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Although glucocorticoids (GCs) are effective in inducing remission in systemic lupus erythematosus (SLE) patients, there is a significant variation in response to therapeutic GCs, and some patients do not achieve full remission. The aim of this study was to explore the impact of environmental factors on the efficacy of GCs in a Chinese population with SLE. This was a prospective cohort study, and a total of 260 SLE patients treated with GCs (prednisone) were followed up for 12 weeks. The efficacy of GCs was measured with the scores on SLE disease activity index. Environmental factors were collected using a questionnaire. Single-variable analysis and multivariate logistic regression analysis were used to discriminate the impact of environmental factors on the efficacy of GCs. Two hundred forty-seven patients (95.00 %) completed the 12-week follow-up. Among these patients, 131 (53.04 %) were classified into sensitive group and 116 (46.96 %) were classified into insensitive group. Results from logistic analysis showed that the following environmental factors were significantly associated with decreased efficacy of GCs: high salt intake (OR = 3.464, 95%CI = 1.481–8.102, P = 0.004), introverted personality (OR = 3.550, 95%CI = 1.901–6.628, P

OBJECTIVES Previous studies have found the association between rs10865331 in 2p15 area and ankylosing spondylitis (AS). This study aimed to identify additional functional genetic variants in 2p15 region associated with AS susceptibility. METHODS We used next generation sequencing (NGS) in 100 AS cases and 100 healthy controls to screen AS susceptible genetic variants, and validated these variants in 620 cases and 620 controls by using imLDRTM technique for single nucleotide polymorphism (SNP) genotyping. RESULTS Totally, we identified 12 SNPs that might confer susceptibility to AS. Of those SNPs, three (rs14170, rs2123111 and rs1729674) were nominally associated (P

The main purpose of this meta-analysis was to evaluate the impact of ankylosing spondylitis on the health-related quality of life assessed by the Medical Outcomes Short-Form-36 questionnaire (SF-36). A systematic literature search was performed on PubMed and Web of Science until January 22, 2016 to obtain eligible studies. Random effect model was performed to summarize the scores of each domain. The radar chart was used to compare the scores of AS patients with other health conditions. Spearman’s correlation analysis and meta-regression were used to explore the related factors. STATA (version 11.0) and SPSS (version 13.0) were adopted in this meta-analysis. Thirty-eight studies were included in this study, which were all reliable to summarize the scores of the SF-36. Pooled mean scores of the physical health domains ranged from 45.93 to 58.17, with the RP and PF domains being the lowest and the highest, respectively. Pooled mean scores of the mental health domains ranged from 47.49 to 62.52, with the VT and SF domains being the lowest and the highest, respectively. Besides, the physical component summary was lower than the mental component summary. BASDAI and BASFI were negatively associated with some domains of the SF-36 significantly. Patients with AS had a substantial impaired HRQoL in comparison with the general population. AS could adversely affect the HRQoL of patients. Measuring HRQoL should be considered as an essential part of the overall assessment of health status of AS patients, which would provide valuable clues for improving the management of disease and making decisions regarding treatment.

Background To examine the subjective well-being (SWB) in patients with ankylosing spondylitis (AS) compared with the healthy controls, and to explore the associations between SWB and demographic characteristics, disease-specific variables in AS patients. Methods SWB was assessed with General Well-Being Schedule (GWBS) in 200 AS patients and 210 healthy controls. Comparisons among subgroups were performed to investigate how certain aspects operate as favorable or adverse factors in influencing SWB in the patients with AS. Results Both men and women with AS reported significantly impaired SWB on all scales of the GWBS except for the Control (O) scale. The results revealed that better sleep, lower disease activity and more family care predicted higher SWB. In AS patients, positive attitude towards therapy prospect was significantly associated with higher SWB. Therapy prospect refers to the hope of patients about the disease treatment. Conclusions Compared with general population, SWB might be affected by the onset of AS. There are significant associations between SWB and sleep quality, BASDAI, APGAR, therapy prospect.

Heat shock protein 90 (HSP90) is an important glucocorticoid receptor (GR) chaperone protein, and is supposed to be the key factor in regulating glucocorticoids (GCs) effects. The aim of the present study was to explore whether single nucleotide polymorphisms (SNPs) within HSP90AA1 gene affect the response of systemic lupus erythematosus (SLE) patients to GCs treatment. Two hundred and forty-five SLE patients were treated with GCs (prednisone) for 12 weeks. SLE disease activity index (SLEDAI) was used to assess the response of SLE patients to GCs treatment, and patients were classified into sensitive group and insensitive group. HapMap database and Haploview software were used to select tag SNPs. Tag SNPs were genotyped by using multiplex SNaPshot method. Univariate and multivariate logistic regression analyses were used to discriminate the impact of SNPs of HSP90AA1 gene on the response of SLE patients to GCs treatment. Two hundred and thirty three SLE patients finished the 12-week follow-up. Of these patients, 128 patients were included in sensitive group, and 105 patients were included in insensitive group. Seven tag SNPs were selected within HSP90AA1 gene. We detected significant associations for rs7160651 (dominant model: crude OR 0.514, 95 % CI 0.297–0.890, P = 0.018; adjusted OR 0.518, 95 % CI 0.293–0.916, P = 0.024), rs10873531 (dominant model: crude OR 0.516, 95 % CI 0.305–0.876, P = 0.014; adjusted OR 0.522, 95 % CI 0.304–0.898, P = 0.019) and rs2298877 (dominant model: crude OR 0.543, 95 % CI 0.317–0.928, P = 0.026, adjusted OR 0.558, 95 % CI 0.323–0.967, P = 0.037) polymorphisms, but not for other polymorphisms (P > 0.05). The present study demonstrates that HSP90AA1 gene SNPs may affect the response of SLE patients to GCs treatment.

To investigate the incidence of bone marrow edema in sacroiliac joint under examination of magnetic resonance imaging (MRI) in patients with axial spondyloarthropathy (SpA) in remission.A total of 87 patients with axial SpA were recruited. Disease activity was assessed by calculation of BASDAI and ASDAScrp scores. All the SpA patients completed MRI scan of sacroiliac joint and bone marrow edema in sacroiliac joint was quantized by SPARCC scoring standard.According to BASDAI standard (n=87), 60 patients (69.0%) were categorized as remission, of which 40 patients (66.7%) exhibited bone marrow edema in sacroiliac joint (SPARCC0). 27 patients (31.0%) were categorized as activity, while 23 patients (85.2%) exhibited bone marrow edema in sacroiliac joint (SPARCC0). According to ASDAScrp standard (n=75), 12 patients (16.0%) were classified as remission, of which 4 patients (33.3%) exhibited bone marrow edema in sacroiliac joint (SPARCC0). 63 patients (31.0%) were categorized as activity, while 52 patients (82.5%) exhibited bone marrow edema in sacroiliac joint (SPARCC0). SPARCC score positively correlated with BASDAI (r=0.271, P0.05), ASDAScrp (r=0.291, P=0.011) and patient global assessment (r=0.414, P0.01). All the patients were classified as non-regular treatment group, traditional drugs group, and biologics group based on the therapeutic conditions. Percentages of patients with SPARCC0 in sacroiliac joint were also different among these groups (86.8%, 75.0%, 31.6%, χ(2)=21.483, P0.01).About 1/3 to 2/3 axial SpA patients in clinical remission represent bone marrow edema in sacroiliac joint under MRI examination, which indicates presence of subclinical inflammation in axial SpA with clinical remission. SpA patients treated with biologics could have better remission of radiographic inflammation on MRI.

The relationship between the SLC2A9 (solute carrier family 2, member 9) gene polymorphisms and gout was still inconsistent among the individual genetic association studies. Therefore, this present research was aimed to systematically evaluate the association between SLC2A9 gene polymorphisms and gout susceptibility. Relevant studies were enrolled by searching databases systematically. The pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were used to assess the associations. The heterogeneity between each of the studies was calculated by using the Q statistic methods, and Begg's funnel plot and Egger's tests were performed to evaluate publication bias. A total of 13 studies investigated four single nucleotide polymorphisms (SNPs) in SLC2A9 were included. In this study, we found that the allele C of rs3733591 was higher in patients than in controls in both all-pooled population [C vs. T: OR (95 % CI) = 1.432 (1.213-1.691)] and Asians-pooled population [C vs. T: OR (95 % CI) = 1.583 (1.365-1.835)]. The allele frequency C of s6449213 was lower in the gout patients than in controls in both all-pooled population and Caucasians-pooled population. Additionally, the allele frequency T of rs16890979 and the allele frequency C of rs1014290 were lower in gout patients than in controls. This study demonstrated that the genetic susceptibility for gout is associated with the SLC2A9 gene polymorphisms. Four of them except for the rs3733591 are protective SNPs in Caucasians, and rs16890979 and rs1014290 are protective SNPs in both Caucasians and Asians, while rs3733591 may be susceptibility SNP in Asians.

Tumor necrosis factor (TNF)-α promoter -308G/A polymorphism has been shown to be associated with high TNF-α production and poor response to anti-TNF-α treatment. However, not all patients show a good response to TNF-α antagonists, so this association remains controversial. This study was designed to investigate whether TNF-α promoter -308 G/A polymorphism is associated with responsiveness to anti-TNF therapy in rheumatoid arthritis (RA) patients. The 28-joint count Disease Activity Score (DAS) 28 or the American College of Rheumatology (ACR) improvement criteria 20 were used to measure patient response.A meta-analysis was performed. Pooled ORs and 95 % CIs were calculated by both dominant and recessive genetic models.Fifteen studies with a total of 2127 patients were included in this meta-analysis. The results showed that patients with the G allele responded better to the treatment (OR = 1.87, 95 % CI 1.26-2.79). A subanalysis showed similar results.Based on the results of this meta-analysis, RA patients with the TNF-α promoter -308 G allele respond better to TNF-α antagonist treatment, suggesting that this allele plays a major role in anti-TNF-alpha treatment response.

To the Editor: We thank Liu, et al 1 for their comments on our recent study, “Male sexual dysfunction and ankylosing spondylitis: a systematic review and metaanalysis”2. To derive a more precise estimation of the sexual function and its clinical correlations in men with ankylosing spondylitis (AS), the metaanalysis was performed. Sexual dysfunction was currently established on the basis of 5 domains: erectile function (EF), orgasmic function (OF), sexual drive (SD), intercourse satisfaction (IS), and overall satisfaction (OS). The 5 domains formed the main focus of the object and both metaanalysis and regression … Address correspondence to F. Pan; E-mail: famingpan{at}ahmu.edu.cn

Up to now, many publications have evaluated the correlation between IL-23R polymorphisms and ankylosing spondylitis with conflicting results. We perform this meta-analysis to collect all the relevant studies up to date to further clarify the association of IL-23R polymorphisms with AS. Relevant published data were retrieved through Medline, PubMed, Embase, Web of Science, CNKI, Chinese BioMedical Literature Database on disc, and the statistical analysis was conducted using Stata 11.0. (1) A total of 11 literatures, including 13 population samples, were studied. (2) The allele A frequency of rs11209032 was higher in the AS group than in the controls (A vs. G: OR = 1.173, 95% CI = 1.107-1.243, P < 0.001). (3) The allele A of rs1004819 was higher in the AS group than in the controls in both all-pooled population (A vs. G: OR = 1.147, 95% CI = 1.022-1.287, P = 0.02) and Europe-pooled population (A vs. G: OR = 1.199, 95% CI = 1.007-1.429, P = 0.042). (4) The allele frequency T of rs1343151, G of rs10489629, and A of rs11209026 was lower in the AS group than in the controls. (5) No significant differences were found in allele frequency of rs10889677 polymorphism between cases and controls by random effects model. We concluded that the genetic susceptibility for AS is associated with the IL-23R gene polymorphisms. The protective SNPs include rs1343151, rs10489629, and rs11209026 while rs1004819 and rs11209032 may be the susceptibility SNPs.

Ankylosing spondylitis (AS) is a rheumatoid arthritis, which is a common autoimmune disease with a complex genetic etiology. Although HLA-B27 has been identified to be associated with AS, a number of other genes may also be involved in the disease. Fc receptor-like 3 (FCRL3) gene has been shown to be associated with rheumatoid arthritis in Japanese population. Here we aim to explore the association FCRL3 gene and susceptibility to human leukocyte antigen (HLA)-B27-positive AS in Han Chinese population. Among 169 AS patients, the frequencies of C and T (rs7522061) in FCRL3 gene were 38.7 and 61.3%, respectively; in 184 controls (HLA-B27-positive), the frequencies of C and T were 38.6 and 61.4%, respectively. The frequencies of alleles and genotype are not of statistically significant difference in two groups (chi(2) = 0.000, P = 0.983; chi(2) = 0.099, P = 0.952, respectively), but the distribution of HLA-B27 subtypes are statistically significant difference between cases and controls (chi(2) = 8.214, P = 0.042). Our data reveal that the FCRL3 gene does not appear associated with susceptibility to HLA-B27-positive AS in Han Chinese population.

The main purpose of this meta-analysis is to evaluate the diagnostic value of anti-RA33 antibody for rheumatoid arthritis.In order to obtain eligible studies, a systematic literature search was performed on PubMed, Web of science, EBSCO, CNKI and CBM from January 2000 to September 2015. Quality Assessment of Diagnostic Accuracy Studies (QUADAS) was employed to assess the quality of the relevant studies. Meta-disc 1.4 and Stata 11.0 were adopted in this meta-analysis.After rigorous review, fifty studies were included in this study, which are all reliable to summarise the diagnostic value in this meta-analysis. The result of the analysis shows the pooled sensitivity is 0.33 (95% confidence interval (CI): 0.31-0.34) and the specificity is 0.90 (95% CI: 0.89-0.90), for the diagnosis of rheumatoid arthritis. Besides, the area under the summary ROC curve (AUC) is 0.6863.The current evidence suggests that anti-RA33 antibody has high diagnostic specificity value for rheumatoid arthritis, which may be useful for the disease diagnostic application. To verify this conclusion, more prospective research on the diagnostic value of anti-RA33 antibody for rheumatoid arthritis are needed in the future.

The role and clinical implication of the WWP2 E3 ubiquitin ligase in liver cancer are poorly understood. In the current study, we investigated the expression level of WWP2 and its functions in cell adhesion, invasion, and migration in liver cancer. We used real-time PCR to detect the expression of WWP2 in liver cancer and adjacent samples from the People's Hospital of Lishui and also analyzed The Cancer Genome Atlas (TCGA) RNA-seq data by bioinformatics. Migration and invasion were detected by transwell analysis. We detected a strong WWP2 expression in tumor tissues of the People's Hospital of Lishui, and the survival rate was significantly higher in patients with lower WWP2-expressing tumors. WWP2 small hairpin RNA (shRNA) lentivirus stably infected cells (shWWP2), Huh7, showed slower growth speed compared with scramble control-infected cells in a xenograft mouse model. Knockdown of WWP2 Huh7 and BEL-7404 cells demonstrated a reduction in adhesion, invasion, and migration. Gene set enrichment analysis (GSEA) showed that WWP2 is positively correlated to cancer-related pathways including the chemokine signaling pathway. WWP2 also regulated MMP-9, caspase-9, CXCR3, and CCR5 expression in liver cancer cells. In addition, knockdown of CXCR3 and CCR5 significantly inhibited cell proliferation, adhesion, invasion, and migration in Huh7 and BEL-7404 cells. Our data suggest that targeting of WWP2 may be a therapeutic strategy for liver cancer treatment.

The aim of this study was to compare laparoscopic vs. laparotomic surgery for the treatment of hypersplenism with gallstones.Forty patients were treated with splenectomy and cholecystectomy using either totally laparoscopic surgery (laparoscopic group) or laparotomy (laparotomy group). The outcomes were duration of the surgery, intraoperative bleeding volume, postoperative complications, and number of postoperative hospitalization days.There was no difference in the duration of the surgery between both groups. No patient experienced intraoperative complications. There were postoperative pleural effusions (N.=3) and bleeding at the puncture site (N.=1) in laparoscopic group, and postoperative pleural effusions (N.=2), incision infection (N.=2) and peritoneal effusion (N.=1) in laparotomy group. The length of postoperative hospitalization was markedly shorter in laparoscopic group. The follow-up for 3 to 15 months after the surgery demonstrated that hypersplenism was corrected in all patients. All blood markers (white blood cells, platelets, and hemoglobin) recovered to normal levels. The portal vein thrombosis occurred in 6 patients of laparoscopic group and 5 patients of laparotomy group; this was controlled by oral administration of Warfarin and enteric coated Aspirin capsules.Treatment efficacy is comparable between laparoscopic surgery and traditional laparotomy. Laparoscopic surgery is more advantageous because of smaller trauma, faster postoperative recovery, and minimal invasiveness.

ObjectiveThis study aims to determine whether the genetic polymorphisms of IL-12B gene is a susceptibility factor to Ankylosing spondylitis (AS) in mainland Han Chinese population.MethodEight single-nucleotide polymorphisms (SNPs) (rs10045431, rs11167764, rs3212227, rs6556412, rs6556416, rs6871626, rs6887695 and rs7709212) in the IL-12B gene were genotyped by iMLDR Assay technology in 400 patients [96% (384/400) HLA-B27(+)] and 395 geographically and ethnically matched healthy controls in mainland Han Chinese population. The correlation between IL-12B genetic polymorphisms and AS activity index (BASDAI, BASFI) were tested.ResultsThe significant difference was found in genotype distribution between AS and healthy controls (χ2 = 6.942, P-value = 0.031) of the SNP rs6871626. Furthermore, significant evidence was also detected under the recessive model for minor allele A. The AA genotype carrier had 1.830 fold risk compared with C allele carrier (with CC and AC genotypes) [OR (95% CI) = 1.830 (1.131-2.961), P-value = 0.014]. Nevertheless, the difference was no longer significant after Bonferroni correction. Subset analysis on cases with HLA-B27(+) did find the same results. Three genotypic groups (AA, CC and CA) in rs6871626 site was highly associated with the BASDAI and BASFI (P-value = 0.012 and P-value = 0.023, respectively), after adjustment for effect of age, sex, and disease duration, the P-value was 0.031 and 0.041, respectively. The AA genotype of rs6871626 was also significantly correlated with an increased BASDAI and BASFI compared to the AC and CC genotypes in AS patients.ConclusionOur findings suggest that rs6871626 may be associated AS susceptibility and with disease activity (BASDAI, BASFI) in mainland Han Chinese population.

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Angiogenesis is reported to play a pivotal role in the occurrence, development and metastasis of HCC. The renin-angiotensin system (RAS) is involved in the regulation of angiogenesis. Here, based on the analysis of HCC datasets from Gene Expression Omnibus (GEO) database and The Cancer Genome Atlas (TCGA), we found that there was a negative correlation between the mRNA levels of angiotensin converting enzyme 2 (ACE2) and CD34. To explore the association of RAS with the progression from fibrosis to cirrhosis to HCC, liver specimens and serum samples were collected from patients with hepatic fibrosis, cirrhosis and HCC. Relative hepatic mRNA levels of CD34 and ACE2 were determined by real-time PCR, and the serum concentrations of Angiotensin II (Ang II), Ang (1-7) and vascular endothelial growth factor (VEGF) were detected by ELISA. We found that ACE2 mRNA was gradually decreased, while CD34 mRNA was progressively increased with the increasing grade of disease severity. Concentrations of Ang II, Ang (1-7) and VEGF were higher in the sera of patients than in that of healthy volunteers. These proteins' concentrations were also progressively increased with the increasing grade of disease severity. Moreover, a positive correlation was found between VEGF and Ang II or Ang (1-7), while negative correlation was observed between mRNA levels of CD34 and ACE2. More importantly, patients with higher level of ACE2 expression had longer survival time than those with lower level of ACE2 expression. Taken together, our data suggests that the low expression of ACE2 may be a useful indicator of poor prognosis in HCC. The RAS may have a role in the progression of HCC.

Objectives The results of studies on association between KIR (killer cell immunoglobulin-like receptors) polymorphisms and susceptibility to RA (rheumatoid arthritis) are inconsistent. To comprehensively evaluate the effect of KIR polymorphisms on the risk of RA, a meta-analysis was carried out. Methods The Web of Science, PubMed, the Chinese Biomedical Database (CBM) and Chinese National Knowledge Infrastructure (CNKI) databases were systematically searched to select studies on the association between KIR polymorphisms and RA. The odds ratio (OR) with 95% confidence interval (95%CI) was obtained. Results Nine qualified case–control studies were included in this meta-analysis. The results showed there were two positive associations of 2DL1, 2DS1 (OR2DL1 = 2.20, 95%CI = 1.20–4.01, Praw = 0.01, PFDR = 0.03; OR2DS1 = 1.84, 95%CI = 1.19–2.85, Praw = 0.006, PFDR = 0.018) and one negative association of 2DL3 (OR2DL3 = 0.42, 95%CI = 0.22–0.79, Praw = 0.006, PFDR = 0.018) with susceptibility to RA in East Asians, but not in Caucasians. Conclusion The current meta-analysis provides evidence that 2DL3 might be a potential protective factor and 2DL1, 2DS1 might be risk factors for RA in East Asians but not in Caucasians.

This work aims to compare the curative effect of transumbilical single-port laparoscopic cholecystectomy (TUSPLC) and four-port laparoscopic cholecystectomy (FPLC). 200 patients with cholecystolithiasis were enrolled in this study. They were randomly divided into TUSPLC group and FPLC group, 100 cases in each group, and the TUSPLC and FPLC was performed, respectively. The surgical time, intraoperative complication, conversions rate, postoperative pain, postoperative analgesic drug use, incision infection, postoperative hospitalization time and postoperative cosmetic results in two groups were compared. The total conversion rate, conversion rate with Nassar grade II, and conversion rate with Nassar grade III in TUSPLC group were significantly higher than FPLC group (P < 0.01), and the incision cosmetic result after 1 month in TUSPLC group was obviously better than FPLC group (P < 0.01), but the surgical time in TUSPLC group was significantly longer than FPLC group (P < 0.01). There was no significant difference of incision infection, intraoperative complication, and postoperative hospitalization time, incision pain in postoperative first and second day, postoperative use of analgesia drug and incision cosmetic result on discharge day between two groups (P > 0.05). TUSPLC has obvious advantage in treatment of Nassar grade I patients with cholecystolithiasis. It can be used as a supplement for standard laparoscopic gallbladder surgery. It is safe and feasible, without abdominal scar, thus achieving to excellent cosmetic result and high satisfaction in patients.

To explore the prevalence of osteoporosis (OP) and vertebral osteoporotic fracture (OPF) and related risk factors in patients with rheumatoid arthritis (RA).A total of 644 patients with RA from Jan. 2010 to Oct. 2013 were recruited, anteroposterior and lateral X-rays examination of vertebral column (T5-L5) were conducted, and semi-quantity method were used as the standard for judging vertebral OPF. Meanwhile, patients' clinical and laboratory data including daily dosage of glucocorticoid, duration of glucocorticoid usage, cumulative amount dosage of glucocorticoid were recorded in details. 158 normal subjects were selected as control group.(1)The prevalence of vertebral OPF in patients with RA was 16.6%. Bone mineral density (BMD) of all measured lumbar vertebra in RA group were markedly decreased [(0.97 ± 0.22) g/cm(2)]. The total prevalence of OP at lumbar vertebra in RA was 17.9% (81/452), which was significantly higher than that of control group (4.4%, 7/158) (P0.001). (2) The percentage of OP in RA patients with vertebral OPF was significantly higher than that in patients without OPF [40.6% (41/101) vs 11.4% (40/351); P0.001]. Patients with OPF were of older age, longer use of glucocorticoid, more cumulative amount dosage of glucocorticoid, longer disease duration, higher scores of health assessment questionnaires (HAQ) and increased ESR (P0.05). (3) Logistic regression analysis revealed that age (OR = 1.094, 95% CI 1.065-1.125, P0.001) and gender (1 = male, 2 = female) (OR = 5.600, 95% CI 2.097-15.087, P = 0.001) were the risk factors for the development of OP in RA, while body mass index (BMI) was the protective factor (OR = 0.770, 95% CI 0.696-0.853, P0.001). Age (OR = 1.031, 95% CI 1.009-1.053, P = 0.005) and occurrence of OP at lumbar vertebra (OR = 3.765, 95% CI 2.092-6.776, P0.001) were risk factors of the development of OPF in RA patients. Logistic regression analysis also showed that RA was the risk factor of OPF (OR = 4.716, 95% CI 1.987-11.192, P0.001), even after the adjustment of age, gender and BMI. (4) Receiver operator characteristic(ROC) curve in RA patients with OPF has found that age-OPF and daily dosage of glucocorticoid-OPF AUCROC were 0.689 and 0.636 respectively. The cut-off value in ROC curve of age and daily dose or treatment course of glucocorticoid-OPF were 54.5 years and 6.25 mg (P0.001) , while duration of glucocorticoid usage-OPF AUCROC was 0.685, with cut-off value in ROC of age-OPF 135 days (P0.001).Prevalence of OPF in patients with RA increases remarkably. Old age and OP at spine are risk factors related to the development of OPF in patients with RA.

Objective.No consensus has been reached on sexual dysfunction in men with ankylosing spondylitis (AS). Our study aimed to derive a more precise estimation of the sexual function and its clinical correlations in men with AS.Methods.A metaanalysis was performed and the related literature were searched in PubMed, Elsevier Science Direct, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and in reference lists of articles and systematic reviews. Score of the International Index of Erectile Function (IIEF) was used as the outcome measurement, and standardized mean differences (SMD) with 95% CI were calculated.Results.Eleven studies were included, including 535 men with AS and 430 male controls. Each domain of the IIEF score (erectile function: SMD −0.52, 95% CI −0.68 – −0.37; orgasmic function: −0.72, −1.03 – −0.42; sexual drive: −0.40, −0.62 – −0.18; intercourse satisfaction: −0.86, −1.15 – −0.56; and overall satisfaction: −0.61, −0.91 – −0.32) were lower in men with AS than in controls. In the subgroup analysis, the results did not change except for the sexual drive in the Asians group (−0.15, −0.42–0.13). At metaregression, no study characteristics were significantly associated with effect size of the IIEF score.Conclusion.Sexual function is impaired in male patients with AS and further studies are necessary to better understand risk factors for sexual dysfunction in this population.

In our previous study, we found that glucocorticoid receptor (GR) gene genetic polymorphisms may play a major role in the efficacy of glucocorticoids (GCs) in Chinese systemic lupus erythematosus (SLE) patients. The aim of this study is to explore the association of GR gene genetic polymorphisms and improvement of health-related quality of life (HRQOL) in Chinese SLE patients treated with GCs. A total of 195 Chinese SLE patients were treated with GCs for 12 weeks. The HRQOL of patients was measured with the Medical Outcomes Study Short Form-36 (SF-36) at baseline and 12 weeks. Polymorphisms of GR gene were genotyped by using multiplex SNaPshot method. One hundred eighty-four patients (94.36 %) completed the 12-week follow-up. Twenty-three single-nucleotide polymorphisms of GR gene were genotyped. There was a significant association between rs10482672 polymorphism and improvement in physical function (P = 0.043), general health (P = 0.024), and social function (P = 0.013). The rs12656106 polymorphism was associated with improvement in the total score of SF-36 (P = 0.014), physical function (P = 0.013), general health (P = 0.010), vitality (P = 0.015), social function (P = 0.004), physical component summary (P = 0.016), and mental component summary (P = 0.014). The rs4912905 polymorphism was associated with improvement in bodily pain (P = 0.040) and general health (P = 0.038). The rs4912911 polymorphism was associated with improvement in general health (P = 0.026) and vitality (P = 0.027). The rs4986593 polymorphism was associated with improvement in bodily pain (P = 0.034). The rs7719514 polymorphism was associated with improvement in vitality (P = 0.002) and mental component summary (P = 0.041). We also found a significant association between rs9324924 polymorphism and improvement in physical function (P = 0.040), bodily pain (P = 0.007), and general health (P = 0.019). These results indicate that there may be an association of GR gene rs10482672, rs12656106, rs4912905, rs4912911, rs4986593, rs7719514, and rs9324924 polymorphisms with improvement of HRQOL in Chinese SLE patients treated with GCs.

Background The role of vitamin D in ankylosing spondylitis (AS) is largely unknown. This paper aims to examine the association between serum vitamin D levels and susceptibility and disease activity of AS. Methods We searched the relevant literatures in PubMed, Elsevier Science Direct, Chinese Biomedical Database (CBM), Chinese National Knowledge Infrastructure (CNKI) and Wanfang (Chinese) Database published before June 2014. Eight independent case–control studies with a total of 533 AS patients and 478 matching controls were selected into this meta-analysis. Standard mean differences (SMDs) with 95% confidence intervals (CIs) were used to assess the levels of serum vitamin D, parathyroid hormone (PTH), serum calcium and alkaline phosphatase (ALP) in cases and controls, respectively. Correlation coefficients (CORs) have been performed to value the correlationship between vitamin D and disease activity (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) of AS patients. Results Meta-analysis results suggested that vitamin D may play a protective role in AS (for total vitamin D: SMD = − 0.71, P P = 0.002; for 1,25OHD: SMD = − 0.72, P = 0.19). Differences in PTH and serum calcium levels were not significant in AS (SMD = − 0.10, P = 0.67; SMD = 0.12, P = 0.17 respectively), while ALP was associated with AS susceptibility (SMD = 0.20, P = 0.04). The relationship between serum vitamin D levels and disease activity was statistically significant except for 25OHD versus (vs.) CRP or BASDAI (for CRP vs. 25OHD: COR = − 0.22, P = 0.08; for BASDAI vs. 25OHD: COR = − 0.20, P = 0.06, respectively). Conclusion The higher levels of serum vitamin D were associated with a decreased risk of AS, and showed an inverse relationship with AS activity.

Schizophrenia is a common, complex multi-factorial psychiatric disorder. Many studies have reported associations between the C957T and C939T polymorphisms in Dopamine D2 receptor (DRD2) gene and schizophrenia, but results are inconsistent. To derive a more precise estimation of the relationship, a meta-analysis was conducted to systematically summarize the possibility. We included 13 articles involving 3079 schizophrenia cases and 3851 healthy controls. Positive associations were found between C957T polymorphism and schizophrenia risk in C vs. T (OR=1.26, 95% CI=1.09-1.46, Praw=0.002, PFDR=0.005) and CC+CT vs. TT (OR=1.47, 95% CI=1.25-1.73, Praw0.001, PFDR0.001). When stratified by race, a significantly increased risk of schizophrenia was observed in Caucasians, but not in Asians. No association between C939T polymorphism and schizophrenia was found in overall or Asian population. Our study suggested that C957T of DRD2 gene polymorphism is likely to be a risk factor for schizophrenia, especially in Caucasian.

Objective. The aim of this study was to describe the associations between serum levels of 25hydroxyvitamin D [25(OH)D] and disease activity, inflammatory cytokines and bone loss/erosions in patients with RA. Methods. The study included 130 patients with RA and 80 healthy controls. Serum 25(OH)D, IL-17 and IL-23 levels were detected by ELISA. Radiographic bone erosion was assessed using the van der Heijde modified Sharp score and BMD was measured using DXA. Results. There were no significant differences in age, gender and BMI between the RA and control groups. Serum level of 25(OH)D was markedly lower in the RA group than in the control group [43.12 nmol/l (S.D. 15.59) vs 57.93 (15.95), P < 0.01]. In RA patients, 25(OH)D levels were significantly and negatively associated with clinical parameters of disease activity including swollen joint count, tender joint count, joint pain degree, morning stiffness time and HAQ score and laboratory measures including platelets and ESR after adjustment for gender, age and BMI. They were also negatively associated with serum levels of IL-17 and IL-23. While 25(OH)D levels were not associated with radiographic bone erosions of RA, they were significantly lower in those with osteopenia and osteoporosis than in those with normal BMD (P < 0.01). Conclusion. 25(OH)D levels were reduced in patients with RA and were negatively associated with disease activity, IL-17/IL-23 and bone loss in RA. These suggest that vitamin D deficiency may play a role in the aetiology of RA.

We investigated whether TESPA1 gene polymorphisms were associated with increased risk of developing ankylosing spondylitis (AS). We also studied whether TESPA1 gene interacts with environmental factors. A total of 494 patients with AS and 478 matched healthy controls were genotyped for four SNPs (rs1801876, rs2171497, rs4758994, and rs997173) in the TESPA1 gene. We found no evidence of association between these SNPs and AS susceptibility, and between their haplotypes and the disease. But, patients with rs1801876 GA, GG, and AA genotypes had significantly different Bath Ankylosing Spondylitis Functional Index (BASFI) scores (p = 0.023). There were significantly different visual analogue scale (VAS) night pain assessment scores (p = 0.040) and BASFI scores (p = 0.023) among different genotypes at rs2171497 locus. There were also significantly different chest expansion scores (p = 0.042) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores (p = 0.014) among different genotypes at rs997173 locus. For multiple testing, Bonferroni correction was performed. After Bonferroni correction, clinical characteristics of these three loci showed association between different genotype groups. These findings indicated that the TESPA1 gene is not involved in AS genetic predisposition in the Han Chinese population; however, it may play an important role in the clinical characteristics of AS.

The relationship between circulating follicular helper T (Tfh) cells and ankylosing spondylitis (AS) remains unclear. The aims of our study were to measure the levels of circulating Tfh cells and several related parameters in patients with AS, and examine the correlation of these factors with disease activity.We designated CD4 + CXCR5 + ICOS+ T cells as circulating Tfh cells. The percentage of circulating Tfh cells was detected using flow cytometry. Plasma IL-21 and immunoglobulin (IgA, IgM, and IgG) levels were quantified using enzyme-linked immunosorbent assay in 60 AS patients and 60 healthy controls (HC).The percentage of circulating Tfh cells was increased in AS patients compared with that in HC. As AS patients were divided into active and inactive groups, the percentage of circulating Tfh cells was significantly increased in active group compared with both inactive group and HC. Plasma IL-21 and immunoglobulin levels were elevated in AS patients, and the differences were significant except IgG. In addition, the percentage of circulating Tfh cells was positively correlated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and plasma IL-21 levels were positively correlated with plasma immunoglobulin levels. But neither circulating Tfh cells nor BASDAI was significantly correlated with plasma IL-21 and immunoglobulin levels in AS patients, with the exception of significant correlation between BASDAI and plasma IgM levels in active AS patients.Our study has shown the increased percentage of circulating Tfh cells correlated with disease activity, and the high plasma IL-21 levels were associated with high plasma immunoglobulin levels in patients with AS, indicating that the circulating Tfh cells may be associated with the development of AS.

This paper aims to investigate the influence of single-nucleotide polymorphisms (SNPs) in the receptor of activator of nuclear factor kappaB ligand (RANKL) gene (TNFSF11) and osteoprotegerin (OPG) gene (TNFRSF11B) on bone and joint injury in patients with rheumatoid arthritis (RA).Two hundred RA patients and 201 matched controls were analysed by case-control design, and their samples were genotyped. Bone mineral density (BMD) and serum OPG and RANKL levels were measured. Clinical and laboratory parameters were recorded, and the radiographic changes in both hands of RA were evaluated by Sharp's method.Our results showed no significant differences in the distribution frequency of the alleles and genotypes of TNFRSF11B (rs2073618 and rs3102735) and TNFSF11 (rs2277438) between the RA group and controls (p0.05). Compared to patients with TNFSF11 (rs2277438) AA or GG genotype, RA with TNFSF11 (rs2277438) AG genotype had significantly decreased BMD values at lumbar spine 3, lumbar spine 4, lumbar spine 2-4 (p0.05-0.01), and apparently elevated Sharp scores (p0.05), respectively. The RA group showed significantly higher serum levels of RANKL, RANKL/OPG ratio and a lower serum level of OPG than that of the controls (p0.05-0.0001). RA patients with RANKL-rs2277438 heterozygotic genotype (AG) had significantly increased serum levels of RANKL (p0.05), compared to homozygotic genotype (AA or GG).These results indicate that SNP of TNFRSF11B (rs2073618 and rs3102735) and TNFSF11 (rs2277438) may not be susceptibility factors for RA in Chinese Han population. SNP of TNFSF11 (rs2277438) may have an important influence on bone and joint injury in RA.

Our aim was to investigate whether genetic polymorphism of IL-1F7 (rs3811047) was involved in the susceptibility to rheumatoid arthritis (RA) in Chinese Han population. Single nucleotide polymorphism (SNP) of IL-1F7 gene (rs3811047) was analyzed in 184 unrelated Chinese Han patients with RA and 184 healthy controls by ligase detection reaction based on high temperature ligase detection reactions polymerase chain reaction (LDR-PCR). There were no statistically significant differences in the genetic polymorphism (genotypes and allele frequencies) of IL-1F7 (rs3811047) in the patients with RA compared with control. Although all of the clinical and laboratory measures were similar to each other among patients with different genotypes, RA patients carrying AA or AG genotypes had lower swollen joint count, swollen joint index, rest pain and health assessment questionnaire (HAQ) score than that in patients having GG genotype ( P 0.05). These findings show that no evidence for the involvement of a pro-inflammatory polymorphism in the IL-1F7 in the susceptibility to RA in China. Patients carrying A allele had less severe disease activity than those not carrying this allele, suggesting that the A allele of IL-1F7 gene (rs3811047) may have a protective effect on RA.

Recent studies have explored the role of killer cell immunoglobulin-like receptors (KIRs) in chronic autoimmune diseases. The purpose of this study was to demonstrate whether KIR genes contribute to the pathogenesis of ankylosing spondylitis (AS) in Chinese populations. Sixteen KIR genes were genotyped from 60 unrelated patients with AS and 60 HLA-B27-positive matched healthy controls by PCR-SSP. The frequencies of the KIR alleles and genotypes in the AS and control groups were assessed by the χ 2 test. Our results showed that the frequency of the activator receptor KIR3DS1 gene in the AS group was significantly increased compared to the controls (χ 2 = 5.263, P = 0.006, OR = 3.059, 95 % CI = 1.357–6.896). Moreover, the frequency of the KIR3DL1/3DS1 genotype was greater in the AS group than in the control group (P = 0.039, OR = 3.059, 95 % CI = 1.357–6.896). In contrast, the frequency of the no KIR3DL1/no 3DS1 genotype was lower in patients with AS compared with the controls (P = 0.032, OR = 0.110, 95 % CI = 0.013–0.911). KIR3DS1, in addition to HLA-B27, may play an important independent role in the pathogenesis of AS in the Chinese population.

Previous studies have found that the Fc receptor-like (FCRL) molecule, involved in controlling B cell signaling, may contribute to the autoimmune disease process. Many studies have reported the relation of FCRL gene family with SLE and RA. We hypothesized that FCRL4 may be a key gene for ankylosing spondylitis (AS) development. To test this hypothesis, we screened FCRL4 polymorphisms in the Chinese Han population. Five tag single nucleotide polymorphisms (SNPs), including rs14335, rs849826, rs10489674, rs2778003, and rs2777963, were selected. Using a case-control study, five tag SNPs, which captured the majority of known common variation within FCRL4 gene, were selected and genotyped by Multiplex Snapshot technique. We analyzed 299 patients and 300 controls from China. The genotype analysis demonstrated that one of the FCRL4 tag SNPs rs2777963 TT genotype may be a risk factor of AS (χ(2) = 7.374, p = 0.024). The haplotype analysis indicated that there were no significant differences between AS cases and controls. Patients with AS who had rs14335 AA genotype had a significantly declined visual analogue scale patient's global assessment scores compared to those with the GG genotype (31.21 ± 26.25 vs 40.54 ± 25.40, p = 0.035) and GA genotype (38.29 ± 24.94 vs 40.54 ± 25.40, p = 0.044), and in locus rs10489674, TT genotype had significantly increased Bath Ankylosing Spondylitis Disease Activity Index scores compared to those with the CC genotype (4.73 ± 2.43 vs 3.15 ± 1.61, p = 0.003) and CT genotype (4.73 ± 2.43 vs 2.97 ± 1.71, p = 0.001). The FCRL4 polymorphisms may play an important role in the susceptibility and severity of AS in the Chinese Han population.

Immunotherapy has markedly improved treatment outcomes in rheumatoid arthritis (RA). Tumor necrosis factor (TNF)-α antagonists, such as infliximab (IFX), etanercept (ETN), adalimumab (ADA), golimumab (GOLI) and certolizumab pegol (CZP) have been widely used for the treatment of RA. IFX provides significant, clinically relevant improvement in physical function and the quality of life, inhibits progressive joint damage and sustains improvement in the signs and symptoms of patients with RA. ETN is effective and safe for patients with RA. Combination therapy with ETN plus methotrexate (MTX) reduces disease activity, decreases total joint score progression, slows the pace of joint destruction and improves function more effectively compared to any of the monotherapies. ADA with or without MTX also relieves the signs and symptoms of RA. CZP and GOLI expand the therapeutic schedule for patients with RA. The TNF-α inhibitors have similar efficacy, but distinct clinical pharmacokinetic and -dynamic properties. The common adverse events of these TNF-α antagonists include adverse reactions, infections and injection-site reaction. Additionally, these adverse events are mostly mild or moderate and their incidence is low. Certain patients exhibit a lack of response to anti-TNF-α therapies. Some patients may discontinue the initial drug and switch to a second anti-TNF-α agent. The shortage of clinical response to one agent may not predict deficiency of response to another. This review mainly addresses the latest developments of these biological agents in the treatment of RA.

Osteoporosis represents an important cause of morbidity in adult rheumatoid arthritis (RA) patients who exhibit increased fracture risk. It is thought that osteoclast and its dysfunction which mediated by many cytokines are the principal pathogenesis of this bone disease, although the mechanisms are still not fully understood. Osteoprotegerin (OPG) and receptor activator of nuclear factor-kappa B ligand (RANKL) have been revealed in the pathogenesis of primary osteoporosis and other metabolic bone diseases. Thus, the aim of this study was to investigate the possible role of the OPG/RANKL system in RA-related bone loss. A total of 64 Chinese patients with RA and 60 healthy control subjects were involved. Serum levels of OPG and RANKL were measured by ELISA. BMD of nondominant forearm, lumbar spine(L1–4) and proximal femur, including femoral neck, Wards triangle, greater trochanter were assessed using dual-energy X-ray absorptiometry. RA patients had a higher incidence of osteoporosis (23/64, 35.9%) than that in healthy controls (9/60, 15.0%) (P

Interleukin 17 (IL-17) is a Th17 cytokine associated with inflammation, autoimmunity, and defense against some bacteria; it has been implicated in many chronic autoimmune diseases including psoriasis, multiple sclerosis, and systemic sclerosis. However, whether IL-17 plays a role in the pathogenesis of ankylosing spondylitis (AS) remains unclear. To analyze the content of IL-17 and IL-23 in the serum from patients with AS compared with health control subject, 50 patients with AS and 43 healthy volunteers were recruited. Serum IL-17 levels were examined by enzyme linked immunosorbent assay (ELISA). Statistic analyses were performed by SPSS 13.0. Results show that the serum IL-17 and IL-23 levels were significantly elevated in AS patients as compared with normal controls. Nevertheless, no associations of serum IL-17 and IL-23 levels with clinical and laboratory parameters were found; no significant difference regarding serum IL-17 and IL-23 levels was found between less active AS and more active AS. However, there was a strong positive association between the serum levels of IL-17 and IL-23 in the AS patients. Our results indicate increased serum IL-17 and IL-23 levels in AS patients, suggesting that this two cytokine may play critical roles in the pathogenesis of AS. Therefore, further studies are required to confirm this preliminary data.

To examine the interaction between IL-1F7 gene and environmental factors in patients with ankylosing spondylities (AS). 150 AS Han Chinese patients (all human leukocyte antigen-B27 positive) were genotyped using a panel of single-nucleotide polymorphism markers within IL-1F7 gene (rs3811047) by ligase detection reactions. Polymerase chain reaction with sequence-specific primer was used to determine HLA-B27 subtypes. We analyzed the interaction between IF-1F7 gene and eight environmental factors in AS patients by using a case–only study. The genetic polymorphism and environmental factors were considered as dependent variables in logistic models, and P-values, ORi and 95% confidence intervals were used for estimating the effects of interaction. The different frequency of A/G between drinking group and non-drinking group was significant (ORi 3.163, 95% CI 1.368–7.317, P = 0.006). Within the cooking oil group, odds ratio for interaction of G × E between main plants fats and half plants -half animal fats subunits was 4.273 (95% CI 1.590–11.479, P = 0.004). Our data show that there was no interaction between IL-1F7 alleles and the other six environmental factors in AS patients (all P > 0.05). We observed that there was an interaction between IF-1F7 gene and drinking in AS patients. Thus, drinking may be a risk exposure factor to take combined action with predisposing genes in AS patients. This action may increase the incident risk of AS. Also, main plants fats may be protective factors to AS.

This study aims to review the cumulative clinical and laboratory data of 1,790 Chinese patients with systemic lupus erythematosus. Data were compared separately between male and female patients for each disease onset age groups and among three disease onset age groups in male and female patients. The ratio of female to male was 9.2:1, with differences among three age groups. There was no difference in mean age at onset between females and males. But diagnosis delay in male patients is shorter than in females. When compared with females, in adult-onset patients, males presented more frequently with serositis, pleuritis and discoid rash, but less frequently with malar rash, alopecia, oral ulcers, elevated erythrocyte sedimentation rate, anti-nuclear, anti-SSA and anti-SSB antibodies. In younger-onset group, males have less discoid rash. In older-onset group, males have less anti-SSA antibodies. In male patients, only anti-SSB antibodies were different in three age groups and negatively correlate to age. Among female patients, age had negative correlations with malar rash, discoid rash, photosensitivity, anti-dsDNA, anti-Sm, anti-SSB and anti-rRNP antibodies, but positive correlation with leucopenia. We conclude that women of childbearing age possess a distinct clinical and laboratory profile. In addition, differences in disease manifestations seem to be correlated with female sex hormones rather than age.

The incidence of esophageal cancer (EC), especially adenocarcinoma, has increased tremendously in Western countries and the prognosis of EC remains poor. Paeonol (Pae), a phenolic component from the root bark of Paeonia moutan, possesses antitumor effects in vitro and in vivo. The present study showed that Pae had an antiproliferative effect on the two human EC cell lines (SEG-1 and Eca-109), with different sensitivities to Pae. Acridine orange staining and flow cytometry assays showed that Pae induced apoptosis on the two cell lines. Further analyses indicated that Pae resulted in a cell cycle arrest at S-phase. Immunohistochemical staining showed the expression of Bcl-2 was decreased and that of Bax was increased in treatment groups, with the ratio of Bcl-2/Bax decreased correspondingly. The results show that Pae shows growth inhibitory and apoptosis induction property and may be a promising agent for the EC treatment.

Background/aim Paeonol, a phenolic component from the root bark of Paeonia moutan, has shown great promise in antitumour activities in our previous studies. The present study was designed to investigate whether paeonol has synergistic effect with cisplatin on the growth-inhibitory of human oesophageal cancer cell lines and the possible mechanism. Methods Cell viabililty was measured by MTT assay. Drug–drug interactions were analysed by the coefficient of drug interaction. Apoptosis was detected by acridine orange fluorescence staining and flow cytometry assay. Bcl-2, Bax and caspase-3 expression was assayed by immunohistochemical staining. Results A synergistic inhibitory effect on viability of the two cell lines was observed after combination of paeonol with various concentrations of cisplatin. Further study showed the combination induced greater apoptosis than the groups treated with paeonol or cisplatin alone. The expression of Bcl-2 was decreased and that of Bax was increased in treatment groups, especially in the combination group, with the ratio of Bcl-2/Bax decreased correspondingly. And the combination also resulted in greater activation of caspase-3 than did either agent alone. Conclusions Paeonol, in combination with cisplatin, had a significantly synergistic growth-inhibitory effect on oesophageal cell line, which may be related to apoptosis induction.

Sir, Diabetic kidney disease is one of the most devastating complications affecting diabetic patients’ survival. When suffering from both type 1 diabetes mellitus (DM) and end-stage renal disease (ESRD), simultaneous pancreas-kidney transplantation (SPKT) is the best therapeutic option and life-saving procedure.[1] Hypertension is known to be a common comorbidity associated with DM. The incidence of hypertension is above 60%, in some regions even exceeding 75%, among patients with DM.[2] Both hypertension and DM related closely to an increased risk of morbidity and mortality due to long-term macro- and microvascular pathological conditions, notably chronic kidney disease.[3] Furthermore, 80-90% of patients at stages IV and V chronic kidney disease suffer from resistant hypertension.[4] Therefore, hypertension may have a great impact on the long-term outcome after SPKT. Here, we present a case of SPKT patient who survived over 10 years without cardiovascular complications under effectively immunosuppressive and anti-hypertensive medication. A 43-year-old man diagnosed as hypertension and type 1 DM with ESRD underwent SPKT at our hospital in December 2004. The body weight, body height, and body mass index of the patient were 171 cm, 62 kg, and 21.2 kg/m2, respectively. He had been received hemodialysis therapy for 3 years. His blood glucose was unstable despite the treatment of oral drugs and insulin injection. His blood pressure was well-controlled under the combination of diuretic and calcium channel blockers. The systolic and diastolic blood pressure maintained