Primary Sjögren syndrome (PSS) is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands and other organs. PSS shows strong clinical heterogeneity, presents different degrees of topical and systemic damage, and multidisciplinary collaboration are required to develop PSS treatment strategies. However, our country currently has not unified diagnosis and treatment consensus for PSS. Based on domestic and foreign diagnosis and treatment experience, consensus and guideline, experts from multiple related disciplines achieved consensus using the nominal group technique, providing guidance and reference for standardized diagnosis and treatment of PSS.

In recent years, chimeric antigen receptor (CAR) cell therapy, as an emerging immunotherapy method, has achieved significant results in the field of hematological cancer treatment. However, applying CAR cell therapy to autoimmune diseases remains a relatively novel and challenging method. Autoimmune diseases are caused by an individual’s immune system mistakenly attacking their own tissues, and their complex etiology and diverse symptoms make traditional treatment methods and biologics still unable to meet clinical needs. CAR cell therapy, using engineering T cells or other immune cells to recognize and kill specific antigens, is highly targeted and durable, which providing new hope for the treatment of autoimmune diseases. This article systematically reviews the latest research progress and challenges of using CAR cell therapy in the treatment of autoimmune diseases, such as safety, immune response issues, and difficulties in clinical application.

Dermatopathological examination is the “gold standard” for skin lesion diagnosis, which can help to make the most accurate diagnosis of rheumatic immune diseases with skin lesions. The dermatopathological manifestations of skin lesions in most rheumatic diseases are not very specific, while the dermatohistopathological features are relatively distinct in discoid lupus erythematosus, scleroderma, adult Still disease and vasculitis. Dermatopathology plays different roles in the diagnosis of rheumatic immune diseases, differentiation of comorbidities, disease classification and staging, and exploration of pathogenesis of rheumatic diseases. Mastering and applying dermatopathological techniques are very important for the precise diagnosis and treatment of rheumatic diseases.

With the growing number of autoimmune disorders globally, systemic lupus erythematosus (SLE), a common autoimmune disease, has received increased attention for its associated brain damage. Brain damage is common in SLE patients, and the prognosis is poor. Accurate detection of early brain damage is critical for timely diagnosis and therapy. Magnetic resonance imaging, as a non-invasive imaging technology, can provide multi-modal, high-resolution and rich data, which has good application value for quantitative research, clinical diagnosis and evaluation of early SLE brain damage. The aim of the article is to explore the role of multimodal magnetic resonance in the mechanism research and clinical diagnosis of early brain damage in SLE patients, as well as to give additional support for early intervention and treatment of brain damage.

Objective To investigate the clinical characteristics of patients with relapsing polychondritis (RP) involving airway. Methods The clinical data of 141 RP patients hospitalized in the First Affiliated Hospital of Naval Medical University from July 2007 to December 2023 were analyzed retrospectively. Results The incidence of airway involvement in RP patients was 58.87%, among which airway wall thickening was the most common. RP patients with airway involvement were diagnosed at a later age (P=0.011). RP patients without airway involvement were more likely to have ear cartilage, eye and cardiovascular system involvement (P=0.008, P=0.009 and P=0.021); the hypersensitive C-reactive protein and platelet counts in RP patients without airway involvement were higher than those in RP patients with airway involvement (P=0.023, P=0.013), while the neutrophil counts in the patients were lower than those in RP patients with airway involvement (P=0.018). Univariate Logistic regression analysis showed that age at diagnosis and neutrophil count were positively correlated with airway involvement. In contrast, ear cartilage, eye and cardiovascular involvement, erythrocyte sedimentation rate, hypersensitive C-reactive protein, platelet count, and alanine transferase were negatively correlated with airway involvement. Multivariate Logistic regression analysis confirmed that age at diagnosis and neutrophil count were independent risk factors for airway involvement. Conclusions Airway involvement in RP patients is related to age at diagnosis and neutrophil count. The patients should receive regular chest CT and bronchial examination if necessary.

Objective To investigate the possible mechanism of shikonin in inhibiting synovial cell proliferation and inflammatory response and the effect of combining with low-intensity pulsed ultrasound (LI-PUS) in the treatment of rheumatoid arthritis. Methods Abnormal proliferation of mouse synoviocytes were induced by lipopolysaccharide (LPS) in vitro experiments. CCK-8 and ELISA were performed to detect the proliferation of synoviocytes and the expression levels of inflammatory factors and antioxidants. Cell scratch assay was used to detect the migration of synoviocytes. Immunofluorescence was used to detect the expression of nuclear factor (NF)-κB in synoviocytes. In vivo experiments, a mouse rheumatoid arthritis (RA) model was induced by complete Freund’s adjuvant. Forty mice were equally divided into 4 groups, which were normal group, model control group, shikonin perilla treatment group, and shikonin perilla+LI-PUS combination treatment group. The arthritic swelling indexes of the mice were recorded in day 12 and day 24 of treatment. At the end of the experiment, the serum levels of inflammatory factors were tested, and the expression levels of c-Jun N-terminal protein kinase (JNK), extracellular signal-regulated kinase (ERK), and NF-κB in the synovial tissues of the knee joints in mice were detected by Western blot. Results Shikonin inhibited the expression of inflammatory cytokines in LPS-induced synoviocytes. Shikonin intervention was able to significantly reverse LPS-induced oxidative stress in synoviocytes. The migration of synoviocytes were significantly inhibited under the intervention of different concentrations of shikonin. The level of NF-κB protein expression in synovial cells was reduced after the intervention of shikonin. The results of animal experiments showed that adjuvant-induced arthritis mice had significantly higher joint swelling scores, which could be significantly reduced after the intervention of shikonin. Shikonin+LI-PUS group showed good therapeutic effect on mice. Shikonin inhibited the expression of inflammatory cytokines, in which IL-1β was significantly reduced, and the combination of shikonin+LI-PUS showed highly significant anti-inflammatory effect. Western blot results showed that the phosphorylation content of ERK, JNK and NF-κB in the synovial tissue of mice in the model group was significantly higher than that in the normal group, which was significantly suppressed in the shikonin group and the shikonin+LI-PUS combination treatment group, and the shikonin+LI-PUS combination treatment group was superior to the shikonin group. Conclusions Shikonin can inhibit LPS-induced abnormal proliferation of synoviocytes and exert anti-arthritic activity through the ERK-JNK/NF-κB signaling pathway, and the combination of traditional Chinese medicine and low-intensity pulsed ultrasound is superior to the treatment of traditional Chinese medicine alone.

Objective To explore the difference of plasma endogenous opioid peptide level in patients with depression and its relationship with the severity of depression or anxiety, and analyze whether endogenous opioid peptide is helpful to the diagnosis and treatment of depression. Methods A total of 96 patients with depression who visited our hospital from June 2020 to February 2023 were enrolled as the depression group, and 50 healthy subjects were recruited as the control group. General demographic and clinical data [Hamilton depression scale 17(HAMD-17), Hamilton anxiety scale 14(HAMA-14), inventory of depressive symptomatology 30(IDS-30)] were collected. Peripheral blood was collected, plasma was extracted, and plasma β-endorphin (β-EP) and enkephalin (ENK) were compared between the two groups using enzyme-linked immunosorbent assay (ELISA). Due to the repeated impact of the epidemic, only 28 patients agreed to follow-up studies and blood collection plans. During the follow-up period, the treatment was in accordance with the plan made by outpatient physician, and there was not any research intervention. After 8 weeks of follow-up, 24 patients finished the studies, and their clinical data and blood samples were collected and compared. Results The plasma β-EP level in depression group was significantly higher than that in control group [49.48（36.79,61.14） ng/mL vs 30.84（23.51,38.14）ng/mL， P<0.05], while the plasma ENK level was significantly lower than that in control group [15.85（10.51,19.56）ng/mL vs 23.72（21.44,26.98）ng/mL， P<0.05]. Correlation analysis showed that there was no significant correlation between β-EP and ENK levels at baseline and the scores of the three scales (P > 0.05). There were no significant differences in plasma β-EP and ENK levels between cured group and non-cured group after 8-week of treatment compared to baseline (P > 0.05). Conclusions β-EP and ENK are expected to be biomarkers of depression.

Objective To explore the effects of nursing management based on theory of planned behavior (TPB) on self-efficacy, health attitude and health behaviors in patients during stroke convalescence. Methods A total of 102 patients during stroke convalescence in the hospital from October 2022 to April 2023 were enrolled and randomly divided into observation group and control group, and each group had 51 patients. The control group was given routine nursing, while observation group was additionally given TPB-based nursing management. After 6 months of observation, the indexes including cognitive function, limb function [mini-mental state examination (MMSE), Fugl-Meyer assessment (FMA)], health belief [Champion health belief model scale (CHBMS)], self-efficacy [stroke self-efficacy questionnaire (SSEQ)], health behaviors [health promotion lifestyle profile (HPLP)], compliance of medication and life-style, and psychological state [Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD)] in the two groups were compared. Results After intervention, scores of MMSE, FMA, CHBMS, SSEQ and HPLP were higher in observation group than those in control group (all P<0.05). The compliance rates of medication (96.08%), diet control (90.20%), stopping smoking and drinking (96.08%), and appropriate exercise (82.35%) in observation group were respectively higher than those in control group (80.39%, 72.55%, 80.39%, 56.86%) (all P<0.05), while the score of HAMA and HAMD were lower in observation group than those in control group (all P<0.05). Conclusions TPB-based nursing management is beneficial to improve health attitude and self-efficacy in patients during stroke convalescence, thereby enhancing behavior control, promoting the maintenance of healthy behaviors, relieving negative psychological emotions and promoting health management.

Objective To explore the application effect of intelligent classroom in blended teaching of rheumatic diseases in Army Medical University. Methods The research subjects were clinical students at our school in 2021 and 2022, in which the traditional teaching method of rheumatic diseases were applied to the students in 2021, and the blended teaching method was used for students in 2022. The effects of two teaching methods were retrospectively analyzed by comparing their final grades. At the same time, a questionnaire was used to evaluate 2022 students’ acceptance of the blended teaching method. Results The questionnaire shows that more than 80% of students are willing to accept intelligent classroom teaching, and the blended teaching based on intelligent classroom can significantly improve students’ final grades. Conclusions Blended teaching based on intelligent classroom can significantly improve the teaching quality of rheumatic diseases, help students understand rheumatic diseases better, improve students’ autonomous learning and lifelong learning ability.

Calcinosis cutis is one of the complications of dermatomyositis and systemic sclerosis, while it is rare in other autoimmune diseases, especially in systemic lupus erythematosus(SLE). This article reports a female patient who had been diagnosed with SLE for 8 years ago, and developed extensive calcification, mainly affecting the limbs. Her condition improved after receiving treatment with tofacitinib. SLE patients complicated with calcinosis are rare, and their pathogenesis and treatment strategies still require doing more exploration and research. Early detection, early diagnosis, and early treatment are essential for the patients.

Primary skeletal muscle lymphoma is rare, and primary skeletal muscle non-specified peripheral T-cell lymphoma (PTCL-NOS) is even rarer. It is prone to be misdiagnosed and missed as its lack of specificity of clinical manifestations. At present, its diagnosis primarily relies on ¹⁸F-FDG-PET/CT to screen hypermetabolic lesions and tissue biopsy to confirm it. This article reports a case of oropharyngeal ulcers accompanied by fever as the main clinical manifestations, while there were no atypical cells found in multiple biopsies of the ulcer sites. PET/CT showed heterogeneous hypermetabolism in the calf muscles of two legs and the pharynx. Finally, the patient diagnosis was confirmed as primary skeletal muscle PTCL-NOS through calf muscle biopsy, hematoxylin and eosin staining (HE) staining and immunohistochemistry. The diagnostic process of the case was challenging. It suggests that recognition of primary skeletal muscle PTCL-NOS needs to be improved to achieve early diagnosis and better prognosis.

There are several challenges in the early diagnosis of Sjögren syndrome (SS), such as prominent glandular dysfunction in patients to make long diagnostic delays. These challenges are mainly attributed to the lack of adequate understanding of the early-stage characteristic of SS. Clinical and experimental studies have shown that early diagnosis and intervention in SS can help delay disease progression and reduce the risk of complications. To achieve early diagnosis and treatment of SS, it’s necessary to identify more useful biomarkers for the early stages of SS, and to identify high-risk people for SS through appropriate screening.

Mesenchymal stem cell (MSC), a type of cell with the ability to differentiate into multiple lineages and immunomodulatory properties, have gained widespread attention in the treatment of systemic rheumatic diseases recently. Systemic rheumatic diseases such as systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, and Sjögren syndrome often led to a significant decline in patients’ quality of life, while current treatment methods have limitations. Therefore, it’s important to explore new method, and the application of MSC in these diseases has great significance. Current research indicates that MSC can exert therapeutic effects through various mechanisms, including regulating immune responses, promoting tissue repair, and reducing inflammation, and some clinical studies have showed the potential efficacy of MSC in systemic rheumatic diseases. However, many issues still need to be addressed, such as the source of cells, optimization of treatment protocols, and long-term safety assessments. This article systematically reviews the current application status of MSC in systemic rheumatic diseases, analyze their efficacy, safety, and future research directions, to provide a reference for development in this field.

With the prolonged survival of patients with solid tumors, the incidence of myeloid neoplasms in the patients is gradually increasing after cytotoxic therapy such as chemotherapy and/or radiotherapy. The treatment efficacy and prognosis in the patients are worse than those in patients with primary myeloid neoplasms. Studies have shown that cytotoxic therapy of solid tumors may increase the risk of myeloid neoplasms, and its pathogenesis involves gene mutations, chromosomal abnormalities, and clonal hematopoiesis of indeterminate potential (CHIP). In response to the issue, researchers have proposed individualized treatment strategies, which is selecting appropriate treatment methods based on the molecular biological characteristics of tumors and the overall condition of patients. This article summarizes the incidence, prognosis, pathogenesis, and current treatment methods of myeloid neoplasms post cytotoxic therapy for solid tumors, providing important insights for guiding clinical practice and improving patient prognosis.