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Straw strip burial in saline soil is an effective method for tideland reclamation in China, but optimal forms of straw strips for regulating soil water and salinity remain unclear. An indoor soil column test investigated the water and salt distribution in soil treated with four different straw forms under freshwater irrigation. The treatments included no straw layer (CK), straw stalks arranged longitudinally (T5), horizontally (T25), longitudinally combined horizontally in layers (T25+2.5), and randomly (T2.5). The results showed that compared to CK, T25, T5, and T25+2.5 significantly reduced the infiltration rate of irrigation water, leading to prolonged infiltration times. Wetting front curves under T5, T25+2.5, and T25 exhibited similar inverted “V” shapes, while CK and T2.5 showed fluctuating parallel lines. Water retention in the soil was higher under straw strip treatments (T5, T25, T25+2.5) and straw layer treatment (T2.5) compared to CK after 24 h of the first irrigation. T5 demonstrated the most effective salt removal, surpassing other treatments, with a desalination rate of 97.71%. Additionally, T5 had the highest salt leaching efficiency (SLE) in the 0–20 cm soil layer, recommending it as the optimal form for managing saline soils in crop production due to its simplicity and higher SLE. We found that buried straw strips reduced soil water infiltration rate and wetting front propulsion speed, increased soil water content and enhanced salt leaching efficiency in the saline soil. Our findings provide a basis for developing strategies that improve soil quality and irrigation efficiency, mitigate the effects of salinity on crop production, and ensure food security for a rapidly growing global population.

Ensuring the security of germplasm resources is of great significance for the sustainable development of agriculture and ecological balance. By combining the morphological characteristics of maize seeds with hyperspectral data, maize variety classification has been achieved using machine learning algorithms. Initially, the morphological data of seeds are obtained from images, followed by the selection of feature subsets using Recursive Feature Elimination (RFE) and Select From Model (SFM) methods, indicating that features selected by RFE exhibit better performance in maize seed classification. For hyperspectral data (350–2500 nm), Competitive Adaptive Re-weighted Sampling (CARS) and the Successive Projections Algorithm (SPA) are employed to extract feature wavelengths, with the SPA algorithm demonstrating superior performance in maize seed classification tasks. Subsequently, the two sets of data are merged, and a Random Forest (RF) classifier optimized by Grey Wolf Optimization (GWO) is utilized. Given the limitations of GWO, strategies such as logistic chaotic mapping for population initialization, random perturbation, and final replacement mechanisms are incorporated to enhance the algorithm’s search capabilities. The experimental results show that the proposed ZGWO-RF model achieves an accuracy of 95.9%, precision of 96.2%, and recall of 96.1% on the test set, outperforming the unimproved model. The constructed model exhibits improved identification effects on multi-source data, providing a new tool for non-destructive testing and the accurate classification of seeds in the future.

Abstract Background Macrophages are key innate immune cells implicated in the pathogenesis of Behçet’s disease (BD), and macrophage polarization plays a pivotal role in inflammatory response. This study aimed to investigate the role of BD serum on the phenotypes and functions of macrophage polarization. Methods BD or HC serum-treated human monocyte-derived macrophages (HMDMs) were examined M1/M2 phenotypes using flow cytometry and ELISA. The phagocytic capacity of HMDMs and CD4+T cell differentiation facilitated by HMDMs were measured by flow cytometry. Transcriptome analysis of BD and HC serum-stimulated HMDMs was conducted to identify differentially expressed genes. NF-κB signaling was examined using western blot to explore the mechanism of macrophage polarization induced by BD serum. Results BD serum-treated macrophages expressed a higher level of CD86, IL-12, and TNF-α and a lower level of CD163, which were compatible with the M1-like phenotype. Furthermore, BD serum-treated macrophages showed enhanced phagocytic capacity and promoted more Th1 cell differentiation. Sixty-one differentially expressed genes were identified between BD and HC serum-treated macrophages and were enriched in NF-κB signaling. BD serum-treated macrophages showed upregulated p-p65 and downregulated IκBα, and NF-κB inhibitor attenuated BD serum-stimulated M1-like phenotype. Conclusions BD serum promoted macrophage polarization toward a proinflammatory M1-like phenotype through NF-κB signaling and potentially facilitated inflammation in BD. M1 polarized macrophages may be a potential therapeutic target for BD.

Natural abundance of the stable isotope (δ13C and δ15N) in plants is widely used to indicate water use efficiency (WUE). However, soil water and texture properties may affect this relationship, which remains largely elusive. Therefore, the purpose of this study was to evaluate δ13C as affected by different combinations of alternate wetting and drying irrigation (AWD) with varied soil clay contents in different organs and whole plant and assess the feasibility of using δ13C and δ15N as a physiological indicator of whole-plant water use efficiency (WUEwhole-plant). Three AWD regimes, I100 (30 mm flooded when soil reached 100% saturation), I90 (30 mm flooded when reached 90% saturation) and I70 (30 mm flooded when reached 70% saturation) and three soil clay contents, 40% (S40), 50% (S50), and 60% (S60), were included. Observed variations in WUEwhole-plant did not conform to theoretical expectations of the organs δ13C (δ13Corgans) of plant biomass based on pooled data from all treatments. However, a positive relationship between δ13Cleaf and WUEET (dry biomass/evapotranspiration) was observed under I90 regime, whereas there were no significant relationships between δ13Corgans and WUEET under I100 or I70 regimes. Under I100, weak relationships between δ13Corgans and WUEET could be explained by (i) variation in C allocation patterns under different clay content, and (ii) relatively higher rate of panicle water loss, which was independent of stomatal regulation and photosynthesis. Under I70, weak relationships between δ13Corgans and WUEET could be ascribed to (i) bigger cracks induced by water-limited irrigation regime and high clay content soil, and (ii) damage caused by severe drought. In addition, a negative relationship was observed between WUEwhole-plant and shoot δ15N (δ15Nshoot) across the three irrigation treatments, indicating that WUEwhole-plant is tightly associated with N metabolism and N isotope discrimination in rice. Therefore, δ13C should be used cautiously as an indicator of rice WUEwhole-plant at different AWD regimes with high clay content, whereas δ15N could be considered an effective indicator of WUEwhole-plant.

Objective: The aim of this study was to evaluate the effectiveness and safety of low-dose interferon alpha-2a (IFNα2a) in Behçet’s syndrome (BS) patients with refractory vascular/cardiac or neurological involvement. Methods: In this retrospective cohort study, we consecutively included 25 BS patients with refractory vascular/cardiac ( n = 16) or neurological involvement ( n = 9) who received IFNα2a treatment in our center between June 2018 and September 2021. The low-dose IFNα2a (3 million IU, every other day) was used as an add-on treatment with the continuation of glucocorticoids (GCs) and immunosuppressants. Results: In total, 25 patients (20 males, 5 females) with a mean age of 31.92 ± 9.25 years were included. IFNα2a was administered for BS patients with refractory vascular/cardiac involvement ( n = 16) and neurological involvement ( n = 9). Before the initiation of IFNα2a, patients had insufficient response or intolerance to conventional therapies. After a median follow-up of 23 [interquartile range (IQR), 11–30] months, all patients achieved clinical improvement. The Behçet’s disease Current Activity Form (BDCAF) score improved significantly (5 versus 0, median, p 0.05). Decrease in erythrocyte sedimentation rate [ESR; 24 (IQR, 12–43.5) versus 5 (IQR, 2.75–10.5) mm/h, p = 0.0001] and C-reactive protein [CRP; 6.64 (IQR, 3.67–19.82) versus 1.24 (IQR, 0.24–3.12) mg/liter, p

Objective: The objective of the study was to compare the application effects of in-vial exhaust method and conventional exhaust method in the process of coronavirus disease 2019 vaccine injection. Materials and Methods: Using convenient sampling method, 102 vaccines were selected as experiment group during the process of vaccine injection, and the in-vial exhaust method was used. One hundred and five vaccines were selected as the control group and the conventional exhaust method was adopted. The incidence of vaccine solution spillage and exhausting time in the two groups during exhaust were observed. Results: The incidence of solution spillage in the experiment group was lower than that in the control group (0 vs. 6.67%, P < 0.05). The exhausting time of the experiment group was shorter than that of the control group ([15.12 ± 4.43] s vs. [22.74 ± 6.53] s, P < 0.05). Conclusion: Implementing the in-vial exhaust method in the vaccine injection can effectively reduce the incidence of solution spillage, reduce nucleic acid contamination, and ensure that the vaccine is injected at the prescribed dose. Moreover, the operation is simple and easy, which improves the nurse's vaccination efficiency, and has a higher promotion and application value.

Pollutants in water seriously threaten the health of human beings and will lead to potential ecological risks to the aquatic environment. Researchers use many chemical, physiological and morphological methods to detect the comprehensive toxicity in water. Among them, the photosynthetic inhibition method is considered a powerful method to detect the comprehensive toxicity in water, takes the chlorophyll fluorescence in the body as a natural probe, and determines the toxicity effect of pollutants by measuring the variation of photosynthetic fluorescence parameters. It has the advantages of fast and convenient measurement and real-time online detection. The widely used photosynthetic fluorescence parameters are the maximal quantum yield of photosystem II (Fv/Fm) and performance index PIABS. There are the problems that the sensitivity is not high enough, and the substances that can be detected are limited when researchers use Fv/Fm and PIABS as indicators to detect the comprehensive toxicity in water. So, in this paper, we proposed a construction method of Performance Index of Comprehensive Toxicity Effect (PICTE) using multi-parameter fusion based on the chlorophyll a fluorescence rise kinetics curve (OJIP) of algae. The fluorescence information of point J and point I in the curve was integrated. The area surrounded by the curve and the time corresponding to point J and point I were weighted for data items to construct PICTE. On this basis, Chlorella vulgaris was used as the tested algae species to compare the performance differences of Fv/Fm, PICTE, PIABS in the detection of toxic substances under the stress of five common water pollutants: Diuron (DCMU, 3-(3,4-dichlorophenol)-1,1-dimethylurea), Dibromothymoquinone (DBMIB, 2,5-dibromo-3-methyl-6-isopropyl-benzoquinone), Methyl viologen (MV, 1,1ꞌ-dimethyl-4,4ꞌ-bipyridinium-dichloride), Malathion, Carbofuran. The performance differences of Fv/Fm, PICTE, PIABS in detecting toxic substances, including lowest detection limit, highest response concentration, stability, and reproducibility, were studied. The results show that: in terms of toxicity detection, the constructed PICTE was sensitive to all five toxic substances and could detect more kinds of pollutants than Fv/Fm. The lowest detection limit of PICTE for five toxic substances compared with PIABS was reduced by 74.43%, 77.01%, 67.30%, 60.69%, and 50.81%, respectively. At the same time, it has a stronger ability to detect toxic substances with high concentration. The stability and reproducibility of PICTE for detecting the toxicity of DCMU, DBMIB, Malathion, and Carbofuran were all excellent, and all of the relative standard deviation (RSD) was

A two-year field experiment was executed to investigate the impact of different controlled irrigation and drainage regimes on the morphological and mechanical traits related to the lodging resistance of rice in Jiangsu province, China. Three irrigation regimes were comprised of conventional flooding practices (CK), controlled irrigation and drainage mode I (CID-1), and controlled irrigation and drainage mode II (CID-2). Results indicated that there was no significant difference in the heights of rice plants under the three irrigation regimes, but the average diameter of CK treatment was 21% higher than that of CID-2 in the 2013 season. Similarly, the value of the section modulus of CK was significantly higher than that of CID-2 (p < 0.05). On the contrary, the length of basal internodes of CK and CID-1 was significantly lower than that of CID-2 in 2013 (p < 0.05). For both seasons, the safety factor against stem breakage (SFs) of CID-2 always had the lowest value under different irrigation regimes, which might be related to the significantly lower values of bending strength of culm at breaking (S) and the bending stress (BS) as well as lower ash content and cellulose content in CID-2 compared with CK and CID-1. Collectively, properly increasing the depth of water levels after heavy rain under the current water-saving mode (CID-1) would not increase the risk of lodging for rice plants, whereas if the water depth after heavy rain was kept higher than 20 cm (CID-2), the SFs would be significantly lower than that of CK, and the rice plants would be much more likely to undergo lodging.

Background: To investigate the efficacy and safety of biologics in the perioperative management of severe aortic valve regurgitation (AR) caused by Behçet syndrome (BS). Methods: We retrospectively analyzed 20 patients with severe AR caused by BS who were all treated with biologics during the perioperative period of cardiac surgeries in our center between February 2016 and October 2020. Results: A total of 20 patients with severe AR were enrolled, including 19 males and 1 female, with a mean age of 39.1 ± 8.8 years and a median course of 8 [interquartile range (IQR) 5.25–10.00] years. Before biologic administration, 92.9% of the patients who underwent aortic valve replacement had failed conventional therapy and developed postoperative paravalvular leakage (PVL) at a median interval of 4 months. Biologics were administered with background glucocorticoids (GCs) and immunosuppressants during the perioperative period for 22 aortic valve surgeries, including preoperatively with a median interval of 3.5 (IQR 2.75–4.25) months in 13 cases and within 3 months postoperatively in 9 cases. After a median follow up of 21 (IQR 15–32) months, 2 out of 13 cases (15.4%) preoperatively, and 1 out of 9 cases (11.1%) postoperatively treated with biologics developed PVL, and the rest were event free. The Behçet’s Disease Current Activity Form score improved significantly (7 versus 0, median, p

Objectives:NLRP3-associated autoinflammatory disease (NLRP3-AID) and Behçet's syndrome (BS) both belong to autoinflammatory diseases and rarely co-occur. Here we reported a Chinese pedigree of NLRP3-AID presented with BS.Methods: We recorded a Chinese pedigree of NLRP3-AID presented with BS. Whole-exome sequencing was performed to find the hereditary susceptibility gene, and Sanger sequencing was performed on a consecutive cohort of 30 BS patients. We also reviewed the English literature on vasculitis associated with NLRP3-AID.Results: The proband was a 45-year-old Chinese Han woman. She and her 12-year-old daughter presented with recurrent fevers, cold-induced urticaria, oral, and genital ulcers, conjunctivitis, uveitis, optic atrophy, erythema nodosum, headache, and hearing loss. They were initially suspected of having BS, and both responded poorly to corticosteroids and immunosuppressants, while anti-TNF therapy was moderately effective. Pedigree analysis revealed another four relatives with similar symptoms, and a heterozygous NLRP3 gene mutation c.1316C>T, p.Ala439Val was identified by whole-exome sequencing and Sanger sequencing. However, we did not discover NLRP3 gene mutation by Sanger sequencing in a confirmative cohort of 30 BS cases. A few case reports of vasculitis coexisting with NLRP3-AID, including a case of glomerulonephritis, and five cases of retinal vasculitis, were summarized through literature review.Conclusions: Our study is the first report of NLRP3-AID associated with BS. The coexistence of NLRP3-AID and BS reveals the extensive heterogeneity of the pathogenesis of systemic autoinflammatory diseases and calls for specific therapeutics.

Abstract Background To investigate the diagnostic value of the interferon-γ release assay (IGRA) for detecting tuberculosis (TB) infection in patients with Behçet’s disease (BD). Methods We retrospective analyzed the data collected from 173 BD patients hospitalized between 2010 and 2015. Ninety-nine healthy volunteers were enrolled as a control group. IGRA was performed using T-SPOT.TB. The diagnosis of active TB (ATB) was based on clinical, radiological, microbiological, histopathological information and the response to anti-TB therapy. Latent TB (LTB) infection was defined as asymptomatic patients with positive T-SPOT.TB. Results TB infection was documented in 59 BD patients (34.1%). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of T-SPOT.TB for the diagnosis of ATB were 88.9%, 74.8%, 29.1%, 98.3%, 3.53 and 0.15, respectively. The receiver-operating-characteristic curve demonstrated that spot-forming cells (SFCs) of 70/106 PBMC was the optimal cutoff for diagnosing ATB, with an area under the curve of 0.891. Furthermore, the median SFCs in ATB group was significantly higher than those in LTB infection (466/106 PBMC vs. 68/106 PBMC, p = 0.007) or previous TB infection (466/106 PBMC vs. 96/106 PBMC, p = 0.018). A significant discrepancy between T-SPOT.TB and tuberculin skin test was noted (kappa coefficient = 0.391, p = 0.002). Conclusions T-SPOT.TB, an IGRA, may assist in the diagnosis of ATB in BD patients, and the higher SFCs suggest ATB in BD patients.

Neutrophil extracellular traps (NETs) are upregulated and promote thrombosis in Behçet’s disease (BD). However, whether NETs promote autoinflammation in BD remains unclear. This study aimed to investigate the potential role of NETs in promoting macrophage activation in BD. Firstly, we quantified NETs by measuring double-stranded DNA (dsDNA) using PicoGreen and calculating the proportion of NETosis. Then macrophages were stimulated with BD- or healthy controls (HC)-derived NETs, and IL-8 and TNF-α production and IFN-γ+ CD4+ T cells differentiation were measured using ELISA and flow cytometry, respectively. The protein components in NETs were analyzed by western blot. Macrophages were stimulated with Histone H4 neutralized NETs, and IL-8 and TNF-α production were measured using ELISA. The level of 8-hydroxydeoxyguanosine (8-OHdG) DNA in NETs was measured using ELISA. The levels of reactive oxygen species (ROS) in serum and neutrophils were measured using ROS probes by a microplate reader and flow cytometry. We found that circulating NETs and neutrophil-derived NETs were significantly higher in BD than HC. BD NETs stimulated macrophages produced higher levels of IL-8 and TNF-α, and promoted IFN-γ+ CD4+ T cells differentiation. BD NETs were enriched in Histone H4, and neutralizing Histone H4 abrogated the BD NETs-mediated IL-8 production by macrophages, but not TNF-α. Also, BD neutrophils produced more 8-OHdG DNA than HC neutrophils, and the percentage of 8-OHdG DNA in dsDNA from BD neutrophils was also higher than that of HC neutrophils. The ROS levels in serum and neutrophils were both higher in BD than HC. Our findings suggested that excessive BD NETs promoted macrophages activation and facilitated IFN-γ+ CD4+ T cells differentiation. Higher levels of Histone H4 and oxidized DNA in BD NETs might mediate macrophages hyperactivation.

Objectives: This study aimed to investigate the efficacy and safety of tocilizumab (TCZ) in severe and refractory parenchymal neuro-Behçet’s syndrome (p-NBS). Methods: We retrospectively analyzed five patients with p-NBS treated with TCZ in our center between 2013 and 2020, and six cases from literature research with the index terms “neuro-Behçet’s syndrome” and “tocilizumab” on PubMed NCBI. Results: A total of 11 patients with p-NBS were enrolled (5 males, 6 females), with a mean age of 34.5 ± 8.0 years at the onset. All the patients had parenchymal neurological lesions, six patients (54.5%) suffered from multiple lesions, and nine patients (81.8%) were disabled. Before TCZ administration, all the patients had failed conventional therapy, eight patients (72.7%) received two or more immunosuppressants, and five patients showed insufficient response or intolerance to other biologics. TCZ was administrated at 8 mg/kg every 4 weeks, with background glucocorticoids (GCs) and immunosuppressants. After a median follow-up of 13 (interquartile range, 3.5–23.5) months, all the patients achieved both clinical and radiological improvements, and the Behçet’s Disease Current Activity Form score improved significantly (3 versus 0, median, p = 0.004), the Rankin score also decreased (4 versus 2, median, p = 0.005). Levels of interleukin-6 in the cerebrospinal fluid decreased significantly in five patients (533.4 ± 389.7 pg/ml versus 34.5 ± 27.1 pg/ml, p = 0.048), after a median of two (interquartile range, 1–4) times of TCZ infusions. Furthermore, the GC dosage ( per os ) reduced from 69.2 ± 16.9 mg/d to 16.4 ± 16.2 mg/d ( p = 0.000), and immunosuppressants were tapered in number and dosage in seven (63.6%) and four (36.3%) patients, respectively. No serious adverse events or deaths were observed during follow-up. Conclusions: TCZ is well tolerated and effective in severe and refractory p-NBS, with a favorable GC- and immunosuppressant-sparing effect. Cerebrospinal fluid interleukin-6 might be used to monitor the effects of TCZ in p-NBS.

Abstract Background The diagnosis of Behçet’s disease (BD) remains challenging due to the lack of diagnostic biomarkers. This study aims to identify potential serum metabolites associated with BD and its disease activity. Methods Medical records and serum samples of 24 pretreated BD patients, 12 post-treated BD patients, and age-matched healthy controls (HC) were collected for metabolomics and lipidomics profiling using UPLC-QTOF-MS and UPLC-QTOF-MSE approaches. Additionally, serum samples from an independent cohort of BD patients, disease controls including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Takayasu’s arteritis (TA), Crohn’s disease (CD) patients, and HC were collected for further validation of two potential biomarkers using UPLC-QTOFMS analysis. Results Unsupervised principal component analysis (PCA) showed a clear separation of metabolomics profiles of BD patients from HC. Statistical analysis of the data revealed differential metabolites between BD patients and HC. The serum levels of some phosphatidylcholines (PCs) were found to be significantly lower in BD patients, while the levels of several polyunsaturated fatty acids (PUFAs) were increased markedly in the BD group compared with HC. Furthermore, the serum level of two omega-6 PUFAs, linoleic acid (LA) and arachidonic acid (AA), were dramatically decreased in patients with remission. A validation cohort confirmed that the serum LA and AA levels in BD patients were significantly higher than those in HC and patients with RA, SLE, TA, and CD. In addition, receiver operating characteristic (ROC) analysis indicated good sensitivity and specificity. Conclusions The serum metabolomics profiles in BD patients are altered. Serum LA and AA are promising diagnostic biomarkers for BD.

Objectives: To analyze the diagnosis and treatment of hydrocephalus associated with autoimmune diseases and to explore the possible mechanism of hydrocephalus in these patients. Methods: A retrospective case series study was conducted at Peking Union Medical College Hospital, Beijing, China. Files were retrieved from the hospital archives by screening records from Jan 1990 to Jan 2016. Medical records were screened for data regarding (1) the number of patients diagnosed with hydrocephalus associated with autoimmune diseases, (2) the clinical manifestation of hydrocephalus associated with autoimmune disease, and (3) the outcomes of these patients treated with medication or ventriculoperitoneal shunt (VPS). Results: A total of 19 of 19,643 hospitalized autoimmune diseases patients were found to have hydrocephalus. Seven of the 19 patients had systemic lupus erythematosus (SLE), 3 patients had Sjögren’s syndrome, 2 patients had rheumatoid arthritis (RA), 1 patient had connective tissue disease, 1 patient had juvenile idiopathic arthritis (JIA), 1 patient had Guillain-Barre syndrome (GBS), 1 patient had systemic sclerosis, 1 patient had Crohn’s disease, 1 patient had relapsing polychondritis (RPC), and 1 patient had autoinflammatory disease (AID). Of the 19 patients, 13 received medication treatment, and the most commonly used drugs were corticosteroids and mannitol. A total of 6 patients received both medication therapy and VPS treatment with a programable valve. After average follow-up lengths of 11 months for patients who received VPS and 8.2 for patients who received medical treatment, the clinical symptoms of patients treated by VPS or medication were improved (83% (5/6) vs. 15.4% (2/13), respectively), patients were in stable condition (17% (1/6) vs. 30.8% (4/13), respectively), and mortality decreased (0% vs. 53.8% (7/13), respectively). Conclusions: VPS along with corticosteroids and immunosuppressants represents an effective treatment approach for patients who suffer from hydrocephalus associated with autoimmune diseases.

Objective: The objective of this study was to investigate the effectiveness and safety of interferon (IFN) α2a as an add-on treatment for refractory Behçet’s uveitis (BU). Methods: In this retrospective cohort study, 30 refractory BU patients who received IFNα2a treatment in Peking Union Medical College Hospital between February 2015 and June 2018 were consecutively included. IFNα2a was used mainly as an add-on treatment for BU patients who underwent relapse under corticosteroids and conventional immunosuppressive agents. The primary outcome was treatment success rate before and after initiation of IFNα2a. Changes in ocular relapse rates, disease activity, corticosteroid- and immunosuppressant-sparing effects, as well as side effects were secondary outcomes. Results: A total of 30 patients (27 males and 3 females) with a mean age of 30.5 ± 8.7 years were included. Twenty-one patients (70%) were treated with at least 2 immunosuppressive agents before the initiation of IFNα2a. Treatment success was achieved in 26 patients (86.7%), and the median uveitis relapse rate decreased from 7.3 (range 2–12) to 0 (range 0–6) per patient-year ( p = 0.000002) during a mean follow-up of 21.7 ± 7.5 months, corticosteroids were lowered in 25 cases (83.3%) and completely withdrawn in four (13.3%). In addition, immunosuppressive agents were reduced in number and dosage in 22 (73.3%) and 29 patients (96.7%), respectively, and were completely withdrawn in 12 cases (40%). No severe adverse events were observed and serum autoantibodies remained negative during the treatment of IFNα2a. Conclusion: IFNα2a is effective and relatively safe in refractory BU, with significant steroid- and immunosuppressant-sparing effects.

Objective. To investigate the clinical features and potential risk factors of aneurysmal lesions in Behcet’s disease (BD). Methods. We retrospectively reviewed the clinical data of BD patients with aneurysmal lesions in our institute from 1997 to 2017 and compared them with 207 BD patients without aneurysmal lesions. The treatment and outcome of these patients were also analyzed. Results. Sixty-nine patients were included with 117 aneurysmal lesions. The average period between BD onset and diagnosis of aneurysmal lesion was 5.4±5.5 years. Thirty-three patients (47.8%) had multiple aneurysmal lesions. Ten patients developed 20 pulmonary artery aneurysms alone. For the other 97 aortic and/or peripheral artery aneurysms in 59 patients, the most commonly affected vessels were abdominal aorta (27/97, 27.8%), coronary artery (10/97, 10.3%), and superficial femoral artery (8/97, 8.2%). Multivariate analysis revealed pathergy reaction (OR=3.78 (1.70-8.41)), arterial stenosis or occlusion (OR=44.12 (11.56-168.35)), and arterial thrombosis (OR=9.27 (2.33-36.93)) as independent predictors of aneurysmal lesions in BD. With a mean follow-up of 5.5±4.0 years, 40 patients (58.0%) achieved clinical improvements, 15 patients (21.7%) relapsed, and 10 patients (14.5%) died. The respective estimated cumulative 1- and 5-year relapse-free rates were 91.3% and 76.3%, and the respective estimated 1- and 5-year survival rates were 95.0% and 87.2%. Conclusion. Aneurysmal lesions are severe complications in BD. Pathergy reaction, arterial stenosis or occlusion, and arterial thrombosis are the risk factors of aneurysmal lesions in BD. Achieving BD remission and performing surgical or interventional procedures are both important in the treatment of these patients.

To investigate the clinical features of parenchymal neuro-Behcet’s disease (p-NBD), we retrospectively reviewed the medical records of 1009 BD patients admitted to Peking Union Medical College Hospital from 2000 to 2016. Forty-two patients (25 males and 17 females) with p-NBD and eighty-four age- and sex-matched BD patients without neurological involvement who were served as controls were enrolled. Neurological onset was concomitant with the onset of BD in six cases (14.3%). Pyramidal signs (50.0%) and headache (33.3%) were the most common manifestations. On MRI, the lesions were mainly in the midline structures and hyperintense in the T2-weighted image. The most common lesion was the brainstem (54.8%). Spinal cord involvement was observed in five cases, four of which with cervical cord involvement. Multifocal lesions were observed in 13 patients. Ocular involvement was more prevalent in p-NBD (35.7%) (P=0.041, OR=2.36, 95% CI=1.03-5.44) compared with controls. All patients received corticosteroids and immunosuppressants, mainly cyclophosphamide (39/42). Six patients with severe/refractory condition received biological agents and achieved response measured by decreased Rankin score (P=0.002). With a median follow-up of 28 months, 22 patients (61.1%) achieved clinical improvements, while 10 (27.8%) relapsed and 4 died (mortality rate 11.1%). p-NBD is a rare yet disabling and life-threatening complication of BD. Ocular involvement is a risk factor for p-NBD. Promptly aggressive treatment is essential for improving prognosis, and biological agents might be a promising approach for severe/refractory p-NBD.

With the increasing use of immunosuppressive agents, the number of opportunistic infections has risen in patients with autoimmune diseases. Pneumocystis pneumonia (PCP) is one of these opportunistic infections that have a high mortality rate. However, only a few studies have described PCP in these patients, and these studies are limited in scope. We conducted this retrospective study to describe the clinical characteristics and factors associated with outcomes of PCP in patients with autoimmune diseases.A retrospective study was performed in laboratory diagnosed PCP patients with autoimmune diseases in an academic hospital over a 10-year period. Patients with human immunodeficiency virus (HIV) infection were not included. Clinical characteristics were collected and the factors related to death were analysed.A total of 69 patients with PCP during the study period were included. Common clinical features included fever (81%), cough (56%), and dyspnea (35%). Ground glass opacity (81%) and reticulation (52%) were the most common radiological findings. Concurrent pulmonary infections including bacterium, aspergillus and cytomegalovirus were found in 34% of the patients. The overall in-hospital mortality rate was 32%. High mortality was associated with lower PaO2/FiO2 ratios and albumin levels. The lymphocyte count, CD4+ T cell count, previous usage of immunosuppressive agents, the duration and dose of glucocorticoids did not affect the outcome.The mortality rate in PCP patients with autoimmune diseases is high. Low PaO2/FiO2 ratios and albumin levels are independent prognostic factors of mortality.