Preoperative Computed Tomography Angiography for Evaluation of Feasibility of Free Flaps in Difficult Reconstruction of Head and Neck.

BACKGROUND: Free tissue transfer has been advocated for anatomic and functional reconstruction of soft tissue defects after surgical removal of an extensive recurrent tumor and/or arising from previous irradiation in the head and neck. We report a case series of difficult reconstruction in the head and neck in which preoperative computed tomography (CT) angiography was utilized to evaluate the feasibility of free flap reconstruction. The preoperative radiological evaluation was performed to determine the availability of reliable vessels for anastomosis in free flap reconstruction. If none was found, regional pedicle flap or palliative treatment was applied instead. The use of CT angiography allows the clinical surgeon to perform precise surgical planning with greater confidence. This may improve surgical results, thereby potentially reducing perioperative morbidity. METHODS: Twenty CT angiograms were obtained from 20 patients. All patients were men with a mean age of 57.2 years (range, 42-72 years) and were scheduled to undergo difficult reconstruction in the head and neck. All patients (20/20 [100%]) suffered from oral squamous cell carcinoma. They had all received extensive operations and radiation therapy. Eighteen patients (18/20 [90%]) had completed a course of perioperative irradiation. The CT angiography reports were used to perform detailed preoperative surgical planning accordingly. The findings of CT angiography were classified into 3 groups: group I: normal CT angiography (patent recipient arteries) (Fig. 3); group II: abnormal CT angiography (recipient vessels were present but stenosis or atherosclerotic lesions were noted) (Fig. 4); group III: abnormal CT angiography with no patent recipient arteries in bilateral sides of the neck (Fig. 5); CT angiography results were correlated to the operative findings. RESULTS: The patients were classified into 3 groups based on the angiographic findings. Six patients (6/20 [30%]) were assigned to group I, 8 patients (8/20 [40%]) to group II, and 6 patients (6/20 [30%]) to group III. In groups I and III, all patients (12/12 [100%]) underwent the treatment according to the original preoperative detailed planning. No flap failure was noted in these 2 groups. In group II, 4 patients' recipient vessels (4/8 [50%]) possessed adequate blood flow intraoperatively; hence, microvascular free flaps were transplanted. Venous congestion in 1 case (1/4 [25%]) was noted. The remaining patients in this group (4/8 [50%]) underwent reconstruction with pedicle flaps rather than free flaps because of the lack of suitable target vessels intraoperatively. All flaps (4/4 [100%]) survived. Among the patients who were treated surgically, intraoperative findings were in accordance with those predicted by CT angiography. The total abnormality rate of CT angiography was 70%. Vascular abnormalities detected as a result of preoperative CT angiography led to changes in the operative plan in 50% (10/20) of the patients. CONCLUSIONS: The use of CT angiography should be considered for difficult microsurgical reconstructions in the head and neck. When an abnormality in vascular anatomy is detected by CT angiography, the surgeon is advised to consider altering the operative plan accordingly. This allows precise operation, thereby maximizing the possibility of an optimal outcome. Changing the operative plan based on results of CT angiography may also help to avoid the difficult situation in which the surgeon finds that there are no suitable recipient vessels for free flap reconstruction during the operation. In addition, CT angiography enables surgeons to conduct the preoperative surgical planning with greater confidence, thereby potentially enhancing the success rate of difficult reconstructions in the head and neck, which in turn would tend to improve the perioperative course for the patient and consequently to improve results by decreasing vascular complication rates.

Robot-assisted free flap reconstruction of oropharyngeal cancer--a preliminary report.

BACKGROUND: The robotic surgical system provides a clear, magnified, 3-dimensional (3D) view as well as a precise and stable instrumental movement, which minimizes many technical difficulties that may be encountered in the surgical treatment of oropharyngeal tumors. A preliminary result of transoral robot-assisted free flap reconstruction of oropharyngeal cancer is presented herein. MATERIALS AND METHODS: Between May and December 2013, the Da Vinci Surgical System (Da Vinci Si, Intuitive Surgical, Sunnyvale, CA) was used in 5 (4 men and 1 woman) cases of oropharyngeal reconstruction. Robot-assisted reconstruction was performed for inset of the flap and for performing a venous anastomosis of the free radial forearm fasciocutaneous flap. RESULTS: All of the reconstructive surgeries were successful without flap failure or take-backs. There were no wound infections or fistulas. CONCLUSION: The application of a robotic surgical system seems to be a safe option in the free flap reconstruction of oropharyngeal defects without lip or mandible splitting.

Differential autophagic cell death under stress with ectopic cytoplasmic and mitochondrial-specific PPP2R2B in human neuroblastoma cells.

Protein phosphatase 2A is one of four major classes of serine/threonine phosphatases. Overexpression of brain-specific regulatory subunit PPP2R2 in neuron cells is implicated in pathogenesis. The alternative splicing of PPP2R2B encodes two isoforms. They are subunit of cytoplasmic specific Bß1 and mitochondria-targeted Bß2. The two constructs were transfected into human neuroblastoma cells, SK-N-SH, respectively, and the stable clones overexpressing either Bß1 or Bß2 established. We have reported that Bß2 clones are sensitive to reactive oxygen species (ROS) treatment by inducing autophagic cell death. To study more on the onset of neuropathogenesis under strain, both clones were exposed to different environmental stress, e.g. starvation and endoplasmic reticulum (ER) stress. To learn how PPP2R2B overexpression responds to starvation, cells were incubated in Hank's buffered salt solution of deprived nutrient. Cell death was induced in Bß1 clones after 6 h starvation, but not in Bß2 clones. The pharmacological inhibitor, Bafilomycin A1, rescued the cell death while suppressing autophagy. On the other hand, to assess how cells respond to ER stress, the cells were treated with 0.1 µM of N-glycosylation inhibitor, tunicamycin (TM). In contrast with Bß1, the apoptotic cell death appeared in Bß2 after 48 h treatment. The formation of autophagolysosome was detected in Bß2 following 12 h treatment with TM as evidenced by lysotracker and GFP-LC3 staining for fluorescence microscopy analysis. The autophagy inhibitor, 3-methyladenine, salvaged the final apoptosis. The stable cell lines with ectopically transfected PPP2R2B genes encoding isoforms of brain-specific regulatory subunit exhibit distinct apoptosis under different stressors. The induced autophagic apoptotic cell death is related to mitochondrial membrane potential drop and ROS generation. Disturbance of autophagy alleviates the induced cell death. The results promised a good model for understanding the onset in pathogenesis under stress in neuron cells with aberrant PPP2R2B expression.

Management of extremity neurilemmomas: clinical series and literature review.

BACKGROUND: Delicate enucleation of neurilemmoma preserves most of nerve fascicles and causes minimal nerve function impairment. Accurate preoperative diagnosis of neurilemmoma is based on clinical findings and image studies. MATERIALS AND METHODS: Between November 2003 and February 2013, operations for the treatment of neurilemmoma were performed on 14 patients (12 men and 2 women) at our institution. The image studies in this series were collected. The tumor mass was approached by splitting the epineurium. In a few cases, enucleation of the neurilemmoma caused some fascicles loss, but reconstruction with sural nerve grafts preserved nerve function. RESULTS: Before surgery, 7 patients received computed tomographic scan, 4 patients underwent magnetic resonance imaging, and 3 patients received sonography. Six patients presented with motor or sensory deficits immediately after tumor enucleation. Three patients recovered completely from the neurological defects with or without nerve reconstruction. CONCLUSIONS: Our results indicate that neurilemmoma can be removed by delicate enucleation with an acceptable risk of injury to the nerve trunk.

Prognostic implications of left ventricular torsion measured by feature-tracking cardiac magnetic resonance in patients with ST-elevation myocardial infarction.

AIMS: The prognostic implication of left ventricular (LV) torsion on ST-elevation myocardial infarction (STEMI) is unclear. METHODS AND RESULTS: We analysed cardiovascular magnetic resonance (CMR) findings of 420 patients from a registry study (NCT03768453). These patients received CMR examination within 1 week after timely primary percutaneous coronary intervention. LV torsion and other CMR indexes were measured. Compared with healthy control subjects, STEMI significantly decreased patients' LV torsion (1.04 vs. 1.63°/cm, P < 0.001). During follow-up (median, 52 months), the reduction of LV torsion was greater in patients with than without composite major adverse cardiac and cerebrovascular events (MACCEs, 0.79 vs. 1.08°/cm, P < 0.001). The risk of MACCEs would increase to 1.125- or 1.092-fold, and the risk of 1-year LV remodelling would increase to 1.110- or 1.082-fold for every 0.1°/cm reduction in LV torsion after adjustment for clinical or CMR parameters respectively. When divided dichotomously, patients with LV torsion≤ 0.802°/cm had significantly higher risk of MACCEs (40.2 vs. 12.3%, P < 0.001) and more remarkable LV remodelling (46.1 vs. 11.9%, P < 0.001) than patients with better LV torsion. The addition of LV torsion to conventional prognostic factors such as the LV ejection fraction and infarction size led to a better risk classification model of patients for both MACCEs and LV remodelling. Finally, tobacco use, worse post-PCI flow, and greater microvascular obstruction size were presumptive risk factors for reduced LV torsion. CONCLUSION: LV torsion measured by CMR is closely associated with the prognosis of STEMI and would be a promising indicator to improve patients' risk stratification. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT03768453.

Study of the Pattern Preparation and Performance of the Resistance Grid of Thin-Film Strain Sensors.

The thin-film strain sensor is a cutting-force sensor that can be integrated with cutting tools. The quality of the alloy film strain layer resistance grid plays an important role in the performance of the sensor. In this paper, the two film patterning processes of photolithography magnetron sputtering and photolithography ion beam etching are compared, and the effects of the geometric size of the thin-film resistance grid on the resistance value and resistance strain coefficient of the thin film are compared and analyzed. Through orthogonal experiments of incident angle, argon flow rate, and substrate negative bias in the ion beam etching process parameters, the effects of the process parameters on photoresist stripping quality, etching rate, surface roughness, and resistivity are discussed. The effects of process parameters on etching rate, surface roughness, and resistivity are analyzed by the range method. The effect of substrate temperature on the preparation of Ni Cr alloy films is observed by scanning electron microscope. The surface morphology of the films before and after ion beam etching is observed by atomic force microscope. The influence of the lithography process on the surface quality of the film is discussed, and the etching process parameters are optimized.

Fabrication, Performance, Characterization and Experimental Calibration of Embedded Thin-Film Sensor for Tool Cutting Force Measurement.

Thin-film strain sensors are widely used because of their small volume, fast strain response and high measurement accuracy. Among them, the thin-film material and preparation process of thin-film strain sensors for force measurement are important aspects. In this paper, the preparation process parameters of the transition layer, insulating layer and Ni-Cr alloy layer in a thin-film strain sensor are analyzed and optimized, and the influence of each process parameter on the properties of the thin film are discussed. The surface microstructure of the insulating layer with Al2O3 or Si3N4 transition layers and the film without transition layer were observed by atomic force microscopy. It is analyzed that adding a transition layer between the stainless steel substrate and insulation layer can improve the adhesion and flatness of the insulation layer. The effects of process parameters on elastic modulus, nanohardness and strain sensitivity coefficient of the Ni-Cr resistance layer are discussed, and electrical parameters such as the resistance strain coefficient are analyzed and characterized. The static calibration of the thin-film strain sensor is carried out, and the relationship between the strain value and the output voltage is obtained. The results show that the thin-film strain sensor can obtain the strain generated by the cutting tool and transform it into an electrical signal with good linearity through the bridge, accurately measuring the cutting force.

Is polycystic ovary syndrome appropriately diagnosed by obstetricians and gynaecologists across China: a nationwide survey.

BACKGROUND: To describe the diagnostic criteria used and their application accuracy in the practice of polycystic ovary syndrome (PCOS) caring among obstetricians and gynaecologists across China. METHODS: This was an Online cross-sectional survey of Obstetricians and gynecologists involved in PCOS caring conducted via the largest continuing education platform of obstetrics and gynecology across China from September 2019 to November 2019. RESULTS: A total of 2,328 respondents were eligible for the final analysis. Of these, 94.5 % were general obstetricians and gynaecologists (Ge-ObGyn), and 5.5 % were reproductive endocrinologists (Re-ObGyn). Overall, the most frequently used criteria were the Androgen Excess and Polycystic Ovary Syndrome Society (AE-PCOS) criteria (48.2 %), followed by the Rotterdam criteria (35.7 %) and NIH criteria (12.1 %). Of the respondents, 31.3 % used their diagnostic criteria in their clinical practice. More respondents who chose the Rotterdam criteria could accurately apply the diagnostic criteria than those who chose the AE-PCOS criteria (41.2 % vs. 32.1 %, P < 0.001). Compared with Ge-ObGyn, Re-ObGyn were less likely to use the AE-PCOS criteria (adjusted odds ratio, 0.513; 95 % CI, 0.328-0.802; P < 0.05) and 1.492 times more likely to accurately use their criteria (95 % CI, 1.014-2.196; P < 0.05). CONCLUSIONS: Less than one-third of obstetricians and gynaecologists across China could accurately use the diagnostic criteria they choose to diagnose PCOS. There is an urgent need to train obstetricians and gynaecologists on PCOS diagnosis in an effort to improve the medical care quality of patients with PCOS.

Impact of Concomitant Impairments of the Left and Right Ventricular Myocardial Strain on the Prognoses of Patients With ST-Elevation Myocardial Infarction.

Background: The impact of concomitant impairments of left and right ventricular (LV and RV) strain on the long-term prognosis of acute ST-elevation myocardial infarction (STEMI) is not clear. Methods: We analyzed CMR images and followed up 420 first STEMI patients from the EARLY Assessment of MYOcardial Tissue Characteristics by CMR in STEMI (EARLY-MYO-CMR) registry (NCT03768453). These patients received timely primary percutaneous coronary intervention (PCI) within 12 h and CMR examination within 1 week (median, 5 days; range, 2-7 days) after infarction. Global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) of both ventricles were measured based on CMR cine images. Conventional CMR indexes were also assessed. Primary clinical outcome was composite major adverse cardiac and cerebrovascular events (MACCEs) including cardiovascular death, re-infarction, re-hospitalization for heart failure and stroke. In addition, CMR data from 40 people without apparent heart disease were used as control group. Results: Compared to controls, both LV and RV strains were remarkably reduced in STEMI patients. During follow-up (median: 52 months, interquartile range: 29-68 months), 80 patients experienced major adverse cardiac and cerebrovascular events (MACCEs) including cardiovascular death, re-infarction, heart failure, and stroke. LV-GCS > -11.20% was an independent predictor of MACCEs (P < 0.001). RV-GRS was the only RV strain index that could effectively predict the risk of MACCEs (AUC = 0.604, 95% CI [0.533, 0.674], P = 0.004). Patient with RV-GRS ≤ 38.79% experienced more MACCEs than those with preserved RV-GRS (log rank P < 0.001). Moreover, patients with the concomitant decrease of LV-GCS and RV-GRS were more likely to experience MACCEs than patients with decreased LV-GCS alone (log rank P = 0.010). RV-GRS was incremental to LV-GCS for the predictive power of MACCEs (continuous NRI: 0.327; 95% CI: 0.095-0.558; P = 0.006). Finally, tobacco use (P = 0.003), right coronary artery involvement (P = 0.002), and LV-GCS > -11.20% (P = 0.012) was correlated with lower RV-GRS. Conclusions: The concomitant decrease of LV and RV strain is associated with a worse long-term prognosis than impaired LV strain alone. Combination assessment of both LV and RV strain indexes could improve risk stratification of patients with STEMI. Trial Registration: ClinicalTrials.gov, NCT03768453. Registered 7 December 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03768453.

Large range and high resolution on-line displacement measurement system by combining double interferometres.

A stabilized interferometric displacement measurement system, which is suitable for on-line measurement and is endowed with large measurement range and high resolution, is proposed. The system is stabilized by a feedback loop which compensates the influences induced by the environmental disturbances and makes the system stabile enough for on-line measurement. Two different wavelengths are working simultaneously in the system. The measurement range which is determined by the synthetic-wavelength interferometric signal is expanded to the order of millimeter, while the measurement resolution which is determined by one of the single-wavelength interferometric signal is the order of sub-nanometer.

[Evaluation of MRI in the diagnosis of rheumatoid arthritis].

OBJECTIVE: to study the features of rheumatoid arthritis (RA) on MRI of hands and wrists and compare MRI with clinical manifestations and laboratory tests of RA. METHODS: a total of 25 patients fulfilling the 2009 ACR/EULAR RA criteria were enrolled. MRI and plain films of hands and wrists and clinical data of swollen joints, tender joints, visual scale (VAS) score, DAS28 score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), RF classification, anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies) were obtained simultaneously. RESULTS: MRI revealed pathologic findings on the wrist and hand joints in all diagnosed RA patients. VAS had a positive correlation with bone marrow edema(r = 0.562, P = 0.003). Although the disease duration was less or more than 1 year, the difference of bone erosion had statistical significance between anti-CCP antibody-positive group and anti-CCP antibody negative group (all P = 0.000). The serum concentration of RF-IgA had a positive correlation with bone marrow edema (r = 0.561, P = 0.041). The synovitis score of MRI of RA was higher in the RF-IgG positive group than that in the RF-IgG negative group (P = 0.035). There was significant difference in MRI synovitis between the RF-IgG or RF-IgM positive and negative groups of patients with a disease course of under 1 year (P = 0.015, P = 0.007). The serum CRP level had a positive correlation with arthroderma (r = 0.457, P = 0.022). CONCLUSION: MRI is proved to be a valuable examination for an early diagnosis and assessment of RA.

[Differentiation of Amanita hemibapha (Berk. & Broome) Sacc. subsp. hemibapha and Amanita hemibapha var. ochracea Zhu L. Yang by Fourier transform infrared spectroscopy].

In order to demonstrate the ability of Fourier transform infrared (FTIR) spectroscopy for the differentiation of macro-fungi at variety level, FTIR spectroscopy was used to obtain vibrational spectra of Amanita hemibapha (Berk. & Broome) Sacc. subsp. hemibapha and Amanita hemibapha var. ochracea Zhu L. Yang. The results show that their spectra are very similar to each other, with a small difference in the relative intensity of absorbance. For the purpose of enhancing the spectral resolution and amplifying the differences, the first-derivative spectra and second-derivative spectra were selected for evaluating the correlation coefficients respectively. The results show that the second-derivative spectra of two fruit bodies of Amanita hemibapha (Berk. & Broome) Sacc. subsp. hemibapha and one fruit body of Amanita hemibapha var. ochracea Zhu L. Yang have obvious differences, the correlation coefficients are only 0.245 and 0.356 respectively, the second-derivative spectra of two fruit bodies of Amanita hemibapha (Berk. &Broome) Sacc. subsp. hemibapha are very similar, and the correlation coefficient is 0.865. The authors' results show that Fourier transform infrared spectroscopy in combination with correlation analysis method can be used to identify Amanita hemibapha (Berk. & Broome) Sacc. subsp. hemibapha and Amanita hemibapha var. ochracea Zhu L. Yang rapidly and accurately.

[Fourier transform infrared spectroscopic study of Coprinus comatus].

In the paper, Fourier transform infrared (FTIR) spectroscopy was used to study the fruiting body of wild growing and cultivated Coprinus comatus and the cap of the mushroom before and after deliquescing into inky liquid. The results show that the infrared spectra of Coprinus comatus are mainly composed of the absorption bands of protein and polysaccharide. Remarkable differences are observed in the absorption bands of polysaccharide between the spectra of the wild growing and cultivated mushrooms, by which the wild growing and cultivated Coprinus comatus can be discriminated. It was also found that the absorption bands of polysaccharide become weaker obviously in the black-inky samples of deliquescing cap compared with the un-deliquescing cap, indicating that the polysaccharides in the cap of Coprinus comatus are transformed during the process of cap deliquescing into a black, inky liquid. The spectral results can offer useful information for a further study of Coprinus comatus.

Author Correction: Identifying long-term stable refugia for relict plant species in East Asia.

In the original version of this Article, an incorrect sample size was provided for the number of relict species (443 instead of 442) and the number of relict forests (423 instead of 422). These errors have been corrected in both the PDF and HTML versions of the Article.

Identifying long-term stable refugia for relict plant species in East Asia.

Today East Asia harbors many "relict" plant species whose ranges were much larger during the Paleogene-Neogene and earlier. The ecological and climatic conditions suitable for these relict species have not been identified. Here, we map the abundance and distribution patterns of relict species, showing high abundance in the humid subtropical/warm-temperate forest regions. We further use Ecological Niche Modeling to show that these patterns align with maps of climate refugia, and we predict species' chances of persistence given the future climatic changes expected for East Asia. By 2070, potentially suitable areas with high richness of relict species will decrease, although the areas as a whole will probably expand. We identify areas in southwestern China and northern Vietnam as long-term climatically stable refugia likely to preserve ancient lineages, highlighting areas that could be prioritized for conservation of such species.

[Investigation of Amanitaceae mushrooms by Fourier transform infrared spectroscopy].

In the present paper, FTIR was used for obtaining vibrational spectra of untreated Amanitaceae mushrooms harvested in the mountains of Yunnan province, Southwest of China. The results show that the spectra of fruiting body and spore exhibit obvious differences. In the spectra of fruiting body, the strongest absorption band appears at about 1 655 cm(-1), which is described as amide I. There are two strong absorption bands at 1 077 and 1 042 cm(-1) which are assigned to C-O stretching in carbohydrate. The vibrational spectra indicate that the main compositions of the Amanitaceae mushrooms are protein and carbohydrate. The spectrum of spore of Amanita fritillaria shows strong bands at 2 926, 2 855 and 1 747 cm(-1), which can be assigned to the absorption of lipids. The spectra of fruiting body exhibit complicated patterns in the interval between 1 800 and 750 cm(-1), which may be used to discriminate different species of Amanitaceae mushrooms. In addition, FTIR spectral differences were observed between different parts of Amanita manginiana. The result suggests that the chemical constituents are various in different parts of fruiting bodies. It is showed that FTIR spectroscopic method is a valuable tool for rapid and nondestructive identification of Amanita mushrooms.

[Fourier transform infrared spectroscopic study of truffles].

Truffles, which belong to ascomycetes, are rare wild growing edible mushrooms; their fruit body contains high nutritive value composition, and their polysaccharide constituents have potential medical applications. In the present paper, Fourier transform infrared (FTIR) spectroscopy was used for obtaining vibrational spectra of mushrooms of truffles growing in mountains of Yunnan province, southwest China. The results show that the mushrooms exhibit characteristic spectra. The two strongest absorption bands appear at about 1 077 and 1 042 cm(-1), respectively. The spectra exhibit complicated patterns between 1200 and 750 cm(-1), which may be used as fingerprints to discriminate different species of truffles. Great changes were also found between mold and healthy truffles, showing major differences observed in the bands of protein. In addition, some vibrational-spectrum differences were observed among the same species of truffles from different growing areas. It is showed that FTIR can provide valuable information about the chemical constituents of intact truffles prior to any extraction method is used.

[Fourier transform infrared spectroscopic study of different parts of wild growing edible mushrooms].

In this paper, vibrational spectra of different parts of fruiting bodies of wild growing mushrooms were recorded with Fourier transform infrared spectrometer. It was different for the spectra of cap skin, gill, cap meat and stem of the same mushroom. The great differences were found between cap skin and other parts of the same mushrooms of Russula virescens and Russula rubra, whereas the spectra of mushroom Termitomyces albuminosus show greated differences between gill and other parts. These indicate variety in the chemical composition of different parts of the same fruiting body. The results suggest that the mushrooms could be identified at the species level by comparison of the vibrational spectra of different parts of fruiting bodies of mushrooms.

Predictors of response to TNF-α antagonist therapy in Chinese rheumatoid arthritis.

This study aimed to investigate the clinical, immunological, and radiologic predictors of response to tumor necrosis factor (TNF)-α antagonist therapy in Chinese rheumatoid arthritis (RA). Ninety RA patients were divided into two groups according to their responsiveness to TNF-α antagonist therapy at 1 month: group A (responders) and group B (non-responders). After 3 months of therapy, all the 90 patients were re-assessed and re-divided into another two groups: group C (responders) and group D (non-responders). Serum samples and clinical characteristics as well as radiographic features were collected at baseline, first month, and third month post-initial administration of TNF-α antagonist. Serum TNF-α, interleukin (IL)-6, IL-8, IL-34, and matrix metalloproteinase (MMP)-3 were measured by enzyme-linked immunosorbent assay (ELISA). Disease activity and Sharp score were evaluated. (1) Comparisons between groups A and B: subjects in group A showed a lower level of erythrocyte sedimentation rate (ESR) and a higher level of albumin (ALB) at baseline than that of group B (p < 0.05). The cutoff value of ALB for prediction was ≥34.9 g/l and that of ESR was ≤55.5 mm/h. (2) Comparisons between groups C and D: group C showed lower levels of ESR, health assessment questionnaire (HAQ), and IL-34 at baseline (p < 0.05). The threshold for prediction were as follows: ESR ≤60 mm/h, HAQ ≤1.3125, and IL-34 ≤194.12 pg/ml. (3) The serum cytokines were positively correlated with C-reactive protein (CRP) and disease activity index, while ALB was negatively correlated with CRP and disease activity. Baseline ALB ≥34.9 g/l or ESR ≤55.5 mm/h might predict a good response at 1-month treatment of TNF-α antagonist, while baseline ESR ≤60 mm/h, HAQ ≤1.3125, and IL-34 ≤194.12 pg/ml might predict a good response at 3-month treatment.

Interleukin-34 in rheumatoid arthritis: potential role in clinical therapy.

OBJECTIVE: To investigate, whether interleukin (IL)-34 can be used as marker for treatment effectiveness in rheumatoid arthritis (RA). METHODS: Serum samples were collected from 35 healthy participants and 83 patients with RA before as well as 4 weeks and 12 weeks after treatment initiation with the tumor necrosis factor α (TNF-α) inhibitor Etanercept. Related clinical data and hand radiograms of the patients were evaluated and serum IL-34, IL-6, IL-8, TNF-α, matrix metalloproteinase-3 (MMP-3) in addition to anti-cyclic citrullinated peptide (CCP) antibody concentrations were measured by ELISA. RESULTS: Serum concentrations of IL-34, IL-6, IL-8, TNF-α, MMP-3 and anti-CCP antibodies were markedly elevated in RA patients compared with controls (P<0.001), significantly decreased during treatment and correlated with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and RA disease activity (P<0.05). IL-34 correlated withIL-6, IL-8, TNF-α, MMP-3 and anti-CCP antibodies in RA patients at baseline (P<0.01) and also with IL-8, MMP-3, IL-6, and DAS28 changes during therapy. Patients in stage III of hand X-ray RA scores had higher IL-34 serum concentrations than in stage II (P<0.05). IL-34 level decreased significantly (P<0.01) starting from 4 weeks after therapy initiation. CONCLUSIONS: IL-34 serum concentrations correlated with inflammatory cytokines before and during therapy and were significantly higher in stage III of hand X-ray score patients than in stage II participants. IL-34 might be used both as a biomarker for RA diagnosis and therapy efficiency.