OBJECTIVE To investigate the effects of MIR149 rs2292832 and MIR499 rs3746444 gene polymorphisms on the efficacy of tofacitinib combined with iguratimod in the treatment of moderate‑to‑severe rheumatoid arthritis （RA）， to provide genetic reference for individualized treatment of moderate‑to‑severe RA patients.METHODS This was a prospective cohort study， and patients were grouped according to genotyping results. A total of 320 patients with moderate-to-severe RA diagnosed in the department of immunology of our hospital between January 2023 and January 2024 were enrolled. All patients received standardized treatment with tofacitinib （5 mg twice daily） combined with iguratimod （25 mg twice daily） for 24 weeks treatment course. Clinical efficacy outcomes， including American College of Rheumatology （ACR） 20/50/70 responses， disease activity score‑28 based on C‑reactive protein （DAS28-CRP）， erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP）， were compared among patients with different genotypes. Combined-genotype analysis and multivariate Logistic regression analysis were also performed.RESULTS The MIR149 rs2292832 CC-genotype patients exhibited significantly higher ACR20， ACR50 and ACR70 response rates （88.90%， 67.78%， 45.56%） than those carrying CT- and TT-genotypes （ P ＜0.05）. After 24 weeks treatment， the reductions in DAS28‑CRP， ESR and CRP were significantly greater in CC‑genotype patients than in CT‑ and TT‑genotype patients （ P ＜0.05）， and the 24‑week DAS28‑CRP was significantly lower in the CC‑genotype patients than in CT‑ and TT‑genotype patients （ P ＜0.05）. The MIR499 rs3746444 GG-genotype showed significantly higher ACR20， ACR50 and ACR70 response rates （91.46%， 73.17%， 52.44%） than those carrying AG‑ and AA‑genotypes （ P ＜0.05）. After 24 weeks of treatment， the reductions in DAS28‑CRP， ESR and CRP were significantly greater in GG‑genotype patients than in AG- and AA-genotype patients and the 24‑weeks DAS28‑CRP was significantly lower in the GG‑genotype patients than in AG- and AA-genotype patients （ P ＜0.05）. Among the nine combined‑genotyps， the CC+GG genotype yielded the best treatment response. The MIR149 rs2292832 CC and MIR499 rs3746444 GG genotypes were independent predictors of clinical remission （ P ＜0.01）， whereas baseline DAS28‑CRP ≥ 6.5 served as a negative predictor of clinical remission （ P ＜0.05）.CONCLUSIONS Gene polymorphisms of MIR149 rs2292832 and MIR499 rs3746444 significantly influence the therapeutic effect of tofacitinib combined with iguratimod in patients with moderate-to-severe RA. Patients carrying CC and GG genotypes achieve better treatment responses.

Objective To investigate the correlation between serum bicarbonate level and cardiovascular events in peritoneal dialysis(PD)patients.Methods The data of PD patients who underwent PD catheterization and were followed up regularly until March 31,2023 were retrospectively collected.The included patients were divided into low bicarbonate group and normal bicarbonate group according to the time-averaged serum bicarbonate level.The incidence of cardiovascular events(including coronary heart disease,heart failure,stroke,peripheral vascular dis-ease,death related to cardiovascular surgery or death due to aneurysm dissection or rupture,fatal pulmonary em-bolism,or death from other or unknown cardiovascular causes)was compared between the two groups and the risk factors for cardiovascular events were analyzed.Results At the end of follow-up,a total of 110 PD patients were included,and 34 patients had cardiovascular events.Compared with the normal bicarbonate group,the low bicar-bonate group had a higher incidence of cardiovascular events.Univariate Cox regression analysis showed that the risk of cardiovascular events in the low bicarbonate group was 4.197 times higher than that in the normal bicarbon-ate group(95％CI=2.115-8.331,P＜0.001).After adjusting for multiple confounding factors,the risk of car-diovascular events in the low bicarbonate group was 3.506 times higher than that in the normal bicarbonate group(95％CI=1.709-7.193,P=0.001).The results of multivariate competing risk model showed that the risk of cardiovascular events in the low bicarbonate group was 3.801 times higher than that in the normal bicarbonate group(95％CI=1.920-7.525,P＜0.001).Conclusion Low serum bicarbonate level is closely related to the oc-currence of cardiovascular events in patients with PD,and it is an independent risk factor for cardiovascular events in patients with PD.

OBJECTIVE: To introduce a new method of complete remaining parotid fascia in parotidectomy, preventing Frey's syndrome. METHOD: Thirty-five patients with benign tumor in the parotid gland were treated by remaining parotid fascia. All 35 patients were followed up after 6 months to 24 months. RESULT: The parotid fasciae of 26 out of 35 were remained completely and none of these 26 patients developed Frey's syndrome. The parotid fasciae of 9 out of 35 were excised partly and Frey's syndrome occurred in 2 of these 9 patients. There was significant difference of Frey's syndrome between the parotid fasciae being remained completely and the parotid fasciae being remained partly. CONCLUSION The parotid fascia could be reserved completely in parotidectomy. The complete parotid fascia could prevent Frey's syndrome in the patients after undergoing parotidectomy.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Fasciotomy ; Female ; Humans ; Male ; Middle Aged ; Parotid Gland ; surgery ; Parotid Neoplasms ; surgery ; Postoperative Complications ; prevention & control ; Sweating, Gustatory ; prevention & control ; Young Adult