Objective Based on 25 indicators including immune factors, cell count classification, and smear results of the knee joint fluid, machine learning models were established to distinguish between osteoarthritis (OA) and rheumatoid arthritis (RA). Methods 100 OA and 40 RA patients scheduled for total knee arthroplasty were enrolled respectively. Each patient's knee joint fluid was collected preoperatively. Nucleated cells were counted and classified. The expression levels of immune factors, including tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, IL-8, IL-15, matrix metalloproteinase 3 (MMP3), MMP9, MMP13, rheumatoid factor (RF), serum amyloid A (SAA), C-reactive protein (CRP), and others were measured. Smears and microscopic classification of all the immune factors were performed. Independent influencing factors for OA or RA were identified using univariate binary logistic regression, Lasso regression, and multivariate binary logistic regression. Based on the independent influencing factors, three machine learning models were constructed which are logistic regression, random forest, and support vector machine. Receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA) were used to evaluate and compare the models. Results A total of 5 indicators in the knee joint fluid were screened out to distinguish OA and RA, which were IL-1β(odds ratio(OR)=10.512, 95× confidence interval (95×CI) was 1.048-105.42, P=0.045), IL-6 (OR=1.007, 95×CI was 1.001-1.014, P=0.022), MMP9 (OR=3.202, 95×CI was 1.235-8.305, P=0.017), MMP13 (OR=1.002, 95× CI was 1-1.004, P=0.049), and RF (OR=1.091, 95×CI was 1.01-1.179, P=0.026). According to the results of ROC, calibration curve and DCA, the accuracy (0.979), sensitivity (0.98) and area under the curve (AUC, 0.996, 95×CI was 0.991-1) of the random forest model were the highest. It has good validity and feasibility, and its distinguishing ability is better than the other two models. Conclusion The machine learning model based on immune factors in the knee joint fluid holds significant value in distinguishing OA and RA. It provides an important reference for the clinical early differential diagnosis, prevention and treatment of OA and RA.
Humans ; Arthritis, Rheumatoid/metabolism* ; Machine Learning ; Male ; Female ; Middle Aged ; Aged ; Synovial Fluid/immunology* ; Osteoarthritis, Knee/metabolism* ; Knee Joint/metabolism* ; ROC Curve ; Diagnosis, Differential

Objective: To investigate the awareness of hepatitis C prevention and control knowledge and its influencing factors among female sex workers (FSWs) in Jiaxing City, Zhejiang Province. Methods: According to the HIV/AIDS Sentinel Surveillance Plan, FSWs at ages of 15 to 65 years monitored by the national AIDS surveillance sentinel in Jiaxing City were recruited, and demographic information, awareness of hepatitis C prevention and control knowledge and related behaviors were collected by questionnaire surveys. Factors affecting the awareness of hepatitis C prevention and control knowledge were identified by a multivariable logistic regression model. Results: A total of 430 questionnaires were allocated, and 412 were valid, with an effective rate of 95.81%. The respondents had a mean age of (28.58±4.93) years, and included 258 unmarried FSWs (62.62%), 344 with registered residence outside Zhejiang Province (83.50%), 212 with junior high school education or below (51.46%) and 243 from high-end entertainment places (58.98%). The overall awareness of hepatitis C prevention and control knowledge among FSWs was 20.39%, and the awareness of "Transfusion of blood containing hepatitis C virus may acquire hepatitis C" (38.83%) and the awareness of "tattooing, eyebrow tattooing and ear piercing in streets or small shops may infect hepatitis C" (38.11%) were relatively low. Multivariable logistic regression analysis identified marital status (divorced or widowed, OR=0.161, 95%CI: 0.054-0.482), educational level (high school or technical secondary school, OR=2.568, 95%CI: 1.446-4.560; junior college or above, OR=6.110, 95%CI: 2.658 -14.045) and grade of entertainment places (high-end entertainment places, OR=2.756, 95%CI: 1.525-4.982) as factors affecting the awareness of hepatitis C prevention and control knowledge among FSWs. Conclusion FSWs in Jiaxing City have a low awareness of hepatitis C prevention and control knowledge, especially lacking of knowledge about the transmission routes and prognosis of hepatitis C.

AIM: To study the effect of intense pulsed light(IPL)combined with meibomian gland massage on postoperative dry eye in cataract patients with meibomian gland dysfunction(MGD).METHODS: A retrospective analysis was conducted on the general data of 100 patients(100 eyes)with cataract and postoperative dry eye syndrome accompanied by MGD treated in our hospital from June 2022 to June 2023. They were divided into a control group(n=50)and an observation group(n=50)according to different treatment methods, and received meibomian gland massage and meibomian gland massage combined with IPL treatment, respectively. The tear film break-up time(BUT), Schirmer I test(S I t), meibomian gland secretion score, ocular surface disease index(OSDI), ocular staining score(OSS), and treatment efficacy of the two groups of patients were compared before treatment and at 1 wk and 1 and 3 mo after treatment.RESULTS: The BUT and SIt in both groups after treatment were higher than those before treatment, while the secretion of meibomian gland, OSS score, and OSDI score were lower than those before treatment(all P<0.05); the observation group had higher levels of BUT and SIT at 1 wk, 1 and 3 mo compared to the control group(all P<0.05), and lower levels of meibomian gland secretion, OSS score, and OSDI score compared to the control group(all P<0.05); the effective rate of treatment in the observation group was 86.0%, which was higher than that in the control group(68.0%; P<0.05).CONCLUSION: IPL combined with meibomian gland massage for treating postoperative dry eye in cataract patients with MGD can promote the extension of BUT, increase tear secretion, and reduce OSS and OSDI scores.

Objective To analyze the stress distributions of two root canal preparation shapes of oval root canals with micro-crack.Methods Twenty single-canal mandibular premolars with oval canals were expanded to create micro-cracks.Roots were sectioned after staining.The generation and distribution of dentin micro-cracks were observed under microscope.Then a finite element(FE)model of sectioned enlarged oval canal roots with micro-cracks was established.The stress distribution of micro-crack and root were analyzed under lateral loading.Results Cracks always appeared in the buccolingual sides of oval canal roots and extended from the intracanal wall to the root surface.This was consistent with the stress concentration on the buccolingual side of the root canal wall shown by FE analysis.When micro-cracks occurred,stresses were transferred to the crack tip and the peak values increased sharply nearly 5 times.This made the cracks propagate easily along this direction,especially in the long axis direction of the tooth.Conclusions The presence of micro-cracks does not change the general stress concentration on root with two preparation morphologies of oval canals.However,the micro-crack causes an extreme stress concentration in the crack tip.This may be the mechanism of rapid propagation of microcracks into vertical root fracture,and dentists need to pay high attention.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Disturbance of macrophage-associated lipid metabolism plays a key role in atherosclerosis. Crosstalk between autophagy deficiency and inflammation response in foam cells (FCs) through epigenetic regulation is still poorly understood. Here, we demonstrate that in macrophages, oxidized low-density lipoprotein (ox-LDL) leads to abnormal crosstalk between autophagy and inflammation, thereby causing aberrant lipid metabolism mediated through a dysfunctional transcription factor EB (TFEB)-P300-bromodomain-containing protein 4 (BRD4) axis. ox-LDL led to macrophage autophagy deficiency along with TFEB cytoplasmic accumulation and increased reactive oxygen species generation. This activated P300 promoted BRD4 binding on the promoter regions of inflammatory genes, consequently contributing to inflammation with atherogenesis. Particularly, ox-LDL activated BRD4-dependent super-enhancer associated with liquid-liquid phase separation (LLPS) on the regulatory regions of inflammatory genes. Curcumin (Cur) prominently restored FCs autophagy by promoting TFEB nuclear translocation, optimizing lipid catabolism, and reducing inflammation. The consequences of P300 and BRD4 on super-enhancer formation and inflammatory response in FCs could be prevented by Cur. Furthermore, the anti-atherogenesis effect of Cur was inhibited by macrophage-specific Brd4 overexpression or Tfeb knock-out in Apoe knock-out mice via bone marrow transplantation. The findings identify a novel TFEB-P300-BRD4 axis and establish a new epigenetic paradigm by which Cur regulates autophagy, inhibits inflammation, and decreases lipid content.

Psoraleae Fructus (PF) is a well-known traditional herbal medicine in China, and it is widely used for osteoporosis, vitiligo, and other diseases in clinical settings. However, liver injury caused by PF and its preparations has been frequently reported in recent years. Our previous studies have demonstrated that PF could cause idiosyncratic drug-induced liver injury (IDILI), but the mechanism underlying its hepatotoxicity remains unclear. This paper reports that bavachin isolated from PF enhances the specific stimuli-induced activation of the NLRP3 inflammasome and leads to hepatotoxicity. Bavachin boosts the secretion of IL-1β and caspase-1 caused by ATP or nigericin but not those induced by poly(I:C), monosodium urate crystal, or intracellular lipopolysaccharide. Bavachin does not affect AIM2 or NLRC4 inflammasome activation. Mechanistically, bavachin specifically increases the production of nigericin-induced mitochondrial reactive oxygen species among the most important upstream events in the activation of the NLRP3 inflammasome. Bavachin increases the levels of aspartate transaminase and alanine aminotransferase in serum and hepatocyte injury accompanied by the secretion of IL-1β via a mouse model of lipopolysaccharide-mediated susceptibility to IDILI. These results suggest that bavachin specifically enhances the ATP- or nigericin-induced activation of the NLRP3 inflammasome. Bavachin also potentially contributes to PF-induced idiosyncratic hepatotoxicity. Moreover, bavachin and PF should be evaded among patients with diseases linked to the ATP- or nigericin-mediated activation of the NLRP3 inflammasome, which may be a dangerous factor for liver injury.
Adenosine Triphosphate ; Animals ; Chemical and Drug Induced Liver Injury/etiology* ; Flavonoids ; Humans ; Inflammasomes ; Mice ; NLR Family, Pyrin Domain-Containing 3 Protein ; Nigericin

Objective    To explore the effects of perioperative autologous platelet transfusion on postoperative complications and prognosis of adult cardiac surgery patient. Methods    Using the method of systematic review of Cochrane Collaboration, we searched PubMed, Web of Science, EMbase, The Cochrane Library, CNKI and Wangfang databases, retrieving the literature from January 1970 to June 2020 to collect clinical randomized controlled trials on the effects of autologous platelet transfusion on complications and prognosis of adult cardiac surgery patients. The extracted valid data was analyzed by RevMan5.3 software. Results    Ten studies were included, with a total of 1 083 patients. The results of meta-analysis showed that there were statistical differences in the perioperative blood loss (MD=−195.15, 95%CI − 320.48-−69.83, P=0.002) and perioperative blood transfusion (MD=−0.88, 95%CI −1.23-−0.52, P<0.001). There was no statistical difference in the death rate 30 days after the operation (RR=0.90, 95%CI 0.48-1.70, P=0.75), reoperations (OR=0.48, 95%CI 0.23-1.02, P=0.06), postoperative myocardial infarction (OR=1.29, 95%CI 0.48-3.51, P=0.61), postoperative infection (OR=1.71, 95%CI 0.89-3.29, P=0.11) or postoperative ICU retention time (MD=−0.31, 95%CI − 0.67-0.05, P=0.09). Conclusion    Perioperative autologous platelet transfusion can reduce perioperative blood loss and  blood transfusion in adult cardiac surgery patients, but has no significant impact onprognosis and postoperativecomplications, which indicates that perioperative autologous platelet transfusion is a safe and beneficial blood protection measure for patients undergoing cardiac surgery.

Objective: To evaluate the safety of enterovirus 71（EV71）inactivated vaccines produced by Wuhan Institute of Bio Products through learning the incidence of adverse events following immunization（AEFI）in children aged 6 months to 3 years old after vaccination. Methods: According to the national requirement for vaccine safety monitoring program，data of AEFI cases after inoculated EV71 vaccines from September 2017 to October 2018 in Zhejiang Province was collected by combining active and passive monitoring. Demographic characteristics，space distribution，dose and incidence of AEFI were analyzed. Results: A total of 107 503 children were included in this study，of which 27 173 were actively monitored and 80 330 were passively monitored. The monitoring results showed that 288 cases of AEFI occurred after inoculated EV71 vaccines，the reported incidence rate was 267.90/100 000. Of 288 cases，266 cases had common reactions（247.43/100 000），14 cases had abnormal reactions（13.02/100 000）and 8 cases had complications（7.44/100 000）；145 cases were passively monitored（180.51/100 000）and 143 cases were actively monitored（526.26/100 000）；150 cases were males and 138 cases were females，with the males to females ratio of 1.09∶1. The AEFI of EV71 vaccines were reported in all the cities of Zhejiang Province，with Jinhua，Taizhou and Hangzhou ranking the top three and accounting for 50.69% of all the reported cases. About 202 cases of AEFI（70.14%）occurred after the first dose of EV71 vaccines，and 163 cases（56.60%）occurred on the day of inoculation.Most of common reactions were fever，swelling and sclerosis. The harm of the reported abnormal reactions was mild，with 8 cases of anaphylactic rash and no other serious abnormal reactions were found. Conclusion The reported incidence rate of AEFI of the domestic EV71 vaccine in children aged from 6 months to 3 years is 267.90/100 000，without serious abnormal reactions，suggesting that the EV71 vaccine is safe.

Objective To investigate the relationship of the neutrophil to lymphocyte ratio (NLR)with stroke in elderly persons with CDK.Methods Totally 220 subjects with stage 3-5 CKD were followed.Fatal and nonfatal cerebrovascular event (CVE) were recorded during this period.NLR at baseline was determined from complete blood count differential.We investigated if NLR could predict stroke.Resuits Median NLR was 2.13.NLR was equally associated with estimated glomerular flitrationrate (eGFR).Totally 116 strokes occurred during follow-up period.NLR could predict stroke independently.Increased NLR over 2.13 was related to a significantly decreased survival time (log-rank Chi-square =4.963,P =0.026).Multivariate Cox regression analysis showed that the risk factor of ischemic stroke in CKD patients was high NLR,hazard ratio (HR) 1.11 [95％ confidence interval (CI) 1.007 to 1.223,P =0.035].Conclusions NLR could independently predict stroke in elderly patients with moderate to severe CKD.