Ankylosing spondylitis coexisting with Clonorchis sinensis infection: A case report

BACKGROUND Ankylosing spondylitis(AS)is a chronic immune-mediated inflammatory disease.The prevailing theory links AS onset to infections in susceptible individuals.Furthermore,infections may impair the immune responses.Numerous studies have investigated links between AS and various infections-bacterial,viral,fungal,and other microorganism infections.However,limited attention has been given to the association between AS and Clonorchis sinensis(C.sinensis)infection.CASE SUMMARY A 27-year-old male with a 10-yr history of AS presented to our hospital with inflammatory lower back pain as the primary manifestation.Ten years ago,the patient had achieved a stable condition after treatment with biological agents.However,he experienced a recurrence of lumbosacral pain with an unexplained cause 10 d before hospital admission.A lumbosacral magnetic resonance imaging(MRI)scan revealed bone marrow edema in the left sacroiliac joint,and laboratory indicators were elevated.Moreover,the presence of C.sinensis eggs was detected in the stool.The patient was prescribed praziquantel,resulting in the disap-pearance of C.sinensis eggs in subsequent routine stool tests and relief from lumbosacral pain.A follow-up MRI scan performed after 4 months revealed a reduction in bone marrow edema around the left sacroiliac joint.CONCLUSION C.sinensis infections could potentially trigger the exacerbation of AS.Clinicians should pay attention to investigating the presence of infections.INTRODUCTION Ankylosing spondylitis(AS)is a chronic inflammatory and rheumatic disease resulting from an imbalance between innate and acquired immune responses[1].While it can affect any part of the spine,its primary symptoms are persistent back pain and stiffness in the lower back and pelvis.The prevalence of AS per 10000 individuals is 23.8 in Europe,31.9 in North America,16.7 in Asia,10.2 in Latin America,and 7.4 in Africa[2].Infections commonly occur in the first 3 months and may act as potential triggers for the first symptoms of AS,often manifesting as gastrointestinal,urinary tract,and respiratory infections of microbiological origin[3,4].Clonorchis sinensis(C.sinensis)infection is a severe parasitic disease affecting millions globally,especially prevalent in China,South Korea,the Far East of Russia,and Vietnam,with an estimated 15 million cases[5].Transmission occurs through the consumption of undercooked freshwater fish containing metacercariae.Adult C.sinensis parasites then establish themselves within the human hepatobiliary system[6].C.sinensis infection triggers the activation of sphingosine 1-phosphate receptor 2,leading to the injury and fibrosis of the hepatobiliary[7].Recent research in a rat model found that C.sinensis infection increases the risk of hepatocellular carcinoma by stimulating hepatic progenitor cell proliferation[8].Complications of C.sinensis infection include cholestasis,cholangitis,biliary system fibrosis,and in severe cases,the development of cholangiocarcinoma[9].Consequently,the primary preventive measure is to abstain from consuming raw or undercooked freshwater fish.Praziquantel is the recommended and effective treatment for this infection[10].While there is existing literature on the coexistence of AS and parasitic infections,there is limited research specifically addressing the simultaneous presence of AS and C.sinensis infection.This case report details a rare scenario of AS coexisting with C.sinensis infection,underscoring the potential impact of C.sinensis infection on AS disease activity.

Spontaneous intra-abdominal hematomas in a hepatocellular carcinoma patient treated with lenvatinib:a case report

A 44-year-old patient was admitted with tumor rupture in the left hepatic lateral lobe,and he underwent emergent exploratory laparotomy and proceeded for hepatic left lateral lobectomy on September 19,2021.The final diagnosis of hepatocellular carcinoma was confirmed by histopathological examination of the surgical specimen.Afterward,the patient received hepatic arterial infusion chemotherapy with FOLFOX(oxaliplatin,fluorouracil,and leucovorin)for 5 cycles.Subsequently,recurrence of the hepatocellular carcinoma was diagnosed in the abdominal cavity.The patient was then treated with lenvatinib.Within less than 1 month of the treatment with lenvatinib,the patient was admitted to the emergency room on June 2,2022,because of acute intra-abdominal bleeding(hematomas).Percutaneous intra-abdominal angiography found that the bleeding vessels were the right gastroepiploic artery and left gastric artery.The patient was stabilized after arterial embolization using gelatin sponges.The diagnosis and management of spontaneous intra-abdominal hematomas are discussed.

Effect of magnetic resonance imaging in liver metastases

This letter to the editor is a commentary on a study titled"Liver metastases:The role of magnetic resonance imaging."Exploring a noninvasive imaging evaluation system for the biological behavior of hepatocellular carcinoma(HCC)is the key to achieving precise diagnosis and treatment and improving prognosis.This review summarizes the role of magnetic resonance imaging in the detection and evaluation of liver metastases,describes its main imaging features,and focuses on the added value of the latest imaging tools(such as T1 weighted in phase imaging,T1 weighted out of phase imaging;diffusion-weighted imaging,T2 weighted imaging).In this study,I investigated the necessity and benefits of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid for HCC diagnostic testing and prognostic evaluation.

The Correlation Between Decreased Ornithine Level and Alleviation of Rheumatoid Arthritis Patients Assessed by a Randomized,Placebo-Controlled,Double-Blind Clinical Trial of Sinomenine

Sinomenine(SIN)is commonly used as part of rheumatoid arthritis(RA)therapy in China,but there is still no published evidence of the efficacy of SIN monotherapy.This work investigates the efficacy and safety of SIN in treating RA patients and analyzes the correlation between ornithine level and the alleviation of disease activity in RA patients.In this 24 week,randomized,placebo-controlled,double-blind clinical trial,people with mild to moderate RA were randomly assigned(1:1:1,stratified by hospital)to receive SIN(120 mg,twice daily),methotrexate(MTX)(10 mg per week),or SIN+MTX therapy.The primary outcome was the proportion of patients who achieved a 50%improvement in the American College of Rheumatology(ACR50)criteria at week 24 and who showed improvement according to the clinical disease activity index(CDAI).In this prospective subgroup analysis,we also assessed whether the 24-week alterations of disease activity in the treatment group were significantly correlated to the levels of blood ornithine.Of the 135 enrolled participants,38,39,and 36 patients were treated with SIN,MTX,and SIN+MTX,respectively.In the SIN-treated group,52.63%of patients achieved ACR50 after 24-weeks of treatment,which was comparable to the results in the MTX-treated and SIN+MTX-treated groups.Hepatic and gastrointestinal disorders were the main adverse events;however,the ratio of patients suffering from hepatic disorder in the SIN group(1/38)was much lower than that in the MTX(10/39)and SIN+MTX(8/36)groups.A total of 221 serum samples were collected at the four follow-up time points in the three treatments,and the levels of ornithine,citrulline,and arginine were obtained through ultrahigh performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UHPLC-Q-TOF/MS).The serum ornithine level decreased after the 24-week treatment along with a decrease in disease activity,and may reflect therapeutic responses with a sensitivity value of 80%.In conclusion,SIN revealed a comparable efficacy to MTX for treating RA patients,but with fewer side effects.In addition,the serum ornithine level was found for the first time to have a close correlation with the alleviation of RA,which shows the value of this measure as an assessment indicator of drugs in treating RA.

Effect of glucocorticoid inhalation combined with oral montelukast on airway function and serum inflammatory cytokines in patients with bronchial asthma

Objective:To study the effect of glucocorticoid inhalation combined with oral montelukast on airway function and serum inflammatory cytokines in patients with bronchial asthma. Methods: 138 patients diagnosed with bronchial asthma in our hospital between August 2014 and February 2016 were selected and randomly divided into two groups (n=69), observation group received oral montelukast combined with symbicort inhalation treatment, and control group received symbicort inhalation treatment. 3 months and 6 months after treatment, spirometer was used to measure the airway function parameters, and enzyme-linked immunosorbent assay kits were used to determine Th1/Th2, Treg/Th17 and Th9/cTfh cytokine content. Results:3 months and 6 months after treatment, 1 second (FEV1)/forced vital capacity (FVC), tidal expiratory flow at 25%, 50%and 75%of tidal volume (TEF25%, TEF50%and TEF75%) of observation group were significantly higher than those of control group (P<0.05);serum interleukin-2 (IL-2), interferon-γ (IFN-γ), tumor necrosis factor (TNF-α), IL-10 and transforming growth factor (TGF-β) levels of observation group were significantly higher than those of control group (P<0.05) while IL-4, IL-6, IL-17, IL-22, IL-9 and IL-21 levels were significantly lower than those of control group (P<0.05). Conclusions:Montelukast combined with conventional inhalation treatment of bronchial asthma can more effectively improve the airway function and inhibit the airway inflammatory response mediated by Th1/Th2, Treg/Th17 and Th9/cTfh imbalance.

Sphingolipid inhibitor response gene GhMYB86 controls fiber elongation by regulating microtubule arrangement

Although the cell membrane and cytoskeleton play essential roles in cellular morphogenesis,the interaction between the membrane and cytoskeleton is poorly understood.Cotton fibers are extremely elongated single cells,which makes them an ideal model for studying cell development.Here,we used the sphingolipid biosynthesis inhibitor,fumonisin B1(FB1),and found that it effectively suppressed the myeloblastosis(MYB)transcription factor GhMYB86,thereby negatively affecting fiber elongation.A direct target of GhMYB86 is GhTUB7,which encodes the tubulin protein,the major component of the microtubule cytoskeleton.Interestingly,both the overexpression of GhMYB86 and GhTUB7 caused an ectopic microtubule arrangement at the fiber tips,and then leading to shortened fibers.Moreover,we found that GhMBE2 interacted with GhMYB86 and that FB1 and reactive oxygen species induced its transport into the nucleus,thereby enhancing the promotion of GhTUB7 by GhMYB86.Overall,we established a GhMBE2-GhMYB86-GhTUB7 regulation module for fiber elongation and revealed that membrane sphingolipids affect fiber elongation by altering microtubule arrangement.

Efficacy of Rebixiao Chinese herbal tablets and Chinese formula granules in acute gout arthritis patients:a randomized,multicenter,double-blind,controlled trial

OBJECTIVE:To evaluate the clinical efficacy and safety of Rebixiao(RBX)Chinese herbal tablets(CHT)and Chinese formula granules(CFG)in the treatment of acute gout arthritis(AGA).METHODS:This randomized,multicenter,double-blind,controlled trial included 165 AGA patients with the damp-heat symptom pattern who were randomly divided into an RBX CHT group and an RBX CFG group and treated for 7 d at three centers.The total effective rates of the joint symptom score,Traditional Chinese Medicine(TCM)symptoms score,erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP)were used to evaluate the clinical efficacy.Safety assessments were also performed.RESULTS:Of the 165 enrolled patients,147 completed the clinical observation.There was no difference in baseline between the two groups.The total effective rates of the joint symptom score were 94.36%and 97.36%,and the total effective rates of the TCM symptoms score were 95.77%and 97.36%in the CFG group and CHT group,respectively.No statistical difference was found between the two groups(P>0.05).Additionally,ESR and CRP were similar in both groups(P>0.05).Furthermore,treatment efficacy regarding TCM and joint symptoms,the ESR,and CRP were consistent within each center and among the different centers(P>0.05).In addition,the incidence of adverse events was 4.22%and 2.63%in the CFG group and CHT group,respectively,and no difference was observed between the two groups(P>0.05).CONCLUSION:RBX CFG and CHT have significant and similar efficacy in the treatment of AGA,and CFG did not increase adverse side effects.