Abstract Background and Aims Both obstructive sleep apnea-hypopnea syndrome (OSAHS) and chronic kidney disease (CKD) are common disease. Patients with OSAHS were evidenced to have oxidative stress, increased albuminuria and renal injury. Previous reports show high prevalence of OSAHS among CKD patients, while its risk factors are hardly investigated. The objective of this study is to assess the risk factors of OSAHS in patients with CKD. Method We selected 181 patients with CKD who were hospitalized in department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital from September 2020 to February 2023. All participants underwent full-night standard nocturnal polysomnography (PSG) monitoring in the sleep center using Alice 4, 5 or 6 devices. An apnea hypopnea index (AHI)>5 events/h was consistent with the diagnosis of OSA. The 181 Patients are divided into three groups based on the level of AHI to studied the differences of clinical and biochemical characteristics. According to Kidney Disease Improving Global Outcomes (KDIGO) risk categories, all patients are divided into non very high risk and very high risk group, logistic regression is used for analyzing risk factors of OSAHS in patients with CKD. Results The prevalence of OSAHS was 86.7% (157 of 181), with 29.8% mild, 30.9% moderate and 25.9% severe respectively. The urea nitrogen (P=0.039) and cystatin C (P = 0.030) levels in patients of severe OSAHS group were significantly higher than those within non or mild OSAHS group. The eGFR in non or mild OSAHS group was significantly higher than moderate OSAHS group (P = 0.036). Pearson correlation analysis showed a significant negative correlation between AHI (p = 0.022), ODI (p = 0.033), and hypopnea index (p = 0.004) of sleep parameters and eGFR, while a significant positive correlation was found between LaSO2 (p = 0.005), MaSO2 (p = 0.030), and eGFR. Stepwise linear regression analysis showed that the hypopnea index was an independent risk factor for eGFR (p = 0.033, R2: 0.215), and CT90 was an independent risk factor for UACR (p < 0.001, R2: 0.105). Logistic regression analysis revealed that hypopnea index (OR = 1.058) was significantly correlated with very high risk in KDIGO risk categories (p < 0.05). Conclusion OSAHS is high prevalence in patients with CKD. Regression analysis shows that hypopnea index is not only an independent risk factor for eGFR but also a significant predictor associated with very high risk according to KDIGO risk category.

睡眠呼吸暂停低通气综合征( sleep apnea hypopnea syn-drome,SAHS)是一种常见的睡眠呼吸障碍性疾病,依据病因可按阻塞型、中枢型及混合型,其中最多见的是阻塞性睡眠呼吸暂停低通气综合征( obstructive sleep apnea hypopnea syndrome, OSAHS).有研究显示OSAHS的患病率约2％～4％,在30～70岁的成年人中,中度至重度OSAHS的患病率为11. 3％(男为13％,女为6％) ,且随着年龄的增长和肥胖患病率的增加OSAHS患病率呈逐渐上升的趋势[1].其发病机制为上气道在睡眠期间反复发生完全或不完全阻塞,引发低氧血症、频繁低通气、睡眠唤醒、呼吸暂停等病理生理改变.OSAHS患者易发生多种合并症,包括糖尿病、高血压、脑中风等[2,3].

AIMComparison of clinical and pathological features of secondary IgA nephropathy of ankylosing spondylitis (SIgAN-AS) and primary IgA nephropathy (PIgAN).MATERIALS AND METHODSClinical characteristics and pathological data of patients diagnosed with IgAN by renal biopsy were collected in our hospital from January 2008 to October 2018. Patients with SIgAN-AS and PIgAN were recruited at a ratio of 1 : 5. Fifteen patients with SIgAN-AS and 75 patients with PIgAN were enrolled in this retrospective study. Results There were 15 cases in the SIgAN-AS group, including 13 males and 2 females. The cohort of 75 patients with PIgAN included 37 males and 38 females. There were significantly more males in the SIgAN-AS group 13/15 (86.67%) vs 37/75 (49.30%), p < 0.05. Compared with PIgAN patients, SIgAN-AS patients had higher incidences of hematuria (12/15 (80.00%) vs. 37/75 (49.33%), p < 0.05), lower levels of 24-hour urinary protein (0.85 ± 0.68 vs. 1.57 ± 1.54 g, p < 0.05), but higher levels of estimated glomerular filtration rate (eGFR) (CKD-EPI formula; 112.56 ± 24.53 vs. 88.23 ± 29.39, p < 0.05), albumin (44.67 ± 3.48 vs. 41.09 ± 7.07 g/L, p < 0.05), erythrocyte sedimentation rate (ESR) (43.20 ± 33.94 vs. 18.79 ± 16.26 mm/h, p < 0.001), and C-reactive protein (CRP) (21.19 ± 30.61 vs. 2.11 ± 4.58 mg/L, p < 0.001). From the perspective of renal pathology of PIgAN, patients with SIgAN-AS had a lower incidence of renal tubular atrophy/interstitial fibrosis of nephropathy (p < 0.05). Immunohistostaining analysis showed a higher incidence of dominant deposits of single IgA in the mesangial cell area (p < 0.05).CONCLUSIONSIgAN-AS was more commonly observed in males and displayed a milder progression than those PIgAN. The majority of SIgAN-AS patients can be improved by early intervention.

Objective Renal impairment is a significant complication of systemic lupus erythematosus (SLE). Additionally, infection in patients with end-stage renal disease (ESRD) attributable to SLE is common, and it increases the risk of mortality. This study explored the infection profile and risk factors for mortality in patients with ESRD attributable to SLE. Methods In this retrospective, observational study of 125 hospitalized patients, demographic, clinical, laboratory, treatment, and prognosis data were retrieved and analyzed. Results The 125 cases included 98 pulmonary infections (78.4%), 14 urinary infections (11.2%), and 13 intestinal infections (10.4%). Twenty-six patients died within 1 month after enrollment. Univariate Cox regression and Kaplan–Meier analyses revealed several possible indicators potentially influencing patient survival. Furthermore, multivariate Cox regression analysis identified a higher SLE Disease Activity Index-2000 score, recent higher-dose glucocorticoid use, hypertension, and catheter indwelling as risk factors for higher mortality. Conclusions Infections were common in patients with advanced SLE and ESRD, and several risk factors might increase the risk of mortality. Once infection is identified, empiric antibiotics should be initiated immediately, and subsequent antibiotics should be applied per the results of drug sensitivity testing to clear the infection.

Abstract Objectives Rhabdomyolysis is a series of symptoms caused by the dissolution of striped muscle, and acute kidney injury (AKI) is a potential complication of severe rhabdomyolysis. The underlying causes of AKI are remarkably complex and diverse. Here, we aim to investigate whether pifithrin-α protected against rhabdomyolysis-induced AKI and to determine the involved mechanisms. Methods Intramuscular injection in the right thigh caudal muscle of C57BL/6J mice with 7.5 ml/kg saline (Group A) or of the same volume 50% glycerol was used to induce rhabdomyolysis and subsequent AKI (Group B). Pifithrin-α was injected intraperitoneally 4 h before (Group C) or 4 h after (Group D) the glycerol injection. Serum creatine kinase, blood urea nitrogen, and creatinine were determined, and the renal cortex was histologically analyzed. Renal expression levels of interested mRNAs and proteins were determined and compared, too. Results Intramuscular injection of glycerol induced rhabdomyolysis and subsequent AKI in mice (Groups B–D). Renal function reduction and histologic injury of renal tubular epithelial cells were associated with increased p53 activation, oxidative stress, and inflammation. Notably, compared with pifithrin-α rescue therapy (Group D), pretreatment of pifithrin-α (Group C) protected the mice from severe injury more effectively. Conclusions Our present study suggests that p53 may be a therapeutic target of AKI caused by glycerol, and the inhibition of p53 can block glycerol-mediated AKI by using pharmacological agents instead of genetic inhibitory approaches, which further supports that p53 played a pivotal role in renal tubular injury when challenged with glycerol.

Background Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve multiple organs or systems. Lupus nephritis (LN) is associated with high mortality and morbidity. However, plenty of patients do not respond to present treatment or relapse. Iguratimod (IGU) is a new small molecular, anti-rheumatic drug and has shown the potential for drug repurposing from rheumatoid arthritis (RA) to LN treatment. It has been approved for treating RA in northeast Asia. Beyond expectation in a recent observational study, over 90% of thirteen refractory LN patients responded to iguratimod monotherapy in 24 weeks, with no steroids dose increasing or any other medication add-on during the entire follow-up. Methods/design This study is a multi-center, randomized, 52-week parallel positive drug-controlled study. The study was designed as a head-to-head comparison between the iguratimod and present first-line therapy on LN patients. A total of 120 patients (60 patients each group) is in the enrolling plan. All enrolled patients are assigned randomly into trial and control groups. The patients will be selected from six study sites in China and will all have biopsy-proven active lupus nephritis. In the first 24 weeks of the trial, IGU is compared with cyclophosphamide as an induction therapy, and in the second 24 weeks, IGU is compared with azathioprine as a maintenance therapy. The primary outcome is renal remission rate including both complete remission and partial remission at week 52, which will be analyzed using a non-inferiority hypothesis test. Discussion Most patients diagnosed with SLE will develop LN within 5 years and LN remains a major cause of morbidity and death for SLE patients. Although some medications are proven effective for the treatment of this condition, at least 20–35% LN patients have to suffer from relapse or ineffective treatment and medication intolerance is also frequent. This trial is designed to demonstrate whether iguratimod can be used as an alternative induction or maintenance therapy in subjects who have lupus nephritis. Data from this study will provide an evidence on whether or not iguratimod should be recommended to active LN patients. Trial registration ClinicalTrials.gov NCT 02936375 . Registered on October 18, 2016.

Renal involvement is one of the most common extra-articular complications caused by ankylosing spondylitis (AS). The main pathological manifestation is secondary IgA nephropathy(SIgAN) in Chinese AS patients. The difference between SIgAN and primary IgAN (PIgAN) remains unclear due to the lack of cases. Therefore, the aim of this retrospective study was to compare the clinical and pathological features of SIgAN of AS (SIgAN-AS) and PIgAN, to detect the pathogenesis of SIgAN Clinical characteristics and pathological data were collected in patients who were diagnosed with IgAN by renal biopsy in our hospital from Jan 2008 to Oct 2018. Patients with SIgAN-AS were recruited by the ratio 1:5 of patients with primary IgAN as the control group in the study. Fifteen patients with SIgAN-AS and Seventy-five patients with PIgAN were enrolled in this retrospective study. There were 15 cases in AS group, including 13 male and 2 female. The cohort of 75 patients with PIgAN included 34 male and 41 female. There were more males in AS group 13/15 (86.7%) vs 37/75(49.3%) ,P < 0.05. Compared with PIgAN patients, SIgAN-AS patients had higher incidences of hematuria( 13/15(86.7%)vs 44/75 (58.7%) , P < 0.05), lower levels of 24-hour urinary protein(0.85±0.68 vs 1.57±1.54g, P < 0.05), but higher levels of eGFR (CKD-MDRD formula) (117.60±37.33 vs 85.35±31.36, P < 0.05),eGFR (CKD-EPI formula) (128.01±41.58 vs 92.75±36.09, P < 0.05), Albumin (44.67±3.48 vs 41.09±7.07 g/L, P < 0.05) ESR (43.20 ±33.94 vs 18.79±16.26mm/h, P < 0.001) , and CRP (21.19±30.61 vs 2.11±4.58mg/L, P < 0.001) . From the perspective of renal pathology of PIgAN, SIgA-AS patients had fewer incidences of renal tubular atrophy / interstitial fibrosis of nephropathy (P <0.05). The immunohistostaining analysis showed higher incidences of dominant deposits of single IgA in mesangial cell area (P < 0.05). Patients with SIgAN-AS is more common in male and display a milder progression than those with primary IgAN. Majority of the SIgAN-AS can be improved with early intervention.

BACKGROUND:The aim of this study was to evaluate disease-activity-guided stepwise tapering or discontinuation of rhTNFR:Fc, an etanercept biosimilar, in patients with ankylosing spondylitis (AS) in a prospective, randomized, open-label, multicentric study.METHODS:Active AS patients with AS disease activity score (ASDAS) ⩾2.1 recruited from 10 hospitals were treated with rhTNFR:Fc 50 mg weekly for 12 weeks, and further randomized into different tapering or discontinuation groups according to ASDAS at week 12. Patients who achieved clinical remission (ASDAS < 1.3) were assigned randomly to stepwise tapering group or discontinuation group. Patients who achieved low disease activity (LDA, 1.3⩽ASDAS < 2.1) were assigned randomly to stepwise tapering, delayed tapering, or discontinuation group. All patients were evaluated every 12 weeks until week 48. The primary endpoint was cumulative flare rates in different groups at week 48.RESULTS:A total of 311 patients were enrolled with an average ASDAS of 3.6 ± 1.0, and 259 completed 12 weeks of rhTNFR:Fc induction therapy, with 148 patients (57.1%) achieved clinical remission, 100 (38.6%) achieved LDA, and 11 (4.3%) remained as high disease activity (ASDAS⩾2.1). In patients who achieved clinical remission at week 12, stepwise tapering of rhTNFR:Fc demonstrated significantly lower flare rates at each evaluation compared with discontinuation. In patients who achieved LDA, there was no significant difference of flare rates between stepwise tapering, delayed tapering, and discontinuation. With stepwise tapering of rhTNFR:Fc, flare rates were comparable in AS patients, irrespective of initial ASDAS before tapering.CONCLUSION:Stepwise tapering of rhTNFR:Fc when patients achieved clinical remission was able to maintain favorable low flare rates in 48 weeks. LDA was an alternative therapeutic target, as well as an viable timing for initiation of rhTNFR:Fc tapering. rhTNFR:Fc 25 mg monthly maintained flare-free status in a considerable number of patients. However, abrupt discontinuation of rhTNFR:Fc even if patients achieved clinical remission should be avoided.TRIAL REGISTRATION:ClinicalTrials.gov: NCT03880968,URL: https://clinicaltrials.gov/ct2/show/NCT03880968.

Background: There is no systematic or large-scale study in the published literature in which the relationship between drug therapies and renal involvement in ankylosing spondylitis (AS) has been rigorously evaluated. In addition, the sensitivity of the kidneys to drugs varies significantly between races and regional populations. Therefore, the aim of the present study was to investigate the impact of drugs on renal involvement in Chinese AS patients. Materials and methods: The clinical characteristics and biochemical data of 907 AS patients were collected and analyzed, and the differences between patients who had received drugs and those who had not were analyzed using intergroup comparisons to screen out confounding factors. Multivariate logistic regression analysis that corrected for the confounding factors explored the impact of the AS therapeutic drugs on the clinical manifestations of renal involvement. Results: Renal involvement in Chinese AS patients increased significantly following nonsteroidal anti-inflammatory drug (NSAID) or conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) monotherapy, and combination therapy with NSAIDs, csDMARDs, and TNF-alpha inhibitor. For AS patients, NSAID monotherapy increased the probability of hematuria 2.4-fold and the probability of mixed manifestations of renal involvement 3.0-fold. csDMARD monotherapy increased the probability of proteinuria 2.4-fold; combination therapy with NSAIDs, csDMARDs, and TNF-alpha inhibitor increased the probability of hematuria 4.1-fold. In addition, the study found that TNF-alpha inhibitor monotherapy and combination therapy with NSAIDs or csDMARDs caused no apparent impact on renal involvement in AS patients. Conclusion: NSAID or csDMARD monotherapy may significantly increase renal involvement in Chinese AS patients. Combination therapy with TNF-alpha inhibitor with NSAIDs and csDMARDs should be used prudently.

Objective: To observe the therapeutic effects of human Wharton-Jelly mesenchymal stromal cells derived extracellular vesicles (MSCs-EVs) for cyclosporin-A-induced renal injury in rats and further to investigate the mechanism. Methods: EVs from MSCs were made using the ultra-centrifugation method. The cyclosporin A-induced renal injury model in rats was set up, and MSCs-EVs were administrated at d7 and d21 intravenously. The animals were sacrificed at d28, and the serum and kidneys were obtained. Renal fibrosis was assessed using Masson's staining and alpha-SMA IHC staining. Renal function was determined using serum creatinine. The SOD and malondialdehyde (MDA) in the renal tissues were also assayed. In vitro, HK2 cells were injured by CsA for 24 h as well as incubated with MSCs-EVs administration, and ROS and alpha-SMA expression were assessed. Results: In this animal study, renal fibrosis was alleviated and the epithelial-mesenchymal transition (EMT) was suppressed after the MSCs-EVs treatment compared with the control group. Renal function was also improved. The oxidative stress which was reflexed by the MDA and SOD change was declined after the EVs therapy. In vitro, NRK-52E cells were injured by CsA. The EVs therapy reduced alpha-SMA expression and ROS generation. Conclusion: MSCs-EVs alleviated CsA-induced renal injury and improved renal function, which could be attributed to the anti-oxidative property of MSCs-EVs.

Objective To know the evaluation of teaching behavior,capacity and self-development from standardized training of residents and specialists.Methods Based on prepared questionnaire,122 residents and specialists trained in Shanghai Sixth People's Hospital and Shanghai First People's Hospital were investigated.Results In teaching behavior assessment,63.9％ (78/122) of training doctors considered that they got little teaching time,and 84.4％ (103/122) of them considered the heavy clinical work as the most reason.They thought that residents provided few and low-quality clinical knowledge.In capacity assessment,although evaluation results of residents were not consistent with that of specialists,they all agreed with the attitude,ability,technique and self-promotion embodied in teachers' and learners' capacity.As the results of their average score were over 3.74.In self-development assessment,8.0％ (7/87) of residents and 37.1％ (13/35) of specialists had the strong desire to become clinical teachers.Although only 3.4％ (3/87) of training doctors wanted residents to become the main clinical teachers,and 91.8％ (112/122) of them considered the heavy clinical work as the biggest obstacle,they still optimistically believed that senior residents and junior attending could be good clinical teachers.Conclusions Clinical teaching is not sufficient.Few residents participate in clinical teaching,but senior residents and junior attending have the capacity to become good clinical teachers.However,more steps are needed to encourage them.

强直性脊柱炎(AS)是一种主要累及骶髂关节和脊柱的炎症性疾病,关节外可累及全身多个器官,如肾脏、肺脏及心脏等.AS继发肾脏损害发病率约为10％～35％,国内外报道以肾淀粉样变性、肾小球肾炎和非甾体抗炎药相关的肾毒性及急性肾损伤为主,不同类型的肾脏损害有不同的治疗方案及预后.本文简要概述AS继发肾脏损伤的发病特征、临床表现及治疗进展.

Partial discharge detection is important for identifying insulation defects of power cables, and the extraction of effective characteristic parameters is the emphasis of the study. In this paper, a feature extraction method based on 2 Dimensions Littlewood - Pale empirical wavelet transform (2D-LPEWT) is proposed to realize the accurate identification of different types of defects in cable discharge. By constructing a cable-insulated partial discharge detection platform, three-dimensional spectrum of four typical defect models was decomposed by 2D-LPEWT. And then Tamura features, moments and entropy characteristics are extracted from the obtained wavelet coefficients sub-graphs, and the effects of different feature extraction methods on performance of KNN, decision tree and SVM are discussed. Results show that the proposed feature extraction method can achieve high recognition accuracy under different classifiers, and has good practicability.

BACKGROUND/AIMS:Renal involvement is one of the most common extra-articular complications caused by ankylosing spondylitis (AS). Most studies have focused on the incidence rate, clinical manifestation and pathology, while risk factors have hardly been investigated. Therefore, the objective of this study was to assess the risk factors of renal involvement in patients with AS.METHODS:Clinical and biochemical data of 926 AS patients were collected. Based on the manifestations of renal involvement, patients were divided into three groups and the differences in clinical and biochemical characteristics were compared. A group with non-renal involvement served as a control. Multivariable logistic regression was used for analyzing risk factors of renal involvement in AS.RESULTS:Of the 926 AS patients, 201 patients suffered from renal involvement. Moreover, female AS patients faced a higher risk of hematuria compared to male patients. As indicated by the data obtained from multivariate logistic regression analysis, gender, uric acid (UA), immunoglobulin A (IgA), and serum albumin (ALB) were found to be risk factors of renal involvement in AS. An increase in UA or IgA levels, or a decrease in ALB level can increase the risk of renal involvement with multiple manifestations (more than one manifestation of renal damage). According to our findings, no definite variable was identified as a risk factor of proteinuria in AS patients.CONCLUSION:In AS patients, UA, IgA, and ALB levels can indicate the risk of renal involvement in AS patient and need to be paid special attention. Furthermore, women are subjected to a higher risk of hematuria.

Gas insulated metal enclosed transmission line (GIL) is gradually replacing traditional overhead lines and high voltage cables due to its large transmission capacity and low loss. As the basis of studying optical detection of partial discharge (PD), it is necessary to pay attention to the propagation characteristics of PD signals in GIL. Simulation models of the single-core and three-core GIL are established, and parameters of different detection points and planes of the optical signal generated by partial discharge are observed and compared. The results show that in different cavities, the color and symmetry of the detection plane are different, and the horizontal position of the PD source affects the spot and relative irradiance. The optical signals on the detection plane of single-core and three-core GIL have similar changes.

Due to the high transmission capacity and low loss, Gas-insulated metal-enclosed transmission line (GIL) is gradually replacing conventional overhead lines and highvoltage cables. As the basis of the research on the optical detection of partial discharge (PD), the propagation characteristics of the PD signal in GIL must be paid attention. In this paper, the single-core and three-cores GIL simulation models were established. And parameters of the optical signals generated by PD were observed and compared at the detection point and different detection surfaces. The results show that: In the cavity with different structures, there are different shades of faculae on detection surfaces, and the symmetry properties are also different. The horizontal location of the PD source affects the faculae and relative irradiance values. The optical signals on the detection surface of single-core and three-cores GIL have similar variations. The relative irradiance value obtained at the fixed detection point is related to the internal structure of the cavity, the position and surface of the PD source.

Accurate recognition of distribution line fault types can provide directional guidance for line operation and maintenance personnel. Based on the analysis of time-frequency features of fault waveform, a recognized method of distribution line fault type was proposed in this paper. Through modeling and theoretical analysis of waveforms of different fault types, characteristic parameters, which could characterize waveforms of different fault types from three aspects, time domain, frequency domain, and electric arc, were put forward. Calculation formula for extracting characteristic parameters according to fault waveform data was proposed, recognition logic was established by taking multi-parameter fusion as a basis, and then,automatic recognition of distribution line fault types caused by different factors was realized through detection and classification of characteristic parameters of input waveform data. Finally, 136 groups of field fault waveform data provided by the Electric Power Research Institute were used to do closed-loop control and verification of the algorithm, and results indicated that recognition success rate reached 90%, which verified the feasibility of using time-frequency characteristics of fault waveform to realize recognition of distribution line fault types.

Partial discharge occurs with acoustic, electrical, optical, and thermal phenomena. In the study of UHF electromagnetic signals generated by PD, it was found that different voltage levels and size structures of power equipment have an impact on the signal propagation. This article used the research ideas of UHF signals to simulate and model different voltage levels of GIL and simulated the propagation of optical signals in GIL. By observing the optical parameters on the detection planes and the detection point, the influence of voltage level on the propagation of the optical signals in GIL was studied, which provides a reference for GIL equipment manufacturing and partial discharge optical detection research.

目的:探讨脊柱关节炎继发IgA肾病患者的临床、病理特点.方法:回顾性分析2010年01月～2017年01月上海市第六人民医院肾脏内科收治的17例脊柱关节炎继发IgAN患者的临床表现、实验室检查、病理特点、治疗与转归.结果:17例SpA患者中,男13例,女4例,肾活检时年龄为(33.2±9.1)岁,15例患者(88.2％)为HLA-B27阳性,17例患者有蛋白尿,15例患者有蛋白尿合并血尿,1例患者有肾功能不全;肾活检病理中,所有患者均有系膜细胞增生,10例患者(58.8％)有肾小球球性硬化,其中7例患者(41.2％)肾小球球性硬化比例>10％,9例患者(52.9％)有肾小管萎缩,3例患者(17.6％)有新月体形成,3例患者(17.6％)有球囊粘连,3例患者(17.6％)有肾间质纤维化,肾间质血管病变8例(47.1％).除3例失访患者外,大部分患者蛋白尿和血尿缓解或稳定,所有患者肾功能基本保持稳定.结论:脊柱关节炎继发IgAN临床起病隐匿,常表现为血尿及蛋白尿.病理中新月体、球囊粘连均发生在骶髂关节炎≥3级患者,肾小球球性硬化及间质炎性细胞浸润较多见.通过肾穿刺活检可明确病理分型并有助于制定合适的治疗方案,预后较好.