As a new treatment option after conventional corticosteroids and immunomodulatory drugs, biologics have been widely used in the clinical management of non-infectious uveitis in many countries due to their approved efficacy and safety. Anti-tumor necrosis factor-alpha monoclonal antibody is the most commonly used one. However, the guidance on its standardized application is lacking. The Ocular Immunology Group of Immunology and Rheumatology Academy in Cross-Straits Medicine Exchange Association compiled the Chinese expert consensus on treatment of non-infectious uveitis with anti-tumor necrosis factor-alpha monoclonal antibody. This evidence-based consensus is made according to the principle of consensus building and combines the clinical experience of the experts. Twelve recommendations are formatted on the application of Adalimumab and Infliximab. The interpretation of this consensus point will help improve the normative and effective application of anti-tumor necrosis factor-alpha monoclonal antibody in ophthalmologists, rheumatologists and immunologists.

Objective:To investigate the urinary sediment findings and the clinicopathologic features of IgA nephropathy (IgAN) patients with acute kidney injury (AKI).Methods:It was a retrospective study. The patients with renal biopsy-proven primary IgAN in Peking University First Hospital from January 31, 2013 to July 31, 2015 were selected. According to whether AKI occurred at renal biopsy or not, the patients were divided into AKI group and non-AKI group. Morning urine samples were obtained on the day of renal biopsy. Urine sediments, including various cells and casts, were examined. The clinical data, urinary sediments, and renal pathological changes were compared between the two groups. Logistic regression analysis was performed to identify the association between clinical pathological changes, urinary sediment indicators and AKI, or clinical pathological changes and urinary sediment indicators.Results:There were 502 IgAN patients enrolled in this study, with age of (36.1±12.1) years old and 261 males (52.0%). The incidence of AKI was 11.4% (57/502) among the enrolled patients at the time of renal biopsy. Common causes of AKI included gross hematuria-induced AKI (10 cases), acute tubulointerstitial nephritis (10 cases), crescentic IgAN (9 cases), malignant hypertensive renal damage (6 cases), and multiple etioloqy or unknown etiology (22 cases). Compared with non-AKI group, AKI group had higher proportions of males and malignant hypertension, higher levels of proteinuria and urinary erythrocyte counts, and higher frequencies of gross hematuria, leukocyturia, renal tubular epithelial cells, and granular casts (all P<0.05). AKI group also had higher proportions of severe tubular atrophy/interstitial fibrosis (T2) and cellular/cellular fibrous crescent formation (C2) than non-AKI group (both P<0.05). Logistic regression analysis results showed that, there were statistically significant differences in the correlation between AKI and gender, 24 h urinary protein, urinary erythrocyte counts, granular casts and renal tubular atrophy/interstitial fibrosis (T) scores (all P<0.05). Hematuria, leukocyturia, red blood cell casts, white blood cell casts, granular casts, and fatty casts were correlated with endothelial hypercellularity (E) and cellular/cellular fibrous crescent formation (C) scores, respectively (all P<0.05). Hematuria was correlated with mesangial hypercellularity (M) scores ( OR=2.613, 95% CI 1.520-4.493, P=0.001). Hematuria ( OR=1.723, 95% CI 1.017-2.919, P=0.043) and fatty casts ( OR=2.646, 95% CI 1.122-6.238, P=0.026) were correlated with segmental sclerosis or adhesion (S) scores. Leukocyturia ( OR=1.645, 95% CI 1.154-2.347, P=0.006) and fatty casts ( OR=2.344, 95% CI 1.202-4.572, P=0.012) were correlated with T scores. Epithelial cell cast was correlated with C scores ( OR=1.857, 95% CI 1.174-2.939, P=0.008). Conclusions:AKI is a common complication among IgAN patients with diverse etiology and more severe clinicopathological features. Urinary sediment findings can reflect renal pathological changes to some extent, and therefore assist in the clinical diagnosis and treatment of IgAN patients with AKI.

Objective:To analyze the evolution path and diffusion mechanism of the unified drug management system of countywide medical communities in China, and provide references for the deepening implementation of the system.Methods:The policy documents of the central and provincial governments were retrieved with the keywords of " medical community" " drug management" " county-township-village integration" and " central pharmacy". By means of the policy diffusion theory, the evolution path of the diffusion of the unified drug management system for the countywide medical communities was identified from such dimensions as time, space and hierarchy. On the other hand, the action mechanism of the diffusion of the system was summarized from such aspects as competition, administrative instruction, learning and imitation.Results:A total of 36 effective policy documents were collected. The time diffusion of the drug unified management system of countywide medical communities was characterized by an " S" curve. By the end of 2022, there were 30 provinces implementing the countywide medical community drug unified management system, and the policy diffusion has entered a saturation and stagnation stage; spatial diffusion showed " proximity effect" ; hierarchy diffusion embodied the " leader follower" mode. In the process of policy diffusion, competition mechanism, administrative instruction mechanism, learning mechanism, and imitation mechanism coexisted, but there were difference in the dominant mechanism at different stages of policy diffusion.Conclusions:The unified drug management system of the countywide medical communities has been widely disseminated. It is recommended to promote the introduction of supporting policies, optimize the system evaluation system, and comprehensively use various diffusion mechanisms to promote the optimization of the system, so as to promote the deepening and sustainable operation of the system.

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Objective:This study aims to analyze of the quality of diagnosis and treatment data of community medical institutions on the national health information platform in a district of Beijing from the perspective of scientific research informatization, to provide experience and reference for promoting the informatization construction of primary medical units and tapping the scientific research potential of the regional data platform.Methods:Based on the data backup database of the national health information platform in the region, the data quality was analyzed and evaluated mainly in three dimensions: integrity, integration, and consistency.Results:Through the construction of the national health information platform, the district successfully achieved the effective collection of diagnosis and treatment data from community medical institutions, covering the main data such as patients′ basic information, visit information, test information, prescription information, etc. However, the data collected so far were still insufficient in terms of data integration and consistency.Conclusions:A regional medical data center is suggested to construct to break down the barriers between data systems, conduct pre-structuring of diagnosis and treatment data, improve data integration and consistency, and at the same time, carry out effective scientific research prospective design to promote the effective transformation of clinical data to scientific research data.

Objective:To explore the effectiveness and complications of non-incision removal of tunneled cuffed catheter (TCC).Methods:The clinical characteristics, surgical plans and complications of patients with TCC removal in the Renal Division of Peking University First Hospital from January 1, 2015 to December 31, 2020 were collected and analyzed retrospectively. The patients were divided into non-incision removal group and traditional incision removal group. The clinical characteristics, procedure success rate, procedural duration and complications were compared between the two groups.Results:A total of 349 patients were included in this study, for whom 368 catheter removal procedures were performed, including 286 procedures in the non-incision removal group, 75 procedures in the traditional incision removal group, and 7 procedures without records of surgical plans. There was no significant difference in age, sex, basic kidney diseases and catheter remaining time and location between the two groups (all P>0.05). Two procedures in the non-incision removal group and 1 procedure in the traditional incision removal group failed respectively, and there was no significant difference in the procedure success rate between the two groups (99.3% vs 98.7%, χ2=0.290, P=0.590). The procedural duration in the non-incision removal group was lower than that in the traditional incision removal group [(5.36±1.70) min vs (17.55±3.28) min, t=44.198, P<0.001]. Among the patients who needed TCC exchange, there was no significant difference in the selection of new catheter position between the two groups ( P=0.330). In terms of complications, there were 2 procedures of local hematoma in the non-incision removal group and 1 procedure of infection in the traditional incision removal group, and there was no severe complication in both groups. Conclusions:There was no significant difference in the procedural success rate and complications between non-incision removal group and traditional incision removal group, and non-incision procedure may be superior in reducing the procedure duration and harm less to the patients. Non-incision procedure is a safe and effective method to remove TCC.

Objective:To explore the association of access blood flow measured by ultrasound dilution and color Doppler ultrasound with patency loss of arteriovenous fistula (AVF).Methods:This was a bidirectional cohort study. The adult patients who underwent maintenance hemodialysis (MHD) with AVF in Peking University First Hospital from January 1, 2018 to July 31, 2020 were enrolled. AVF blood flow was measured by ultrasonic dilution method (Qa), and color Doppler ultrasound in cephalic vein and brachial artery. Patients were divided into low Qa (<500 ml/min), normal Qa (500-1 500 ml/min) and high Qa (>1 500 ml/min) groups according to baseline AVF blood flow measured by ultrasonic dilution method. Qa was monitored every 3 months within the first year. The endpoint events of follow-up were defined as AVF patency loss or death. The deadline of the follow-up was July 31, 2022. Linear regression analysis was used to assess the change trend of Qa. Fine and Gray competitive risk model was used to evaluate the cumulative incidence of AVF patency loss. The Cox proportional hazards regression model was used to evaluate the association between access AVF blood flow and patency loss.Results:A total of 163 patients were enrolled, with age of (57.0±13.7) years old and 110 males (67.5%). The median follow-up time was 45(22, 53) months. Forty-four patients (27.0%) had AVF failure, and 29 patients (17.8%) died. The cumulative incidence rates of AVF patency loss in patients with low Qa, low blood flow of brachial artery and cephalic vein (<500 ml/min), and in those with a downward trend of Qa were higher than those in patients with normal or high blood flow, and in those with a upward trend of Qa (Gray′s test, all P<0.05). After adjusted for age, sex, age of fistula, diabetes and vascular stenosis, multivariable Cox regression analysis results showed that baseline Qa<500 ml/min ( HR=3.508, 95% CI 1.382-8.905, P=0.008), baseline brachial artery flow<500 ml/min ( HR=2.413, 95% CI 1.058-5.503, P=0.036) and a downward trend of Qa ( HR=2.498, 95% CI 1.241-5.027, P=0.010) were independently associated with AVF patency loss. Conclusions:Patients with low baseline value or downward trend of AVF blood flow are at significantly higher risk of patency loss. The brachial artery measurement of AVF blood flow is the preference location for color Doppler ultrasonic.

Objective To investigate the clinical features and prognostic risk factors of pneumocystis pneumonia (PCP) in patients with glomerular disease. Methods The medical charts of all patients with confirmed PCP, diagnosed in Peking University First Hospital from August 2006 to February 2018 were retrospectively reviewed, and 36 cases with glomerular disease were enrolled. Clinical and imaging data were collected and analyzed. Thirty-six patients were divided into survival group and death group. The clinical data, baseline estimated glomerular filtration rate (eGFR), mechanical ventilation and APACHE II score were compared. Results A total of 27 males and 9 females were included, with age of (49.6 ± 17.5) years. All patients were receiving immunosuppressive therapy at the PCP onset, with a median duration of 2.5 months, and none of them was receiving PCP prophylaxis. The main clinical manifestations included fever (100.0% ), dyspnea (75.0% ) and dry cough (61.1% ). Hypoxemia occurred in 97.2% of patients and 17 cases presented as type 1 respiratory failure. Fifteen out of 30(50.0%) patients had CD4+ T cell counts below 200 cells/mm3. Ground glass opacity was the most common finding in CT imaging of 28 patients, followed with grid shadows, consolidation and nodules. Thirty-five patients received trimethoprim-sulfamethoxazole (TMP-SMX) as initial therapy, and 17.1% (6/35) of them developed acute kidney injury due to sulfonamide use. Ten patients died during hospitalization, with respiratory failure as the only direct cause of death. Elder age, delayed diagnosis of PCP, mechanical ventilation and high APACHEⅡscores were associated with poor survival. Conclusions PCP is a severe complication of immunosuppressive therapy in patients with glomerular disease. Early diagnosis and prompt treatment are critical to improve prognosis. Hydration prior to sulfonamide treatment and alkalization of urine are necessary to reduce the incidence of acute kidney injury.

Objective To understand the cognitive level of chronic obstructive pulmonary disease (COPD) disease management and pulmonary rehabilitation among medical staff in the respiratory departments and community of public health institutions in Panyu of Guangzhou, in order to assess the status of prevention and treatment of COPD in this area. Methods From March to October 2017, a questionnaire survey was conducted among 339 medical staff in Panyu, including respiratory doctors, nurses and therapists of four tertiary hospitals, five secondary hospitals, and three first-level hospitals, GPs, nurses and therapists at 16 community health service centres, among them, there are 147 respiratory and general practitioners (hereinafter referred to as doctors), 171 respiratory and general nurses (hereinafter collectively referred to as nurses), and 22 rehabilitation therapists (hereinafter collectively referred to as therapists). Using Epidata software to create questionnaire database entry data. Results The awareness rate of COPD airflow limitation severity of nurses was only 19.9％, which was lower than that of doctors (39.7％) and therapists (22.7％). Doctors, nurses, and therapists are familiar with the low percentage of the GOLD guidelines, which are respectively only 12.3％, 7.6％, and 4.5％. Nurses were diagnosed with pulmonary function as a basis for COPD, and the awareness rate was only 60.2％ lower than that of doctors (82.9％) and therapists (81.8％). In alleviating COPD patients′shortness of breath, only 31.8％therapists chose short-acting beta-agonists, lower than doctors (61％) and nurses (45％). There is disagreement about the long-term use of inhaled corticosteroids in COPD. Medical staff have the highest awareness of lip-reducing and abdominal breathing, followed by Taiji and Ba Duan Jin exercises, and low awareness of modern rehabilitation programs such as elastic bands, upper and lower limb exercises. The effective pulmonary rehabilitation program should last at least 8 weeks, and the awareness rate of this therapy practice was 40.9％, higher than doctors (13.7％) and nurses (18.1％). Medical staff believe that the main factors affecting patient compliance are the cost of the drug and the patient′s lack of understanding of the benefits of the treatment. Additionally, 40.4％ of doctors, 51.5％ of nurses, and 54.5％of therapists believe that community health services cannot manage COPD. The reasons that affect community management of COPD, doctors believe that patient compliance and lack of man power, nurses believe that the main shortage of manpower and equipment, the therapist believes that the lack of medical awareness and poor patient compliance. Conclusion Doctors, nurses, and therapists have inconsistent understandings of COPD disease management and pulmonary rehabilitation, and each has its own focus. It is necessary to strengthen learning exchanges for each weak knowledge point. The awareness rate of modern rehabilitation exercise for pulmonary rehabilitation is not as high as that of traditional Chinese medicine. It is necessary to pay attention to the promotion of the benefits and significance of COPD pulmonary rehabilitation treatment and improve compliance.

Objective To elucidate the clinical and pathological characteristics of the patients with thymoma-associated glomerulonephropathy.Methods In this retrospective study,the clinicopathologic characteristics of patients diagnosed as thymoma-associated glomerulonephropathy inPeking University First Hospital during the period between Oct 2008 and Jun 2017 were analyzed,including the histological classfication of thymoma,the clinicopathological features and the short-term prognosis.Results Altogether twelve patients were included with an average age of (55+ 16) years;male/female ratio was 3∶ 1.The B2 type thymoma was the most common type.Nine cases also suffered from myasthenia gravis,and eight cases of glomerulopathy accompanied by thymoma activity.The clinical presentation of glomerulopathy included nephrotic syndrome (11/12),acute kidney injury (10/12).Eleven patients received renal biopsy,among which five cases were minimal change nephropathy,three cases were membranous nephropathy,and the other three cases were focal segmental glomerulosclerosis,thrombotic microangiopathy and endocapillary proliferative glomerulonephritis,respectively.Eleven patients received immunosuppression therapy.After a median 12 months follow up,the proteinuria decreased in 7 cases,and renal function completely or partially recovered in 6 cases.Conclusions Minimal change disease is the most frequent pathological type of thymoma-associated glomerulonephropathy.Immunotherapy with glucocorticoid as first-line drug may be considered for thymoma-associated glomerulonephropathy with surgery,chemoradiation contraindications or non-remission of kidney disease after anti-tumor therapy.