Objective To investigate the level of IL-17 and its clinical significance in patients with primary Sj(o)gren's syndrome (pSS) complicated with interstitial lung disease (ILD).Methods IL-17 levels were detected by enzyme linked immunosorbent assay (ELISA) in 53 untreated patients with pSS (25patients with only lacriminal and/or salivary gland involvement,28 with only interstitial lung disease involvement) and 15 healthy controls.The related clinical and laboratory data were recorded.ANOVA,LSDtest and Pearson test were used for statistical analysis.Results There were significant differences between the 3 groups(F=22.504,P=0.000).The mean concentration of sera IL-I7 in the patients with ILD was significantly higher than in patients with only lacriminal or salivary gland involvement (P＜0.05).There was no difference in the levels of sera IL-17 between the patients with only lacriminal and/or salivary gland involvement and healthy controls (P＞0.05).Conclusion Our results show that patients with pSS concomitant with ILD have high serum IL-17 levels,which highlight the role of IL-17 in Sj(o)gren's syndrome interstitial lung injury.

Objective:To improve the diagnosis of anti-synthetase antibody syndrome(ASS) by analyzing the clinical features of 6 patients.Methods:Six cases of ASS with complete data were included in this study as they were diagnosed or other CTD during the period of hospitalization in Wuxi People's Hospital from January 2016 to February 2020. Their clinical and laboratory characteristics, and follow-up information were analyzed. Features and changes in the course of disease were analyzed.Results:Four out of 6 patients were females, with age of disease onset as 34-72 years, and an interval of 4-59 months from the first diagnosis to the diagnosis of ASS. The first diagnosis was Sjogren's syndrome (SS) in 2 cases, rheumatoid arthritis (RA) in 1 case, mixed connective tissue disease (MCTD) in 1 case, systemic sclerosis (SSc) in 1 case, and undifferentiated connective tissue disease (UCTD) in 1 case. At the first diagnosis, 5 cases had dry cough and/or dyspnea, followed by fever (4 cases), arthritis and Raynaud's phenomenon (3 cases). Anti-nuclear antibody(ANA), which was more common in cytoplasmic type, and anti-SSA/52 000 antibody were mostly positive(5 cases). The presence of non-specific interstitial pneumonia (NSIP) pattern (6 cases) in high resolution CT(HRCT) was found at the initial diagnosis. During follow-up, patients developed repeated liver function or muscle enzyme abnor-malities (3 cases), mechanic's hand (MH) (3 cases), and lung interstitial disease progression (4 cases). The myositis antibodies were found to be positive.Conclusion:ASS can occur in the course of or at the same time as other CTDs. ASS should be considered in patients with interstitiallung disease (ILD) (especially NSIP pattern) in HRCT, and/or positive of cytoplasmic type ANA and/or anti-SSA/52 000 antibodies At the same time, if repeated liver function or muscle enzyme abnormalities, new onset of MH, and lung interstitial disease progresses during treatment, consideration may be given to the possibility of complicated ASS. Myositis-specific antibodies are helpful in the diagnosis of ASS.

Objective To explain the concept and surgical technique of 3D printing uncement radius distal prosthesis,evaluate and discuss the medium-term outcome of the prosthesis for giant cell tumor in distal radius.Methods From September 2015 to March 2017,13 patients diagnosed as giant cell tumor in distal radius were performed with en bloc resection combined with 3D print uncement prosthesis.All patients graded Campanacci Ⅲ or occurred local recurrence.Two patients with local recurrence had a local lesion curettage,inactivation and bone cement filling.There were 7 males and 6 females,with an average age of 37.8 years.Through the preoperative three-dimensional CT data,the 3D model of the distal radius was obtained based on the contralateral radius and the 3D printing uncemented distal radius prosthesis was made.Directly reconstrucion was conducted if the wrist joint ligament and joint capsule can be preserved.The surrounding soft tissue,remaining joint ligament and joint capsule were sutured to the prosthesis together combined with a brace if the wrist joint ligament and joint capsule can be only preserved partially.Radiocarpal joint was temporarily fixed by Kuntscher pin if the wrist joint ligament and joint capsule can't be preserved completely.Results In our series,the average resection length of the distal radius measured from the radial styloid process was 65.54±6.70mm.The length of prosthesis was consistent with the resection length and the length ratio of prosthesis to prosthetic stem is 1:1.The follow-up time was 17.77±4.97 months.There were no local recurrence and metastasis.At the end of the followup,except waist flexion,the wrist extension,wrist pronation,wrist supination,hand grip strength and Mayo wrist were significantly improved from 41.69°± 11.35°,41.92°± 11.09°,40.00°±7.64°,16.84±6.28 mmHg,47.69±9.27 points preoperatively to 57.46°±17.18°,55.00°±17.91°,53.46°±19.30°,23.08±6.29 mmHg,70.00±11.55 points,respectively.The DASH score was significantly decreased from 32.07±6.71 points to 19.15±8.41 points postoperatively.During surgery,there was one patient received temporary wrist fixation with kirschner's needle,which got a relatively poor postoperative function.Excluding this patient,comparing the resuits of 8 cases with directly suturing of wrist joint ligament and joint capsule and that of 4 cases with reconstructing by suturing and fixing with a brace,there were no statistical differences.There were no wrist dislocation or subluxation,aseptic prosthesis loosening,wrist joint degenerative changes or other prosthesis related complications.Conclusion 33D printing uncemented distal radius prosthesis is a good choice for the Campanacci grade Ⅲ or recurrent giant cell tumor in distal radius,because of its personalized design and uncemented fixation;in clinical application,we should pay attention to the evaluation of preoperative wrist joint capsule and surrounding ligament and the intraoperative soft tissue repair techniques.

Objective To calculate the standardized cesarean delivery rate by considering the individual characteristics of puerprae, and to evaluate the medical quality of obstetrics in the hospital. Methods Medical records of 69 406 puerprae from January to December in 2016 were collected from 33 tertiary general hospitals in Shanxi province. A logistic regression model was used to construct a maternal risk adjustment model of cesarean delivery, with the area under the ROC curve (AUC) used to evaluate the goodness of fit of the model. Results Of the 69 406 puerprae, 30 881 used caesarean delivery, accounting to 44. 37% . The cesarean section rate difference was statistically significant among those of different age, nationality, conditions upon admission, whether to participate in a clinical pathway, fetus number, birth weight and maternal gestational age, as well as the severity of complications (P< 0. 001). According to the logistic model, those of older age, history of cesarean delivery, twins or triplet births, neonatal overweight, malposition, placenta previa, and those with various pregnancy complications tend to use maternal cesarean section surgery, with a goodness-of-fit of 0. 82. With risk adjusted, the ranking of actual cesarean section rate and standardized cesarean section rate varies among the hospitals. Conclusions With the factor of puerprae factor adjusted, the standardized cesarean delivery rate can eliminate risk factors of the puerprae, it is feasible to scientifically evaluate the cesarean delivery rate of the hospital′s obstetric department.

Objective:To investigate the clinical characteristics and treatment of Beh?et′s disease complicated with cardiac valve involvement.Methods:We searched the wanfang medical database and Medline database to reviewed the domestic and foreign literature reports on cardiac Beh?et′s disease and analyzed their clinical features and therapeutic strategies. Chi-squared test was used for data analysis.Results:It was shown that Beh?et′s disease with cardiac valve involvement mainly affect men. The male to female ratio was 3.86∶1 in China and 2.50∶1 in foreign patients( χ2=1.32, P=0.251). The preoperative diagnosis rate was not high(60.3% in China, 57.1% abroad) ( χ2=0.13, P=0.716). Aortic valve and perivalvular lesions were the most common involved sites, of which aortic regurgitation was the most frequenty occurred, followed by mitral valve lesions. Glucocorticoids was still the main means treatment for medical(93/235 in China, 28/420 abroad), cyclophosphamide was more widely used in China(28/235), azathioprine was more widely used in foreign countries (12/42). Aortic replacement (AVR) was the mainly surgical approach, followed by artificial aortic valve replacement and left ventricular outflow tract plasty (Bentall).The incidence of postoperative perivalvular leakage or valve prolapse was higher with AVR than with Bentall(AVR 76.3%/Bentall 21.8% at home, χ2=32.60, P<0.001, AVR 71.4%/Bentall 0 abroad, χ2=13.84, P<0.001). Conclusions:Cardiac valve involvement is a severe complication of Beh?et′s disease. Heart involvement are more common, and the preoperative diagnosis rate is lower in China. The incidence of perivalve leakage (PVL) or valve prolapse (PD) after operation is higher with AVR than with Bentall surgery.The Bentall operation could improve prognosis and the postoperative complications abroad are lower than domestic.

Objective:To investigate the clinical features and prognosis of male with anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody.Methods:The clinical data of 246 patients with DM and anti-MDA5 autoantibodies hospitalized by Jiangsu Myositis Cooperation Group from 2017 to 2020 were collected and retrospectively analyzed. Chi-square test was performed to compared between counting data groups; Quantitative data were expressed by M ( Q1, Q3), and rank sum test was used for comparison between groups; Single factor survival analysis was performed by Kaplan-Meier method and Log rank test; Cox regression analysis were used for multivariate survival analysis. Results:①The male group had a higher proportion of rash at the sun exposure area [67.1%(47/70) vs 52.8%(93/176), χ2=4.18, P=0.041] and V-sign [50.0%(35/70) vs 30.7%(54/176), χ2=8.09, P=0.004] than the female group. The male group had higher levels of creatine kinase [112(18, 981)U/L vs 57 (13.6, 1 433)U/L, Z=-3.50, P<0.001] and ferritin [1 500 (166, 32 716)ng/ml vs 569 (18, 14 839)ng/ml, Z=-5.85, P<0.001] than the female group. The proportion of ILD [40.0%(28/70) vs 59.7%(105/176), χ2=7.82, P=0.020] patients and the red blood cell sedimentation rate[31.0(4.0, 101.5)mm/1 h vs 43.4(5.0, 126.5)mm/1 h, Z=-2.22, P=0.026] in the male group was lower than that of the female group, but the proportion of rapidly progressive interstitial lung disease (PR-ILD) [47.1%(33/70) vs 31.3%(55/176), χ2=5.51, P=0.019] was higher than that of the female group. ②In male patients with positive anti-MDA5 antibodies,the death group had a shorter course of disease[1.0(1.0, 3.0) month vs 2.5(0.5,84) month, Z=-3.07, P=0.002], the incidence of arthritis [16.7%(4/24) vs 42.2%(19/45), χ2=4.60, P=0.032] were low than those in survival group,while aspartate aminotransferase (AST)[64(22.1, 565)U/L vs 51(14,601)U/L, Z=-2.42, P=0.016], lactate dehydrogenase (LDH) [485(24,1 464)U/L vs 352(170, 1 213)U/L, Z=-3.38, P=0.001], C-reactive protein (CRP) [11.6(2.9, 61.7) mg/L vs 4.95(0.6, 86.4) mg/L, Z=-1.96, P=0.050], and ferritin levels [2 000(681, 7 676) vs 1 125 (166, 32 716)ng/ml, Z=-3.18, P=0.001] were higher than those in the survival group, and RP-ILD [95.8%(23/24) vs 22.2%(10/45), χ2=33.99, P<0.001] occurred at a significantly higher rate. ③Cox regression analysis indicated that the course of disease LDH level, and RP-ILD were related factors for the prognosis of male anti-MDA5 antibodies [ HR (95% CI)=0.203(0.077, 0.534), P=0.001; HR (95% CI)=1.002(1.001, 1.004), P=0.003; HR (95% CI)=95.674 (10.872, 841.904), P<0.001]. Conclusion:The clinical manifestations of male anti-MDA5 antibody-positive patients are different from those of female. The incidence of ILD is low, but the proportion of PR-ILD is high. The course of disease, serum LDH level, and RP-ILD are prognostic factors of male anti-MDA5 antibody-positive patients.