후복막섬유증 5례의 임상적 고찰

정충식,김수현,안병수,심대성,박도영,김철성,장대수 조선대학교 1994 The Medical Journal of Chosun University Vol.19 No.1

Retroperitoneal fibrosis is a fibrotic process of the retroperitoneum that frequently produces ureteral obstruction. It can occur as an idiopathic disease or in association with various non-malignant and malignant condition. In the early phase of the retroperitoneal fibrosis ; symptoms originate from the disease process itself, while in the late state the clinical features represent the effect of obstructive uropathy and renal failure. Treatment consist of steroid therapy, urinary diversion and ureterolysis with jntraperitonealization or lateralization or wrapping with omentum. Herein we present 5 cases of retroperitoneal fibrosis.

고지방 케톤 생성 식이를 먹인 백서 뇌에서 단백질 발현의 변화

정현정,윤도준 관동대학교 의과학연구소 2001 關東醫大學術誌 Vol.5 No.1

Ketogenic diet has been known to be effective on the treatment of epilepsy for a long period. Recently ketogenic diet therapy was revitalized because it was known to be a good treatment modality for the intractable childhood epilepsy. The clinical efficacy of the ketogenic diet has now been well-documented. Although a number of suggestions regarding underlying mechanism have been proposed, the mechanism of ketogenic diet on the epilepsy is still uncertain. To search the protein related to the mechanism of ketogenic diet therapy, in this study we have induced the ketosis in young rat by feeding high-fat ketogenic diet and analyzed the alteration of protein expression in the brain using SDS-PAGE and 2D electrophoresis technique. Some proteins were newly expressed in the rat brain fed on ketogenic diet, however, others were only found in the rat brain fed on normal diet. We conclude that ketogenic diet feeding makes changes of protein expression in rat brain, and these changes may be associated with the mechanism of ketogenic diet therapy.

免疫細胞 및 腫瘍細胞에 미치는 丹蔘의 效果

鄭鉉雨,姜聲度,陳千植 대한동의병리학회 1998 동의생리병리학회지 Vol.12 No.2

免疫은 人體內에서 어떤 요인으로 인해서든지 異物이 침입하거나 變異細胞가 발생하면 Immune system이 관여하여 異物은 물론 새로이 발생된 變異細胞를 非自己로 인식하여 처리하는 能力을 발휘함으로써 個體의 恒常性을 維持하려는 현상을 말하고, 이러한 免疫作用에 관여하는 細胞는 特異性 免疫에 관여하는 免疫細胞外에도 Macrophage, NK cell, 수지상세포 및 랑게르한스 세포등을 들 수 있으며, 腫瘍은 組織이 自律的으로 過剩 成長한 것으로 이것은 개체에 대해서 意義가 없거나 이롭지 않을뿐더러 正常組織에 대해서 破壞的인 작용을 하는 것으로 東醫學에서는 正氣補養 및 補血을 爲主로하면서 破積·活血·解鬱·行氣등의 治法들을 兼用하고 있고, 西醫學에서는 手術療法, 放射線療法, 化學療法 및 免疫療法과 遺傳子療法등을 使用하나 癌腫에 따른 感受性과 治療 後의 經過 그리고 副作用이 각기 다르고, 또 이에 따른 많은 문제점들을 안고 있는 것이다. 癌細胞의 增殖을 抑制하는 方法에는 necrosis와 apoptosis가 있는데, apoptosis란 necrosis(세포괴사)와는 대조되는 용어로 초기에 핵의 응축, 세포질의 응축, 수포상의 세포돌기 형성등이 관찰되고, 生體內의 apoptosis는 腫瘍發生時 macrophage에서 분비되는 각종 cytokine에 의해 일어나거나 cytotoxic T-lymphocyte에 의해 일어나는 것으로 抗癌劑들의 부작용 및 tumor regression과 관계가 있는 것으로 알려져 있다. Nitric oxide(NO)는 cNOS와 iNOS 2 종류가 있으며 cNOS는 vascular endothelium 및 brain에서, iNOS는 활성화된 macrophage 및 여러 세포에서 발견되었다. Macrophage가 생산하는 NO는 生體內에서 癌細胞를 공격하여 傷害시키는 癌 免疫의 effector로서 그 역할을 하고 있고, 癌細胞의 增殖을 抑制한다. 丹蔘은 活血祛瘀시키면서 凉血安神시기 때문에 産後瘀滯腹痛·경폐징하·心腹刺痛과 熱毒으로 인한 癰腫·瘡瘍등에 利用되고, 最近에는 肝臟腫大와 動脈硬化症, 그리고 食道癌·胸腺癌 및 腹腔腫瘍에도 사용하고 있는 藥物로 本 硏究에서는 丹蔘에 대한 癌細胞 增殖 抑制作用과 免疫細胞 增强作用을 관찰한 결과 丹蔘은 In vitro上에서 A431 cell line과 KHOS-NP cell line의 增殖을 抑制하지는 않았지만 마우스 胸腺 및 脾臟細胞의 增殖을 活性化시켰다. 그러나 腹腔 macrophage에서 생성되는 NO는 丹蔘에 의해 in vitro상에서 억제되었고 in vivo상에서도 對照群과 큰 차이를 보이지 않았는데, 이는 丹蔘이 腹腔 macrophage의 活性化보다는 T-lymphocytes나 splenocytes의 增殖에 작용하는 것으로 思料된다. To investigate effect of water extract of Salviae Radix on human cancer cell-lines and immunocytes, this research estimated the proliferation of A431 cell lines, KHOS-NP cell lines, mouse thymocytes and mouse splenocytes, nitric oxide(NO) production from peritoneal macrophages, apoptosis and sub-population of mouse thymocytes. The result were obtained as follows ; 1. Salviae Radix wasn't effect the proliferation of A431 cell lines and KHOS-NP cell lines. 2. Salviae Radix was accelerate the proliferation of mouse thymocytes and splenocytes. 3. Salviae Radix was not accelerate the NO production from peritoneal macrophages in vitro. 4. Salviae Radix was inhibited the NO production from peritoneal macrophages in vivo. 5. Salviae Radix was accelerate the induction of apoptosis and sub-population of the mouse thymocytes.

Lipomyces starkeyi KSM 22 Glucanhydrolase 함유 용액의 치은 섬유아세표에 대한 영향

윤현정,정현주,김옥수,김도만 전남대학교 치의학연구소 2002 구강과학 Vol.14 No.3

A novel glucanhydrolase from a mutant of Lipomyces starkeyi KSM 22 has additional amylase activity besides mutanolytic activity and has been suggested as promising anti-plaque agent. It has been shown effective in hydrolysis of mutan, reduction of mutan formation by Streptococcus mutans and removal pre-formed sucrose-dependent adherent microbial film and has been strongly bound to hydroxyapatitie. These in vitro properties of Lipomyces starkeyi KSM 22 glucanllydrolase are desirable for its application as a dental plaque control agent. In human experimental gingivitis model and 6month clinical trial. mouthrinsing with Lipomyces starkeyi KSM 22 dextranase was comparable to 0.12% chlorhexidine mouthwash in inhibition of plaque accumulation and gingival inflammation and local side effect was negligible. This study was aimed to evaluate the cytotoxic effect of Lipomyces starkeyi KSM 22 glucanhydrolase on human gingival fibroblasts. Primary culture of human gingival fibroblasts at the 4th to 6th passages were used. Glucanhydrolase solution was made from lyophilized glucanhydrolase powder from a mutant of Lipomyces starkeyi KSM 22 solved in PBS and added to DMEM to the final concentration of 0.5, 1, and 2unit. Cells were exposed to glucanhydrolase solution or 0.1% chlorhexidine and the cells cultured in DMEM with 10% FBS and 1% antibiotics as control. After exposure, the morphological change, cell attachmcnt. and cell activity by MTT assay were evaluated in 0.5, 1.5, 3, 6, 24 hours after treatment. The cell proliferation and cell activity was also evaluated at 2 and 7days after Iminute exposure, twice a day. The cell morphology was similar between the Lipomyces starkeyi KSM 22 glucanllydrolase groups and control group during the incubation periods. while most fibroblasts remained as round cell regardless of incubation time in the chlorhexidine group. The numbers of the attached cells in the glucanhydrolase groups were comparable to that of control and significantly higher than the chlorhexidine group. The numbers of the proliferated cells in the glucanhydrolase groups at 7 days of incubation were comparable to the control group and higher than the chlorhexidine group. The cell activity in glucanhydrolase groups paralleled with the increased cell number by attachment and proliferation. According to these results, Lipomyces starkeyi KSM 22 glucanhydrolase has little harmful effect on attachment and proliferation of human gingival fibroblasts, in contrast to 0.1% chlorhexidine which was cytotoxic to human gingival fibroblasts. Therefore this glucanhydrolase preparation is considered as a safe and promising agent for new mouthwash formula in the near future.

HMG-CoA 환원효소 억제제에 의한 ICAM-1 유전자의 발현조절

김현진,정효균,홍우정,김군순,조영석,김도희,채수흥,구본정,송민호,노흥규,김영건 충남대학교 의과대학 지역사회의학연구소 2001 충남의대잡지 Vol.28 No.1

Background : ICAM-1 act as one of major adhesion molecules in the atherosclerotic lesion. ICAM-1 expression is mainly regulated at the level of transcription and depend on IFN-γ signal transduction pathway in which the STAT1 transcrption factor is a critical intermediate. IFN-γreceptor not only initiates tyrosine 701 phosphorylation of STAT1 by Jak1 and Jak2, but also phosphorylates serine 727 through the activation of Raf-1/MAP kinases. HMG-CoA reductase inhibitors have anti-atherosclertic effects, beyond normalization of hypercholesterolemia, by directly acting on endothelial cells, macrophages and vascular smooth muscle cells. HMG-CoA reductase inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibition posttranslational farnesylation and geranyl-geranylation processing of small GTP-binding preoteins and inhibition of normal signaling activities. Method : We made several 5'-deletion constructs of rat ICAM-1 promoter and analyzed the promoter activities by measuring the luciferase activity after transfection into ECV304 cells and smooth muscle cells. We checked the level of total and phosphorylated STAT1 protein by immunoblot analysis using specific antibodies. Results : Lovastatin inhibits IFN-γ-induced ICAM-1 gene expression in the ECV304cell. The cells pretreated with PD98059, MEKK inhibitor showed significantly low ICAM-1 RNA induction with IFN-γ stimulatio. IFN-γ induced phosphorylation of tyrosine 701 was not significantly changed by the pretreatment of lovastatin. But lovastatin suppresses IFN-γ-induced phosphorylation of ERK1/ERK2 which are responsible for the seine 727 phosphorylation in STAT1. Conclusion : We showed that HMG-CoA reductase inhibitors, lovastatin, suppresses IFN-γ mediated ICAM-1 gene expression through the inhibition of transcription. HMG-CoA reductase inhibitor suppresses IFN-γ-induced phosphorylation of serine 727 in STAT1 through the modulation of MAP kinases.

불량행위 청소년을 중심으로 한 학교폭력 가해자의 사회인구학적 특성 및 정신병리(V)

박지도,최현경,장우성,조동환,김정기 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : 이 연구는 불량행위 청소년군과 학생군을 대상으로 학교내외에서 행하는 폭력행동의 특징을 알아보고 특히 가해자의 정신병리와 청소년의 폭력행동과의 관계를 알아봄으로써 학교폭력의 이해와 대처방법 그리고 예방프로그램의 수립에 도움이 되고자 한다. 방 법 : 불량행위 청소년(청소년 선도프로그램인 BBS참석자) 남자 331명과 남자 중고등학교생 394명을 폭력의 유형을 괴롭힘, 금품갈취, 신체적 폭력, 언어적 폭력, 위협 등의 5가지 유형으로 나눈 설문문항을 바탕으로 각 경우의 경험빈도를 5점 척도로 하여 각 문항에서 3점 이상을 가해자군으로 분류하였으며 설문지를 통한 조사와 정신병리의 측정도구로서 한국판 아동-청소년 문제행동 평가 척도표(CBCL : Child Behavior Checklist, 청소년용)및 청소년의 자기개념을 알아보기 위해 한국판 피어스-해리스 소아 자기 개념척도(Piers-Harris Children's Self-Concept Scale, Piers, 1984, 이하 자기개념척도)를 적용하였으며 Chi-square test, T-test, 그리고 Two-way ANOVA를 사용하여 비교하였다. 결 과 : 사회 인구학적 특성에서는 대부분의 요인에서 불량행위군과 학생군 그리고 가해자군과 비가해군간에 차이는 보이지 않았으나 흡연과 음주하는 비율이 불량행위군과 학생군 두 군 모두 가해자군이 비가해자군보다 의미있게 높게 나타났다. 부모의 부부싸움 빈도는 불량행위군에서는 가해자와 비가해자군간에 차이를 보이지 않았으나 학생군에서는 가해자군에서 종종 싸운다는 비율이 의미있게 높게 나타났다. 학교생활에서는 성적이나 교우관계에서는 두 군 사이와 가해여부에 따라 유의한 차이를 보이지는 않았으며 성적은 불량행위군이 학생군에 비해 낮은 반면 가해여부에 따라서는 차이가 없었다. 하지만 학생군에서는 가해자군이 비가해자군보다 성적이 낮았으며 만화방을 이용하는 빈도도 가해자군에서 높게 나타났다. 폭력물 시청 시 느낌은 불량행위군과 학생군 모두에게서 가해자군이 비가해자군에 비해 흥분된다는 비율이 높게 나타났다. CBCL(Child Behavior Checklist)척도는 불량행위군의 경우 비행, 공격성, 외현화, 사회성 척도가 학생군에 비해 유의하게 높았고 위축, 사회적 미성숙, 사고문제, 주의집중, 내재화 척도는 학생군에서 불량행위군에 비해 유의하게 높았다. 전체 대상군을 가해자군과 비가해자군으로 나누어 비교하였을 때 신체증상, 사고문제, 주의집중, 비행, 공격성, 내재화, 외현화척도에서 가해자군이 비가해자군에 비해 유의하게 높았으며 군과 가해여부의 상호작용효과 검증결과에서는 유의한 상호작용을 보이는 척도는 없었으나 각 집단의 모든 척도에서 가해자군이 비가해자군보다 높은 점수를 보여주었으며 불량행위군의 경우 가해자군일수록 비행, 공격성, 외현화 척도가 높아지는 경향을 보였으며 학생군의 경우에서도 마찬가지로 비행, 공격성, 외현화 척도에서 가해자군이 비가해자군보다 높게 나타났다. 자기개념 척도는 불량행위군의 경우 행동, 지적학업척도에서 학생군에 비해 유의하게 낮게 나타났으며 불안, 인기척도는 학생군에서 불량행위군보다 유의하게 낮게 나타났다. 전체 대상군을 가해자군과 비가해자군으로 나누어 비교하였을 때 행동, 지적학업척도는 가해자군이 비가해자군에 비해 유의하게 낮은 점수를 보여주었으며 각 군과 가해여부의 상호작용검증결과에서는 유의한 상호작용효과를 보인 것은 없었으나 두 군 모두 행동척도가 가해자군이 비가해자군에 비해 낮은 경향을 보여주었다. 결 론 : 불량행위군과 학생군에서의 폭력가해자는 사회인구학적 변인에서는 비가해자와 유사한 특징을 가지나 각자의 내재된 심리상태와 정신병리에 따라 폭력 영상물과 음주 흡연의 가능성증가 그리고 가정에서의 폭력의 학습 등 주변의 위해 요인에 가해자군이 비가해자군에 비해 영향을 많이 받는 것으로 생각된다. 이에 학교폭력에 대한 대책수립 시 결과에만 초점을 맞춘 처벌 위주의 방식에서 벗어나 이들이 가진 심리적 특징과 정신병리를 이해하고 그에 따른 예방적인 대책수립이 필요할 것으로 생각된다. Objective : The purpose of this study was to identify the characteristics of school violence, self concept, psychopathology and psychosocial characteristics of male aldolescent delinquency doing school violence. And we hoped to use this result as basic material for prevention of school violence through comparison of those of students group. Method : We surveyed 725 male adolescents including 331 deliquents from educational program called "Big Brothers and Sister" in Pusan. We used self-reporting questionnaire composed of demographic data and attitude to violence. In order to investigate the psychopathology and self-concept, we used Child Behavior Check List, Youth edit, Korean version(CBCL) and the Piers-Harris Children's Self-Concept Scale. Statistical methods employed were Chi-square, t-test, two-way ANOVA. Result : The results show that in most demographic and psychosocial factor including age, education, socio-economic condition, religion and relationship with friends, there was no significant difference between delinquent and student group. And there was no significant difference between bully and non-bully in both group. The frequency of alcohol drinking and smoking were higher in bullying groups. For the feeling of watching violent mass-media, bullying delinquents reported more excited state than non-bullying delinquents in both group. On results of CBCL, subscales of delinquent behavior, aggressive behavior, externalizing problem, social scale in delinquent group were higher than those in student group. Subscale of somatic complaints, thought problem, attention problem, delinquent behavior, aggressive behavior, internalizing problem, and externalizing problem in bullying group were higher than those in nonbullying group. In both delinquent and student group, subscale of delinquent behavior, aggressive behavior, and externalizing problem in bullying group were significantly higher than those in nonbully group. In the results of self-concept scale, subscales of behavior, intellectual and school status in delinquent group were lower than those in student group. Subscale of somatic complaints, thought problem, attention problem, delinquent behavior, aggressive behavior, internalizing problem, and externalizing problem in bullying group were higher than those in nonbully group Conclusion : In both delinquent and student groups, most psychosocial factors in bully group were not significantly different with those in nonbully group. Bully group was more influenced by internal psychic state, psychopathology and environmental factor than nonbully group.

Rifampicin에 의한 것으로 추정되는 위막성 대장염1예

김수현,이은우,정종혁,문승현,김동한,양혁승,오영상,김호동,김도현,박혁,박정환,박경옥,이영직 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Pseudomembranous colitis, caused by altering the normal colonic flora and allowing the multiplication of Clostridium difficile, is an deleterious adverse effect of antibiotics. But it is rarely reported by rifampicin. Rifampicin is one of the first line drug in the treatment of tuberculosis and many patients are exposed to its potential adverse effects. We experienced a patient that had abdominal discomfort and hematochezia due to pseudomembranous colitis after receiving antituberculous medication, and which was probably caused by rifampicin. A 82 years old man was admitted with abdominal discomfort and hematochezia for one week. On the past history he had been diagnosed as endobronchial tuberculosis about 4 months ago. Colonoscopy revealed multiple discrete whitish mucosal lesion on rectosigmoid colon, and histologic findings were consistent with pseudomembranous colitis. The antituberculous agents were discontinued and vancomycin was administered. The patient's symptoms were resolved within several days. There was no recurrence after reinstitution of the antituberculous agents excluding rifampicin. We report here on a case of pseudomembranous colitis probably due to rifampicin.

濟州産 柑橘醱酵酒 蒸溜酒의 熟成條件

高正三,吳現道,高男權,姜順善 濟州大學校 亞熱帶農業硏究所 1992 亞熱帶農業硏究 Vol.9 No.-

제주산 온주밀감을 이용하여 醱酵最適條件에서 얻어진 감귤주의 單式蒸溜하여 알콜농도를 43˚와 60˚로 조절한 다음 불란서산 참나무 술통재의 切片(1×1×3cm)을 浸漬 하여 熟成條件을 검토하였다. 알콜농도 60˚인 증류수중의 메탄올은 0.136g/100㎖, 알데히드는 4.07㎎/100㎖휴젤油는18.35㎎/100㎖, 에스테르는 27.03㎎/100㎖였다. 알콜농도가 높고 온도가 높을수록 참나무성분의 浸出이 잘 일어났으며, 단기간 熟成을 위해서는 다소 고온에서 熟成하는 것이 좋을 것으로 판단되었다. 숙성 pH는 4.1에서 색소침출효과가 좋았으며 자외선 처리효과는 없었다. 色素浸出은 온도에 많은 영향을 받고 있는 것을 알 수 있었으며, 官能檢査 결과 45˚, pH 4.1에서 6개월 熟成時에 외관 및 기호도에서 충분한 상품가치를 나타내었다. 감귤 브랜디의 경우 외국산 유명제품과 큰 차이를 보이지 않아 브랜딩기술의 확립과 熟成技術의 보완한다면 産業化에 대한 충분한 가능성이 있는 것으로 平價되었다. In order to produce citrus brandy made from Citrus unshiu produced in Cheju, aging conditions of citrus fine spirit with dipping oak chip were investigated. Citrus fine spirit prepared with simple distillation of citrus wine was adjusted to 43。 and 60。 alcohol concentration, and then three pieces of oak chip (1×1×3cm) was added to 300㎖ citrus fine spirit. The contents of methanol, aldehyde, fusel oil and ester were 0.136g/100㎖, 4.07mg/100㎖, 18.35mg/㎖ and 27.03mg/100㎖ respectively. The absorbance at 500nm of citrus fine spirit was increased with high alcohol concentration and high temperature. Color extraction from oak chip was mainly affected on temperature, and the effect of UV irradiation was not appeared. Compared with commercial Scotch whisky, citrus brandy adjusted to pH 4.1 and aged at 45℃ for 6 month was good in sensory evaluation.

편마비 환자의 정상측과 마비측의 비복근 운동점에서의 근육 두께 차이

김동건,도현경,김현동,황지선,정규영,정호중 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.1

Objective : To investigate any difference of muscle thickness in the motor points of the gastrocnemius between the paretic and non-paretic legs in hemiplegics. Method : Ultrasonography was used to assess in vivo the gastrocnemius muscle thickness at the motor points in the paretic and non-paretic legs of twenty-four patients with stroke. Results : Muscle thickness at the motor points were reduced in the paretic legs compared to the non-paretic legs (p<0.05). There was no correlation between muscle thickness and duration of hemiplegia, site of hemiplegia. However, it did not take regular pattern of the muscular atrophy in the paretic legs. Conclusion : The gastrocnemius muscle of the paretic leg had smaller thickness compared with the non-paretic leg. The present results indicate that paresis in hemiplegics may affect the accuracy of intramuscular injection of botulinum toxin A. Therefore, we recommend ultrasonography for visually controlled, anatomically precise injection of botulinum toxins.

연쇄알구균 감염에 의한 급성 인후염 후 반응성 관절염 1예

박은하,도연실,양정채,강미라,서현주,정숙인,손준성,기현균,오원섭,백경란,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

연쇄알구균에 의한 급성 인후염 후 발생한 반응성 관절염은 급성 류마티스열의 개정된 진단기준을 충족하지 못하면서, 지속적 혹은 재발성의 비이동성 관절염과 발열, 홍반성 결절, 일시적 간기능 이상 등을 보이면서 심장염과 무도증을 드물게 동반하는 질환이다. 따라서, 발열을 동반한 급성 관절염 환자에서 감별해야 할 질환 중의 하나이며, 심근염 예방을 위한 페니실린 요법의 적응증 및 기간에 대해서는 아직 이론이 많은 상황으로, 보다 광범위한 연구가 필요하다. 저자들은 연쇄알구균에 의한 급성 인후염 1주 후에 발생한 하지의 다발성 비이동성 관절염과 함께 결절홍반 및 일시적 간기능 이상을 보인 환자에서 PSRA로 진단하고 비스테로이드성 항염증제 및 스테로이드로 성공적인 치료를 하였기에 이를 문헌 고찰과 함께 보고하는 바이다. Poststreptococcal reactive arthritis (PSRA) is associated with recent streptococcal infections. However, PSRA is distinct from acute rheumatic fever by its clinical manifestations: non-migrating arthritis, erythema nodosum or erythema multiforme, and transient elevation of serum transaminases. We experienced a 33-year-old man who presented with fever, arthritis of both knees and ankles, and erythema nodosums on extensor surfaces of lower legs which developed 6 days after the onset of pharyngitis symptoms. Blood and urine cultures were negative. Throat culture was negative for group A β-hemolytic streptococcus. The ASO titers increased up to 2080 IU/mL in sequential monitoring. The result of bone scan was compatible to arthritis of both knees and ankles. There were no signs or symptom of carditis. He showed clinical improvement with anti-inflammatory drugs (naproxen 1,000 mg/day and prednisolone 7.5 mg/d). PSRA should be included in the differential diagnosis of patients presenting with arthritis combined with fever.