ObjectiveTo study the clinical characteristics and influencing factors of rheumatoid arthritis （RA） in the patients with cold dampness obstruction syndrome. MethodsThe RA patients treated in the Department of Traditional Chinese Medicine and Rheumatology of the China-Japan Friendship Hospital from August 2022 to June 2024 were selected. The demographic information， clinical data， laboratory test results， and traditional Chinese medicine （TCM） symptom information were collected for syndrome differentiation， on the basis of which the characteristics and influencing factors of cold dampness obstruction syndrome were analyzed. ResultsA total of 258 RA patients were selected in this study， including 88 （34.1%） patients with cold dampness obstruction syndrome， 53 （20.5%） patients with dampness and heat obstruction syndrome， 31 （12.0%） patients with wind dampness obstruction syndrome， 29 （11.2%） patients with liver-kidney deficiency syndrome， 19 （7.4%） patients with Qi-blood deficiency syndrome， 14 （5.4%） patients with phlegm-stasis obstruction syndrome， 15 （5.8%） patients with stasis obstructing collateral syndrome and 9 （3.5%） patients with Qi-Yin deficiency syndrome. The patients were assigned into two groups of cold dampness obstruction syndrome and other syndromes. The group of cold dampness obstruction syndrome had lower joint fever， 28-tender joint count （TJC28）， and 28-joint disease activity score （DAS28）-C-reactive protein （CRP） and higher central sensitization， cold feeling of joints， fear of wind and cold， cold limbs， and abdominal distention than the group of other syndromes （P<0.05）. The binary logistic regression analysis showed that central sensitization （OR 5.749， 95%CI 2.116-15.616， P<0.001） and DAS28-CRP （OR 0.600， 95% CI 0.418-0.862， P=0.006） were the independent factors influencing cold dampness obstruction syndrome in RA. ConclusionCold dampness obstruction syndrome is a common syndrome in RA patients. It is associated with central sensitization， cold feeling of joints， abdominal distension and may be a clinical syndrome associated with central sensitization.

[摘 要] 嵌合抗原受体基因修饰T细胞（CAR-T细胞）疗法是一种肿瘤免疫治疗方法：来自人体的T细胞在体外经遗传学修饰、表达特异性嵌合抗原受体（CAR），然后将其回输入患者体内，用于靶向识别和消除肿瘤细胞。尽管CAR-T细胞疗法在血液系统肿瘤治疗中取得了较为显著的成功，其在实体瘤治疗中仍面临障碍。细胞因子释放综合征（CRS）等免疫相关不良反应（irAE）制约了CAR-T细胞的安全应用，肿瘤相关抗原（TAA）的异质性限制了单一CAR-T细胞的广谱适用性，也制约了其通用型开发。鉴于此，要使CAR-T细胞疗法在实体瘤临床治疗中得到应用，还需开展进一步的改良与提升研究。本文围绕实体瘤中CAR-T细胞疗法，从“CAR基因修饰策略”、“通用免疫受体的再靶向策略”及“抗原通用性‘赋靶’策略”三个方面对CAR-T细胞领域中为提高安全性和通用性所进行的探索进行述评，系统剖析各策略的研究路径、优势及局限性，并展望未来发展方向。通过综述CAR-T细胞安全性和普适性设计策略的进展，本文旨在为实体瘤的CAR-T细胞疗法研发提供创新思路。

AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People's Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study. Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality. Further stratification was performed according to preoperative deviation angles [>35 prism diopters(PD)vs ≤35 PD] and age(≥18 years adult group vs <18 years adolescent group). The baseline patient characteristics were collected, deviation angles at multiple timepoints before and after treatment were measured, and stereopsis test results were documented. Through comparative analysis of therapeutic outcomes across subgroups, we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included. At the final follow-up, both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001). Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05). For patients with deviations >35 PD, surgery yielded significantly better outcomes than injection therapy in postoperative angle, success rate, and stereopsis recovery(P<0.05). Similarly, in patients aged ≥18 years, surgical treatment was superior to injections in reducing strabismus angle, improving success rates, and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE. Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy, particularly in patients with deviations >35 PD and those aged ≥18 years. For patients with angles ≤35 PD or under 18 years, BTXA injection remains a viable treatment option.

Objective:To evaluate the predictive effect of the loss of signal (LOS) on the recurrent laryngeal nerve (RLN) injury.Methods:The literatures on PubMed, Web of Science, CNKI, and Wanfang Medical Network database were published before 30 April 2023. English search terms included "thyroid gland surgery" "thyroidectomy" "intraoperative neuromonitoring" "intraoperative nerve monitoring" and "recurrent laryngeal nerve". Chinese search terms included "thyroidectomy", "thyroid surgery" "recurrent laryngeal nerve" "intraoperative nerve monitoring". Two evaluators screened the literature, extracted the materials and evaluated the risk of bias of the study independently. If there were different opinions, researchers should resolve which through consultation and ask the third-party researcher when necessary. The Meta-analysis was performed with the Review Manager 5.4 software.Results:A total of thirty-three studies were included and were all analyzed for primary outcome measures while only twenty-six of which were analyzed for secondary outcome measures. Meta-analysis showed that the positive predictive value of LOS in intraoperative nerve monitoring (IONM) was 65% [ OR=1.88, 95% CI: 1.36-2.60]. Then these thirty-three articles included in IONM were divided into I-IONM, C-IONM and mixed groups. Subgroup analysis showed that the positive predictive value of LOS in I-IONM, C-IONM and mixed groups were 62% [ OR=1.63, 95% CI: 1.05-2.52], 75% [ OR=2.93, 95% CI: 1.64-5.22] and 70% [ OR=2.38, 95% CI: 1.77-3.12] respectively. When these thirty-three included articles were divided into Asian, European, North American and Oceania, subgroup analysis showed that the positive predictive value of LOS was 50% [ OR=1.01, 95% CI: 0.44-2.31], 70% [ OR=2.29, 95% CI: 1.60-3.28], 82% [ OR=4.68, 95% CI: 3.79-5.78] and 83% [ OR=4.81, 95% CI: 3.10-7.46] respectively. Meta-analysis of secondary outcome measures in twenty-six articles showed that the negative predictive value of LOS was 99.6% [ RD=1.51, 95% CI: 1.48-1.53], with the sensitivity of 89% [ RD=1.24, 95% CI: 1.11-1.37] and specificity of 98%[ RD=1.43, 95% CI: 1.40-1.47]. Conclusion:The occurrence of LOS during IONM in thyroidectomy has a positive prediction effect and a higher negative prediction effect, sensitivity and specificity on RLN injury.

Objective:To investigate the characteristics of gut microbiota in patients with type 2 diabetes (T2DM) complicated by nonalcoholic fatty liver disease (NAFLD).Methods:A total of 74 patients first diagnosed with T2DM at the Endocrinology Department of Peking Union Medical College Hospital from April 2021 to October 2023 were included. Among them, 28 patients had concurrent NAFLD while 46 patients did not. Additionally, 51 healthy controls were matched (HC group). Clinical laboratory parameters were collected, and 16S rRNA sequencing with fecal samples was conducted to compare the differences in gut microbiota across the groups.Results:Compared to the group with T2DM, patients with concurrent T2DM and NAFLD were younger, had higher level of insulin resistance as assessed by the homeostatic model assessment of insulin resistance, higher body mass index (BMI), and higher triglyceride levels. There was no difference in α-diversity across the three groups ( P>0.05), while there was a significant difference in β-diversity ( P=0.03). The Eubacterium coprostanoligenes, Fusicatenibacter, Parasutterella and Tyzzerella 3 were enriched in the group with concurrent T2DM and NAFLD as shown by the relative abundance, while the relative abundance of Flavonifractor was decreased in this group. Tyzzerella 3 abundance was positively correlated with triglyceride and albumin levels and negatively correlated with high-density lipoprotein cholesterol (HDL-C) levels. Conclusion:Patients with T2DM complicated by NAFLD exhibit dysbiosis in gut microbiota composition and specific genera abundance, with Flavonifractor identified as a potential protective factor for T2DM complicated by NAFLD.

Objective:To explore the impact of parenting style on social anxiety among college students, and examine the mediating effect of core self-evaluation.Methods:From November 2022 to January 2023, a total of 1 126 college students in Harbin were taken as research subjects.Interaction anxiousness scale(IAS), short-egna minnen betraffende upfostran-Chinese(s-EMBU-C) and core self-evaluations scale(CSES) were used for analysis. Data were analyzed using SPSS 26.0 software for correlation analysis and analysis of variance.AMOS 27.0 software was used for mediation effect test.Results:Social anxiety (42.31±8.23) was negatively correlated with positive parenting style (5.44±1.45) ( r=-0.072, P<0.05) and core self-evaluation (32.12±6.01) ( r=-0.350, P<0.01), while positively correlated with negative parenting style (7.40±1.74)( r=0.302, P<0.01). Core self-evaluation was positively correlated with positive parenting style ( r=0.362, P<0.01) and negatively correlated with negative parenting style ( r=-0.346, P<0.01).Parent parenting styles had a significant mean direct effect on social anxiety of college students ( βpositive=0.098, βnegtive=0.222).Mediation analyses indicated that core self-evaluation played a masking role between positive parenting styles and social anxiety, with an absolute value of 90.82% for the ratio of indirect(-0.089) to direct effects(0.098).Core self-evaluation had partial mediating effect on negative parenting styles, with direct effect and indirect effect accounting for 73.03% and 26.97% of the total effect, respectively. Conclusion:Parenting style can either directly affect college students' social anxiety or indirectly through the mediating effect of core self-evaluations, with core self-evaluations playing a masking role in the positive parenting styles pathway.

Objective:This study aims to discuss the diagnosis and treatment of pediatric appendicovesical fistula (AVF).Methods:A retrospective analysis was conducted on the clinical data of a pediatric patient with AVF admitted to our hospital in March 2023. The patient was a 6-year and 11-month old male who was hospitalized on March 21, 2023, due to difficulty urinating accompanied by diarrhea for two weeks. Computed tomography (CT) revealed bladder stones. The preoperative diagnosis was bladder stones. Transurethral cystoscopic lithotripsy with laser was performed under general anesthesia. Two weeks postoperatively, the child presented with recurrent symptoms of frequent urination, urinary pain, and diarrhea. Urine routine examination indicated a urinary tract infection. Over a month of antibiotic treatment was ineffective, and symptoms such as pneumaturia and fecaluria emerged, with exacerbation of diarrhea, suggesting the possibility of a fistulous tract between the child's intestine and bladder. Further bladder ultrasonography with contrast showed microbubbles of contrast medium leaking from the right posterior bladder wall into the intestinal tract. Enhanced magnetic resonance imaging (MRI) demonstrated a small, sharp tube-like shadow at the upper edge of the right posterior bladder, with a strip-like, significantly enhanced shadow within the lumen. The preoperative diagnosis was revised to appendicovesical fistula. During cystoscopic examination, a papillary-like protrusion was identified on the right lateral wall of the bladder, with no evident orificium fistulae or foreign body discharge noted at the protrusion site. Consequently, robot-assisted laparoscopic partial cystectomy, appendectomy, and lysis of adhesions were performed.Results:The patient was administered antibiotic for a 10-day course of anti-infection and a urinary catheter was maintained for 13 days. The patient recovered entirely and had been discharged after the removal of the urinary catheter. At an 11-month follow-up, there were no reported specific discomforts.Conclusions:Pediatric AVF is rare, and bladder contrast-enhanced ultrasonography and MRI are preferred for initial diagnostic evaluation. The diagnosis can be confirmed by specific clinical presentations such as intermittent pneumaturia and fecaluria, diarrhea with bladder stones. Laparoscopic surgery or robot-assisted laparoscopic surgery could be a feasible treatment option.

Objective:To evaluate the effects of heparin on focal adhesion kinase (FAK)/Ras homolog gene family member A (RhoA)/Rho-associated coiled-coil-containing protein kinase (ROCK) signaling pathways during acute lung injury (ALI) in septic mice.Methods:Thirty SPF healthy adult male C57BL/6J mice, aged 6-8 weeks, weighing 20-23 g, were assigned into 3 groups ( n=10 each) using a random number table method: control group (group C), ALI group, and heparin group (group H). Septic ALI model was prepared by intraperitoneal injection of lipopolysaccharide 15 mg/kg, while group C received the equal volume of normal saline. In group H, heparin sodium solution 10 U was injected via the tail vein at 30 min before developing the model. The equal volume of normal saline was injected in C and ALI groups. Venous blood samples were collected from the eyeballs under deep anesthesia at 24 h after lipopolysaccharide injection. The mice were subsequently sacrificed and lung tissues were obtained for determination of the serum concentrations of interleukin-1beta (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) (using enzyme-linked immunosorbent assay), wet/dry lung weight (W/D) ratio, expression of vascular endothelial adhesion factor 1 (VCAM-1) (by immunohistochemical staining) and expression of FAK, phosphorylated FAK (p-FAK), RhoA, GTP-bound RhoA (RhoA-GTP) and ROCK (by Western blot) and for examination of the pathological changes. The lung injury was assessed and scored. Results:Comparison with group C, the serum concentrations of IL-1β, IL-6 and TNF-α, W/D ratio and lung injury scores were significantly increased, and the expression of VCAM-1, p-FAK, RhoA-GTP and ROCK was up-regulated in ALI group ( P<0.05). Compared with ALI group, the serum concentrations of IL-1β, IL-6 and TNF-α, W/D ratio and lung injury scores were significantly decreased, and the expression of VCAM-1, p-FAK, RhoA-GTP and ROCK was down-regulated in H group ( P<0.05). Conclusions:The mechanism through which heparin mitigates ALI is associated with the inhibition of the FAK/RhoA/ROCK signaling pathway in septic mice.

Objective To compare the efficacy of anterior-posterior and posterior-anterior screw fixation for posterior malleolar fractures surgery.Methods A retrospective analysis of 376 cases of posterior malleolar fractures treated with lag screws from January 2011 to October 2022 with more than 12 months of follow-up period was conducted.The patients were divided into two subgroups based on the thickness of the fracture fragment,with 167 cases in the small fracture subgroup having a fracture fragment thickness＜17 mm(screw thread length)and 209 cases in the large fracture subgroup having a fracture fragment thickness ≥ 17 mm.Each subgroup was further divided into anterior-posterior and posterior-anterior groups based on the direction of screw fixation in the posterior malleolar fracture surgery.In the small fracture subgroups,there were 74 cases in the anterior-posterior group and 93 cases in the posterior-anterior group.In the large fracture subgroup,there were 88 cases in the anterior-posterior group and 121 cases in the posterior-anterior group.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was measured at the last follow-up.The displacement of the fracture fragment in the direction of the fracture line(Dn)and perpendicular to the fracture line(Dt)were measured on the first day after surgery and at the last follow-up,and the displacement of the fracture fragment was calculated,which was the difference between Dn+Dt at the last follow-up and Dn+Dt on the first day after surgery.Results On the first day after surgery,X-ray showed no significant difference in Dn and Dt between the anterior-posterior and posterior-anterior groups in both of the small and large fracture subgroups(P＞0.05).The entire group was followed up for 12-85 months,with an average of 19.3 months.In the small fracture subgroup,the displacement of the fracture fragment in the posterior-anterior group[(0.11±0.19)mm]was superior to that in the anterior-posterior group[(0.19±0.21)mm;P=0.011],and the AOFAS score was also superior to that in the anterior-posterior group[(80.2±8.4)points vs.(76.2±8.6)points,P=0.003].In the large fracture subgroup,there was no significant difference in fracture displacement between the posterior-anterior group[(0.11±0.18)mm]and the anterior-posterior group[(0.12±0.19)mm;P=0.630],and there was also no significant difference in AOFAS scores[(84.1±7.8)points vs.(82.8±7.6)points,P=0.246].Conclusions There is no significant difference in the reduction effect between anterior-posterior and posterior-anterior lag screw internal fixation for posterior malleolar fractures in trimalleolar fractures.For patients with fracture thickness＜17 mm,posterior-anterior fixation is superior to anterior-posterior fixation;for patients with fracture thickness ≥17 mm,there is no significant difference in the efficacy between anterior-posterior and posterior-anterior fixation.

Objective: To explore the relationship between sedentary behavior with cardiorespiratory fitness and executive function in adolescents, and to provide some references for sedentary behavior prevention and executive function improvement. Methods: From September to December 2022, a total of 5 018 adolescents aged 13 to 18 years were selected by stratified random sampling method in Shanghai, Suzhou, Taiyuan,Wuyuan, Xingyi, and Urumqi to conduct physical activity survey, as well as cardiorespiratory fitness and executive function assessment. Pearson s correlation was used to analyze the relationship between sedentary behavior, cardiorespiratory fitness and executive function. The mediation effect model was fitted by the bootstrap mediation procedure in the PROCESS (version 3.3 ) SPSS macro compiled by Haves, and the mediation effect of adolescents cardiorespiratory fitness in the relationship between static behavior and executive function was examined using model 4 in the PROCESS SPSS macro, where Boosrap method was used to compute the mediation effect of adolescents cardiorespiratory fitness. where the Boosrap method was used to calculate confidence intervals for the mediating effects. Results: Adolescents daily sedentary time was positively correlated with both the refreshing function (1-back and 2-back) and the switch function reaction time ( r =0.05, 0.07, 0.05, P <0.01). Adolescent VO 2max was negatively correlated with both the refreshing function (1-back,2-back) and the switching function ( r =-0.09, -0.14 , -0.11, P <0.01). Adolescents daily sedentary time was negatively correlated with VO 2max ( r =-0.04, P <0.01); cardiorespiratory fitness mediated effect values between sedentary behavior and refreshing function (1-back and 2-back) and converted function were 0.20(95% CI =0.06-0.36), 0.43(95% CI =0.14-0.74) and 0.13 (95% CI =0.04-0.22), with mediating effect shares of 6.87%, 8.33% and 8.59%, respectively. Conclusion The duration of sedentary behavior in adolescents is related to executive function performance, and cardiorespiratory fitness may serve as a mediator to mediate the association between sedentary behavior and executive function in adolescents.