esophagogastric junction outflow obstruction manometric feature based on the Chicago Classification updates.

BACKGROUND: The critical diagnostic criteria for esophagogastric junction outflow obstruction (EGJOO) were published in the latest Chicago Classification version 4.0 (CCv4.0). In addition to the previous criterion [elevated integrated relaxation pressure (IRP) in supine position], manometric diagnosis of EGJOO requires meeting the criteria of elevated median-IRP during upright wet swallows and elevated intrabolus pressure. However, with the diagnostic criteria modification, the change in manometric features of EGJOO remained unclear. AIM: To evaluate the esophageal motility characteristics of patients with EGJOO and select valuable parameters for confirming the diagnosis of EGJOO. METHODS: We performed a retrospective analysis of 370 patients who underwent high-resolution manometry with 5 mL water swallows × 10 in supine, × 5 in upright position and the rapid drink challenge (RDC) with 200 mL water from November 2016 to November 2021 at Peking University First Hospital. Fifty-one patients with elevated integrated supine IRP and evidence of peristalsis were enrolled, with 24 patients meeting the updated manometric EGJOO diagnosis (CCv4.0) as the EGJOO group and 27 patients not meeting the updated EGJOO criteria as the isolated supine IRP elevated group (either normal median IRP in upright position or less than 20% of supine swallows with elevated IBP). Forty-six patients with normal manometric features were collected as the normal high-resolution manometry (HRM) group. Upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES) parameters were compared between groups. RESULTS: Compared with the normal HRM group, patients with EGJOO (CCv4.0) had significantly lower proximal esophageal contractile integral (PECI) and proximal esophageal length (PEL), with elevated IRP on RDC (P < 0.05 for each comparison), while isolated supine IRP elevated patients had no such feature. Patients with EGJOO also had more significant abnormalities in the esophagogastric junction than isolated supine IRP elevated patients, including higher LES resting pressure (LESP), intrabolus pressure, median supine IRP, median upright IRP, and IRP on RDC (P < 0.05 for each comparison). Patients with dysphagia had significantly lower PECI and PEL than patients without dysphagia among the fifty-one with elevated supine IRP. Further multivariate analysis revealed that PEL, LESP, and IRP on RDC are factors associated with EGJOO. The receiver-operating characteristic analysis showed UES nadir pressure, PEL, PECI, LESP, and IRP on RDC are parameters supportive for confirming the diagnosis of EGJOO. CONCLUSION: Based on CCv4.0, patients with EGJOO have more severe esophagogastric junction dysfunction and are implicated in the proximal esophagus. Additionally, several parameters are supportive for confirming the diagnosis of EGJOO.

[The predictive value of Holter recordings to detect moderate-severe obstructive sleep apnea syndrome].

OBJECTIVE: To evaluate the predictive value of Holter ECG recordings for patients with moderate-severe obstructive sleep apnea and hypopnea syndrome (OSAHS). METHODS: Holter recordings was performed in 76 patients who were diagnosed OSAHS by polysomnography (PSG) within one month from Jan. 2008 to July 2009 in our hospital. Twenty-eight patients were identified as mild OSAHS (AHI < or = 20) and forty-eight patients were moderate-to-severe OSAHS (AHI > 20). The indexes of heart rate variability (HRV), total scores of thirteen sleep apnea risk indexes of Holter recordings and BMI were analyzed by bivariate Logistic regression analysis. RESULTS: Clinical features (eg. Gender, age, complicated with hypertension, coronary heart disease, diabetes mellitus, hyperglycemia, and taken beta-blocker), total scores, the sum of thirteen sleep apnea risk scores collected by Holter recordings (5.64 + or - 2.33 vs. 6.42 + or - 2.22, respectively, P > 0.05) were similar between patients with mild OSAHS and moderate-to-severity OSAHS. VLF/Total Power > 70%, the difference of daytime/nighttime LF Power < -70 and BMI were independent predictors of moderate-to-severe OSAHS with OR 3.98 (1.087 - 14.596), 3.69 (1.106 - 12.285) and 1.28 (1.062 - 1.544), respectively (all P < 0.05). CONCLUSIONS: VLF/Total Power and the difference of daytime/nighttime LF Power and BMI could be used as screening parameters to recognize patients with moderate-to-severe OSAHS.

[Immunogenicity of S1 gene DNA vaccine of mouse hepatitis virus delivered by attenuated Salmonella typhimurium].

The complete S1 gene from mouse hepatitis virus (MHV) was amplified by RT-PCR and cloned into the pMD18-T vector. After confirmed by the restriction endonuclease analysis and PCR amplification, the positive clone of S1 gene was sequenced and then was transferred into eukaryotic expressing vector pVAXI. The recombinant plasmid pVAX1-S1 was transfected into COS-7 cells. The expressed S1 protein was successfully detected with indirect immunofluorescent assay. Finally, The recombinant plasmid pVAX1-S1 was transformed by electroporation into attenuated Salmonella typhimurium strain SL7207 and confirmed by PCR and Salmonella agglutination test. The recombinant was named as SL7207(pVAX1-S1). 6-week-old BALB/c mice were inoculated orally with SL7207 (pVAX1-S1) at dosage of 5 x 10 (8) CFU, 1 x 10(9) CFU and 2 x 10(9) CFU respectively. The immunized mice showed no clinic symptom. The results suggested that SL7207 (pVAX1-S1) was safe for mice after oral immunization at dosage of 2 x 10(9) CFU or below. BALB/c mice were immunized orally with SL7207 harboring recombinant plasmid at the dosage of 109 and boosted two weeks later with the same dose, for a total of three times. The recombinant Salmonella SL7207 ( pVAX1-S1 ) could induce significant humoral immune response in mice compared with the control (P < 0.05 or 0.01) at 2 w post-boosting and 2 w post-three immunization. The antibodies against MHV were also detected in small intestinal mucosal samples from immunized mice at 2 w post-three immunization. These results indicated that recombinant SL7207(pVAX1-S1) induced both systemic and local mucosal immunity.

[Expression of actA gene of Listeria monocytogenes in Escherichia coli and preparation of ActA monoclonal antibodies].

The actA gene was amplified from Lm-4 strain of Listeria monocytogenes serotype 1/2a by PCR and inserted into T vector. Sequencing showed actA gene was 1833bp long and nucleotide homology was 100% compared with actA gene of Listeria monocytogenes EGD strain in GenBank. The cloned actA gene was then inserted into prokaryotic expression vector pGEX-6P-1 and pET respectively. The predicted fusion protein was detected by SDS-PAGE after IPTG induction of recombinant bacteria. The fusion protein expressed in both vectors showed approximate molecular weight of 120kDa and 97kDa. The expressed fusion protein His-ActA was purified and used as antigen to immunize BALB/c mice, hybridomas were generated with traditional hybridoma techniques. McAbs were screened by ELISA, four hybridoma cell lines secreting antibodies against ActA protein were established and the ELISA titer of these ascitic McAbs were around 1 :5 x 10(4) - 1: 1 x 10(5) . The subtype and specifity of McAbs were identified by kit and Western blot. The McAb 1A5 reacted with the expressed fusion protein GST-ActA and His-ActA in Western blot, consistent with that of mouse anti-Lm-4 polyclonal antibodies. The successful expression of ActA protein in E. coli and preparation of its monoclonal antibodies has provided useful tools for studies on the biological activity of ActA protein and its role in listerial pathogenesis.

Tegaserod inhibits noxious rectal distention induced responses and limbic system c-Fos expression in rats with visceral hypersensitivity.

AIM: To examine the effects of tegaserod, a serotonin (5-HT) 4 receptor partial agonist, on abdominal withdrawal reflex (AWR) to rectal distention (RD) and c-Fos expression in limbic system. METHODS: Neonatal Sprague-Dawley rats randomly received colonic irritation by acetic acid from postnatal day 8 to d 21 as a visceral hypersensitive model (group H) or by intrarectal saline as a control group (group C). When they became adults, rectal distention (RD) was performed by a balloon (6F; Fogarty arterial embolectomy catheter; length, 20 mm; diameter, 2 mm) which was rapidly inflated with increasing volumes of saline (0.4, 0.8 and 1.2 mL) for 20 s at five-minute intervals. Five subgroups of group H (H-saline, H-vehicle, H-Teg0.1, H-Teg0.3 and H-Teg1.0) were injected randomly with saline, vehicle (1-methyl-2-thpyrrolidone) or tegaserod at doses of 0.1, 0.3 and 1.0 mg/kg ip, respectively. Two subgroups of group C (C-Saline and C-Teg1.0) were injected with saline or tegaserod (1.0 mg/kg) ip. RD was performed 10 min after injection, AWR was recorded and c-Fos expression in limbic system was analyzed quantitatively by immunohistochemistry. RESULTS: Compared to saline, tegaserod significantly inhibited AWR in group H (0.4 mL: from 2.0 to 0.5; 0.8 mL: from 3.5 to 1.5; 1.2 mL: from 4.0 to 3.0, P<0.01), but had no significant effect on group C. Tegaserod dose-dependently attenuated the number of c-Fos positive neurons in limbic structures, anterior cingulate cortex (ACC) showed the greatest attenuation. In group H, tegaserod (1.0 mg/kg) resulted in a significant overall decrease to 57% of H-saline (283+/-41 vs 162+/-16, P<0.01), in ACC to 42% of H-saline (72+/-10 vs 31+/-8, P<0.01). In group C, tegaserod (1.0 mg/kg) resulted in an overall decrease to 77% of C-saline (214+/-13 vs 164+/-22, P<0.01), in ACC to 65% of C-saline (48+/-8 vs 31+/-7, P<0.01). CONCLUSION: Tegaserod inhibits the response to rectal distention in rats with visceral hypersensitivity and dose-dependently attenuates c-Fos expression in limbic system, especially in anterior cingulate cortex.

[Tegaserod inhibits noxious rectal distention induced response and spinal nNOS expression in rats with visceral hypersensitivity].

OBJECTIVE: To examine the effects of 5-HT4 receptor partial agonist tegaserod on response to rectal distention (RD) and on nNOS expression in spinal cord, and to investigate the mechanism of tegaserod influencing visceral sensation. METHODS: Neonatal SD rats randomLy received colonic irritation by acetic acid from postnatal day 8 to day 21 as visceral hypersensitive model (Group H); or by saline intrarectally as control group (Group C). Five subgroups of Group H were i.p. injected randomLy with saline, vehicle (1-methyl-2-thpyrrolidone) or tegaserod at doses of 0.1, 0.3 and 1.0 mg/kg, respectively. Two subgroups of Group C were i.p. injected with saline or tegaserod at dose of 1.0 mg/kg. Ten minutes after injection rectal distention was performed, AWR was recorded and nNOS expression in spinal cord (L6-S1) was analyzed quantitatively by NADPH-diaphorase histochemistry. RESULTS: Tegaserod significantly inhibited AWR in Group H, but had no effect in Group C. Tegaserod (1.0 mg/kg) inhibited AWR more significantly in Group H than in Group C at the largest volume of distention (1.2 mL). In Group H, tegaserod (1.0 mg/kg) significantly decreased overall nNOS positive cells in spinal cord to 40% of saline. The greatest attenuation was in dorsal horn (31% of H-saline). Tegaserod (0.1 mg/kg) did not affect the overall nNOS(P>0.20), but decreased the number of nNOS positive cells in central canal (79% of H-saline P<0.01). CONCLUSION: Tegaserod inhibits response to rectal distention in rats with visceral hypersensitivity and dose dependently attenuates spinal nNOS expression, especially in dorsal horn and central canal. nNOS may be involved in the modulation of visceral sensitivity by tegaserod.