Objective To determine the level of ieptin (LEP) and soluable leptin receptor (sLEP-R) in the peripheral blood of rheumatoid arthritis (RA). The change of LEP/sLEP-R in patients with RA and the relationship between LEP/sLEP-R with osteoporosis is also investigated. Methods Sixty-four patients with RA and 60 normal controls were involved. Levels of LEP and sLEP-R were measured by ELISA. Bone mineral density (BMD) of non-dominant forearm, lumbar vertebrae(L_(1～4)) and hip were measured by dual energy X-ray absorptiometry. Results ① Compared with normal controls, the level of LEP in RA increased significantly,but the level of sLEP-R in RA decreased significantly (P<0.01). ② BMD of all detected regions in RA were significantly reduced than those in the normal controls (P<0.01). There was a higher incidence of osteoporosis in patients with RA (35.9%) than in normal controls (15.0%)(P<0.01). ③ There was a positive lineary correlation between age and the level of LEP in the peripheral blood of RA (P<0.01). There was negative lineary correlations between BMD and level of LEP in the peripheral blood of RA (P<0.05). There was a negative lineary correlation between age and level of sLEP-R in the peripheral blood of RA (P<0.01). There was positive lineary correlation between BMD and level of sLEP-R in the peripheral blood of RA (P<0.05). There was no correlations between clinical or laboratory parameters and level of LEP/sLEP-R in the peripheral blood of RA. ④ Analysis of Logistic Regression showed that the level of sLEP-R in the peripheral blood of RA was an independent protective factor for the occurrence of osteoporosis in RA (OR=3.089, P=0.017, 95%CI: 0.017-7.108). Conclusion The level of LEP in RA increases significantly, while the level of sLEP-R decreases significantly. There is a closely correlation between bone metabolism status and the level of LEP or sLEP-R in RA. The level of sLEP-R in the peripheral blood of RA is an independent protective factor for the occurrence of osteoporosis in RA.

Objective:To explore an applicative value of a 5-type precise diagnostic technique in integrated precise repair and reconstruction of digit-tip injuries.Methods:From March 2012 to June 2022, 45 digit-tip injuries (38 patients, with an average age of 33 years old) were classified under microscope on the basis of effectiveness of blood vessels remained in the severed tissue. Among the injured digits, there were 15 thumbs, 9 index fingers, 16 middle fingers, 4 ring fingers and 1 little finger. The diagnosis was categorised into 5 types according to involvement of blood vessels: Type I, injury of proper palmar digital artery (10 digits) ; Type II, injury of small artery (5 digits) ; Type Ⅲ, injury of whole vein (4 digits) ; Type IV, injury of superficial palmar arch (4 digits) ; and Type V, vessels missing (22 digits). The timing and therapeutic method of surgery were selected based on the precise classification of 5 types of diagnosis: (1) For type Ⅰ-Ⅳ injuries, 16 patients (23 digits) received in situ tissue replantation after emergency classification. Of which, type Ⅰ-Ⅱ injuries received conventional replantation, type Ⅲ injuries had replantation with arterialised vein, and type IV injuries received replantation with artery-vein shunt. (2) For the type V injuries, 22 patients (22 digits), staged and categorised flap reconstruction with toe flaps were performed. Of which, 7 were performed in emergency surgery, 12 in subemergency surgery and 3 in elective surgery. Based on the severity of defects, small tissue flaps of toe were used in reconstruction of type V injuries and following toe flaps were employed: 9 hallux nail flaps, 3 hallux nail flaps (for reconstruction of distal phalanx), 5 hallux fibular flaps, 3 hallux abdominal flaps and 2 compound tissue flaps with nail bed of the second toe. The sizes of the 45 replanted/transferred tissues flaps were 1.0 cm×0.6 cm×0.4 cm-2.2 cm×1.5 cm×0.8 cm. Donor sites directly sutured. Medical APP was applied in the rehabilitation exercises. Functions of digits were assessed by scheduled follow-ups at outpatient clinic and via remote medical APP to evaluate the clinical efficacy.Results:All small tissue blocks and (or) tissue flaps survived after replantation and (or) flap reconstruction of 45 injured digits. Postoperative follow-up lasted for 6 months to 7 years, with 36 months in average. The appearances of the reconstructed digit-tips were close to normal digits, with TPD at 3-7 mm. According to the Michigan Hand Outcomes Questionnaire (MHQ), 32 patients (37 digits) were in excellent, 5 patients (7 digits) in good, and 1 patient (1 digit) in poor, with 97.78% of excellent and good rate.Conclusion:Five-type precise diagnostic technique is the key to the integrated and precise reconstruction of digit-tip injuries. This method has been clinically validated and achieved realistic recovery from the injured digits.