[Clinical analysis of FRAX in the assessment of fracture risk in patients with rheumatic disease in three medical center].

Objective: The aim is to analyze the fracture risk in rheumatic patients by fracture risk assessment tool (FRAX), which is recommended by World Health Organization (WHO), so that we can prevent the occurrence of osteoporotic fracture earlier. Methods: Totally 617 participants, 204 out-patients with rheumatism, 204 in-patients with rheumatism and 209 healthy controls, from March to October in 2018 of Fourth Medical Center of PLA General Hospital, Jishuitan Hospital and China-Japan Friendship Hospital, were enrolled in this study. The probability of hip fracture (PHF) and major osteoporotic fracture (PMOF) in 10 years with FRAX were compared, and the differences between taking sleroids or not and with or without bone mass density (BMD) of femoral neck were evaluated. Correlation analysis was conducted between PHF, PMOF and clinical information, including age, disease duration, gender, steroid usage, osteocalcin, P1NP and ß-crosslaps. Results: There was no significant difference in PMOF within 10 years (3.455±2.690 vs 2.973±2.149 vs 3.323±1.828) among the three groups (P>0.05), but the PHF (0.986±1.619 vs 0.515±0.873 vs 0.149±0.311) was different (P<0.05). PHF and PMOF increased gradually with age. PMOF of patients without glucocorticoid therapy in 10 years was lower than that of patients with glucocorticoid (3.554±2.584 vs 2.857±2.238, P<0.05). There is no difference between the results of FRAX calculated with BMD or not (3.012±2.231 vs 3.207±2.601, P>0.05). PHF and PMOF were positively correlated with age, course of disease, glucocorticoid use and osteocalcin level, while PHF was negatively correlated with TP1NP among in-patients. Conclusion: The prevalence of 10-year hip fracture calculated by FRAX in rheumatism patients is higher than that of healthy group. FRAX can be used to calculate fracture risk without BMD. Combination of FRAX and bone turnover markers may be more effective in prediction of osteoporotic fracture in rheumatic patients.

[Chemotherapy combined with androgen-deprivation therapy in high-volume metastatic hormone sensitive prostate cancer: a short-term efficacy and safety analysis].

Objective: To investigate the short-term efficacy and adverse events of chemotherapy combined with androgen-deprivation therapy in high-volume metastatic hormone sensitive prostate cancer. Methods: From March 2015 to August 2017, 55 patients with high-volume metastatic hormone sensitive prostate cancer were enrolled at Department of Urology, Fudan University Shanghai Cancer Center receiving chemotherapy combined with androgen-deprivation therapy. The age was 65(8) years (M(Q(R))) (range: 46 to 79 years). Patients were enrolled in the study for continuous androgen-deprivation therapy (medical or surgical castration), combined with docetaxel 75 mg/m(2) intravenous injection on the first day, repeated every 21 days (6 cycles). Endpoints included overall survival, progression-free survival of prostate cancer, prostate specific antigen (PSA) response rate, and adverse events. Results: The follow-up time was 21.2(11.7) months. The PSA value before chemotherapy was 144.9(415.3) µg/L. The days in patients undergoing androgen deprivation therapy before chemotherapy was 14(23) days. Four patients (7.3%) presented 0 in Eastern Cooperative Oncology Group scoring system and 51 patients(92.7%) presented 1. Thirty-nine patients (70.9%) completed more than 6 cycles of combined chemotherapy, 17 patients (30.9%) showed PSA<0.2 µg/L at 6 months after treatment, and 14 patients (25.5%) showed PSA<0.2 µg/L at 12 months after treatment. Twenty-eight patients (50.9%) had grade 3 to 4 neutropenia and 1 patient (1.8%) developed infectious neutropenia and died. Nausea and vomit occurred in 16 patients (29.1%). Twelve patients (21.8%) underwent dose adjustment due to adverse events in blood system. Conclusions: The short-term effect was confirmed in high-volume metastatic hormone sensitive prostate cancer using chemotherapy combined androgen-deprivation therapy, and the long-term effect remains to be seen. Myelosuppression during chemotherapy requires close attention, and taking timely examination is recommended.

[Exploration of death risk factors in patients with antineutrophil cytoplasmic antibody associated vasculitis].

Objectives: Death risk factors of patients with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) were explored by the analysis of clinical characteristics of AAV patients, as to provide the basis for early diagnosis and treatment, and reduction of mortality and also improvement of prognosis. Methods: A retrospective study was conducted in patients with AAV which were admitted to this hospital from November 2003 to February 2017, by the contrasts of the similarities and differences of clinical characteristics between the death group and non-death group, for explore the risk factors of death. Results: (1) A total of 66 patients with AAV were included in this study, in which 20 were died (male/female was 12/8), and 46 were still alive, with a total mortality rate of 30.3%.(2)The average age of disease onset in the death group was (67±13) years, which was significantly higher than that of the control group (55±18, P=0.009). (3)The mean value of vasculitis damage index (VDI) in the death group was (6.4±2.5), which was significantly higher than that in the non-death group (4.4±2.5, P=0.006). (4)As to multiple organs involvements among the heart, lung, kidney, gastrointestinal tract, central nervous system and other organs, the proportion of three or more organs involvement in the death group was 85% (17/20), which was significantly higher than that in the control group 47.8%(22/46), P=0.004 8.The incidence of heart murmurs, recent premature beats, aortic insufficiency, chronic heart failure/cardiomyopathy, and massive hemoptysis were significantly higher than those in the control group (P<0.05). (5) The incidence of infection in the death group (55%) was significantly higher than that in the control group (28.3%, P=0.038). Conclusion: An onset age of more than 65, multiple organs involvement, especially the occurrence of massive hemoptysis, heart valve diseases, heart failure and other cardiovascular involvements, increased VDI and combination of infections are the risk factors of death in AAV patients.

[The clinical analysis of 46 cases with antineutrophil cytoplasmic antibody-associated vasculitis].

OBJECTIVE: To investigate the clinical features of patients with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV), and to explore the disease activity of AAV patients and the relationship with prognosis. METHODS: The clinical data of 46 cases of AAV patients in the First Affiliated Hospital of PLA General Hospital were analyzed retrospectively.The clinical and laboratory features of each clinical subtype were compared.The disease activity of AAV and the relationship between disease activity and prognosis were evaluated. RESULTS: Among the 46 patients with AAV, 24 were male, and 22 were female, with the average age of 56±18.Among the subtypes of AAV, the number of granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA) were 22, 17 and 4 respectively, while the positive rate of ANCA are 72.7%, 88.2% and 50.0% respectively.For GPA, the results of ANCA were mainly C-ANCA or ANCA directed toward proteinase-3 (PR3), and for MPA, the results of ANCA were mainly P-ANCA or ANCA directed toward myeloperoxidase (MPO). Upper and lower respiratory disease, renal involvement and non-deformity arthropathy were the common clinical manifestations of all primary AAV subtypes.Epistaxis, nasal blood scab, saddle nose, pulmonary nodule and intrapulmonary cavities were the characteristic manifestations of GPA, while rapid progress of renal failure was prominent in MPA.Whatever their ANCA results, there were no significant differences between each other as to system-organ involvements and laboratory indexes.Seven patients (15.2%) died during hospitalization or in follow-up visits.Serious involvements of heart, lung, kidney, and complicated with infections were the main risk factors of death in AAV patients. CONCLUSIONS: Upper and lower respiratory involvements and kidney diseases are the primary manifestations of AAV patients.ANCA results are irrelevant with disease activity and system-organ involvements.Serious involvements of heart, lung, kidney, and complicated with infections are the main risk factors of death in AAV patients.

A novel genotypic test for rapid detection of multidrug-resistant Mycobacterium tuberculosis isolates by a multiplex probe array.

AIMS: To develop and evaluate a novel genotypic test for rapid detection of rifampicin and isoniazid resistance of multidrug-resistant (MDR) Mycobacterium tuberculosis isolates by a multiplex probe array. METHODS AND RESULTS: A multiplex probe array was designed for genotypic test to simultaneously screen the mutations of rpoB, katG, inhA and ahpC genes, associated with rifampin and isoniazid resistance in M. tuberculosis, with a probe detecting one of the recently confirmed genetic markers of isoniazid resistance ahpC-6 and -9 locus added. By using the genotypic test developed, 52 MDR isolates were identified, among which 46 isolates had mutations in rpoB (88.5%) and 45 at codon 315 of katG, regulatory region of inhA and oxyR-ahpC intergenic region (86.5%), whereas all 35 susceptible isolates identified showed a wild-type hybridization pattern. The sensitivity and specificity were 88.5% and 100% for rifampicin resistance, and 86.5% and 100% for isoniazid resistance, respectively. CONCLUSION: A rapid and simultaneous detection of rifampicin and isoniazid resistance caused by the mutations of rpoB, katG, inhA and ahpC genes in M. tuberculosis isolates could be achieved by a multiplex probe array developed. SIGNIFICANCE AND IMPACT OF THE STUDY: This genotypic test protocol has the potential to be developed on clinical application for the rapid detection of drug resistant M. tuberculosis isolates before an efficient chemotherapy is initiated.