Objective:To investigate the rates of low disease activity and clinical remission in patients with systemic lupus erythematosus(SLE)in a real-world setting,and to analyze the related factors of low disease activity and clinical remission.Methods:One thousand patients with SLE were enrolled from 11 teaching hospitals.Demographic,clinical and laboratory data,as well as treatment regimes were collec-ted by self-completed questionnaire.The rates of low disease activity and remission were calculated based on the lupus low disease activity state(LLDAS)and definitions of remission in SLE(DORIS).Charac-teristics of patients with LLDAS and DORIS were analyzed.Multivariate Logistic regression analysis was used to evaluate the related factors of LLDAS and DORIS remission.Results:20.7％of patients met the criteria of LLDAS,while 10.4％of patients achieved remission defined by DORIS.Patients who met LLDAS or DORIS remission had significantly higher proportion of patients with high income and longer disease duration,compared with non-remission group.Moreover,the rates of anemia,creatinine eleva-tion,increased erythrocyte sedimentation rate(ESR)and hypoalbuminemia was significantly lower in the LLDAS or DORIS group than in the non-remission group.Patients who received hydroxychloroquine for more than 12 months or immunosuppressant therapy for no less than 6 months earned higher rates of LLDAS and DORIS remission.The results of Logistic regression analysis showed that increased ESR,positive anti-dsDNA antibodies,low level of complement(C3 and C4),proteinuria,low household in-come were negatively related with LLDAS and DORIS remission.However,hydroxychloroquine usage for longer than 12 months were positively related with LLDAS and DORIS remission.Conclusion:LLDAS and DORIS remission of SLE patients remain to be improved.Treatment-to-target strategy and standar-dized application of hydroxychloroquine and immunosuppressants in SLE are recommended.

Objective:To compare the efficacy of pars plana vitrectomy (PPV) combined with human amniotic membrane (hAM) plugging technique or internal limiting membrane (ILM) flap insertion technique for high myopia macular hole retinal detachment (MHRD).Methods:A non-randomized controlled clinical study was performed.Sixteen eyes of 15 patients with high myopia MHRD treated in the Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from July 2020 to August 2021 were included.All patients underwent PPV and were divided into hAM plug group (7 eyes of 7 patients) and the ILM insertion group (9 eyes of 8 patients) based on the different plugging materials.The best corrected visual acuity (BCVA) and intraocular pressure were measured before surgery and at 1 week, 1, 3, and 6 months postoperative, respectively.Slit-lamp microscopy combined with lenses, scanning laser ophthalmoscope and optical coherence tomography (OCT) were used to examine the fundus, the macular hole closure and retinal reposition.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (No.SH9H-2021-T322-2). Written informed consent was obtained from each subject.Results:The retinal reattachment was achieved in 6 eyes in the hAM plug group and all 9 eyes in the ILM insertion group after initial surgery.The macular hole closure was observed in 5 eyes in the hAM plug group and 8 eyes in the ILM insertion group after initial surgery, and there was no statistical difference in the macular hole closure rate between the two groups ( P>0.05). There were significant differences in the overall comparison of BCVA between the two groups over time ( Ftime=4.420, P<0.05). Postoperative BCVA at different time points was better than preoperative BCVA in each group, but the differences were not significant (all at P>0.05). There was no significant difference in the overall comparison of BCVA between the two groups ( Fgroup=0.183, P>0.05). Two eyes in the hAM plug group and 4 eyes in the ILM insertion group developed transient ocular hypertension, which returned to normal after 1 week of treatment. Conclusions:Both PPV combined with hAM plugging technique and ILM insertion technique are safe and effective for the treatment of MHRD in high myopia.The hAM plugging technique can not only achieve anatomical reduction but also functional recovery of the retina even in complicated fundus conditions.

Objective:To explore the efficacy and safety of single-incision transobturator bulbourethral sling suspension without skin tunnel puncture in male patients with urinary incontinence.Methods:The clinical data of 6 male patients with urinary incontinence who underwent single-incision transobturator bulbourethral sling suspension without skin tunnel puncture in Beijing Hospital from August 2023 to August 2024 were retrospectively analyzed.The age of the patients ranged from 66 to 76 years old, with an average of 71.7 years old. The disease duration ranged from 18 to 48 months, with an average of 30 months. Six patients used 1 to 3 pads per day, with an average of 2.3 pads. The International Continence Incontinence Questionnaire Short Form (ICI-Q-SF) scored 13 to 19, with an average of 15.8. The Incontinence Quality of Life Questionnaire (I-QOL) scored 5.3 to 30.6, with an average of 18.8. Three patients underwent transurethral resection of the prostate for benign prostatic hyperplasia and three patients underwent radical prostatectomy for prostate cancer. The degree of urinary incontinence was mild in 2 cases and moderate in 4 cases. The technical points are as follows: the puncture method has been changed from the traditional outside-in approach to an inside-out approach. After the puncture needle passes through from beneath the skin at the incision, the sling is guided in, avoiding the need for skin tunneling punctures. Upon completion of the puncture, the ends of the sling on both sides are tied with a certain tension at the midline of the incision, and the incision is then closed layer by layer. The efficacy and safety of surgery were evaluated by recording the number of daily pad use, subjective scoring scale [International Committee on Urinary Incontinence Questionnaire-Short Form (ICI-Q-SF), Incontinence Quality of Life (I-QOL)] and complications at 1 month after surgery. Social continence was defined as 0 to 1 pad use per day. Successful treatment was defined as social continence. Treatment improvement was defined as no social continence, but 50% or more improvement of symptoms compared with that before surgery. Other conditions were defined as treatment failure.Results:All operations were successfully completed. After 1 to 11 months of follow-up, all patients achieved social continence. The patients' postoperative daily use of urinary pads ranged from 0 to 1 piece, with a mean of 0.5 piece. ICI-Q-SF scores ranged from 1 to 7, with a mean of 3. I-QOL scores ranged from 72.1 to 85.2, with a mean of 77.0. All the indicators were significantly improved compared with those before operation. In terms of postoperative complications, one patient had dysuria and urinary retention 2 days after the removal of the catheter, which was improved after symptomatic treatment of anti-inflammatory, detumescence, and indwelling catheter. At the last follow-up, there were no surgical related complications.Conclusions:The single-incision transobturator bulbourethral sling suspension without skin tunnel puncture for the treatment of male urinary incontinence is safe and effective. Compared to the traditional surgical method, it does not increase the difficulty of the procedure and is technically feasible, offering clinicians a new approach and perspective.

Objective To analyze the clinical characteristics of IgG4-related disease (IgG4-RD),guide the selection of therapeutic drugs,and to explore the significance of potential tumor identification for IgG4-RD.Methods A total of 92 patients diagnosed with IgG4-RD and admitted to this hospital from January 1,2017 to December 31,2021were selected as the research subjects by using the Yidu Cloud system.The clinical data conducted the summary analysis. The clinical characteristics of IgG4-RD were summarized.Results The mean age of IgG4-RD was definitely diagnosed in the 92 patients was (58.1±11.3)years old,with 65 male ca-ses (70.7％) and 27 female cases (29.3％).The most commonly affected organ tissues were lymph nodes (37 cases,40.2％),pancreas (33 cases,35.9％) and salivary glands (31 cases,33.7％).In the patients woth the 92 patients,28 cases (30.4％) had involvement of a single organ tissue,while 32 cases (34.8％) had involvement of two or more organs.In the 92 patients,89 cases received steroid therapy,and 71 cases received immunosup-pressive therapy,in which 45 cases (63.4％) used cyclophosphamide.The initial treatment effective rate (72.7％ vs. 55.6％) and one-year non-recurrence rate (38.2％ vs. 20.0％) of the steroid combined immuno-suppressive therapy group were better than those of the single steroid group,but the differences were not sta-tistically significant (P>0.05).The proportion of the patients with tumor comorbidity and IgG4 level>40 g/L (18.2％) was significantly higher than that of the non-tumor comorbidity (1.2％),and the difference was statistically significant (P<0.05).However,there was no statistically significant difference in the proportion of patients with tumor comorbidity compared to the non-tumor comorbidity in other IgG4 level groups (P>0.05).Conclusion IgG4-RD is more common in middle-aged and elderly men,lymph nodes,pancreas and sal-ivary glands are commonly involved,and most patients have the double organs and multiple organs involve-ment. The combination use of hormone and immunosuppressant in treatment is recommended .The IgG4 lev-el>40 g/L in the patients with IgG4-RD may has the suggestive significance for complicating tumor.

Objective To evaluate the effects of andrographolide on insulin resistance,dysbiosis and Notch/zinc finger protein transcription factor 1(Snail1)signaling pathway in diabetic rats.Methods A total of 70 male Wistar rats with SPF grade were selected,and 30 of them were selected for andrographolide LD50 test.After determining the lethal dose,50 mg/kg was selected for administration and observation,the remaining 40 rats,10 were used as the NC group,30 were established as the diabetes model,and a total of 28 rats were successfully modeled,which were divided into T2DM group(n=9),Metformin treatment group(Met,n=9),and andrographolide administration group(And,n=10).The NC group and T2DM group were not treated.The changes were evaluated after 14 days of intervention.Results Compared with NC group,HOMA-IR,the abundance levels of Bacteroidetes,Firmicute,mRNA and protein expression levels of Notch and Snail1,and positive expression rates were increased(P<0.05),while the abundance levels of Lactobacillus and Bifidobacterium were decreased in T2DM,Met and And group(P<0.05).Compared with T2DM group,HOMA-IR,the abundance levels of Bacteroidetes,Firmicute,mRNA and protein expression levels of Notch and Snail1,and positive expression rates were decreased,while the abundance levels of Lactobacillus and bifidobacterium were increased in Met and And group(P<0.05).Conclusions After andrographolide intervention,insulin resistance was alleviated,microbiota imbalance was improved,and Notch/Snail1 signaling pathway was suppressed in diabetic rats.

Objective:To observe the effect of pecking moxibustion on the pattern characteristics of redness,swelling,heat,and pain in the affected joints,also the synovial cell ultrastructure in rats with rheumatoid arthritis(RA)due to damp heat affecting bones/joints,and to explore the anti-inflammatory mechanism of pecking moxibustion in treating the early stage of RA. Methods:Eighteen rats were randomly selected from 78 female ones as the blank group,and all the other rats were subjected to preparing the"differentiation of disease and pattern"RA model due to damp heat affecting bones/joints by using the method of"collagen-induced arthritis plus windy,damp,and hot environment stimulation".Fifty-four rats with successful modeling were randomly divided into a model group,a drug group,and a pecking moxibustion group,with 18 rats in each group.Rats in the drug group were given methotrexate at a dose of 1 mg/(kg·bw)on the 1st,8th,and 15th days.Rats in the pecking moxibustion group were treated with pecking moxibustion at Quchi(LI11),Dazhui(GV14),and Ashi points,and each point was treated with moxibustion for 15 min every day and a total of 3 courses of treatment,with 6 d as a course of treatment.After treatment,the capillary permeability,joint swelling,joint surface temperature,and plantar thermal pain threshold of the diseased joints in rats were observed,and the ultrastructural changes of synovial cells were observed by transmission electron microscopy. Results:The local swelling,surface temperature,and Evans blue(EB)leakage volume were significantly higher(P<0.05),the thermal pain threshold was significantly lower(P<0.05),and the synovial cell ultrastructure was obviously damaged in the affected joints in the model group compared with the blank group.The swelling degree,surface temperature,and EB leakage volume were significantly reduced(P<0.05),the thermal pain threshold was significantly increased(P<0.05),and the ultrastructural abnormalities of synovial cells were significantly improved in the diseased joints in the drug group and the pecking moxibustion group compared with the model group.The thermal pain threshold of rats in the pecking moxibustion group was significantly improved compared with the drug group(P<0.05). Conclusion:Pecking moxibustion obviously improves the pattern characteristics of local redness,swelling,heat,and pain in the diseased joints of rats with RA due to damp heat affecting bones/joints and effectively repairs the ultrastructure of the damaged synovium.It suggests that the pecking moxibustion intervention has a significant anti-inflammatory effect on early RA.

Objective:To compare the complications associated with various urinary flow diversion methods and identify the factors that contribute to the decline in renal function after radical total cystectomy for myoinfiltrating urothelial carcinoma.Methods:This study conducted a retrospective analysis on the clinical data of 46 patients with pathologically confirmed muscle-invasive bladder cancer.The patients underwent laparoscopic radical cystectomy with either ileal conduit diversion(n=21)or ureterocutaneous diversion(n=25)between January 2017 and December 2021.Perioperative data, postoperative pathology, postoperative complications, and follow-up results were compared between the two groups.Results:The study found significant differences between the two groups in terms of age[(67±6)years vs.(73±8)years, t=3.132, P=0.003], Charlson comorbidity index adjusted for age[(3.80±1.15) vs.(4.52±1.03), t=2.223, P=0.031], prognostic nutritional index[(48.81±5.74) vs.(43.64±4.74), t=3.347, P=0.002], operation time[(449±108)minutes vs.(326±130)minutes, P=0.001]], hospital stay[(20.1±11.1)days vs.(13.3±5.2)days, t=2.762, P=0.008], proportion of Clavien grade 3 or higher complications within 3 months after surgery(4/21 vs 0/25, χ2=2.105, P<0.05), and proportion of stoma-free patients(18/21 vs.5/25, χ2=6.373, P<0.01). According to Logistic multivariate analysis, perioperative blood transfusion and urinary tract infection were identified as independent risk factors for renal function decline 12 months after surgery.Escherichia coli was found to be the most common bacteria cultured from urinary tract infections in both groups after surgery. Conclusions:Laparoscopic radical cystectomy with ureterocutaneous diversion offers benefits such as shorter hospital stays and fewer perioperative complications for older and frail patients.However, a higher proportion of patients may require ureteral stenting.It is important to note that perioperative blood transfusion and urinary tract infection are major risk factors for renal function decline following radical cystectomy.

Objective:To study the efficacy of Barbed reposition pharyngoplasty (BRP) combined with Han-Uvulopalatopharyngoplasty (H-UPPP) in surgical treatment of OSAHS patients.Methods:OSAHS patients admitted to our department from June 2021 to February 2022 who met the surgical enrollment criteria were divided into two groups by surgical procedure: H-UPPP operation group [Control group, 47 cases, including 42 males and 5 females, aged 18-64 (37.77±11.65)years, and H-UPPP+BRP group [Study group, 48 cases, including 45 males and 3 females, aged 23-60 (39.10±9.86) years]. The surgical efficacy 6 months after operation was retrospectively analyzed. Meanwhile, the relationship between the surgical efficacy and modified Friedman pharyngeal anatomical stages was analyzed. The postoperative pain VAS score at first 3 days and the incidence of foreign body sensation in pharynx after 6 months of operation were compared between the two groups. Statistical analysis was conducted by SPSS 23.0.Results:There were no significant differences in gender, age, BMI, Friedman pharyngeal anatomical stages, ESS score, AHI and LSpO 2 between the two groups, preoperatively ( P>0.05). There was significant difference between the two groups in ratio of cumulative time of oxygen saturation below 90% to total sleep time(CT90), preoperatively. Surgical efficacy of H-UPPP operation group was 48.9% (23/47), while H-UPPP+BRP operation group was 70.8% (34/48), which was statistically significant ( χ2=4.74, P=0.029). H-UPPP+BRP group seemed to have a higher surgical efficacy than H-UPPP group in patients with Friedman Ⅱb (87% vs. 61.9%) and Ⅲ stage (44.4% vs. 15%), but there was no statistically significant difference ( P>0.05). H-UPPP+BRP group had a higher pain VAS score in first three days ( t=-3.10, P=0.003), also had higher incidence of pharyngeal foreign body sensation after 6 months of operation ( χ2=4.727, P=0.030). Conclusions:In the surgical treatment of OSAHS patients, the overall efficacy of BRP combined H-UPPP surgery is higher than that of H-UPPP surgery alone. It may be more suitable for OSAHS patients with modified Friedman type Ⅱb and type Ⅲ stage.

Sports-related traumatic brain injury (srTBI) is a traumatic brain injury (TBI) caused by sports, which can result in cognitive and motor dysfunction. Currently, research on the molecular mechanism of srTBI and related drug development mainly relies on monolayer culture models and animal models. However, many differences exist in cell populations and inflammatory responses between these models and human pathophysiological processes. Most of the researches derived from the models can't effectively conducted translational research. Emerging three-dimensional (3D)
Animals ; Brain Injuries ; Brain Injuries, Traumatic ; Humans

Objective To determine the off -label use of antibacterial agents,we investigated and analyzed the current status about off -label use of antibacterial agents.Methods The random sampling was conducted to select the outpatient prescription including antibacterial agents from January to April in 2016.According to drug instructions,the off -label drug use of prescription was analyzed.Results 1 264 prescriptions involving 58 kinds of drugs were analyzed.The main categories of off -label drug use were no pediatric and elderly information(23.42%), indication(4.1 5%),dosage (6.31 %),dosage range (62.95%)and administration route (3.1 5%).Conclusion The off -label use of antibacterial agents is common in our hospital.It's in need to regulate off -label drug use.