Objective: To investigate the efficacy, nursing characteristics, and management of different desensitization strategies before allogeneic hematopoietic stem cell transplantation (allo-HSCT) among patients with high level of human leukocyte antigen (HLA) antibodies. Methods: A retrospective analysis was conducted on 82 patients with high levels of HLA antibodies who underwent allo-HSCT at the First Affiliated Hospital of Soochow University and Suzhou Hopes Hematonosis Hospital between January 2020 to November 2023. Patients were divided into two groups based on the desensitization strategy they received: the anti-CD20 monoclonal antibody combined with therapeutic plasma exchange (TPE) group (n=50) and the anti-CD20 monoclonal antibody combined with Protein A immunoabsorption group (n=32). The differences of efficacy between the desensitization strategies were analyzed. The safety of both desensitization strategies were assessed by close monitoring of adverse events throughout the treatment. The nursing characteristics and interventions specific to these strategies were comprehensively summarized. Results: There were no significant differences in age, gender, and diagnosis between the two groups of patients receiving different desensitization strategies (P>0.05). Following desensitization in the immunoadsorption group, the mean fluorescence intensity (MFI) levels of anti-HLA Class I antibody decreased significantly compared to initial screening (P=0.048), while the decrease in MFI values of anti-HLA Class II antibody was not statistically significant (P=0.173). In the TPE group, the MFI levels for both anti-HLA Class I and II antibodies after desensitization decreased significantly compared to initial screening (P=0.025 and 0.028, respectively). Monitoring of adverse events during desensitization treatment, found that patients in the immunoadsorption group experienced mild decreases in blood pressure during the process, with two patients developing severe hypotension. No allergic reactions occurred, and no damage of liver or kidney function was observed after the immunoadsorption. In the immunoadsorption group, a total of 19 patients underwent sera immunoglobulin assays before and after immunoadsorption. Compared to the initial screening, the immunoglobulin G (IgG) levels significantly decreased after immunoadsorption (P<0.001). In TPE group, 12 patients experienced mild hypotension during the plasma exchange process, but no severe hypotension was observed. One patient developed an allergic reaction. After the TPE treatment, no damage of liver or kidney function was observed, nor any decrease of IgG levels. In terms of safety of intravenous access, neither group experienced severe complications such as catheter-related bloodstream infections or deep vein thrombosis. In the TPE group, catheter occlusion occurred during the process of plasma exchange in 2 patients, while no such incident was observed in the immunoadsorption group. Patients of both groups exhibited anxiety and depression before treatment. After psychological care, the scores for anxiety and depression significantly decreased (P<0.001). Conclusion: Both desensitization strategies significantly decreased the HLA antibodies in highly sensitized patients with high level of HLA antibodies undergoing allo-HSCT. For patients receiving immunoabsorption, nursing care should focus on preventing and managing hypotension and implementing infection-prevention measures due to IgG depletion. In contrast, for those undergoing TPE, vigilant monitoring and prompt management of potential allergic reactions are essential components of nursing practice.

Objective This study aimed to investigate the effect of acupoint injection on glycometabolism in patients with Polycystic ovary syndrome(PCOS).Methods Eighty patients who were newly diagnosed with polycystic ovary syndrome(PCOS)in our hospital were randomly allocated into two groups:a control group and a treatment group,with 40 cases in each group.The two groups were treated with dietary exercise lifestyle and dietary exercise lifestyle+acupoint injection intervention for 3 months,respectively.The basal disposition index(DI0),early-phase disposition index(DI30),and total disposition index(DI120)represented β-cell function at fasting,early phase,and 120 minutes during the oral glucose tolerance test(OGTT).The homeostatic model assessment for insulin resistance(HOMA-IR)and the M value obtained from the high insulin-euglycemic clamp(HEC)test indicated insulin sensitivity.The changes in anthropometric indicators[waist-to-hip ratio(WHR),body mass index(BMI)],blood glucose and insulin levels[fasting blood glucose(Glu0),2 h post-OGTT blood glucose(Glu120),fasting insulin(Ins0),2 h post-OGTT insulin(Ins120),and glycated hemoglobin A1c(HbA1c)],sex hormones[free testosterone index(FAI),luteinizing hormone/follicle-stimulating hormone(LH/FSH)],pancreatic β-cell function and insulin sensitivity,oxidative stress[malondialdehyde(MDA),Cu/Zn superoxide dismutase(Cu/Zn SOD),glutathione peroxidase 1(GPX1)],and inflammation[interleukin-6(IL-6),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)]were compared before and after treatment,and safety observations were conducted.Results The baseline levels of the two groups were consistent(P>0.05);after treatment,the Glu0,Ins0,HOMA-IR,MDA,IL-6,IL-1β,and TNF-α in the treatment group were significantly reduced compared to those observed in the control group(P<0.05,P<0.01),while DI0,DI120,M value,Cu/Zn SOD,and GPX1 were higher than those in the control group(P<0.05,P<0.01).However,there were no statistically significant differences in anthropometric indicators,sex hormones,and other glucose metabolism indicators(P>0.05),and the incidence of adverse reactions between the two groups was not statistically significant(P>0.05).Conclusion Acupoint injection can alleviate glycometabolism in patients with PCOS of kidney deficiency and blood stasis to a certain extent,improve systemic oxidative stress and inflammatory status,and provide a possible external treatment method in traditional Chinese medicine for these patients.

Objective:To assess the long-term risk of relapse in patients with Crohn's disease (CD) who discontinued infliximab (IFX) monoclonal antibody and to identify risk factors associated with relapse.Methods:A single-center retrospective observational study was conducted from February 2006 to October 2016. The study included CD patients who were treated with scheduled IFX infusions at the First Affiliated Hospital of Sun Yat-sen University and assessed in corticosteroid-free clinical remission at the time of withdrawal were included. The primary outcome was clinical relapse. We evaluated the risk of relapse using Kaplan-Meier method. Factors associated with time to relapse was identified using the multiple Cox proportional hazards regression analysis.Results:We included 97 eligible patients, and 75 (77.3%) experienced a relapse after a median follow-up time of 124 months. Among them, 45 patients (46.4%) relapsed within 3 years after IFX withdrawal. The 1-, 2-, 3-, 5-, and 10-year relapse-free survival were 79.4%, 59.8%, 52.6%, 42.0% and 22.6%, respectively. Risk factors for relapse included age ≤ 16 ( HR = 2.62, 95% CI: 1.30-5.31; P = 0.007) and failure to achieve biological remission (CRP > 3 mg/L, HR = 2.37, 95% CI: 1.29-4.36; P = 0.006) at drug withdrawal. Induction with biologics or systemic steroids were both effective (89%-100% relieved) in relapsers. Conclusions:Nearly half of CD patients relapsed within 3 years after discontinuation of IFX treatment. Early age of discontinuation and failure to achieve serum biological remission at the time of discontinuation are independent predictors of clinical relapse.

Objective To analyze the feasibility of probiotics in delaying the progression of early Alzheimer's disease(AD)based on the changes of brain-gut-microbiota axis factors.Methods A total of 100 patients with early AD who visited Shaoxing 7th People's Hospital from December 2023 to December 2024 were selected and divided into control group(40 cases)and study group(60 cases)based on different treatment methods.The control group was treated with donepezil hydrochloride,while study group was treated with donepezil hydrochloride combined with probiotic preparations.The cognitive function,daily living ability,intestinal flora,and relative expression levels of brain-gut-microbiota axis factors,interleukin(IL)-6,tumor necrosis factor-α(TNF-α),5-hydroxytryptamine(5-HT),γ-aminobutyric acid(GABA),and lipopolysaccharide(LPS)/Toll-like receptor 4(TLR4)/nuclear factor-KB(NF-κB)axis factors were compared before and after treatment in both groups.The clinical efficacy and prognosis monitoring results were also compared.Results The total effective rate and the proportion of patients with a clinical dementia rating score of 0 in study group were higher than those in control group(P＜0.05).The cognitive function and daily living ability scores in study group were higher than those in control group(P＜0.05).The copy numbers of lactobacillus and bifidobacterium in study group were higher than those in control group,while the copy numbers of enterococcus and escherichia coli were lower(P＜0.05).The relative expression levels of amyloid-β protein 1-42,IL-6,TNF-α,TLR4,and NF-κB in study group were lower than those in control group,and the levels of 5-HT and GABA were higher(P＜0.05).Conclusion Probiotics can delay the progression of early AD patients and improve clinical efficacy.It is speculated that the mechanism of action may be related to regulating the brain-gut-microbiota axis-mediated LPS/TLR4/NF-κB pathway to restore the intestinal microecology and alleviate neurological inflammation.

Objective To investigate the mechanism underlying the inhibitory effect of Buyang Huanwu Decoction(BYHWD)on vascular aging.Methods Eighteen male SD rats were randomized into young group,intraperitoneal D-galactose injection-induced aging group,and BYHWD gavage group.The changes in pulse wave velocity(PWV),vascular SA-β-gal activity,and expressions of p16,p21 and SA-β-gal of the rats were examined.Serum exosomes were isolated from the rats,and after characterization using NTA and TEM and for surface markers and vascular cell markers,were examined for miR-590-5p expression using qRT-PCR.The M1/M2 macrophage ratio and cytokine levels were evaluated using immunofluorescence staining and qRT-PCR.Bioinformatics analysis and dual-luciferase reporter assays were carried out to predict the potential target genes of miR-590-5p and validate its targeting relationship with SLC8A3,whose expressions were detected in the vascular tissues of the rats by Western blotting.Results Compared with the young rats,the aging rats exhibited significantly increased PWV in the abdominal aorta with elevated vascular expressions of p16,p21 and SA-β-gal,which were all reversed by BYHWD treatment.The isolated serum exosomes were positive for CD63,CD81,CD31 and SM-22,and the exosomes from aging rats showed significantly downregulated expression of miR-590-5p,which was upregulated after BYHWD treatment.The aging rat vessels showed an increased M1/M2 macrophage ratio with elevated M1-specific cytokines and reduced M2-specific cytokines,and BYHWD treatment effectively inhibited M1 polarization of the macrophages.Pearson analysis revealed a negative correlation between exosomal miR-590-5p upregulation and the M1/M2 ratio.Bioinformatics analysis and dual-luciferase assays confirmed that miR-590-5p targets SLC8A3.Western blotting demonstrated increased SLC8A3 expression in aging rat vessels,which was downregulated after BYHWD treatment.Conclusion BYHWD attenuates vascular aging in rats by modulating macrophage M1 polarization and suppressing vascular inflammation via exosomal miR-590-5p-mediated downregulation of SLC8A3.

OBJECTIVES: To investigate the mechanism underlying the inhibitory effect of Buyang Huanwu Decoction (BYHWD) on vascular aging. METHODS: Eighteen male SD rats were randomized into young group, intraperitoneal D-galactose injection-induced aging group, and BYHWD gavage group. The changes in pulse wave velocity (PWV), vascular SA-β-gal activity, and expressions of p16, p21 and SA‑β‑gal of the rats were examined. Serum exosomes were isolated from the rats, and after characterization using NTA and TEM and for surface markers and vascular cell markers, were examined for miR-590-5p expression using qRT-PCR. The M1/M2 macrophage ratio and cytokine levels were evaluated using immunofluorescence staining and qRT-PCR. Bioinformatics analysis and dual-luciferase reporter assays were carried out to predict the potential target genes of miR-590-5p and validate its targeting relationship with SLC8A3, whose expressions were detected in the vascular tissues of the rats by Western blotting. RESULTS: Compared with the young rats, the aging rats exhibited significantly increased PWV in the abdominal aorta with elevated vascular expressions of p16, p21 and SA-β-gal, which were all reversed by BYHWD treatment. The isolated serum exosomes were positive for CD63, CD81, CD31 and SM-22, and the exosomes from aging rats showed significantly downregulated expression of miR-590-5p, which was upregulated after BYHWD treatment. The aging rat vessels showed an increased M1/M2 macrophage ratio with elevated M1-specific cytokines and reduced M2-specific cytokines, and BYHWD treatment effectively inhibited M1 polarization of the macrophages. Pearson analysis revealed a negative correlation between exosomal miR-590-5p upregulation and the M1/M2 ratio. Bioinformatics analysis and dual-luciferase assays confirmed that miR-590-5p targets SLC8A3. Western blotting demonstrated increased SLC8A3 expression in aging rat vessels, which was downregulated after BYHWD treatment. CONCLUSIONS BYHWD attenuates vascular aging in rats by modulating macrophage M1 polarization and suppressing vascular inflammation via exosomal miR-590-5p-mediated downregulation of SLC8A3.
Animals ; MicroRNAs/genetics* ; Rats, Sprague-Dawley ; Drugs, Chinese Herbal/pharmacology* ; Male ; Macrophages/drug effects* ; Rats ; Exosomes/metabolism* ; Aging/drug effects* ; Signal Transduction

Objective To explore the applicability of four risk assessment methods in evaluating occupational health risks associated with low-level benzene homologues exposure in key work sites within the automobile manufacturing industry. Methods The work sites (paint mixing and spray painting) with exposure to benzene homologues among six automobile manufacturing enterprises in Guangdong Province were selected as the study subjects using the judgmental sampling method. Qualitative risk assessment, exposure index method, non-carcinogenic risk assessment, and the International Council on Mining and Metals risk rating method were independently applied to evaluate the occupational health risks of benzene homologues at these work sites. Accuracy, consistency, and correlation of the four methods were compared. Results The air levels of benzene, toluene, xylene, and ethylbenzene in work sites of paint mixing and spray painting across all six enterprises met national occupational health standards. The median ratios of occupational exposure limits for benzene and toluene in spray painting site were higher than those in paint mixing site (0.017 vs 0.010, P<0.05). Using this ratio as a reference for evaluating method accuracy, the non-carcinogenic risk assessment method could distinguish paint mixing site from spray painting site in terms of risk level (P<0.05), whereas the other three methods could not (both P>0.05). The result of consistency testing revealed that the Kappa coefficients between the four methods ranged from -0.13-0.26, indicating poor consistency. The result of Spearman correlation analysis showed that the non-carcinogenic risk assessment and exposure index methods had higher correlation with occupational exposure limits ratios (Spearman correlation coefficients were 0.501 and 0.656, respectively, all P<0.05). Conclusion Occupational health risk assessment can serve as a supplementary tool to evaluate the hazard level of key work sites in the automobile manufacturing industry. Non-carcinogenic risk assessment shows higher accuracy.

Objective To investigate the expression of LncRNA RMST in gastric cancer and its value in diagnosis and prognosis.Methods Tumor and adjacent normal tissues were collected and analyzed from 92 gastric cancer patients.The expression of LncRNA RMST in these tissues was measured using RT-qPCR.ROC curve analysis was performed to evaluate the diagnostic value of LncRNA RMST for gastric cancer.Survival curves were plotted to assess the prognostic significance of LncRNA RMST in gastric cancer.Results LncRNA RMST expression was significantly lower in gastric cancer tissues than in normal tissues.Further analysis revealed that LncRNA RMST expression levels decreased progressively with advancing cancer stages and were significantly correlated with tumor size,TNM staging,and lymph node metastasis(P<0.05),with no significant correlation with patient age or gender.Additionally,ROC curve analysis indicated that LncRNA RMST has substantial diagnostic value in gastric cancer,with AUC of 0.76(95%CI:0.69～0.83,P<0.01),sensitivity of 70.31%,and specificity of 71.56%.Survival analysis showed that patients with high LncRNA RMST expression had significantly higher overall survival rates than those with low expression.Conclusion LncRNA RMST plays a critical role in the occurrence,progres-sion,and prognosis of gastric cancer.It may serve as a potential biomarker for the diagnosis and prognosis of gastric cancer,offering new insights for clinical screening and therapeutic strategies.

ObjectiveTo construct a comprehensive evaluation indicator system for clinical practice guidelines of traditional Chinese medicine （TCM） that is scientific， systematic， and reflects the characteristics of TCM. MethodsA systematic search was conducted in Chinese and English databases， including CNKI， Wanfang， VIP， SinoMed， PubMed， Embase， and Cochrane Library， to include literature on domestic and international guideline evaluation tools and TCM-related research. Document analysis and CiteSpace were utilized for keyword co-occurrence and clustering analysis. ResultsA total of 65 relevant studies were included， from which seven core thematic domains were identified. Based on the research objectives， a two-step construction strategy was adopted： first， an external evaluation framework was established by referencing international tools to cover methodological rigor and procedural standardization； second， an internal evaluation framework was developed to reflect the distinctive features of TCM clinical practice， including syndrome differentiation and efficacy feedback. Through expert consensus， the indicator system was refined， resulting in a dual-layered structure comprising 8 primary indicators， 22 secondary indicators， and 62 evaluation criteria. ConclusionThe comprehensive evaluation system for TCM clinical practice guidelines， based on bibliometric analysis and core element extraction， integrates both theoretical integrity and practical applicability. This study provides a preliminary research foundation for further optimization， validation， and development of a refined comprehensive evaluation system.

The paper introduces Professor SUN Shentian's experience in clinical practice of Ningshen (tranquilizing the mind) point. This point is an empirical point discovered by Professor SUN on the basis of meridian differentiation, nerve function and anatomic location, and in association with the years of clinical practice. The point is located in the prefrontal area, jointed with the distribution of the governor vessel, and responded to the body surface projection area of the frontal pole. It works on regulating the mind, regaining consciousness, improving cognition, alleviating depression, mutually treating physical and mental disorders, as well as unblocking collaterals, regulating the tendons and relieving spasm. This point is widely used in treatment of mental disorders, stroke and extrapyramidal diseases and obtains the reliable therapeutic effect in clinical practice.
Humans ; Acupuncture Points ; Acupuncture Therapy/history* ; China ; Meridians ; History, 20th Century