Abstract:Alzheimer's disease(AD)is a progressively degenerative neurological disorder that severely threatens the health of elderly individuals,and there are currently no effective drugs to prevent its onset or slow its progression.We summarizes the epidemiological characteristics and related risk factors of AD,highlighting that its prevalence significantly increases with age,is higher in women than in men,and is more common in rural areas than in urban areas.Modifiable risk factors for AD primarily include education level,cardiovascular health,and psychosocial factors.Strengthening early screening and managing risk factors may help delay the onset of AD.

Abstract:Dementia was a global public health issue and has become one of the major chronic diseases seriously threatening human health.Alzheimer's disease(AD)and vascular dementia(VaD)were the two most common causes of dementia in the elderly.Cerebral small vessel disease(CSVD)was a common cause of vascular cognitive impairment.There was a complex interaction between AD and CSVD.This article systematically explores the relationship between the two in terms of clinical phenotypes and pathological mechanisms.It summarizes the current status and challenges in the diagnosis and treatment of AD and emphasizes the significance of managing vascular risk factors in the early intervention of dementia.

Abstract:Patients with Alzheimer's disease(AD)often experience different types of sleep disorders during the course of their illness,including insomnia,excessive daytime sleepiness,and circadian rhythm disturbances.Recent studies have indicated a close bidirectional relationship between sleep disorders and AD,with mechanisms primarily involving the deposition of pathological proteins in the brain,the function of the suprachiasmatic nucleus,and neurotransmitter systems.This article aims to systematically review the relationships and underlying molecular mechanisms between sleep disorders and AD,to provide new perspectives for related clinical research.

Abstract:Objective To investigate the clinical characteristics of patients with psoriatic arthritis(PsA)sine psoriasis and disease features.Methods A retrospective study was conducted.Totally 17 patients with PsA sine psoriasis were recruited,who received consecutive treatment in Shanghai Sixth People's Hospital from June 2023 to October 2024.The demographic characteristics,clinical manifestations,laboratory results,delayed time to diagnosis and treatment,treatment regimens,and clinical outcomes were analyzed.Results The study included 17 patients with PsA sine psoriasis,with an average age of(51.4±16.6)years and a male-to-female ratio of 11∶6.The median time from onset to diagnosis was 3 years(IQR:2-10).Nine patients(52.9％)were misdiagnosed as rheumatoid arthritis,2(11.8％)as gout,2(11.8％)as osteoarthritis,and 4(23.5％)as undifferentiated arthritis.Among them,3 patients(17.6％)reported a family history of psoriasis,while 16(94.1％)displayed psoriatic nail lesion.Peripheral joint involvement was observed in all patients,with axial joint involvement in 7(41.2％),dactylitis in 14(82.4％),and enthesitis in 7(41.2％).Joint deformities and limited mobility were noted in 5 patients(29.4％).Laboratory findings revealed elevated erythrocyte sedimentation rate(ESR)in 15 patients(88.2％)and elevated high-sensitive C-reactive protein(CRP)level in 12(70.6％).Human leukocyte antigen-B27(HLA-B27)was positive in 3 patients(17.6％),and hyperuricemia was present in 4(23.5％).Joint ultrasound examination revealed synovitis in 11 patients(64.7％),tenosynovitis in 9 patients(52.9％),enthesitis in 7 patients(41.2％),double contour sign in 2 patients(11.8％),osteophyte formation in 7 patients(41.2％),and bone erosion-like changes in 5 patients(29.4％).Conclusion Patients with PsA sine psoriasis commonly present with dactylitis and enthesitis.Ultrasonography is prone to demonstrate manifestations such as synovitis,tenosynovitis,and enthesitis.The patients may experience prolonged diagnosis,and there are high rates of missed diagnosis and misdiagnosis.The patients are likely to have psoriatic nail damage and a family history of psoriasis.

Abstract:In 2009,the Assessment of Spondyloarthritis International Society(ASAS)first introduced the term "non-radiographic axial spondyloarthritis(nr-axSpA)" in its classification criteria for axial spondyloarthritis(axSpA).However,numerous physicians lack a comprehensive understanding of this concept and fail to grasp the essential characteristics of the disease.The mechanical application of the ASAS-axSpA classification criteria has resulted in overdiagnosis,misdiagnosis,inappropriate selection of therapeutic agents,and suboptimal treatment outcomes in clinical practice and research,presenting significant challenges to the diagnosis and treatment of nr-axSpA.Based on the Guideline for the Diagnosis and Treatment of Non-Radiographic Axial Spondyloarthritis(2024 edition),the diagnostic and therapeutic strategies for nr-axSpA include:elucidating the concept of nr-axSpA,determining appropriate imaging methodologies and accurately interpreting the results,comprehensively evaluating clinical data to make clinical diagnosis,precisely assessing disease activity,establishing definitive treatment objectives,and adhering to individualized principles in selecting suitable treatment regimens for patients,so as to effectively manage inflammation and alleviate symptoms,prevent disease progression,and improve prognosis and quality of life through standardized treatment.

Abstract:The Assessment of SpondyloArthritis International Society(ASAS)definitions of "positive MRI" for axial spondyloarthritis(axSpA)are an integral part of its classification criteria.However,these definitions are not intended for clinical practice and often leads to an overestimation of inflammatory sacroiliitis,with a significantly increased risk of misdiagnosis in radiographically negative cases,which provide only limited guidance for image interpretation in daily practice and should not be used as the basis for confirming a diagnosis.Therefore,mastering the basic principles of ASAS definitions of "positive MRI" and ASAS classification criteria,their correct application in research,and the reasons why they should not be used in clinical practice is an essential condition for the accurate diagnosis of axSpA.The diagnosis of axSpA should be made through a comprehensive judgment based on the overall clinical picture,with attention to the clinical relevance of imaging signs and adherence to the logic of individualized diagnosis and treatment.

Abstract:Spondyloarthritis(SpA)represents a group of complex inflammatory disorders,among which ankylosing spondylitis(AS)is the most representative subtype.Heterogeneous outcomes in SpA are significantly driven by high rates of misdiagnosis due to ambiguities in current classification/diagnostic criteria,substantial inter-patient heterogeneity,and the complex,multifaceted pathogenesis of the disease.Consequently,implementing individualized precision medicine approaches is crucial for effective long-term disease management.Future diagnostic and therapeutic endeavors should focus on refining early classification criteria,developing comprehensive disease management strategies tailored to patient characteristics,and leveraging big data technology to establish precision treatment protocols,aiming to improve prognosis and enhance quality of life of the patients.

Abstract:Objective To explore the effectiveness of C-reactive protein(CRP)to high-density lipoprotein cholesterol ratio(CHR)in predicting all-cause mortality in peritoneal dialysis(PD)patients.Methods Clinical data of 283 patients who underwent peritoneal dialysis catheterization,regular dialysis,and were followed up for at least 3 months at the Peritoneal Dialysis Center of Shengjing Hospital Affiliated to China Medical University from January 1,2012 to December 31,2020 were retrospectively analyzed.The primary endpoint was all-cause mortality.Using X-tile software,patients were divided into three groups based on CHR levels:low CHR group(CHR≤ 2.847,94 cases),medium CHR group(2.847＜CHR≤5.662,72 cases),and high CHR group(CHR＞5.662,117 cases).Baseline clinical data of the three groups were compared,and Kaplan Meier method and Log rank test were used for survival analysis.Cox proportional hazards regression model was used to analyze the correlation between CHR and all-cause mortality,and subgroup analysis and interaction test were conducted to further evaluate the predictive value of CHR for patient prognosis.Results There were statistically significant differences in age,gender,BMI,cardiovascular history,hemoglobin,albumin,eGFR,CRP,triglycerides,and high-density lipoprotein cholesterol among the low CHR group,medium CHR group,and high CHR group patients(P＜0.05).For 283 patients,the median follow-up time was 26(13 to 43)months.During the follow-up process,a total of 78 patients died,including 13 deaths in the low CHR group,16 deaths in the medium CHR group,and 49 deaths in the high CHR group.The difference in the number of deaths among the three groups of patients was statistically significant(P＜0.001).The Kaplan Meier survival curve showed that the survival rate of the low CHR group was significantly higher than that of the high CHR group(Log rank P＜0.001).After the Cox proportional hazards model,it was found that the risk of all-cause mortality in the high CHR group was 2.304 times higher than that in the low CHR group(HR 2.304,95％CI,1.102-4.816,P=0.026).Subgroup analysis found that the risk of all-cause mortality in the high CHR group was still higher than that in the low CHR group in different PD patients.Interaction tests showed that the differences among different subgroups were not significant.Conclusion CHR is an independent risk factor for all-cause mortality in PD patients and an effective indicator for evaluating the prognosis of PD patients.

Abstract:Imaging modalities,including X-ray,MRI,CT,and ultrasound,play a crucial role in the diagnosis and management of axial spondyloarthritis(axSpA).Pelvic and spinal radiography remains the classical method for the diagnosis and radiographic progression assessment of axSpA.CT is a gold standard for evaluating structural changes.Novel ligament syndesmophytes measurement and dual-energy CT or positron emission tomography-computed tomography(PET-CT)are gaining clinical recognition.MRI has high sensitivity and specificity of bone marrow edema and has become indispensable for early diagnosis.The application of advanced imaging sequences and novel modalities makes simultaneous assessment of structural bone damage possible.With the rapid advancement of the application of artificial intelligence in medical imaging,novel imaging techniques and machine learning/deep learning have emerged as powerful tools for assisting diagnosis and evaluating disease progression.

Abstract:Psoriatic arthritis(PsA)requires a multidimensional stratified treatment approach targeting peripheral joints,axial involvement,enthesitis,dactylitis,and extra-articular manifestations including cutaneous/nail psoriasis,uveitis,inflammatory bowel disease(IBD),and comorbidities to achieve treat-to-target goals.For axial involvement,TNF inhibitors(TNFi)or IL-17A inhibitors are preferred first-line options,while IL-12/23inhibitors(IL-12/23i)and IL-23inhibitors(IL-23i)are not recommended due to insufficient clinical evidence;peripheral arthritis should be initially managed with csDMARDs(e.g,methotrexate),with timely escalation to TNFi,IL-17i or IL-23i for high disease activity,as clinical studies demonstrate superior efficacy of early intensive biologic therapy over conventional drugs;enthesitis and dactylitis patients should directly receive TNFi,IL-17i or tsDMARDs therapy,avoiding csDMARD monotherapy;patients with concomitant cutaneous/nail psoriasis require combination biologics targeting IL-17/IL-23 pathways,with IL-17A/Finhibitors or IL-23i prioritized for severe skin lesions,body surface area score(BSA)≥10.For the management of extra-articular manifestations,monoclonal TNFi(adalimumab or infliximab)are preferred for uveitis,while IL-17i is contraindicated in IBD.The latest evidence emphasizes that dynamic treatment adjustment(e.g.,switching to IL-17i or JAKinhibitors after TNFi failure)and personalized regimens tailored to individual patient characteristics are crucial for achieving sustained clinical remission.With the development of novel targeted drugs like TYK2 inhibitors,PsA's precision treatment framework will be further refined.

Abstract:Objective To investigate the clinical characteristics of patients with rheumatoid arthritis(RA)who have an increased copy number of Epstein-Barr virus(EBV)DNA in whole blood.Methods The clinical data of 155 patients with rheumatoid arthritis hospitalized in the Department of Rheumatology and Immunology of the People's Hospital of Jingmen City from April 2016 to September 2022 were retrospectively analyzed,including general condition,clinical manifestations,28 joint disease activity score(DAS28)characteristics,laboratory and imaging examinations and treatment.The patients were divided into the group with increase in EBV-DNA copy number(44 cases)and the group with no increase in EBV-DNA copy number(111 cases)according to the presence or absence of the increase in EBV-DNA copy number to make comparison.Results The incidence rate of increased copy number of EBV-DNA was 28.4％(44/155).DAS28 and RF titers and anti-RA33 antibody titers were significantly higher in the group with increase in copy number of EBV-DNA than in the group with no increase in copy number of EBV-DNA(P＜0.05).Patients in the group with increase in copy number of EBV-DNA were prone to interstitial lung disease(ILD),and the proportion of patients with interstitial lung disease was higher in this group than in the group without increase in copy number of EBV-DNA[5 cases(11.4％)vs.1 case(0.9％),P=0.007].About 29.5％(13/44)patients were given tofacitinib citrate tablets,and compared with the group without increase in EBV-DNA copy number[8 cases(7.2％)],the difference was statistically significant(x2=13.424,P＜0.001).Conclusion Increased copy number of EBV-DNA is more common in patients with rheumatoid arthritis,and the patients with increased copy number of EBV-DNA are prone to interstitial lung disease.These patients have significantly higher DAS28 and RF titers,higher anti-RA33 antibody titers,and high disease activity.The treatment with targeted synthetic disease-modifying antirheumatic drugs(tsDMARDs)may have better effects.

Abstract:Spondyloarthritis (SpA)is a group of complex chronic inflammatory diseases that not only cause patients to suffer from long-term pain and functional impairment but are also commonly accompanied by severe psychological abnormalities.Studies indicate that the prevalence rates of depression,anxiety,chronic fatigue,and sense of social isolation are significantly higher in SpA patients than in the general population.These psychological issues profoundly affect patients' quality of life,may exacerbate disease progression,and reduce treatment efficacy and adherence.However,in clinical practice,psychological health issues in SpA patients are often underrecognized.Through early identification,systematic assessment,and multidisciplinary collaborative comprehensive management,the psychological health of SpA patients can be effectively improved,disease control can be optimized,and ultimately,treatment outcomes and overall quality of life are significantly enhanced.

Abstract:Psoriatic arthritis(PsA),which is closely linked to psoriasis,is a chronic systemic inflammatory disease characterized by complex and heterogeneous manifestations.In China,delayed diagnosis and suboptimal treatment are prevalent,significantly affecting the prognosis of patients.In recent years,standardized screening questionnaires such as EARP and PEST have provided new insights for the identification of early PsA patients.Furthermore,psoriasis in special areas,nail lesions,as well as musculoskeletal symptoms like enthesitis and dactylitis are helpful in recognizing high-risk populations of PsA.The use of biomarkers,MRI and musculoskeletal ultrasound can assist in differentiating PsA from other inflammatory arthritis including rheumatoid arthritis(RA)and ankylosing spondylitis(AS),so that early diagnosis and timely intervention of PsA can be achieved,which effectively reduces disease-related disability and improve patients' quality of life.

Abstract:With the accelerated aging of the population in China,osteoporosis has emerged as a critical public health problem that significantly threatens the health of the elderly.Vitamin D deficiency or insufficiency is widespread in the general population,particularly among postmenopausal women and older adults,thereby increasing the risk of osteoporosis.Adequate vitamin D status is fundamental for maintaining bone health.However,as its primary source relies on synthesis in the skin upon sun exposure,insufficient sun exposure often restricts vitamin D production,making vitamin D deficiency highly prevalent.Consequently,critical questions requiring urgent resolution in clinical practice arise:What dosage of vitamin D is required for patients with osteoporosis to maintain skeletal health?How should vitamin D be supplemented scientifically as fundamental therapy for osteoporosis?This review focuses on vitamin D supplementation strategies for patients with osteoporosis,including suitable dosage and supplementation regimens,to ensure the therapeutic efficacy of anti-osteoporosis medications.

Abstract:Obesity-related metabolic comorbidities,such as prediabetes,type 2 diabetes,dyslipidemia,hypertension,hyperuricemia,metabolic dysfuction-associated steatotic liver disease,cardiovascular diseases,obesity-related glomerulopathy,and polycystic ovary syndrome,are the most common challenges for endocrinologist.The core features involve metabolic disorders triggered by insulin resistance and a chronic low-grade inflammatory state.These conditions collectively elevate the risk of multisystem health complications and cardiovascular mortality.Proactive prevention and treatment of obesity and its metabolic comorbidities are crucial for reducing healthcare expenditures and improving patients'quality of life.

Abstract:Objective To investigate the association of left ventricular remodeling(LVR)and left ventricular diastolic dysfunction(LVDD)with bone mineral density(BMD)and fracture in elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 361 elderly T2DM patients admitted to the First Hospital of Lanzhou University from January 2021 to January 2024 were included,and another 61 non-diabetic elderly patients during the same period were selected as the control group.The T2DM patients were divided into three groups based on BMD levels:normal group,osteopenia group,and osteoporosis group.Their fracture history and blood and urine biochemistry were collected,left ventricular remodeling was assessed using body surface area-standardized left ventricular mass index(LVMI)and relative ventricular wall thickness(RWT),and left ventricular diastolic function was assessed by E/A and mean e.BMD was measured using dual-energy X-ray absorptiometry(DXA),and the Fracture Risk Assessment Tool(FRAX)was adjusted to assess the risk of osteoporotic fracture at the hip(HF)and major site(MOF)over the next 10 years;statistical analyses were performed using SPSS 27.0 software.Results Compared with non-diabetic patients,T2DM patients had higher levels of FPG,LAD,IVST,LVMI and incidence of LVDD,lower BMD of lumbar spine(LS),femoral neck(FN)and whole body(WB),and significantly increased incidence of MOF,HF and fragility fractures(P＜0.05).In T2DM patients with different BMD levels,fracture risk increased significantly as BMD levels decreased and LVMI levels and the prevalence of LVDD increased.Correlation analysis showed that LVMI and LVDD were significantly correlated with decrease of BMD and increase of fracture risk(P＜0.05),but not with fragility fracture.Multifactorial linear regression analyses showed that LVMI and LVDD were negatively correlated with BMD of FN,WB and LS,while positively correlated with fracture risk.After adjusting for confounders,LVMI remained significantly correlated with low BMD and high fracture risk,while LVDD was not correlated with them.Conclusion LVR and LVDD are associated with decreased BMD and increased fracture risk in elderly T2DM patients,and LVMI is independently associated with them,which suggests that abnormal heart structure and function may be related to the risk of osteoporosis.

Abstract:Objective To investigate the predictive value of cardiometabolic index(CMI)and triglyceride glucose index(TyG)in the long-term prognosis of patients with acute myocardial infarction(AMI),and to explore whether the combination of the two can improve the predictive efficiency.Methods A total of 685 patients with confirmed AMI who were admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were included in the study,and they were divided into event group(n=120)and non-event group(n=565)according to whether major cardiovascular adverse events(MACE)occurred during the follow-up period.Gensini score was used to quantitatively assess the degree of coronary artery stenosis.Multivariate Cox regression was used to analyze the independent risk factors for MACE.ROC curve was used to evaluate the predictive efficiency of CMI index and TyG index in MACE,and they were grouped according to the best cut-off value.Kaplan-Meier curves were used to assess the survival differences between groups.Results Multivariate Cox regression analysis showed that CMI index(HR 1.647,95％CI:1.310-2.071,P＜0.001)and TyG index(HR 2.824,95％CI:1.871-4.263,P＜0.001)were independent risk factors for MACE.ROC curve analysis showed that the best cut-off value of CMI index was 1.619,the specificity was 0.846,and the sensitivity was 0.708.The best cut-off value of TyG index was 9.434,the specificity was 0.543,and the sensitivity was 0.867.Kaplan-Meier survival curve showed that:compared with the group of CMI index ≤1.619,the cumulative incidence of MACE in the group of CMI index＞1.619 was higher(P＜0.001);compared with the group of TyG index ≤9.434,the cumulative incidence of MACE in the group of TyG index＞9.434 was higher(P＜0.001).A new multivariate Cox regression model was constructed by combining the best cutoff values of the two.The results showed that the risk of MACE in patients with CMI index＞1.619+TyG index＞9.434 was 16.346 times that of patients with CMI index ≤1.619+TyG index ≤9.434.Conclusion Both CMI index and TyG index can predict the clinical prognosis of AMI patients,and their combination can improve the predictive efficiency.

Abstract:Osteoporosis is a chronic aging disease.With the acceleration of the ageing of the population in China,the prevalence of osteoporosis and the incidence of osteoporotic fractures have significantly increased.Currently,a variety of anti-osteoporosis drugs are available.However,due to the limitations such as treatment duration,rare but severe adverse reactions,and decline of BMD after treatment discontinuation,monotherapy fails to provide sustained efficacy throughout the disease course.Sequential therapy has emerged as an inevitable strategy for the long-term management of osteoporosis.At present,although some studies have been made on sequential treatment strategies,the appropriate sequential treatment protocol based on fracture risks still needs to be further explored.

Abstract:Choosing appropriate anti-osteoporosis drugs can reduce the risk of fractures and achieve treatment goals.This article focuses on a hot topic in our clinical practice,whether clinical physicians can choose bone resorption inhibitors or bone formation promoters on the level of bone turnover biochemical markers in the management of primary osteoporosis?This article provides a review on important guidelines or relevant research results at home and abroad.

Abstract:The management of osteoporosis with anti-resorptive agents requires distinct post-treatment strategies based on the differences in pharmacological mechanisms after achieving therapeutic targets.Bisphosphonates(e.g.,zoledronic acid,alendronate)exhibit a"residual effect"due to their skeletal retention,allowing for a drug holiday once treatment goals are met[e.g.,no new fractures,bone mineral density(BMD)improvement to target T-score]and the initial treatment course is completed.During this period,annual monitoring of BMD and bone turnover markers is mandatory,with therapy re-initiated upon deterioration of markers.In contrast,denosumab requires continuous exposure for sustained efficacy.Discontinuation of the drug triggers rebound osteoclast activation,leading to rapid bone loss and a sharp increase in fracture risk.Thus,treatment must not be interrupted immediately without transition.Upon target achievement or when drug discontinuation is necessary,prompt sequential therapy with bisphosphonates(preferably zoledronic acid)is needed to suppress rebound effects,followed by CTX-guided assessment for additional dosing.Clinical challenges include suboptimal adherence and inappropriate discontinuation,particularly unstructured denosumab withdrawal.Future efforts should focus on optimizing sequential protocols and developing novel monitoring models to achieve personalized long-term management.