The disease "Sjögren syndrome" has been widely known as a "syndrome" for a long time. However, this nomenclature and its classification as "primary" and "secondary" have raised debates in recent years. The word "syndrome" denotes an aggregate of symptoms and signs that are associated with a morbid process, independent of pathogenesis. It is now well recognized that "Sjögren syndrome" is an independent systemic autoimmune disease with specific clinical manifestations, serological markers and associated underlying pathogenesis mechanisms. Thus, the use of "syndrome" to designate this disease is not accurate. Furthermore, the traditional distinction between "primary" and "secondary" forms fails to account for the complex interplay between overlapping autoimmune diseases. Based on this background, the International Task Force on Nomenclature of Sjögren disease was established with the aim to develop a rational consensus on the nomenclature of Sjögren syndrome. Following the literature review and collecting experiences from both international professionals as well as patients, the International Task Force on Nomenclature of Sjögren disease published the "2023 International Rome Consensus for the Nomenclature of Sjögren disease" in 2025. The consensus issued five recommendations, officially recommended the use of "Sjögren disease" as nomenclature for this disease, and the acronym "SjD" be used for its abbreviation. It also recommended the descriptor "associated" should be used in lieu of "secondary" for Sjögren disease occurring in association with a second systemic autoimmune disease. The change from "Sjögren syndrome" to "Sjögren disease" improved clarity in both clinical practice and research, highlighted the distinct pathogenesis of this disorder.

Objective: To systematically investigate the rheumatic disease spectrum associated with anti-PM/Scl antibodies and to clarify their clinical significance in idiopathic inflammatory myopathies (IIM). Methods: Patients who were tested positive for anti-PM/Scl antibodies by immunoblotting at Peking University People' s Hospital from January 2016 to December 2024 were enrolled. Clinical and immunolo gical data were systematically collected and compared across the subgroups defined by anti-PM/Scl75, anti-PM/Scl100, or dual antibody positivity. Results: A total of 422 anti-PM/Scl-positive patients were enrolled. Among them, 83.2% (351/422) were diagnosed with connective tissue disease (CTD), 7.8% (33/422) were not diagnosed with CTD, and 9.0% (38/422) had an undetermined clinical diagnosis. Among 422 patients, most commonly represented by IIM (19.7%), systemic sclerosis (SSc, 14.2%), overlap syndrome (11.8%), undifferentiated CTD (UCTD, 10.4%), rheumatoid arthritis (6.9%), Sjögren syndrome (6.4%), and systemic lupus erythematosus (6.2%), the remaining diseases accounting for 24.4%. Within the IIM subgroup, dermatomyositis predominated (74.7%), followed next by anti-synthetase syndrome (21.7%) and immune-mediated necrotizing myopathy (3.6%). Anti-PM/Scl75 antibodies were detected in 52.1% (220/422) of the total patients, anti-PM/Scl100 in 43.6% (184/422), and both in 4.3% (18/422). In the subsequent detailed analysis of the anti-PM/ Scl-positive subgroup, double-positive patients showed a significantly higher prevalence of SSc (38.9% vs. 14.1% vs. 12.0%, P=0.015) and interstitial lung disease (ILD, 70.6% vs. 28.8% vs. 35.4%, P=0.002) than those individuals with single antibody positivity alone. Raynaud phenomenon was observed more frequently in both the double-positive and anti-PM/Scl75-positive groups than in the anti-PM/Scl100-positive group (29.4% vs. 21.3% vs. 10.9%, P=0.007). The measured proportion of peri-pheral CD8⁺ T cells was also higher in double-positive patients (35.9%±14.1% vs. 30.4%±11.2% vs. 26.5%±9.7%, P= 0.008), whereas absolute regulatory T-cell levels were lower in the anti-PM/Scl75-positive group compared directly with the anti-PM/Scl100-positive group [7.6% (5.4%, 10.9%) vs. 9.0% (7.9%, 12.0%) vs. 8.8% (5.2%, 9.7%), P=0.017]. Additionally, co-positivity for anti-PM/Scl and other myositis- specific or myositis-associated antibodies was strongly associated with an increased frequency of ILD (P < 0.05). Conclusion: Anti-PM/Scl antibodies define a broad disease spectrum encompassing IIM, SSc, overlap syndromes, and UCTD. Dual positivity for anti-PM/Scl75 and anti-PM/Scl100 identifies patients prone to systemic sclerosis and pulmonary involvement, suggesting additive pathogenic effects of the two antibody specificities.

Objective: To explore the serum biomarkers of myopenia in patients with rheumatoid arthritis (RA) via serum proteomic profiling. Methods: This cross-sectional study recruited active RA patients who either sustained non-myopenic or myopenia state over a 2-year follow-up period and unlabeled liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to analyze the serum proteomic profiles. Bioinformatics analyses were then applied to identify differentially expressed proteins between the two groups. Further validation cohort enrolled 102 RA patients (including 51 cases of non-myopenia group and 51 cases of myopenia group) and 51 healthy controls (HC) with age- and gender- matched propensity score at a 1 ∶ 1 ∶ 1 ratio. Enzyme-linked immunosorbent assay (ELISA) was used to verify the expression levels of the candidate protein. Multivariate logistic regression analysis was performed to identify baseline factors associated with myopenia in the RA patients. Results: Initial proteomic analysis of baseline serum samples from 9 non-myopenia RA patients and 10 myopenia RA patients identified 38 differentially expressed proteins. Among them, inter-alpha-trypsin inhibitor heavy chain H3 (ITIH3) showed a significant upregulation in the myopenia group (log₂FC=2.09) and was consistently detected across all the samples. Subsequent ELISA validation confirmed that the serum ITIH3 level in 102 RA patients was significantly higher than that in 51 HC [(119.4±79.7) mg/L vs. (42.3±16.6) mg/L, P < 0.001], in which both myopenia group and non-myopenia group of the RA patients showed higher levels of serum ITIH3 than the HC group (both P < 0.001). Importantly, the serum ITIH3 level in the 51 patients with myopenia were significantly higher than that in the 51 patients without myopenia [(148.1±94.7) mg/L vs. (90.8±46.6) mg/L, P < 0.001]. After adjustment for confounding covariates including gender, age, disease duration, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), radiological joint destruction and previous treatment, the multivariate Logistic regression analysis showed that the baseline serum ITIH3 level was an independent risk factor for myopenia in the RA patients (OR=1.024, 95%CI: 1.013-1.038, P < 0.001). Conclusion: This study identifies serum ITIH3 as a significant and independent risk factor for myopenia in patients with RA, which imply that ITIH3 might be a potential biomarker of myopenia. Further longitudinal large-sample multicenter validation is warranted to elucidate the precise role of ITIH3 in the pathophysiology of RA-associated myopenia and the clinical utility in risk stratification and management.

Objective: To establish a molecular classification framework for Sjögren syndrome (SS) by stratifying patients into distinct subtypes through unsupervised clustering of B cell single-cell RNA sequencing (scRNA-seq). This study characterizes subtype-specific gene signatures to construct protein-protein interaction (PPI) networks, thereby elucidating core regulatory mechanisms and potential therapeutic targets. Concurrently, it defines the clinical heterogeneity of SS by profiling autoantibodies and B-cell subset distributions across subtypes. Methods: The scRNA-seq data from 24 SS patients and 4 healthy controls were obtained from the Gene Expression Omnibus (GEO) database. We constructed a B cell atlas and identified differential gene expression profiles between SS and healthy controls B cells. Unsupervised clustering was applied to stratify SS patients into different molecular subtypes. Functional enrichment analysis of subtype-specific gene signatures was performed to infer associated biological processes/pathways. PPI networks were constructed using the STRING database and Cytoscape software to identify core functions and potential therapeutic targets for subtype-specific genes. The prevalence of autoantibodies and proportions of B cell subsets were statistically analyzed across subtypes. Results: The B cells were classified into eight subsets: transitional B cell, naïve B cell, memory B cell, double negative 1 (DN1) B cell, double negative 2 (DN2) B cell, VAV3⁺IRF1⁺ B cell, GP9⁺ B cell, and plasma cell. The FindAllMarkers function identified 792 differentially expressed genes (DEGs) between the SS patients and healthy controls. Unsupervised clustering stratified patients into three subtypes: (1) Inter-feron-dominant subtype characterized by enrichment in type Ⅰ/Ⅱ interferon and non-canonical nuclear factor kappa-B (NF-κB) signaling pathways. This subtype showed the highest proportions of naïve B cells and transitional B cells, along with the highest anti-Sjögren syndrome antigen A (SSA)/Sjögren syndrome antigen B (SSB) positivity. (2) B cell activation subtype characterized by enrichment in Fc receptor and B cell receptor signaling pathways. This subtype exhibited the highest proportions of memory B cells and DN1 B cells. (3) Endoplasmic reticulum stress subtype characterized by enrichment in protein folding and endoplasmic reticulum-associated degradation pathways. This subtype was marked by the highest proportion of VAV3⁺IRF1⁺ B cells. PPI networks identified subtype-specific hub genes regulating these core functions. Conclusion: Stratification of SS patients through clustering of B cell DEGs successfully defined three molecular subtypes (interferon-dominant, B cell activation, and endoplasmic reticulum stress subtypes). Each subtype exhibits distinct autoantibody profiles and B cell subset distributions. This molecular typing framework advances our understanding of SS heterogeneity and provides actionable insights for targeted therapy development.

Objective: To systematically compare serum metabolome differences between patients with thrombocytopenia in primary Sjögren syndrome (pSS) and those with normal platelet count using non- targeted metabolomics technology, so as to identify differential metabolites, analyze the relationship between the relative quantification of these metabolites and platelet counts, and screen metabolic pathways associated with platelet counts in pSS patients with thrombocytopenia. Methods: The patients with pSS were selected and grouped according to the presence or absence of thrombocytopenia. Serum samples were collected from the study subjects and analyzed by liquid chromatography-mass spectrometry (LC-MS). The samples were analysed by human metabolome database (HMDB), lipid metabolites and pathways strategy (LIPID MAPS) and other databases for classification and annotation. The samples were analyzed by principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) for multi-variate statistical analysis to screen the differential metabolites between the groups, and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was made to study the functions and metabolic pathways of the metabolites. Correlation analysis was performed between the abundance of serum differential metabolites and platelet counts of pSS patients with thrombocytopenia. Results: This study included 62 patients with pSS, of whom 32 had thrombocytopenia and 30 had normal platelet counts. A total of 137 differentially expressed metabolites, enriched in 54 metabolic pathways, were found in the serum of patients with thrombocytopenia compared with those without thrombocytopenia. Among them, the expression of desoxycorticosterone, hydrocortisone, and taurine was positively correlated with platelet count, and the expression of neopterin was negatively correlated with platelet count. Enrichment analysis showed that desoxycorticosterone and hydrocortisone were enriched in the steroid hormone biosynthesis pathway, taurine was enriched in the metabolic pathway of taurine and taurine, and neopterin was enriched in the folate metabolic pathway. Conclusion: Thrombocytopenia in pSS patients may be related to the reduced activity of steroid hormone biosynthesis pathway and the metabolic pathway of taurine and taurine, and the increased activity of the pathway of folate metabolism.

Objective: Renal involvement is a common extra-glandular lesion in primary Sjögren syndrome (pSS), generally associated with poor prognosis. Early immunotherapy might alleviate renal injury and improve long-term renal function. Growing evidence suggests that rituximab (RTX) is effective for systemic manifestations in pSS. In this retrospective study, we preliminarily investigated the efficacy of RTX on renal involvement in pSS. Methods: Clinical and laboratory data from the clinical large-scale data application platform of peking University People' s Hospital were collected. From July 2013 to January 2025, 17 patients with secondary renal damage due to pSS who were treated with RTX in the Department of Rheumatology and Immunology and the Department of Nephrology of Peking University People' s Hospital were consecutively included. During the same period, 34 patients treated with conventional immunosuppressive drugs were matched for age, gender, and baseline disease conditions. The RTX group received glucocorticoid therapy along with RTX, while the control group received glucocorticoid therapy along with immunosuppressive drugs for 6 months. We evaluated the effect of different treatments by comparing general laboratory parameters, renal injury index, and immunological features before and after treatment in the two groups. Results: After 6 months, renal function indices showed significant reductions in levels of the urinary N-acetyl-β-glucosaminidase (NAG), beta2-microglobulin (β2-MG), creatinine, and urea nitrogen in the RTX group ( P < 0.01, P < 0.05). It was shown that the levels of 24 h urinary total protein (24h UTP), urinary retinol-binding protein in the RTX group were lower, while the serum potassium in the RTX group were higher than those in the control group, all with no significant difference (P>0.05). Regarding immunological features, the RTX group had significantly lower levels of immunoglobulin G (IgG, P < 0.05) and rheumatoid factor (RF, P < 0.05), and higher levels of complement 3 (C3) and complement 4 (C4) compared with the control group ( P < 0.05). The total European League Against Rheumatism Sjögren syndrome disease activity index (ESSDAI) score and renal score in the RTX group were significantly lower than those in the control group, with statistically significant differences ( P < 0.05). Furthermore, after the 6-month treatment, a higher proportion of patients in the RTX group were able to taper their prednisone dose to lower levels (0-5 mg, quaque die) compared with the control group (64.71% vs. 32.35%, P=0.038). In addition to these positive outcomes, the incidence of infection was 1/17 in the RTX group and 3/34 in the control group. No serious adverse events were observed during the trial. Conclusion: Through targeted depletion of pathogenic B cells, RTX had the potential to ameliorate glomerular and tubulointerstitial damage, as well as modulate renal excretion and acid-base equilibrium in pSS patients. It was suggested that RTX might be superior to traditional immunosuppressive drugs, and helpful in glucocorticoid tapering. Meanwhile, medication adherence was guaranteed with a favorable safety profile. Thus, RTX is considered to be a promising option in clinical practice.

Objective: To evaluate the clinical features of sarcoidosis with ocular lesions as the initial manifestation and to analyze its treatment and prognostic outcomes. Methods: A retrospective study was conducted to evaluate the clinical data of sarcoidosis patients from July 2010 to July 2025 in the Department of Rheumatology and Immunology, Beijing Tongren Hospital. Results: Among the 23 patients, the male-to-female ratio was 1 ∶ 2.3, with a mean age of (45.1±14.1) years, a median disease duration of 0.5 (0.25, 1.50) years, and a median diagnosis time of 0.5 (0.20, 1.00) years. Fourteen patients presented with ocular lesions as the initial manifestations, while 9 patients had non-ocular lesions (such as respiratory system involvement or joint swelling/pain) as the initial manifestations. The most common ocular lesions were non-infectious uveitis and orbital masses. Orbital masses were most commonly encountered as lacrimal gland enlargement. Other ocular lesions included optic neuritis and optic perineuritis. The median follow-up time was 21.21 (5.00, 147.29) months. Following treatment, all the patients achieved significant clinical improvement, of whom 3 patients with non-infectious uveitis and 1 with optic perineuritis showed improved visual acuity and overall visual function. During the follow-up period, 2 patients with sarcoidosis experienced disease recurrence. After their treatment regimens were reinitiated, both patients achieved remission with a favorable prognosis. Compared with the patients with non-ocular-onset as the initial manifestation, the patients with ocular-onset as the initial manifestation had a significantly longer diagnosis time, and the difference was statistically significant (P =0.025). The C-reactive protein (CRP) level was 1.90 (0.50, 4.62) mg/L in the ocular-onset group and 11.70 (0.90, 31.45) mg/L in the non-ocular-onset group, and the difference was statistically significant (P =0.042). The erythrocyte sedimentation rate (ESR) was 14.00 (8.50, 24.00) mm/h in the ocular-onset group and 26.00 (15.50, 47.00) mm/h in the non-ocular-onset group, and the difference was statistically significant (P =0.033). The ocular-onset group had significantly lower levels of both CRP and ESR compared with the non-ocular-onset group. Conclusion: Sarcoidosis with ocular-onset as the initial manifestation poses diagnostic challenges, as routine inflammatory markers have limited utility in suggesting the disease and thus it is easily overlooked. Therefore, enhancing clinicians' ability to recognize these ocular-onset features is crucial for achieving early diagnosis and enabling timely intervention.

Objective: To evaluate the association of systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) with Behçet disease uveitis (BU), and to assess their predictive value for inflammatory activity and clinical prognosis in BU patients. Methods: There were 194 patients diagnosed with Behçet disease (BD) and 122 healthy controls. The BD patients were classified into two subgroups based on disease activity: An active phase cohort (n=90) and a stable phase cohort (n=104). Furthermore, the patients were categorized according to the presence or absence of uveitis into two cohorts: BU (n=49) and non-BU (n=145). Among the BU cohort, 26 patients were in the active inflammatory stage, while 23 patients were in the quiescent inflammatory stage. SII and SIRI were calculated using routine blood parameters, including platelet, neutrophil, lymphocyte, and monocyte counts. Spearman correlation analysis was performed to assess the associations of SII and SIRI with BU onset, inflammatory activity, and inflammatory markers. Receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal thresholds and predictive accuracy of SII and SIRI for BU onset and inflammatory activity. Results: SII and SIRI levels were significantly elevated in BD patients with ocular and vascular manifestations compared to those with stable disease (P < 0.05). No significant differences were observed in SII or SIRI levels among the patients with other clinical manifestations of BD. In the patients with BU, both SII and SIRI were significantly higher than in the non-BU and healthy control the groups (P < 0.001). Moreover, SII and SIRI levels were higher during the active inflamma-tory stage than in the inactive stage of BU (P=0.004). Spearman correlation analysis revealed that SII was positively associated with BD disease activity (ρ=0.303, P < 0.001), BU onset (ρ=0.442, P < 0.001), inflammatory activity (ρ=0.392, P=0.005), C-reactive protein (CRP, ρ=0.272, P < 0.001), and erythrocyte sedimentation rate (ESR, ρ=0.285, P < 0.001). SIRI was only positively correlated with BU onset (ρ=0.301, P=0.006). Logistic regression analysis demonstrated that eleva-ted SII was an independent risk factor for BU onset (OR=1.003, 95% CI: 1.001-1.004, P < 0.001). ROC curve analysis indicated that the optimal thresholds for SII were 711.800 [area under curve (AUC)=0.752] for predicting BU onset, 1 622.300 (AUC=0.741) for predicting inflammatory activity, and 1 634.200 (AUC=0.726) for predicting poor prognosis. The corresponding thresholds for SIRI were 1.260 (AUC=0.709), 1.390 (AUC=0.704), and 2.790 (AUC=0.678), respectively. Kaplan-Meier analysis indicated that elevated SII independently predicted adverse prognostic events (HR=3.440, 95%CI: 1.040-11.410, P=0.043). Conclusion: SII and SIRI may serve as potential clinical indicators for predicting inflammatory activity and prognosis in BD patients with uveitis. SII, in particular, demonstrates superior predictive performance for BU onset and disease activity, providing a basis for early identification of high-risk patients and clinical decision-making.

Objective: To evaluate the use of aspirin during pregnancy in patients with systemic lupus erythematosus (SLE) and to assess its effects on pregnancy outcomes. Methods: We consecutively enrolled SLE patients discharged from the Department of Obstetrics at Peking University Third Hospital between 2010 and 2024. Collected data included general patient characteristics, such as age, histories of adverse pregnancy, thrombosis, hypertension and renal disease. SLE related organ involvement, antiphospholipid antibodies (aPLs), SLE disease activity index (SLEDAI) score, medication regimens during pregnancy, and pregnancy outcomes were all documented. Differences in clinical characteristics between the aspirin user group and the non-user group were compared. Logistic regression analysis was used to assess the impact of aspirin on pregnancy outcomes. Results: A total of 171 SLE patients were included in this study. The mean age was (31±4) years, and 46 patients had a history of adverse pregnancy. The most commonly involved organs were skin and joints, accounting for 68.4% and 45.6% respectively. In the study, 52 cases had renal involvement, accounting for 30.4%. SLEDAI scores during pregnancy of the 87.1% patients were less than 4 scores. Aspirin use during pregnancy accounted for 48.5%. Among them, 19 patients (11.1%) used between 2010 and 2017, while 64 patients (37.4%) used after 2017, demonstrating an increasing trend. Regarding pregnancy outcomes, the rates of fetal loss, preterm birth, preeclampsia/eclampsia, and early-onset preeclampsia were 14.0%, 23.4%, 22.8%, and 10.5%, respectively. After adjusting for covariates such as age, adverse pregnancy history, SLEDAI score, and aPLs, aspirin use was a protective factor for live birth (OR=2.34, 95%CI: 1.18－4.65, P=0.015) and reduced the incidence of preeclampsia/eclampsia and early-onset preeclampsia (OR=0.42, 95%CI: 0.19－0.91, P=0.028; OR=0.31, 95%CI: 0.11－0.89, P=0.029, respectively) for the total 171 SLE patients. Among the SLE pregnant patients without high-risk factors for preeclampsia/eclampsia, aspirin use was a protective factor for live birth (OR=8.22, 95%CI: 1.61－42.16, P=0.012) and might help reduce the incidence of early-onset preeclampsia/eclampsia (OR=0.26, 95%CI: 0.06－1.10, P=0.067). Conclusion: Aspirin can reduce the incidence of preeclampsia/eclampsia, early-onset preeclampsia, and stillbirth in pregnant SLE patients. Even for those without high-risk factors for preeclampsia/eclampsia, aspirin should be taken under physician evaluation and recommendation. Current clinical practice in managing SLE during pregnancy deviates from guideline recommendations, underscoring the need for greater standardization.

Objective: To evaluate the clinical results of total hip arthroplasty (THA) for the treatment of patients with systemic lupus erythematosus (SLE) with end-stage osteonecrosis of femoral head (ONFH). Methods: Between March 2002 and June 2024, 235 SLE patients with end-stage ONFH who underwent 340 THAs were retrospectively reviewed. Before operation and at the last follow-up visit, the patient demographics, disease-related, hip and surgery-related, and laboratory parameters were collected via outpatient questionnaire, telephone, and online questionnaire. Objective clinical results were evaluated using the Harris hip score (HHS) system and subjective clinical results were evaluated using the short form-12 (SF-12) outcome score. The patient satisfaction at the last follow-up was evaluated by using a four-point scale with the options "very unsatisfied", "unsatisfied", "satisfied", or "very satisfied". Results: The median duration of follow-up was 58.0 (34.7, 101.2) months (12.4-283.2 months). At the last follow-up, the HHS increased from 32.0 (23.8, 39.3) before surgery to 88.0 (84.0, 91.0), the SF-12 mental component score (MCS) increased from 42.3(35.7, 48.7) before surgery to 52.3 (47.8, 55.9) and the SF-12 physical component score (PCS) increased from 36.8 (28.3, 43.4) before surgery to 52.0 (46.7, 54.5) (all P < 0.001). Evaluation of the hip satisfaction at the last follow-up showed that 58.8% (200 hips) were very satisfied, 35.3% (120 hips) were satisfied, 4.1% (14 hips) were less satisfied, 1.8% (6 hips) were very unsatisfactory, and the overall satisfaction rate was 94.1%. The postoperative systemic complications included pulmonary infection in 6 hips (1.8%), urinary tract infection in 10 hips (2.9%), cholecystitis in one hip (0.3%), intracranial infection in one hip (0.3%), cerebral infarction in 2 hips (0.6%), pulmonary embolism in 2 hips (0.6%), and atrial fibrillation in 2 hips (0.6%). Consequently, all hips were divided into those with systemic complications (25 hips) and those without systemic complications (315 hips). The results of intergroup comparisons showed significant differences in preoperative SF-12 PCS (P=0.031), postoperative SF-12 PCS (P=0.007), and postoperative HHS (P=0.005). The postoperative orthopedic complications included delayed wound healing in 28 hips (8.2%), joint noise in 11 hips (3.2%), periprosthetic infection in 3 hips (0.9%), dislocation in 3 hips (0.9%), and periprosthetic fracture in 2 hips (0.6%). All hips were divided into the delayed wound healing group (28 hips) and the normal wound healing group (312 hips). The results of intergroup comparisons revealed significant differences in preoperative SF-12 PCS (P=0.009), postoperative SF-12 MCS (P=0.025), and the proportion of THA using ceramic-on-polyethylene bearing (P=0.009) between the two groups. Multivariate logistic regression analysis indicated that preoperative SF-12 PCS (P=0.014, OR=0.94) and the use of ceramic-on-polyethylene bearing surface (P=0.014, OR=2.90) were associated factors for delayed wound healing after THA. Conclusion: The clinical results of THA reconstruction for the treatment of ONFH in SLE patients were reliable with high level of clinical scores and patient satisfaction. Unfortunately, a relatively high rate of systemic and orthopedic complications, including urinary tract infection and delayed healing of incision, deserved attention. Therefore, the perioperative management regimen should be emphasized in order to minimize the risk of postoperative complications.

Objective: To evaluate the characteristics and their change trends of major radiographic parameters of hips in axial spondyloarthritis (axSpA) patients with end-stage hip involvement from a single high-volume tertiary center over a 24-year period. Methods: Between 2001 and 2024, the radiographic trends of hips in axSpA patients with end-stage hip involvement were retrospectively reviewed. These radiographic parameters included bony ankylosis, acetabular protrusio, dislocation, obturator foramen ratio (OFR), canal flare index (CFI) and neck shaft angle (NSA). The baseline demographic, disease-related and laboratory parameters before surgery were also collected. Trend analyses over the study period were assessed using the Jonkheere-Terpstra trend test or the Cochran-Armitage trend test for clinical and radiographic parameters. All the joints were divided into the 2001-2012 group and 2013-2024 group according to the year of surgery, and the intergroup comparisons were conducted to further elucidate temporal changes. Results: The overall incidence of bony ankylosis, acetabular protrusio and dislocation before operation were 40.2%, 14.8% and 9.8%, respectively. The median value of OFR, CFI and NSA were 1.5 (1.2, 1.7), 3.2 (2.6, 3.8) and 141.0° (135.0°, 148.0°), respectively. Notably, only the value of OFR demonstrated increasing trend (P=0.001) among these radiographic parameters of hip, although some clinical parameters demonstrated increasing trend [hemoglobin (Hb) (P < 0.001), albumin (ALB) (P < 0.001), short form 12-item health survey (SF-12) physical component summary (PCS) (P=0.005), Harris hip score (HHS) (P=0.003)] or decreasing trend [erythrocyte sedimentation rate (ESR) (P < 0.001), C-reactive protein (CRP) (P < 0.001), Bath ankylosing spondylitis disease activity index (BASDAI) (P=0.013), Bath ankylosing spondylitis functional index (BASFI) (P < 0.001)]. The results of intergroup comparisons between 2001-2012 inpatient group (n=421) and 2013-2024 inpatient group (n=577) showed that no significant differences were found for these radiographic parameters of hip, although some clinical parameters were significantly different, including gender (P=0.004), body mass index (BMI) (P=0.002), age at disease onset (P < 0.001) and HHS (P < 0.001). Conclusion: The radiographic parameters of hip in axSpA patients with end-stage hip involvement did not show a trend of improvement over time, despite observed improvements in disease activity control and functional status. This dissociation between clinical improvement and persistent structural damage presents considerable technical challenges for subsequent surgical reconstruction with total hip arthroplasty.

Objective: To investigate the correlation between superb microvascular imaging (SMI) blood flow grading, ultrasound semi-quantitative scores, and clinical symptom severity in patients with primary knee osteoarthritis (KOA). Methods: A total of 94 knees from 47 patients with primary KOA were evaluated. Ultrasound semi-quantitative scoring and synovial SMI grading were performed for each knee joint. Clinical assessments included the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), visual analog scale (VAS) for pain, and serum biomarkers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Correlations between clinical scores and ultrasound parameters were analyzed. Results: SMI demonstrated a significantly higher synovial blood flow detection rate than power Doppler (PD) (14.9% vs. 9.6%, Z=-2.531, P=0.011). WOMAC stiffness scores showed positive correlations with synovitis, articular cartilage damage, and elevated SMI scores (all P < 0.05). WOMAC function scores were positively correlated with osteophyte severity, synovial thickening, and elevated SMI scores (all P < 0.05). The total WOMAC scores were positively associated with synovitis, synovial thickening, articular cartilage damage, and osteophyte severity (all P < 0.05). However, non-parametric Bootstrap analysis (B=2 000 replicates) revealed no independent associations between SMI blood flow grading, age, or body mass index (BMI) and WOMAC pain, stiffness, function, or total scores (all P>0.05, 95%CI contained zero). Conclusion: The SMI technique demonstrates significantly higher sensitivity than PD in detecting intensity grade of synovial microvascular flow. While SMI compensates for the limitations of PD in identifying low-grade inflammation, its high sensitivity to low- velocity blood flow did not correlate with symptom severity or WOMAC pain scores. These findings suggest that SMI serves as a valuable tool for visualizing microvascular activity in subclinical synovitis, but its role as a direct indicator of clinical symptom severity in KOA remains limited. Further studies with larger sample sizes are warranted to validate its clinical utility.

Objective: To investigate the clinical characteristics, treatment regimens, and the efficacy and safety of antifibrotic agents in elderly patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). Methods: This single-center retrospective cohort study enrolled 129 elderly patients (≥60 years) with a confirmed diagnosis of CTD-ILD at Beijing Hospital from June 2016 to June 2024. Baseline data, including comorbidities and CTD subtypes, treatment regimens (glucocorticoids, immunosuppressants, antifibrotic agents), pulmonary function parameters, high-resolution computed tomography (HRCT) imaging features, and adverse events were retrieved from the electronic medical record system. Treatment efficacy was evaluated according to the 2022 American Thoracic Society/European Respiratory Society criteria for progressive pulmonary fibrosis. Statistical analyses were performed using SPSS 26.0, with χ² tests or t-tests applied for between-group comparisons. Results: (1) Clinical characteristics: The predominant CTD subtypes were rheumatoid arthritis (RA), primary Sjögren syndrome (pSS), and polymyositis or dermatomyositis (PM/DM). Hypertension was present in 45.7% of the patients, reflecting the characteristics of multiple comorbidities in the elderly population. (2) CTD treatment regimens: 76.0% of the patients received glucocorticoid therapy, 83.7% used immunosuppressants (IS)/conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), among which cyclophosphamide had the highest usage rate (47.3%); 31.8% of the patients were combined with antifibrotic drugs (nintedanib 16.3%, pirfenidone 10.1%, and 5.4% used both). (3) Efficacy of antifibrotic therapy: There was no statistically significant difference in the 6-month HRCT progression rate between the antifibrotic and non-antifibrotic groups (31.3% vs. 45.2%, P=0.193). However, the proportion of the patients with pulmonary function deterioration in the antifibrotic group was significantly lower than that in the non-antifibrotic group (34.1% vs. 53.4%, P=0.041), suggesting a potential role in delaying pulmonary function deterioration. (4) Safety of antifibrotic agents: Gastrointestinal adverse events occurred in 39.0% of the patients receiving antifibrotics (26.8% diarrhea, 22.0% nausea), and abnormal liver function was observed in 17.1%. (5) Long-term outcomes: During a 2-year follow-up, 67.4% of the patients experienced infections (47.3% pulmonary infections), 14.0% progressed to respiratory failure, and the all-cause mortality rate was 2.3%. Conclusion: The main subtypes of CTD-ILD in the elderly are RA, pSS, and PM/DM, which are often complicated with hypertension. Antifibrotic agents may significantly delay the deterioration of pulmonary function, but attention should be paid to the risks of gastrointestinal adverse effects and hepatotoxicity. Infection remains the primary complication, emphasizing the need to balance benefits of immunosuppressive therapy and the risk of infection to formulate treatment strategies.

Objective: To investigate and analyze the clinical behavior and therapeutic status of patients with antiphospholipid syndrome (APS). Methods: Patients diagnosed with APS between September 2021 and October 2025 were enrolled in this investigation. Data collection included: demographic characteristics, disease duration, initial presenting symptoms, departments of first visit and diagnosis, time of the first visit and definite diagnosis, the interval of follow-up, previous and current medications. Assessments using the 36-item short form health survey (SF-36), hospital anxiety and depression scale (HADS), and general medication adherence scale (GMAS) were also conducted. Age- and gender-matched healthy controls were selected and completed parallel SF-36 and HADS evaluations during the same period. Results: In the study, 196 patients with APS were investigated. The median age of onset was 36 years, the male to female ratio was 1:6.8, and median disease duration was 3.0 years. Rheumatology & Immunology was the most common department for the first hospital visit (33.2%, 65/196), followed by Hematology (21.9%) and Reproductive Endocrinology and Infertility Center (18.4%). Other departments included Neurology (5.6%), Vascular Surgery (5.1%), and Emergency (4.1%). The median time from symptom onset to APS diagnosis was 6.0 months, with 32.1%(63/196) of patients experiencing a diagnostic delay of over one year. Regarding follow-up adherence, 56.6% (111/196) of patients with APS maintained regular follow-ups at intervals of ≤3 months, while 7.1% (14/196) of the patients visited their doctor less than once a year. The primary pharmacological treatments for the APS patients included hydroxychloroquine, warfarin and other anticoagulants, and antiplatelet agents. According to the GMAS assessment, 76.1% of the patients demonstrated high or good medication adhe-rence. Among all SF-36 domains, the scores of general health (GH) in the APS patients were significantly lower compared with healthy controls (P < 0.05). According to the HADS, the proportion of anxiety symptoms was significantly higher in the APS patients compared with healthy controls (13.8% vs. 6.7%, P < 0.05). Conclusion: In this study, delayed diagnosis in APS remained prevalent. Compared with healthy controls, the APS patients exhibited significantly impaired physical function and elevated anxiety symptoms. Regular follow-up monitoring should be emphasized, and greater attention must be paid to psychoeducational interventions.

Objective: To explore the effects and the molecular mechanisms of homo sapiens longevity assurance homolog 2 of yeast LAG1(LASS2) dephosphorylation on the biological functions of prostate cancer cells. Methods: Firstly, we examined the expression profiles of LASS2 by immunohistochemical staining using microarray sections from 90 human patients with prostate cancer; then FLAG-tagged LASS2 plasmid was transferred into HEK 293T cells and phosphorylation sites was detected by mass spectrometry. Furthermore, we constructed five phosphorylation-deficient mutants of LASS2 and stably transfected the variants to human prostate cancer cell line PC-3M-1E8 cell with high metastatic potential. The cell biology functions of LASS2 and its five mutants were studied using growth curve, MTT assay, plate colony formation assay, wound migration assay, matrigel invasion study and flow cytometry; and the effect of LASS2 and its phosphorylation-deficient mutants on the physical interaction between LASS2 and ATP6V0C (C subunit of V0 domain of the vacuolar ATPase), ATP6V0C expression, vacuolar ATPase (V-ATPase) activity, extracellular hydrogen ion concentration and secretion of active matrix metalloproteinase 2(MMP-2) was detected. Finally, we examined the effect of protein phosphatase inhibitor calyculin A on growth, migration and invasion of aggressive prostate cancer cells. Results: LASS2 levels decreased with increasing Gleason scores of prostate cancer tissues by immunohistochemical staining; moreover, proteome analysis by mass spectrometry had identified that three residues in the C-terminal region of LASS2(Ser-341, Ser-348, and Ser-349) were phosphorylated. Dephosphorylation of LASS2 at serine residue 348 significantly enhanced growth, migration (from 49.11%±5.62% to 74.28%±8.77%, P < 0.001) and invasion (from 129.67±13.65 to 206.67±13.50, P < 0.001) of prostate cancer cells, decreased S phase arrest (from 44.17% to 37.90%, P < 0.05) and inhibited cell apoptosis (from 48.540%±0.269% to 29.700%±0.778%, P < 0.05) in vivo through increasing V-ATPase activity, extracellular hydrogen ion concentration and secretion of active MMP-2. Calyculin A significantly reduced growth and invasion of metastatic human prostate cancer cells. Conclusion: Phosphorylation of LASS2 is essential for regulation of V-ATPase activity, and serine residue 348 of LASS2 is illustrated to be a key phosphorylation site. Phosphorylated LASS2 inhibits prostate cancer cell invasion via negative regulation of V-ATPase activity and protein phosphatase inhibitors are potential therapeutic strategy in aggressive prostate cancer.

Objective: To investigate the physical and motor development of preterm small for gestational age infant (SGA) within 2 years after birth. Methods: SGA born in Peking University Third Hospital from January 1, 2018 to December 31, 2022 and followed up regularly in the Center for Child Health and Deve-lopment were selected as study subjects. They were divided into preterm SGA group and full-term SGA group. Length, weight, head circumference, Peabody motor development score, vitamin A and D, bone mineral density and feeding status of SGA 0-3, 3-6, 6-10, 10-16, 16-21, 21-27 months after birth were collected through the electronic child health care follow-up system. The preterm infants were calculated according to the corrected gestational age. SPSS 25.0 statistical software was used to analyze the data. Results: A total of 158 SGA completed the regular follow-up, including 87 preterm SGA and 71 full-term SGA. The birth length, weight and head circumference of the two groups were statistically significant (all P < 0.05). The body weight of preterm SGA caught up faster 0-3 months after birth, and the head circumference of preterm SGA was higher than that of full-term SGA 0-3 months [(38.18±2.14) cm vs. (37.12±1.66) cm] and 6-10 months [(43.04±1.54) cm vs. (42.35±1.70) cm] after birth. The differences were statistically significant (all P < 0.05). The scores of gross motor, fine motor and total motor development 3-6 and 6-10 months after birth were significantly higher in preterm SGA than in full-term SGA (all P < 0.05). Breastfeeding 0-3 months of age and 3-6 months of age was significantly associated with catch-up growth in preterm SGA (P < 0.05). There were no significant differences in vitamins A and D and bone mineral density between the two groups. Conclusion: In the first year after birth, the weight and head circumference of preterm SGA increase faster than those of full-term SGA, and the motor development of preterm SGA is better than that of full-term SGA. After the first year of life, the physical indicators and motor development of the two groups tend to be consistent. Breastfeeding is the preferred feeding mode for preterm SGA, which promotes rapid catch-up growth in the early stage. The absence of maternal diabetes during pregnancy is also one of the positive factors for the occurrence of catch-up growth in SGA.

Objective: To explore the diagnostic significance of fecal calprotectin detection in infants with milk protein-allergic enteritis, and to provide valuable clinical basis for the early diagnosis and treatment decision-making of infants with milk protein-allergic enteritis. Methods: A retrospective analysis was conducted on the clinical data of 87 infants with suspected milk protein-allergic enteritis admitted in Hangzhou Children's Hospital from January 2020 to January 2023, and 38 infants with confirmed milk protein-allergic enteritis were assigned to group A, 49 infants with non-milk protein-allergic enteritis were assigned to group B, and 73 healthy infants who underwent physical examinations in Hangzhou Children's Hospital during the same period were assigned to the group C. General data of the three groups were collected through questionnaires, and fecal specimens were collected to detect the level of fecal calprotectin. The area under receiver operating characteristic (ROC)curve (AUC)was used to analyze the diagnostic value of fecal calprotectin for allergic enteritis and milk protein-allergic enteritis. The correlation between eosinophilic granulocytes (EOS)and platelets (PLT)levels and fecal calprotectin levels was analyzed by Pearson method. Results: The levels of EOS in groups A, B and C were (0.73±0.21)×10⁹/L, (0.41±0.10)×10⁹ /L, (0.26±0.05)×10⁹ /L respectively, the levels of PLT were (381.03±46.04)×10⁹ /L, (336.98±52.57)×10⁹ /L, (300.22±23.00)×10⁹ /L respectively, and the levels of EOS, PLT in group A were higher than those in group B and group C (P < 0.05), and those in group B were higher than those in group C (P < 0.05). The levels of fecal calprotectin in groups A, B and C were (324.45±174.56) μg/g, (196.12±83.39) μg/g, (143.73±50.54) μg/g respectively, and the levels of fecal calprotectin in group A were higher than those in group B and group C (P < 0.05), and those in group B were higher than those in group C (P < 0.05). The AUC values of fecal calprotectin and milk protein in the diagnosis of allergic enteritis were 0.758 and 0.792, respectively, the sensitivities were 0.575 and 0.711 respectively, the specificities were 0.904 and 0.861 respectively, the optimal cut-off values were 202.500 and 235.000 respectively, and the 95%CI were 0.683-0.833 and 0.688-0.896 respectively. The level of EOS was positively correlated with the level of fecal calprotectin (r=0.325, P < 0.05), and the PLT level was positively correlated with the level of fecal calprotectin (r=0.280, P < 0.05). Conclusion: Fecal calprotectin may have high clinical significance in infants with milk protein-allergic enteritis, and EOS and PLT levels may be positively correlated with the levels of fecal calprotectin. The higher the fecal calprotectin level, the more serious the inflammatory response.

Objective: To assess the association between socioeconomic status and vision impairment (Ⅵ) among Chinese elderly aged 65 years and above, and explore its comparison and contrast from 2008 to 2018. Methods: Using the 2008 and 2018 waves of cross-sectional data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which included 12970 and 9702 participants, respectively. Logistic regression models with a stepwise forward approach were employed to assess the association between the household income, educated level, job before retirement and Ⅵ. Results: In 2008, the prevalence of Ⅵ among the elderly aged 65 years and above in China was 16.92% (95%CI: 15.91%-17.98%), which increased to 18.45% (95%CI: 17.41%-19.53%) in 2018. In terms of household income, the highest and upper middle income groups had lower odds of Ⅵ compared with the lowest one in 2008. By 2018, only the upper middle had lower odds (OR=0.761, 95%CI: 0.603-0.961), with its disparity narrowing compared with 2008. For educated level, in 2008, individuals with primary school education, and those with junior high school education or above had lower odds of Ⅵ compared with illiterate individuals. By 2018, the disparity in Ⅵ between the illiterate individuals and those with primary school education widened, while the gap between the illiterate ones and those with junior high school education or above decreased. In addition, after controlling for other factors, the odds of Ⅵ for the individuals educated by junior high school and above was higher than for those educated by primary school (OR=0.691, 95%CI: 0.533-0.896; OR=0.592, 95%CI: 0.494-0.708). Regarding job before retirement, in 2008, compared with the professional, technical or managerial personnel, those engaged in agriculture or domestic work had higher odds of Ⅵ. In 2018, this disparity persisted (OR=1.707, 95%CI: 1.319-2.210; OR=1.925, 95%CI: 1.310-2.829), with the gaps widening compared with the reference group. Conclusion: The prevalence of Ⅵ among Chinese elderly increased from 2008 to 2018, with socioeconomic status, specifically household income, educated level, and job before retirement, demonstrating associations with Ⅵ. To be specific, the gap in the odds of Ⅵ across household income strata decreased from 2008 to 2018; disparities among different educated levels generally diminished, while the gap between illiterate individuals and ones educated by primary school widened; and job-before-retirement groups exhibited expanding disparities over time.

Objective: To explore the factors influencing dietary patterns and blood glucose control in patients with type 2 diabetes based on the health action process approach (HAPA) model. Methods: Patients with type 2 diabetes were selected in 11 community health centers affiliated to Dongcheng Hospital of Dongying City, Shandong Province. The glycosylated hemoglobin (HbA1c) level was detected by venous blood collection, and general data questionnaire, food frequency questionnaire, the Summary of Diabetes Self-Care Activities measure and HAPA scale were used to collect information. The dietary patterns of the patients were divided into different types by factor analysis. The effects of various dimensions of HAPA model on dietary patterns and blood glucose control of the type 2 diabetes patients were analyzed by structural equation model. Results: A total of 819 patients with type 2 diabetes were enrolled in the study, and the overall HbA1c level was 7.1%±1.1%. The overall diet management scores of the study subjects were 5.0 (1.0, 7.0), and the specific daily diets were divided into medium/low glycemic index (GI) dietary pattern, meat dietary pattern, fruit dietary pattern, high GI and starch dietary patterns, and egg and milk dietary pattern. Structural equation model results showed that positive outcome expectancies (β=0.417, P < 0.001), negative outcome expectancies (β=-0.239, P < 0.001) and perceived risk severity (β=0.075, P=0.036) affected dietary management behavior intention. Beha-vioral intention of diet management affected action planning (β=0.531, P < 0.001) and coping planning (β=0.228, P < 0.001). Action planning influenced overall diet management behavior (β=0.183, P < 0.001). The overall diet management behavior affected medium/low GI dietary pattern (β=0.133, P < 0.001), fruit dietary pattern (β=-0.103, P=0.003), high GI and starch dietary pattern (β=-0.110, P=0.002) and egg and milk dietary pattern (β=0.076, P=0.031). Medium/low GI dietary pattern (β=-0.086, P=0.013) and meat dietary pattern (β=0.084, P=0.015) affected the level of HbA1c. In addition, action self-efficacy can affect behavior intention (β=0.384, P < 0.001), action planning (β=0.122, P=0.006) and coping planning (β=0.146, P=0.001). Maintenance self-efficacy affected action planning (β=0.170, P < 0.001), coping planning (β=0.408, P < 0.001), and overall diet management behavior (β=0.265, P < 0.001). Conclusion: There were differences in dietary patterns among the participants with type 2 diabetes, and the weekly diet management behavior was not good enough of the patients with type 2 diabetes, because HAPA model could explain the dietary patterns and blood glucose control level of type 2 diabetes patients. In the future, targeted dietary interventions can be developed based on the HAPA model to improve the overall diet management level of patients and promote patients to develop a healthy diet pattern with low GI, thus controlling blood sugar level and improving quality of life.

Objective: To assess the associations between brachial-ankle pulse wave velocity (baPWV), ankle brachial index (ABI) and all-cause and cardiovascular mortality in a rural population in north China. Methods: The current study utilized the baseline data of Beijing Fangshan family cohort study and the data of the death surveillance system of the Beijing Fangshan District Center for Disease Prevention and Control. The main outcomes were all-cause mortality and cardiovascular mortality. Cardiovascular deaths which included deaths from coronary heart disease (CHD), stroke, heart failure, sudden cardiac death and arrhythmia, were coded according to the International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10). The R4.2.2 software was used for statistical analysis, and the adjusted hazard ratios (HR) for all-cause and CVD mortality associated with baPWV and ABI were calculated using Cox proportional hazards regressions with shared frailty models. Results: A total of 7 686 participants were followed up for a median of 6.35 years in Fangshan District, Beijing, China. Totally 576 deaths were identified, with a mortality density of 11.88/1 000 person-years, of which 335 deaths were from cardiovascular diseases. We found that baPWV (HR=1.40, 95%CI: 1.02-1.92) and ABI (HR=3.32, 95%CI: 2.57-4.28) were associated with all-cause mortality after adjusting for confounding factors. ABI was more strongly associated with cardiovascular mortality than baPWV. There was no significant difference in the risk of all-cause mortality among different subgroups. The risk of cardiovascular mortality was significantly increased in the participants with hypertension (HR=1.72, 95%CI: 1.30-2.27). Conclusion: baPWV and ABI were associated with all-cause and cardiovascular mortality in a rural population of north China. The association of ABI and cardiovascular mortality was more significant than that of baPWV. And abnormal baPWV or ABI was associated with cardiovascular mortality, especially in people with hypertension.

Objective: To understand the general information of patrol practitioners before the implementation of the new occupational policy of "ski patrol" in China. Methods: From November 2024 to March 2025, electronic survey questionnaires were distributed to those personnel engaged in snow rescue in selected ski resorts with chair-lift or Gondola-lift in North, Northeast and Northwest of China. The questionnaire covers a total of 41 questions from five aspects: personal basic information, occupational status, skiing skills, rescue skills training, and rescue skills mastery. Results: In this study, 207 questionnaires were collected from 15 different ski resorts in 5 provinces including Beijing, Hebei, Xinjiang Uygur Autonomous Region, Jilin, and Liaoning. The survey revealed that patrollers were predominantly young males (92.3%), with an average age of (26.2±7.5) years. 52.2% of the respondents had a high school or equivalent education, and 37.2% had a bachelor' s degree or above, and engaged in snow rescue operations for 2 (1, 5) years. During the non-snow season, 61.4% of people worked full-time or part-time in outdoor rescue related work (including rescue training). In the next 3－5 years, 62.8% of people were still willing to work as ski rangers, 53.1% were interested in working as ski instructors, and only 10.1% were considering leaving the skiing field. In the study, 82.1% of the respondents were proficient in skiing on the highest level slopes of the ski resort, and 71.5% were proficient in skiing on ungroomed slopes (including but not limited to powder, mogul, forest, etc.). and 76.3% had received training in towing rescue sleds (Toboggan), and most of them could tow toboggan on intermediate and advanced slopes at ski resorts. More than half (59.4%) of the respondents worked at ski resorts that organized snow rescue training for more than 3 days per year. And 77.3% of the respondents had received training from medical staff, 85.5% had been trained by emergency response instructors, 84.1% had received training from senior ski patrols, 58.5% had received training from ski doctors with experience in event support, and 58.9% had received training from instructors from international ski patrols organizations. In terms of rescue skills, the proportion of personnel trained and proficient in cardiopulmonary resuscitation, hemostasis and bandaging, and treatment of limb injuries was the highest, while the proportion of personnel capable of assessing and treating chest, abdominal, spinal, and pelvic injuries, as well as airway management, was relatively low. 30.4% of the respondents had participated in national or higher-level snow event rescue operations. Conclusion: Ski patrollers are primarily young males, and their education level needs to be improved. Although the self-evaluation of skiing ability, towing toboggan ability, and rescue ability are relatively high, more accurate skill assessment, qualification recognition, and further training and assessment are still needed through the new occupational system.

Objective: To study the effect of porous surface structure on fatigue strength of zirconia fabricated by stereolithography apparatus (SLA), and to provide reference for the surface design of 3D printed zirconia implants. Methods: Zirconia specimens were fabricated by SLA. According to the surface structure, zirconia specimens were divided into non-porous group, 200 μm group and 400 μm group. The surface morphology was observed by 3D laser morphology microscope and scanning electron microscope, and the surface roughness, pore parameters and grain size were measured. The flexural strength of the specimen was measured by three-point bending test and Weibull analysis was performed. The fatigue strength of the specimens was measured by fatigue test, and the fatigue mechanism was analyzed by fractrography. The crystal phase before and after fatigue test of the specimen was analyzed by X-ray diffraction. Results: The surface roughness of the area between the pores of non-porous group, 200 μm group and 400 μm group was (0.79±0.09) μm, (0.81±0.16) μm and (0.81±0.09) μm, respectively, with no significant difference among them. The surface grain size was (324.11±21.38) nm, (308.06±11.34) nm, (311.62±15.02) nm, respectively, with no significant difference among them. The results of three-point bending test showed that the three-point bending strength of the non-porous group [(1 030.70±111.71) MPa] was significantly higher than that of the porous groups (P < 0.001). The 200 μm group [(272.04±61.16) MPa] was significantly higher than the 400 μm group [(201.21±25.58) MPa] (P < 0.01). The fatigue strength of the non-porous group [(702.29± 21.62) MPa] was significantly higher than that of the porous groups (P < 0.001), and the fatigue strength of the 200 μm group [(159.57±9.30) MPa] was significantly higher than that of the 400 μm group [(125.36±6.11) MPa] (P < 0.001). The fracture analysis results showed that the crack origins were mainly internal defects, air holes, inclusions and the joint of printing layer, etc. There was no significant difference in the content of monoclinic phase before and after fatigue test among all the groups. Conclusion: The surface porous microstructure could significantly reduce the fatigue strength of the zirconia specimens, and the larger pore size showed the lower fatigue strength. In the future, the material and printing process of 3D printing zirconia should be improved, and the surface structure design should be further optimized to improve the mechanical properties of 3D printing zirconia.

A case of systemic lupus erythematosus (SLE) complicated with contactin-1 (CNTN1) antibody-positive autoimmune nodopathy (AN) is reported, with the aim of providing insights for the early recognition and precise management of this rare comorbidity. A 48-year-old woman was admitted with a history of limb numbness and weakness for more than one year and 8 months of bilateral lower-limb edema. More than one year prior, she presented to another hospital with distal limb weakness and numbness; cerebrospinal fluid examination revealed albuminocytologic dissociation, electromyography showed findings consistent with peripheral neuropathy. She was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and treated with intravenous immunoglobulin and methylprednisolone pulse therapy, but her symptoms continued to progress. Six months before admission, she developed bilateral leg edema; laboratory tests showed leukopenia (3×10⁹/L), proteinuria (urine protein/creatinine ratio 4.5 g/d) with hypoalbuminemia and hyperlipidemia, and serum anti-CNTN1 antibody positivity. Lumbar MRI revealed thickening of bilateral lumbosacral nerve roots, edema of the common peroneal nerve, and diffuse thickening of the brachial plexus. She was diagnosed with immune-mediated peripheral neuropathy and nephrotic syndrome, and treated with a single intravenous dose of rituximab (600 mg), followed by dexamethasone (15 mg/d for 5 days) transitioned to oral prednisone (60 mg/d, tapered). Limb weakness and numbness improved, leukocyte count normalized, but edema worsened. One week before the current admission, she developed alopecia; repeat testing showed worsened proteinuria (urine protein/creatinine 7.05 g/d), positive antinuclear antibody (1 ∶ 1000, cytoplasmic granular pattern), anti-double-stranded DNA (anti-dsDNA), anti-SSA, anti-Ro52 antibodies, and weakly positive anti-SSB antibody. SLE was suspected, and she was admitted to the Department of Rheumatology and Immunology, Peking University People' s Hospital. Repeat testing revealed elevated anti-dsDNA antibody (137 IU/mL), low C4, and seroconversion to negative for anti-CNTN1 antibody in both serum and CSF. Renal biopsy demonstrated atypical membranous nephropathy. Final diagnoses were SLE, CNTN1 antibody-positive AN, and lupus nephritis. She received intravenous methylprednisolone (40 mg/d) transitioned to oral prednisone (50 mg/d, tapered), hydroxychloroquine (0.2 g twice daily), and rituximab induction (500 mg weekly ×4) followed by 500 mg every 6 months as maintenance. During 2 years of follow-up, alopecia, limb weakness, and numbness improved, leukocyte count remained normal, and urine protein/creatinine decreased to 0.19 g/d. Autoimmune nodopathy, first formally recognized in July 2021, is a novel subtype of peripheral neuropathy. This is the third reported case worldwide of SLE coexisting with AN. The literature is reviewed, and possible shared pathogenic mechanisms, disease characteristics, and B-cell-depleting therapy as the cornerstone of management are discussed.

This article reports the diagnosis and therapeutic management of a 53-year-old male with VEXAS syndrome mimicking relapsing polychondritis. The patient presented with multiple subcutaneous nodules and auricular/nasal chondritis. Blood routine examination revealed leukopenia, moderate macrocytic anemia and thrombocytopenia. Inflammatory markers were elevated, including erythrocyte sedimentation rate, C-reactive protein (CRP) and interleukin-6. Serological tests were negative for antinuclear antibody (ANA), anti-extractable nuclear antigen antibody spectrum (ENA), and anti-neutrophil cytoplasmic antibody (ANCA), but positive for anticardiolipin antibodies, anti-β2-glycoprotein Ⅰ anti-bodies, and anti-phosphatidylserine-prothrombin antibodies, and screening revealed no thromboembolic events, with no evidence of infection. Genetic testing confirmed a UBA1 gene mutation in Exon 3, spe- cifically p.Met41Val (c.121A>G). Bone marrow aspiration demonstrated grade Ⅲ bone marrow hyperplasia and vacuolization of myeloid precursors without dyshematopoiesis. A skin biopsy indicated a perivascular lymphocytic infiltrate with focal dense neutrophilic infiltrates, consistent with neutrophilic dermatosis. The consultation with experts from the hematology department indicated that there was currently insufficient evidence for the diagnosis of myelodysplastic syndrome. Based on these findings, a diagnosis of VEXAS syndrome was established, with main involvements of the ears/nasal cartilage, skin, and hematopoietic system. The patient' s condition improved significantly following treatment with high-dose glucocorticoids, intravenous immunoglobulin and ruxolitinib phosphate. Throughout the scheduled follow-up period, the patient showed marked clinical improvement, with resolution of subcutaneous nodules and alleviation of swelling and pain in the auricles and nasal bridge. Hematologic parameters improved significantly, serum inflammatory markers returned to near-normal levels, and both anti-cardiolipin antibody and anti-β2-glycoprotein Ⅰ antibody turned negative. Additionally, the titer of anti-phosphatidylserine-prothrombin antibody decreased substantially. Notwithstanding substantial concerns about thrombotic risk due to positive phospholipid antibodies in the context of ruxolitinib treatment, thrombotic events were avoided with patient compliance to low-dose aspirin therapy. This case highlighted that the male patients aged over 50 years presenting with chondritis, refractory autoinflammatory manifestations, and/or unexplained hematological abnormalities, clinicians should consider bone marrow evaluation and UBA1 gene testing to promptly identify VEXAS syndrome, enabling early personalized treatment and improved outcomes.

This article reports the diagnosis and treatment process of a 52-year-old female patient who was finally diagnosed with POEMS syndrome. Her main clinical manifestations included Raynaud phenomenon of both hands, skin pigmentation, swelling of both hands and feet, and numbness of both feet. The patient was admitted to the Department of Rheumatology and Immunology, Peking University People's Hospital on April 8, 2024, due to "purplish red skin on the neck and chest for 1.5 years, swelling of both hands for 1 year, and numbness of both feet for 8 months". One and a half years ago, she was diagnosed with systemic sclerosis (SSc) in another hospital, based on evidence from a series of clinical manifestations. Her main symptoms were Raynaud phenomenon of both hands, skin pigmentation, swelling of both hands and feet, and numbness of both feet, which met the 2013 classification criteria for SSc by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). During the disease course, the patient received regular treatment with glucocorticoids and disease-modifying antirheumatic drugs (DMARDs), but her condition still progressed continuously. Eight months ago, she developed new-onset numbness in both her feet accompanied by pinprick-like pain, indicating the complexity of the condition and the need for further investigation of the etiology. Differential diagnosis should consider possibilities, such as mixed connective tissue disease, eosinophilic fasciitis, and malignant tumors. Auxiliary examinations showed that the patient's serum antinuclear antibody, anti-topoisomerase Ⅰ(Scl-70) antibody, anti-U1 ribonucleoprotein (RNP) antibody, and antineutrophil cytoplasmic antibody were all negative. Imaging examinations revealed no pulmonary arterial hypertension or pulmonary interstitial fibrosis. In addition, the patient had multiple endocrine abnormalities and responded poorly to treatment with glucocorticoids and DMARDs, suggesting the need to be alert to the possibility of lymphoproliferative diseases. Further examinations including vascular endothelial growth factor detection, whole-body bone scan, and bone marrow aspiration and biopsy were performed, and the final diagnosis of POEMS syndrome was confirmed. The patient was then transferred to the Department of Hemato-logy and received treatment with the pomalidomide combined with dexamethasone regimen, and her clinical symptoms gradually relieved. This case suggests that POEMS syndrome is similar to rheumatological and immunological diseases such as SSc in terms of clinical manifestations. Clinicians should be more vigilant during diagnosis and treatment, and pay attention to differentiation, so as to reduce missed diagnoses and misdiagnoses, thereby formulating more accurate and effective treatment plans for patients.

This article presents a comprehensive case analysis of a young female patient with systemic lupus erythematosus (SLE) who developed neuropsychiatric symptoms during prolonged immunosuppressive therapy. The patient, maintained on glucocorticoids and cyclosporine, presented with fever, headache, and left-sided limb numbness. Cranial magnetic resonance imaging (MRI) revealed an acute inflammatory lesion in the right parietal lobe, leading to an initial clinical diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE). However, despite adjustments to the immunosuppressive regimen, her condition continued to deteriorate, manifesting as impaired consciousness and meningeal signs including neck stiffness. Subsequent laboratory investigations proved crucial for diagnostic reevaluation: Blood culture identified Listeria monocytogenes, and cerebrospinal fluid (CSF) analysis via next-generation sequencing (NGS) detected varicella-zoster virus (VZV). Targeted anti-infective therapy with meropenem and linezolid, combined with intravenous immunoglobulin support, resulted in significant improvement of neurological symptoms and radiological abnormalities, ultimately confirming central nervous system (CNS) mixed infection rather than NPSLE. This case underscored the critical importance of differentiating between CNS infection and NPSLE in immunosuppressed SLE patients. Clinical observations indicated that CNS infections typically presented with more pronounced systemic manifestations including high-grade fever, severe headache, and marked meningeal signs, accompanied by significantly elevated inflammatory markers. In contrast, NPSLE patients might exhibit fever but generally show lower overall lupus disease activity scores. CSF analysis played a pivotal diagnostic role: CNS infections commonly demonstrate significant pleocytosis, elevated protein levels, and reduced glucose concentrations, whereas NPSLE-related CSF changes were usually milder. Serial neuroimaging follow-up and treatment response assessment provided additional discriminatory value, as infectious lesions typically showed rapid resolution following appropriate antimicrobial therapy. The application of CSF NGS technology in this case enabled rapid identification of mixed pathogens, highlighting its advantage in diagnosing complex infections. Clinical management should integrate comprehensive evaluation of etiological, radiological, and therapeutic response characteristics to prevent misdiagnosis as NPSLE, which could lead to inappropriate intensification of immunosuppression and subsequent clinical deterioration. We recommend early multidisciplinary collaboration and proactive utilization of precision diagnostic techniques like CSF NGS to guide timely, targeted anti-infective strategies, ultimately improving the patient outcomes. This case provides valuable insights for clinicians regarding the differential diagnosis of CNS complications in immunocompromised patients, emphasizing the necessity of integrated modern diagnostic approaches for personalized therapeutic decision-making.

Charcot neuroarthropathy (CN) is a rare but severely disabling complication most commonly seen in patients with longstanding diabetic peripheral neuropathy. CN is characterized by progressive destruction, dislocation, and deformity of the foot and ankle joints, often accompanied by altered biomechanics, chronic ulceration, secondary infection, and, in advanced cases, a high risk of amputation or even mortality. The early clinical presentation of CN is frequently atypical, with mild or painless swelling, warmth, and erythema due to underlying sensory deficits, which can easily lead to misdiagnosis as other rheumatic or autoimmune joint disorders such as rheumatoid arthritis and gout. In this report, we present the case of a 60-year-old woman with a 12-year history of type 2 diabetes mellitus who developed persistent swelling and pain in her left ankle for eight months, along with progressive numbness in her left foot for six months. Her initial laboratory and imaging findings suggested a diagnosis of rheumatoid arthritis combined with gout, resulting in the administration of anti-rheumatic and uric acid-lowering therapies, which proved ineffective. Further diagnostic workup, including advanced imaging modalities, neuroelec-trophysiological testing, and synovial biopsy, ultimately confirmed the diagnosis of diabetic Charcot neuroarthropathy, revealing severe joint dislocation, bone fragmentation, and extensive osteolysis. The patient received comprehensive management, including strict glycemic control, anti-osteoporosis treatment, neurotrophic support, and ultimately underwent left ankle multi-joint fusion surgery. During postoperative follow-up, the patient demonstrated significant improvement in limb function, with no recurrence of ulcers or infection. This case highlights the importance of considering CN in diabetic patients with unilateral, painless joint swelling, deformity, and sensory disturbance. Accurate differential diagnosis from rheu-matic and autoimmune diseases, early recognition, and standardized intervention are crucial to prevent irreversible deformity and reduce the risk of amputation, ultimately improving patient outcomes. Early multidisciplinary management and individualized treatment strategies play a key role in optimizing prognosis for patients with diabetic CN.

This case report describes the diagnostic and therapeutic management of a 70-year-old female patient with rheumatoid arthritis (RA) complicated by necrotizing fasciitis (NF).The patient has a history of RA for over 20 years, without previous standardized diagnosis or treatment.On October 3, 2023, the patient presented with swelling and pain in the bilateral proximal interphalangeal joints, the third metacarpophalangeal joint of the right hand, bilateral wrists, knees, and ankles, accompanied by redness, swelling, pain, and fever in the left gluteal region, perianal area, perineum, and the lateral upper segment of the right thigh. Laboratory tests revealed significantly elevated levels of rheumatoid factor, anti-cyclic citrullinated peptide antibodies, white blood cells, neutrophils, C-reactive protein, and erythrocyte sedimentation rate. CT imaging showed multiple large patchy areas of increased density with blurred margins in the subcutaneous adipose tissue of the bilateral gluteal regions and lower limbs, gluteus maximus muscles, and perineum, along with exudative changes in the subcutaneous adipose tissue of the bilateral lower limbs. Surgical exploration revealed extensive black necrotic tissue, and postoperative pathological examination indicated suppurative changes with abscess formation and inflammatory necrotic tissue, accompanied by local granulation tissue hyperplasia. Bacterial culture identified Staphylococcus aureus. Thus, the diagnosis of RA complicated with NF was confirmed. Following timely surgical intervention and antibiotic therapy, the patient is currently recovering satisfactorily. RA complicated with NF is relatively rare and associated with high mortality and a prolonged disease course. Elderly RA patients undergoing treatment with immunosuppressants, nonsteroidal anti-inflammatory drugs, and biologics should be highly vigilant for the risk of developing NF. Clinicians should enhance their understanding of RA complicated with NF, establish an early diagnosis, provide active treatment, and improve patient prognosis.

Rheumatoid arthritis is an autoimmune disease primarily characterized by chronic symmetric arthritis. While rheumatoid arthritis with elevated eosinophils exhibits distinct clinical features, the potential coexistence of immunoglobulin (Ig)G4-related disease warrants clinical vigilance. This article reports a case of a patient presenting with polyarticular swelling and pain accompanied by morning stiffness. Positive tests for anti-keratin antibody, anti-cyclic citrullinated peptide antibody, anti-perinuclear factor, and rheumatoid factor were observed with a significantly elevated erythrocyte sedimentation rate, leading to a definitive diagnosis of rheumatoid arthritis. The patient also exhibited elevated peripheral blood eosinophils and showed poor response to treatments, such as leflunomide and tripterygium glycosides. After switching to methotrexate and tocilizumab, the patient's joint symptoms improved significantly, but peripheral blood eosinophilia showed no notable improvement. During the course of the disease, the patient developed lymphadenopathy and parotid gland enlargement. Lymph node ultrasound revealed a hypoechoic nodule in the left supraclavicular area, abnormal lymph nodes in both axillae and the right inguinal region, and visible lymph nodes in the bilateral cervical and left inguinal areas. Parotid ultrasound indicated hypoechoic nodules within both parotid glands and widening of the parotid ducts. Further bone marrow aspiration biopsy showed no significant abnormalities, while lymph node pathological biopsy suggested infiltration of IgG4-positive cells. Subsequent serum IgG4 testing revealed elevated level of IgG4. The patient was ultimately considered likely to have rheumatoid arthritis complicated with IgG4-related disease. Treatment was adjusted to regular infusions of rituximab (500 mg every six months), resulting in significant improvement of joint swelling and pain, as well as marked reductions in C-reactive protein and eosinophil levels, achieving disease remission. Through case analysis and literature review, this article discusses the diagnosis and treatment of rheumatoid arthritis patients with elevated eosinophils. For patients with rheumatoid arthritis with elevated eosinophils, it is necessary to be vigilant of the possibility of concurrent IgG4-related diseases. The use of rituximab provides novel perspectives for clinical treatment strategies.

Mesonephric-like adenocarcinoma (MLA) in the corpus uteri is a highly aggressive malignant tumor, which is easily confused with other types of endometrial cancer. When the tumor morphology and cellular characteristics are not consistent with the clinical biological behavior, attention should be paid to it. This study is to investigate the clinicopathologic features of MLA in the corpus uteri. Three cases of MLA in the corpus uteri diagnosed in the First Affiliated Hospital of Xi'an Jiaotong University from 2020 to 2023 were studied by clinical data, microscopic features and immunohistochemistry. The related literature was reviewed. The clinical manifestations of the three cases of MLA in the corpus uteri were nonspecific. One case was from our hospital and the other two cases were from other hospitals. The age range was 54-58 years. In the specimen description, there was a diffusely growing mass in the endometrium of the uterus, with an uneven surface and tough texture. The muscle wall was extensively invaded. At low magnification, the tumor cells were arranged in tubular, glandular, papillary, micropapillary and solid growth patterns. At high magnification, the cells lining the lumen were arranged in a single layer, cuboidal or columnar pattern, with mild to moderate atypia, with vesicular nuclei and nuclear furrows. Some of the lumens showed eosinophilic homogeneous pink staining without structural-like material. In the solid area, the cells were plat fusiform, arranged in bundles or whirlpools, with large nuclear atypia and frequent mitotic figures. A large number of intravascular cancer thrombus were observed in all the three cases. The tumor cells were positive for GATA3 and/or thyroid transcription factor-1 (TTF1), diffusely positive for pair box gene 2 (PAX2) and PAX8, and positive for CD10 in some luminal margins. Estrogen receptor (ER) was focal positive, and progesterone receptor (PR) was negative. KRAS mutation was detected in case 1. According to the 2023 updated International Federation of Gynecology and Obstetrics (FIGO) staging guidelines for endometrial cancer, all the three cases were in advanced stage. It is suggested that pathologists should make accurate diagnosis based on morphological manifestations, using a set of matched immunohistochemical markers and necessary molecular tests to avoid misdiagnosis and better guide clinical diagnosis and treatment.