OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

As artificial intelligence technology rapidly advances, its deployment within the medical sector presents substantial ethical challenges. Consequently, it becomes crucial to create a standardized, transparent, and secure framework for processing medical data. This includes setting the ethical boundaries for medical artificial intelligence and safeguarding both patient rights and data integrity. This consensus governs every facet of medical data handling through artificial intelligence, encompassing data gathering, processing, storage, transmission, utilization, and sharing. Its purpose is to ensure the management of medical data adheres to ethical standards and legal requirements, while safeguarding patient privacy and data security. Concurrently, the principles of compliance with the law, patient privacy respect, patient interest protection, and safety and reliability are underscored. Key issues such as informed consent, data usage, intellectual property protection, conflict of interest, and benefit sharing are examined in depth. The enactment of this expert consensus is intended to foster the profound integration and sustainable advancement of artificial intelligence within the medical domain, while simultaneously ensuring that artificial intelligence adheres strictly to the relevant ethical norms and legal frameworks during the processing of medical data.
Artificial Intelligence/legislation & jurisprudence* ; Humans ; Consensus ; Computer Security/standards* ; Confidentiality/ethics* ; Informed Consent/ethics*

Myocardial infarction (MI) is one of the leading causes of death in the world. With the improvement of clinical therapy, the mortality of acute MI has been significantly reduced. However, as for the long-term impact of MI on cardiac remodeling and cardiac function, there is no effective prevention and treatment measures. Erythropoietin (EPO), a glycoprotein cytokine essential to hematopoiesis, has anti-apoptotic and pro-angiogenetic effects. Studies have shown that EPO plays a protective role in cardiomyocytes in cardiovascular diseases, such as cardiac ischemia injury and heart failure. EPO has been demonstrated to protect ischemic myocardium and improve MI repair by promoting the activation of cardiac progenitor cells (CPCs). This study aimed to investigate whether EPO can promote MI repair by enhancing the activity of stem cell antigen 1 positive stem cells (Sca-1⁺ SCs). Darbepoetin alpha (a long-acting EPO analog, EPO_anlg) was injected into the border zone of MI in adult mice. Infarct size, cardiac remodeling and performance, cardiomyocyte apoptosis and microvessel density were measured. Lin^- Sca-1⁺ SCs were isolated from neonatal and adult mouse hearts by magnetic sorting technology, and were used to identify the colony forming ability and the effect of EPO, respectively. The results showed that, compared to MI alone, EPO_anlg reduced the infarct percentage, cardiomyocyte apoptosis ratio and left ventricular (LV) chamber dilatation, improved cardiac performance, and increased the numbers of coronary microvessels in vivo. In vitro, EPO increased the proliferation, migration and clone formation of Lin^- Sca-1⁺ SCs likely via the EPO receptor and downstream STAT-5/p38 MAPK signaling pathways. These results suggest that EPO participates in the repair process of MI by activating Sca-1⁺ SCs.
Animals ; Mice ; Ventricular Remodeling ; Erythropoietin ; Myocardial Infarction ; Heart ; Stem Cells

OBJECTIVES: To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China. METHODS: A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups. RESULTS: Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05). CONCLUSIONS There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.
Bronchopulmonary Dysplasia/epidemiology* ; Female ; Gestational Age ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Pregnancy ; Respiratory Distress Syndrome, Newborn/epidemiology* ; Retrospective Studies ; Treatment Outcome

Carcinoma, Hepatocellular ; Hemangiosarcoma ; Humans ; Liver Neoplasms ; Lung Neoplasms ; Palatine Tonsil

Objective:To explore the feasibility of preparing an iodine-coated titanium plate with potassium iodide and verify its antibacterial performance.Methods:Iodine was coated onto the surface of a titanium plate in electrolyte of potassium iodide using the electrophoretic deposition method. The signs and composition of the surface of the iodine-coated titanium plate were observed by scanning electron microscopy and energy dispersive spectroscopy. The experiment was conducted in a control group and 3 antibacterial test groups. The control group consisted of 10 titanium plates which had been pretreated but not loaded with iodine; the 3 experimental groups also had in each 10 titanium plates which had been pretreated and loaded with iodine in the electrolytes of concentrations of 1,000 mg/L, 2,000 mg/L and 4,000 mg/L, respectively. The antimicrobial tests in vitro were conducted with standard strains of staphylococcus aureus [1×10 6 Colony-Forming Units (CFU)/mL ATCC25923] to determine the antibacterial property of the plates. Results:The iodine-coated titanium plates appeared grey and their surface was evenly covered with a flat coating with no collapse. The scanning electron microscopy observed on the surface of the iodine-coated titanium plates an iodine coating with scattered irregular collapses in different sizes. The iodine content was 0 mass%, 5.10 mass%, 10.32 mass% and 15.05 mass%, respectively, in the control, 1,000 mg/L, 2,000 mg/L and 4 000 mg/L groups under the energy dispersive spectroscopy. Their counts of in vitro antibacterial colony were 56.00±5.09, 21.40±2.76, 9.10±2.51, and 2.00±1.88, respectively, showing significant differences between groups ( P< 0.05). Conclusions:A titanium plate with a steady and even iodine coating can be prepared by virtue of the electrophoretic deposition method in electrolyte of potassium iodide. The antibacterial property of an iodine-coated titanium plate is superior to that of a titanium plate without iodine coating.

Eight C_(19)-diterpenoid alkaloids( 1-8) were isolated from the ethyl acetate soluble fraction of 95% ethanol extract of the ground roots of Aconitum austroyunnanense through various column chromatographies on silica gel,ODS,Sephadex LH-20 and MCI gel.Their structures were elucidated as 14α-benzoyloxy-13β,15α-dihydroxy-1α,6α,8β,16β,18-pentamethoxy-19-oxoaconitan( 1),N-deethylaconitine( 2),spicatine B( 3),leucanthumsine A( 4),acofamine B( 5),macrorhynine B( 6),aconitilearine( 7),and ambiguine( 8) based on their chemical and physicochemical properties and spectroscopic data. Compound 1 was a new compound and alkaloids 2-8 were isolated from this plant for the first time. Some isolated alkaloids were tested in vitro for cytotoxic potential by employing the MTT method. As a result,alkaloid 1 exhibited weak cytotoxic activity against three tested tumor cell lines( A-549,He La,and Hep G2) with IC_(50) values less than 20 μmol·L~(-1).
Aconitum ; Alkaloids ; Diterpenes ; Molecular Structure ; Plant Roots

AIM: To investigate the changes and effects of orthokeratology on corneal morphology. METHODS: Totally 90 patients were treated with orthokeratology from January 2015 to December 2016. They were divided into observation group (overnight wearing) and control group(daytime wearing),45 cases (90 eyes) in each. The central corneal thickness, corneal curvature, spherical equivalent (SE), uncorrected visual acuity (UCVA) of both groups were compared before and after wearing orthokeratology lens for 1wk,1,3,and 6mo. RESULTS: The central corneal thickness of two groups before wearing glasses was significantly higher than that of the cornea after wearing glasses 1wk,1,3 and 6mo(all P<0.05); the central corneal thickness of the observation group at 1, 3 and 6mo after wearing glasses was significantly lower than that of the control group (P<0 05). The corneal curvature values of the two groups before wearing glasses were significantly higher than that of the cornea after wearing for 1wk,1,3 and 6mo (all P<0.05). The corneal curvature of observation group at 6mo was significantly lower than that of the control group (40.0士0.5D vs 41.3士0.9D, P<0.05). The staining rate of corneal epithelium was observed at 3mo after wearing glasses. The positive rate of epithelial staining was 49% (44/90) in the observation group and 29% (26/90) in the comparison group;the grade 0,grade 1 accounted for the majority of the two groups. With the orthokeratology lens wearing longer, the SE level of two groups showed a downward trend. The spherical equivalent of observation group at 6mo was significantly lower than that of the control group (-0.42士0.20D vs -0 52士0.19D, P<0.05). The UCVA value of two groups after wearing glasses significantly increased than that before wearing glasses (all P<0.05). CONCLUSION: Wearing orthokeratology lens can reduce myopia degree. Wearing it overnight has the better outcome than wearing in the daytime.