Objective:To explore the inhibitory effects of seabuckthorn polysaccharide on hepatic oxidative stress in a mice model of acute liver injury induced by intraperitoneal injection of LPS and D -GalN and detect the expression on hepatic BCL-2/Bax and PPAR-γ.Methods: C57BL/6 male mice were randomly divided into six groups:control group ( CTRL), model group ( L/G), dexamethasone positive control group ( DXM ) , low ( SPL ) , medium ( SPM ) and high dose group ( SPH ) of seabuckthorn polysaccharide.Mice in the SPL,SPM and SPH group were gavaged with 50,100 and 200 mg/kg seabuckthorn polysaccharide for 14 days respectively.Acute liver injury model were established by intraperitoneal injection of LPS (10 μg/kg) and D-GalN (700 mg/kg) .Serum and liver samples were collected 4 h after model establishment .Serum levels of ALT and AST and the content of MDA were de-tected.Hepatic expression of SOD 2 BCL-2 and Bax was determined by Western blot and the expression of PPAR-γwas detected by im-munohistochemistry .Results:ALT and AST levels significantly increased in the model group and decreased dose-dependently after pre-treatment with seabuckthorn polysaccharide .The level of MDA in the model group increased significantly as compared with the control group and decreased in seabuckthorn polysaccharide groups ,while the level of SOD 2 decreased in the model group and recovered in sea-buckthorn polysaccharide groups .The expression of Bax decreased after pretreatment with seabuckthorn polysaccharide .There was no obvious effect on BCL-2 expression after sea buckthorn polysaccharide supplementation .The expression of PPAR-γreduced in the sea-buckthorn polysaccharide group as compared with the model group .Conclusion:Seabuckthorn polysaccharide protects against LPS /D-GalN-induced liver injury.The effect is associated with an upregulation of SOD 2 and downregulation of Bax .

Objective:To observe the clinical efficacy and adverse reactions of rituximab in the treatment of systemic sclerosis (SSc).Methods:Eight SSc patients who received rituximab treatment in the Department of Rheumatology of Shanghai Ruijin Hospital from November 2016 to May 2020 were treated with rituximab at week 0, week 2, week 4, week 24 and week 48. The clinical symptoms and laboratory parameters were evaluated at baseline, week 4, week 24 and week 48 respectively. All data were analyzed by Wilcoxon test.Results:All the patients were diagnosed as diffuse SSc, including seven females and one male, with a median disease course of 2.5 years. At week 0, week 24 and week 48, the modified Rodnon skin scores (MRss) were 16.5 (11.8, 29.5) , 14.5 (9.5, 27) ( Z=0.841) and 10.5 (7, 24.3) ( Z=0.420) respectively, which were significantly improved as compared with the baseline ( P<0.05). The patients' self-scores were 60(50, 77.5), 52.5(41.3, 67.5)( Z=0.113) and 47.5(36.3, 57.5)( Z=0.474) respectively, which were significantly improved at week 24 and week 48, and the High Resolution CT (HRCT) scores at baseline and week 48 were 2.7(1.02, 3.7) and 1.6(0.65, 2.95)( Z=0.964) respectively, significantly improved after treatment ( P<0.05). The pulmonary aterial hypertension (PAH) values were 48(41, 58.5) mmHg and 47(38.5, 57) mmHg ( Z=0.315) respectively. There was no significant difference between the two groups. Clinical observation showed that the condition was improved and no adverse reaction occurred at the same time period. Conclusion:The improvement of skin sclerosis, pulmonary interstitial lesion and pulmonary artery pressure can be observed during the treatment with rituximab, which may be a new choice for the treatment of SSc. There is no serious adverse reaction during the treatment, and the patients are well tolerated and safe.

Objective:To investigate the effect and safety of rituximab, programmed death 1 (PD-1) monoclonal antibody, and Bruton tyrosine kinase (BTK) inhibitor on elderly refractory primary central nervous system lymphoma (PCNSL).Methods:The clinical data of an elderly patient with refractory PCNSL treated with the combination of rituximab, PD-1 monoclonal antibody and BTK inhibitor in the First Hospital of Jilin University in February 2020 were retrospectively analyzed. The relevant literature was reviewed.Results:The patient had primary central nervous system diffuse large B-cell lymphoma (high-risk group), and the Memorial Sloan Kettering Cancer Center (MSKCC) score was 2 (estimated overall survival time was 7 months). Disease progressed after 1 course of treatment. Complete remission was achieved after the therapy of rituximab, PD-1 monoclonal antibody combined with BTK inhibitor. PD-1 monoclonal antibody maintenance therapy was performed and patient was followed up until November 17, 2021. The patient's condition was stable. The second progression-free survival (PFS) time was 20 months, and the overall survival time was 21 months. The patient well tolerated the new drug treatment, and no adverse reactions of grade 3 or above occurred.Conclusions:The new targeted combination therapy can be used as a treatment option for elderly PCNSL patients, which can further improve the curative effect and significantly improve the prognosis.

Objective To explore the clinical effect and safety of remimazolam combined with alfentanil in painless gastroenteroscopy in elderly patients.Methods 188 elderly patients who were scheduled to undergo painless gastroenteroscopy from October 2021 to February 2023 were selected and divided into group A,group B,group C,and group D by random number table method,with 47 cases in each group.The group A,group B and group C were used remimazolam 0.2,0.3 and 0.4 mg/kg,and alfentanil 3 μg/kg respectively,and the remimazolam 2.5 mg/time was added during the operation.The group D was used propofol 1.5 mg/kg and alfentanil 3 μg/kg,and a single dose of propofol 0.5 mg/kg was added during the operation.The hemodynamics at different time points[3 min before anesthesia administration(T0),immediately after endoscopy(T1),3 min after endoscopy(T2),at the end of examination(T3),at the time of awakening(T4)],anesthesia onset time,sedation success rate,gastrointestinal endoscopy time,awakening time,time to leave the observation room and intraoperative/postoperative complications were compared,and the test results of neurobehavioral cognitive state examination(NCSE)were compared at different times.Results The percutaneous arterial oxygen saturation(SpO2)at T1 and T2 time point were higher than group C and group D,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the heart rate(HR)and mean arterial pressure(MAP)among group A,group B,group C and group D at each time point(P>0.05).There was no statistically significant difference in SpO2 between group A and group B at each time point(P>0.05).There was no statistically significant difference in the success rate of sedation,gastrointestinal endoscopy examination time and time of leaving the observation room among the four groups(P>0.05),but the onset time of anesthesia in group A was longer than that in group B,group C and group D,and the awakening time in group A and group B was shorter than that in group C and group D,and the differences were statistically significant(P<0.05).There was no statistically significant difference in awakening time between group A and group B(P>0.05).The incidence rate of bradycardia in group A and group B was lower than in group D,and the incidence rates of hypoxemia,respiratory depression,hypotension,and dizziness in group A were lower than those in group D,and the incidence rate of injection pain in group A,group B and group C was lower than that in group D,and the differences were statistically significant(P<0.05).After 10 minutes of complete wakefulness,there was no statistically significant difference in the passing rates of calculation ability and the memory tests between group A and group B(P>0.05),but the passing rates of calculation ability and memory test in group A were higher than those in group C and group D,and the differences were statistically significant(P<0.05).Conclusion During painless gastroenteroscopy in elderly patients,the sedative effect of using 0.3 mg/kg remimazolam combined with alfentanil is good,and it has stable hemodynamics,and the occurrence rate of complications such as bradycardia and espiratory depression is low,and the early postoperative cognitive function is recovered well.

In clinical dentistry,addressing unique conditions such as tilted,elongated,and torsion teeth during prepa-ration can be effectively managed through digital tooth morphology design.The production of a multi-stage 3D-printed guide offered a more efficient and accurate solution.This article presented a case of significant inclination,elongation,and torsion in the maxillary and mandibular canines that were successfully treated using crown restoration modification.A crown preparation guide was fabricated based on the final form design of the restoration using the target restorative space analysis technique to ensure precise tooth preparation.A tooth preparation guide was also designed and utilized fur-ther to enhance accuracy and efficiency during complex tooth preparation.The combined application of these multi-stage guides demonstrated promising clinical prospects.

Objective:To investigate the status quo of decision-making fatigue of parents of critically ill children and analyze its influencing factors, so as to provide a theoretical basis for reducing the degree of decision-making fatigue of parents of critically ill children.Methods:Using the convenient sampling method, parents of 310 critically ill children who were treated in 3 Class Ⅲ Grade A hospitals in Henan Province were selected as the research objects from April 2020 to April 2021. The General Information Questionnaire, the Chinese version of Decision-making Fatigue Scale, Self-Control Scale and the Chinese version of Willpower Belief Measurement Questionnaire were used to conduct a questionnaire survey. Univariate and multiple linear regression analysis were used to analyze the influencing factors of decision-making fatigue in parents of critically ill children. A total of 310 questionnaires were distributed in this study and 302 valid questionnaires were recovered, with an effective recovery rate of 97.42%.Results:The total score of decision-making fatigue of parents of 302 critically ill children was (9.13±1.73) , the total score of self-control was (53.41±7.29) and the total score of willpower belief was (22.67±3.64) . The results of multiple linear regression analysis showed that the relationship with the children, the length of ICU stay, the monthly family income, the presence or absence of sleep disorders, parental self-control and parental willpower beliefs were the influencing factors of decision-making fatigue in parents of critically ill children ( P<0.05) . Conclusions:The decision-making fatigue level of parents of critically ill children is at a moderately low level, which is affected by a variety of factors. Medical workers should intervene according to specific circumstances to reduce the decision-making fatigue of parents of critically ill children and maximize the interests of the children.

OBJECTIVE To establish the fingerprints of c ultivated and wild Anemarrhena asphodeloides，and to identify their differential components. METHODS Using an evaporative light-scattering detector ， the high performance liquid chromatography combined with Similarity Evaluation System of TCM Chromatographic Fingerprint （2012 edition） were used to establish fingerprints of 14 batches of cultivated A. asphodeloides and 14 batches of wild medicinal materials ，and evaluate their similarity. The common peaks were identified by comparison with the chromatogram of the mixed control. At the same time ，the contents of components corresponding to common peaks in cultivated and wild A. asphodeloides were determined. The principal component analysis and orthogonal partial least squares discrimination analysis were adopted to identify differential components of them ，and compare the contents of them. RESULTS Among 28 batches of A. asphodeloides ，10 common peaks were found ，i.e. neomangiferin（peak 1），mangiferin（peak 2），isomangiferin（peak 3），timosaponin B Ⅱ（peak 7），timosaponin B Ⅲ（peak 8）， timosaponin Ⅰ（peak 9），timosaponin A Ⅲ（peak 10）. The similarities of fingerprints of samples with control fingerprint were no less than 0.963. The average total contents of seven components in cultivated and wild A. asphodeloides were 74.18 and 84.72 mg/g， respectively；there was statistical significance （P＜0.05）. The cultivated and wild A. asphodeloides could be divided into two categories. The differential components were neomangiferin ，mangiferin，timosaponin B Ⅱ and timosaponin A Ⅲ（VIP values were all higher than 1）. The content of neomangiferin in cultivated products was significantly higher than that in wild products （P＜ 0.05），and the contents of mangiferin ，timosaponin B Ⅱ and ti mosaponin A Ⅲ were significantly lower than those in wild products （P＜0.05）. CONCLUSIONS Fingerprint of A. asphodeloides is established ，and differential components of cultivated and wild A. asphodeloides are identified primarily.

BACKGROUND: Rheumatoid arthritis (RA), a chronic systemic autoimmune disease, is characterized by synovitis and progressive damage to the bone and cartilage of the joints, leading to disability and reduced quality of life. This study was a randomized clinical trial comparing the outcomes between withdrawal and dose reduction of tofacitinib in patients with RA who achieved sustained disease control. METHODS: The study was designed as a multicenter, open-label, randomized controlled trial. Eligible patients who were taking tofacitinib (5 mg twice daily) and had achieved sustained RA remission or low disease activity (disease activity score in 28 joints [DAS28] ≤3.2) for at least 3 months were enrolled at six centers in Shanghai, China. Patients were randomly assigned (1:1:1) to one of three treatment groups: continuation of tofacitinib (5 mg twice daily); reduction in tofacitinib dose (5 mg daily); and withdrawal of tofacitinib. Efficacy and safety were assessed up to 6 months. RESULTS: Overall, 122 eligible patients were enrolled, with 41 in the continuation group, 42 in the dose-reduction group, and 39 in the withdrawal group. After 6 months, the percentage of patients with a DAS28-erythrocyte sedimentation rate (ESR) of <3.2 was significantly lower in the withdrawal group than that in the reduction and continuation groups (20.5%, 64.3%, and 95.1%, respectively; P  < 0.0001 for both comparisons). The average flare-free time was 5.8 months for the continuation group, 4.7 months for the dose reduction group, and 2.4 months for the withdrawal group. CONCLUSION: Withdrawal of tofacitinib in patients with RA with stable disease control resulted in a rapid and significant loss of efficacy, while standard or reduced doses of tofacitinib maintained a favorable state. TRIAL REGISTRATION Chictr.org, ChiCTR2000039799.
Humans ; Quality of Life ; China ; Arthritis, Rheumatoid/drug therapy* ; Piperidines/therapeutic use* ; Treatment Outcome ; Antirheumatic Agents/therapeutic use* ; Pyrroles/therapeutic use*