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Impact of corticosteroids on initiation and half-year durability of humoral response in COVID-19 survivors

Chinese Medical Journal Pulmonary and Critical Care Medicine 2024年第1期2卷 48-55页

作者： Yeming Wang Li Guo Guohui Fan Yang Han Qiao Zhang Lili Ren Hui Zhang Geng Wang Xueyang Zhang Tingxuan Huang Weiyang Wang Lan Chen Lixue Huang Xiaoying Gu Xinming Wang Jingchuan Zhong Ying Wang Hui Li Jiapei Yu Zhibo Liu Chaolin Huang Bin Cao Jianwei Wang National Center for Respiratory Medicine State Key Laboratory of Respiratory Health and MultimorbidityNational Clinical Research Center for Respiratory DiseasesInstitute of Respiratory MedicineChinese Academy of Medical SciencesChina-Japan Friendship HospitalBeijing 100029China National Health Commission Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory Institute of Pathogen BiologyChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 102629China Key Laboratory of Respiratory Disease Pathogenomics Chinese Academy of Medical SciencesBeijing 100029China School of Population Medicine and Public Health Chinese Academy of Medical Sciences&Peking Union Medical CollegeState Key Laboratory of Respiratory Health and MultimorbidityKey Laboratory of Pathogen Infection Prevention and Control(Peking Union Medical College)Ministry of EducationBeijing 100730China National Center for Respiratory Medicine State Key Laboratory of Respiratory Health and MultimorbidityNational Clinical Research Center for Respiratory DiseasesInstitute of Respiratory MedicineChinese Academy of Medical SciencesDepartment of Clinical research and Data managementCenter of Respiratory MedicineChina-Japan Friendship HospitalBeijing 100029China Jin Yin-tan Hospital WuhanHubei 430023China Department of Pulmonary and Critical Care Medicine West China HospitalSichuan UniversityChengduSichuan 610041China Department of rheumatology and Clinical Immunology Chinese Academy of Medical Sciences&Peking Union Medical CollegeNational Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID)Ministry of Science&TechnologyState Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College Hospital(PUMCH)Key Laboratory of Rheumatology and Clinical ImmunologyMinistry of EducationBeijing 100730China Department of Pulmonary and Critical Care Medicine Center of Respiratory MedicineChina-Japan Friendship HospsitalInstitute of Respiratory MedicineChinese

Background:The impact of corticosteroids on humoral responses in coronavirus disease 2019(COVID-19)sur-vivors during the acute phase and subsequent 6-month period remains unknown.This study aimed to determine how the use of corticosteroids influences the initiation and duration of humoral responses in COVID-19 survivors 6 months after infection onset.Methods:We used kinetic antibody data from the lopinavir-ritonavir trial conducted at Jin Yin-Tan Hospital in January 2020,which involved adults hospitalized with severe COVID-19(LOTUS,ChiCTR2000029308).Anti-body samples were collected from 192 patients during hospitalization,and kinetic antibodies were monitored at all available time points after recruitment.Additionally,plasma samples were collected from 101 COVID-19 survivors for comprehensive humoral immune measurement at the half-year follow-up visit.The main focus was comparing the humoral responses between patients treated with systemic corticosteroid therapy and the non-corticosteroid group.Results:From illness onset to day 30,the median antibody titre areas under the receiver operating characteristic curve(AUCs)of nucleoprotein(N),spike protein(S),and receptor-binding domain(RBD)immunoglobulin G(IgG)were significantly lower in the corticosteroids group.The AUCs of N-,S-,and RBD-IgM as well as neutralizing antibodies(NAbs)were numerically lower in the corticosteroids group compared with the non-corticosteroid group.However,peak titres of N,S,RBD-IgM and-IgG and NAbs were not influenced by corticosteroids.During 6-month follow-up,we observed a delayed decline for most binding antibodies,except N-IgM(𝛽−0.05,95%CI[−0.10,0.00])in the corticosteroids group,though not reaching statistical significance.No significant difference was observed for NAbs.However,for the half-year seropositive rate,corticosteroids significantly accelerated the decay of IgA and IgM but made no difference to N-,S-,and RBD-IgG or NAbs.Additionally,corticosteroids group showed a trend towards delayed viral clearance compared with the non-cort

关键词： COVID-19 Corticosteroid Immunity Antibody Humoral response

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Chinese registry of rheumatoid arthritis(CREDIT)V:sex impacts rheumatoid arthritis in Chinese patients

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Chinese Medical Journal 2022年第18期135卷 2210-2217页

作者： Nan Jiang Qin Li Hongbin Li Yongfei Fang Lijun Wu Xinwang Duan Jian Xu Cheng Zhao Zhenyu Jiang Yanhong Wang Qian Wang Xiaomei Leng Mengtao Li Xinping Tian Xiaofeng Zeng CREDIT Co-Authors Department of rheumatology and Clinical Immunology Peking Union Medical College Hospital(PUMCH)Chinese Academy of Medical Sciences and Peking Union Medical CollegeNational Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID)Ministry of Science and TechnologyState Key Laboratory of Complex Severe and Rare DiseasesKey Laboratory of Rheumatology and Clinical ImmunologyMinistry of EducationBeijing 100730China Department of rheumatology the First People’s Hospital of Yunnan ProvinceKunmingYunnan 650032China Department of rheumatology the Affiliated Hospital of Inner Mongolia Medical CollegeHohhotInner Mongolia 010050China Department of rheumatology Southwest HospitalThird Military Medical UniversityChongqing 400038China Department of rheumatology and Immunology People’s Hospital of Xinjiang Uygur Autonomous RegionUrumqiXinjiang 830001China Department of rheumatology The Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi 330006China Department of rheumatology and Immunology First Affiliated Hospital of Kunming Medical UniversityKunmingYunnan 650032China Department of rheumatology The First Affiliated Hospital of Guangxi Medical UniversityManningGuangxi 530021China Department of rheumatology The First Hospital of Jilin UniversityChangchunJilin 130021China Department of Epidemiology and Bio-Statistics Institute of Basic Medical SciencesChinese Academy of Medical SciencesSchool of Basic MedicinePeking Union Medical CollegeBeijing 100005China. 不详

Background: The impact of sex on the clinical manifestations of rheumatoid arthritis (RA) were diversely reported in the literature. The Chinese Registry of rhEumatoiD arthrITis provides a platform for the investigation of this issue in Chinese patients.Methods: Demographic and clinical parameters were collected from all enrolled patients with RA and from patients with early RA (disease duration ≤6 months). The differences in data regarding disease activity, comorbidities, and medications for RA were compared between men and women. The proportions of patients who achieved remission and low disease activity were compared at enrollment and during 3-, 6-, and 12-month follow-up visits.Results: A total of 11,564 patients were enrolled, 83.6% of whom were female. In all the enrolled patients and patients with early RA, C-reactive protein (CRP, 12.0vs. 6.7 mg/L), pain visual analogue scale (4.8vs. 4.5), patient’s and physician’s global assessment (4.9vs. 4.5 and 4.9vs. 4.5), 28-joint disease activity score using DAS28-CRP (4.3vs. 4.0) simplified disease activity index (21.9vs. 19.9), and clinical disease activity index (19.3vs. 18.0) were significantly higher in men than in women. Additionally, the swollen joint count/tender joint count and DAS28 using erythrocyte sedimentation rate were higher in male patients than in female patients with early RA. More female patients with early RA reached the treatment target at baseline than male patients (23.4%vs. 18.2%, assessed by CDAI). At 3 months, 6 months, and 12 months, the proportion of remission and treatment target achievement was similar in both sexes. Coronary artery disease (CAD) and stroke were more frequent in men than in women.Conclusions: In Chinese patients with RA, men were found to have more active disease, as well as more cases of CAD and stroke. Therefore, sex should be carefully considered during the personalization of RA treatment.

关键词： Rheumatoid arthritis Sex Disease activity Treatment target Comorbidities

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Transcriptional reprogramming during human osteoclast differentiation identifies regulators of osteoclast activity

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Bone Research 2024年第1期12卷 180-198页

作者： Morten S.Hansen Kaja Madsen Maria Price Kent Søe Yasunori Omata Mario M.Zaiss Caroline M.Gorvin Morten Frost Alexander Rauch Molecular Endocrinology Laboratory(KMEB) Department of EndocrinologyOdense University HospitalDK-5000 Odense CDenmark Department of Clinical Research Faculty of Health SciencesUniversity of Southern DenmarkDK-5000 Odense CDenmark Clinical Cell Biology Pathology Research UnitDepartment of Clinical ResearchUniversity of Southern DenmarkDK-5000 Odense CDenmark institute of Metabolism and Systems Research(IMSR)and Centre for Diabetes Endocrinology and Metabolism(CEDAM)University of BirminghamBirmingham B152TTUK Centre for Membrane Proteins and Receptors(COMPARE) Universities of Birmingham and NottinghamBirmingham B152TTUK Department of Molecular Medicine University of Southern DenmarkDK-5000 Odense CDenmark Department of Orthopedic Surgery Faculty of MedicineThe University of TokyoTokyo 113-8655Japan Department of Internal Medicine 3 Rheumatology and ImmunologyFriedrich-Alexander-University Erlangen-Nürnberg(FAU)and Universitätsklinikum ErlangenD-91054 ErlangenGermany Deutsches Zentrum Immuntherapie(DZI) Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum ErlangenD-91054 ErlangenGermany Steno Diabetes Center Odense Odense University HospitalDK-5000 Odense CDenmark

Enhanced osteoclastogenesis and osteoclast activity contribute to the development of osteoporosis,which is characterized by increased bone resorption and inadequate bone formation.As novel antiosteoporotic therapeutics are needed,understanding the genetic regulation of human osteoclastogenesis could help identify potential treatment targets.This study aimed to provide an overview of transcriptional reprogramming during human osteoclast differentiation.Osteoclasts were differentiated from CD14+monocytes from eight female donors.RNA sequencing during differentiation revealed 8980 differentially expressed genes grouped into eight temporal patterns conserved across donors.These patterns revealed distinct molecular functions associated with postmenopausal osteoporosis susceptibility genes based on RNA from iliac crest biopsies and bone mineral density SNPs.Network analyses revealed mutual dependencies between temporal expression patterns and provided insight into subtype-specific transcriptional networks.The donor-specific expression patterns revealed genes at the monocyte stage,such as filamin B(FLNB)and oxidized low-density lipoprotein receptor 1(OLR1,encoding LOX-1),that are predictive of the resorptive activity of mature osteoclasts.The expression of differentially expressed G-protein coupled receptors was strong during osteoclast differentiation,and these receptors are associated with bone mineral density SNPs,suggesting that they play a pivotal role in osteoclast differentiation and activity.The regulatory effects of three differentially expressed G-protein coupled receptors were exemplified by in vitro pharmacological modulation of complement 5 A receptor 1(C5AR1),somatostatin receptor 2(SSTR2),and free fatty acid receptor 4(FFAR4/GPR120).Activating C5AR1 enhanced osteoclast formation,while activating SSTR2 decreased the resorptive activity of mature osteoclasts,and activating FFAR4 decreased both the number and resorptive activity of mature osteoclasts.In conclusion,we report the occurrence of transcriptional

关键词： osteoclast programming identif

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B1-cell-produced anti-phosphatidylserine antibodies contribute to lupus nephritis development via TLR-mediated Syk activation

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Cellular & Molecular Immunology 2023年第8期20卷 881-894页

作者： Kongyang Ma Wenhan Du Shiyun Wang Fan Xiao Jingyi Li Jie Tian Yida Xing Xiaodan Kong Ke Rui Rencai Qin Xiaoxia Zhu Jing Wang Cainan Luo Haijing Wu Yun Zhang Chengping Wen Lan He Dongzhou Liu Hejian Zou Qianjin Lu Lijun Wu Liwei Lu Centre for Infection and Immunity Studies School of MedicineThe Sun Yat-sen UniversityShenzhen518107GuangdongChina Department of Pathology and Shenzhen institute of Research and Innovation The University of Hong KongHong Kong999077China Department of rheumatology Shenzhen People’s HospitalThe Second Clinical Medical CollegeJinan UniversityShenzhenChina Chongqing International institute for Immunology Chongqing400038China Department of rheumatology and Immunology Southwest HospitalThe First Hospital Affiliated to Army Medical UniversityChongqing400038China Department of Laboratory Medicine Affiliated Hospital and Institute of Medical ImmunologyJiangsu UniversityZhenjiangChina Department of rheumatology The Second Affiliated Hospital of Dalian Medical UniversityDalianChina Department of rheumatology Huashan HospitalFudan UniversityShanghaiChina Department of rheumatology and Immunology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an710061ShaanxiChina Department of rheumatology and Immunology People’s Hospital of Xinjiang Uygur Autonomous RegionUrumqiChina Department of Dermatology Hunan Key Laboratory of Medical EpigenomicsSecond Xiangya HospitalCentral South UniversityChangshaHunanChina Key Laboratory of Chinese Medicine rheumatology of Zhejiang Province Institute of Basic Research in Clinical MedicineCollege of Basic Medical ScienceZhejiang Chinese Medical UniversityHangzhou310053China Centre for Oncology and Immunology Hong Kong Science ParkHong KongChina

Autoantibodies produced by B cells play a pivotal role in the pathogenesis of systemic lupus erythematosus (SLE). However, both the cellular source of antiphospholipid antibodies and their contributions to the development of lupus nephritis (LN) remain largely unclear. Here, we report a pathogenic role of anti-phosphatidylserine (PS) autoantibodies in the development of LN. Elevated serum PS-specific IgG levels were measured in model mice and SLE patients, especially in those with LN. PS-specific IgG accumulation was found in the kidney biopsies of LN patients. Both transfer of SLE PS-specific IgG and PS immunization triggered lupus-like glomerular immune complex deposition in recipient mice. ELISPOT analysis identified B1a cells as the main cell type that secretes PS-specific IgG in both lupus model mice and patients. Adoptive transfer of PS-specific B1a cells accelerated the PS-specific autoimmune response and renal damage in recipient lupus model mice, whereas depletion of B1a cells attenuated lupus progression. In culture, PS-specific B1a cells were significantly expanded upon treatment with chromatin components, while blockade of TLR signal cascades by DNase I digestion and inhibitory ODN 2088 or R406 treatment profoundly abrogated chromatin-induced PS-specific IgG secretion by lupus B1a cells. Thus, our study has demonstrated that the anti-PS autoantibodies produced by B1 cells contribute to lupus nephritis development. Our findings that blockade of the TLR/Syk signaling cascade inhibits PS-specific B1-cell expansion provide new insights into lupus pathogenesis and may facilitate the development of novel therapeutic targets for the treatment of LN in SLE.

关键词： B1 cell Anti-phosphatidylserine antibodies Lupus nephritis TLR Syk

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Mechanism-driven strategies for prevention of rheumatoid arthritis

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rheumatology & Autoimmunity 2022年第3期2卷 109-119页

作者： V.Michael Holers Kristine A.Kuhn M.Kristen Demoruelle Jill M.Norris Gary S.Firestein Eddie A.James William H.Robinson Jane H.Buckner Kevin D.Deane Division of rheumatology University of Colorado School of MedicineAuroraColoradoUSA Department of Epidemiology Colorado School of Public HealthAuroraColoradoUSA Division of rheumatology Allergy and ImmunologyUniversity of California San DiegoLa JollaCaliforniaUSA Benaroya Research institute SeattleWashingtonUSA Division of Immunology and rheumatology Stanford UniversityStanfordCaliforniaUSA Department of Medicine Division of RheumatologyVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA

In seropositive rheumatoid arthritis(RA),the onset of clinically apparent inflammatory arthritis(IA)is typically preceded by a prolonged period of autoimmunity manifest by the presence of circulating autoantibodies that can include antibodies to citrullinated protein antigens(ACPA)and rheumatoid factor.This period before clinical IA can be designated preclinical RA in those individuals who have progressed to a clinical diagnosis of RA,and an“at‐risk”status in those who have not developed IA but exhibit predictive biomarkers of future clinical RA.With the goal of developing RA prevention strategies,studies have characterized immune phenotypes of preclinical RA/at-risk states.From these studies,a model has emerged wherein mucosal inflammation and dysbiosis may lead first to local autoantibody production,which should normally be transient,but instead is followed by a systemic spread of the autoimmunity as manifested by serum autoantibody elevations,ultimately driving the development of clinically identified joint inflammation.This model can be envisioned as the progression of disease development through serial“checkpoints”that in principle should constrain or resolve autoimmunity;however,instead,the checkpoints“fail”and clinical RA develops.Herein we review the immune processes that are likely to be present at each step and the potential therapeutic strategies that could be envisioned to delay,diminish,halt,or even reverse the progression to clinical RA.Notably,these prevention strategies could utilize existing therapies approved for clinical RA,therapies approved for other diseases that target relevant pathways in the preclinical/at-risk state,or approaches that target novel pathways.

关键词： autoimmune disease inflammation mucosa prevention rheumatoid arthritis

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Disturbed gut virome with potent interferonogenic property in systemic lupus erythematosus

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Science Bulletin 2023年第3期68卷 295-304,M0004页

作者： Beidi Chen Jiabao Cao Wei Liu Yuqing Zhang Yudong Liu Min Wang Fei Xiao Jie Ma Jun Wang Xuan Zhang Department of rheumatology Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijing 100730China Division of rheumatology and Immunology Peking University Third HospitalBeijing 100191China CAS Key Laboratory of Pathogenic Microbiology and Immunology Institute of MicrobiologyChinese Academy of SciencesBeijing 100101China University of Chinese Academy of Sciences Beijing 100101China The Key Laboratory of Geriatrics Beijing HospitalNational Center of GerontologyNational Health CommissionInstitute of Geriatric MedicineBeijing Institute of GeriatricsChinese Academy of Medical SciencesBeijing 100730China

Accumulating evidence suggests an essential role of disturbed gut microbiota in the etiopathogenesis of systemic lupus erythematosus(SLE),but it remains unclear as to gut virome.In this study,fecal virus-like particles(VLPs)isolated from 76 non-treated SLE patients and 75 healthy controls were subjected to gut virome profiling.The proportion of bacteriophages was significantly elevated in the SLE gut,and the altered viral taxa were correlated with clinical parameters.Gut virome and bacteriome were closely associated with each other in SLE patients.The combination of gut viral and bacterial markers displayed better performance in distinguishing SLE patients from healthy controls.Further,VLPs from non-treated SLE patients promoted interferon-a production in an epithelial cell line and human immune cells.Intriguingly,the interferon-stimulatory capacity diminished in VLPs from post-treated SLE patients.Our findings may shed novel insights into SLE pathogenesis.Further in-depth understanding of gut virome might help develop future biomarkers and therapeutics for SLE patients.

关键词： Systemic lupus erythematosus Gut virome Virus-like particles Interferon-a

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Aryl hydrocarbon receptor activation drives polymorphonuclear myeloid-derived suppressor cell response and efficiently attenuates experimental Sjögren’s syndrome

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Cellular & Molecular Immunology 2022年第12期19卷 1361-1372页

作者： Yanxia Wei Na Peng Chong Deng Futao Zhao Jie Tian Yuan Tang Sulan Yu Yacun Chen Yu Xue Fan Xiao Yingbo Zhou Xiaomei Li Hejian Zou Ke Rui Xiang Lin Liwei Lu Department of Pathology and Shenzhen institute of Research and Innovation The University of Hong KongHong KongChina Department of Pathogenic Biology and Immunology Jiangsu Key Laboratory of Immunity and MetabolismXuzhou Medical UniversityXuzhouChina Department of rheumatology the Second People’s HospitalChina Three Gorges UniversityYichangChina Centre for Oncology and Immunology Hong Kong Science ParkHong KongChina Department of rheumatology Shanghai Ninth People’s HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina Department of Laboratory Medicine Affiliated Hospital and Institute of Medical ImmunologyJiangsu UniversityZhenjiangChina School of Chinese Medicine and Shenzhen institute of Research and Innovation The University of Hong KongHong KongChina Department of rheumatology Huashan HospitalFudan UniversityShanghaiChina Department of rheumatology and Immunology The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiAnhuiChina

Myeloid-derived suppressor cells(MDSCs)comprise heterogeneous myeloid cell populations with immunosuppressive capacity that contribute to immune regulation and tolerance induction.We previously reported impaired MDSC function in patients with primary Sjögren’s syndrome(pSS)and mice with experimental SS(ESS).However,the molecular mechanisms underlying MDSC dysfunction remain largely unclear.In this study,we first found that aryl hydrocarbon receptor(AhR)was highly expressed by human and murine polymorphonuclear MDSCs(PMN-MDSCs).Indole-3-propionic acid(IPA),a natural AhR ligand produced from dietary tryptophan,significantly promoted PMN-MDSC differentiation and suppressive function on CD4^(+)T cells.In contrast,feeding a tryptophan-free diet resulted in a decreased PMN-MDSC response,a phenotype that could be reversed by IPA supplementation.The functional importance of PMN-MDSCs was demonstrated in ESS mice by using a cell-depletion approach.Notably,AhR expression was reduced in PMN-MDSCs during ESS development,while AhR antagonism resulted in exacerbated ESS pathology and dysregulated T effector cells,which could be phenocopied by a tryptophan-free diet.Interferon regulatory factor 4(IRF4),a repressive transcription factor,was upregulated in PMN-MDSCs during ESS progression.Chromatin immunoprecipitation analysis revealed that IRF4 could bind to the promoter region of AhR,while IRF4 deficiency markedly enhanced AhR-mediated PMN-MDSC responses.Furthermore,dietary supplementation with IPA markedly ameliorated salivary glandular pathology in ESS mice with restored MDSC immunosuppressive function.Together,our results identify a novel function of AhR in modulating the PMN-MDSC response and demonstrate the therapeutic potential of targeting AhR for the treatment of pSS.

关键词： myeloid-derived suppressor cell Sjogren's syndrome Aryl hydrocarbon receptor

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Polylysine complexes and their biomedical applications

再生工程(英文)

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再生工程(英文) 2023年第1期4卷 20-27页

作者： Haofang Zhu Rui Liu Yixuan Shang Lingyun Sun Department of rheumatology and Immunology Institute of Translational MedicineThe Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjing 210008China

Poly-L-lysine(PLL)is a water-soluble biopolymer consist of repeating unit of L-lysine.It displays intrinsic non-antigenicity,antibacterial property,biocompatibility,and biodegradability,and facile synthesis procedure,there-fore has attracted particular attention in various biomedical and pharmaceutical applications.Following a brief introduction to PLL synthesis,this review focuses on the significant advances of PLL and PLL-derived complexes utilized in cargo delivery,tissue adhesives,and antibacterial materials.Meanwhile,this review summarized the modification and optimization of PLL complexes for further clinical translational studies.The final section dis-cusses the challenges and opportunities of PLL-based complexes in the biomedical areas.

关键词： Polylysine cargo delivery bioadhesive antibacterial biomedicine

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Diagnostic use of superb microvascular imaging in evaluating septic arthritis of the manubriosternal joint:A case report

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World Journal of Clinical Cases 2023年第18期11卷 4397-4405页

作者： Goda Seskute Dominyka Kausaite Ana Chalkovskaja Egle Bulotaite Irena Butrimiene Clinic of rheumatology Orthopaedics Traumatologyand Reconstructive SurgeryCentre of RheumatologyInstitute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Clinic of Internal Diseases Family Medicine and OncologyInstitute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Department of Radiology Nuclear Medicine and Medical PhysicsInstitute of Biomedical SciencesFaculty of MedicineVilnius UniversityVilnius 01513Lithuania

BACKGROUND Septic arthritis of the manubriosternal joint is a diagnostic challenge due to its rarity and anatomical characteristic.Conventional ultrasound,plain radiographs,and computed tomography are not able to confirm or even suspect arthritis early.Superb microvascular imaging is a new advanced Doppler technique in evaluating low-flow microvascular patterns.The higher sensitivity for increased perisynovial vascularity helps to suspect septic arthritis and forms a methodical approach to using magnetic resonance imaging(MRI).CASE SUMMARY A 34-year-old immunocompetent woman presented with a fever and a dull ache in the chest radiating to the right arm.Traumatic injury and the most common respiratory and cardiac disorders were ruled out.Blood cultures came back positive for Staphylococcus aureus,and sepsis was confirmed.A small lump was noted on the chest during the first week of hospitalization.Superb microvascular imaging was performed and septic arthritis of the manubriosternal joint was detected.MRI confirmed the diagnosis and showed septic arthritis of the manubriosternal joint with several localized abscesses behind the sternum.The patient was treated for three weeks with intravenous antibiotics and the outcome was favorable:Inflammatory markers became normal,and the lump disappeared.Three months later,the patient was examined for a new episode of mild pain in the sternum and was diagnosed with persistent perichondritis by ultrasound in comparison with MRI.CONCLUSION Superb microvascular imaging is a useful tool for the early diagnosis of septic arthritis of the manubriosternal joint and following-up.

关键词： Power Doppler Superb microvascular imaging Ultrasound Septic arthritis Manubriosternal joint Case report

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Lidocaine in fibromyalgia:A systematic review

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World Journal of Psychiatry 2022年第4期12卷 615-622页

作者： Jozélio Freire de Carvalho Thelma L Skare Health Sciences institute Federal University of BahiaSalvador 40231-300Brazil rheumatology Unit Evangélico Mackenzie HospitalCuritiba 80730-420Brazil

BACKGROUND Fibromyalgia(FM)patients are treated with antidepressants,and in most cases,these drugs lose efficacy or present side effects.Intravenous lidocaine(IL)is an anesthetic drug used in some FM trials.AIM To systematically review the safety and efficacy of IL in FM patients.METHODS To systematically search PubMed for articles in English,Spanish,and Japanese with English Abstracts on FM and lidocaine between 1966 and February 2021.This study was registered at PROSPERO.RESULTS We found only ten articles published in this field,with a total of 461 patients.Females predominated varying from 95%to 100%in the studies.Age varied from 40.9 to 55 years old.Disease duration varied from 1 mo to 6.4 years.Lidocaine dose varied from 2 to 7.5 mg/kg via intravenous infusion.Follow-up period varied from 65.7 to 90 days.Regarding outcomes,most studies used the visual analogue scale(VAS)for pain;before short-term lidocaine administration,VAS was between 6.1 and 8.1 and after treatment was between 1.7 and 4.5 mm.Concerning long term lidocaine,VAS varied from 30%to 35.4%after lidocaine infusion.Side effects were observed in 0%to 39.6%of cases,they were usually mild or moderate.CONCLUSION This study demonstrates the short-term effectiveness and safety of intravenous lidocaine in FM patients.However,more studies,including long-term follow-up,are still needed.

关键词： Lidocaine Fibromyalgia Pain Intravenous infusions

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