Objective:To investigate the clinical significance of CX3CL1 in pSS-ILD.Methods:A total of 103 pSS patients treated in the Department of Rheumatology and Immunology of the Affiliated Hospital of Guilin Medical College from December 2019 to December 2020 were included (42 cases with ILD and 61 cases without ILD), and 46 healthy physical check-up subjects in the health check-up center of the Affiliated Hospital of Guilin Medical college were included as controls. Demographic data, clinical manifestations, clinical parameters, lung function test, lung HRCT and serum samples of enrolled patients were collected. The serum levels of CX3CL1 and KL-6 in PSS-ILD patients, pSS patients and healthy subjects were detected by ELISA, and the correlation between CX3CL1 and clinical related indexes in pSS-ILD and pSS patients was analyzed. Independent sample t test, Kruskal-Wallis H test, Pearson correlation and Logistic regression analysis were used for statistical analysis. Results:As KL-6, the levels of CX3CL1 were significantly higher in the pSS-ILD group compared to both the pSS and control groups [CX3CL1: 9.08 (3.97, 30.56)ng/ml, 8.12 (6.16, 8.89)ng/ml, and 7.09 (5.86, 9.07)ng/ml, H=3.53, P=0.019; KL-6: 19.08 (8.05, 24.72)mU/ml, 15.9 (4.52, 19.26)mU/ml, 12.74 (8.09, 16.23) mU/ml, H=9.85, P=0.008]. Furthermore, CX3CL1 was shown to be positively correlated with KL-6( r=0.82, P<0.001). The cutoff value for CX3CL1 was determined to be at a concentration of 9.07 ng/ml with a specificity of 86.9% and sensitivity of 43.6%. The area under the receiver operating characteristic curve was 0.603. CX3CL1 exhibited significant correlations with predcited carbon monoxide dispersion as a percentage of expected value ( r=-0.45, P=0.004), HRCT score ( r=0.54, P<0.001), pulmonary hypertension ( r=0.37, P=0.039), ESSDAI score ( r=0.36, P=0.049), as well as chest tightness and acute breath (coefficient of association r=0.49, P<0.001). Conclusion:The level of serum CX3CL1 is directly proportionate to the severity of KL-6, pulmonary fibrosis, and lung function impairment, thereby suggests that CX3CL1 can be utilized as a parameter for the diagnosis and assessment of pSS-ILD.

Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy(PCNL) by middle renal calice used as main access for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite.Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones.The rate of stone removal and complications were the main points of the analysis.Results Seventy-two cases underwent first session PCNL by single access tract(middle calices),3 cases underwent first session PCNL by double access tracts (2 cases by middle and lower calices,1 case by upper and middle calices).Of these patients,1 case had fragments with no further treatment,16 cases underwent second session PCNL.All were treated by single access tract (middle calices) and 2 cases had extracorporeal shock wave lithotripsy before the second PCNL.Seventy-six cases composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stones removal rate 82.6％ (76/92).Hemoglobin dropped 1-4 g/L,11 cases and 3 cases were given blood transfusion in the operation procedure and post operation respectively.One case developed pyelonephritis and 1 case had split renal dysfunction with peri-parenchyma infection.Conclusions By middle calices as a main access to perform PCNL for staghorn stones is effective and safe.Using pneumatic and ultrasonic lithotrite will be very useful with high stones free rate and short procedure time and less complication.