[Clinical and immunological characteristics of systemic lupus erythematosus with retinopathy].

OBJECTIVE: To investigate the clinical and immunological characteristics of systemic lupus erythematosus (SLE) with retinopathy. METHODS: Fifty SLE patients with retinopathy without hypertension and diabetes (retinopathy group) who were hospitalized in the Peking University People's Hospital from January 2009 to July 2022 were screened. Fifty SLE patients without blurred vision during the course of the SLE and without retinopathy in the fundus examinations (non-retinopathy group) matched for sex and age were selected. Their clinical manifestations, laboratory tests and lymphocyte subsets were statistically analyzed. RESULTS: The most common fundus ocular change of the SLE patients with retinopathy was cotton-wool spots (33/50, 66.0%), followed by intraretinal hemorrhage (31/50, 62.0%). Retinopathy could occur at any stage of SLE duration, with a median of 1 year (20 days to 30 years). The proportion of lupus nephritis (72.0% vs. 46.0%, P=0.008) and serositis (58.0% vs. 28.0%, P=0.002) in the retinopathy group were significantly higher than those in the non-retinopathy group. The proportion of neuropsychiatric systemic lupus erythematosus (NPSLE) in the retinopathy group was higher, but there was no significant difference between the two groups. Compared with the non-retinopathy group, the proportion of positive anti-cardiolipin antibody (30.0% vs. 12.0%, P=0.027), the SLEDAI score (median 22.0 vs. 10.5, P < 0.001), erythrocyte sedimentation rate (P < 0.001), C-reactive protein (P=0.019) and twenty-four hours urine total protein level (P=0.026) in the retinopathy group were significantly higher, and the hemoglobin level was significantly lower [(91.64±25.18) g/L vs. (113.96±18.57) g/L, P < 0.001]. The proportion of CD19+ B cells in peripheral blood of the patients with SLE retinopathy was significantly increased (P=0.010), the proportion of CD4+ T cells was significantly decreased (P=0.025) and the proportion of natural killer (NK) cells was lower (P=0.051) when compared with the non-retinopathy group. CONCLUSION: Retinopathy in SLE suggests a higher activity of SLE disease with more frequent hematologic and retinal involvement. It is recommended to perform fundus examination as soon as a patient is diagnosed with SLE. SLE patients with retinopathy may have stronger abnormal proliferation of B cells, and aggressive treatment should be applied to prevent other important organs involvement.

[Correlation between daily fluid intake behavioral habits and pathological characteristics of upper tract urothelial carcinoma].

OBJECTIVE: To investigate the correlation between drinking habits and pathological characteristics of patients with upper tract urothelial carcinoma (UTUC). METHODS: A preoperative questionnaire survey was conducted to understand the drinking habits of UTUC patients who were admitted to the Department of Urology, Peking University First Hospital for radical nephroureterectomy within one year from August 2020 to July 2021, and statistical analysis was performed in combination with their postoperative pathological characteristics. The statistical procedure was performed using SPSS 22.0 software, and firstly, the preliminary analysis was performed one by one using the columnar χ2 test on the pathological characteristics of UTUC tumors as the dependent variable and the factors related to patients' general information, past history and drinking habits as the independent variables, and the independent variables that met P < 0.2 between the case and control groups for each dependent variable were specified for screening. The screened variables were included in the binary Logistic regression analysis. A difference of P < 0.05 was used to indicate a statistically significant difference. RESULTS: A total of 239 patients, 134 males and 105 females, with a mean age of (68.1±9.98)years and a median disease duration of 4.8 months, were included in this study. Multifactorial Logistic regression results suggested that after adjusting for the effects of other variables, UTUC patients who had the habit of drinking at least once every hour during the daytime had a significantly increased risk of high grade (G3) tumors(OR=1.941, 95%CI: 0.352-1.029, P < 0.01); these patients also had a significantly decreased risk of multifocal UTUC tumors (OR=0.344, 95% CI: 1.18-5.582, P=0.004). The patients who had the habit of drinking over 100 mL water each time had a significantly decreased risk of mutifocal UTUC incidence (OR=0.477, 95%CI: 0.225-1.012, P=0.046). Patients who pay attention to daily water intakes had a significantly increased risk of renipelvic carcinoma (OR=2.530, 95%CI: 1.434-4.463, P=0.001) and a significantly decreased risk of ureteral carcinoma (OR=0.314, 95%CI: 0.172-0.573, P < 0.01). Other variables included in the regression model did not differ significantly in their effects on the occurrence of tumor pathological characteristics. CONCLUSION: Having the awareness of drinking water every 1 h during the day, drinking over 100 mL water each time, having the awareness of daily drinking habits correlated significantly with pathological characteristics of UTUC such as the presence of G3 tumor, multifocal tumors and location of the tumor. This conclusion still needs to be verified by subsequent trials with higher levels of evidence.

Effects of acarbose on polycystic ovary syndrome: a meta-analysis.

OBJECTIVE: Whether or not acarbose benefits patients with polycystic ovary syndrome (PCOS) remains controversial. Therefore, we performed a meta-analysis to synthesize the literature regarding the therapeutic effects of acarbose on PCOS. METHODS: A comprehensive literature search was performed using terms, such as polycystic ovary syndrome, ovary polycystic disease, PCOS, hyperandrogenemia, acarbose, alpha-glucosidase inhibitors, and randomized controlled trials (RCTs), in the following bibliographic databases: Medline; Embase; and Cochrane Controlled Trials Register. The identified reference lists were checked manually. RESULTS: 6 RCTs met the inclusion criteria. Based on the meta-analysis of 3 studies, acarbose was superior to placebo or no treatment in reducing serum levels of testosterone (Std MD = - 3.38, 95% CI:-5.97~-0.78, P = 0.01) and acarbose caused a significantly higher incidence of side effects, such as abdominal distention and diarrhea (OR = 23.78, 95% CI: 5.67~99.75, P < 0.0001). The changes in Ferriman-Gallwey score or body mass index (BMI) were not significant. Based on the meta-analysis of 2 studies, acarbose were superior to placebo or no treatment in reducing triglycerides (TG; WMD = -18.18, 95% CI:-36.30~-0.06, P = 0.05) and very low-density lipoprotein (VLDL) cholesterol (WMD = - 6.49, 95% CI:-9.14~-3.84, P < 0.00001), and increasing high-density lipoprotein (HDL) cholesterol (WMD = 5.14, 95% CI:1.73~8.55, P = 0.003). There were no significant differences between acarbose and metformin with respect to improvements in ovulation rate, menstrual patterns, or changes in serum levels of testosterone, adverse events, or BMI. Heterogeneities were detected during the meta-analysis. CONCLUSIONS: This is the first meta-analysis to evaluate the role that acarbose plays in the treatment of PCOS. The currently available data showed that acarbose can reduce testosterone, TG, and VLDL, and increase HDL. Acarbose caused a significantly higher incidence of gastrointestinal disturbance. Given the small RCTs and poor quality of RCTs included, these results are not conclusive. A large-scale, randomized controlled study is needed to ascertain this uncertainty.

First Report of Pantoea agglomerans Causing Brown Apical Necrosis of Walnut in China.

Brown apical necrosis (BAN) of walnut (Juglans regia L.) causes premature fruit drop and yield losses and has been reported to be an important walnut production problem in Spain, Italy, France, and Turkey (1,2). A number of organisms have been associated with BAN on walnut: Xanthomonas arboricola pv. juglandis, Fusarium spp., and Alternaria spp. (3). Since the spring of 2007, BAN was observed in 50 to 60% of the trees in walnut orchards in Taian City and Laiwu City, Shandong Province, China. Surface-disinfested tissue from premature walnut fruits was placed onto potato dextrose agar. Alternaria spp., X. arboricola pv. juglandis, and Pantoea agglomerans (formerly Enterobacter agglomerans) were isolated 76, 35, and 45% of the time, respectively. The P. agglomerans cultures formed a yellow lawn and were rod shaped with the body length of 1.5 to 3.0 µm, width of 0.5 to 1.0 µm, and four to six flagella. In biochemical tests, these bacteria were gram negative, lactose positive, and indole negative. Genomic DNA was extracted from one HXJ isolate and the 16S rRNA gene sequence (GenBank Accession No. HM016799) was obtained using universal primers 27F and 1492R. HM016799 had 99% sequence identity with P. agglomerans accessions in GenBank (GU477762, GQ494018, FJ756355, and AB004757). To confirm pathogenicity, HXJ isolate (108 CFU·ml-1) was inoculated at the bottom of the stigma within 5 days after florescence (DAF) and in premature fruit wounded with a needle within 30 DAF in 2008 to 2010. Stigmas injected with only sterile water served as controls. The bacteria were inoculated into three replicate 9-year-old plants of the walnut cv. Xiangling. Forty nuts on each plant were inoculated. The plants were grown in Shandong Province, China (36°09'59″N, 117°13'30″E). Ten days after inoculation, typical internal BAN symptoms were observed on all treated nuts and the controls were still healthy. In the inoculated stigmas, necrosis of stigma and style spread to internal tissues and reached the kernel. In treated premature fruit, internal tissues became necrotic and blackish and eventually led to nut drop. The same bacterium was reisolated from the inoculated tissue. On the basis of morphological, physiological, and biochemical characteristics and sequencing of the 16S rRNA gene, the bacterium was identified as P. agglomerans. To our knowledge, this is the first report of P. agglomerans causing internal type BAN of walnut in China or worldwide. References: (1) A. Belisario et al. Plant Dis. 6:599, 2002. (2) G. Bouvet. Acta Hortic. 705:447, 2005. (3) C. Moragrega and H. Özaktan. J. Plant Pathol. 92:S1.67, 2010.

Lymphonodovenous anastomosis in the treatment of chyluria.

Thirty cases of chyluria were treated by means of lymphonodovenous anastomoses according to the principles of lymphovenous shunt. A conical tissue of lymph node close to the greater saphenous vein in the inguinal region was removed and the remaining tunnel-shaped node was anastomosed to the vein to drain the lymph into the venous system. Twenty-one cases were followed up for six months after the operation. Among them, 16 (76.2%) showed disappearance of chyluria, and 2 (9.5%) were improved, giving an effective rate of 85.7%. This operation avoids damage to both the afferent and efferent lymphatic vessels, and affords a large anastomotic stoma for free passage of the lymph into the vein.

Summary and prospects of fourteen years' experience with treatment of chyluria by microsurgery.

Since 1974, 125 cases of chyluria have been treated at our hospital using a microsurgical technique. The duration of illness was longer than 1 year in 94% of the cases. For male patients (95 cases), lymphaticovenous anastomosis was performed at the inguinal part of the spermatic cord and, for females (30 cases), at 3 different regions of the lower extremities, namely dorsum of foot, anterior aspect of leg and anterior aspect of thigh. Most of the patients in our series were followed for 6 months to 4 years (the longest 14 years). Among them, 59 cases were followed for more than 1 year. In 45 patients the urine was completely free from chyle (76.3%), and in 4 other patients the urine was weakly chyle positive or they had occasional mild attacks. The total effect rate was 83.1% (45 of 59). Lymphatic fistulae in the kidney did not close immediately after anastomosis, so chyluria persisted for variable periods in most cases, usually not longer than 6 months. In the surgical treatment of chyluria, lymphaticovenous anastomosis, undertaken at a superficial part of the body, was probably the operation of choice because of less damage, little postoperative morbidity and rare serous complications.