1.Effect of inhomogeneity on accuracy of various IMRT dose calculation models
Xiaobo LI ; Xiaowu DENG ; Benhua XU ; Zhixing LIN ; Yuangui CHEN ; Miaoyun HUANG
Chinese Journal of Radiological Medicine and Protection 2015;35(8):628-631
Objective To investigate the dosimetric performance of two algorithms for correcting the presence of tissue inhomogeneities,the finite site pencil beam (FSPB) and X-ray voxel Monte Carlo (XVMC) plans were implemented in the MONACO system,with the accuracy of application to clinic treatment of two algorithms were evaluated.Methods In a non-uniform artificial anthropomorphic phantom,regular open fields and intensity modulation radiated therapy (IMRT) plans of the MONACO were measured by using calibrated EBT2 films,and the dose accuracy of the two kinds of plans was analyzed by comparing the planned and measured plane dose.Results In an anthropomorphic phantom,the deviations between the calculated values by XVMC and the measured values by films were less than ± 2%.While the deviations of FSPB values between calculation and measurements was within ± 3%,except at the condition of 15 MV,10 cm ×2 cm field,the dose error in lung was up to 6.51%.The verification of individual IMRT beams based on films showed that the pass rates of calculation by XVMC and FSPB were larger than 90% with γ criterion of 3%/3 mm and 4%/4 mm,respectively.At 3%/3 mm,the pass rates of FSPB were in the range of 80%-90%.At the same time,the pass rates of all individual fields were higher than 90%.Conclusions The accuracy of dose calculation of XVMC is better than that of FSPB when being in multi-segments and non-uniform media.The error of algorithm can be controlled within ±3%,for the calculation by XVMC.And the dose deficiency of PTV arising from algorithm can be avoided.
2.Establishment of extraction method and 2-dimensional electrophoresis conditions for root tuber proteome analysis of Rehmannia glutinosa.
Linkun WU ; Haibin WANG ; Chuihuai YOU ; Zhixing ZHANG ; Miaomiao NIU ; Zhongyi ZHANG ; Wenxiong LIN
China Journal of Chinese Materia Medica 2011;36(8):984-987
OBJECTIVETo establish an efficient and high resolution 2-DE (two-dimensional electrophoresis) protocol for root tuber proteome analysis of Rehmannia glutinosa.
METHODProteins from root tuber of R. glutinosa were extracted by using five different methods and their productivity and profiles were assessed by means of SDS-PAGE and two-dimensional electrophoresis.
RESULTThe trichloroacetic acid (TCA)-phenol extraction method was found most effective for the extraction with the highest protein yield, the most spots in protein patterns, and the highest resolution of proteins, and the clearest background could be achieved simultaneously. A 1:5 solution of ampholine pH 3-10 and pH 5-8 for a nonlinear gel and the 170 microg of protein loading dosage obtained maps with more protein spots and higher resolution of separation patterns.
CONCLUSIONThis study based on the optimized root tuber proteome preparation and the 2-DE protocol gets a high resolution and reproducibility 2-DE image, which will be expected to have excellent applications in proteomics studies of R. glutinosa tuber root.
Electrophoresis, Gel, Two-Dimensional ; methods ; Plant Proteins ; analysis ; chemistry ; Plant Roots ; chemistry ; Proteome ; chemistry ; isolation & purification ; Rehmannia ; chemistry
3.Ultrasonography in the diagnosis of benign and malignant thyroid nodules with rim calcification
Cuiping HUA ; Jianwei WANG ; Zhixing GUO ; Qingguang LIN ; Xuebin ZOU ; Zimin LAI ; Jueming CHEN ; Feng HAN
Chinese Journal of Medical Ultrasound (Electronic Edition) 2017;14(10):755-759
Objective The aim of this study was to investigate the value of ultrasound in diagnosis of benign and malignant thyroid nodules with rim calcification. Methods Sixty thyroid nodules with rim calcifications from Sun Yat-sen University Cancer center which were detected on ultrasound from January 2008 to December 2015 were included in this study, and all the thyroid nodules had pathological results. Ultrasonic features of thyroid nodules, including the size, border, internal echo, growth pattern, rear echo, interruption or inner sink of the rim calcification and hypoechoic soft tissue extrusion around rim calcification were analyzed. Results Thirty-seven nodules (61.7%) were confirmed to be benign, and twenty-three nodules (38.3%) were malignant. The ultrasonic features of interruption or inner sink of rim calcifications and hypoechoic soft tissue extrusion around rim calcification, were more often in malignant nodules than benign nodules. The sensitivity, specificity, the positive predictive values and the negative predictive values for interruption or inner sink of rim calcifications were 85.7%, 89.4%, 85.7% and 89.4%, respectively. The sensitivity, specificity, the positive predictive values and the negative predictive values for hypoechoic soft tissue extrusion around rim calcification were 81.3%, 94.4%, 92.9% and 85.0%, respectively. Internal hypoechogenicity was more frequently observed in the malignant nodules (82.6%) than in benign nodules (40.5%). The longitudinal growth pattern of thyroid was more frequently observed in malignant nodules (30.4%) than in benign nodules (2.7%). The differences of this two ultrasound features were statistically significant(χ2=9.958 and 9.440,both P<0.01).There were no significant differences in size,border and the rear echo between malignant and benign nodules (all P>0.05). Conclusion The interruption or inner sink of the rim calcification could be useful in differential diagnosis of thyroid nodules with rim calcification.
4.Network meta-analysis of the modeling effects of different factors on rabbit models of steroid-induced osteonecrosis of femoral head
Zhixing HU ; Qun LI ; Chao YANG ; Xiaoxiao WANG ; Luochangting FANG ; Wuqiong HOU ; Na LIN ; Weiheng CHEN ; Chunfang LIU ; Ya LIN
Chinese Journal of Tissue Engineering Research 2024;28(6):976-984
OBJECTIVE:The rabbit model of steroid-induced osteonecrosis of femoral head is the most commonly used animal model of femoral head necrosis.The pathological changes of the femoral head are close to clinical practice,however,the conditions,methods and evaluation standards of animal models reported in and outside China are not uniform,which leads to the low scientific value of animal models and is difficult to popularize.This study aimed to clarify the influence of different mold-making conditions on the establishment of steroid-induced osteonecrosis of femoral head rabbit model and analyze the appropriate conditions for the successful model establishment. METHODS:We searched the CNKI,WanFang,VIP,CBM,WoS,PubMed and EMbsae databases for the literature on the modeling of steroid-induced osteonecrosis of femoral head rabbits up to April 1,2022,completed the screening of the literature according to the inclusion and exclusion criteria and literature quality evaluation,and extracted the outcome index data in the literature.RevMan Stata and ADDIS statistical software were used to conduct a meta-analysis of the included data. RESULTS:(1)A total of 82 articles with 1 366 rabbits were included in the study.The steroid-induced osteonecrosis of femoral head modeling methods were divided into three types:steroid-alone method,steroid combined lipopolysaccharide method and steroid combined serum method.Among these,33 articles used steroid-alone method;20 articles used steroid combined lipopolysaccharide method;29 articles used steroid combined serum method.(2)Meta-analysis results showed that the three modeling methods significantly increased the rate of empty bone lacunae in the femoral head of steroid-induced osteonecrosis of femoral head rabbits(P<0.001),and significantly decreased the ratio of the trabecular bone area in the femoral head of steroid-induced osteonecrosis of femoral head rabbits(P<0.001).The order of empty bone lacunae rate of each modeling method was:steroid combined with lipopolysaccharide method>steroid-alone method>steroid combined with serum method>normal group,and the order of trabecular bone area rate of each modeling method was:normal group>steroid combined with serum method>steroid-alone method>steroid combined with lipopolysaccharide method.(3)The results of subgroup analysis suggested that the rate of empty bone lacunae in the rabbit model induced by steroid alone might be related to the rabbit variety and the type of steroid used for modeling(difference between groups P<0.05),in which the combined effect amount of New Zealand white rabbits was higher than that of Chinese white rabbits(P<0.05)and Japanese white rabbits,and the combined effect amount of dexamethasone was higher than that of other steroids.The rate of empty bone lacunae induced by steroid combined with lipopolysaccharide was related to the administration mode of lipopolysaccharide and the type of steroid(P<0.05),among which the combined effect of methylprednisolone sodium succinate was significantly higher than that of other steroids(P<0.05),and the combined effect of prednisolone was significantly lower than that of other steroids(P<0.05).The combined effect of lipopolysaccharide 100 μg/kg×twice was significantly lower than 10 μg/kg×twice and 50 μg/kg×twice(P<0.05).The rate of empty bone lacunae in the model induced by steroid combined with serum was related to serum dose and steroid type(P<0.05),among which the combined effect amount of dexamethasone sodium phosphate was significantly higher than other steroid types(P<0.05),and the combined effect amount of dexamethasone was significantly lower than other steroid types(P<0.05);the combined effect amount of serum"10 mL/kg+6 mL/kg"combined dose was lower than other serum doses(P<0.05). CONCLUSION:(1)With the rate of empty bone lacunae and the ratio of trabecular bone area as the judgment standard for the successful establishment of the model,the three modeling methods can successfully construct the rabbit steroid-induced osteonecrosis of femoral head model,of which the steroid combined with lipopolysaccharide method is the best.(2)New Zealand white rabbits and dexamethasone are recommended when selecting the steroid-alone method.Methylprednisolone sodium succinate and low-dose lipopolysaccharide are recommended when selecting the steroid combined with lipopolysaccharide method.Dexamethasone sodium phosphate is recommended when selecting the steroid combined with serum modeling method.
5.Association of compound hot extreme with blood pressure in Guangdong province
Zhixing LI ; Shunwei LIN ; Xiaojun XU ; Ruilin MENG ; Guanhao HE ; Jianxiong HU ; He ZHOU ; Weilin ZENG ; Xing LI ; Jianpeng XIAO ; Tao LIU ; Wenjun MA
Journal of Environmental and Occupational Medicine 2022;39(3):247-252
Background It is projected that the frequency, density, and duration of compound hot extreme may increase in the 21st century in the context of global warming. Objective To explore the association between compound hot extreme and blood pressure, and identify sensitive populations. Methods This was a cross-sectional study. The study subjects were from six Guangdong Province Chronic Disease and Nutrition Surveys during 2002 through 2015. A questionnaire was administered to the participants with questions about demographic information, drinking and smoking status, and measurements on their height, weight, and blood pressure were also collected. We chose the data of May, September, and October to explore the association between compound hot extreme and blood pressure. Compound hot extreme means a hot day with a proceeding hot night. Daily meteorological data were obtained from China Meteorological Data Service Centre. We employed inverse distance weighting to interpolate the temperature and relative humidity values for each participant. A distributed lag non-linear model was used to estimate the association between compound hot extreme and blood pressure. Stratified analyses by sex, age, area, body mass index (BMI), smoking status, and drinking status were also performed to identify sensitive populations. A sensitivity analysis was conducted by adjusting the degrees of freedom for lag spline and removing relative humidity. Result A total of 10967 participants without history of hypertension were included in this study. The average systolic blood pressure (SBP) was 120.8 mmHg and the average diastolic blood pressure (DBP) was 74.5 mmHg. The proportion of participants who experienced hot day, hot night, or compound hot extreme were 9.34%, 17.95% and 2.90%, respectively. Compared to hot day, hot night and compound hot extreme were related with decreased blood pressure, and the effect of compound hot extreme was stronger: the changes and 95%CI for SBP was −6.2 (−10.3-−2.1) mmHg, and for DBP was −2.7 (−5.2-−0.2) mmHg. Compound hot extreme induced decreased SBP among male, population ≥ 65 years, and those whose BMI < 24 kg·m-2, and their ORs (95%CIs) were −6.2 (−10.7-−1.6). −19.1 (−33.0-−5.1), and −6.7 (−11.8~−1.6) mmHg, respectively, and also decreased DBP among population ≥ 65 years, and its OR (95%CI) was −8.4 (−15.6-−1.1) mmHg. During compound hot extremes, participants living in rural areas showed decreased SBP and DBP, and the ORs (95%CIs) were −10.5 (−16.6-−4.5) and −4.4 (−7.7-−1.1) mmHg respectively, while those living in urban areas showed increased SBP, and the OR (95%CI) was 9.7 (2.9-16.5) mmHg. A significant decrease in blood pressure [OR (95%CI)] was also found in non-smokers [DBP, −3.7 (−6.6-−0.8) mmHg] and non-drinkers [SBP, −4.8 (−9.4-−0.2) mmHg; DBP, −3.4 (−6.0-−0.9) mmHg]. Conclusion Compound hot extreme is negatively associated with SBP, and being male, aged 65 years and over, and having BMI < 24 kg·m−2 may be more sensitive to compound hot extreme.
6.Advances of CRISPR/dCas9 system in live cell imaging.
Siyu LIN ; Xing ZHONG ; Lixin MA ; Jie QIAO ; Yi LIU
Chinese Journal of Biotechnology 2021;37(9):3061-3070
The study of distinct genes, chromosomes and the spatio-temporal relationships between them is of great significance in genetics, developmental biology and biomedicine. CRISPR/Cas9 has become the most widely used gene editing tool due to its excellent targeting ability. Recently, researchers have developed a series of advanced live cell imaging techniques based on the nuclease-inactivated mutant of Cas9 (dCas9), providing rapid and convenient tools for high-resolution imaging of specific sites in the chromatin and genome. This review summarizes the advances of CRISPR/dCas9 system in live cell imaging from three aspects, including the strategies of cell delivery, optimization of the fluorescence signals, as well as orthogonal and multicolor imaging. Furthermore, we shed light on the development trends and prospects of this field.
CRISPR-Cas Systems/genetics*
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Chromatin
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Endonucleases
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Gene Editing
7.Mechanism of Osteoking in Improving Energy Metabolism in Rats with Myofascial Pain Syndrome Based on cAMP/PKA/PGC1α Signaling Pathway
Xiaoxiao WANG ; Qun LI ; Chao YANG ; Changting FANGLUO ; Zhixing HU ; Lili WANG ; Suya ZAHNG ; Xueting LIU ; Yanqiong ZHANG ; Chunfang LIU ; Na LIN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(24):54-62
ObjectiveFrom the perspective of energy metabolism, the mechanism of Osteoking (OK) in the treatment of myofascial pain syndrome (MPS) was revealed through systems biology prediction combined with holistic animal experimental validation methods. MethodFirstly, the key targets of MPS and their related molecular mechanisms were predicted by the systems biology method, and the core network targets were screened. Then, the network-predicted targets were verified by animal experiments. Specifically, 60 SD rats were randomly divided into normal group, model group, low, medium, and high dose OK groups (0.66, 1.31, 2.63 mL·kg-1), and positive celecoxib group (21 mg·kg-1). The MPS model was established by beating combined with a centrifugal exercise method for eight weeks. Except for two days after modeling, the intervention of OK or celecoxib was performed. After the completion of the model, the drug was administered for two weeks. The histopathological changes of trigger point muscle tissue were observed by hematoxylin-eosin staining. The content/activity of Na-K-ATP enzyme (Na+-K+-ATPase), Ca2+ pump (Ca2+ATPase), Ca2+, lactate dehydrogenase (LDH), glutathione (GSH), malondialal (MDA), superoxide dismutase (SOD), cyclic adenosine phosphate (cAMP), and protein kinase A (PKA) in serum and/or trigger point muscle tissue in MPS rats was detected by enzyme-linked immunosorbent assay. Protein expression levels of PKA and the peroxisome proliferator-activated receptor γ coactivator 1α (PGC1α) in MPS rats were detected by immunohistochemistry. The protein expression levels of PKA, PGC1α, and mitochondrial transcription factor A (TFAM) in MPS rats were detected by Western blot. ResultThe network prediction results suggest that OK acts on the key target of energy metabolism related to the occurrence and development of MPS and may participate in the activation of the cAMP/PKA/PGC1α signaling pathway. The experimental validation results show that compared with the normal group, contracture nodules and disordered arrangement of muscle fibers appear in the trigger point muscle tissue of MPS rats. Na+-K+-ATPase, Ca2+ATPase, SOD activity, Ca2+, and GSH contents in serum and/or trigger point muscle tissue are significantly decreased (P<0.01). Both LDH activity and MDA contents are significantly increased (P<0.01), and the protein expression levels of cAMP, PKA, PGC1α, and TFAM are significantly decreased (P<0.01). Compared with the model group, OK improves the histopathological morphology of trigger point muscle fibers in MPS rats, and after the intervention of OK, Na+-K+-ATPase, Ca2+ATPase, SOD activity, Ca2+, and GSH contents in serum and/or trigger point muscle tissue in MPS rats are significantly increased (P<0.05, P<0.01). LDH activity and MDA contents are significantly reduced (P<0.05, P<0.01). The protein expression levels of cAMP, PKA, PGC1α, and TFAM are significantly increased (P<0.05, P<0.01). ConclusionThe mechanism of OK's intervention in MPS rats may be related to its effective activation of the cAMP/PKA/PGC1α signaling pathway, thus promoting mitochondrial energy metabolism and trigger point muscle fiber damage repair in muscle cells.
8.Repair Mechanism of Jianpi Huogu Prescription on Vascular Injury in Alcohol-induced Osteonecrosis of Femoral Head Based on VEGF/VEGFR2/PI3K/Akt Signaling Pathway
Changting FANG-LUO ; Qianqian WANG ; Congcong SUN ; Qun LI ; Chao YANG ; Xiaoxiao WANG ; Zhixing HU ; Chunfang LIU ; Na LIN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(8):186-194
MethodIn the experiment, 46% vol Red Star Erguotou (10 mL·kg·d-1) was used to establish the AONFH rat model, and the intervention effect of JPHGP at different doses (2.5, 5.0, 10.0 g·kg-1) was observed. Jiangusheng pill (JGS, 1.53 g·kg-1) was selected as the positive control. After 8 weeks of administration, the bone histomorphometry of the femoral head was analyzed by Micro-CT imaging, and the area of medullary microvessels in the femoral head was detected by ink perfusion. The pathological change was observed by hematoxylin and eosin (HE) staining. The protein expressions of Platelet endothelial cell adhesion molecule-1 (CD31), VEGF, VEGFR2, PI3K, phosphor-Akt (p-Akt) and phosphatase and Tensin homologue deleted on chromosome 10 (PTEN) in the femoral head were determined by immunohistochemistry and Western blot. ResultCompared with normal group, the model group presented the fracture and thinning of trabeculae in the femoral head, increased empty bone lacunae, and elevated number and diameter of adipocytes (P<0.01). Micro-CT imaging revealed a decrease in bone mineral density (BMD), bone volume fraction (BV/TV), trabecular thickness (Tb.Th) and trabecular number (Tb.N) (P<0.05, P<0.01) while an increase in bone surface-to-volume ratio (BS/BV) and trabecular separation (Tb.Sp) (P<0.01). The results of ink perfusion showed that the area of medullary microvessels in the femoral head was reduced (P<0.01). Compared with model group, JPHGP lowered the empty bone lacunae rate as well as the number and diameter of adipocytes in the femoral head of AONFH rats. Micro-CT imaging indicated that JPHGP low-dose group had elevated BV/TV, Tb.Th and Tb.N (P<0.05, P<0.01) while decreased BS/BV (P<0.01), and there was an upward trend in BMD while a downward trend in Tb.Sp, but without statistical difference. In addition, JPHGP medium- and high-dose groups had a rise in BMD, BV/TV, Tb.Th and Tb.N (P<0.05, P<0.01), a decrease in BS/BV and Tb.Sp (P<0.05, P<0.01) and enlarged area of medullary microvessels in the femoral head (P<0.05, P<0.01). The expressions of CD31, VEGF, VEGFR2, PI3K, p-Akt in the model group were lower than those in the normal group (P<0.01), and after medium and high doses of JPHGP treatment, the expressions of CD31, PI3K and p-Akt in the femoral head of rats were up-regulated (P<0.01) while the protein expression of PTEN was down-regulated (P<0.01). Moreover, JPHGP up-regulated the expressions of VEGF and VEGFR2 (P<0.05, P<0.01). ConclusionJPHGP can repair the vascular injury in AONFH, and its mechanism may be related to the activation of VEGF/VEGFR2/PI3K/Akt signaling pathway. This study provides certain scientific basis and reference for the clinical application of JPHGP. ObjecctiveTo observe the repair effect of Jianpi Huogu prescription (JPHGP) on vascular injury in experimental alcohol-induced osteonecrosis of femoral head (AONFH), and to explore its mechanism based on vascular endothelial growth factor (VEGF)/VEGFR2/phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway.
9.Protective Effect of Jianpi Huogu Prescription on Functional Injury of Vascular Endothelial Cells Caused by Alcohol Based on Akt/JNK/p38 MAPK Signaling Pathway
Xiaoxiao WANG ; Lianhua HE ; Changting FANG-LUO ; Qun LI ; Chao YANG ; Zhixing HU ; Weiheng CHEN ; Chunfang LIU ; Lan HAN ; Na LIN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(11):64-71
ObjectiveTo investigate the protective effect of Jianpi Huogu prescription (JPHGP) on the functional injury of vascular endothelial cells caused by alcohol and explore its mechanism based on protein kinase B/c-Jun amino-terminal kinase/p38 MAPK (Akt/JNK/p38 MAPK) signaling pathway. MethodThrough chick embryo allantoic membrane, thoracic aortic ring, and migration, invasion, adhesion, and lumen formation of human umbilical vein endothelial cells (HUVEC), the effect of JPHGP with different concentrations (8, 16 and 32 μg·L-1) on angiogenesis was observed in the presence or absence of alcohol. The expression levels of phosphorylation of Akt, JNK, and p38 MAPK were determined by Western blot. ResultAs compared with the normal group, the number and length of capillaries around the arterial ring in the model group were decreased, and the migration, invasion, and lumen formation capacity of HUVEC were decreased (P<0.05, P<0.01). After treatment with 16 and 32 μg·L-1 JPHGP, the length of neovascularization in chick embryo allantoic membrane was significantly increased (P<0.05, P<0.01). Compared with the model group, the 8, 16, and 32 μg·L-1 JPHGP groups increased the number of capillaries around the thoracic aortic ring in a concentration-dependent manner (P<0.05, P<0.01), and the 32 μg·L-1 JPHGP group increased the length of capillaries around the thoracic aortic ring (P<0.05). The 16 and 32 μg·L-1 JPHGP groups enhanced the migration, invasion, and lumen formation capacity of HUVEC. The results of Western blot showed that, as compared with the normal group, the protein expression levels of p-JNK/JNK, p-p38 MAPK/p38 MAPK, and p-Akt/Akt were significantly decreased in the model group (P<0.01), and as compared with the model group, the protein expression levels of p-p38 MAPK/p38 MAPK and p-Akt/Akt were significantly increased in the 8, 16, and 32 μg·L-1 JPHGP groups (P<0.01) and the protein expression level of p-JNK/JNK was increased significantly in the 16 and 32 μg·L-1 JPHGP groups (P<0.01). ConclusionJPHGP has a protective effect on the functional injury of vascular endothelial cells caused by alcohol, and its mechanism may be related to the activation of Akt/JNK/p38 MAPK signaling pathway. Relevant research results will provide certain scientific basis for clarifying the effect of JPHGP on 'invigorating spleen and promoting blood circulation'.
10.Meta-analysis of Effect of Tripterygium wilfordii Polyglycoside Tablets Combined with Methotrexate and/or Leflunomide on Autoantibodies in Rheumatoid Arthritis
Chao YANG ; Zhixing HU ; Ruirui MING ; Tengteng XU ; Luochangting FANG ; Xiaoxiao WANG ; Taixian LI ; Lin CHEN ; Chunfang LIU
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(5):39-48
ObjectiveTo evaluate the effect of Tripterygium wilfordii polyglycoside tablets (TWPT) combined with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) including methotrexate (MTX) and/or leflunomide (LEF) on autoantibodies in rheumatoid arthritis (RA) patients. MethodPubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, Wanfang Data, and China Biomedical Literature Service System (SinoMed) were searched for randomized controlled trials (RCTs) of TWPT combined with MTX and/or LEF in the treatment of RA patients from database inception to December 1, 2021. Primary outcome indicators included rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), and secondary outcome indicators included immunoglobulin (IgA, IgG, and IgM) and adverse drug events (ADE). ResultThirty-one RCTs, involving 2 643 adult patients, were included, including 20 RCTs of TWPT combined with MTX, 10 of TWPT combined with LEF, and one of TWPT combined with MTX and TWPT. The follow-up time ranged from two weeks to 13 months. Compared with csDMARDs alone, TWPT combined with other drugs significantly improved serum RF of RA patients [SMD=-2.45, 95% CI [-2.97, -1.93], P<0.000 01], anti-CCP [SMD=-1.41, 95% CI (-2.35, -0.48), P=0.003], IgM [SMD=-1.90, 95% CI (-3.03, -0.76), P=0.001], and IgA [SMD=-1.18, 95% CI (-2.23, -0.12), P=0.03]. There were no significant effects on IgG [SMD=-1.02, 95% CI (-2.04, 0.01), P=0.05] and ADE [RR=0.87, 95% CI (0.66, 1.15), P=0.32]. ConclusionThe results of this study show that compared with csDMARDs alone, TWPT combined with csDMARDs can effectively improve the levels of autoantibodies in RA patients without increasing the incidence of ADE. However, due to the limited quality and quantity of the included RCTs, the relevant conclusions are only used as a reference for the clinical diagnosis and treatment of RA, and more high-quality studies are still needed to further confirm their efficacy.