OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

BACKGROUND: China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis (PSSP-UL). Although acupuncture is known to be effective for PSSP-UL, there is room to enhance its efficacy. OBJECTIVE: This study explored a semi-personalized acupuncture approach for PSSP-UL that used three-dimensional kinematic analysis (3DKA) results to select additional acupoints, and investigated the feasibility, efficacy and safety of this approach. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This single-blind, single-center, randomized, controlled trial involved 74 participants who experienced a first-ever ischemic or hemorrhagic stroke with spastic upper limb paresis. The participants were then randomly assigned to the intervention group or the control group in a 1:1 ratio. Both groups received conventional treatments and acupuncture treatment 5 days a week for 4 weeks. The main acupoints in both groups were the same, while participants in the intervention group received additional acupoints selected on the basis of 3DKA results. Follow-up assessments were conducted for 8 weeks after the treatment. MAIN OUTCOME MEASURES: The primary outcome was the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) response rate (≥ 6-point change) at week 4. Secondary outcomes included changes in motor function (FMA-UE), Brunnstrom recovery stage (BRS), manual muscle test (MMT), spasticity (Modified Ashworth Scale, MAS), and activities of daily life (Modified Barthel Index, MBI) at week 4 and week 12. RESULTS: Sixty-four participants completed the trial and underwent analyses. Compared with control group, the intervention group exhibited a significantly higher FMA-UE response rate at week 4 (χ² = 5.479, P = 0.019) and greater improvements in FMA-UE at both week 4 and week 12 (both P < 0.001). The intervention group also showed bigger improvements from baseline in the MMT grades for shoulder adduction and elbow flexion at weeks 4 and 12 as well as thumb adduction at week 4 (P = 0.007, P = 0.049, P = 0.019, P = 0.008, P = 0.029, respectively). The intervention group showed a better change in the MBI at both week 4 and week 12 (P = 0.004 and P = 0.010, respectively). Although the intervention group had a higher BRS for the hand at week 12 (P = 0.041), no intergroup differences were observed at week 4 (all P > 0.05). The two groups showed no differences in MAS grades as well as in BRS for the arm at weeks 4 and 12 (all P > 0.05). CONCLUSION: Semi-personalized acupuncture prescription based on 3DKA results significantly improved motor function, muscle strength, and activities of daily living in patients with PSSP-UL. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200056216. Please cite this article as: Huang XY, Liao OP, Jiang SY, Tao JM, Li Y, Lu XY, Li YY, Wang C, Li J, Ma XP. Three-dimensional kinematic analysis can improve the efficacy of acupoint selection for post-stroke patients with upper limb spastic paresis: A randomized controlled trial. J Integr Med. 2025; 23(1): 15-24.
Humans ; Male ; Female ; Middle Aged ; Acupuncture Points ; Upper Extremity/physiopathology* ; Biomechanical Phenomena ; Single-Blind Method ; Aged ; Stroke/therapy* ; Acupuncture Therapy/methods* ; Stroke Rehabilitation/methods* ; Adult ; Muscle Spasticity/therapy* ; Paresis/physiopathology* ; Treatment Outcome

Objective:To evaluate the clinically curative effect of intervention treatment of electronic bronchoscope in treating tracheobronchial tuberculosis at clinical activity stage.Methods:Sixty patients with tracheobronchial tuberculosis at clinical activity stage(type I,II,III and VI)who admitted to Liuzhou People's Hospital from September 2020 to September 2023 were selected,and they were divided into drug group(anti-tuberculosis drug treatment)and combination group(anti-tuberculosis drug treatment+interventional treatment with electronic bronchoscope)by the random number table method,with 30 cases in each group.The curative effects of the two groups were observed,and the negative conversion rate of sputum bacteria,clinical symptom scores(cough symptom,expectoration symptom)before and after treatment,Modified British Medical Research Council Dyspnea Scale(mMRC)score between two groups were compared,and the differences in indicators of pulmonary function such as forced expiratory volume in the first second(FEV1),forced vital capacity(FVC)and maximum voluntary ventilation(MVV)between the two groups also were compared.And then,the incidence of complications was calculated.Results:During the 1,2 and 3 months of follow-up,there were respectively 21 cases,27 cases and 30 cases occurred negative conversion of sputum bacteria in 30 patients of the combination group,and there were respectively 15 cases,18 cases and 23 cases occurred negative conversion of sputum bacteria in 30 patients of the drug group.At the 1st month of follow-up,the negative conversion rate of sputum bacteria in combination group was higher than that in drug group,while there was no statistically significant difference between the two groups(P＞0.05).At the 2nd and 3rd month of follow-up,the negative conversion rate of sputum bacteria in the combination group was higher than that in the drug group,and the differences were statistically significant(x2=7.200,7.925,P<0.05).The effective rate of treatment of the combination group was 100%,which was higher than 80%of the drug group,and the difference of that between two groups was significant(x2=6.667,P<0.05).After 2 months of treatment,the mMRC score,cough symptom score and expectoration symptom score of the combination group were all lower than those of the drug group,and the differences were statistically significant(t=3.504,3.950,3.530,P<0.05).The improvement effects of FEV1,FVC and MVV of the combination group were all better than those of the drug group,and the differences were statistically significant(t=6.626,4.966,4.097,P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Anti-tuberculosis drug therapy combined with electronic bronchoscopy intervention has a good therapeutic effect in clinically active tracheobronchial tuberculosis.

Prostate-specific membrane antigen(PSMA)positron emission tomography(PET)is currently a precise diagnostic imaging technology for prostate cancer(PCa).Artificial intelligence(AI)technologies,particularly machine learning and deep learning algorithms,when combined with PSMA PET,showed extensive potential applications in various aspects of PCa management.These include the diagnosis and differential diagnosis of primary tumors,staging,recurrence detection,and treatment planning for PCa.At present,a few AI models have received clinical approval.This paper reviews the application progress of AI combined with PSMA PET in the diagnosis and treatment of PCa,explores the current limitations of AI technologies in clinical practice,and aim to provide references to future diagnosis and treatment studies for PCa.

Objective:To evaluate the clinically curative effect of intervention treatment of electronic bronchoscope in treating tracheobronchial tuberculosis at clinical activity stage.Methods:Sixty patients with tracheobronchial tuberculosis at clinical activity stage(type I,II,III and VI)who admitted to Liuzhou People's Hospital from September 2020 to September 2023 were selected,and they were divided into drug group(anti-tuberculosis drug treatment)and combination group(anti-tuberculosis drug treatment+interventional treatment with electronic bronchoscope)by the random number table method,with 30 cases in each group.The curative effects of the two groups were observed,and the negative conversion rate of sputum bacteria,clinical symptom scores(cough symptom,expectoration symptom)before and after treatment,Modified British Medical Research Council Dyspnea Scale(mMRC)score between two groups were compared,and the differences in indicators of pulmonary function such as forced expiratory volume in the first second(FEV1),forced vital capacity(FVC)and maximum voluntary ventilation(MVV)between the two groups also were compared.And then,the incidence of complications was calculated.Results:During the 1,2 and 3 months of follow-up,there were respectively 21 cases,27 cases and 30 cases occurred negative conversion of sputum bacteria in 30 patients of the combination group,and there were respectively 15 cases,18 cases and 23 cases occurred negative conversion of sputum bacteria in 30 patients of the drug group.At the 1st month of follow-up,the negative conversion rate of sputum bacteria in combination group was higher than that in drug group,while there was no statistically significant difference between the two groups(P＞0.05).At the 2nd and 3rd month of follow-up,the negative conversion rate of sputum bacteria in the combination group was higher than that in the drug group,and the differences were statistically significant(x2=7.200,7.925,P<0.05).The effective rate of treatment of the combination group was 100%,which was higher than 80%of the drug group,and the difference of that between two groups was significant(x2=6.667,P<0.05).After 2 months of treatment,the mMRC score,cough symptom score and expectoration symptom score of the combination group were all lower than those of the drug group,and the differences were statistically significant(t=3.504,3.950,3.530,P<0.05).The improvement effects of FEV1,FVC and MVV of the combination group were all better than those of the drug group,and the differences were statistically significant(t=6.626,4.966,4.097,P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Anti-tuberculosis drug therapy combined with electronic bronchoscopy intervention has a good therapeutic effect in clinically active tracheobronchial tuberculosis.

Objective to analyze the Budget Execution Rate of administrative departments in sample hospitals,and to realize the cost control of Budget performance integration with Balanced Score Card(BSC)Financial Dimension Quantitative Assessment.Methods The budget and execution data of 23 administrative departments were collected from January to June in the sample 2023.The budget execution rate was calculated and cleaned,and the data were segmented by histogram.Using the financial dimension 25 to divide by the total number of items in each department's budget to obtain the scoreof each item in each department,and using the interpolation method to calculate the cost scores of each department,then into the performance appraisal.Results(1)Each item score should be multiplied by item coefficient,and then sum up;(2)The total score of self-executing Project+the total score of centralized executing project.(3)Cost score:1 the scores of 8 departments of non-homing items were 5.54～15.76,2 the scores of 15 departments of homing items were 7.68～17.06.Conclusion It adopts the concept of BSC and Hospital Resource Planning as the cost control of administrative departments to make up for the lack of qualitative and quantitative BSC;can focus on monitoring the dispersion of large data;histogram score results of segmentation objective and easy to operate,makes the interpolation calculation more credible.In a word,it provides quantitative ideas and methods in the aspects of different responsibilities and difficult performance evaluation.

Objective to analyze the Budget Execution Rate of administrative departments in sample hospitals,and to realize the cost control of Budget performance integration with Balanced Score Card(BSC)Financial Dimension Quantitative Assessment.Methods The budget and execution data of 23 administrative departments were collected from January to June in the sample 2023.The budget execution rate was calculated and cleaned,and the data were segmented by histogram.Using the financial dimension 25 to divide by the total number of items in each department's budget to obtain the scoreof each item in each department,and using the interpolation method to calculate the cost scores of each department,then into the performance appraisal.Results(1)Each item score should be multiplied by item coefficient,and then sum up;(2)The total score of self-executing Project+the total score of centralized executing project.(3)Cost score:1 the scores of 8 departments of non-homing items were 5.54～15.76,2 the scores of 15 departments of homing items were 7.68～17.06.Conclusion It adopts the concept of BSC and Hospital Resource Planning as the cost control of administrative departments to make up for the lack of qualitative and quantitative BSC;can focus on monitoring the dispersion of large data;histogram score results of segmentation objective and easy to operate,makes the interpolation calculation more credible.In a word,it provides quantitative ideas and methods in the aspects of different responsibilities and difficult performance evaluation.

Objective This study aimed to compare the current Essen rabies post-exposure immunization schedule(0-3-7-14-28)in China and the simple 4-dose schedule(0-3-7-14)newly recommended by the World Health Organization in terms of their safety,efficacy,and protection. Methods Mice were vaccinated according to different immunization schedules,and blood was collected for detection of rabies virus neutralizing antibodies(RVNAs)on days 14,21,28,35,and 120 after the first immunization.Additionally,different groups of mice were injected with lethal doses of the CVS-11 virus on day 0,subjected to different rabies immunization schedules,and assessed for morbidity and death status.In a clinical trial,185 rabies-exposed individuals were selected for post-exposure vaccination according to the Essen schedule,and blood was collected for RVNAs detection on days 28 and 42 after the first immunization. Results A statistically significant difference in RVNAs between mice in the Essen and 0-3-7-14 schedule groups was observed on the 35th day(P<0.05).The groups 0-3-7-14,0-3-7-21,and 0-3-7-28 showed no statistically significant difference(P>0.05)in RVNAs levels at any time point.The post-exposure immune protective test showed that the survival rate of mice in the control group was 20%,whereas that in the immunization groups was 40%.In the clinical trial,the RVNAs positive conversion rates on days 28(14 days after 4 doses)and 42(14 days after 5 doses)were both 100%,and no significant difference in RVNAs levels was observed(P>0.05). Conclusion The simple 4-dose schedule can produce sufficient RVNAs levels,with no significant effect of a delayed fourth vaccine dose(14-28 d)on the immunization potential.

Objective To investigate the clinical efficacy and safety of Yiqi Huatan Tongluo Prescription(mainly composed of Fici Simplicissimae Radix,Notoginseng Radix et Rhizoma,Pinelliae Rhizoma Praeparatum,Poria,Nelumbinis Folium,and Glycyrrhizae Radix et Rhizoma,etc.)combined with drug-coated balloon(DCB)in the treatment of coronary heart disease(CHD)and to observe its effect on low-shear related serological indicators.Methods A total of 106 patients with CHD of qi deficiency and phlegm stasis obstructing collateral type who were scheduled to undergo percutaneous coronary intervention were randomly divided into a treatment group and a control group,with 53 cases in each group.The control group was treated with drug-eluting stent implantation,and the treatment group was treated with DCB.After the operation,the control group was given conventional antiplatelet aggregation drugs,and the treatment group was given oral administration of Yiqi Huatan Tongluo Prescription.The medication for the two groups lasted for 12 weeks.The changes in the serum levels of monocyte chemoattractant protein 1(MCP-1),interleukin 1 β(IL-1β)and vascular endothelial growth factor(VEGF)in the two groups were observed before and after treatment.Moreover,the traditional Chinese medicine(TCM)syndrome efficacy after treatment and the incidence of adverse events one year after operation were compared between the two groups.Results(1)After 12 weeks of treatment,the total effective rate for TCM syndrome efficacy of the treatment group was 88.68％(47/53),and that of the control group was 75.47％(40/53).The intergroup comparison(tested by chi-square test)showed that the TCM syndrome efficacy in the treatment group was significantly superior to that in the control group(P＜0.05).(2)The analysis of indicators related to endothelial dysfunction in the blood flow with low shear stress showed that after treatment,the levels of serum MCP-1,IL-1βand VEGF in the control group presented no obvious changes(P＞0.05),but the serum levels of MCP-1 and IL-1β in the treatment group were significantly lowered compared with those before treatment(P＜0.05).The intergroup comparison showed that the decrease of serum MCP-1,IL-1β and VEGF levels in the treatment group was significantly superior to that in the control group(P＜0.05).(3)The one-year follow-up after the operation showed that the total incidence of adverse events in the treatment group was 18.87％(10/53),and that in the control group was 20.75％(11/53).There was no significant difference between the two groups(P＞0.05).Conclusion Yiqi Huatan Tongluo Prescription combined with DCB has definite action on the targets related to endothelial dysfunction in coronary blood flow with low shear stress,which is conducive to reducing inflammatory response,improving the symptoms of angina pectoris and enhancing clinical efficacy.The incidence of adverse events did not increase one year after operation,indicating good safety and effectiveness.

Objective To investigate the risk factors for bronchopulmonary dysplasia(BPD)in twin preterm infants with a gestational age of<34 weeks,and to provide a basis for early identification of BPD in twin preterm infants in clinical practice.Methods A retrospective analysis was performed for the twin preterm infants with a gestational age of<34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020.According to their conditions,they were divided into group A(both twins had BPD),group B(only one twin had BPD),and group C(neither twin had BPD).The risk factors for BPD in twin preterm infants were analyzed.Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins.Results A total of 904 pairs of twins with a gestational age of<34 weeks were included in this study.The multivariate logistic regression analysis showed that compared with group C,birth weight discordance of>25%between the twins was an independent risk factor for BPD in one of the twins(OR=3.370,95%CI:1.500-7.568,P<0.05),and high gestational age at birth was a protective factor against BPD(P<0.05).The conditional logistic regression analysis of group B showed that small-for-gestational-age(SGA)birth was an independent risk factor for BPD in individual twins(OR=5.017,95%CI:1.040-24.190,P<0.05).Conclusions The development of BPD in twin preterm infants is associated with gestational age,birth weight discordance between the twins,and SGA birth.