Mixed Connective Tissue Disease

A study was done that involved 46 patients with high-titer serum antibody to ribonucleoprotein (RNP). Common cutaneous manifestations included swollen hands or sclerodactyly (50 percent), cutaneous lupus erythematosus (48 percent), periungual telangiectasia (46 percent), alopecia (46 percent), dyspigmentation (28 percent), photosensitivity (28 percent) and vasculitis (22 percent). Frequent systemic characteristics included Raynaud phenomenon (93 percent), arthritis or arthralgia (91 percent), adenopathy (43 percent), vascular headaches (35 percent), serositis (35 percent), hoarseness (28 percent), myositis (26 percent), sicca syndrome (24 percent), renal disease (17 percent) and central nervous system disease (9 percent). Associated laboratory findings included antinuclear antibodies (100 percent), epidermal nuclear lgG deposition (91 percent), hypergammaglobulinemia (78 percent), esophageal dysmotility (61 percent), abnormal pulmonary function (59 percent), rheumatoid factor (57 percent), lupus erythematosus cells (37 percent), positive lupus band test (34 percent), hypocomplementemia (28 percent) and elevated anti-nDNA (21 percent).It appears that patients with high-titer anti-RNP (without appreciable amounts of “anti-Sm”) have a high prevalence of Raynaud phenomenon and a low prevalence of progressive renal insufficiency and severe central nervous system disease.     

A Neoplastic Connective Tissue Mast Cell Capable of Continuous Growth In Tissue Culture

A neoplastic connective tissue mast cell from a dog mast cell sarcoma has been grown in tissue culture for 50 passages over a period of 2 years. The cells were grown as monolayer cultures in glass bottles, using Eagle's basal medium fortified with calf serum. The cultures were contaminated with an Alkaligenes sp. for 10 months but finally were sterilized bacteriologically by treatment with specific antiserum combined with antibiotics. The cells grow in a fibroblastic pattern, and contain mitochondria, mast cell granules, and lipid granules or droplets. The mast cell granules stain basophilic with Giemsa's stain and metachromatically with azure A or toluidine blue. They also stain with Sudan black B and with periodic acid-Schiff stain. The interphase nuclei are vesicular, contain from 1 to 20 nucleoli, and frequently show bizarre outlines. Multinucleate cells are often seen, as are mitotic figures. Extracellular fibrous material occurs in all cultures and apparently originates from the cell surface. This material does not have the structure of connective tissue fibers and has not been identified. The cells develop an increased number of metachromatic granules when grown in medium containing heparin and an increased number of sudanophilic granules when grown in medium containing stearic acid. Only small amounts of histamine were present in the tumor from which this cell line was derived and in the cells grown in tissue culture.     

Cardiovascular Involvement in Connective Tissue Disease: The Role of Interstitial Lung Disease

Objective

The aim of this study was to assess cardiovascular involvement in patients with connective tissue disease (CTD), and determine whether interstitial lung disease (ILD) in these patients is associated with elevated cardiovascular risk.

Methods

This study evaluated a retrospective cohort of 436 CTD patients admitted to a large teaching hospital in Zhejiang province, China, along with an additional 436 participants of an annual community health screening conducted in the physical examination center who served as age- and gender-matched controls. Demographic, clinical, serologic and imaging characteristics, as well as medications used by each participant were recorded. Cardiovascular involvement was defined by uniform criteria. Correlations between clinical/serologic factors and cardiovascular involvement were determined by univariate and multivariate analyses.

Results

CTD patients had a significantly higher cardiovascular involvement rate than controls (64.7% vs 23.4%), with higher rates of diabetes, hypertension, and hyperlipidemia, elevated systolic and diastolic pressures, C-reactive protein, total cholesterol, and low-density lipoprotein cholesterol, and lower albumin and high-density lipoprotein cholesterol (all p < 0.05). Furthermore, CTP patients with cardiovascular involvement were significantly older, had higher systolic and diastolic pressures, C-reactive protein, glucose, and uric acid, higher rates of diabetes, hypertension, and use of moderate- to high-dose glucocorticoids, and longer disease duration compared to patients without involvement (all p < 0.05). Moreover, CTD in patients with cardiovascular involvement was more likely to be complicated by ILD (p < 0.01), which manifested as a higher alveolar inflammation score (p < 0.05). In the multivariate analysis, cardiovascular involvement in CTD patients was associated with age, systolic pressure, body mass index, uric acid, disease duration > 2 years, use of moderate- to high-dose glucocorticoids, and ILD with a high alveolar inflammation score.

Conclusion

Cardiovascular involvement is increased in CTD patients, and is associated with ILD with a higher alveolar inflammation score. Thus, early-stage echocardiography and CT scans should be used to detect potential cardiovascular complications in these patients.     

结缔组织病患者活动期血凝增加机制研究

目的：评价不同结缔组织病患者活动期和健康对照者血液中嗜酸性粒细胞中组织因子(TF)表达的变化。方法：研究对象为9 例处于活动期的不同类型结缔组织病患者和9 例健康对照者，分离结缔组织病患者和正常对照者外周血中嗜酸性粒细胞。用 western blot和RT-PCR检测嗜酸性粒细胞中TF蛋白及mRNA水平变化情况。结果：发现结缔组织病患者嗜酸性粒细胞中TF蛋 白表达水平显著高于正常对照者(P<0.001)；结缔组织病患者嗜酸性粒细胞中TF 的循环阈值(Ct)中位数是35.10 (19.45-36.50)，正 常对照者为37.17 (35.33-37.87)，患者中TF mRNA水平明显高于正常对照者(p = 0.002)。结论：我们的结果证实人血液嗜酸性粒细 胞中TF表达会发生变化。结缔组织病患者活动期高表达TF可能有助于血液凝固性增加。     

Periodic-Acid-Foot Stain for Connective Tissue

A marked increase in reticular argyrophilia may be obtained in the Foot ammoniated silver carbonate technic by interposing a strong periodic acid oxidation, 4% aqueous for 2 hours at 25-27°C., prior to silvering. Sections so oxidized before the silver bath show a histological picture of connective tissue that is stronger than that given by the original technic. Stroma of lymphoid tissues (but not other types) is further intensified by brief (5-10 sec.) passage through aqueous 1.5% uranium nitrate after oxidation but before silver impregnation. The specific action of periodic acid (cleavage of the 1,2-glycol linkage to produce aldehyde radicals) strengthens the premise that the carbonyl radical plays an important part in the phenomenon of connective tissue argyrophilia.     

Significance of Pulmonary Arterial Pressure as a Prognostic Indicator in Lung-Dominant Connective Tissue Disease

Background

Lung-dominant connective tissue disease (LD-CTD) is a new concept for classifying the subset of patients with interstitial pneumonia who have clinical features suggesting an associated CTD, but whose features fall short of a clear diagnosis of CTD under the current rheumatologic classification systems. The impact of mean pulmonary arterial pressure (MPAP) in LD-CTD has not been sufficiently elucidated.

Objectives

To evaluate the survival impact of MPAP measured during the initial evaluation in patients with LD-CTD.

Methods

We retrospectively analyzed the initial evaluation data of 100 LD-CTD patients undergoing pulmonary function test, 6-min walk test (6MWT), and right heart catheterization (RHC).

Results

The mean MPAP was 16.2±4.4 mm Hg, and 18 patients had MPAP≥20 mm Hg. A univariate Cox proportional hazard model showed that MPAP and several variables have a statistically significant impact on survival. With stepwise, multivariate Cox proportional analysis, MPAP (HR  = 1.293; 95% CI 1.130–1.480; p<0.001) and mean forced vital capacity (FVC) % predicted (HR = 0.958; 95% CI 0.930–0.986; p = 0.004) were shown to be independent determinants of survival.

Conclusions

Higher MPAP and lower %FVC at the initial evaluation were significant independent prognostic factors of LD-CTD. MPAP evaluation provides additional information of disease status and will help physicians to predict mortality in LD-CTD.     

Mallory's Connective Tissue Stain Following Hematoxylin

The following combination of hematoxylin with Mallory's connective tissue stain is useful in bringing out nuclei as well as in differentiating tissue:

Slightly overstain in Mayer's hematoxylin (50 g. potassium alum and 0.2 g. sodium iodate added to 1 liter 0.1% aqueous hematoxylin). Wash; and stain 30 seconds to 1 minute in 0.04% aqueous acid fuchsin-Stain 4 minutes in: 0.5 g. anilin blue and 2 g. orange G dissolved hi 100 cc. of 1% aqueous phosphomolybdic acid. Pass thru 95% alcohol to absolute; clear in xylol and mount in balsam.     

THE SMOOTH MUSCLE CELL : I. In Vivo Synthesis of Connective Tissue Proteins

These studies have examined the ability of smooth muscle cells from developing aorta of the prepubertal rat to utilize amino acids in the synthesis and secretion of connective tissue proteins. Prepubertal rats, previously given either an alcohol carrier or estradiol-17-beta, were each given an intravenous injection of proline-³H. The animals were sacrificed after 15 and 30 min, and 4 hr. Light and electron microscope radioautographs of the aortic smooth muscle and of the myometrial cells demonstrated that the aortic cells, in both groups of animals, and the myometrial cells, in the estrogen-stimulated animals, took up the proline and rapidly secreted it in both collagen and elastic fibers within 4 hr. In contrast, the myometrial cells of the nonstimulated animal took up relatively small amounts of proline and retained most of the amino acid within the cells. Electron microscope radioautographs demonstrated that the organelles involved in this activity were the rough endoplasmic reticulum and Golgi complex together with peripheral elements, presumed to be small vesicles. These studies have demonstrated that the smooth muscle cells of the developing aorta and of the estrogen-stimulated myometrium have a capacity to synthesize and secrete proteins associated with the extracellular connective tissue matrix.     

结缔组织生长因子在慢性阻塞性肺疾病血管重建中表达研究

目的：探讨结缔组织生长因子（CTGF）在慢性阻塞性肺疾病（COPD）血管重建中的表达及意义。方法：将30例有吸烟史的男性鳞癌需要手术的患者按其肺功能结果分成二组,对照组：（肺功能正常组）;COPD稳定期组：（肺功能异常组）,每组15例,标本来自于癌旁的肺组织,肺血管重塑的形态学观察行HE和MASSON三色染色,行免疫组化来观察CTGF蛋白、PCNA蛋白在肺血管平滑肌中的表达。结果：（1）COPD组肺动脉管壁面积/管总面积（WA%）、管壁的胶原厚度、肺动脉平滑肌中CTGF蛋白及PCNA蛋白的表达与对照组相比差异有统计学意义。（2）CTGF与管壁面积/管总面积（WA%）、管壁的胶原厚度及血管平滑肌中PCNA表达呈正相关（,r值分别为0.81、0.68、0.86,P〈0.05）。吸烟指数与管壁面积/管总面积及PCNA的表达呈正相关（r=0.73,0.99,P〈0.01）。结论：单纯吸烟者即有血管重建,吸烟伴COPD者血管重建更加严重,CTGF在COPD患者肺血管中的表达较对照组高,可能参与了COPD血管重建过程。     

结缔组织生长因子在慢性阻塞性肺疾病血管重建中表达研究

目的:探讨结缔组织生长因子(CTGF)在慢性阻塞性肺疾病(COPD)血管重建中的表达及意义。方法:将30例有吸烟史的男性鳞癌需要手术的患者按其肺功能结果分成二组,对照组:(肺功能正常组);COPD稳定期组:(肺功能异常组),每组15例,标本来自于癌旁的肺组织,肺血管重塑的形态学观察行HE和MASSON三色染色,行免疫组化来观察CTGF蛋白、PCNA蛋白在肺血管平滑肌中的表达。结果:(1)COPD组肺动脉管壁面积/管总面积(WA%)、管壁的胶原厚度、肺动脉平滑肌中CTGF蛋白及PCNA蛋白的表达与对照组相比差异有统计学意义。(2)CTGF与管壁面积/管总面积(WA%)、管壁的胶原厚度及血管平滑肌中PCNA表达呈正相关(,r值分别为0.81、0.68、0.86,P<0.05)。吸烟指数与管壁面积/管总面积及PCNA的表达呈正相关(r=0.73,0.99,P<0.01)。结论:单纯吸烟者即有血管重建,吸烟伴COPD者血管重建更加严重,CTGF在COPD患者肺血管中的表达较对照组高,可能参与了COPD血管重建过程。     

结缔组织生长因子与肾脏纤维化

结缔组织生长因子属于CNN家族,是TGF-β的下游因子,它的表达受到TGF-β强烈诱导。结缔组织生长因子介导了FN、ColⅠ、ColⅢ、ColⅣ等mRNA及蛋白的表达,在纤维化的过程中可能起着重要的作用。