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

Objective To analyze and compare the ability of two chemiluminescent immunoassay systems for detecting HBsAg mutant strains.Methods The two chemiluminescent immunoassay systems,I3000 and Liaison XL,were used to detect nine HBsAg mutant strains with known HBsAg mutation sites respectively,and to compare the detection ability of these two systems for the nine HBsAg mutant strains.The clinical serum samples that were negative for HBsAg by the I3000 system were reviewed by the Liaison XL system for HBsAg,qRT-PCR amplification primers were designed for the HBsAg mutant strains with positive results by the Liaison XL system,and fluorescence quantitative PCR and Hepatitis B serologic tests were performed on the clinical samples that had inconsistent negative-positive results between the two aforementioned systems.Results The Liaison XL detected all nine HBsAg mutant strains with known HBsAg mutation sites with positive results,whereas the I3000 detected six of them with positive but three with negative results.Using the Liaison XL system to test 1 520 samples from hospitalized patients who were negative for HBsAg with the I3000 detection system,four positive results were found,including one positive result by the fluorescence quantitative PCR assay,which belonged to the HBsAg mutant of the mutant strain P124L-F/Y143H-D144E-G145R and the patient's test values for HBeAb and HBcAb were high,suggesting that the patient was a minor triple positive.Conclusion Liaison XL can detect the P124L-F/Y143H-D144E-G145R HBsAg mutant in clinical samples,and it is very important to select HBsAg test reagents with strong HBsAg mutant recognition and capture ability.

Objective To analyze the relationship of red blood cell distribution width(RDW)and blood lipid metabolism indicators with carotid atherosclerotic plaque stability in elderly patients with acute cerebral infarction(ACI).Methods A total of 110 elderly ACI patients admitted in our hospital from March 2021 to November 2024 were retrospectively recruited,and according to their carotid plaque characteristics,they were divided into stable plaque group(48 cases)and unstable plaque group(62 cases).The RDW,and levels of TC,TG,HDLC,LDL-C and homocysteine(Hcy)were detected.Results The unstable plaque group had significantly higher levels of RDW,TC,TG,LDL-C and Hcy,but lower HDL-C level than the stable plaque group(P＜0.01).RDW,TC,TG,HDL-C,LDL-C and Hcy were the influencing factors of carotid atherosclerotic plaque stability in elderly ACI patients(P＜0.05,P＜0.01).ROC curve analysis suggested that the AUC value of combined detection of RDW,TC,TG,HDL-C,LDL-C and Hcy in evaluating the stability of carotid atherosclerotic plaque was 0.940(95％CI:0.898～0.983),and the combination had bet-ter efficiency than single indicator detection(P＜0.05).Conclusion RDW and blood lipid metabo-lism indicators are associated with the stability of carotid atherosclerotic plaque in elderly ACI patients,and they can be used as biochemical evaluation indicators for the stability.

Objective To analyze and compare the ability of two chemiluminescent immunoassay systems for detecting HBsAg mutant strains.Methods The two chemiluminescent immunoassay systems,I3000 and Liaison XL,were used to detect nine HBsAg mutant strains with known HBsAg mutation sites respectively,and to compare the detection ability of these two systems for the nine HBsAg mutant strains.The clinical serum samples that were negative for HBsAg by the I3000 system were reviewed by the Liaison XL system for HBsAg,qRT-PCR amplification primers were designed for the HBsAg mutant strains with positive results by the Liaison XL system,and fluorescence quantitative PCR and Hepatitis B serologic tests were performed on the clinical samples that had inconsistent negative-positive results between the two aforementioned systems.Results The Liaison XL detected all nine HBsAg mutant strains with known HBsAg mutation sites with positive results,whereas the I3000 detected six of them with positive but three with negative results.Using the Liaison XL system to test 1 520 samples from hospitalized patients who were negative for HBsAg with the I3000 detection system,four positive results were found,including one positive result by the fluorescence quantitative PCR assay,which belonged to the HBsAg mutant of the mutant strain P124L-F/Y143H-D144E-G145R and the patient's test values for HBeAb and HBcAb were high,suggesting that the patient was a minor triple positive.Conclusion Liaison XL can detect the P124L-F/Y143H-D144E-G145R HBsAg mutant in clinical samples,and it is very important to select HBsAg test reagents with strong HBsAg mutant recognition and capture ability.

Objective To analyze the relationship of red blood cell distribution width(RDW)and blood lipid metabolism indicators with carotid atherosclerotic plaque stability in elderly patients with acute cerebral infarction(ACI).Methods A total of 110 elderly ACI patients admitted in our hospital from March 2021 to November 2024 were retrospectively recruited,and according to their carotid plaque characteristics,they were divided into stable plaque group(48 cases)and unstable plaque group(62 cases).The RDW,and levels of TC,TG,HDLC,LDL-C and homocysteine(Hcy)were detected.Results The unstable plaque group had significantly higher levels of RDW,TC,TG,LDL-C and Hcy,but lower HDL-C level than the stable plaque group(P＜0.01).RDW,TC,TG,HDL-C,LDL-C and Hcy were the influencing factors of carotid atherosclerotic plaque stability in elderly ACI patients(P＜0.05,P＜0.01).ROC curve analysis suggested that the AUC value of combined detection of RDW,TC,TG,HDL-C,LDL-C and Hcy in evaluating the stability of carotid atherosclerotic plaque was 0.940(95％CI:0.898～0.983),and the combination had bet-ter efficiency than single indicator detection(P＜0.05).Conclusion RDW and blood lipid metabo-lism indicators are associated with the stability of carotid atherosclerotic plaque in elderly ACI patients,and they can be used as biochemical evaluation indicators for the stability.

In order to promote the development of hair transplantation, particularly the establishment of standards, the Hair Transplantation Expert Group of Plastic and Aesthetic National Medical Quality Control Center invited experts in the field of hair transplantation across China and formed a draft of the Expert Consensus on Standard Terminology for Hair Transplantation based on the collation of relevant literature and monographs. By combining Delphi methodology and consensus meetings, the expert group conducted several rounds of consultations on issues such as follicular unit anatomy, harvesting, dissection, and implantation, ultimately presenting 54 terminologies. This consensus considers the original Chinese and English meanings as well as the professional characteristics of terms used in hair transplantation, highlights the unique features and advantages of hair transplantation, and preserves its essence while promoting innovation, with the hope of providing valuable reference for clinical researchers engaged in hair transplantation both domestically and internationally, and better facilitating the standardization and advancement of the field.

In order to promote the development of hair transplantation, particularly the establishment of standards, the Hair Transplantation Expert Group of Plastic and Aesthetic National Medical Quality Control Center invited experts in the field of hair transplantation across China and formed a draft of the Expert Consensus on Standard Terminology for Hair Transplantation based on the collation of relevant literature and monographs. By combining Delphi methodology and consensus meetings, the expert group conducted several rounds of consultations on issues such as follicular unit anatomy, harvesting, dissection, and implantation, ultimately presenting 54 terminologies. This consensus considers the original Chinese and English meanings as well as the professional characteristics of terms used in hair transplantation, highlights the unique features and advantages of hair transplantation, and preserves its essence while promoting innovation, with the hope of providing valuable reference for clinical researchers engaged in hair transplantation both domestically and internationally, and better facilitating the standardization and advancement of the field.

Benign prostatic hyperplasia(BPH) is a common disease in middle-aged and elderly men, with lower urinary tract symptoms as the main manifestation, severely affecting the quality of life of patients. The pathogenesis of BPH is not yet fully understood, and there are still some challenges and limitations in western medicine treatment for BPH. Therefore, finding new and more effective treatment strategies is urgent. In recent years, many basic and clinical studies have confirmed the important role of traditional Chinese medicine in the treatment of BPH. This article reviews the progress of basic and clinical research in the treatment of BPH with traditional Chinese medicine, and believes that basic research mainly focuses on the active ingredients of Chinese medicine [regulating pathways such as NF-E2-related factor 2(Nrf2)/antioxidant response element(ARE), nuclear factor κB(NF-κB), epidermal growth factor receptor(EGFR)/signal transducer and activator of transcription 3(STAT3), phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)/mammalian target of rapamycin(mTOR), p38 mitogen-activated protein kinase(p38 MAPK)/forkhead box O subtype(FOXO3a), etc.], single Chinese herbs(regulating inflammatory factors, oxidative stress-related proteins, cell cycle-related proteins, and apoptotic factors, etc.), and Chinese herbal compounds and patent medicines [regulating extracellular signal-regulated kinase(ERK1/2), transforming growth factor-β(TGF-β)/Smad, mitogen-activated protein kinase(MAPK), PI3K/Akt, Nrf2, trefoil factor 2(TFF2)/Wnt, interleukin-6(IL-6)/Janus kinase 2(JAK2)/STAT3, hypoxia-inducible factor 1α(HIF-1α)/vascular endothelial growth factor receptor(VEGFR), etc.], and then play a therapeutic role by inhibiting BPH cell proliferation, oxidative stress, inflammatory response, promoting apoptosis, and inhibiting epithelial-mesenchymal transition. Clinical studies mainly focus on internal treatment, external treatment, combined internal and external treatment, and integrated Chinese and western medicine treatment as the main methods, aiming to improve traditional Chinese medicine syndrome scores, prostate symptom scores, residual urine volume, effective bladder volume, sexual quality of life, increase average urine flow rate, maximum urine flow rate, and promote balance of sex hormone secretion. Through this research, it is hoped to provide some reference ideas for clinical research and drug development for BPH.
Prostatic Hyperplasia/metabolism* ; Male ; Humans ; Drugs, Chinese Herbal/therapeutic use* ; Animals ; Signal Transduction/drug effects* ; Medicine, Chinese Traditional ; NF-E2-Related Factor 2/genetics*

OBJECTIVE: This study tests the efficacy of Bletilla striata polysaccharide (BSP), carboxymethyl chitosan (CMC), baicalin (BA) and silver titanate (ST) in a wound dressings to fight infection, promote healing and provide superior biocompatibility. METHODS: The antibacterial activity of BA and ST was evaluated in vitro using the inhibition zone method. BA/ST/BSP/CMC porous sponge dressings were prepared and characterized. The biocompatibility of BA/ST/BSP/CMC was assessed using the cell counting kit-8 assay. The therapeutic effect of BA/ST/BSP/CMC was further investigated using the dorsal skin burn model in Sprague-Dawley rats. RESULTS: The wound dressing had good antibacterial activity against Escherichia coli and Staphylococcus aureus through BA and ST, while the combination of BSP and CMC played an important role in promoting wound healing. The BA/ST/BSP/CMC porous sponge dressings were prepared using a freeze-drying method with the concentrations of BA and ST at 20 and 0.83 mg/mL, respectively, and the optimal ratio of 5% BSP to 4% CMC was 1:3. The average porosity, water absorption and air permeability of BA/ST/BSP/CMC porous sponge dressings were measured to be 90.43%, 746.1% and 66.60%, respectively. After treatment for 3 and 7 days, the healing rates of the BA/ST/BSP/CMC group and BA/BSP/CMC group were significantly higher than those of the normal saline (NS) group and silver sulfadiazine (SSD) group (P < 0.05). Interleukin-1β expression in the BA/ST/BSP/CMC group at 1 and 3 days was significantly lower than that in the other three groups (P < 0.05). After being treated for 3 days, vascular endothelial growth factor expression in the BA/BSP/CMC group and BA/ST/BSP/CMC group was significantly higher than that in the NS group and SSD group (P < 0.05). Inspection of histological sections showed that the BA/ST/BSP/CMC group and BA/BSP/CMC group began to develop scabbing and peeling of damaged skin after 3 days of treatment, indicating accelerated healing relative to the NS group and SSD group. CONCLUSION The optimized concentration of BA/ST/BSP/CMC dressing was as follows: 6 mg BSP, 14.4 mg CMC, 0.5 mg ST and 12 mg BA. The BA/ST/BSP/CMC dressing, containing antibacterial constituents, was non-cytotoxic and effective in accelerating the healing of burn wounds, making it a promising candidate for wound healing. Please cite this article as: Gong YR, Zhang C, Xiang X, Wang ZB, Wang YQ, Su YH, Zhang HQ. Baicalin, silver titanate, Bletilla striata polysaccharide and carboxymethyl chitosan in a porous sponge dressing for burn wound healing. J Integr Med. 2023; 21(5): 487-495.
Rats ; Animals ; Chitosan/pharmacology* ; Silver/pharmacology* ; Porosity ; Vascular Endothelial Growth Factor A/pharmacology* ; Rats, Sprague-Dawley ; Wound Healing ; Polysaccharides/pharmacology* ; Bandages ; Burns/drug therapy* ; Anti-Bacterial Agents/pharmacology* ; Silver Sulfadiazine/pharmacology*

This study aimed to observe the effect of terpinen-4-ol(T4O) on the proliferation of vascular smooth muscle cells(VSMCs) exposed to high glucose(HG) and reveal the mechanism via the Krüppel-like factor 4(KLF4)/nuclear factor kappaB(NF-κB) signaling pathway. The VSMCs were first incubated with T4O for 2 h and then cultured with HG for 48 h to establish the model of inflammatory injury. The proliferation, cell cycle, and migration rate of VSMCs were examined by MTT method, flow cytometry, and wound healing assay, respectively. The content of inflammatory cytokines including interleukin(IL)-6 and tumor necrosis factor-alpha(TNF-α) in the supernatant of VSMCs was measured by enzyme-linked immunosorbent assay(ELISA). Western blot was employed to determine the protein levels of proliferating cell nuclear antigen(PCNA), Cyclin D1, KLF4, NF-κB p-p65/NF-κB p65, IL-1β, and IL-18. The KLF4 expression in VSMCs was silenced by the siRNA technology, and then the effects of T4O on the cell cycle and protein expression of the HG-induced VSMCs were observed. The results showed that different doses of T4O inhibited the HG-induced proliferation and migration of VSMCs, increased the percentage of cells in G_1 phase, and decreased the percentage of cells in S phase, and down-regulated the protein levels of PCNA and Cyclin D1. In addition, T4O reduced the HG-induced secretion and release of the inflammatory cytokines IL-6 and TNF-α and down-regulated the expression of KLF4, NF-κB p-p65/NF-κB p65, IL-1β, and IL-18. Compared with si-NC+HG, siKLF4+HG increased the percentage of cells in G_1 phase, decreased the percentage of cells in S phase, down-regulated the expression of PCNA, Cyclin D1, and KLF4, and inhibited the activation of NF-κB signaling pathway. Notably, the combination of silencing KLF4 with T4O treatment further promoted the changes in the above indicators. The results indicate that T4O may inhibit the HG-induced proliferation and migration of VSMCs by down-regulating the level of KLF4 and inhibiting the activation of NF-κB signaling pathway.
NF-kappa B/metabolism* ; Interleukin-18/metabolism* ; Proliferating Cell Nuclear Antigen/genetics* ; Cyclin D1/metabolism* ; Tumor Necrosis Factor-alpha/metabolism* ; Muscle, Smooth, Vascular ; Cell Proliferation ; Signal Transduction ; Cytokines/metabolism* ; Glucose/metabolism*