ObjectiveTo investigate the possible mechanism of Jishe Qushi Capsule （脊蛇祛湿胶囊， JQC） in treating rheumatoid arthritis （RA） from the perspective of macrophage polarization mediated by neutrophil extracellular traps （NETs）. MethodsTwenty-four female SD rats were randomly divided into four groups， blank control group， model group， JQC group， and peptidylarginine deiminase 4 （PAD4） inhibitor group with 6 rats in each group. All groups but the blank control group were subjected to the induction of collagen-induced arthritis （CIA）. After successful model establishment， rats in the JQC group received intragastric administration of JQC 1.47 g/kg daily； rats in the PAD4 inhibitor group received intraperitoneal injections of the PAD4 inhibitor 4 mg/kg weekly. Rats in the blank， model， and PAD4 inhibitor groups received 2 ml of pure water daily by gavage. All treatments lasted 4 weeks. Joint lesions of each group were assessed on day 7， 14， 21， 28， and 35 after model establishment， and arthritis index （AI） scores were recorded. At 24 h after the final administration， histopathology of knee joints， including HE staining， safranin O-fast green staining， and TRAP staining， was performed. Flow cytometry was used to detect the counts of M1 and M2 macrophages in peripheral blood. ELISA was used to determine serum levels of TRACP， NETs， TNF-α， IL-1β， and iNOS. Western Blotting and qRT-PCR were used to measure MPO， NE， RANKL， OPG， and p65 protein and mRNA expression in knee cartilage tissue. ResultsCompared with the blank control group， the model group showed increased AI scores （P＜0.05）， marked synovial inflammatory infiltration， angiogenesis， and bone-cartilage destruction， increased TRAP-positive osteoclasts， increased M1 macrophages and decreased M2 macrophages， elevated serum TRACP， NETs， TNF-α， IL-1β， and iNOS （P＜0.05）， elevated MPO， NE， RANKL， and p65 protein/mRNA expression and decreased OPG protein/mRNA expression in knee cartilage tissue （P＜0.05）. Compared with the model group， the JQC group exhibited improved synovial inflammation， angiogenesis， and bone-cartilage damage， reduced AI scores on day 21， 28， and 35， decreased osteoclast counts， decreased M1 macrophages and increased M2 macrophages， reduced serum TRACP， NETs， TNF-α， IL-1β， and iNOS （P＜0.05）， decreased MPO， NE， RANKL， and p65 protein/mRNA expression and increased OPG expression （P＜0.05）. Compared with the PAD4 inhibitor group， the JQC group showed significantly lower AI scores， reduced M1 macrophages， increased M2 macrophages （P＜0.05）， reduced serum TRACP， TNF-α， IL-1β， and iNOS， decreased MPO， RANKL， and p65 expression， and increased OPG levels （P＜0.05）. ConclusionThe therapeutic mechanism of JQC for RA may involve inhibition of NETs formation， downregulation of the RANKL/NF-κB signaling pathway， and regulation of macrophage M1/M2 polarization imbalance， thereby suppressing osteoclastogenesis and inflammatory bone destruction.

Objective To explore the relationship between developmental endothelial locus-1(Del-1)and inflammatory response and disease severity in patients with chronic obstructive pulmonary disease(COPD).Method 82 COPD patients admitted to Huai'an Fifth People's Hospital from January 2023 to July 2023 were selected as the COPD group.Among them,40 patients with acute exacerbation were included in the acute exacerbation group,and 42 patients in the stable phase were included in the stable group.Another 40 healthy volunteers who underwent physical examinations during the same period were selected as the control group.The levels of serum Del-1,C-reactive protein(CRP),interleukin-1β(IL-1β)and neutrophil to lymphocyte ratio(NLR)in all study subjects were detected.Pearson's method was used to analyze the correlation between serum Del-1 and inflammatory markers.The predictive value of serum Del-1 for acute exacerbation in COPD patients was analyzed using receiver operating characteristic(ROC)curves.Result The serum CRP,IL-1β and NLR levels in the COPD group were higher than those in the control group(t=12.047,13.107,9.404),the serum Del-1 level in the COPD group was 386.87±42.34 pg/ml,lower than that in the control group 512.63±60.21 pg/ml(t=13.343),and the differences were statistically significant(all P<0.05).The serum CRP,IL-1β and NLR levels in the acute exacerbation group were higher than those in the stable group(t=4.170,5.292,5.919),the serum Del-1 level in the acute exacerbation group was 347.64±40.69 pg/ml,lower than that in the stable group 424.23±48.31 pg/ml(t=7.746),and the differences were statistically significant(all P<0.05).Pearson analysis showed that the serum Del-1 level in COPD patients were negatively correlated with serum CRP,IL-1β and NLR levels(r=-0.534,-0.587,-0.612,all P<0.05).ROC analysis showed that serum Del-1 had a high predictive value for acute exacerbation in COPD patients,with an AUC(95%CI)of 0.886(0.812～0.960).When the optimal cutoffvalue was 380.65 pg/ml,the sensitivity and specificity were 82.50%and 85.00%,respectively.Conclusion Serum Del-1 is low expression in COPD patients and is ngeatively correlated with their inflammatory response and disease severity,it is expected to become a new biomarker for predicting the risk of acute exacerbation of COPD.

In January 2025,American Cancer Society released the latest cancer statistics,projecting approximately 2 041 910 new cancer cases and 618 120 cancer-related deaths in the United States(U.S.).The cancer mortality rate in the U.S.continues to decline,with a reversal in gender disparities and an increasing cancer burden among middle-aged and young populations.Significant differences in incidence and mortality rates are attributed to variations in population characteristics,intervention screening measures,healthcare accessibility,and policy factors across different regions and populations within the U.S.Compared with the U.S.,the cancer spectrum in China is different,and the incidence rates of lung cancer and breast cancer are rapidly rising among young women,with an average annual growth rate exceeding 3%.Infection-related cancer incidence rates are relatively high,with the incidence of gastric cancer,liver cancer and cervix cancer in China being 25.4/105,26.0/105 and 21.8/105 in 2022 respectively,surpassing U.S.incidence levels.Alarmingly,the cumulative HPV vaccination coverage among eligible Chinese women during 2018-2020 was merely 2.24%,reflecting dual barriers of low screening compliance and inadequate prevention infrastructure.There is a need to further enhance primary cancer prevention and comprehensive risk factor control,prioritize cancer prevention strategies for young and female populations,formulate population-tailored prioritized prevention frameworks and strengthen multi-stakeholder financing mechanisms for personalized screening programs,with the aim of achieving the"Healthy China 2030"cancer prevention and control goals and contributing China's approach to global cancer governance.

Objective:To explore the therapeutic efficacy and prognostic factors of combined rituximab and intensive chemotherapy for sporadic adult Burkitt lymphoma (BL) .Methods:This retrospective study examined the clinical and survival data of 30 patients newly diagnosed with BL between July 2011 and February 2023 at the Blood Diseases Hospital. Kaplan-Meier method was used for survival analysis, and the log-rank test was used for univariate analysis of prognostic factors.Results:The median age of the 30 patients was 43 years (24 - 66 years), and the male to female ratio was 3: 2. Extranodal invasion was present in 80% of the patients, with involvement of the bone marrow in 53.3% and central nervous system in 10.0%. The Ann Arbor stage was Ⅲ and Ⅳ in 86.7%. According to the number of Burkitt Lymphoma International Prognostic Index (BL-IPI) risk factors, patients were classified as low risk (0) in 20.0%, intermediate risk (1) in 43.3%, and high risk (≥2) in 36.7%. All patients were treated with an induction regimen of rituximab combined with intensive chemotherapy, with objective and complete response rates of 80.0% and 76.7%, respectively. The median follow-up was 49 months (6-153 months), and the 5-year progression-free survival (PFS) and overall survival (OS) rates were both (76.7±7.7) %. All patients with limited stage ( n=4) achieved continuous complete remission (CCR). Patients who had high risk, advanced stage sensitive to induction therapy ( n=10) sequentially received first-line autologous hematopoietic stem cell transplantation (auto-HSCT) as consolidation therapy; 9 patients achieved CCR, whereas 1 patient with central nervous system invasion developed early disease progression and died. The BL-IPI low, intermediate, and high risk groups had respective 5-year PFS rates of (83.3±15.2) %, 100.0%, and (45.5±15.0) % ( P=0.0069) and OS rates of (83.3±15.2) %, 100.0%, and (45.5±15.0) % ( P=0.0075). The main adverse effects of induction therapy were myelosuppression and secondary infections, which were effectively managed by appropriate symptomatic treatment. Univariate analysis demonstrated that worse PFS was associated with BL-IPI score ≥2 ( HR=4.90, 95% CI 1.02-23.45, P=0.0329) ; extranodal invasion at ≥2 sites ( HR=12.62, 95% CI 2.59-61.62, P=0.0021) ; and failure to achieve first complete response (CR1) after induction therapy ( HR=31.86, 95% CI 4.19-242.20, P<0.0001) . Conclusions:Intensive immunochemotherapy regimens were effective and well-tolerated by adult patients with highly aggressive BL. Treatment efficacy was ideal in patients with limited-stage disease, whereas prognosis was unsatisfactory in patients with high-risk BL-IPI. Sequential first-line auto-HSCT consolidation therapy may further improve outcomes in patients with high-risk advanced-stage disease who are sensitive to induction therapy. BL-IPI score ≥2, extranodal invasion at ≥2 sites, and failure to achieve CR1 after induction therapy were adverse prognostic factors in adult patients with BL.

BACKGROUND:The individualized precise puncture approach is a new approach proposed for vertebral body augmentation in recent years,and has achieved good clinical results,but there is still a lack of relevant biomechanical research.OBJECTIVE:To investigate the biomechanical effects of individualized precise puncture vertebral augmentation on the vertebral endplate and intervertebral disc of osteoporotic vertebral compression fracture using finite element analysis method.METHODS:A total of six preoperative and postoperative models of wedge type,biconcave type,and collapse type were established using the preoperative and postoperative CT imaging data of three osteoporotic vertebral compression fracture patients who had completed individualized precise puncture vertebral augmentation.500 N moment and 10 N/m rotation moment were loaded in the vertical direction of the vertebral body to simulate the normal physiological activities of the vertebral body,including forward flexion,back extension,left bending,right bending,left rotation,and right rotation,to observe the stress changes of endplates,adjacent endplates,and intervertebral discs of different types of fractured vertebral bodies after individualized precise puncture vertebral augmentation.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)After individualized precise puncture vertebral augmentation,the maximum von Mises stress values of wedge-shaped,biconcave,and collapsed fractured vertebral endplates and adjacent vertebral endplates were reduced to a certain extent.The postoperative maximum von Mises stress value increased in the T10 inferior endplate of the superior vertebral body with wedge deformity and the L1 superior endplate of the inferior vertebral body with collapsed deformity.(3)After individualized precise puncture vertebral augmentation,the overall maximum von Mises stress value of adjacent intervertebral discs in the three finite element models decreased.(4)The results show that individualized precise puncture vertebral augmentation can reduce the maximum von Mises stress value of the endplate of wedge-shaped deformity,biconcave deformity and collapsed vertebral body to a certain extent,and diminish the risk of postoperative vertebral body re-fracture.In addition,individualized precise puncture vertebral augmentation decreases the maximum von Mises stress value of the intervertebral disc,which can theoretically alleviate intervertebral disc degeneration to a certain extent.

OBJECTIVE To investigate the therapeutic mechanisms of electroacupuncture at"Tianshu"(ST25)and"Sanyinjiao"(SP6)acupoints combined with metformin in the treatment of type 2 diabetes mellitus(T2DM)using serum non-targeted metabolomics.METHODS Male SD rats were randomly divided into blank group,model group,metformin group,electroacupunc-ture group,and acupuncture-medicine combination(electroacupuncture combined with metformin)group.A type 2 diabetes model was established by high-fat diet combined with intraperitoneal injection of streptozotocin.The metformin group was treated with 250 mg·kg-1 metformin by gavage,the electroacupuncture group was treated with bilateral Tianshu and Sanyinjiao,the acupuncture-medicine combination group was treated with metformin by gavage combined with electroacupuncture,and the blank group and model group were treated with normal saline by gavage.All rats were treated 6 times a week for 7 weeks.After the intervention,the blood glucose level in the tail vein of the rats was measured using a blood glucose meter in the fasting state.The blood glucose levels of the rats were measured at 30,60,120,and 240 min after intraperitoneal injection of 50%glucose solution(4 mL·kg-1)to evaluate glu-cose tolerance.The serum insulin level of the rats was detected by ELISA and the insulin resistance index was calculated.The blood biochemical parameters were measured by an automatic blood biochemical analyzer.HE staining was used to evaluate the pathological conditions of the liver and pancreatic tissues of the rats.Ultra-performance liquid chromatography-mass spectrometry(UPLC-MS)technology was used for mass spectrometry detection to identify differential metabolites,and MetaboAnalyst 5.0 was used for pathway enrichment analysis.RESULTS Compared with the blank group,the fasting blood glucose,area under the glucose tolerance curve,and insulin resistance index of the model group rats were significantly increased(P<0.001),blood TP and GLB were significantly de-creased(P<0.01),AST,ALT,and ALP were significantly increased(P<0.05,P<0.01,P<0.001),and obvious inflammatory cell infiltration and pathological damage were observed in the liver and pancreas tissues;compared with the model group,the fasting blood glucose,area under the glucose tolerance curve,and insulin resistance index of the acupuncture-medicine combination group were sig-nificantly decreased(P<0.05,P<0.01,P<0.001),blood ALP was significantly decreased(P<0.01),TP and GLB were significant-ly increased(P<0.05),and the pathological damage of the liver and pancreas was significantly improved.Serum metabolomics showed that the metabolic profiles of the groups were well distinguished.Compared with the blank group,the differential metabolites in the model group were enriched in histidine metabolism,thiamine metabolism,taurine and hypotaurine metabolism,ascorbic acid and alde-hyde ester metabolism,valine,leucine and isoleucine biosynthesis pathways;compared with the model group,237 metabolites such as 3-aminoadipic acid,3-oxocyclobutanecarboxylic acid and phosphorylcholine in the acupuncture-medicine combination group were sig-nificantly reduced,and the pathways were enriched in histidine metabolism,linoleic acid metabolism,thiamine metabolism,taurine and hypotaurine metabolism,valine,leucine and isoleucine biosynthesis pathways.CONCLUSION Electroacupuncture combined with metformin can effectively improve the glucose and lipid metabolism of T2DM rats,and its potential mechanism may be related to the regulation of amino acid metabolism.

BACKGROUND:Pedicle internal bone cement augmentation combined with vertebroplasty has been used to treat diseases such as Kummell's disease and osteolytic metastases of the pedicle.However,the impact of this surgical method on adjacent vertebrae and intervertebral discs remains unclear.OBJECTIVE:A three-dimensional finite element model was used to explore the impact of percutaneous vertebroplasty combined with pedicles augmentation in the treatment of severe osteoporotic vertebral fractures on the biomechanics of adjacent segmental vertebral bodies and intervertebral discs.METHODS:A female patient who had undergone percutaneous vertebroplasty combined with pedicles augmentation for a severe osteoporotic vertebral fracture(L1)was selected.Preoperative and postoperative CT files were extracted.The study range was T12 to L2,including the injured vertebra,adjacent vertebrae,and intervertebral discs.Software like Mimics,SolidWorks,and Geomagic was used to establish finite element models of the spinal functional unit before and after surgery.A 500 N force and a 10 N·m rotational torque were applied in the vertical direction of the T12 upper endplate to simulate movements such as flexion,extension,lateral bending,and rotation,analyzing the stress changes in the vertebral endplates and intervertebral discs of adjacent segments before and after surgery.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)We calculated and analyzed that under simulated load,the stress distribution of the inferior endplate of T12 was more uniform and the maximum stress value was reduced after surgery,with no significant difference compared with before surgery(P＞0.05).The stress distribution of the superior endplate of L2 after surgery was more uniform and the maximum stress was not significantly different from that before surgery(P＞0.05).Similarly,the stress distribution of T12/L1 and L1/L2 intervertebral discs after surgery was also more uniform and the maximum stress value was significantly reduced(P＜0.05).(3)Therefore,percutaneous vertebroplasty combined with pedicles augmentation can effectively improve the stress distribution of adjacent vertebral endplates and intervertebral discs after surgery and reduce stress,ultimately reducing the risk of postoperative re-fractures and significantly delaying intervertebral disc degeneration.

Mental state is an important part of the normal life activities of the human body, and it is also the most external expression and the most easily obtained information of the physical condition. The normal activities of the mind depend on the normal operation of the viscera, qi, and blood, and are a unified whole that prospers together and suffers together. The theory of the five-spirit-viscera in the Yellow Emperor’s Inner Classic revealed that the normal mental activities of the human body were dominated by the five internal organs, that is, the five internal organs were the body and the five spirits were the function. And it highlighted the viewpoint that the five internal organs store the spirits and are actually one. The heart governs the spirit and belongs to the four internal organs. On this basis, Synopsis of Golden Chamber used the internal organs to diagnose and treat mental diseases, integrating the theory of the five spirits into it, forming a unique method of diagnosis and treatment with the heart as the leading factor and regulating the qi and blood of the four internal organs. It identified the pathogenesis of diseases such as pathogenic crying, lily disease, and hysteria from five levels: heart deficiency and weak qi, heart-lung disharmony, heart-liver disharmony, the heart of the loss of the spleen nourishment, and disharmony between heart and kidney. The treatment was mainly to replenish the deficiency of the viscera and eliminate the pathogens, reflecting the characteristics of regulating the mind and calming the four internal organs. This unique view on diagnosis and treatment has profoundly influenced the diagnosis and treatment theories of mental illnesses by later doctors, and is of great significance to the current clinical treatment of such illnesses.

Objective To compare the 12-month efficacy and safety of N-butyl cyanoacrylate (NBCA) versus radiofrequency ablation (RFA) in treating great saphenous vein (GSV) insufficiency. Methods A total of 155 patients with GSV insufficiency from five centers were randomly allocated to the NBCA group or RFA group. Postoperative efficacy and safety outcomes were evaluated. Results Immediate postoperative closure rates of the GSV trunk were 100% in both groups. The closure rates of NBCA and RFA group were 98.6% and 98.5% at 3 months, 97.1% and 98.5% at 6 months, 98.1% and 95.9% at 12 months, with no statistically significant differences (P>0.05). After treatment, CEAP classification improved significantly from baseline in both groups. In terms of safety, 1 case of phlebitis, 1 case of ablation-related thrombus extension (ARTE) and 2 cases of calf muscle venous thrombosis(CMVT) occurred in the NBCA group, while 2 cases of limb numbness, 1 case of persistent thigh pain and 2 cases of CMVT in the RFA group. All reported serious adverse events in both groups were assessed as unrelated to the medical device or the trial procedure. Conclusions NBCA demonstrates non-inferior efficacy and safety compared to RFA for treating GSV insufficiency over 12 months.