It is proposed that the pathogenesis of rheumatoid arthritis （RA） is centered on deficiency， dampness， and blood stasis， which interact with and evolve into one another during the onset and progression of the disease. The development of RA is closely associated with insufficiency of healthy qi and the interbinding of dampness and blood stasis. Accordingly， treatment emphasizes an integrated approach that combines tonifying deficiency， eliminating dampness， and resolving blood stasis， and is implemented in three main stages. In the initial stage， therapy focuses on supporting healthy qi， dispelling dampness， and relieving impediment， with modified Huangqi Guizhi Wuwu Decoction （黄芪桂枝五物汤） combined with Yiyiren Decoction （薏苡仁汤）. In the active stage， treatment aims to eliminate dampness， resolve blood stasis， and unblock the collaterals， using modified Wutou Decoction （乌头汤） or Guizhi Shaoyao Zhimu Decoction （桂枝芍药知母汤）. In the remission stage， therapy emphasizes strengthening the spleen and reple-nishing qi to prevent recurrence， with modified Shenling Baizhu Powder （参苓白术散） combined with Guipi Decoction （归脾汤）.

OBJECTIVE To provide a reference for improving postoperative pain management outcomes， accelerating patient recovery， and ensuring the safe use of opioids. METHODS A prospective cohort study was conducted， in which patients undergoing elective hip or knee replacement in the Department of Orthopedics at Baoding No.1 Central Hospital （hereinafter referred to as “our hospital”） from November 2021 to November 2023 were randomly divided into control group and observation group using a random number table， with 178 cases in each group. Patients in the control group received postoperative pain management implemented by medical staff according to the clinical pathway for perioperative pain treatment. Patients in the observation group， under the enhanced recovery after surgery model， received postoperative pain management through a multidisciplinary collaborative team including clinical pharmacists. The occurrence and resolution of opioid-related drug-related problems （DRPs） were compared between the two groups， and the DRPs were classified and analyzed using the Pharmaceutical Care Network Europe Classification System （V9.1）. Postoperative pain scores， sleep quality scores， length of hospital stay， and incidence of adverse reactions were compared between the two groups. RESULTS A total of 162 opioid-related DRPs were identified in 2 groups， with 58 in the observation group （identified 52 patients） and 104 in the control group （identified 91 patients）， showing a statistically significant difference （P＜0.05）. The primary issue involved in the DRPs for both groups was therapeutic effectiveness. Clinical pharmacists in the observation group conducted 88 interventions for the identified 58 opioid-related DRPs， achieving an overall intervention success rate of 84.5%. The pain scores and sleep quality scores from postoperative day 1 to 7， the length of hospitalization for hip replacement， the average hospitalization duration， and the total incidence of opioid-related adverse reactions were all significantly lower or shorter in the observation group compared to the control group （P＜0.05）. Furthermore， the main time effect， time-group interaction effect for pain scores and sleep quality scores were statistically significant in both groups （P＜0.05）， indicating that the control group exhibited greater reductions in these scores and observation group exhibited more rapid improvements. CONCLUSIONS The full involvement of clinical pharmacists in postoperative pain management and opioid medication administration in the orthopedics department enables timely identification and intervention of DRPs， enhance postoperative analgesia efficacy， decrease adverse drug reactions， shorten hospital stays， and accelerate patient recovery.

Objective: To explore the relationship between sleep quality and executive function among middle school students, so as to provide theoretical support for the promotion of adolescents physical and mental health development. Methods: From September to December 2023, 5 713 junior and senior high school students aged 13 to 18 were selected by stratified cluster random sampling method from Shanghai, Suzhou, Taiyuan, Wuyuan, Xingyi, and Urumqi. Pittsburgh Sleep Quality Index was used to conduct sleep quality survey. And conduct executive function was tested on middle school students, including inhibitory function, refresh function and conversion function tests. Spearman correlation and linear regression were used to analyze the relationship between sleep quality and executive function of middle school students. Results: The total Pittsburgh Sleep Quality Index (PSQI) score of boys was [4.0(2.0,6.0)] and that of girls was [5.0(3.0,6.0)], and the difference was statistically significant ( Z=-10.90, P < 0.01 ). The total PSQI score of boys was positively correlated with both 2-back reaction time and conversion function of executive function ( r =0.04, 0.04); the total PSQI score of girls was negatively correlated with 2-back reaction time ( r =-0.04) ( P <0.05). After controlling for variables such as mental health, physical activity and nutritional status,linear regression analyses showed that PSQI total score of middle school students was positively correlated with the inhibitory function and the conversion function response time [ B (95% CI )=1.28(0.21-2.34), 7.62(2.34-12.90), P <0.05]; the associations of total PSQI scores among middle school students with both 2-back and 1-back response time were not statistically significant [ B (95% CI )=-5.88(-16.14-4.37), 8.05( -3.39 -19.50), P >0.05]. Conclusion Positive correlations are observed on sleep quality with inhibitory and conversion functions of executive function among middle school students.

Objective To explore the impact of multi-model adaptive statistical iterative reconstruction (ASiR-V) algorithm on radiation dose and image quality in children’s ultra-low-dose chest CT examination. Methods A total of 72 children who underwent chest CT scans at Qingdao Municipal Hospital with admissions between January 2024 and January 2025 were selected as subjects and divided into two groups using a random number table. In the control group (n = 36), the tube voltage was set at 100 kVp and the conventional filtered back projection algorithm was used. In the observation group (n = 36), the tube voltage was set at 80 kVp and images were reconstructed using 30% ASiR-V (observation group 1), 60% ASiR-V (observation group 2), and 90% ASiR-V (observation group 3), respectively. Radiation doses were recorded for each group, and both subjective and objective evaluations of image quality were conducted. Results Compared with the control group, the observation group demonstrated significantly lower volume CT dose index [(0.86 ± 0.09) mGy], dose length product [(25.90 ± 3.55) mGy·cm], and effective dose [(0.01 ± 0.001) mSv] (P < 0.05). There was no significant difference in subjective evaluation scores of image quality among the four groups (z = −2.206, P = 0.530). Additionally, Fisher’s exact test showed that the proportion of images scoring 4-5 points was higher in observation group 2 than in observation group 3 (P = 0.024). The noise value of the ascending aorta in the mediastinal window and the noise values of the right and left middle lung fields and the right and left upper lung fields in the lung window were lower in observation groups 2 and 3 than in the control group, and these values were lower in observation group 3 than in observation group 2 (P < 0.05). The signal-to-noise ratios of the ascending aorta and liver in observation groups 2 and 3 were higher than those in the control group, and the ratios were higher in observation group 3 than in observation group 2 (P < 0.05). Conclusion Reconstruction using the 60% ASiR-V algorithm for pediatric ultra-low-dose chest CT examination can ensure good image quality while reducing radiation dose and improving examination safety.

Objective To investigate the effects and molecular mechanism of Homer protein homolog 1a (Homer 1a) overexpression on nerve injury in mice with traumatic brain injury (TBI). Methods Sixty male C57BL/6 mice were randomly divided into five groups: sham group, TBI group, empty lentivirus (Lv-NC) group, Homer 1a overexpression lentivirus (Lv-Homer 1a) group and Lv-Homer 1a + 740 Y-P group, with 12 mice in each group. The lentivirus was orthotopic injected into the cerebral cortex of mice 5 d before modeling, while 740 Y-P was injected intraperitoneally 1 d before modeling. The TBI model was established using the free-fall impact method, and the modified neurological severity scores (mNSS) of the mice was assessed 72 h post-surgery. The water content of brain tissue was quantified, and the histopathological damage and neuronal loss in brain tissue were assessed using HE staining and Nissl staining respectively. The formation of autophagosomes in brain tissue was observed by transmission electron microscopy. The protein expression levels of Homer 1a, microtubule-associated protein 1 light chain 3B (LC3B), Beclin 1, phosphatidylinositol 3-kinase (PI3K), phosphorylation PI3K(p-PI3K), protein kinase B (AKT), p-AKT, mammalian target of rapamycin (mTOR), and p-mTOR in brain tissue were detected by Western blot analysis. Results Compared to the sham group, the mice in the TBI group exhibited a significant increase in mNSS and cerebral water content. Moreover, severe brain tissue pathological damage was observed, accompanied by a substantial loss of neurons and an increase in autophagosome formation. The protein expressions of Homer 1a and Beclin 1, as well as the protein ratio of LC3B-II/LC3B-I, in brain tissues were significantly elevated, while the protein ratios of p-PI3K/PI3K, p-AKT/AKT, and p-mTOR/mTOR were significantly reduced. Compared to the TBI group, the Lv-Homer 1a group exhibited reduced mNSS and brain water content. Additionally, there was an improvement in pathological brain tissue damage and neuron loss. Furthermore, there was an increase in autophagosome formation and expression of autophagy-related proteins, while the protein ratios of p-PI3K/PI3K, p-AKT/AKT, and p-mTOR/mTOR were decreased. Compared to the Lv-Homer 1a group, the nerve injury in the Lv-Homer 1a+740 Y-P group was exacerbated, accompanied by a reduction in autophagosome formation and expression of autophagy-related proteins, while the PI3K/AKT/mTOR signaling pathway was activated. Conclusion Overexpression of Homer 1a effectively mitigates neurological damage in TBI mice, potentially through modulation of autophagy mediated by the PI3K/AKT/mTOR signaling pathway.
Animals ; TOR Serine-Threonine Kinases/genetics* ; Autophagy ; Brain Injuries, Traumatic/pathology* ; Male ; Proto-Oncogene Proteins c-akt/genetics* ; Phosphatidylinositol 3-Kinases/genetics* ; Homer Scaffolding Proteins/metabolism* ; Mice, Inbred C57BL ; Signal Transduction ; Mice

Objective:To evaluate the clinical efficacy of Jianpi Bushen Prescription in treating acute gouty arthritis with spleen-kidney deficiency syndrome using propensity score matching method.Methods:A retrospective analysis method was used to select 156 patients with acute gouty arthritis with spleen kidney deficiency type admitted from March 2022 to March 2024. They were divided into an observation group of 89 cases and a control group of 67 cases according to the treatment method. Propensity score matching (PSM) was further adopted to balance the confounding factors before treatment in a 1:1 ratio. Finally, 42 patients in each group were successfully matched. The control group received conventional Western medicine, the observation group received additional treatment with Jianpi Bushen Prescription on the basis of the control group. The treatment for both groups lasted for 1 month. TCM syndrome scores were performed before and after treatment, and the levels of serum uric acid (UA), ESR, and pH were measured using an automatic dry biochemical analyzer. The VAS scale was used to assess the degree of pain, the Oswestry Disability Index (ODI) was used to evaluate the degree of joint function improvement, and the Quality of Life Scale-36 (SF-36) was used to evaluate the quality of life of patients. Adverse reactions during treatment were observed and recorded to evaluate clinical efficacy.Results:The total effective rate of the observation group 92.86% (39/42) was higher than that of the control group 73.81% (31/42), with statistical significance ( χ2=5.49, P<0.05). After treatment, the joint pain, soreness and weakness of the waist and knees, poor flexion and extension, and pale and greasy tongue coating, were lower than those in the control group ( t values were 3.38, 4.26, 3.96, 3.97, 4.41, respectively, P<0.01). After treatment, the serum uric acid (UA) [(351.84±36.46) μmol/L vs. (380.19±39.42) μmol/L, t=3.42] and erythrocyte sedimentation rate (ESR) [(17.91±3.71) mm/h vs. (21.43±3.90) mm/h, t=4.24] of the observation group were lower than those in the control group, and the pH value (7.24±0.49 vs. 6.98±0.57, t=2.24) was higher than that of the control group ( P<0.05). After treatment, the VAS and ODI of the observation group were lower than those of the control group ( t values were 5.80, 6.25, respectively, P<0.01), and the SF-36 score was higher than that of the control group ( t=3.23, P<0.05). During the treatment, the incidence of adverse reactions was 14.29% (6/42) in the observation group and 9.52% (4/42) in the control group. There was no statistical significance in the incidence of adverse reactions between the two groups ( χ2=0.45, P>0.05). Conclusions:Jianpi Bushen Prescription has good efficacy on the treatment of acute gouty arthritis with spleen-kidney deficiency syndrome. It can reduce the levels of uric acid, improve the life quality of patients, and enhance efficacy, with good treatment safety.

Turner syndrome（TS），a condition among females with a karyotype containing one X chromosome and complete or partial absence of the second sex chromosome，affects 20～50 in 100 000 newborn girls. Congenital or acquired cardiovascular diseases are present in about half of patients with TS. The congenital defects occur in about 25%～50% of TS patients；aortic dilatation as an important risk factor for aortic dissection is common in adult patients with TS. Furthermore，arrhythmias are found more frequently in patients with TS. A higher prevalence of hypertension in children and adolescents with TS has also been reported，and the application of 24h ambulatory blood pressure monitoring may facilitates the diagnosis of hypertension among these children and adolescent.Thus，active health education，correct follow-up and timely intervention are crucially needed.

Objective To investigate T cell subtypes and their functions in liver immune microenvironments among patients with alveolar echinococcosis (AE) using single-cell RNA sequencing (scRNA-seq). Methods Four AE patients that were admitted to Qinghai Provincial People’s Hospital in 2023 for hepatic surgery for the first time were enrolled, and liver specimens were sampled 1 cm (peri-lesion, PL group) and > 5 cm from AE lesions (distal lesion, DL group) among each patient. Finally, a total of eight liver specimens were sampled from four AE patients for scRNA-seq analysis. Genome and transcriptome data of liver specimens were processed using the software Cell Ranger and R package. Differentially expressed genes (DEGs) and their biological functions were analyzed using gene ontology (GO) enrichment analysis and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis, and the primary intercellular communication patterns and interaction mechanisms were identified among T cell subtypes in liver specimens using the CellChat package. In addition, the developmental stages of T cells were subjected to trajectory analysis with the monocle package to investigate the expression of genes associated with cell growth and tumor transformation, and to predict the developmental trajectories of T cells. Results All four AE patients were female, with a mean age of (25.00 ± 9.06) years, and there were three cases from Jiuzhi County, Golog Tibetan Autonomous Prefecture and one case from Chengduo County, Yushu Tibetan Autonomous Prefecture, Qinghai Province. The viability of single-cell samples from eight liver specimens was 90.41% to 96.33%, and a total of 81 763 cells were analyzed, with 19 cell types annotated. Of these cell types, 13 were immune cells (87.60%), and T cells (33.13%), neutrophils (15.40%), and natural killer cells (11.92%) were the three most common cell types. Re-clustering of 27 752 T cells and proliferative T cells identified 10 distinct T cell subtypes, with CD8⁺ cytotoxic T cells (23.43%), CD8⁺ naive T cells (12.80%), and CD4⁺ effector memory T cells (17.73%) as dominant cell types. The proportions of T helper 2 (Th2) cells (5.19% vs. 3.63%; χ² = 38.35, P < 0.01) and CD4⁺ effector memory T cells (21.59% vs. 13.67%; χ² = 244.70, P < 0.01) were significantly higher in liver specimens in the PL group than in the DL group, and the proportion of CD4⁺ helper T cells was significantly lower in the PL group than in the DL group (7.50% vs. 14.75%; χ² = 330.52, P < 0.01). KEGG pathway analysis revealed that Th2 cells were significantly enriched in cell apoptosis and multiple cancer-associated pathways, and CD4⁺ effector memory T cells were significantly enriched in the regulation of cytokines and chronic inflammation, while CD4⁺ helper T cells were significantly enriched in immune responses regulation. Trajectory analysis of T cells showed that CD4⁺ helper T cells were at an earlier developmental stage relative to Th2 cells and CD4⁺ effector memory T cells, and the expression of inhibitor of DNA binding 3 (ID3), thioredoxin interacting protein (TXNIP), Bcl2-associated athanogene 3 (BAG3) and heat shock protein family B (small) member 1 (HSPB1) genes appeared a tendency towards a decline over time. Conclusions CD4⁺ effector memory T cells and CD8⁺ cytotoxic T cells are primary interacting cells in the liver specimens of AE patients. Reduced expression of Th2 cells and CD4⁺ helper T cells contributes to an inhibitory immune microenvironment, which promotes immune evasion by Echinococcus multilocularis, and Th2 cells are significantly enriched in multiple cancer-associated pathways, which may be linked to the invasive growth of E. multilocularis.

Sex determination region of Y chromosome related HMG-box gene（SOX）was a group of related transcription factors with similar structures. In SOX family genes，SRY is the determinant gene of mammalian gonadal differentiation，which directly determines the direction of testis differentiation. SOX9 is an essential gene that initiates the development of testis during the process of sex differentiation. SOX8 and SOX2 also participate in sexual development and maintenance of male reproductive function. Similar to the SRY gene，these SOX family genes all have one high mobility group（HMG）domain. The product of HMG domain binds and bends specific target DNA. This article reviews the role of SOX family genes（SRY，SOX9，SOX8，SOX2）in male sex determination and male reproductive function.

Based on the Delphi method, combined with the results of the previous literature study and expert interviews, 3 rounds of expert consultation were conducted to evaluate the degree of concentration of expert opinions and their importance from 3 aspects: arithmetic mean, full score ratio ( Ki), and rank sum ( Si), to construct a diagnostic scale for rheumatoid arthritis (RA) cold-dampness syndrome. In this study, 30 expert questionnaires were distributed in the 1st round, 30 questionnaires were recovered, and the expert coordination coefficient was 0.309; 30 expert questionnaires were distributed in the 2nd round, 30 questionnaires were recovered, and the expert coordination coefficient was 0.320; and 30 expert questionnaires were distributed in the 3rd round, 29 questionnaires were recovered, and the expert coordination coefficient was 0.387. The maximum value of the coefficient of variation of the experts of the 3 rounds was 0.27, and the minimum value was 0.09, suggesting that the consistency and credibility of the experts' evaluation of the importance of the entries of cold-dampness syndrome were high. In this study, the mean values and weights of 17 entries were finally obtained, of which the top 5 entries were cold pain in joints (4.793, 0.066 6); aggravated by cold (4.586, 0.063 7); white tongue coating (4.552, 0.063 2); aggravated in cloudy and rainy days (4.448, 0.061 8); and painful joints that are not warm to the touch (4.379, 0.060 8). This study completed the screening of relevant entries and conducted preliminary discussions, laying the foundation for constructing a diagnostic scale for RA cold-dampness syndrome and forming the final diagnostic criteria. The research method is scientific and reliable, which can provide reference for the diagnostic standard of RA cold-dampness syndrome, but further clinical practice research is still needed.