OBJECTIVE To evaluate the efficacy and safety of total glucosides of paeonia （TGP） in the treatment of systemic lupus erythematosus （SLE）. METHODS Randomized controlled trial （RCT） about TGP combined with western medicine versus western medicine alone for SLE treatment were retrieved from PubMed， Embase， Cochrane Library， Web of Science， CNKI， VIP， Wanfang Data， and CBM. The search period spanned from the inception of each database to June 1， 2025. After literature screening， data extraction， and quality assessment of the included studies， Meta-analysis was performed using RevMan 5.4 software. RESULTS Fifteen RCTs， involving 1 318 patients， were included. Meta-analysis results showed that compared with western medicine alone， TGP combined with western medicine significantly improved clinical efficacy [OR＝4.96， 95%CI（3.41， 7.23）， P＜0.000 01]， complement 3 [MD＝0.18， 95%CI （0.13， 0.23）， P＜0.000 01] and complement 4[MD＝0.08， 般021） 95%CI （0.04， 0.11）， P＜0.000 01]， and reduced the levels of immunoglobulin G （IgG） [MD＝－3.10， 95%CI （－3.59，－2.62）， P＜0.000 01]， IgA [MD＝－0.68， 95%CI （－0.78， －0.58）， P＜0.000 01]， IgM [MD＝－0.43， 95%CI （－0.53，－0.34）， P＜0.000 01]， systemic lupus erythematosus disease activity index （SLEDAI） [MD＝－1.59， 95%CI （－2.20， －0.99）， P＜0.000 01]， recurrence rate [OR＝0.23， 95%CI （0.13， 0.42）， P＜0.000 01] and the incidence of adverse drug reactions [OR＝ 0.54， 95%CI （0.36， 0.82）， P＝0.004]. CONCLUSIONS TGP therapy can improve clinical efficacy of SLE patients， promote the restoration of immunoglobulins and complements， reduce SLEDAI and recurrence rate and has good safety.

Objective: Spinal stenosis and degenerative spinal disorders are increasingly prevalent and have a substantial impact on quality of life. Surgical decompression, performed using either open microscopic or endoscopic approaches, remains a cornerstone of management for these conditions. This study examines evolving trends in single-level lumbar spinal decompression procedures performed at a tertiary academic hospital in Singapore. Methods: A retrospective observational study was conducted involving 588 patients who underwent single-level spinal decompression between 2021 and 2024, including endoscopic spine surgery (ESS; n=364) and microdecompression (n=224). Primary outcome measures were changes in 36-Item Short Form Health Survey (SF-36) and visual analogue scale (VAS) scores at 3 months, 6 months, and 2 years postoperatively. Secondary outcomes included length of hospital stay, reoperation rates, and operative time. Patient demographics, spinal level and pathology characteristics, surgical techniques, and postoperative outcomes were analyzed. Difference-in-differences (DID) analysis was used to compare outcomes between the 2 groups. Results: Both groups demonstrated significant postoperative improvements in SF-36 and VAS scores. At 2 years, Short Form Health Survey physical function (SFPF) scores improved in the endoscopic group (mean difference [MD], 18.6; standard deviation [SD], 21.7; p=0.064) and in the open microscopic group (MD, 36.7; SD, 20.9; p=0.007), with a non-significant DID of -18.1 (p=0.155). No DID comparisons across SF-36 domains reached statistical significance. Mean operative time for endoscopic procedures decreased from 249 minutes in 2022 to 145 minutes in 2024, reflecting a procedural learning curve. Surgeons with higher endoscopic caseloads exhibited greater improvements in functional outcomes. Conclusion Both endoscopic and open microscopic decompression achieve comparable short- and long-term clinical outcomes. ESS provides similar effectiveness while being associated with shorter recovery periods and reduced hospital stay. Further research is warranted to identify factors contributing to incomplete symptom resolution or the need for revision surgery.

This study explores whether the current external quality assessment (EQA) level and acceptable bias for basic semen analysis in China are clinically useful. We collected data of semen EQA from Andrology laboratories in the Hunan Province (China) in 2022 and searched for data in the published literature from January 2000 to December 2023 in China. On the basis of these data, we analyzed the coefficients of variation and acceptable biases of different quality control materials for basic semen analysis through robust statistics. We compared these findings with quality specifications based on biological variation from optimal, desirable, and minimum levels of bias to seek a unified and more suitable semen EQA bias evaluation standard for China's national conditions. Different sources of semen quality control material exhibited considerable variation in acceptable biases among laboratories, ranging from 8.2% to 56.9%. A total of 50.0% of the laboratories met the minimum quality specifications for progressive motility (PR), whereas 100.0% and 75.0% of laboratories met only the minimum quality specifications for sperm concentration and total motility (nonprogressive [NP] + PR), respectively. The Z value for sperm concentration and PR+NP was equivalent to the desirable performance specification, whereas the Z value for PR was equivalent only to the minimum performance specification. This study highlights the feasibility of operating external quality assessment schemes for basic semen analysis using quality specifications based on biological variation. These specifications should be unified among external quality control (EQC) centers based on biological variation.
Semen Analysis/standards* ; Humans ; China ; Male ; Quality Control ; Sperm Motility ; Sperm Count/standards*

INTRODUCTION: Trastuzumab deruxtecan (T-DXd) has revolutionised treatment for metastatic breast cancer (MBC). While effective, its high cost and toxicities, such as fatigue and nausea, pose challenges. METHOD: Medical records from the Joint Breast Cancer Registry in Singapore were used to study MBC patients treated with T-DXd (February 2021-June 2024). This study was conducted to address whether reducing dose intensity and density may have an adverse effect on treatment outcomes. RESULTS: Eighty-seven MBC patients were treated with T-DXd, with a median age of 59 years. At the time of data cutoff, 32.1% of patients were still receiving T-DXd. Over half (54%) of the patients received treatment with an initial relative dose intensity (RDI) of <;85%. Overall median real-world progression-free survival (rwPFS) was 8.1 months. rwPFS was similar between RDI groups (<85%: 8.7 months, <85%: 8.1 months, P=0.62). However, human epidermal growth receptor 2 (HER2)-positive patients showed significantly better rwPFS outcomes compared to HER2-low patients (8.8 versus 2.5 months, P<0.001). Only 16% with central nervous system (CNS) involvement had CNS progressive disease on treatment. No significant progression-free survival (PFS) differences were found between patients with or without CNS disease, regardless of RDI groups. Five patients (5.7%) developed interstitial lung disease (ILD), with 3 (3.4%) having grade 3 events. Two required high-dose steroids and none were rechallenged after ILD. There were no fatalities. CONCLUSION Our study demonstrated that reduced dose intensity and density had no significant impact on rwPFS or treatment-related toxicities. Furthermore, only 5.7% of patients developed ILD. T-Dxd provided good control of CNS disease, with 82% of patients achieving CNS disease control.
Humans ; Female ; Breast Neoplasms/mortality* ; Middle Aged ; Trastuzumab/adverse effects* ; Aged ; Adult ; Singapore/epidemiology* ; Antineoplastic Agents, Immunological/adverse effects* ; Camptothecin/adverse effects* ; Immunoconjugates/adverse effects* ; Retrospective Studies ; Progression-Free Survival ; Receptor, ErbB-2/metabolism* ; Neoplasm Metastasis ; Dose-Response Relationship, Drug ; Treatment Outcome ; Registries

Paraganglioma（PGL）is an extra-adrenal catecholamine-secreting endocrine tumor. We reported a young female patient who was admitted to the hospital with right flank pain and diagnosed with right retroperitoneal PGL with Mayo Ⅳ inferior vena cava tumor thrombus（double tumor thrombus）. After multidisciplinary consultation，right retroperitoneal PGL resection，right nephrectomy，inferior vena cava Mayo Ⅳ tumor thrombus resection and reconstruction were performed. Postoperative pathology showed that the primary tumor and inferior vena cava tumor thrombus was consistent with PGL. Genetic testing revealed a heterozygous germline nonsense mutation at c.69_70delinsTT（p.Q24*）locus of the SDHB gene in the patient. His mother was a carrier of the gene，but his father and sister did not carry the mutation. The patient recovered smoothly after surgery.

Objective:To observe the effects of early enteral nutrition(EN)intervention on neurological function,nutritional status,and inflammatory stress response in patients with severe traumatic brain injury.Methods:This study was a single-center prospective study,68 patients with severe traumatic brain injury were divided into control group[received parenteral nutrition(PN)intervention,n=34]and observation group(received early EN intervention,n=34)according to the envelope lottery method.The improvement of neurological function[serum central nervous system specific(S1 00(3)protein,national institutes of health stroke scale(NIHSS)score,myelin basic protein(MBP)],nutritional status[transferrin(TRF),total protein(TP),albumin(ALB)and prealbumin(PA)],inflammatory stress indicators[C-reactive protein(CRP),procalcitonin(PCT),glutathione peroxidase(GSH-PX),malondialdehyde(MDA)],daily living activity ability,quality of life,and incidence of complications between two groups were compared.Results:Compared with the control group after intervention,the observation group had lower NIHSS scores,S100[3 protein,MBP,CRP,PCT and MDA,had higher TRF,TP,ALB,PA,GSH-PX,improved Barthel index and world health organization quality of life assessment scale-100(WHOQOL-100)score(P＜0.05).There was no difference in the incidence of complications between the two groups(P＞0.05).Conclusion:Early EN intervention in patients with severe traumatic brain injury can effectively improve neurological function,nutritional status,and reduce the body's inflammatory stress response,which is worthy of clinical reference and application.

Pathological cardiac hypertrophy is an early and significant cardiac structural charac-teristic that contributes to the onset and progression of heart failure(HF).Its mainly structural feature is the abnormally enlarged cardiomyocyte.Effective intervention targets for abnormally en-larged cardiomyocyte remain to be identified.Previous studies have shown that the cellular shape and size can be regulated by the actin related protein 2/3(Arp2/3)complex,which is an actin-binding protein complex involved in the actin nucleation and assembly.However,the roles of the Arp2/3 complex in cardiomyocyte hypertrophy remain unknown.Here our study identifies its no-vel roles in the occurrence and development of cardiomyocyte hypertrophy.We found that mRNA levels of all subunits from the Arp2/3 complex are significantly upregulated(P<0.05)in the an-giotensin II(Ang Ⅱ)-induced neonatal rat primary and H9c2 cardiomyocyte hypertrophy.Fur-ther studies showed that siRNA-directed ARPC2 silencing inhibits the reactivation of fetal genes and enlargement of cardiomyocyte area induced by Ang Ⅱ in neonatal rat primary cardiomyocytes(NRCMs)and H9c2 cells(P<0.05).In addition,the upstream activators of the Arp2/3 com-plex including SH3 protein interacting with Nck,90 kD(SPIN90)and Ras-related C3 botulinum toxin substrate 1(Rac1)/WASp family Verprolin-homologous protein-2(WAVE-2)are upregu-lated(P<0.05)in Ang Ⅱ-induced neonatal rat primary and H9c2 cardiomyocyte hypertrophy,indicating the excessive activation of the Arp2/3 complex.We further show that CK666,a specif-ic Arp2/3 complex inhibitor,prevents the reactivation of fetal genes and the enlargement of car-diomyocyte area induced by Ang Ⅱ in NRCMs and H9c2 cells(P<0.05).Our results reveal that the Arp2/3 complex plays a crucial role in Ang Ⅱ-induced cardiomyocyte hypertrophy,which is beneficial to further studies about the molecular mechanisms by which the Arp2/3 complex regu-lates pathological cardiac hypertrophy.

Objective:To observe the effects of early enteral nutrition(EN)intervention on neurological function,nutritional status,and inflammatory stress response in patients with severe traumatic brain injury.Methods:This study was a single-center prospective study,68 patients with severe traumatic brain injury were divided into control group[received parenteral nutrition(PN)intervention,n=34]and observation group(received early EN intervention,n=34)according to the envelope lottery method.The improvement of neurological function[serum central nervous system specific(S1 00(3)protein,national institutes of health stroke scale(NIHSS)score,myelin basic protein(MBP)],nutritional status[transferrin(TRF),total protein(TP),albumin(ALB)and prealbumin(PA)],inflammatory stress indicators[C-reactive protein(CRP),procalcitonin(PCT),glutathione peroxidase(GSH-PX),malondialdehyde(MDA)],daily living activity ability,quality of life,and incidence of complications between two groups were compared.Results:Compared with the control group after intervention,the observation group had lower NIHSS scores,S100[3 protein,MBP,CRP,PCT and MDA,had higher TRF,TP,ALB,PA,GSH-PX,improved Barthel index and world health organization quality of life assessment scale-100(WHOQOL-100)score(P＜0.05).There was no difference in the incidence of complications between the two groups(P＞0.05).Conclusion:Early EN intervention in patients with severe traumatic brain injury can effectively improve neurological function,nutritional status,and reduce the body's inflammatory stress response,which is worthy of clinical reference and application.

Pathological cardiac hypertrophy is an early and significant cardiac structural charac-teristic that contributes to the onset and progression of heart failure(HF).Its mainly structural feature is the abnormally enlarged cardiomyocyte.Effective intervention targets for abnormally en-larged cardiomyocyte remain to be identified.Previous studies have shown that the cellular shape and size can be regulated by the actin related protein 2/3(Arp2/3)complex,which is an actin-binding protein complex involved in the actin nucleation and assembly.However,the roles of the Arp2/3 complex in cardiomyocyte hypertrophy remain unknown.Here our study identifies its no-vel roles in the occurrence and development of cardiomyocyte hypertrophy.We found that mRNA levels of all subunits from the Arp2/3 complex are significantly upregulated(P<0.05)in the an-giotensin II(Ang Ⅱ)-induced neonatal rat primary and H9c2 cardiomyocyte hypertrophy.Fur-ther studies showed that siRNA-directed ARPC2 silencing inhibits the reactivation of fetal genes and enlargement of cardiomyocyte area induced by Ang Ⅱ in neonatal rat primary cardiomyocytes(NRCMs)and H9c2 cells(P<0.05).In addition,the upstream activators of the Arp2/3 com-plex including SH3 protein interacting with Nck,90 kD(SPIN90)and Ras-related C3 botulinum toxin substrate 1(Rac1)/WASp family Verprolin-homologous protein-2(WAVE-2)are upregu-lated(P<0.05)in Ang Ⅱ-induced neonatal rat primary and H9c2 cardiomyocyte hypertrophy,indicating the excessive activation of the Arp2/3 complex.We further show that CK666,a specif-ic Arp2/3 complex inhibitor,prevents the reactivation of fetal genes and the enlargement of car-diomyocyte area induced by Ang Ⅱ in NRCMs and H9c2 cells(P<0.05).Our results reveal that the Arp2/3 complex plays a crucial role in Ang Ⅱ-induced cardiomyocyte hypertrophy,which is beneficial to further studies about the molecular mechanisms by which the Arp2/3 complex regu-lates pathological cardiac hypertrophy.

Objective:To analyze the clinical characteristics of patients with chronic obstructive pulmonary disease (COPD) complicated by fatigue.Methods:COPD patients enrolled in the RealDTC study from June 2023 to March 2024 were included. Demographic data, history of acute exacerbations in the past year, smoking status, biofuel exposure, occupational exposure, modified Medical Research Council (mMRC) dyspnea score, COPD Assessment Test (CAT) score, forced expiratory volume in the first second predicted of percentage (FEV 1%pred), forced expiratory volume in one second (FEV 1)/forced vital capacity (FVC), and comorbidities (bronchial asthma, bronchiectasis, tuberculosis, cardiovascular disease, diabetes mellitus) were collected. Fatigue was evaluated using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire, with a score ≤43 defined as fatigue. Patients were divided into fatigue and non-fatigue groups, and multivariate regression analysis was used to screen factors associated with fatigue in COPD patients. Results:A total of 597 COPD patients were included, of which 280(46.9%) had fatigue symptoms. Compared with non-fatigue patients, fatigue patients had lower FEV 1%pred, FEV 1/FVC, and body mass index (BMI), higher CAT and mMRC scores, and a higher proportion of occupational exposure, bronchiectasis, and treatment with long-acting β 2-agonists (LABA)/long-acting muscarinic antagonists (LAMA)/inhaled corticosteroids (ICS) (all P<0.05). Multivariate regression analysis showed that high CAT score ( OR=2.312, 95% CI: 1.366-3.911), high mMRC score ( OR=1.484, 95% CI: 1.053-2.091), occupational exposure ( OR=1.513, 95% CI: 1.082-2.116), comorbid bronchiectasis ( OR=2.452, 95% CI: 1.102-5.457), low BMI ( OR=0.935, 95% CI: 0.891-0.981), and high CAT-energy score ( OR=1.301, 95% CI: 1.149-1.473) were risk factors for fatigue in COPD patients. The CAT-energy score was highly correlated with the FACIT-F score ( r=0.260, P<0.001), and a CAT-energy score ≥2 could preliminarily screen COPD patients with fatigue. Conclusions:COPD patients with comorbid fatigue have a heavy symptom burden, are more likely to have a history of occupational exposure and bronchiectasis, and the CAT-energy score is of great reference value for screening COPD patients with fatigue.