Endoscopic findings of gastrointestinal involvement in Chinese patients with Behcet's disease

AIM:To report the incidence,clinical features and outcomes of gastrointestinal(GI)involvement in Behcet’s disease(BD).METHODS:A total of 168 consecutive patients with BD were screened and upper and lower GI endoscopies were performed in 148 patients.Four hundred age-and sex-matched controls were enrolled for comparison.RESULTS:Fifty-two(35.1%)patients had GI lesions.After a mean follow-up of 10 mo,ileocecal ulcers had been confirmed in 20 patients,including active ulcer(s)in 18 patients,but no ileocecal ulceration was found in controls.GI symptoms were present in 14 patients with active ulcer(s),while 4 patients with smaller ulcer were asymptomatic.Endoscopic features of ileocecalulcer were:a single ulcer(50%),larger than 1 cm in diameter(72.2%),and round/oval or volcano-type in shape(83.3%).Compared with patients without GI involvement,less ocular lesions,lower levels of albumin,erythrocyte count and hemoglobin,and higher levels of C-reactive protein and erythrocyte sedimentation rate were confirmed in the intestinal BD group.Four patients had esophageal ulcers in the BD group but no case in controls.The other endoscopic findings were similar between the two groups.The prevalence of Helicobacter pylori infection was similar in both groups.Most patients received an immunomodulator and responded well.CONCLUSION:GI lesions commonly occur in Chinese BD patients.The most frequently involved area is the ileocecal region.Esophageal ulcer might be a rare but unique lesion.

Expression of FLICE-inhibitory Protein in Synovial Tissue and Its Association with Synovial Inflammation in Juvenile Idiopathic Arthritis

Objective To examine the expression of FLICE-inhibitory protein (FLIP) in juvenile idiopathic arthritis (JIA) and analyze its correlation with synovial inflammation. Methods The expression of FLIP was assessed in 11 JIA and 3 normal synovial tissue samples by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. The cell types expressing FLIP were further characterized,and the correlation of FLIP expression with the degree of synovial inflammation,as well as the activity of caspase 8 was then analyzed. Results RT-PCR revealed the expression of FLIP mRNA in all 11 JIA samples,but not in 3 normal synovial tissues. In JIA,FLIP expression could be found in both the lining and sublining layers,mainly in the macrophage-like cells. Moreover,the expression of FLIP in JIA synovial tissues was positively correlated with the degree of synovial inflammation (r=0.563,P<0.05). Conclusion The expression of antiapoptotic FLIP in JIA synovial tissue and its correlation to accumulation of inflammatory cells in synovial tissue suggests that FLIP potentially extends the lifespan of synovial cells and thus contributes to the progression of joint destruction.

Clinical heterogeneity and five phenotypes identified in pediatric Behçet’s syndrome: a cohort study from Shanghai Behçet’s syndrome database

Objectives Behçet’s syndrome(BS)is a rare disease of unknown etiology,with limited reports especially in pediatric BS.The clinical characteristics and phenotypes of pediatric BS as a highly heterogeneous variable vessel vasculitis were investigated in this study.Methods A cross-sectional study was conducted to compare clinical variables and descriptive characteristics of BS by age of onset and gender.Cluster analysis was then performed to identify the phenotypes of pediatric BS.Results A total of 2082 BS patients were included in this study,1834 adults and 248 children.Compared with adult-onset BS,pediatric BS had a higher incidence of folliculitis[relative risks(RR)and 95%confidence interval(CI)1.3(1.0–1.5)],uveitis of the left eye[RR and 95%CI 2.3(1.0–5.0)],intestinal ulcer complications[RR and 95%CI 2.1(1.1–4.2)],pericarditis[RR and 95%CI 2.5(1.0–6.2)],and psychiatric disorders[RR and 95%CI 2.8(1.0–7.9)],while the incidence of thrombocytopenia was lower[RR 0.2(0.1–1.0)].Among pediatric BS,females had more genital ulcers,while males were more likely to have skin lesions,panuveitis,vascular involvement,venous lesions,cardiac involvement,and aortic aneurysms.Cluster analysis classified pediatric BS into five clusters(C1–C5):C1(n=61,24.6%)showed gastrointestinal(GI)involvement;C2(n=44,17.7%)was the central nervous system(CNS)type where 23 cases overlapped joint involvement;in C3(n=35,14.1%),all patients presented with arthritis or arthralgia;all patients in C4(n=29,11.7%)manifested ocular involvement,with a few patients overlapping with GI involvement or joint damage;C5(n=79,31.9%)was the mucocutaneous type,presenting both oral ulcers,genital ulcers,and skin lesions.Conclusions The clinical features of pediatric and adult BS differ significantly.Male and female pediatric BS also have a distinct demography.Five phenotypes including GI,CNS,joint,ocular,and mucocutaneous types were identified for pediatric BS.

Surgical Intervention for Behcet＇s Disease with Aorta Aneurysm and Pseudoaneurysm： Opposite Outcomes in Two Cases

Behcet＇s disease （BD） is a chronic, relapsing autoimmune disorder characterized by oral and genital ulcerations with uveitis, and additional clinical manifestations in multiple organ systems. The occurrence of vascular involvement in BD is reported to be in the range of 5 30%.

Is Warfarin Indicated in Behcet＇s Syndrome Associated with hrombosis？ Reflections on Treatment and Death of a Patient

A 37-year-old male patient was admitted to Huadong Hospital with diagnosis of Behcet＇s syndrome （BS） for 5 years and deep vein thrombosis （DVT） for 2 months. The patient complained of recurrent oral ulceration, approximately five to seven times per year starting 5 years before presentation. He had a history of genital ulceration one to two times every year. The patient did not follow a strict treatment regimen.

Reply to "Comment to Deep vein thrombosis induced by vasculitis in the Behcet's syndrome"

We appreciate the attention from all the authors of the manuscript entitled "Comment to Deep Vein Thrombosis Induced by Vasculitis in The Behcet's Syndrome".As Behcet's disease belong to one type of vacuities,there is no need to repeat the term as "Vasculitis in The Behcet's Syndrome"and this type of thrombosis is regarded as inflammation related thrombosis,so inflammation is the mechanism,while vasculitis is a diagnostic term,so I recommend of change into Deep Vein Thrombosis Induced by vascular inflammation in patients with Behcet's Syndrome.

Metformin Might Inhibit Virus through Increasing Insulin Sensitivity

To the Editor：Metformin is believed to be the most widely used medication for diabetes as well as the first-line medication for the treatment of type 2 diabetes,especially in patients who are overweight.Metformin is described as a magic medicine currently due to its broad range of potential benefits for polycystic ovary syndrome,cardiovascular disease,and various cancers and even prolonged lifespan.Recently,limited in vitro and in vivo research suggests that metformin may have inhibitory effect on virus,especially hepatitis C virus （HCV）.Besides,it would be amazing if metformin possess antivirus function in hepatitis B virus （HBV）,human immunodeficiency virus （HIV）,etc.,to benefits virus-infected patients from other aspects of mechanism.

Effect of Mechanical Stress in Combination with Verapamil on Levels of Aggrecan and ADAMTS-5 mRNAs and Proteins in Human Osteoarthritic Chondrocyte/Agarose Constructs

To the Editor： Osteoarthritis （OA） has the highest prevalence and economic impact among arthritic maladies and is the most common cause of long-term disability among individuals over 65 years of age. OA is characterized by the degeneration of articular cartilage and the loss of cartilage matrix in affected joints. It is widely accepted that an imbalance between the biosynthesis and the degradation of extracellular matrix （ECM） occurs in OA cartilage.