Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due...Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due to the frequency of other types of joint diseases and the existence of degenerative and dystrophic valve disease. In adults, the initial rheumatic attack is marked by the predominance of joint damage over cardiac damage. However, it is often at this age that rheumatic valve disease is discovered. The revised Jones criteria also find their place in the diagnosis of AAR in adults. Objective: To study the demographic, clinical, and biological characteristics of acute rheumatic fever (ARF) in the General Medicine Department of the Siguiri Prefectural Hospital. Materials and Methods: This descriptive observational study examined the demographic, clinical and biological characteristics of acute rheumatic fever (ARF) at the Siguiri Prefectural Hospital, Guinea, between April 1 and September 31, 2021 according to Jones criteria. The data were collected on a form containing sociodemographic variables (age, sex, profession), rheumatological, cardiac, pulmonary and neurological clinical signs, biological variables and treatment. Results: Figure 1 shows the flow of the hospital frequency of the RAA in the General Medicine Department of the Prefectural Hospital of Siguiri. During the study period, 420 patients were hospitalized, of whom 161 patients had AAR, a frequency of 38.33%. Table 1 shows the distribution of patients diagnosed with ARB, by sociodemographic characteristics. The average age was 44.7 ± 19.78 years and the extremes of 14 and 90 years, the female sex dominated with a ratio of 0.75. The informal sector was in the majority in 45.34% of cases and most were illiterate, i.e. 53.42%. In our study, the incidence was lower during the dry season than during the rainy season, a hot season with high rainfall and humidity, the rainy period was a provider with a peak in August and September. The lifestyle was characterized by overcrowding in 87.58% of patients. The main complaint was fever, i.e. 88.82%. Rheumatological manifestations such as arthritis were 98.14%, chest pain was 37.89% (61 cases). The diagnosis was confirmed by ASLO titration in 85.71% of patients and 98.55% (136 cases) had a titration greater than 400 U/ml. Conclusion: The results obtained from our study show a high prevalence of acute rheumatic fever, which makes it a worrying health problem in the Siguiri health district. Young female adult patients, married with an informal profession and not in school residing in Siguiri were the most encountered in our study. The main functional signs mentioned by the patients were fever, cough and abdominal pain;osteoarticular pain and chest pain dominated the clinical picture. Almost all of our patients had an ASLO titer greater than 400 U/ml and a positive C-reactive protein. Our results show a high risk of spread of acute rheumatic fever within the population of Siguiri. Due to the serious complications caused by acute rheumatic fever, particular attention must be paid to it by carrying out other, much larger studies in order to identify the problem of RAA.展开更多
BACKGROUND Rheumatic immune diseases are a group of chronic inflammatory diseases charac-terized by joint and systemic multi-organ involvement,including rheumatoid arthritis,systemic lupus erythematosus,and Sjogren’s...BACKGROUND Rheumatic immune diseases are a group of chronic inflammatory diseases charac-terized by joint and systemic multi-organ involvement,including rheumatoid arthritis,systemic lupus erythematosus,and Sjogren’s syndrome,among others.The pathogenesis of these diseases is related to the abnormal activation and regulatory imbalance of the immune system.The prevalence and morbidity of rheumatic immune diseases are high,imposing a significant burden on patients'quality of life and socio-economic costs.Currently,the treatment of rheumatic immune diseases mainly relies on Western medicine,such as non-steroidal anti-inflammatory drugs,glucocorticoids,disease-modifying antirheumatic drugs,and biologics.However,the therapeutic effects of Western medicine are not ideal,some patients poorly respond or are resistant to Western medicine,and long-term use often causes various adverse reactions.AIM To systematically evaluate the efficacy and safety of Tripterygium wilfordii gly-cosides tablets combined with Western medicine in the treatment of patients with rheumatic immune diseases.METHODS This study conducted a meta-analysis to systematically evaluate the efficacy and safety of Tripterygium wilfordii glycosides tablets combined with Western medicine for patients with rheumatic immune diseases.Chinese and English databases were searched for randomized controlled trials(RCTs)on the treatment of rheumatic immune diseases with Tripterygium wilfordii glycosides tablets combined with Western medicine.The quality of the included studies was assessed using the Cochrane risk of bias assessment tool.Meta-analysis was performed using RevMan 5.4 software.RESULTS The meta-analysis included 11 RCTs involving 1026 patients with rheumatic immune diseases.The combined treatment significantly reduced the risk of disease recurrence(relative risk=1.07,95%confidence interval:1.01-1.15,P<0.05)and showed no significant heterogeneity(I2=0%,P=0.53),indicating that Tripterygium wilfordii glycosides tablets combined with Western medicine is an effective method to reduce the possibility of postoperative recurrence in patients with rheumatic immune diseases.However,due to the limited number and quality of the studies included,these results should be interpreted with caution.CONCLUSION Tripterygium wilfordii glycosides tablets combined with Western medicine is an effective and safe treatment option for patients with rheumatic immune diseases and can be considered a clinical choice.However,more high-quality research is needed to validate this conclusion and provide more solid evidence for clinical practice.展开更多
Objective:To assess the effectiveness of COVID-19 vaccination in patients with rheumatic diseases undergoing biologic(bDMARDs)or targeted-synthetic disease-modifying anti-rheumatic drugs(tsDMARDs).Methods:This cross-s...Objective:To assess the effectiveness of COVID-19 vaccination in patients with rheumatic diseases undergoing biologic(bDMARDs)or targeted-synthetic disease-modifying anti-rheumatic drugs(tsDMARDs).Methods:This cross-sectional study was conducted at ten rheumatology clinics in Turkey between May 1,2021,and October 30,2022.Patients with rheumatic diseases on bDMARD or tsDMARD therapy who received at least two doses of an mRNA or inactivated SARS-CoV-2 vaccine were included.After vaccination,COVID-19 infection rates,adverse events,and rheumatic disease flares were recorded.Data were collected via face-to-face or telephone interviews.Results:A total of 963 participants were included in the final analysis;44%were male,and the median age was 49 years.The most frequently observed rheumatic diseases were ankylosing spondylitis and rheumatoid arthritis,accounting for 37.2%and 32.6%of cases,respectively.Adalimumab(19.2%)and infliximab(17.8%)were the most commonly used bDMARDs.Of the participants,634(65.9%)received an inactivated vaccine(CoronaVac)and 329(34.1%)an mRNA vaccine(BioNTech).A total of 502(52.1%)patients received a booster dose.Following the first,second,and third vaccine doses,adverse event rates were 19.9%,15.9%,and 26.7%,respectively.Forty-two(4.4%)patients experienced a disease flare within six months after their first vaccination dose.COVID-19 infection occurred in 79 participants(8.2%)after two vaccine doses;most cases were symptomatic but did not require hospitalization.The COVID-19 infection rate was lower in participants who received a booster dose than those who did not(3.4%vs.8.2%,P<0.001).Conclusions:Our study indicates that both mRNA and inactivated SARS-CoV-2 vaccines are effective in preventing severe COVID-19 outcomes,with an acceptable rate of adverse events and disease flares among patients with rheumatic diseases on bDMARD or tsDMARD therapy.展开更多
Sydenham chorea(SC)is the neurological manifestation associated with acute rheu-matic fever(ARF).ARF and rheumatic heart disease(RHD)are autoimmune complica-tions triggered by a group A streptococcal(GAS)infection.In ...Sydenham chorea(SC)is the neurological manifestation associated with acute rheu-matic fever(ARF).ARF and rheumatic heart disease(RHD)are autoimmune complica-tions triggered by a group A streptococcal(GAS)infection.In ARF/RHD and SC,tissue cross-reactive antibodies and T-cells generated against GAS antigens have been impli-cated in the pathogenesis.In SC,antibodies against GAS antigens are known to cross-react with neuronal proteins causing neurological manifestations including choreiform movements and neuropsychiatric symptoms such as irritability,attention deficit,and obsessive-compulsive disorder.Previous studies in a rat autoimmune valvulitis(RAV)model of RHD,have shown that injection of streptococcal M protein could cause both cardiac and neurological symptoms.In this study it was shown that adoptive transfer of serum with anti-GAS M antibodies to naive rats caused carditis but failed to demon-strate neurobehavioral symptoms.However,when the blood-brain barrier(BBB)was disrupted using lipopolysaccharide,all animals that received anti-GAS M protein anti-bodies,developed neurobehavioral defects in addition to carditis.This highlights that impaired BBB integrity is essential for the development of neurobehavioral symptoms.The use of the RAV model and the disruption of BBB required for the development of neurobehavioral changes provides a platform to further investigate the mechanisms that lead to antibodies binding to basal ganglia structures that cause SC.展开更多
Co-inhibitory receptors serve as crucial regulators of T-cell function,playing a pivotal role in modulating the delicate balance between immune tolerance and autoimmunity.Initially identified in autoimmune disease mod...Co-inhibitory receptors serve as crucial regulators of T-cell function,playing a pivotal role in modulating the delicate balance between immune tolerance and autoimmunity.Initially identified in autoimmune disease models,co-inhibitory receptors,including CTLA-4,PD-1,TIM-3,and TIGIT,were found to be integral to immune regulation.Their blockade or absence in these models resulted in the induction or exacerbation of autoimmune diseases.Additionally,scholars have observed that co-inhibitory receptors on lymphocytes hold the potential to influence the prognosis in the context of chronic inflammation.Consequently,the blocking of co-suppressor receptors has emerged as a novel therapeutic approach for inhibiting refractory inflammatory diseases,particularly rheumatoid arthritis.From the standpoint of traditional Chinese medicine(TCM),the treatment of rheumatoid arthritis based on the“strengthening body resistance(FúZhèng)”theory can be construed as the regulation of co-suppressor receptors to modulate the body’s immune function in combating chronic inflammation.This article provides a succinct overview of the role of co-suppressor receptors in anti-inflammatory processes and explores the research prospects of co-suppressor receptor intervention in the treatment of rheumatoid arthritis.The exploration integrates the“strengthening body resistance(FúZhèng)”theory with relevant Chinese medicine formulations.展开更多
Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAP...Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.展开更多
This article reviews the literature concerning rheu-matic manifestations of inflammatory bowel disease (IBD),including common immune-mediated pathways,frequency,clinical course and therapy. Musculoskel-etal complicati...This article reviews the literature concerning rheu-matic manifestations of inflammatory bowel disease (IBD),including common immune-mediated pathways,frequency,clinical course and therapy. Musculoskel-etal complications are frequent and well-recognized manifestations in IBD,and affect up to 33% of pa-tients with IBD. The strong link between the bowel and the osteo-articular system is suggested by many clinical and experimental observations,notably in HLA-B27 transgenic rats. The autoimmune pathogenic mechanisms shared by IBD and spondyloarthropathies include genetic susceptibility to abnormal antigen pre-sentation,aberrant recognition of self,the presence of autoantibodies against specific antigens shared by the colon and other extra-colonic tissues,and increased intestinal permeability. The response against microor-ganisms may have an important role through molecular mimicry and other mechanisms. Rheumatic mani-festations of IBD have been divided into peripheral arthritis,and axial involvement,including sacroiliitis,with or without spondylitis,similar to idiopathic anky-losing spondylitis. Other periarticular features can oc-cur,including enthesopathy,tendonitis,clubbing,peri-ostitis,and granulomatous lesions of joints and bones.Osteoporosis and osteomalacia secondary to IBD and iatrogenic complications can also occur. The manage-ment of the rheumatic manifestations of IBD consists of physical therapy in combination with local injection of corticosteroids and nonsteroidal anti-inflammatory drugs; caution is in order however,because of their possible harmful effects on intestinal integrity,perme-ability,and even on gut inflammation. Sulfasalazine,methotrexate,azathioprine,cyclosporine and lefluno-mide should be used for selected indications. In some cases,tumor necrosis factor-α blocking agents should be considered as first-line therapy.展开更多
Systemic rheumatic diseases(SRDs)are chronic,inflammatory,autoimmune disorders with the presence of autoantibodies that may affect any organ or system.Liver dysfunction in SRDs can be associated with prescribed drugs,...Systemic rheumatic diseases(SRDs)are chronic,inflammatory,autoimmune disorders with the presence of autoantibodies that may affect any organ or system.Liver dysfunction in SRDs can be associated with prescribed drugs,viral hepatitis,alternative hepatic comorbidities and coexisting autoimmune liver diseases(AILDs),requiring an exclusion of secondary conditions before considering liver involvement.The patterns of overlap diseases depend predominantly on genetic determinants with common susceptible loci widely distributing in both disorders.In AILDs,it is important to identify the overlapping SRDs at an early stage since such a coexistence may influence the disease course and prognosis.Commonly co-occurring SRDs in AILDs are Sjögren syndrome(SS),rheumatoid arthritis(RA)or systemic lupus erythematosus(SLE)in autoimmune hepatitis(AIH),and SS,RA or systemic sclerosis in primary biliary cholangitis.Owing to different disease complications and therapies,it is imperative to differentiate between SLE liver involvement and SLE-AIH overlap disease.Therapeutic options can be personalized to control coexisting conditions of liver autoimmunity and rheumatic manifestations in AILD-SRD overlap diseases.The collaboration between hepatologists and rheumatologists can lead to significant advances in managing such a complex scenario.In this review,we provide a comprehensive overview on coexisting AILDs in different SRDs and the therapeutic approach in managing these overlap diseases.展开更多
Objectives:The purpose is to distinguish family care(FC)patterns of childhood rheumatic diseases in Chinese families and to determine the predictors of FC patterns.Methods:This secondary analysis contained two cross-s...Objectives:The purpose is to distinguish family care(FC)patterns of childhood rheumatic diseases in Chinese families and to determine the predictors of FC patterns.Methods:This secondary analysis contained two cross-section surveys with a convenient sample of totally 398 caregivers who have a child with rheumatic diseases from four pediatric hospitals.Caregivers were required to completed Family Management Measure questionnaire.Cluster analysis was used to distinguish patterns and multinomial logistic regression analysis was used to find predictors.Results:Four patterns were identified:the normal-perspective and collaborative(28.4%),the effortless and contradictory(24.6%),the chaotic and strenuous(18.3%),and the confident and concerning(28.7%).Disease category(x2=21.23,P=0.002),geographic location(x2=8.41,P=0,038),maternal educational level(x2=12.69,P=0.048)and family monthly income(x2=33.21,P<0.001)predicted different patterns.Conclusions:FC patterns were different among families.Disease-related and family-related factors were vital predictors to distinguish patterns consistent with the Family Management Style Framework.The result assisted that clinicians recognize FC patterns and predictors effectively to provide tailored advice in time.展开更多
Autoantibodies can help clinicians to allow early detection of autoimmune diseases and their clinical manifestations, to determine effective monitoring of prognosis and the treatment response. From this point, they ha...Autoantibodies can help clinicians to allow early detection of autoimmune diseases and their clinical manifestations, to determine effective monitoring of prognosis and the treatment response. From this point, they have a high impact in rheumatic disease management. When usedcarefully they allow rapid diagnosis and appropriate treatment. However, as they may be present in healthy population they may cause confusion for interpreting the situation. False positive test results may lead to wrong treatment and unnecessary anxiety for patients. Autoantibody positivity alone does not make a diagnosis. Similarly, the absence of autoantibodies alone does not exclude diagnosis. The success of the test is closely related to sensitivity, specificity and likelihood ratios. So, interpretation of these is very important for a proper laboratory evaluation. In conclusion, in spite of the remarkable advances in science and technology, a deeply investigated anamnesis and comprehensive physical examination still continue to be the best diagnostic method. The most correct approach is that clinicians apply laboratory tests to confirm or exclude preliminary diagnosis based on anamnesis and physical examination. This review will discuss these issues.展开更多
Rheumatic diseases, characterized by chronic inflammation and damage to various organs and systems, include systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis and other connective tissue diseas...Rheumatic diseases, characterized by chronic inflammation and damage to various organs and systems, include systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis and other connective tissue diseases. Bone is a target in many inflammatory rheumatic diseases. In recent years, the survival of patients with rheumatic diseases has increased markedly and the relationship between rheumatic diseases and osteoporosis(OP) has become more prominent. OP and related fragility fractures increase the morbidity and mortality of rheumatic disease. The cause of OP in rheumatic diseases is complex. The pathogenesis of OP in rheumatic diseases is multifactorial, including disease and treatment-related factors. Osteoimmunology, a crosstalk between inflammatory and bone cells, provides some insight into the pathogenesis of bone loss in systematic inflammatory diseases. The aim of this article is to review different risk factors in rheumatic diseases. Several factors play a role, such as chronic inflammation, immunological factors, traditional factors, metabolism and drug factors. Chronic inflammation is the most important risk factor and drug treatment is complex in patients with OP and rheumatic disease. Attention should be paid to bone loss in rheumatic disease. Optimal treatment of the underlying rheumatic disease is the first step towards prevention of OP and fractures. Apart from that, a healthy lifestyle is important as well as calcium and vitamin D supplementation. Bisphosphonates or denosumab might be necessary for patients with a low T score.展开更多
Physical activity covers not just sports but also simple everyday movements such as housework,walking and playing.Regular exercise has a great importance in maintaining good health,indeed inactivity is a risk factor f...Physical activity covers not just sports but also simple everyday movements such as housework,walking and playing.Regular exercise has a great importance in maintaining good health,indeed inactivity is a risk factor for different chronic diseases.Physical exercise can play a crucial role in the treatment of rheumatic diseases,optimizing both physical and mental health,enhancing energy,decreasing fatigue and improving sleep.An exercise program for patients with rheumatic diseases aims to preserve or restore a range of motion of the affected joints,to increase muscle strength and endurance,and to improve mood and decrease health risks associated with a sedentary lifestyle.In this editorial I describe the benefits of the exercise on physical limitations and fatigue in rheumatic diseases that seem to have a short and long-term effectiveness.A literature review was conducted on Pub Med,Scopus and Google Scholar using appropriate keywords based on the present editorial.展开更多
BACKGROUND Primary cardiac tumors are uncommon,of which cardiac myxoma accounts for 50%-80%.Left ventricular myxoma has been rarely reported,accounting for only 3%-4%of all cardiac myxomas.Multiple left ventricular my...BACKGROUND Primary cardiac tumors are uncommon,of which cardiac myxoma accounts for 50%-80%.Left ventricular myxoma has been rarely reported,accounting for only 3%-4%of all cardiac myxomas.Multiple left ventricular myxomas are,relatively,even rarer.CASE SUMMARY In this report,we present a case of multiple left ventricular myxomas combined with severe rheumatic valve lesions.Symptomatically,the patient presented with fatigue,shortness of breath,and palpitation after activities.The patient underwent complete surgical resection of multiple left ventricular myxomas combined with mechanical replacement of the mitral and aortic valves,tricuspid valvuloplasty.The patient recovered well after the operation,with no obvious related complications.CONCLUSION Multiple left ventricular myxomas may coexist with severe rheumatic valve disease.Operation is an effective treatment.展开更多
Cytokines are believed to be involved in a “vicious circle” of progressive interactions in bone metastasis. Iguratimod is a novel anti-rheumatic drug which is reported to have the capability of anti-cytokines. In th...Cytokines are believed to be involved in a “vicious circle” of progressive interactions in bone metastasis. Iguratimod is a novel anti-rheumatic drug which is reported to have the capability of anti-cytokines. In this study, a rat model was constructed to investigate the effect of iguratimod on bone metastasis and it was found that iguratimod alleviated cancer-induced bone destruction. To further explore whether an anti-tumor activity of iguratimod contributes to the effect of bone resorption suppression, two human breast cancer cell lines MDA-MB-231 and MCF-7 were studied. The effect of iguratimod on tumor proliferation was detected by CCK-8 assay and flow cytometry. The effects of iguratimod on migration and invasion of cancer cells were determined by wound-healing and Transwell assays. Results showed that high dose（30 μg/m L） iguratimod slightly suppressed the proliferation of cancer cells but failed to inhibit their migration and invasion capacity. Interestingly, iguratimod decreased the transcription level of IL-6 in MDA-MB-231 cells in a concentration-dependent manner. Moreover, iguratimod partially impaired NF-κB signaling by suppressing the phosphorylation of NF-κB p65 subunit. Our findings indicated that iguratimod may alleviate bone destruction by partially decreasing the expression of IL-6 in an NF-κB-dependent manner, while it has little effect on the tumor proliferation and invasion.展开更多
Purpose: Active heart surgery programs are few in sub Saharan Africa outside of South Africa, with majority being low volume centers performing small numbers annually. We reviewed our long term outcome to identify fac...Purpose: Active heart surgery programs are few in sub Saharan Africa outside of South Africa, with majority being low volume centers performing small numbers annually. We reviewed our long term outcome to identify factors associated with increased morbidity and mortality, to guide future choice of prosthetic valves in our mostly indigent patients afflicted with rheumatic valvular disease. Methods: Retrospective analysis of patients who underwent heart valve replacement at Lagos State University and Ahmadu Bello University Teaching Hospitals from November 2004 to February 2009. Results: Twenty six patients, 19 (73.1%) females, age 12 - 47;mean 26.69 ± 9.87 years, underwent heart valve replacement. 19 (73.1%) patients had mitral and 7 (26.9%) aortic valve replacement. Mechanical valve was implanted in all except in 2 (7.7%) patients. Left ventricular ejection fraction was >50% in 14 (53.8%), 24 (92.3%) were in New York Heart Association class III/IV, 10 (38.5%) had severe pulmonary hypertension and logistic euroscore was 5.84 ± 3.81. Operative mortality was 11.5% (3/26) and morbidity 7.7% (2/26). Follow-up for survivors was 83.0 ± 27.9 months. 10-year freedom from bleeding and thromboembolism was 70.0% and survival 86.0%. Linearized rate for bleeding was 4.58 and thromboembolism 1.52. Conclusion: Late complications in survivors were primarily anticoagulant related occurring predominantly in child bearing age females especially during pregnancy. Bleeding complications were often associated with noncompliance due to poor socioeconomic status. With average life expectancy of 53 years for females, bioprosthetic valves despite higher structural failure rate, may be best suited especially in child bearing age females still desirous of childbirth to decrease valve related complications. Longer duration of follow-up and meta-analysis of future reported series from the sub region may help clarify the optimal prosthetic valve in sub Saharan Africa with its known poor health infrastructures and delivery system.展开更多
Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients...Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery（CVS） is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence（30/135, 22.2%） was higher than that in the control group（45/427, 10.5%, P 〈 0.05）. Compared with patients in the control group,incidence of rapid AF（19.3% vs 27.4%） and ventricular arrhythmias（6.7% vs 12.1%） in the amiodarone group were significantly lower（P 〈 0.05）. Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group（P 〈 0.05）. The sinus rhythm conversion rate of the patients with total dosage of above 10 g（14/43, 32.6%） was significantly higher than that of the patients receiving less than 10 g（16/92, 17.4%） amiodarone（P 〈 0.05）. Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.展开更多
Hepatitis C virus(HCV) is a hepato- and lymphotropicagent that is able to induce several autoimmune rheumatic disorders: vasculitis, sicca syndrome, arthralgias/arthritis and fibromyalgia. The severity of clinical man...Hepatitis C virus(HCV) is a hepato- and lymphotropicagent that is able to induce several autoimmune rheumatic disorders: vasculitis, sicca syndrome, arthralgias/arthritis and fibromyalgia. The severity of clinical manifestations is variable and sometimes lifethreatening. HCV infection can mimic many primitive rheumatic diseases, therefore, it is mandatory to distinguish HCV-related manifestations from primitive ones because the prognosis and therapeutic strategies can be fairly dissimilar. The new direct-acting antivirals drugs can help to avoid the well-known risks of worsening or new onset of autoimmune diseases during the traditional interferon-based therapies.展开更多
Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chr...Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chronic RHD,who had severe MAC and mitral regurgitation.Fluoroscopy revealed a "crown"-like severe calcification of the mitral annulus.Autopsy of the heart revealed a calcified posterior mitral annulus,fused commissures,and calcified nodules at the atrial aspect of the mitral valve.展开更多
Presented is a summary of 56 cases of rheumatic arthritis treated with blood-letting puncturing and cupping. Patients acupoints selected were pricked first with a three-edged needle and then cupped for 15 min. The tre...Presented is a summary of 56 cases of rheumatic arthritis treated with blood-letting puncturing and cupping. Patients acupoints selected were pricked first with a three-edged needle and then cupped for 15 min. The treatment was conducted once every other day and six times constituted a therapeutic course. After treatment, out of the 56 cases, 45 cases were cured, 4 markedly effective,3 effective and 4 ineffective, with the total effective rate of 92%.展开更多
文摘Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due to the frequency of other types of joint diseases and the existence of degenerative and dystrophic valve disease. In adults, the initial rheumatic attack is marked by the predominance of joint damage over cardiac damage. However, it is often at this age that rheumatic valve disease is discovered. The revised Jones criteria also find their place in the diagnosis of AAR in adults. Objective: To study the demographic, clinical, and biological characteristics of acute rheumatic fever (ARF) in the General Medicine Department of the Siguiri Prefectural Hospital. Materials and Methods: This descriptive observational study examined the demographic, clinical and biological characteristics of acute rheumatic fever (ARF) at the Siguiri Prefectural Hospital, Guinea, between April 1 and September 31, 2021 according to Jones criteria. The data were collected on a form containing sociodemographic variables (age, sex, profession), rheumatological, cardiac, pulmonary and neurological clinical signs, biological variables and treatment. Results: Figure 1 shows the flow of the hospital frequency of the RAA in the General Medicine Department of the Prefectural Hospital of Siguiri. During the study period, 420 patients were hospitalized, of whom 161 patients had AAR, a frequency of 38.33%. Table 1 shows the distribution of patients diagnosed with ARB, by sociodemographic characteristics. The average age was 44.7 ± 19.78 years and the extremes of 14 and 90 years, the female sex dominated with a ratio of 0.75. The informal sector was in the majority in 45.34% of cases and most were illiterate, i.e. 53.42%. In our study, the incidence was lower during the dry season than during the rainy season, a hot season with high rainfall and humidity, the rainy period was a provider with a peak in August and September. The lifestyle was characterized by overcrowding in 87.58% of patients. The main complaint was fever, i.e. 88.82%. Rheumatological manifestations such as arthritis were 98.14%, chest pain was 37.89% (61 cases). The diagnosis was confirmed by ASLO titration in 85.71% of patients and 98.55% (136 cases) had a titration greater than 400 U/ml. Conclusion: The results obtained from our study show a high prevalence of acute rheumatic fever, which makes it a worrying health problem in the Siguiri health district. Young female adult patients, married with an informal profession and not in school residing in Siguiri were the most encountered in our study. The main functional signs mentioned by the patients were fever, cough and abdominal pain;osteoarticular pain and chest pain dominated the clinical picture. Almost all of our patients had an ASLO titer greater than 400 U/ml and a positive C-reactive protein. Our results show a high risk of spread of acute rheumatic fever within the population of Siguiri. Due to the serious complications caused by acute rheumatic fever, particular attention must be paid to it by carrying out other, much larger studies in order to identify the problem of RAA.
文摘BACKGROUND Rheumatic immune diseases are a group of chronic inflammatory diseases charac-terized by joint and systemic multi-organ involvement,including rheumatoid arthritis,systemic lupus erythematosus,and Sjogren’s syndrome,among others.The pathogenesis of these diseases is related to the abnormal activation and regulatory imbalance of the immune system.The prevalence and morbidity of rheumatic immune diseases are high,imposing a significant burden on patients'quality of life and socio-economic costs.Currently,the treatment of rheumatic immune diseases mainly relies on Western medicine,such as non-steroidal anti-inflammatory drugs,glucocorticoids,disease-modifying antirheumatic drugs,and biologics.However,the therapeutic effects of Western medicine are not ideal,some patients poorly respond or are resistant to Western medicine,and long-term use often causes various adverse reactions.AIM To systematically evaluate the efficacy and safety of Tripterygium wilfordii gly-cosides tablets combined with Western medicine in the treatment of patients with rheumatic immune diseases.METHODS This study conducted a meta-analysis to systematically evaluate the efficacy and safety of Tripterygium wilfordii glycosides tablets combined with Western medicine for patients with rheumatic immune diseases.Chinese and English databases were searched for randomized controlled trials(RCTs)on the treatment of rheumatic immune diseases with Tripterygium wilfordii glycosides tablets combined with Western medicine.The quality of the included studies was assessed using the Cochrane risk of bias assessment tool.Meta-analysis was performed using RevMan 5.4 software.RESULTS The meta-analysis included 11 RCTs involving 1026 patients with rheumatic immune diseases.The combined treatment significantly reduced the risk of disease recurrence(relative risk=1.07,95%confidence interval:1.01-1.15,P<0.05)and showed no significant heterogeneity(I2=0%,P=0.53),indicating that Tripterygium wilfordii glycosides tablets combined with Western medicine is an effective method to reduce the possibility of postoperative recurrence in patients with rheumatic immune diseases.However,due to the limited number and quality of the studies included,these results should be interpreted with caution.CONCLUSION Tripterygium wilfordii glycosides tablets combined with Western medicine is an effective and safe treatment option for patients with rheumatic immune diseases and can be considered a clinical choice.However,more high-quality research is needed to validate this conclusion and provide more solid evidence for clinical practice.
文摘Objective:To assess the effectiveness of COVID-19 vaccination in patients with rheumatic diseases undergoing biologic(bDMARDs)or targeted-synthetic disease-modifying anti-rheumatic drugs(tsDMARDs).Methods:This cross-sectional study was conducted at ten rheumatology clinics in Turkey between May 1,2021,and October 30,2022.Patients with rheumatic diseases on bDMARD or tsDMARD therapy who received at least two doses of an mRNA or inactivated SARS-CoV-2 vaccine were included.After vaccination,COVID-19 infection rates,adverse events,and rheumatic disease flares were recorded.Data were collected via face-to-face or telephone interviews.Results:A total of 963 participants were included in the final analysis;44%were male,and the median age was 49 years.The most frequently observed rheumatic diseases were ankylosing spondylitis and rheumatoid arthritis,accounting for 37.2%and 32.6%of cases,respectively.Adalimumab(19.2%)and infliximab(17.8%)were the most commonly used bDMARDs.Of the participants,634(65.9%)received an inactivated vaccine(CoronaVac)and 329(34.1%)an mRNA vaccine(BioNTech).A total of 502(52.1%)patients received a booster dose.Following the first,second,and third vaccine doses,adverse event rates were 19.9%,15.9%,and 26.7%,respectively.Forty-two(4.4%)patients experienced a disease flare within six months after their first vaccination dose.COVID-19 infection occurred in 79 participants(8.2%)after two vaccine doses;most cases were symptomatic but did not require hospitalization.The COVID-19 infection rate was lower in participants who received a booster dose than those who did not(3.4%vs.8.2%,P<0.001).Conclusions:Our study indicates that both mRNA and inactivated SARS-CoV-2 vaccines are effective in preventing severe COVID-19 outcomes,with an acceptable rate of adverse events and disease flares among patients with rheumatic diseases on bDMARD or tsDMARD therapy.
基金supported by an Ideas Grant(APP2010336)from National Health and Medical Research Council(NHMRC)Australia.
文摘Sydenham chorea(SC)is the neurological manifestation associated with acute rheu-matic fever(ARF).ARF and rheumatic heart disease(RHD)are autoimmune complica-tions triggered by a group A streptococcal(GAS)infection.In ARF/RHD and SC,tissue cross-reactive antibodies and T-cells generated against GAS antigens have been impli-cated in the pathogenesis.In SC,antibodies against GAS antigens are known to cross-react with neuronal proteins causing neurological manifestations including choreiform movements and neuropsychiatric symptoms such as irritability,attention deficit,and obsessive-compulsive disorder.Previous studies in a rat autoimmune valvulitis(RAV)model of RHD,have shown that injection of streptococcal M protein could cause both cardiac and neurological symptoms.In this study it was shown that adoptive transfer of serum with anti-GAS M antibodies to naive rats caused carditis but failed to demon-strate neurobehavioral symptoms.However,when the blood-brain barrier(BBB)was disrupted using lipopolysaccharide,all animals that received anti-GAS M protein anti-bodies,developed neurobehavioral defects in addition to carditis.This highlights that impaired BBB integrity is essential for the development of neurobehavioral symptoms.The use of the RAV model and the disruption of BBB required for the development of neurobehavioral changes provides a platform to further investigate the mechanisms that lead to antibodies binding to basal ganglia structures that cause SC.
基金supported by the National Innovation and Entrepreneurship Training Program for College Students(202310268058)Exploration of the Mechanism on Therapeutic Efficacy of Gulong Capsules in Treatment of Osteoarthritis from the Perspective of Multi-omics(E4-H23066).
文摘Co-inhibitory receptors serve as crucial regulators of T-cell function,playing a pivotal role in modulating the delicate balance between immune tolerance and autoimmunity.Initially identified in autoimmune disease models,co-inhibitory receptors,including CTLA-4,PD-1,TIM-3,and TIGIT,were found to be integral to immune regulation.Their blockade or absence in these models resulted in the induction or exacerbation of autoimmune diseases.Additionally,scholars have observed that co-inhibitory receptors on lymphocytes hold the potential to influence the prognosis in the context of chronic inflammation.Consequently,the blocking of co-suppressor receptors has emerged as a novel therapeutic approach for inhibiting refractory inflammatory diseases,particularly rheumatoid arthritis.From the standpoint of traditional Chinese medicine(TCM),the treatment of rheumatoid arthritis based on the“strengthening body resistance(FúZhèng)”theory can be construed as the regulation of co-suppressor receptors to modulate the body’s immune function in combating chronic inflammation.This article provides a succinct overview of the role of co-suppressor receptors in anti-inflammatory processes and explores the research prospects of co-suppressor receptor intervention in the treatment of rheumatoid arthritis.The exploration integrates the“strengthening body resistance(FúZhèng)”theory with relevant Chinese medicine formulations.
文摘Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.
文摘This article reviews the literature concerning rheu-matic manifestations of inflammatory bowel disease (IBD),including common immune-mediated pathways,frequency,clinical course and therapy. Musculoskel-etal complications are frequent and well-recognized manifestations in IBD,and affect up to 33% of pa-tients with IBD. The strong link between the bowel and the osteo-articular system is suggested by many clinical and experimental observations,notably in HLA-B27 transgenic rats. The autoimmune pathogenic mechanisms shared by IBD and spondyloarthropathies include genetic susceptibility to abnormal antigen pre-sentation,aberrant recognition of self,the presence of autoantibodies against specific antigens shared by the colon and other extra-colonic tissues,and increased intestinal permeability. The response against microor-ganisms may have an important role through molecular mimicry and other mechanisms. Rheumatic mani-festations of IBD have been divided into peripheral arthritis,and axial involvement,including sacroiliitis,with or without spondylitis,similar to idiopathic anky-losing spondylitis. Other periarticular features can oc-cur,including enthesopathy,tendonitis,clubbing,peri-ostitis,and granulomatous lesions of joints and bones.Osteoporosis and osteomalacia secondary to IBD and iatrogenic complications can also occur. The manage-ment of the rheumatic manifestations of IBD consists of physical therapy in combination with local injection of corticosteroids and nonsteroidal anti-inflammatory drugs; caution is in order however,because of their possible harmful effects on intestinal integrity,perme-ability,and even on gut inflammation. Sulfasalazine,methotrexate,azathioprine,cyclosporine and lefluno-mide should be used for selected indications. In some cases,tumor necrosis factor-α blocking agents should be considered as first-line therapy.
文摘Systemic rheumatic diseases(SRDs)are chronic,inflammatory,autoimmune disorders with the presence of autoantibodies that may affect any organ or system.Liver dysfunction in SRDs can be associated with prescribed drugs,viral hepatitis,alternative hepatic comorbidities and coexisting autoimmune liver diseases(AILDs),requiring an exclusion of secondary conditions before considering liver involvement.The patterns of overlap diseases depend predominantly on genetic determinants with common susceptible loci widely distributing in both disorders.In AILDs,it is important to identify the overlapping SRDs at an early stage since such a coexistence may influence the disease course and prognosis.Commonly co-occurring SRDs in AILDs are Sjögren syndrome(SS),rheumatoid arthritis(RA)or systemic lupus erythematosus(SLE)in autoimmune hepatitis(AIH),and SS,RA or systemic sclerosis in primary biliary cholangitis.Owing to different disease complications and therapies,it is imperative to differentiate between SLE liver involvement and SLE-AIH overlap disease.Therapeutic options can be personalized to control coexisting conditions of liver autoimmunity and rheumatic manifestations in AILD-SRD overlap diseases.The collaboration between hepatologists and rheumatologists can lead to significant advances in managing such a complex scenario.In this review,we provide a comprehensive overview on coexisting AILDs in different SRDs and the therapeutic approach in managing these overlap diseases.
基金This study was supported by Shanghai Philosophy and Social Science Planning Project(Grant NO.2018BGL034).
文摘Objectives:The purpose is to distinguish family care(FC)patterns of childhood rheumatic diseases in Chinese families and to determine the predictors of FC patterns.Methods:This secondary analysis contained two cross-section surveys with a convenient sample of totally 398 caregivers who have a child with rheumatic diseases from four pediatric hospitals.Caregivers were required to completed Family Management Measure questionnaire.Cluster analysis was used to distinguish patterns and multinomial logistic regression analysis was used to find predictors.Results:Four patterns were identified:the normal-perspective and collaborative(28.4%),the effortless and contradictory(24.6%),the chaotic and strenuous(18.3%),and the confident and concerning(28.7%).Disease category(x2=21.23,P=0.002),geographic location(x2=8.41,P=0,038),maternal educational level(x2=12.69,P=0.048)and family monthly income(x2=33.21,P<0.001)predicted different patterns.Conclusions:FC patterns were different among families.Disease-related and family-related factors were vital predictors to distinguish patterns consistent with the Family Management Style Framework.The result assisted that clinicians recognize FC patterns and predictors effectively to provide tailored advice in time.
文摘Autoantibodies can help clinicians to allow early detection of autoimmune diseases and their clinical manifestations, to determine effective monitoring of prognosis and the treatment response. From this point, they have a high impact in rheumatic disease management. When usedcarefully they allow rapid diagnosis and appropriate treatment. However, as they may be present in healthy population they may cause confusion for interpreting the situation. False positive test results may lead to wrong treatment and unnecessary anxiety for patients. Autoantibody positivity alone does not make a diagnosis. Similarly, the absence of autoantibodies alone does not exclude diagnosis. The success of the test is closely related to sensitivity, specificity and likelihood ratios. So, interpretation of these is very important for a proper laboratory evaluation. In conclusion, in spite of the remarkable advances in science and technology, a deeply investigated anamnesis and comprehensive physical examination still continue to be the best diagnostic method. The most correct approach is that clinicians apply laboratory tests to confirm or exclude preliminary diagnosis based on anamnesis and physical examination. This review will discuss these issues.
文摘Rheumatic diseases, characterized by chronic inflammation and damage to various organs and systems, include systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis and other connective tissue diseases. Bone is a target in many inflammatory rheumatic diseases. In recent years, the survival of patients with rheumatic diseases has increased markedly and the relationship between rheumatic diseases and osteoporosis(OP) has become more prominent. OP and related fragility fractures increase the morbidity and mortality of rheumatic disease. The cause of OP in rheumatic diseases is complex. The pathogenesis of OP in rheumatic diseases is multifactorial, including disease and treatment-related factors. Osteoimmunology, a crosstalk between inflammatory and bone cells, provides some insight into the pathogenesis of bone loss in systematic inflammatory diseases. The aim of this article is to review different risk factors in rheumatic diseases. Several factors play a role, such as chronic inflammation, immunological factors, traditional factors, metabolism and drug factors. Chronic inflammation is the most important risk factor and drug treatment is complex in patients with OP and rheumatic disease. Attention should be paid to bone loss in rheumatic disease. Optimal treatment of the underlying rheumatic disease is the first step towards prevention of OP and fractures. Apart from that, a healthy lifestyle is important as well as calcium and vitamin D supplementation. Bisphosphonates or denosumab might be necessary for patients with a low T score.
基金Supported by A grant-in-aid from FIR 2014-2016(COD:314509),University of Catania
文摘Physical activity covers not just sports but also simple everyday movements such as housework,walking and playing.Regular exercise has a great importance in maintaining good health,indeed inactivity is a risk factor for different chronic diseases.Physical exercise can play a crucial role in the treatment of rheumatic diseases,optimizing both physical and mental health,enhancing energy,decreasing fatigue and improving sleep.An exercise program for patients with rheumatic diseases aims to preserve or restore a range of motion of the affected joints,to increase muscle strength and endurance,and to improve mood and decrease health risks associated with a sedentary lifestyle.In this editorial I describe the benefits of the exercise on physical limitations and fatigue in rheumatic diseases that seem to have a short and long-term effectiveness.A literature review was conducted on Pub Med,Scopus and Google Scholar using appropriate keywords based on the present editorial.
基金Supported by National Natural Science Foundation of China,No.81770379.
文摘BACKGROUND Primary cardiac tumors are uncommon,of which cardiac myxoma accounts for 50%-80%.Left ventricular myxoma has been rarely reported,accounting for only 3%-4%of all cardiac myxomas.Multiple left ventricular myxomas are,relatively,even rarer.CASE SUMMARY In this report,we present a case of multiple left ventricular myxomas combined with severe rheumatic valve lesions.Symptomatically,the patient presented with fatigue,shortness of breath,and palpitation after activities.The patient underwent complete surgical resection of multiple left ventricular myxomas combined with mechanical replacement of the mitral and aortic valves,tricuspid valvuloplasty.The patient recovered well after the operation,with no obvious related complications.CONCLUSION Multiple left ventricular myxomas may coexist with severe rheumatic valve disease.Operation is an effective treatment.
基金supported by grants from the National Natural Science Foundation of China(Nos.81372852 and 81202095)
文摘Cytokines are believed to be involved in a “vicious circle” of progressive interactions in bone metastasis. Iguratimod is a novel anti-rheumatic drug which is reported to have the capability of anti-cytokines. In this study, a rat model was constructed to investigate the effect of iguratimod on bone metastasis and it was found that iguratimod alleviated cancer-induced bone destruction. To further explore whether an anti-tumor activity of iguratimod contributes to the effect of bone resorption suppression, two human breast cancer cell lines MDA-MB-231 and MCF-7 were studied. The effect of iguratimod on tumor proliferation was detected by CCK-8 assay and flow cytometry. The effects of iguratimod on migration and invasion of cancer cells were determined by wound-healing and Transwell assays. Results showed that high dose（30 μg/m L） iguratimod slightly suppressed the proliferation of cancer cells but failed to inhibit their migration and invasion capacity. Interestingly, iguratimod decreased the transcription level of IL-6 in MDA-MB-231 cells in a concentration-dependent manner. Moreover, iguratimod partially impaired NF-κB signaling by suppressing the phosphorylation of NF-κB p65 subunit. Our findings indicated that iguratimod may alleviate bone destruction by partially decreasing the expression of IL-6 in an NF-κB-dependent manner, while it has little effect on the tumor proliferation and invasion.
文摘Purpose: Active heart surgery programs are few in sub Saharan Africa outside of South Africa, with majority being low volume centers performing small numbers annually. We reviewed our long term outcome to identify factors associated with increased morbidity and mortality, to guide future choice of prosthetic valves in our mostly indigent patients afflicted with rheumatic valvular disease. Methods: Retrospective analysis of patients who underwent heart valve replacement at Lagos State University and Ahmadu Bello University Teaching Hospitals from November 2004 to February 2009. Results: Twenty six patients, 19 (73.1%) females, age 12 - 47;mean 26.69 ± 9.87 years, underwent heart valve replacement. 19 (73.1%) patients had mitral and 7 (26.9%) aortic valve replacement. Mechanical valve was implanted in all except in 2 (7.7%) patients. Left ventricular ejection fraction was >50% in 14 (53.8%), 24 (92.3%) were in New York Heart Association class III/IV, 10 (38.5%) had severe pulmonary hypertension and logistic euroscore was 5.84 ± 3.81. Operative mortality was 11.5% (3/26) and morbidity 7.7% (2/26). Follow-up for survivors was 83.0 ± 27.9 months. 10-year freedom from bleeding and thromboembolism was 70.0% and survival 86.0%. Linearized rate for bleeding was 4.58 and thromboembolism 1.52. Conclusion: Late complications in survivors were primarily anticoagulant related occurring predominantly in child bearing age females especially during pregnancy. Bleeding complications were often associated with noncompliance due to poor socioeconomic status. With average life expectancy of 53 years for females, bioprosthetic valves despite higher structural failure rate, may be best suited especially in child bearing age females still desirous of childbirth to decrease valve related complications. Longer duration of follow-up and meta-analysis of future reported series from the sub region may help clarify the optimal prosthetic valve in sub Saharan Africa with its known poor health infrastructures and delivery system.
基金supported by National Key Technology Research and Development Program(No.2011BAI11B22)Medical Scientific Research Foundation of Guangdong Province(No.B2012002)Guangdong Population and Family Planning Foundation(No.2012264)
文摘Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery（CVS） is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence（30/135, 22.2%） was higher than that in the control group（45/427, 10.5%, P 〈 0.05）. Compared with patients in the control group,incidence of rapid AF（19.3% vs 27.4%） and ventricular arrhythmias（6.7% vs 12.1%） in the amiodarone group were significantly lower（P 〈 0.05）. Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group（P 〈 0.05）. The sinus rhythm conversion rate of the patients with total dosage of above 10 g（14/43, 32.6%） was significantly higher than that of the patients receiving less than 10 g（16/92, 17.4%） amiodarone（P 〈 0.05）. Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.
文摘Hepatitis C virus(HCV) is a hepato- and lymphotropicagent that is able to induce several autoimmune rheumatic disorders: vasculitis, sicca syndrome, arthralgias/arthritis and fibromyalgia. The severity of clinical manifestations is variable and sometimes lifethreatening. HCV infection can mimic many primitive rheumatic diseases, therefore, it is mandatory to distinguish HCV-related manifestations from primitive ones because the prognosis and therapeutic strategies can be fairly dissimilar. The new direct-acting antivirals drugs can help to avoid the well-known risks of worsening or new onset of autoimmune diseases during the traditional interferon-based therapies.
文摘We have treated 30 cases of rheumatic gonitis by using acupuncture and the pricking method, with satisfactory therapeutic results reported as follows.
文摘Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chronic RHD,who had severe MAC and mitral regurgitation.Fluoroscopy revealed a "crown"-like severe calcification of the mitral annulus.Autopsy of the heart revealed a calcified posterior mitral annulus,fused commissures,and calcified nodules at the atrial aspect of the mitral valve.
文摘Presented is a summary of 56 cases of rheumatic arthritis treated with blood-letting puncturing and cupping. Patients acupoints selected were pricked first with a three-edged needle and then cupped for 15 min. The treatment was conducted once every other day and six times constituted a therapeutic course. After treatment, out of the 56 cases, 45 cases were cured, 4 markedly effective,3 effective and 4 ineffective, with the total effective rate of 92%.
