BACKGROUND:Rheumatoid arthritis is a complex autoimmune disease characterized by joint swelling,pain,and progressive damage.The basic pathological changes include synovitis and pannus formation,with T lymphocyte infiltration being the key to its pathogenesis.In recent years,the application of traditional Chinese medicine(TCM)monomers in the treatment of rheumatoid arthritis has attracted increasing attention.They have shown long-lasting effcacy and fewer side effects by regulating the T helper cell 17(Th17)/regulatory T cells(Treg)balance in the treatment of rheumatoid arthritis.OBJECTIVE:To discuss the mechanisms by which TCM monomers regulate the Th17/Treg balance to treat rheumatoid arthritis,based on the latest basic research,providing a solid theoretical basis for future applications of TCM in the treatment of rheumatoid arthritis.METHODS:Using keywords such as"rheumatoid arthritis,Th17/Treg,traditional Chinese medicine,Chinese herbal monomer,"and their Chinese equivalents,literature searches were conducted in PubMed,Web of Science,Embase,Cochrane,VIP,CBM,CNKI,and WanFang databases for relevant studies from their inception to August 2024.Inclusion and exclusion criteria were established,and the articles were screened by reading the titles,abstracts,and full texts.Finally,57 relevant articles were included.RESULTS AND CONCLUSION:(1)TCM monomers have immunoregulatory effects in the treatment of rheumatoid arthritis.They exert therapeutic effects by maintaining the Th17/Treg balance through the regulation of transcription factors,cytokines,signaling pathways,and miRNAs.(2)There may be synergistic effects among some TCM monomers,but the specific mechanisms and enhancement effects in regulating the Th17/Treg balance require further exploration.(3)Regulating the Th17/Treg balance using TCM monomers may become a key clinical therapy for the treatment of rheumatoid arthritis.

Objective To analyze the application effect of anterolateral femoral free flap transplantation based on three-dimensional reconstruction in CT angiography in the treatment of chronic osteomyelitis of the foot and ankle complicated with soft tissues defect.Methods A retrospective analysis was conducted on the clinical data of 105 patients with chronic osteomyelitis of the foot and ankle complicated with soft tissues defect who were admitted to Suining Central Hospital in Sichuan Province from January 2020 to January 2023.Patients enrolled were divided into the control group(n=52)and the observation group(n=53)according to different perforating blood vessel examination methods before surgery.The control group underwent anterolateral femoral free flap transplantation based on handheld Doppler ultrasound,while the observation group underwent anterolateral femoral free flap transplantation based on CTA three-dimensional reconstruction technology.Comparison between the groups was made on inflammatory factors(CRP,TNF-α and IL-6),skin flap repair effect,foot and ankle function(AOFAS)score,flap sensation,survival rate of skin flaps,and the incidence of adverse events.Results On day 14 after operation,serum CRP,TNF-α and IL-6 levels in the observation group were lower than those in the control group(P＜0.05).Six months after operation,the effect of flap repair in observation group was better than that in control group,and the survival rate of flap was higher than that in control group(100.00％vs 92.31％)(P＜0.05).Twelve months after operation,AOFAS score and flap sensation score of the observation group were higher(P＜0.05).The incidence of adverse events was lower in the observation group than in the control group(3.77％ vs.15.38％)(P＜0.05).Conclusion Anterolateral femoral free flap transplantation based on CTA 3D reconstruction technique can repair soft tissue defect and reduce the risk of adverse events while can cure chronic osteomyelitis.

Objective:To establish and validate a predictive model for non-curative resection of rectal neuroendocrine tumors (R-NETs) ≤20 mm.Methods:Data from patients with R-NETs treated at the First Affiliated Hospital of Soochow University and the Suzhou Ninth People's Hospital from January 2013 to December 2023 were retrospectively analyzed. Clinical data, endoscopic findings, and pathological characteristics were analyzed. Univariate analysis was performed using independent sample t-tests and Chi-square tests. Variables were screened using the forward stepwise binary logistic regression to establish a risk prediction model for non-curative resection of R-NETs ≤20 mm, with subsequent construction of a nomogram. The performance of the model was evaluated using the receiver operating characteristic (ROC) curve. The consistency between predicted and observed probabilities was assessed using calibration curves, and the clinical net benefit of the model was evaluated using decision curve analysis. Results:A total of 213 patients were included, with age of 50.53±11.42 years, and 102 (47.9%) were male. The distance of the lesion from the dentate line was 7.11±2.79 cm, and the tumor long diameter was 8.24±3.75 mm. Compared to curative resection cases, non-curative resection cases were more likely to exhibit tumor surface depression, higher tumor G-stage, higher Ki-67 index and higher chromograninA (CgA) positivity rate ( P<0.05). Through forward variable selection in binary logistic regression, a model was established with Ki-67 index ( P=0.014, OR=1.214, 95% CI: 1.039-1.417), surface depression ( P=0.027, OR=2.348, 95% CI: 1.100-5.013), and CgA positivity ( P<0.001, OR=5.399, 95% CI: 2.764-10.544) as parameters, with a corresponding nomogram. The area under the ROC curve of the model was 0.766 (95% CI: 0.696-0.837), and clinical decision curve analysis confirmed its good clinical net benefit. The calibration curve showed good consistency between predicted and observed probabilities. Conclusion:This study establishes a risk prediction model for non-curative resection of R-NETs ≤20 mm based on surface depression, Ki-67 index, and CgA positivity. The model demonstrates strong predictive performance and offers valuable guidance for clinical endoscopists.

Objective:To establish and validate a predictive model for non-curative resection of rectal neuroendocrine tumors (R-NETs) ≤20 mm.Methods:Data from patients with R-NETs treated at the First Affiliated Hospital of Soochow University and the Suzhou Ninth People's Hospital from January 2013 to December 2023 were retrospectively analyzed. Clinical data, endoscopic findings, and pathological characteristics were analyzed. Univariate analysis was performed using independent sample t-tests and Chi-square tests. Variables were screened using the forward stepwise binary logistic regression to establish a risk prediction model for non-curative resection of R-NETs ≤20 mm, with subsequent construction of a nomogram. The performance of the model was evaluated using the receiver operating characteristic (ROC) curve. The consistency between predicted and observed probabilities was assessed using calibration curves, and the clinical net benefit of the model was evaluated using decision curve analysis. Results:A total of 213 patients were included, with age of 50.53±11.42 years, and 102 (47.9%) were male. The distance of the lesion from the dentate line was 7.11±2.79 cm, and the tumor long diameter was 8.24±3.75 mm. Compared to curative resection cases, non-curative resection cases were more likely to exhibit tumor surface depression, higher tumor G-stage, higher Ki-67 index and higher chromograninA (CgA) positivity rate ( P<0.05). Through forward variable selection in binary logistic regression, a model was established with Ki-67 index ( P=0.014, OR=1.214, 95% CI: 1.039-1.417), surface depression ( P=0.027, OR=2.348, 95% CI: 1.100-5.013), and CgA positivity ( P<0.001, OR=5.399, 95% CI: 2.764-10.544) as parameters, with a corresponding nomogram. The area under the ROC curve of the model was 0.766 (95% CI: 0.696-0.837), and clinical decision curve analysis confirmed its good clinical net benefit. The calibration curve showed good consistency between predicted and observed probabilities. Conclusion:This study establishes a risk prediction model for non-curative resection of R-NETs ≤20 mm based on surface depression, Ki-67 index, and CgA positivity. The model demonstrates strong predictive performance and offers valuable guidance for clinical endoscopists.

Objective To analyze the application effect of anterolateral femoral free flap transplantation based on three-dimensional reconstruction in CT angiography in the treatment of chronic osteomyelitis of the foot and ankle complicated with soft tissues defect.Methods A retrospective analysis was conducted on the clinical data of 105 patients with chronic osteomyelitis of the foot and ankle complicated with soft tissues defect who were admitted to Suining Central Hospital in Sichuan Province from January 2020 to January 2023.Patients enrolled were divided into the control group(n=52)and the observation group(n=53)according to different perforating blood vessel examination methods before surgery.The control group underwent anterolateral femoral free flap transplantation based on handheld Doppler ultrasound,while the observation group underwent anterolateral femoral free flap transplantation based on CTA three-dimensional reconstruction technology.Comparison between the groups was made on inflammatory factors(CRP,TNF-α and IL-6),skin flap repair effect,foot and ankle function(AOFAS)score,flap sensation,survival rate of skin flaps,and the incidence of adverse events.Results On day 14 after operation,serum CRP,TNF-α and IL-6 levels in the observation group were lower than those in the control group(P＜0.05).Six months after operation,the effect of flap repair in observation group was better than that in control group,and the survival rate of flap was higher than that in control group(100.00％vs 92.31％)(P＜0.05).Twelve months after operation,AOFAS score and flap sensation score of the observation group were higher(P＜0.05).The incidence of adverse events was lower in the observation group than in the control group(3.77％ vs.15.38％)(P＜0.05).Conclusion Anterolateral femoral free flap transplantation based on CTA 3D reconstruction technique can repair soft tissue defect and reduce the risk of adverse events while can cure chronic osteomyelitis.

BACKGROUND:Rheumatoid arthritis is a complex autoimmune disease characterized by joint swelling,pain,and progressive damage.The basic pathological changes include synovitis and pannus formation,with T lymphocyte infiltration being the key to its pathogenesis.In recent years,the application of traditional Chinese medicine(TCM)monomers in the treatment of rheumatoid arthritis has attracted increasing attention.They have shown long-lasting effcacy and fewer side effects by regulating the T helper cell 17(Th17)/regulatory T cells(Treg)balance in the treatment of rheumatoid arthritis.OBJECTIVE:To discuss the mechanisms by which TCM monomers regulate the Th17/Treg balance to treat rheumatoid arthritis,based on the latest basic research,providing a solid theoretical basis for future applications of TCM in the treatment of rheumatoid arthritis.METHODS:Using keywords such as"rheumatoid arthritis,Th17/Treg,traditional Chinese medicine,Chinese herbal monomer,"and their Chinese equivalents,literature searches were conducted in PubMed,Web of Science,Embase,Cochrane,VIP,CBM,CNKI,and WanFang databases for relevant studies from their inception to August 2024.Inclusion and exclusion criteria were established,and the articles were screened by reading the titles,abstracts,and full texts.Finally,57 relevant articles were included.RESULTS AND CONCLUSION:(1)TCM monomers have immunoregulatory effects in the treatment of rheumatoid arthritis.They exert therapeutic effects by maintaining the Th17/Treg balance through the regulation of transcription factors,cytokines,signaling pathways,and miRNAs.(2)There may be synergistic effects among some TCM monomers,but the specific mechanisms and enhancement effects in regulating the Th17/Treg balance require further exploration.(3)Regulating the Th17/Treg balance using TCM monomers may become a key clinical therapy for the treatment of rheumatoid arthritis.

Objective:To explore the clinical effects of combined surgical and high-frequency electro-acupuncture treatment for aesthetic restoration in children with eyelid split nevus.Methods:A retrospective analysis was conducted on the medical records of children treated for eyelid split nevus in the Plastic Surgery Department of the First Affiliated Hospital of Army Medical University from January 2019 to December 2023. All cases underwent combined surgical excision and high-frequency electro-acupuncture vaporization. Surgical removal was used for nevi with significant pigmentation and deep involvement, and high-frequency electro-acupuncture was simultaneously applied to vaporize residual superficial pigmentation layer by layer based on the depth of the pigmentation. The wounds were repaired using either direct suturing or local flap transfer. Postoperative management included the application of growth factors and anti-scar treatments. Postoperative healing, adverse effects, and pigment clearance rate (categorized as healed, significant effect, improved, or ineffective) were observed by comparsons of the pre-treatment and the last follow-up photographs. Eyelid function, appearance, and scar hypertrophy were assessed during follow-up, and family satisfaction (categorized as very satisfied, satisfied, or dissatisfied) was surveyed via telephone.Results:Five children were included, with one male and four females aged between 2 and 10 years (average 7 years). Pigment areas ranged from 0.3 cm × 0.5 cm to 1.7 cm × 1.1 cm, with surgical excision areas from 0.3 cm × 0.4 cm to 1.5 cm × 1.1 cm. All children had good wound healing without complications such as infection, flap ischemic necrosis, wound dehiscence or bleeding. The pigment clearance rate was over 90%, achieving a healed effect. During the follow-up of 14 to 48 months (average 24.2 months), all patients had normal eyelid function without difficulties in opening or closing the eyes, or epiphora. The eyelid appearance was satisfactory without asymmetry, ptosis, ectropion or hypertrophic scars. The aesthetic outcomes and functionality of the eyelids were ideal, and satisfaction was generally rated as very satisfied.Conclusion:Surgical removal combined with high-frequency electro-acupuncture is beneficial for preserving aesthetic appearance while pigmentation in children with eyelid split nevus is removed, offering a new treatment option.

Objective To explore the effects of simethicone on gastrointestinal hormones,intestinal floras and inflammatory process mediated by NOD-like receptor protein 3(NLRP3)inflammasome in patients with irritable bowel syndrome(IBS).Methods A total of 120 patients with IBS admitted to the hospital were prospectively enrolled as the research objects between January 1,2021 and December 31,2022,and they were randomly divided into control group(60 cases)and treatment group(60 cases).The control group was treated with compound eosinophil-Lactobacillus,while treatment group was additionally treated with simethicone.The curative effect after treatment,scores of gastrointestinal symptom rating scale(GSRS),levels of somatostatin(SS),vasoactive intestinal peptide(VIP),NLRP3 inflammasome,interleukin-8(IL-8)and interleukin-1β(IL-1β),counts of intestinal floras before and after treatment,and safety during treatment were compared between the two groups.Results After treatment,total response rate of treatment group was higher than that of control group(91.67% vs.76.67% ,P<0.05).After treatment,GSRS scores in both groups were decreased,which were lower in treatment group than control group(P<0.05).After treatment,levels of SS and VIP in both groups were decreased,which were lower in treatment group than control group(P<0.05).After treatment,counts of eosinophil-Lactobacillus and Bifidobacteria were increased in both groups,the difference was statistically significant(P<0.05),but there was no significant difference in counts of intestinal floras between the two groups(P>0.05).After treatment,levels of NLRP3 inflammasome,IL-8 and IL-1β were decreased in both groups,the difference was statistically significant(P<0.05),but there was no significant difference between the two groups(P>0.05).During treatment,there was no significant difference in side effects between the two groups(P>0.05).Conclusion Simethicone can significantly improve response rate of treatment,improve gastrointestinal symptoms and gastrointestinal hormones in IBS patients,which has no significant effects on intestinal floras and inflammatory process mediated by NLRP3 inflammasome,with good safety.

Objectives:Distolingual root of the permanent mandibular first molar(PMFM-DLR)has been frequently reported,which may complicate the treatment of periodontitis.This study aimed to assess the morphological features of PMFM-DLR and investigate the correlation between the morphological features of PMFM-DLR and periodontal status in patients with Eastern Chinese ethnic background.Materials and methods:A total of 836 cone beam computed tomography(CBCT)images with 1497 mandibular first molars were analyzed to observe the prevalence of PMFM-DLR at the patients and tooth levels in Eastern China.Among them,complete periodontal charts were available for 69 Chinese patients with 103 teeth.Correlation and regression analyses were used to evaluate the correlation between the morphological features of DLR,bone loss,and periodontal clinical parameters,including clinical attachment loss(CAL),probing pocket depth(PPD),gingival recession(GR),and furcation involvement(FI).Results:The patient-level prevalence and tooth-level prevalence of DLR in mandibular first molars were 29.4%and 26.3%,respectively.Multiple linear regression analysis suggested that bone loss at the lingual site and CAL were negatively affected by the angle of separation between distolingual and mesial roots in the transverse section,while they were significantly influenced by age and the angle of separation between distobuccal and mesial roots in the coronal section.Conclusions:The prevalence of PMFM-DLR in Eastern China was relatively high in our cohort.The morphological features of DLR were correlated with the periodontal status of mandibular first molars.This study provides critical information on the morphological features of DLR for improved diagnosis and treatment options of mandibular molars with DLR.

Objective This study aims to assess the role of DNA methylation changes in tongue cancer through a comprehensive analysis of global DNA methylation alterations during experimental lingual carcinogenesis.Methods C57BL/6J mice were subjected to 16-week oral administration of 4-nitroquinoline-1-oxide(4NQO,50 mg/L).Lingual mucosa samples,being representative of normal tissue(week 0)and early(week 12)and advanced(week 28)tumorigen-esis,were harvested for microarray and methylated DNA immunoprecipitation sequencing(MeDIP-Seq).The mRNA and promoter methylation of transforming growth factor-beta-signaling protein 1(SMAD1)were evaluated with real-time quantitative reverse transcription polymerase chain reaction and Massarray in human lingual mucosa and tongue cancer cell lines.Results The cytosine guanine island(CGI)methylation level observed at 28 weeks surpassed that of both 12 weeks and 0 weeks.The promoter methylation level at 12 weeks exceeded that at 0 weeks.Notably,208 differentially expressed genes were negatively correlated to differential methylation in promoters among 0,12,and 28 weeks.The mRNA of SMAD1 was upregulated,con-current with a decrease in promoter methylation levels in cell lines compared to normal mucosa.Conclusion DNA methylation changed during lingual carcinogenesis.Overexpression of SMAD1 was correlated to promoter hypomethyl-ation in tongue cancer cell lines.