BACKGROUND & AIMS:The initial intravenous dose of ustekinumab (UST) for treating Crohn's disease (CD) is recommended based on body weight ranges for clinical convenience. However, patients whose body weight nears the upper threshold may receive a relatively lower dose (<6 mg/kg) based on current dosage calculations. We aimed to investigate whether the body weight-range based dosing calculation method for UST may lead to suboptimal therapeutic doses and then impact effectiveness, particularly in patients with borderline weight. METHODS:A multi-center, observational, real-world cohort study was conducted in four centers. Patients with CD who received UST based on body weight-range dosing calculation were retrospectively enrolled. Participants were classified into two groups according to the initial induction dosage: the relatively higher dose (RHD) induction group (≥6 mg/kg) and the relatively lower dose (RLD) induction group (<6 mg/kg). Steroid-free remission, clinical remission, specific objective response and remission at week 24 were compared in the two groups using propensity score weighting. UST drug concentration was measured at week 24±4. RESULTS:A total of 438 patients were included, with 176 patients in the RHD group and 262 patients in the RLD group. The RHD group demonstrated superior outcomes compared to the RLD group in achieving steroid-free remission (66.2 % vs. 54.9 %, P = 0.020, OR = 1.605, 95 % CI 1.082-2.395), clinical remission (66.7 % vs. 56.4 %, P = 0.032, OR = 1.546, 95 % CI 1.041-2.311) at week 24. In objective evaluation, the RHD group showed higher rates in ultrasound response (64.9 % vs. 52.1 %, P = 0.041, OR = 1.700, 95 % CI 1.027-2.844) and radiologic remission (25.1 % vs. 13.4 %, P = 0.022, OR = 2.163, 95 % CI 1.117-4.205). The drug concentration was significantly higher in the RHD group compared to the RLD group at week 24 [2.06 (1.36-3.17) µg/ml vs. 1.12 (0.25-1.52) µg/ml, P < 0.001]. Additionally, the RHD group required fewer treatment optimizations than the RLD group, but with no statistical difference (20.6 % vs. 24.9 %, P = 0.291, OR = 0.780, 95 % CI 0.488-1.231). The rate of adverse events was similar between the two groups (4.0 % vs 3.4 %, P = 0.767). CONCLUSIONS:This study suggested that the current dose calculation method may result in inadequate induction doses of UST for CD patients whose body weight is close to the upper threshold, potentially impacting the effectiveness of induction. LAY SUMMARY:A multi-center study suggests that the current body weight-range based dosing of ustekinumab for Crohn's disease may lead to insufficient induction doses for patients near the upper weight threshold, negatively impacting treatment effectiveness.

ObjectivesThis research aims to reveal the mechanisms of the effect of the Paraoxonase 1 (PON1) gene on response to leflunomide (LEF) in rheumatoid arthritis (RA) patients, in terms of single nucleotide polymorphism (SNP), DNA methylation levels.MethodsA total of 240 RA patients enrolled were categorized into the good response group and the non-response group according to the difference in DAS28 scores between baseline and 6 months after LEF administration. The identified LEF-response cytosine-phosphate-guanines (CpGs) island (cg17330251) and its internal SNPs (rs705379, etc.) located at the PON1 promoter were detected by Sanger sequencing and methyl target sequencing.ResultsA total of 12 CpG sites at cg17330251 could be identified in our RA patients. There were significant difference between the responders and non-responders in nine CpG sites: cg17330251_2, cg17330251_3, cg17330251_4, cg17330251_6, cg17330251_7, cg17330251_8, cg17330251_9, cg17330251_10, cg17330251_12, [OR (95CI%) = 0.492 (0.250, 0.969), 0.478 (0.243, 0.940), 0.492 (0.250, 0.969), 0.461 (0.234, 0.907), 0.492 (0.250, 0.969), 0.437 (0.225, 0.849), 0.478 (0.243, 0.941), 0.421 (0.212, 0.836), 0.424 (0.213, 0.843), P < 0.05, respectively]. At all these nine CpG sites, the proportions of low methylation levels in the responders were higher than those in the non-responders (P < 0.05). In a dominant model, there was a significant difference in rs705379 wildtype CC and mutant genotypes (CT + TT) between the responders and non-responders (P < 0.05). The average methylation level of 12 CpG sites was lowest in rs705379-CC (median 0.229, IQR 0.195–0.287), then rs705379-CT (median 0.363, IQR 0.332–0.395), and rs705379-TT (median:0.531, IQR:0.496–0.557). The average methylation levels of 12 CpG sites were significantly negative correlated with ΔDAS28 (r = −0.13, P < 0.05). The Logistic regression indicated that combined effect of rs705379, DNA methylation of the PON1 gene [OR (95CI%) = 1.277 [1.003, 1.626)], systemic inflammation index (SIRI) [OR (95CI%) = 1.079 (1.018, 1.143)] served as protective factors on response to LEF in RA patients.ConclusionThe RA patients with SNP-rs705379-CC, the low methylation level of PON1-cg17330251 and more SIRI would be susceptible of response to LEF and more suitable to choose LEF treatment.

OBJECTIVE:This study aims to evaluate the efficacy and safety of JAK inhibitors in the treatment of patients with RA.METHODS:The databases CNKI, VIP, Wanfang, CBM, and PubMed, Embase, Cochrane Library and Web of Science were searched to identify relevant randomized controlled trials (RCTs), all from the time of database creation to April 2024. Screening, data extraction, and risk of bias assessment (using Review Manager-5.3 software) were independently performed by at least two authors. The network meta-analysis was conducted using R 4.1.3 software. PROSPERO registration number: CRD42022370444.RESULTS:Thirty-three RCTs included 15,961 patients The experimental groups involved six JAK inhibitors (filgotinib, tofacitinib, decernotinib, baricitinib, upadacitinib and peficitinib) and 12 interventions (different doses of the six JAK inhibitors), and the control group involved adalimumab (ADA) and placebo. Compared with placebo, all JAK inhibitors showed a significant increase in efficacy measures (ACR20/50/70). Compared with ADA, only tofacitinib, low-dose decernotinib, and high-dose peficitinib showed a significant increase in ACR20/50/70. Decernotinib ranked first in the SUCRA ranking of ACR20/50/70. In terms of safety indicators, only those differences between low-dose filgotinib and high-dose upadacitinib, low-dose tofacitinib and high-dose upadacitinib were statistically significant. Low-dose filgotinib ranked first in the SUCRA ranking with adverse events as safety indicators. Only the efficacy and safety of tofacitinib ranked higher among different SUCRA rankings.CONCLUSION:Six JAK inhibitors have better efficacy than placebo. The superior efficacy of decernotinib and safety of low-dose filgotinib can be found in the SUCRA. However, there are no significant differences in safety between the different JAK inhibitors. Head-to-head trials, directly comparing one against each other, are required to provide more certain evidence.

Objective The semaphorins are membrane or secreted proteins first identified in neural development. Semaphorin 4D (Sema4D) is the first family member found to have immune properties. We evaluated the potential of Sema4D as a marker for rheumatoid arthritis (RA) disease activity, singly and in combination with other known biomarkers including rheumatoid factor (RF) and C-reactive protein (CRP). Methods Three hundred and eleven RA patients were enrolled. The patients were divided into three groups based on their disease activity in 28 joints (DAS28): mild, moderate, and severe. The healthy group included 40 healthy individuals. SerumSema4D was measured by quantitative ELISA and the specificity and sensitivity of biomarkers were evaluated by generating a receiver operating characteristic (ROC) curve to analyze their diagnostic accuracy. Results Serum Sema4D levels in the moderate and severe RA groups were elevated significantly above those of the controls (P < 0.01), while levels in the mild RA and control groups did not differ significantly (P > 0.05). The Sema4D cutoff threshold was 15.7 ng/ml when the DAS28 was applied as a reference. Compared to the erythrocyte sedimentation rate (ESR and CRP, Sema4D had the highest specificity (96.8%) and area under the curve (0.80) for diagnosing RA activity. The highest specificity (100%) for the biomarker combinations was obtained when Sema4D was combined with CRP and anti-CCP, the combination of the Sema4D combined with ESR and anti-CCP had the highest sensitivity (99.35%). According to this result, a new model for jointly calculating RA activity of Sema4D,anti-CCP and CRP was constructed. Meanwhile another model is established by using the method of multivariate analysis.Model comparison results showed the the multiple regression algorithm method fitted the patients' disease activity better. Conclusion The serum Sema 4D level effectively reflects moderate to severe RA activity. Sema4D levels can be used together with conventional RA biomarkers to increase the diagnostic power of RA activity. The multiple regression algorithm method is promising in disease activity calculation.

Although empagliflozin has been recommended for individuals with heart failure, its effects on heart failure with preserved ejection fraction (HFpEF) remain uncertain from a physiopathological standpoint. The metabolites produced by gut microbiota have been shown to have a crucial role in the development of heart failure. Sodium-glucose cotransporter-2 inhibitors (SGLT2) have been shown to change the make-up of the gut microbiota in rodent studies. There is mixed evidence from similar studies investigating whether or not SGLT2 can affect the microbiota in the human gut. This trial is a pragmatic, randomized, open-label controlled study with empagliflozin as an intervention. We will enroll 100 patients with HFpEF and randomly assign them to one of two groups to receive either empagliflozin or a placebo. Patients in the Empagliflozin group will be given 10 mg of the drug daily, while those in the Control group will not be given empagliflozin or any other SGLT2. The purpose of the trial is to validate the changes that occur in gut microbiota in patients with HFpEF who take empagliflozin and to investigate the function of gut microbiota and their metabolites in the process.

To the Editor: Multiple mucocutaneous warts are common in patients due to virus spreading or self-inoculation, as exemplified by 22.2% of the patients with plantar warts having more than one lesion.1 Specific immune responses against human papillomavirus-harboring lesions contribute to self-regression or treatment-mediated clearance of warts. As such, the treatment-induced immune response to one target lesion could likely initiate the immune-mediated clearance of untargeted or remote lesions in patients with multiple warts containing the same human papillomavirus types.

ObjectiveAlthough Leflunomide (LEF) is effective in treating rheumatoid arthritis (RA), there are still a considerable number of patients who respond poorly to LEF treatment. Till date, few LEF efficacy-predicting biomarkers have been identified. Herein, we explored and developed a DNA methylation-based predictive model for LEF-treated RA patient prognosis.MethodsTwo hundred forty-five RA patients were prospectively enrolled from four participating study centers. A whole-genome DNA methylation profiling was conducted to identify LEF-related response signatures via comparison of 40 samples using Illumina 850k methylation arrays. Furthermore, differentially methylated positions (DMPs) were validated in the 245 RA patients using a targeted bisulfite sequencing assay. Lastly, prognostic models were developed, which included clinical characteristics and DMPs scores, for the prediction of LEF treatment response using machine learning algorithms.ResultsWe recognized a seven-DMP signature consisting of cg17330251, cg19814518, cg20124410, cg21109666, cg22572476, cg23403192, and cg24432675, which was effective in predicting RA patient’s LEF response status. In the five machine learning algorithms, the support vector machine (SVM) algorithm provided the best predictive model, with the largest discriminative ability, accuracy, and stability. Lastly, the AUC of the complex model(the 7-DMP scores with the lymphocyte and the diagnostic age) was higher than the simple model (the seven-DMP signature, AUC:0.74 vs 0.73 in the test set).ConclusionIn conclusion, we constructed a prognostic model integrating a 7-DMP scores with the clinical patient profile to predict responses to LEF treatment. Our model will be able to effectively guide clinicians in determining whether a patient is LEF treatment sensitive or not.

目的 探讨消化内科住院患者费用构成及其影响因素,为有效控制住院费用提供理论依据.方法 选取辽宁省某医院消化内科2018年1月1日-2021年4月30日住院患者病案首页数据,采用多元逐步回归模型进行住院患者费用影响因素的分析.结果 最终纳入14 537例住院患者病案首页数据,住院患者中消化系统肿瘤和其他消化系统疾病构成比分别是26.38％和73.62％;治疗费用占比前5名分别是西药费29.79％、手术医用耗材费(16.14％)、实验室诊断费(13.42％)、临床诊断项目费(11.32％)和影像学诊断项目费(9.21％);年龄增长、有保险保障、少数民族、住院天数增长、疾病诊断数量和手术操作数量增长与住院费用呈正相关;住院次数与费用呈负相关;急诊入院患者住院费用高于门诊患者.结论 消化内科住院患者治疗费用前5位分别是西药费、手术用医材费、实验室诊断费、临床诊断项目费和影像学诊断项目费;年龄、民族、付费方式、入院途径、住院次数、住院天数、是否转科、疾病诊断数和手术操作数是消化内科患者住院费用的主要影响因素.

Abstract Objective A bibliometric analysis of the current status and hotspots in rheumatoid arthritis (RA) research was conducted using prognostic studies from various countries, institutions, and individuals throughout the world. Methods Data from 2000 to 2021 were collected from the Web of Science core collection. Bibliographic co-occurrence analysis system (BICOMB) software was used for bibliometric analysis, VOS viewer software was used for visualization of the studies on the RA-prognostic channel. The published papers were analyzed in terms of numbers, document type, journal, references cited, authors, high-frequency words, and research. Results A total of 2759 papers were included. The field of RA prognosis appears to be in a stable stage, with material published in core European and American journals by core researchers and teams. The most cited references were the “The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis” (Citations = 296), while Dr Smolen was the most productive author with 38 papers and 606 citations. Collaborations between institutions occurred more frequently within countries, while international collaborations were most frequent with United States-based institutions (total link strength = 1427). The top four research frontiers were "evaluation methodology", " Disease-Modifying Anti-Rheumatic Drugs(DMARDs)", "diagnostic criteria", and "management standard". Conclusion The annual scientific output on RA prognosis has grown steadily throughout the world. However, there is still a gap between China and western nations in terms of articles of high quality. It is suggested that Chinese researchers should focus on research quality, collaborations between institutions both domestically and internationally, and follow scientific and technical trends in the field.

OBJECTIVES:This study was designed to identify the potential diagnostic biomarkers of rheumatoid arthritis (RA) and to explore the potential pathological relevance of immune cell infiltration in this disease. METHODS:Three previously published datasets containing gene expression data from 35 RA patients and 29 controls (GSE55235, GSE55457, and GSE12021) were downloaded from the GEO database, after which a weighted correlation network analysis (WGCNA) approach was utilized to clarify differentially abundant genes. Candidate biomarkers of RA were then identified via the use of a LASSO regression model and support vector machine recursive feature elimination (SVM-RFE) analyses. Data were validated based upon the area under the receiver operating characteristic curve (AUC) values, with hub genes being identified as those with an AUC > 85% and a P value < 0.05. Lastly, the CIBERSORT algorithm was used to assess immune cell infiltration of RA tissues, and correlations between immune cell infiltration and disease-related diagnostic biomarkers were assessed. RESULTS:The green-yellow module containing 87 genes was found to be highly correlated with RA positivity. FADD, CXCL2, and CXCL8 were identified as potential RA diagnostic biomarkers (AUC > 0.85), and these results were validated using the GSE77298 dataset. Immune cell infiltration analyses revealed the expression of hub genes to be correlated with mast cells, monocytes, activated NK cells, CD8 T cells, resting dendritic cells, and plasma cells. CONCLUSION:These data indicate that FADD, CXCL2, and CXCL8 are valuable diagnostic biomarkers of RA, offering new insight that can guide future studies of RA incidence and progression.

Abstract Objective Serum amyloid A4 (SAA4) is an apolipoprotein that is associated with high-density lipoprotein (HDL) in plasma. In this present investigation, we appraised the potential of SAA4 as a novel diagnostic biomarker for rheumatoid arthritis (RA) combined with other established RA biomarkers, including anticitrullinated protein antibody (anti-CCP), rheumatoid factor (RF)，and C-reactive protein (CRP). Based on the correlative measures of the biomarkers, we developed a diagnostic model of RA by integrating serum levels of SAA4 with these clinical parameters. Methods A number of 316 patients were recruited in the current research. The serum levels of SAA4 were assessed by quantitative ELISA. The specificity and sensitivity of biomarkers were evaluated by using a receiver-operator curve (ROC) analysis to determine their diagnostic efficiency. Univariate and multivariate logistic regression analyses were used to screen and construct the diagnostic models for RA , consisting of diagnostic biomarkers and clinical data. A diagnostic nomogram was then generated based on logistic regression analysis results. Results The serum levels of SAA4 were considerably greatest in RA patients in comparison to other control subjects (P<0.001). Compared with anti-CCP, RF and CRP respectively, SAA4 had the highest specificity (88.60%) for diagnosing RA. The combination of SAA4 with anti-CCP could have the highest diagnostic accuracy when paired together, with highest sensitivity (91.14%) in parallel and highest specificity(98.10) in series. We successfully developed two diagnostic models: the combined model of SAA4 and anti-CCP (model A), and the combined model of SAA4, CRP, anti-CCP, RF and history of diabetes (model B). Both models showed a great area under the curve of ROC for either the training cohort or the validation cohort. The data indicated that the novel RA diagnostic models possessed an advantageous discrimination capacity and application potential. Conclusion Serum SAA4 has utility as a biomarker for RA’s diagnosis and can enhance the detection of RA when combined with anti-CCP.

Aim Cutaneous warts caused by human papillomavirus are benign proliferative lesions that occur at any ages in human lives. Updated, comprehensive and systematic evidence-based guidelines to guide clinical practice are urgently needed. Methods We collaborated with multidisciplinary experts to formulate this guideline based on evidences of already published literature, focusing on 13 clinical questions elected by a panel of experts. We adopted Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to form classification of recommendations as well as the improved Delphi method to retain respective recommendations with a consensus degree of over 80%. Results Our guideline covered aspects of the diagnosis and treatment of cutaneous warts such as diagnostic gold standard, transmission routes, laboratory tests, treatment principle, clinical cure criterion, definitions, and treatments of common warts, flat warts, plantar warts, condyloma acuminatum, and epidermodysplasia verruciformis. Recommendations about special population such as children and pregnant women are also listed. In total, 49 recommendations have been obtained. Conclusions It is a comprehensive and systematic evidence-based guideline and we hope this guideline could systematically and effectively guide the clinical practice of cutaneous warts and improve the overall levels of medical services.

目的 分析国内近年来电子病历相关研究热点,为未来电子病历的研究提供参考.方法 以电子病历或电子病案为关键词检索2015年1月1日-2020年11月30日CNKI数据库中相关文献,基于文献计量学方法对文献年份、作者单位、期刊分布、关键词进行统计分析,借助Gephi软件进行聚类分析.结果 共检索到 2088 篇相关文献,各年份文献量较平均,涉及 696 种期刊,其中《中国数字医学》载文量最多;作者单位数量大且各单位发表文献量较接近;研究热点共3大方面,包括电子病历质量管理及应用、电子病历数据管理及应用、电子病历信息化管理及应用.结论 国内研究热点逐渐深入,突出信息化建设以及数据应用,为推动医院信息化建设以及医院智能化、精细化管理提供基础.

目的 回顾性分析近10年中国医科大学附属第一医院收治的腹主动脉瘤(AAA)病人的流行病学特点,为研究近10年AAA流行病学变化趋势,以及为AAA的进一步预防和诊治提供依据.方法 纳入自2011年1月至2020年12月中国医科大学附属第一医院诊治的1246例AAA病人的病案资料,回顾性分析包括病人年龄、性别、就诊时间、就诊科室、首发症状、住院时间、住院费用、术式选择等信息,分析近10年AAA流行病学变化特点.结果 入院病人平均年龄为(66.9±10.5)岁,男女占比约为4∶1.男性AAA病人以同型半胱氨酸升高为主,女性以血脂升高为主.AAA病人的主要合并症为3级高血压(41.9％)、冠心病(31.1％)和合并髂动脉瘤(25.8％).男性AAA合并髂动脉瘤比率明显高于女性(27.8％vs.17.8％,P＜0.01).72.7％的AAA病人首诊原因为体检发现,其次是AAA破裂(18.7％).AAA病人急诊与门诊就诊例数呈逐年升高态势,急诊与门诊就诊占比约为2∶3.65～69岁为现阶段住院病人主要年龄段.各年份男性占比约为80％,年龄段65～69岁为男性占比可达近90％.各年份腔内修复术(EVAR)是AAA的主要治疗方式,行EVAR治疗病人的例数和比例总体趋势逐年增加,行EVAR治疗的占比随病人年龄增加而逐渐增大.近10年AAA病人的病死率呈降低趋势,2015年后病死率总体维持在2％～3％,以男性为主,年龄段70～74岁的病死率最高为5.8％.AAA病人平均住院(17.0±16.4)d,平均住院费用为(11.3土 10.7)万元.结论 近10年AAA住院病人有逐年增高趋势,主要患病人群为年龄＞60岁男性,男女临床特点有较大差异.采用EVAR治疗的占比逐年增加.对于老年AAA人群,尤其是年龄段65～69岁男性AAA病人,在AAA的防治过程中应给予更多关注.

We developed and validated a nomogram to predict the risk of stroke in patients with rheumatoid arthritis (RA) in northern China. Out of six machine learning algorithms studied to improve diagnostic and prognostic accuracy of the prediction model, the logistic regression algorithm showed high performance in terms of calibration and decision curve analysis. The nomogram included stratifications of sex, age, systolic blood pressure, C-reactive protein, erythrocyte sedimentation rate, total cholesterol, and low-density lipoprotein cholesterol along with the history of traditional risk factors such as hypertensive, diabetes, atrial fibrillation, and coronary heart disease. The nomogram exhibited a high Hosmer-Lemeshow goodness-for-fit and good calibration (P > 0.05). The analysis, including the area under the receiver operating characteristic curve, the net reclassification index, the integrated discrimination improvement, and clinical use, showed that our prediction model was more accurate than the Framingham risk model in predicting stroke risk in RA patients. In conclusion, the nomogram can be used for individualized preoperative prediction of stroke risk in RA patients.

Background: Obstructive sleep apnoea (OSA) is highly prevalent in patients with Stanford type B aortic dissection (TBAD). Few studies have evaluated the effects of OSA on vascular changes in TBAD patients. This study aimed to explore the effect of OSA on aortic morphological changes in TBAD patients and its relation to late aortic events (LAEs). Methods: This case-control study included 143 TBAD patients. The diameters of different parts of the aorta were measured based on computed tomography angiography (CTA). According to the apnoea-hypopnoea index (AHI), OSA was classified as mild (5 ≤ AHI ≤ 15), moderate (15 < AHI ≤ 30), or severe (AHI > 30). The false lumen (FL) status was evaluated and classified as partially thrombosed, patent, or completely thrombosed. Results: The OSA prevalence in TBAD patients was 64.3%, and image differences related to LAEs between TBAD patients with and without OSA included the maximum aortic diameter at onset (37.3 ± 3.9 vs. 40.3 ± 4.5 mm, p < 0.001), the FL diameter of the proximal descending thoracic aorta (16.0 ± 6.8 vs. 20.3 ± 4.7 mm, p < 0.001), and the proportion of the FL that was partially thrombosed (39.2 vs. 64.1%, p = 0.004). Additionally, in the multivariable analysis of patients with OSA, the risks of an aortic diameter ≥40 mm, a proximal descending aorta FL ≥ 22 mm and a partially thrombosed FL were 4.611 (95% CI: 1.796–11.838, p = 0.001), 2.544 (95% CI: 1.050–6.165, p = 0.039), and 2.565 (95% CI: 1.167–5.637, p = 0.019), respectively, after adjustment for confounding factors. Trend tests showed that the risks of an aortic diameter ≥40 mm and a partially thrombosed FL increased with increasing OSA severity. Conclusions: TBAD patients with moderate to severe OSA have aortic dilatation in different parts of the aorta. OSA is an independent risk factor for multiple imaging signs related to LAEs, suggesting that OSA is an important factor affecting the prognosis of TBAD patients.

Objective The purpose of this study was to determine the expression of related genes in patients with rheumatoid arthritis (RA) treated with methotrexate (MTX), to identify hub genes, and to systematically analyse the functions, pathways, and networks of these genes. Methods The PubMed identifiers (PMIDs) of relevant publications were obtained from the PubMed database, and gene data were extracted from these documents using the text mining software PubTator. The Database for Annotation, Visualization and Integrated Discovery (DAVID) was used to obtain enriched Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway information. In addition, the STRING database was used to construct a protein-protein interaction (PPI) network. Genes with which at least 10 other genes interacted were identified as hub genes. Results A total of 216 genes were identified as being associated with treatment efficacy for MIX, of which 14 pathways exhibited significant correlation (p<0.05, FDR<0.05). In addition, the constructed MIX treatment-related network consisted of 267 interactions. Fourteen genes were found to interact with at least 10 other genes (p<0.05, FDR<0.05) and identified as hub genes in the PPI network. These genes were JAK1 , MAPK1, JUN, AKT1, MAPKI4, MAPK8, FGB, FN1, ALB, B2M, IL2RB, GGH, IL2RA, and TP53. Conclusion This study will assist in elucidating the molecular mechanisms associated with the treatment efficacy of MIX for RA and provide a scientific rationale for guiding patient medication. However, the relationship between particular genes and the efficacy of MTX treatment for RA patients requires additional investigation.

基于国内外文献检索及既往病历书写、临床科研经验确定数据结构化节点,通过设计病历书写选择框、逻辑引用、信息系统互联影像、检验系统等方法建立结构化病历模板并在实际临床工作中应用评估,以此设计涵盖多种血管外科疾病的智能化、结构化病历系统,规范临床医师病历书写,提升病历质量,为后期临床科研提供结构化数据支持,并为血管外科专病数据库建设提供了工作基础.

Objective:To evaluate the association between microRNA gene polymorphisms and rheumatoid arthritis (RA) using Meta-analysis.Methods:A systematic search of Chinese biomedical literature database, VIP database, Wanfang data, CNKI, PubMed, Cochrane, and Embase database was performed to identify articles reporting on the association between microRNA gene polymorphisms and RA. The search time limit was from the inception of the database to May 1, 2020. The references of retrieved articles were manually searched to ensure the comprehensiveness of the retrieval. Studies meeting the inclusion criteria were included to conduct data extraction and quality evaluation. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. A Meta-analysis was performed using Stata 15.1 software.Results:A total of 14 cohort studies were included, involving 1945 RA cases and 2405 controls. Meta-analysis results showed that the expression level of G/G genotype of miR-146a in RA patients was significantly higher than that in normal controls [OR=1.15, 95%CI (1.00, 1.33), P=0.048], other phenotypes were not significantly associated with the risk of RA [C/C: OR=0.94, 95%CI (0.83, 1.07), P=0.353; G/C: OR=0.92, 95%CI(0.82,1.03), P=0.135]. The C/T genotype of miR-499 in RA patients was significantly lower than that in normal controls [OR=0.84, 95%CI (0.72,1.00), P=0.044], there were no significant differences in other genotypes [T/T: OR=0.97, 95%CI (0.77,1.24), P=0.831; C/C: OR=1.40, 95%CI (0.96,2.05), P=0.713]. Analysis of subgroups by race showed that there was no statistically significant association between the polymorphisms of miR-146a and miR-499 and the incidence of RA in Caucasian and Asian populations (P＞0.05).Conclusion:This study find that the G/G genotype of miR-146a and C/T genotype of miR-499 are related to genetic susceptibility to RA.

Background: to develop and validate a serum lipid and inflammatory marker model based on the nomogram for the prediction of stroke risk in rheumatoid arthritis patients.Methods: This study was conducted among 313 rheumatoid arthritis with stroke patients and 1827 rheumatoid arthritis patients divided into develop and validation cohorts from the First Affiliated Hospital of China Medical University during January 2011 to December 2018. Logistic regression analysis was used to create a nomogram of predictive model of stroke risk in rheumatoid arthritis patients, after comparing with other machine algorithms. The performance of the nomogram was evaluated by discrimination, calibration and decision curve analysis, also compared with the Framingham Risk Score in predicting stroke in rheumatoid arthritis patients.Results: the nomogram was performed by logistic regression algorithm, and predictors of which included the stratifications of sex, age, systolic blood pressure, C-reactive protein, erythrocyte sedimentation rate, total cholesterol, low density lipoprotein cholesterol and the distribution of being accompanied with hy-med, diabetes, atrial fibrillation and coronary heart disease history, which exhibited a well goodness fit and a good agreement. The analysis with area under the curve, the net reclassification index, the integrated discrimination improvement and clinical use, suggested that this is an easy-to-use nomogram compared with the Framingham Risk Score.Conclusion: This study presents a risk nomogram that incorporates the traditional risk factors, serum lipids and inflammatory markers which can be used to predict stroke in rheumatoid arthritis patients.