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

Purpose: Cuscuta australis R. Brown (CA) is a parasitic plant that attaches to host plants and disrupts the growth, nutrient absorption, and overall development of leguminous plants.However, CA is known to contain various bioactive components, including vitamin A, β-carotene, lutein, and kaempferol, which have demonstrated pharmacological effects in immune responses. This study aims to investigate the potential benefits of CA extracts obtained using different extraction methods to explore its potential as a novel natural resource for applications in the food and pharmaceutical industries. Methods: In this study, water (CAW), ethanol (CAE), and hot water (CAHW) extracts of CA were prepared to investigate their antioxidant and anti-inflammatory effects in RAW264.7 cells. Results: The CAHW group exhibited the highest levels of antioxidant compounds, such as total polyphenols and flavonoids, resulting in a significantly higher ferric reducing antioxidant power compared to the other groups. The 1,1-diphenyl-2-picrylhydrazyl and 2,2-azino-bis-3-ethylen-benzothiazoline-6-sulfonate radical scavenging activities were also high in the CAHW and CAE groups but were lower compared to the positive control, ascorbic acid. In RAW264.7 cells, CA extracts at concentrations of 50, 100, and 200 μg/mL showed no cytotoxicity, and nitric oxide (NO) production was reduced in a dose-dependent manner.At a concentration of 200 μg/mL, all the CA extracts exhibited significant anti-inflammatory activity by modulating the nuclear factor kappa B signaling pathway, effectively resulting in the down-regulation of inflammation-related genes such as cyclooxygenase-2, inducible NO synthase, tumor necrosis factor-alpha, and interleukin-6 in RAW264.7 cells, with the CAHW extract demonstrating the most potent inhibitory effect among all the CA extract groups. Conclusion Overall, CA extraction is effective for both antioxidant and anti-inflammatory activities, with the hot water extraction method proving to be the most effective.

Purpose: Cuscuta australis R. Brown (CA) is a parasitic plant that attaches to host plants and disrupts the growth, nutrient absorption, and overall development of leguminous plants.However, CA is known to contain various bioactive components, including vitamin A, β-carotene, lutein, and kaempferol, which have demonstrated pharmacological effects in immune responses. This study aims to investigate the potential benefits of CA extracts obtained using different extraction methods to explore its potential as a novel natural resource for applications in the food and pharmaceutical industries. Methods: In this study, water (CAW), ethanol (CAE), and hot water (CAHW) extracts of CA were prepared to investigate their antioxidant and anti-inflammatory effects in RAW264.7 cells. Results: The CAHW group exhibited the highest levels of antioxidant compounds, such as total polyphenols and flavonoids, resulting in a significantly higher ferric reducing antioxidant power compared to the other groups. The 1,1-diphenyl-2-picrylhydrazyl and 2,2-azino-bis-3-ethylen-benzothiazoline-6-sulfonate radical scavenging activities were also high in the CAHW and CAE groups but were lower compared to the positive control, ascorbic acid. In RAW264.7 cells, CA extracts at concentrations of 50, 100, and 200 μg/mL showed no cytotoxicity, and nitric oxide (NO) production was reduced in a dose-dependent manner.At a concentration of 200 μg/mL, all the CA extracts exhibited significant anti-inflammatory activity by modulating the nuclear factor kappa B signaling pathway, effectively resulting in the down-regulation of inflammation-related genes such as cyclooxygenase-2, inducible NO synthase, tumor necrosis factor-alpha, and interleukin-6 in RAW264.7 cells, with the CAHW extract demonstrating the most potent inhibitory effect among all the CA extract groups. Conclusion Overall, CA extraction is effective for both antioxidant and anti-inflammatory activities, with the hot water extraction method proving to be the most effective.

Purpose: Cuscuta australis R. Brown (CA) is a parasitic plant that attaches to host plants and disrupts the growth, nutrient absorption, and overall development of leguminous plants.However, CA is known to contain various bioactive components, including vitamin A, β-carotene, lutein, and kaempferol, which have demonstrated pharmacological effects in immune responses. This study aims to investigate the potential benefits of CA extracts obtained using different extraction methods to explore its potential as a novel natural resource for applications in the food and pharmaceutical industries. Methods: In this study, water (CAW), ethanol (CAE), and hot water (CAHW) extracts of CA were prepared to investigate their antioxidant and anti-inflammatory effects in RAW264.7 cells. Results: The CAHW group exhibited the highest levels of antioxidant compounds, such as total polyphenols and flavonoids, resulting in a significantly higher ferric reducing antioxidant power compared to the other groups. The 1,1-diphenyl-2-picrylhydrazyl and 2,2-azino-bis-3-ethylen-benzothiazoline-6-sulfonate radical scavenging activities were also high in the CAHW and CAE groups but were lower compared to the positive control, ascorbic acid. In RAW264.7 cells, CA extracts at concentrations of 50, 100, and 200 μg/mL showed no cytotoxicity, and nitric oxide (NO) production was reduced in a dose-dependent manner.At a concentration of 200 μg/mL, all the CA extracts exhibited significant anti-inflammatory activity by modulating the nuclear factor kappa B signaling pathway, effectively resulting in the down-regulation of inflammation-related genes such as cyclooxygenase-2, inducible NO synthase, tumor necrosis factor-alpha, and interleukin-6 in RAW264.7 cells, with the CAHW extract demonstrating the most potent inhibitory effect among all the CA extract groups. Conclusion Overall, CA extraction is effective for both antioxidant and anti-inflammatory activities, with the hot water extraction method proving to be the most effective.

Objective: To report the clinical manifestations and laboratory features of five patients with congenital thrombotic thrombocytopenic purpura (cTTP) and explore its standardized clinical diagnosis and treatment along with a review of literature. Methods: Clinical data of patients, such as age of onset, disease manifestation, personal history, family history, and misdiagnosed disease, were collected. Treatment outcomes, therapeutic effects of plasma infusion, and organ function evaluation were observed. The relationship among the clinical manifestations, treatment outcomes, and ADAMTS13 gene mutation of patients with cTTP was analyzed. Additionally, detection of ADAMTS13 activity and analysis of ADAMTS13 gene mutation were explored. Results: The age of onset of cTTP was either in childhood or adulthood except in one case, which was at the age of 1. The primary manifestations were obvious thrombocytopenia, anemia, and different degrees of nervous system involvement. Most of the patients were initially suspected of having immune thrombocytopenia. Acute cTTP was induced by pregnancy and infection in two and one case, respectively. ADAMTS13 gene mutation was detected in all cases, and there was an inherent relationship between the mutation site, clinical manifestations, and degree of organ injury. Therapeutic or prophylactic plasma transfusion was effective for treating cTTP. Conclusions: The clinical manifestations of cTTP vary among individuals, resulting in frequent misdiagnosis that delays treatment. ADAMTS13 activity detection in plasma and ADAMTS13 gene mutation analysis are important bases to diagnose cTTP. Prophylactic plasma transfusion is vital to prevent the onset of the disease.
Female ; Pregnancy ; Humans ; Adult ; Blood Component Transfusion ; Plasma ; Purpura, Thrombotic Thrombocytopenic/therapy* ; Mutation ; Purpura, Thrombocytopenic, Idiopathic ; ADAMTS13 Protein/therapeutic use*

Objective::To study the forming process of the gynandrium-like in Amomum villosum. Method::The flowerets were divided into 8 growth periods from 0.5 cm in length to the day after flowering. Fresh sample were anatomized, and paraffin sectioning was performed on the flowerets. The height of anther chamber, the pollen sac angles, the width of anther gap, the diameter of style, the filament-labellum angle (α), and the filament-anther angle (β) were determined. Result::The angle of the pollen sac had no obvious change before flowering, but decreased from 32° to 17° after flowering. The width of anther gap increased to 0.29 mm in the 5^th growth period, while the diameter of style was 0.32 mm in the same period, the ratio of them was 92%. Compared with the day before flowering, the angle α decreased from 83° to 42° during flowering, and the angle β decreased from 186° to 147°. In the filament, the abaxial side had 1 to 5 layers of cells more than the adaxial side. In the style, it was found that the adaxial side had 1 to 6 layers of cells more than the abaxial side. Conclusion::The asymmetry of the cell structure at abaxial and adaxial sides of the filament and style is the basis of the movement. In the 5^th growth period, the width of anther gap increased almost to the size of style, so the style was able to slide in. When blossoming, the pollen sacs quickly squeezed to the gap in middle, and the entrance for style to access was blocked. Therefore, the style had to remain in the gap of the pollen sacs. Meanwhile, angles α and β drastically decreased, resulting in the stamen sandwiched the pistil and bending together toward the labellum. The gynandrium-like structure was formed.