Objective: To investigate the efficacy, safety, and traditional Chinese medicine (TCM) medication patterns of rituximab (RTX) combined with TCM on treating children with steroid-dependent nephrotic syndrome (SDNS). Methods: One hundred and forty-three children with SDNS who visited the Pediatric Nephrology Department of the First Affiliated Hospital of Henan University of Chinese Medicine from January 2018 to December 2022 were enrolled. A cohort study design was adopted, with " RTX treatment" as the exposure factor. Children who met this exposure factor were assigned to the RTX cohort (RTX, glucocorticoid, immunosuppressive agent, combined with traditional Chinese medicine syndrome differentiation treatment), whereas those who did not were assigned to the basic treatment cohort (glucocorticoid, immunosuppressive agent, combined with traditional Chinese medicine syndrome differentiation treatment ), and followed up for 6 months. The frequency of urinary protein recurrences, urinary protein remission duration, proportion and duration of steroid reduction and cessation, cumulative usage of steroids, proportion of recurrence, recurrence amount of steroid used, efficacy of TCM syndrome, and laboratory and safety indicators after treatment, and height and CD19+ B cell count before and after treatment were compared between the two cohorts. The medication patterns of TCM in the two cohorts were analyzed using frequency statistics, association rule analysis, and systematic clustering analysis. Results: Compared with the basic treatment cohort, the RTX cohort showed a decrease in the frequency of urinary protein recurrence, extended sustained remission of urinary protein, an increase in the proportion of steroid reduction and cessation, a shorter duration of steroid reduction and cessation, a decrease in cumulative steroid dosage, a lower recurrence rate, a decrease in CD19+ B cell count, and a decrease in 24-h urinary total protein quantification and the level of cholesterol (P<0.05). No significant difference in the recurrence amount of steroid used, height, TCM syndrome efficacy, albumin, aspartate transaminase, blood urea nitrogen, platelet count, and safety indicators between the two cohorts. Children with SDNS were mostly characterized by qi and yin deficiency syndrome, followed by spleen and kidney yang deficiency syndrome. A total of 175 TCMs were included, including 28 high-frequency drugs such as Huangqi, Fuling, Gancao, Baizhu, Dangshen, and Jiuyurou. The primary use of medication is to nourish the qi and spleen, nourish the kidney, and warm yang. The analysis of association rules yielded eight binary associations and ten three-phase associations, with Huangqi, Baizhu, Fuling, and Dangshen, being the most closely related. Cluster analysis identified four TCM combinations, primarily focusing on tonifying kidney and replenishing essence, benefiting qi and nourishing yin, and removing blood stasis. Conclusion RTX combined with TCM syndrome differentiation treatment can reduce the recurrence frequency of SDNS, prolong the remission period, reduce the glucocorticoid dosage, and have no marked effect on height growth. No apparent adverse reactions were observed. TCM should focus on nourishing qi and yin while removing blood stasis.

BACKGROUND:How to effectively promote bone regeneration and bone reconstruction after bone injury has always been a key issue in clinical bone repair research.The use of biological and degradable materials loaded with bioactive factors to treat bone defects has excellent application prospects in bone repair. OBJECTIVE:To investigate the effect of polylactic acid-glycolic acid copolymer(PLGA)composite scaffold modified by lysine-grafted graphene oxide nanoparticles(LGA-g-GO)on osteogenic differentiation and new bone formation. METHODS:PLGA was dissolved in dichloromethane and PLGA scaffold was prepared by solvent evaporation method.PLGA/GO composite scaffolds were prepared by dispersing graphene oxide uniformly in PLGA solution.LGA-g-GO nanoparticles were prepared by chemical grafting method,and the PLGA/LGA-g-GO composite scaffolds were constructed by blending LGA-g-GO nanoparticles at different mass ratios(1%,2%,and 3%)with PLGA.The micromorphology,hydrophilicity,and protein adsorption capacity of scaffolds of five groups were characterized.MC3T3 cells were inoculated on the surface of scaffolds of five groups to detect cell proliferation and osteogenic differentiation. RESULTS AND CONCLUSION:(1)The surface of PLGA scaffolds was smooth and flat under scanning electron microscope,while the surface of the other four scaffolds was rough.The surface roughness of the composite scaffolds increased with the increase of the addition of LGA-g-GO nanoparticles.The water contact angle of PLGA/LGA-g-GO(3%)composite scaffolds was lower than that of the other four groups(P<0.05).The protein adsorption capacity of PLGA/LGA-g-GO(1%,2%,and 3%)composite scaffolds was stronger than PLGA and PLGA/GO scaffolds(P<0.05).(2)CCK-8 assay showed that PLGA/LGA-g-GO(2%,3%)composite scaffold could promote the proliferation of MC3T3 cells.Alkaline phosphatase staining and alizarin red staining showed that the cell alkaline phosphatase activity in PLGA/LGA-g-GO(2%,3%)group was higher than that in the other three groups(P<0.05).The calcium deposition in the PLGA/GO and PLGA/LGA-g-GO(1%,2%,and 3%)groups was higher than that in the PLGA group(P<0.05).(3)In summary,PLGA/LGA-g-GO composite scaffold can promote the proliferation and osteogenic differentiation of osteoblasts,and is conducive to bone regeneration and bone reconstruction after bone injury.

Objective To evaluate the association between cervical insufficiency(CI)and spontaneous preterm birth(SPB),and to investigate the predictive value of shear wave elastography(SWE),cervical length(CL),and anterior cervical angle(ACA)in identifying SPB resulting from CI.Methods This study recruited 786 pregnant women who attended prenatal outpatient clinics or were hospitalized for treatment at the Affiliated Hospital of Nantong University and the Maternity Hospital affiliated with Jiangnan University from June 2023 to January 2024.Among these participants,723 were full-term pregnancies and 63 were preterm pregnancies.Cervical SWEI,CL,and cervical ACA were measured using a Mindray Resona R9 Pro/Eagus R9s ultrasound device equipped with shear wave elasticity imaging software.Additionally,the participants were categorized into four gestational age groups:19-23+6 weeks,24-27+6 weeks,28-33+6 weeks,and 34-36+6 weeks,to evaluate the relationship between gestational age and ultrasound parameters.Results The mean CL in the preterm group was 25.4 mm,significantly shorter than the 29.7 mm observed in the full-term group(P<0.001).The ACA in the preterm group was 121°,which was significantly higher than the 99° in the full-term group(P<0.001).Additionally,SWE values were significantly lower in the preterm group compared to the full-term group at all measured cervical sites:anterior external os(AE)6.47 kPa versus 9.91 kPa(P<0.001),anterior internal os(AI)10.98 kPa versus 18.62 kPa(P<0.001),posterior internal os(PI)11.32 kPa versus 21.09 kPa(P<0.001),and posterior external os(PE)8.16 kPa versus 13.24 kPa(P<0.001).A significant negative correlation was found between CL and gestational age(r=-0.278,P=0.001).The combined predictive indicators demonstrated high accuracy and specificity for predicting preterm birth,with an area under the curve(AUC)of 0.952,sensitivity of 95%,and specificity of 86%.Conclusions The integration of cervical SWE,CL measurement,and assessment of the angle of ACA can substantially enhance the predictive accuracy for SPB due to CI.This multimodal approach offers clinicians a more robust and precise tool for identifying high-risk pregnancies,enabling timely interventions that can reduce the incidence of preterm birth and improve maternal and neonatal outcomes.

Objective To evaluate the association between cervical insufficiency(CI)and spontaneous preterm birth(SPB),and to investigate the predictive value of shear wave elastography(SWE),cervical length(CL),and anterior cervical angle(ACA)in identifying SPB resulting from CI.Methods This study recruited 786 pregnant women who attended prenatal outpatient clinics or were hospitalized for treatment at the Affiliated Hospital of Nantong University and the Maternity Hospital affiliated with Jiangnan University from June 2023 to January 2024.Among these participants,723 were full-term pregnancies and 63 were preterm pregnancies.Cervical SWEI,CL,and cervical ACA were measured using a Mindray Resona R9 Pro/Eagus R9s ultrasound device equipped with shear wave elasticity imaging software.Additionally,the participants were categorized into four gestational age groups:19-23+6 weeks,24-27+6 weeks,28-33+6 weeks,and 34-36+6 weeks,to evaluate the relationship between gestational age and ultrasound parameters.Results The mean CL in the preterm group was 25.4 mm,significantly shorter than the 29.7 mm observed in the full-term group(P<0.001).The ACA in the preterm group was 121°,which was significantly higher than the 99° in the full-term group(P<0.001).Additionally,SWE values were significantly lower in the preterm group compared to the full-term group at all measured cervical sites:anterior external os(AE)6.47 kPa versus 9.91 kPa(P<0.001),anterior internal os(AI)10.98 kPa versus 18.62 kPa(P<0.001),posterior internal os(PI)11.32 kPa versus 21.09 kPa(P<0.001),and posterior external os(PE)8.16 kPa versus 13.24 kPa(P<0.001).A significant negative correlation was found between CL and gestational age(r=-0.278,P=0.001).The combined predictive indicators demonstrated high accuracy and specificity for predicting preterm birth,with an area under the curve(AUC)of 0.952,sensitivity of 95%,and specificity of 86%.Conclusions The integration of cervical SWE,CL measurement,and assessment of the angle of ACA can substantially enhance the predictive accuracy for SPB due to CI.This multimodal approach offers clinicians a more robust and precise tool for identifying high-risk pregnancies,enabling timely interventions that can reduce the incidence of preterm birth and improve maternal and neonatal outcomes.

Multiple genetic tumor susceptibility syndromes are associated with the development of neurological tumors.The classification of hereditary tumor syndromes has changed in the past few years,and there is now a clear understanding of the pathogenic mechanisms of these syndromes and they are classified into eight pathogenic mechanisms.In 2007,our team first published a special issue on"Genetic tumour syndromes of the nervous system"in China,which provided a detailed introduction to 8 types of hereditary neurological tumor syndromes.Based on this,the newly included susceptible neurological tumor syndromes was introduced and the research and care points that should be paid attention to in the next step were emphasized.

Multiple genetic tumor susceptibility syndromes are associated with the development of neurological tumors.The classification of hereditary tumor syndromes has changed in the past few years,and there is now a clear understanding of the pathogenic mechanisms of these syndromes and they are classified into eight pathogenic mechanisms.In 2007,our team first published a special issue on"Genetic tumour syndromes of the nervous system"in China,which provided a detailed introduction to 8 types of hereditary neurological tumor syndromes.Based on this,the newly included susceptible neurological tumor syndromes was introduced and the research and care points that should be paid attention to in the next step were emphasized.

ObjectiveTo investigate the efficacy and safety of cinobufagin tablets combined with thalidomide/dexamethasone （TD） regimen in the treatment of newly diagnosed multiple myeloma （NDMM） with phlegm and stasis obstruction. MethodsThe clinical data of 50 patients with NDMM of phlegm and stasis obstruction who were hospitalized at the Jiangsu Province Hospital of Chinese Medicine from June 1st， 2015 to July 31th， 2019 were retrospectively analyzed， and they were divided into a control group （bortezomib/dexamethasone-containing regimen， 27 cases） and an observation group （cinobufagin tablets combined with TD regimen， 23 cases）. The clinical efficacy and safety were compared between the two groups after two or three courses of treatment. The primary outcomes were clinical remission rate including overall response rate and deep remission rate， one-year and two-year overall survival rate， and adverse effects. The secondary outcomes were the proportion of plasma cells in bone marrow， hemoglobin， β2-microglobulin， lactate dehydrogenase， serum creatinine， blood urea nitrogen， bone pain score， and KPS functional status score （KPS score） before and after treatment. ResultsIn terms of clinical efficacy， there was no statistically significant difference （P＞0.05） in the overall response rate ［the observation group 69.57%（16/23） vs the control group 70.37% （19/27）］ and deep remission rate ［the observation group 56.52% （13/23） vs the control group 55.56% （15/27）］ between groups after the treatment. The one-year overall survival rates of the observation group and the control group were 90.9% and 92.4%， and the two-year overall survival rates were 81.8% and 80.9% respectively， with no statistically significant differences between groups （P＞0.05）. During the treatment， no renal function injury occurred in both groups. The incidence of peripheral nerve injury in the observation group was 8.70%， which was lower than 48.15% in the control group （P＜0.01）. After the treatment， the proportion of myeloma plasma cells， β2-microglobulin， serum creatinine level， and bone pain score decreased， while the hemoglobin level and KPS score increased in both groups （P＜0.05 or P＜0.01）. Compared between groups after treatment， the bone pain score of the observation group was lower than that of the control group， while the KPS score was higher than that of the control group （P＜0.05）. ConclusionThe clinical efficacy of cinobufagin tablets combined with TD in the treatment of NDMM is equivalent to bortezomib/dexamethasone-containing regimen， but the former is more helpful in relieving the pain and improving the quality of life， and has better safety.

Humans ; East Asian People ; Psoriasis/drug therapy* ; Antibodies, Monoclonal, Humanized/therapeutic use* ; Treatment Outcome ; Severity of Illness Index

BACKGROUND: Observational research has reported that systemic lupus erythematosus (SLE) is related to common female hormone-dependent cancers, but the underlying causal effect remains undefined. This study aimed to explore the causal association of these conditions by Mendelian randomization (MR) analysis. METHODS: We selected instrumental variables for SLE from genome-wide association studies (GWASs) conducted in European and East Asian populations. The genetic variants for female malignant neoplasms were obtained from corresponding ancestry GWASs. We utilized inverse variance weighted (IVW) as the primary analysis, followed by sensitivity analysis. Furthermore, we conducted multivariable MR (MVMR) to estimate direct effects by adjusting for the body mass index and estradiol. Finally, we implemented reverse direction MR analysis and gave a negative example to test the reliability of MR results. RESULTS: We found SLE was significantly negatively associated with overall endometrial cancer risk (odds ratio [OR] = 0.961, 95% confidence interval [CI] = 0.935-0.987, P  = 3.57E-03) and moderately inversely related to endometrioid endometrial cancer (ENEC) (OR = 0.965, 95% CI = 0.936-0.995, P  = 0.024) risk in the European population by IVW. We replicated these results using other MR models and detected a direct effect by MVMR (overall endometrial cancer, OR = 0.962, 95% CI = 0.941-0.983, P  = 5.11E-04; ENEC, OR = 0.964, 95% CI = 0.940-0.989, P  = 0.005). Moreover, we revealed that SLE was correlated with decreased breast cancer risk (OR = 0.951, 95% CI = 0.918-0.986, P  = 0.006) in the East Asian population by IVW, and the effect was still significant in MVMR (OR = 0.934, 95% CI = 0.859-0.976, P  = 0.002). The statistical powers of positive MR results were all >0.9. CONCLUSION This finding suggests a possible causal effect of SLE on the risk of overall endometrial cancer and breast cancer in European and East Asian populations, respectively, by MR analysis, which compensates for inherent limitations of observational research.
Female ; Humans ; Genome-Wide Association Study ; Mendelian Randomization Analysis ; Neoplasms, Hormone-Dependent ; Reproducibility of Results ; Endometrial Neoplasms ; Lupus Erythematosus, Systemic/genetics* ; Carcinoma, Endometrioid ; Breast Neoplasms ; Polymorphism, Single Nucleotide