ObjectivePatients with systemic lupus erythematosus (SLE) exhibit heterogeneous renal courses after acute kidney injury (AKI). This study applied latent class mixed modeling to identify AKI trajectory phenotypes in SLE, developed a risk-stratification model using early post-AKI data, and explored whether hydroxychloroquine (HCQ) use is associated with AKI trajectory class membership.MethodsThis multicenter retrospective study used MIMIC-IV for model development and internal assessment and eICU, NWICU, and local cohorts for exploratory external assessment. Adult SLE patients with AKI were included. The primary model was a race-free, no-imbalance-correction LASSO logistic regression model. Performance was assessed with AUC, Brier score, calibration intercept, and calibration slope. Bootstrap optimism correction was applied. A non-overlap sensitivity analysis examined the influence of structural predictor-outcome overlap. HCQ was evaluated using multivariable logistic regression and propensity score matching.ResultsAmong 279 MIMIC patients, three AKI trajectories were identified (progressive 9.3%, recovery 19.4%, stable 71.3%). The primary race-free LASSO model achieved an apparent AUC of 0.761 (optimism-corrected: 0.706) and a Brier score of 0.086 (corrected: 0.092). When assessed against a non-overlapping post-48-hour renal endpoint, discrimination diminished substantially (AUC 0.593). Exploratory external assessments were event-limited: the main SLE external discrimination subsets contained 6 events in eICU, 3 events in NWICU, and 1 event in the local cohort; therefore, these estimates were considered descriptive rather than definitive validation. HCQ showed an exploratory association not interpretable as causal.ConclusionThis study provides an exploratory risk-stratification framework for early AKI trajectory patterns in SLE. The apparent discrimination was substantially attenuated after removing predictor-outcome overlap and adjusting for optimism. External assessments were event-limited and should be interpreted as exploratory transportability assessments rather than definitive evidence of generalizability.

Current studies have demonstrated an association between osteoporosis (OP) and lipidome traits, yet the causal relationship between OP and lipidome remains controversial. Therefore, our aim is to explore the relationship between the lipidome and OP by calculation of genetic susceptibility. This study utilized a two-sample Mendelian randomization (MR) approach which the instrument variables were derived from a large genome-wide database: lipidome (7174 Finnish individuals), osteoporosis (56,637 samples), fractures (426,795 samples), heel bone density (426,824 samples), whole-body bone density (56,284 samples), femoral neck bone density (32,735 samples), lumbar spine bone density (28,498 samples), and forearm bone density (8143 samples). The primary results were based on inverse variance weighting (IVW) with random effects. Based on the IVW results, we identified 138 significant associations between lipidome traits and osteoporosis and its traits (P < 0.05). Among these, 8, 24, 27, 37, 17, 8, and 17 lipid species were significantly associated with femoral neck bone density, forearm bone density, fractures, heel bone density, lumbar spine bone density, osteoporosis, and whole-body bone density, respectively. Triglycerides were found to be significant protective factors for osteoporosis, forearm BMD, and lumbar BMD, whereas phosphatidylcholine was considered a prominent risk factor for osteoporosis, fractures, heel BMD, and lumbar BMD. The results of the heterogeneity test indicated that our IVW analysis was largely free of heterogeneity (P > 0.05). However, the pleiotropy test revealed significant pleiotropy between heel bone density and the measurement of triacylglycerol (56:6) (P < 0.05). By applying MR methods, this study overcomes the biases inherent in traditional observational studies and provides novel mechanistic insights into lipid metabolism in op.

Background:Ischemic heart disease (IHD) among young adults represents an emerging global health concern, yet comprehensive epidemiological assessments remain limited. This study aimed to quantify the global burden of early-onset IHD and project future trends through 2046. Methods:We analyzed data from the Global Burden of Disease (GBD) 2021 study, examining IHD burden among adults aged 15-44 years across 204 countries and territories from 1990 to 2021. Age-standardized rates were calculated using WHO standard population weights. Temporal trends were assessed using estimated annual percentage change (EAPC) methods. Age-Period-Cohort models were employed to project burden through 2046. DALYs were disaggregated into Years Lived with Disability (YLDs) and Years of Life Lost (YLLs). Results:Globally, age-standardized incidence rates increased modestly from 36.54 (95% UI: 21.69-54.31) per 100,000 in 1990 to 39.18 (95% UI: 23.32-58.20) per 100,000 in 2021, representing a 7.2% increase. Despite modest rate changes, absolute incident cases increased substantially from 1.26 millions to 2.17 millions. Age-standardized mortality rates declined significantly by 15.2%, from 12.21 (95% UI: 11.57-12.88) to 10.35 (95% UI: 9.68-11.04) per 100,000. Disaggregated DALYs analysis revealed divergent trends: YLDs rates increased (EAPC: 0.39%) while YLLs rates declined (EAPC: -0.66%), reflecting improved acute survival but growing chronic disease burden. Men consistently demonstrated higher burden across all measures, with male-to-female ratios ranging from 1.7:1 for incidence to 2.7:1 for mortality in the 40-44 years age group. Substantial regional heterogeneity was observed, with East Asia showing the steepest incidence increases (EAPC: 0.63%) while High-income North America demonstrated declining trends (EAPC: -2.4%). Central Europe achieved the most substantial improvements in both mortality decline (EAPC: -2.16%) and overall disease burden reduction (EAPC: -4.46%). Projections indicate continued increases in incidence and prevalence through 2046, with incident cases reaching 2.58 millions and prevalent cases reaching 12.7 millions globally. Conclusions:Early-onset IHD represents a growing global health challenge characterized by increasing incidence and prevalence but improving survival outcomes. The substantial sex and regional disparities, coupled with projected increases in absolute burden, underscore the urgent need for balanced strategies addressing both acute care improvements and long-term disability prevention.

Background:While plant protein has been suggested to offer renoprotective benefits, the optimal proportion of dietary plant protein and its relationship with outcomes across different stages of chronic kidney disease (CKD) remains unclear. Methods:Using data from the National Health and Nutrition Examination Survey (NHANES), we examined the association between plant protein ratio and estimated glomerular filtration rate (eGFR) across CKD stages. Plant protein ratio was categorized as low (< 33%), medium (33%-66%), and high (≥ 66%). Multiple imputation was performed for missing data. Weighted linear regression models were used to analyze plant protein ratio-eGFR associations, while Cox proportional hazards models assessed mortality risk. Dose-response relationships were evaluated using restricted cubic splines. Results:Among 16,163 participants, distinct patterns emerged across CKD stages. In Non-CKD, high plant protein ratio was associated with significantly higher eGFR compared to low plant protein ratio (β = 0.790, P = 0.039). In CKD G4, medium plant protein ratio showed significantly higher eGFR (β = 1.791, P = 0.025) compared to low plant protein ratio. For mortality risk, CKD G3 patients with medium plant protein ratio demonstrated significantly lower risk (HR = 0.67, 95% CI: 0.44-1.00, P = 0.047) compared to low plant protein ratio. Dose-response analyses revealed stage-specific patterns: U-shaped relationships in early CKD, transitioning to inverted U-shaped and J-shaped patterns in advanced stages. Conclusion:The association between plant protein ratio and outcomes varies across CKD stages, suggesting the need for stage-specific dietary recommendations. While moderate plant protein intake might be beneficial in early CKD, our findings in advanced stages were largely non-significant and require confirmation in larger studies before clinical recommendations can be made. These findings support a more nuanced approach to dietary protein source management in CKD, though further prospective studies are needed to confirm these associations.

Introduction Antinuclear antibodies (ANA) are frequently positive in patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (anti-MDA5+ DM). This study aimed to investigate the association between ANA and clinical characteristics as well as prognosis in a cohort of patients with anti-MDA5+ DM. Material and methods We conducted a systematic retrospective study of medical records from a Nanjing Medical University cohort of patients with myositis-associated interstitial lung disease (ILD). Various parameters were compared and analyzed between the ANA-positive group and the ANA-negative group. Results A total of 246 patients with anti-MDA5+ DM were enrolled in this study, with 28.5% males and 71.5% females. The median age was 53.0 years, the median disease duration was 2 months, and the median follow-up period was 12.0 months. The ANA positivity rate at baseline was 52.4% in anti-MDA5+ DM patients. The ANA-positive group showed significantly higher positivity rates of anti-Ro52 antibodies (72.9% vs. 54.7%, p = 0.003) and anti-aminoacyl-tRNA synthetase (anti-ARS) antibodies (9.3% vs. 2.6%, p = 0.033) compared to the ANA-negative group, but lower ALT levels: 39.0 (21.5, 79.3) vs. 51.3 (36.5, 95.8), p = 0.006. No significant differences were observed between the two groups in terms of overall survival, rapidly progressive interstitial lung disease (RPILD) incidence, age, disease duration, and clinical characteristics. In a subgroup analysis of the ANA-positive group, MDA5+++ patients had a higher incidence of RPILD compared to the MDA5+ group ( p = 0.028). In the ANA-negative subgroup analysis, MDA5+++ patients had a higher mortality rate and worse prognosis compared to the MDA5+ group ( p = 0.026). Multivariate Cox regression analysis showed that elevated lactate dehydrogenase (LDH) levels and the presence of rapidly progressive interstitial lung disease (RPILD) were associated with poor prognosis in ANA-negative anti-MDA5+ DM patients, with hazard ratios of 1.002 (95% CI: 1.001, 1.003, p = 0.020) and 13.694 (95% CI: 15.032, 37.267, p < 0.001), respectively. Conclusions ANA is frequently found in patients with anti-MDA5+ DM. High titers of anti-MDA5 antibodies are associated with mortality and RPILD.

Objective:This study aimed to identify potential diagnostic biomarkers for systemic lupus erythematosus (SLE) using metabolomics approaches and machine learning algorithms, and to evaluate therapeutic targets for SLE treatment. Methods:Serum samples from 44 SLE patients with lupus nephritis, 40 rheumatoid arthritis patients, 39 primary Sjögren's syndrome patients, and matched healthy controls were analyzed using ultra-performance liquid chromatography-high resolution mass spectrometry (UPLC-HRMS). Eight machine learning algorithms were employed to establish diagnostic models. Partial least squares discriminant analysis (PLS-DA) and orthogonal PLS-DA (OPLS-DA) were used to identify differential metabolites. The therapeutic potential of identified metabolites was validated in MRL-Fas lpr mice through histological examination, flow cytometry, and biochemical analysis. Results:A total of 129 metabolites were detected, with machine learning models achieving area under the curve (AUC) values >0.8. The principal component regression model performed best with AUC values of 0.99 and 0.96 for training and test datasets, respectively. Two key metabolites, tryptophan and beta-alanine, showed significantly decreased levels in SLE patients compared to healthy controls (both p<0.05), while exhibiting opposite patterns in other autoimmune diseases. In the mouse model, tryptophan supplementation improved renal histology, reduced proteinuria, increased naïve T cells and central memory T cells, and decreased effector T cell frequencies in both peripheral blood and spleen. Conclusion:This study demonstrates the successful application of machine learning algorithms to metabolomics data for SLE classification and identifies tryptophan and beta-alanine as potential SLE-specific biomarkers. Tryptophan supplementation shows therapeutic promise in lupus mouse models through immunomodulatory effects on T cell subsets and renal protection.

BACKGROUND:Vitamin D is a fat-soluble secosteroid that plays essential roles in calcium homeostasis, bone metabolism, and numerous other physiological processes. Vitamin D deficiency has been associated with increased risk of various diseases and mortality. However, population-based studies examining the relationship between vitamin D and mortality across different age groups remain limited. METHODS:To investigate the correlation between 25-hydroxyvitamin D [25(OH)D] levels, vitamin D status, and mortality in a cohort of 47,478 individuals aged 18-85 years. RESULTS:Higher 25(OH)D levels were associated with lower mortality risk. Compared to the vitamin D deficiency group, the Hazard ratios (HR) for all-cause mortality were 0.71 (95%CI: 0.66-0.76) in the insufficiency group and 0.64 (95%CI: 0.58-0.70) in the sufficiency group. The association varied by age: strongest in adults aged 40-59 years (HR: 0.74, 95% CI: 0.65-0.85), significant in those ≥60 years (HR: 0.86, 95% CI: 0.82-0.90), but non-significant in those aged 18-39 years. The RCS analysis revealed a non-linear relationship between 25(OH)D and mortality, with significant risk reduction observed between 59.25-261.45 nmol/L for the overall population. The optimal 25(OH)D levels (lowest HR) varied by subgroups: 96.81 nmol/L for the overall population, 102.9 nmol/L for females, 67 nmol/L for ages 40-59, and 104.23 nmol/L for ages ≥60 years, while no significant association was found in ages 18-39 years. CONCLUSION:Our findings suggest that Vitamin D are associated with mortality among the whole population. Individuals aged 40-59 may derive potential benefits from vitamin D supplementation.

Background This research aims to study the diagnostic patterns, anatomical locations, and age-related trends in pediatric clavicular lesions, filling a gap in pediatric-specific data for these conditions. Methodology A retrospective study of 20 pediatric patients (aged ≤14 years) with clavicular lesions was conducted based on inclusion and exclusion criteria emphasizing confirmed diagnosis and treatment specifics. The diagnostic process relied on open biopsy, followed by excision or curettage and histopathological examination. Results The study primarily involved patients with an average age of 7.1 ± 3.8 years. Eosinophilic granuloma was the most common diagnosis (30% of cases), particularly in the age group of 0-3 years. Clavicular lesions predominantly manifested as either a palpable lump or localized swelling with pain. The medial of the clavicle was the most frequent lesion location. No malignant tumors were found, and the functional outcomes post-treatment were satisfactory. Conclusions Pediatric clavicular lesions exhibit distinct diagnostic and anatomical characteristics compared to adults. Eosinophilic granuloma is significantly prevalent in early childhood, necessitating age-specific diagnostic and therapeutic approaches. The study advocates for multidisciplinary collaboration in the treatment and improved understanding of these lesions, which are vital for pediatric orthopedic oncology.

This study aims to evaluate the trends in rheumatoid arthritis (RA) in China from 1990 to 2021 by analyzing data from the Global Burden of Disease (GBD) 2021 study and to predict the trends for the next 25 years. Age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) were calculated, and the estimated annual percentage change was used to illustrate differences in age distribution among various populations. Age-period-cohort (APC) analysis and Bayesian APC (BAPC) models were employed to forecast the burden of RA in China from 2022 to 2046. From 1990 to 2021, the ASIR of RA in China increased from 11.6 to 13.7, with a significantly higher ASIR in females than in males. Despite the increase in incidence, the ASMR related to RA decreased from 0.7 to 0.5. Predictions using the BAPC model indicate that the incidence of RA will continue to rise, with an expected ASIR of approximately 16.4 by 2046, and the total number of RA cases is projected to reach around 342,000. In terms of mortality, the ASMR is expected to decline to 0.3 by 2046, although the total number of deaths might reach about 40,000. The incidence of RA in China has significantly increased over the past 30 years. Although the incidence rate and the total number of RA cases may continue to rise in the future, the mortality rate of RA has been consistently declining.

BackgroundInadequate levels of vitamin D (VitD) have been linked to increased rates of various health conditions and mortality. However, little is known about the relationship between mortality outcomes and 25-hydroxyvitamin D [25(OH)D] levels in individuals with rheumatoid arthritis (RA). This study aimed to examine this association using data from the National Health and Nutrition Examination Survey.MethodsA cohort of 2,290 individuals aged 20 to 85 years with RA was analyzed. Lower 25(OH)D levels were inversely associated with all-cause mortality, with a hazard ratio (HR) of 0.91 (0.87 to 0.96) per 10 nmol/L increase. Comparatively, the HR for the VitD insufficiency group was 0.64 (0.50 to 0.83), and for the VitD sufficiency group, it was 0.60 (0.44 to 0.80), both compared to the VitD deficiency group. Cause-specific analysis showed that higher 25(OH)D levels were associated with reduced mortality from heart disease (HR: 0.88, 0.82 to 0.95) and malignant neoplasms (HR: 0.86, 0.79 to 0.94). No significant correlation was found between 25(OH)D levels and cause-specific mortalities for other conditions.ResultsStratified by gender, the HR for males was 0.92 (0.85 to 0.99) and for females was 0.91 (0.86 to 0.98) per 10 nmol/L increase in 25(OH)D levels. Among individuals aged 20-59 years, no significant correlation was observed, while for those aged 60 years and older, the HR was 0.86 (0.82 to 0.90) per 10 nmol/L increase. Nonlinear analysis identified a sharp increase in HR below 59.95 nmol/L, while HR remained below 1 for 25(OH)D levels above 59.95 nmol/L.ConclusionThis study reveals a strong negative correlation between 25(OH)D levels and overall mortality in individuals with RA. Notably, this association is particularly significant for mortality related to heart disease and malignant neoplasms. Targeted VitD supplementation should be emphasized, especially in individuals aged 60 years and older with RA. The proposed minimum threshold for adequate 25(OH)D levels in the RA population is 60 nmol/L.

BackgroundThe prognosis of anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+DM) is poor and heterogeneous. Rapidly progressive interstitial lung disease (RP-ILD) is these patients’ leading cause of death. We sought to develop prediction models for RP-ILD risk in anti-MDA5+DM patients.MethodsPatients with anti-MDA5+DM were enrolled in two cohorts: 170 patients from the southern region of Jiangsu province (discovery cohort) and 85 patients from the northern region of Jiangsu province (validation cohort). Cox proportional hazards models were used to identify risk factors of RP-ILD. RP-ILD risk prediction models were developed and validated by testing every independent prognostic risk factor derived from the Cox model.ResultsThere are no significant differences in baseline clinical parameters and prognosis between discovery and validation cohorts. Among all 255 anti-MDA5+DM patients, with a median follow-up of 12 months, the incidence of RP-ILD was 36.86%. Using the discovery cohort, four variables were included in the final risk prediction model for RP-ILD: C-reactive protein (CRP) levels, anti-Ro52 antibody positivity, short disease duration, and male sex. A point scoring system was used to classify anti-MDA5+DM patients into moderate, high, and very high risk of RP-ILD. After one-year follow-up, the incidence of RP-ILD in the very high risk group was 71.3% and 85.71%, significantly higher than those in the high-risk group (35.19%, 41.69%) and moderate-risk group (9.54%, 6.67%) in both cohorts.ConclusionsThe CROSS model is an easy-to-use prediction classification system for RP-ILD risk in anti-MDA5+DM patients. It has great application prospect in disease management.

IntroductionTo identify the clinical characteristics and risk factors for cutaneous ulcers in patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis (anti-MDA5+ DM) combined with rapidly progressive interstitial lung disease (RPILD).Material and methodsWe conducted a retrospective cohort study on the medical records of patients enrolled from the Nanjing Medical University Myositis-associated ILD cohort (NMMI). The clinical characteristics of patients in the ulcer-positive group were compared with those in the ulcer-negative group by chi-square or Fisher’s exact test. Univariate and multivariate logistic regression analyses were used to assess risk factors for the development of cutaneous ulcers.ResultsA total of 246 patients with anti-MDA5+ DM were retrospectively enrolled in the study, including 176 females (176/246, 71.54%) and 70 males (70/246, 28.46%), with a female-to-male ratio of 2.51 : 1. Among the 246 patients, a total of 88 cases (88/246, 35.77%) with anti-MDA5+ DM combined with RPILD were further studied, including 55 females (55/88, 62.5%) and 33 males (33/88, 37.5%), with a female-to-male ratio of 1.67 : 1. Twelve patients (12/88, 13.64%) had cutaneous ulcers. In terms of clinical characteristics, patients in the ulcer-positive group had significantly more proximal muscle involvement (83.33% vs. 38.16%, p = 0.003) and more heliotrope rash (83.33% vs. 43.42%, p = 0.010) than in the ulcer-negative group. In univariate analysis, cutaneous ulcers were associated with proximal muscle involvement (OR = 8.103; 95% CI: 1.657–39.625; p = 0.010) and heliotrope rash (OR = 6.515; 95% CI: 1.336–31.773; p = 0.020). In multivariate analysis, cutaneous ulcers were associated with proximal muscle involvement (OR = 6.436; 95% CI: 1.274–32.524; p = 0.024), and proximal muscle involvement was an independent risk factor for cutaneous ulcers.ConclusionsWe confirmed the association between cutaneous ulcers and proximal muscle involvement and heliotrope rash in patients with anti-MDA5+ DM combined with RPILD. Proximal muscle involvement is an independent risk factor for cutaneous ulcers.

Background Various autoimmune disorders have been linked to dermatomyositis (DM) based on findings from epidemiological studies. The objective of this study is to examine the causal association between autoimmune disorders and DM utilizing the methodology of Mendelian randomization (MR). Methods We employed summary statistics from the largest European genome-wide association studies (GWAS) on autoimmune disorders to assess the genetically predicted effects on DM risk in a two-sample MR framework. Single nucleotide polymorphisms (SNPs) strongly associated with 10 immune-related traits were extracted from these GWAS datasets and their effects were examined in a European DM GWAS cohort (201 cases and 172834 controls). In order to address potential bias arising from the intricate linkage disequilibrium structure observed in the human leukocyte antigen region, the analysis excluded SNPs within this specific genomic region. Subsequently, a multivariate Mendelian analysis was conducted to investigate the association between one autoimmune disease and DM. Results After applying the Bonferroni correction to account for multiple testing, our MR analyses revealed a potential heightened risk of DM associated with type 1 diabetes (T1D), one of the autoimmune diseases under investigation. We further conducted a Mendelian analysis focusing on T1D and the occurrence of DM, incorporating type 2 diabetes, viral infection, sunburns and smoking status. Our findings revealed that T1D independently increased the risk of DM, regardless of smoking and viral infection, which were previously identified as DM risk factors. Conclusion Our MR study provides evidence supporting a relationship between susceptibility to T1D and increased DM risk in the European population.

Objective Smoking is a major risk factor for peptic ulcer disease (PUD) mortality. This study aims to analyze global trends in smoking-attributable PUD mortality from 1990 to 2021 and project future trends to 2046.Methods Data were obtained from the Global Burden of Disease Study 2021. We calculated age-standardized mortality rates (ASMR) and estimated annual percentage changes (EAPC) for smoking-attributable PUD mortality. Bayesian Age-Period-Cohort models were used to project future trends.Results From 1990 to 2021, global smoking-attributable PUD deaths decreased from 48,900 to 29,400, with the ASMR declining from 1.2 to 0.3 per 100,000 (EAPC: -4.25%). High-income regions showed faster declines, while some low- and middle-income countries experienced slower progress or even increases. Projections suggest a continued global decline in smoking-attributable PUD mortality to 2046, with persistent regional disparities. By 2046, the global ASMR is expected to decrease to approximately 0.1 per 100,000, with higher rates persisting in certain regions such as the Solomon Islands (3.7 per 100,000) and Cambodia (1.6 per 100,000).Conclusion While global smoking-attributable PUD mortality has significantly decreased and is projected to continue declining, substantial regional disparities persist. These findings underscore the need for targeted tobacco control interventions, particularly in high-risk regions, to further reduce the global burden of smoking-attributable PUD mortality.

Objective: To evaluate belimumabf's efficacy in refractory lupus nephritis (LN) patients and identify predictive serum biomarkers for treatment response. Methods: In this single-arm retrospective study, we assessed clinical responses in LN patients at baseline and six months after initiating belimumab. Serum cytokines (IL-2, IL-4, IL-6, IL-10, TNF-alpha, IFN-gamma) were quantified using multiplex magnetic bead flow immunoassay before and after treatment. Results: Fourteen patients with various subtypes of refractory LN participated in the study: seven with class III and V LN, three with type V alone, two with class III, and two with class IV+V and V LN. Post six months of belimumab therapy, all participants exhibited a reduction in the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K scores from their respective baseline values. Notably, most patients showed a decrease in the dosage of prednisone, levels of 24-hour urinary protein, immunoglobulins, erythrocyte sedimentation rate (ESR), and anti-double-stranded DNA antibody IgM, along with serum levels of IL-4, IL-6, IL-10, and IFN-gamma. Meanwhile, levels of C3, C4, IL-2, and TNF-alpha were observed to increase. Of the participants, nine (64.29%) achieved a complete renal response, one (7.14%) showed a partial response, and four (28.57%) exhibited no response. Significantly, higher baseline serum IFN-gamma levels were found in patients who did not achieve complete renal response (CR) compared to those who did (p = 0.009). Receiver operating characteristic (ROC) curve analysis demonstrated that baseline IFN-gamma levels had an area under curve (AUC) of 0.96 (0.70-1.00), with a sensitivity of 0.89 and a specificity of 1.00 (p < 0.001). Conclusion: Belimumab shows potential efficacy in treating refractory LN. Baseline serum IFN-gamma levels may predict response to belimumab therapy, potentially enabling more targeted treatment approaches for this challenging condition.

BackgroundParticulate matter pollution (PMP) is a major global health concern, with the older adult being particularly vulnerable. This study aimed to analyze global trends in PMP-related deaths and disability-adjusted life years (DALYs) among the older adult from 1991 to 2021.MethodsUsing data from the Global Burden of Disease Study 2021, we examined the impacts of ambient particulate matter pollution (APMP) and household air pollution from solid fuels (HAP-SF). We analyzed trends across different regions, socioeconomic development levels, age groups, and genders.ResultsAPMP-related older adult deaths increased from 1,745,000 to 3,850,000, and DALYs from 32,000,000 to 70,000,000. However, age-standardized mortality rate decreased from 384 to 337 per 100,000. HAP-SF-related deaths decreased from 2,700,000 to 2,100,000, and DALYs from 54,000,000 to 42,000,000. Age-standardized mortality rate for HAP-SF declined from 580 to 188 per 100,000. High APMP burden was concentrated in Asia, Africa, and the Middle East, while high HAP-SF burden was found in parts of Africa and South Asia. East Asia had the highest APMP-related older adult deaths (1,680,000) with an age-standardized mortality rate (ASMR) of 619 per 100,000. For HAP-SF, South Asia bore the heaviest burden with 1,020,000 deaths and an ASMR of 616 per 100,000. Females consistently experienced higher age-standardized DALYs rate than males for both APMP and HAP-SF across all regions and years. APMP burden showed a weak negative correlation with the Socio-demographic Index (SDI) at the regional level (r = −0.25, p < 0.001) but no significant correlation at the country level. HAP-SF burden exhibited strong negative correlations with SDI at both regional (r = −0.74, p < 0.001) and country levels (r = −0.83, p < 0.001).ConclusionDespite overall improvements, PMP continues to significantly impact older adult health globally, with substantial regional and gender disparities. These findings emphasize the need for targeted interventions, particularly in developing regions, and continued global efforts in air quality improvement and clean energy promotion.

Background: The present meta-analysis was carried out to assess the risk of infection and other side effects after anti TNF- α use to treat Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis. Methods: To assess the impact of anti-TNF medicines on the prevalence of infectious adverse events (serious infections; tuberculosis; opportunistic infections; any infection; risk of cancer), we performed a meta-analysis. We searched PubMed, Cinahl (via Ebsco), Scopus, and Web of Sciences databases for trials comparing anti-TNF medications to placebo or no therapy in adult patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis from August 2006 to August 2020. A total of 27 articles were used for the data analysis. The risk of bias (RoB) in included studies was evaluated using the QUADAS-2 tool. The odds ratio of these studies was used to construct the forest plot. The random-effects model was used to pool the data. Also, the random-effects model was used with statistical significance at a p-value less than 0.05 to assess the risk of infections and cancer after anti-TNF treatment. Results: The risk of developing cancer (OR=1.13; 95% CI 0.79 to 1.62; p<0.05) which is lesser than serious infections (OR= 1.5; 95% CI 1.0257 to 2.2276; p<0.05) after anti TNF treatment. However, the risk of developing tuberculosis infection is highest in the patients on anti-TNF treatment (OR=3.96; 95% CI 2.87-5.45) followed by skin and soft tissue infections, i.e. (OR= 2.4598; 95% CI 1.0481 to 5.7732; p<0.05). Conclusion: With the growing use of TNF inhibitors in adult patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, it is critical to keep track of their safety profiles using additional resources (e.g., registries and long-term epidemiological studies). The present meta-analysis is recent evidence which suggests that there is a definite high risk of tuberculosis and cancer after anti-TNF treatment.

BackgroundThis study aims to analyze the historical trends of inflammatory bowel disease (IBD) burden in the elderly from 1990 to 2021 and forecast future trends up to 2051.MethodsData from the Global Burden of Disease Study 2021 were utilized. Age-standardized rates (ASR) for incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were calculated. Estimated annual percentage changes (EAPCs) were computed to quantify temporal trends. A Bayesian Age-Period-Cohort model was employed to project future trends.ResultsFrom 1990 to 2021, the global number of elderly IBD increased from 573,500 to 1,278,190. The age-standardized incidence rate (ASIR) rose from 8.01 to 8.77 per 100,000, while the age-standardized prevalence rate (ASPR) slightly decreased from 118.14 to 117.29 per 100,000. Death number increased from 14,400 to 33,490, but the age-standardized mortality rate decreased from 3.21 to 2.84 per 100,000. DALYs increased from 324,100 to 683,750, with the age-standardized DALYs rate declining from 68.78 to 60.88 per 100,000. Significant geographical variations were observed, with high Socio-demographic Index regions showing the highest burden. Projections suggest that by 2051, elderly IBD prevalence number may reach 2,316,000, with ASIR and ASPR potentially rising after 2035 and 2042, respectively. Deaths and DALYs are projected to increase to 75,000 and 1,401,000 respectively, despite continued declines in ASRs.ConclusionThe absolute burden of IBD in the elderly population is projected to increase substantially by 2051, despite decreasing ASRs. These findings underscore the need for tailored healthcare strategies and resource allocation to address the growing challenge of elderly IBD globally.

ObjectiveInterstitial lung disease (ILD) is a common extramuscular complication contributing to significant morbidity and mortality in patients with dermatomyositis (DM) who are positive for antimelanoma differentiation–associated gene 5 antibody (anti-MDA5+). We conducted this study to investigate the association of anti-Ro52 antibodies with clinical characteristics and prognosis in patients with anti-MDA5+ DM.MethodsWe assessed a cohort of 246 patients with anti-MDA5+ DM. To calculate hazard ratios and 95% CIs for rapidly progressive ILD (RP-ILD) and death while controlling for potential confounders, variables selected by univariate Cox regression analysis were included in a multivariate Cox regression model with the stepwise forward-selection method. A 2-tailed analysis withP< 0.05 was considered to be statistically significant.ResultsA total of 246 patients with anti-MDA5+ DM were enrolled; 70 patients were male, and the patient group had an average age of 53.1 (12.4) years. Anti-Ro52 was present in 64.2% (158/246) patients. Patients with anti-MDA5+ DM who were positive for anti-Ro52 had a higher rate of RP-ILD (log-rankP< 0.001) and a higher mortality rate (log-rankP= 0.01). For patients with anti-MDA5+ DM who were positive for anti-Ro52, those with a short disease course and high inflammation were at increased risk of RP-ILD and death. The appearance of active rash was an independent protective factor of death.ConclusionAnti-Ro52 antibodies were highly prevalent in patients with anti-MDA5+ DM, and their coexistence correlated with a higher rate of RP-ILD and mortality. Patients with a short disease course, with increased inflammation, and without rash were more likely to have a poor prognosis.

Objective To investigate the risk factors for herpes zoster in patients with systemic lupus erythematosus（SLE）.Methods A total of 42 SLE patients complicated with herpes zoster（case group） were treated in the hospital from January 2019 to January 2021. Additional 126 SLE patients without herpes zoster were included as control group. The two groups were matched in terms of patient age, sex, and disease duration. The clinical and laboratory data of these patients were analyzed. Results Complications such as lupus nephritis and diabetes mellitus increased the risk of herpes zoster in SLE patients. Compared with the SLE patients without herpes zoster, SLE patients with herpes zoster showed significantly lower lymphocyte counts, CD4 cells, CD4/CD8 ratio and complements, but significantly higher erythrocyte sedimentation rate（ESR） and C-reactive protein. Herpes zoster was associated with significantly higher probability of treatment with intravenous cyclophosphamide and tacrolimus in SLE patients. Univariate logistic regression analysis showed that SLE disease duration, diabetes mellitus, complement C3, complement C4, intravenous cyclophosphamide and tacrolimus use were significantly different in SLE patients with versus without herpes zoster（all P ＜ 0.05）. Multivariate logistic regression analysis demonstrated that CD4/CD8 and disease duration were protective factors for the risk of herpes zoster in SLE patients, while ESR, lupus nephritis, diabetes mellitus, methylprednisolone pulse therapy, intravenous cyclophosphamide and tacrolimus use were independent risk factors for the incidence of herpes zoster in SLE patients. Conclusions ESR, lupus nephritis, diabetes mellitus, methylprednisolone pulse therapy, intravenous cyclophosphamide, and tacrolimus use are risk factors for the development of herpes zoster in SLE patients.