Objective: To analyze the trend in burden of rheumatoid arthritis (RA) in China from 1990 to 2021, so as to provide insights into reducing the RA burden in China. Methods: Data of Global Burden of Disease Study 2021 were collected, and the incidence, mortality and disability-adjusted life years (DALY) of RA in China from 1990 to 2021 were analyzed and compared with global and different Socio-demographic Index (SDI) regions. The trend in burden of RA was analyzed using average annual percent change (AAPC). Results: The crude incidence rates of RA in China increased from 10.87/105 in 1990 to 17.38/105 in 2021, the crude mortality rates increased from 0.41/105 to 0.72/105, and the crude DALY rates increased from 34.26/105 to 58.61/105, with the increases of 59.98%, 77.95% and 71.06%, respectively. From 1990 to 2021, the standardized incidence rates of RA in China showed an increasing trend (AAPC=0.545%, P<0.05), the standardized mortality rates showed a decreasing trend (AAPC=-0.783%, P<0.05), and the standardized DALY rates showed no significant trend (AAPC=-0.017%, P>0.05). In 2021, the standardized incidence rate, standardized mortality rate and standardized DALY rate of RA were higher in females than in males; from 1990 to 2021, the standardized DALY rates of RA showed a decreasing trend in females (AAPC=-0.200%, P<0.05) and an increasing trend in males (AAPC=0.316%, P<0.05). The crude incidence rates of RA first increased and then decreased with age in 2021, reaching the highest in the age group of 75-<80 years at 34.36/105. Both the crude mortality rates and the crude DALY rates increased with age, reaching the highest in the age group of 95 years and older at 26.72/105 and 285.67/105, respectively. The standardized incidence rates and standardized DALY rates of RA in China in 2021 were lower than those in high SDI regions, while the standardized mortality rate was lower than that in medium-low SDI regions. Conclusions The burden of RA in China from 1990 to 2021 showed an upward trend, and was at a high level compared to different SDI regions. Higher disease burden of RA was seen in females and the elderly.

BACKGROUND:Non-coding RNA,as a class of RNA molecules that do not encode proteins,plays a crucial role in cellular regulation.Simultaneously,mesenchymal stem cells possess multipotent differentiation capabilities,making them vital for tissue repair and regeneration.In recent years,researchers have extensively explored the role of non-coding RNA in regulating the functions of mesenchymal stem cells. OBJECTIVE:To systematically understand the trends and key areas of research related to non-coding RNA and mesenchymal stem cells through bibliometric analysis. METHODS:Literature data on non-coding RNA and mesenchymal stem cell-related research were retrieved from the Science Citation Index Expanded in the Web of Science Core Collection from 1990 to the present.The literature data were analyzed using bibliometric tools such as VOSviewer and CiteSpace,focusing on publication output,clustering,citation frequency,burstiness,and intermediary centrality with respect to years,countries or regions,research institutions,cited references,and keywords.This analysis aimed to reveal the knowledge base and emerging hotspots in the research field. RESULTS AND CONCLUSION:(1)This study included a total of 5 348 articles for analysis,showing a significant growth trend in relevant literature from 1997 to 2021.Although there was a slight decrease in 2022,the publication output remained at a high level.China dominated the research in this field,with Shanghai Jiao Tong University being the most active contributor.(2)Analysis of cited references revealed that highly bursty,intermediary,and cited articles were mainly related to topics such as microRNA,extracellular vesicles,and bone metabolism.These articles constitute an important knowledge base for research on non-coding RNA and mesenchymal stem cells.(3)Burstiness analysis of keywords identified persistent bursts in keywords such as exosomes,circular RNA,extracellular vesicles,and injury.(4)Cluster evolution analysis of keywords with continuous growth in publication output included clusters related to tumor microenvironment,osteoarthritis,oxidative stress,and extracellular vesicles.These keywords reflect the current and future research hotspots in the field.(5)The findings of this study not only illustrate the research trends in the field of non-coding RNA and mesenchymal stem cells but also provide potential directions and insights for researchers.

Obsessive-compulsive disorder （OCD） is a highly disabling mental disorder that impairs patients' social function and quality of life， and impose a substantial economic burden. Intolerance of uncertainty （IU） refers to a cognitive bias in perceiving， interpreting and responding to uncertain situations or events. IU is closely associated with the cognitive patterns of OCD patients. Based on magnetic resonance imaging （MRI）， this paper discusses the research progress of the relationship between IU and psychopathological characteristics of OCD， and put forward the research direction， aims to provide evidence-based references for the development of optimized therapeutic interventions for OCD.

Acute Gelsemium poisoning is a systemic disease primarily affecting the central nervous system and respiratory symptoms caused by the ingestion of a substantial amount of Gelsemium within a short period. It manifests as sudden onset and rapid progression, primarily caused by accidental ingestion due to misidentification, and posing significant health risks. The compilation of the Technical Plan for Emergency Health Response to Acute Gelsemium Poisoning describes in detail the specialized practice and technical requirements in the process of handling acute Gelsemium poisoning, including accident investigation and management, laboratory testing and identification, in-hospital treatment, and health monitoring. The guidelines clarify key procedures and requirements such as personal protection, investigation elements, etiology determination, medical rescue, and health education. The key to acute Gelsemium poisoning investigation lies in promptly identifying the toxin through exposure history, clinical manifestations, and sample testing. Because there is no specific antidote for Gelsemium poisoning, immediate removal from exposure, rapid elimination of the toxin, and respiratory monitoring are critical on-site rescue measures. Visual identification of food or herbal materials, followed by laboratory testing to determine Gelsemium alkaloids in samples is a rapid effective screening method. These guidelines offer a scientific, objective, and practical framework to support effective emergency responses to acute Gelsemium poisoning incidences.

Objective:To develop a formula correlating body weight and the insertion length of peripherally inserted central catheters (PICC) in very low birth weight infants (VLBWI) undergoing lower limb PICC placement, aiming to improve the success rate of one-time catheter placement.Methods:A prospective research method was adopted, 205 VLBWI patients who were hospitalized in the NICU of Shenzhen Maternal and Child Health Hospital from May 2023 to February 2024 and had indwelling PICC in the lower extremities were selected as the research subjects using the convenience sampling method. Data including gender, insertion vein, body weight on the day of catheterization, and the vertical distance from the puncture site to the first popliteal crease were collected. Pearson correlation analysis and linear regression analysis were used to construct a predictive formula for estimating the insertion length of PICC based on body weight. The Bland-Altman plot was applied to evaluate the consistency between the predicted insertion depth using the formula and the actual correct insertion length.Results:A total of 182 VLBWI were included in the study, comprising 102 male infants and 80 female infants. The catheterization sites were the right lower extremity in 166 cases and the left lower extremity in 16 cases. The body weight was (1.08 ± 0.26) kg. The vertical distance from the puncture site to the first popliteal crease was (5.58 ± 1.72) cm. The prediction formula for the length of lower extremity PICC catheterization was constructed through linear regression analysis: PICC insertion length = 8.013 + [5.194×body weight (kg)] ± vertical distance from the puncture site to the popliteal crease (cm). Consistency evaluation showed good agreement between the predicted insertion depth and the actual correct insertion length, with 95% of the measurement differences falling within the limits of agreement. The mean difference was 0.07 cm ( P > 0.05). Conclusions:The weight-based formula derived for VLBWI provides a basis for predicting the optimal insertion length of PICC in clinical practice.

Objective:To identify the risk factors for acute graft-versus-host disease (aGVHD) in patients with acute myeloid leukemia (AML) undergoing haploidentical hematopoietic stem cell transplantation (HID-HSCT) .Methods:A total of 141 AML patients who underwent HID-HSCT at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, from January 2020 to July 2021 were included. The cumulative incidence of aGVHD was analyzed using the Fine-Gray competing risk model, with relapse and death as competing events, to compare differences between groups. Potential risk factors were evaluated by univariable and multivariable Cox proportional hazards regression analyses to determine their independent effects on aGVHD.Results:Among the 141 patients, 86 (61.0%) were male and 55 (39.0%) were female, with a median age at transplantation of 34 years. Within 100 days post-transplant, 59 patients developed grade Ⅱ-Ⅳ aGVHD, whereas 86 patients experienced no or grade Ⅰ aGVHD (the grade 0-Ⅰ aGVHD group) . Survival analysis showed that the 3-year overall survival was 68.7% (95% CI: 57.7%-81.9%) in the grade Ⅱ-Ⅳ aGVHD group, compared with 78.8% (95% CI: 70.4%-88.3%) in the grade 0 - Ⅰ aGVHD group, with the difference not being statistically significant ( P=0.190) . Univariable analysis identified donor age ( P=0.020, HR=1.020, 95% CI: 1.000-1.040) and the female donor-male recipient sex combination ( P=0.033, HR=1.980, 95% CI: 1.160-3.380) as risk factors for grade Ⅱ-Ⅳ aGVHD. Multivariable analysis confirmed that donor age ( P=0.005, HR=1.026, 95% CI: 1.008-1.047) and the female donor-male recipient sex combination ( P=0.002, HR=2.339, 95% CI: 1.354-4.037) were independent risk factors for aGVHD. Patients receiving grafts from donors aged >45 years had a significantly higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD compared with those receiving grafts from donors ≤45 years [54.7% (95% CI: 42.3%-67.0%) vs 31.6% (95% CI: 21.0%-42.1%) , P=0.006]. Similarly, patients with the female donor-male recipient sex combination had a higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with other sex combinations [56.8% (95% CI: 40.4%-73.1%) vs 36.9% (95% CI: 27.5%-46.3%) , P=0.015]. Conclusion:Older donor age and the female donor-male recipient sex combination remain independent risk factors for aGVHD in patients with AML undergoing HID-HSCT.

Objective:To investigate the clinical diagnosis and treatment of IgG4-related disease（IgG4-RD） primarily involving the nasal cavity and skull base. Methods:A retrospective analysis was conducted on the clinical data of 8 patients with IgG4-RD primarily involving the nasal cavity and skull base who visited the Nasal and Skull Base Surgery Department at Xiangya Hospital from October 2017 to January 2024. The cohort comprised 4 males and 4 females, aged 8 to 69 years. Clinical data, laboratory examination results, imaging findings, histopathological results, and treatment plans were collected. The clinical manifestations, diagnosis, treatment and follow-up results of IgG4-RD primarily involving nasal cavity and skull base were summarized and previous literature were also reviewed. Results:The initial symptoms in the 8 patients included nasal congestion, headache, sensory function decline, and facial deformities. Three patients also had parotid and pulmonary involvement. Among the 8 patients, 4 underwent partial surgical resection combined with glucocorticoid therapy; 1 underwent partial surgical resection combined with glucocorticoid and immunosuppressant therapy; 1 received glucocorticoid therapy alone; and 2 received glucocorticoid combined with immunosuppressant therapy. Follow-up was conducted one month after treatment, lasting from 5 to 79 months. During the follow-up period, recurrence was observed in 1 patient treated with glucocorticoid combined with immunosuppressants and in 1 patient treated with glucocorticoid alone, while the other 6 patients achieved significant remission. Conclusion:The diagnosis of nasal cavity and skull base IgG4-RD requires the combination of histopathology, laboratory tests, and imaging results. Treatment primarily includes glucocorticoids or combined immunosuppressants. For patients with significant compression symptoms, sensory function impairment, or facial deformities, surgical resection is an important treatment option. Given the high risk of recurrence, early intervention, active treatment, and long-term follow-up are crucial.
Humans ; Male ; Skull Base/pathology* ; Female ; Middle Aged ; Retrospective Studies ; Aged ; Nasal Cavity/pathology* ; Adult ; Immunoglobulin G4-Related Disease/therapy* ; Immunoglobulin G ; Child ; Young Adult ; Adolescent

Intestinal fibrosis is a significant clinical challenge in inflammatory bowel diseases, but no effective anti-fibrotic therapy is currently available. Glucagon receptor (GCGR) and glucagon-like peptide 1 receptor (GLP1R) are both peptide hormone receptors involved in energy metabolism of epithelial cells. However, their role in intestinal fibrosis and the underlying mechanisms remain largely unexplored. Herein GCGR and GLP1R were found to be reduced in the stenotic ileum of patients with Crohn's disease as well as in the fibrotic colon of mice with chronic colitis. The downregulation of GCGR and GLP1R led to the accumulation of the metabolic byproduct lactate, resulting in histone H3K9 lactylation and exacerbated intestinal fibrosis through epithelial-to-mesenchymal transition (EMT). Dual activating GCGR and GLP1R by peptide 1907B reduced the H3K9 lactylation in epithelial cells and ameliorated intestinal fibrosis in vivo. We uncovered the role of GCGR/GLP1R in regulating EMT involved in intestinal fibrosis via histone lactylation. Simultaneously activating GCGR/GLP1R with the novel dual agonist peptide 1907B holds promise as a treatment strategy for alleviating intestinal fibrosis.

Objective:To analyze the efficacy and safety of 3D-printing-assisted anterolateral thigh perforator flap surgery for the treatment of complex soft tissue defects around the ankle joint.Methods:A total of 160 patients with skin and soft tissue defects around the ankle joint at the First People′s Hospital of Xiaoshan District, Hangzhou, from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a control group and an observation group according to the surgical approach, with 80 patients in each group. The control group underwent traditional anterolateral thigh perforator flap surgery, which included 43 males and 37 females, with an age of 21-62 (34.7±5.6) years. The observation group underwent 3D-printing-assisted anterolateral thigh perforator flap surgery, which included 45 males and 35 females, with an age of 20-66 (34.8±5.6) years. The operative time, flap healing time, and hospital stay duration were compared between the two groups. Serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF-α) were compared between the two groups before surgery and 3 days postoperatively. The ankle joint function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, the range of motion (ROM) was assessed using the ROM score, and the flap sensation was evaluated using the modified Highet grading system before surgery, 6 months postoperatively, and at the last follow-up. The incidence of adverse reactions such as arterial crisis, venous crisis, infection, and necrosis during the perioperative period was observed. Patient satisfaction was assessed 6 months after treatment.Results:All patients in both groups successfully completed the surgery, with no cases excluded. The operative time, flap healing time, and hospital stay duration were significantly shorter in the observation group than those in the control group (all P<0.001). Compared with preoperative levels, the levels of IL-6, IL-8, CRP, and TNF-α were significantly reduced in both groups 3 days postoperatively (all P<0.001), and these levels were significantly lower in the observation group than those in the control group at 3 days postoperatively (all P<0.001). Six months postoperatively and at the last follow-up, the AOFAS and ROM scores were significantly higher in the observation group than those in the control group (all P<0.05), and the flap sensation grading was significantly better in the observation group than that in the control group (all P<0.05). The incidence of adverse reactions was 7.5% (6/80) in the observation group, which was significantly lower than 18.8% (15/80) in the control group ( P=0.024). The patient satisfaction rate was 95.0% (76/80) in the observation group, which was significantly higher than 72.5% (58/80) in the control group ( P<0.001). Conclusion:3D-printing-assisted anterolateral thigh perforator flap repair for skin and soft tissue defects around the ankle joint can improve perioperative indicators, reduce the incidence of postoperative adverse reactions, promote the recovery of flap sensation and ankle function, attenuate the inflammatory response of the body, and enhance patient satisfaction.

Objective:To explore the application strategies and clinical effects of superior gluteal artery perforator tissue flaps in repairing stage Ⅳ pressure ulcers in the sacrococcygeal region.Methods:This study was a retrospective observational study. From July 2019 to April 2024, 89 patients with stage Ⅳ pressure ulcers in the sacrococcygeal region who met the inclusion criteria were admitted to the First Affiliated Hospital of Nanchang University, including 59 males and 30 females, aged 21 to 84 years. There were 89 sacrococcygeal pressure ulcers, with an area of 5.0 cm×4.0 cm-21.0 cm×21.0 cm after debridement. According to the shape, size, and depth of the wounds after debridement, combined with the elasticity and texture of the skin around the wounds, and the principle of minimizing damage to the donor area, the appropriate forms of superior gluteal artery perforator tissue flaps were cut for wound repair in the following three conditions. (1) For wounds with a round shape, an area of 5.0 cm×5.0 cm-21.0 cm×21.0 cm, and a depth of 1.0-3.5 cm, the superior gluteal artery perforator propeller flap or myocutaneous flap, bilobed superior gluteal artery perforator relay flap, and bilateral superior gluteal artery perforator rotational flap were used. (2) For wounds with an oval shape, an area of 5.0 cm×4.0 cm-18.5 cm×10.5 cm, and a depth of 1.0-3.0 cm, the superior gluteal artery perforator propeller flap or myocutaneous flap, unilateral superior gluteal artery perforator propeller flap combined with contralateral superior gluteal artery perforator V-Y advanced flap or keystone flap were used. (3) For wounds with a fusiformis shape, an area of 7.0 cm×4.0 cm-17.5 cm×6.0 cm, and a depth of 1.5-5.0 cm, the unilateral or bilateral superior gluteal artery perforator V-Y advanced flap, superior gluteal artery perforator keystone flap, or superior gluteal artery perforator keystone flap combined with gluteus maximus muscle flap were used. In this group of patients, a total of 40 superior gluteal artery perforator propeller flaps (with an resection area of 11.0 cm×6.0 cm-17.0 cm×11.0 cm), 22 superior gluteal artery perforator propeller myocutaneous flaps (with an resection area of 10.0 cm×5.0 cm-14.0 cm×8.0 cm), 7 bilobed superior gluteal artery perforator relay flaps (with a main flap resection area of 5.5 cm×5.5 cm-18.0 cm×11.5 cm and a side flap resection area of 4.5 cm×3.0 cm-11.0 cm×6.5 cm), 5 bilateral superior gluteal artery perforator rotational flaps (with a total resection area of 20.0 cm×16.0 cm-26.0 cm×21.0 cm on both sides), 14 superior gluteal artery perforator V-Y advanced flaps (with an resection area of 12.0 cm×10.0 cm-18.0 cm×18.0 cm), 13 superior gluteal artery perforator keystone flaps (with an resection area of 13.0 cm×6.5 cm-19.0 cm×18.0 cm), and 3 gluteus maximus muscle flaps (with an resection area of 8.0 cm×3.0 cm-15.0 cm×4.5 cm). The donor area wounds were all directly sutured. The survival of tissue flaps was observed and the incidence rate of delayed wound healing in the reception area was calculated, and wound healing in the donor area was observed. The appearance and texture of tissue flaps and recurrence of pressure ulcers were followed up.Results:After surgery, all bilateral superior gluteal artery perforator rotational flaps, superior gluteal artery perforator V-Y advanced flaps, superior gluteal artery perforator keystone flaps, and gluteus maximus muscle flaps survived well. There were 6 cases of delayed wound healing in the reception area after surgery, with an incidence rate of 6.7% (6/89). Two patients had incision dehiscence in the donor area wounds due to postoperative bleeding, the wounds healed after debridement, vacuum sealing drainage, and dressing change. The wounds in the donor area of the remaining patients healed well. Six patients were lost to follow-up. Eighty-three patients were followed up for 3-48 months, of whom 4 patients died. Among the remaining 79 patients, 3 cases had pressure ulcers recur due to improper nursing, while the rest of the patients had tissue flaps with good appearance and soft texture and no recurrence of pressure ulcers.Conclusions:Based on the characteristics of wound shape, size, and depth after debridement of stage Ⅳ pressure ulcers in the sacrococcygeal region, individualized selection of flap, myocutaneous flap, or a combination of flap and gluteus maximus muscle flap based on the perforating branch of the superior gluteal artery perforator can achieve good clinical repair results. The postoperative tissue flap survived well, with a good appearance, soft texture, and less recurrence of pressure ulcers.