Accurate timing of myelination is crucial for the proper functioning of the central nervous system. Here, we identified a de novo heterozygous mutation in TMEM63A (c.1894G>A; p. Ala632Thr) in a 7-year-old boy exhibiting hypomyelination. A Ca²⁺ influx assay suggested that this is a loss-of-function mutation. To explore how TMEM63A deficiency causes hypomyelination, we generated Tmem63a knockout mice. Genetic deletion of TMEM63A resulted in hypomyelination at postnatal day 14 (P14) arising from impaired differentiation of oligodendrocyte precursor cells (OPCs). Notably, the myelin dysplasia was transient, returning to normal levels by P28. Primary cultures of Tmem63a^-/- OPCs presented delayed differentiation. Lentivirus-based expression of TMEM63A but not TMEM63A_A632T rescued the differentiation of Tmem63a^-/- OPCs in vitro and myelination in Tmem63a^-/- mice. These data thus support the conclusion that the mutation in TMEM63A is the pathogenesis of the hypomyelination in the patient. Our study further demonstrated that TMEM63A-mediated Ca²⁺ influx plays critical roles in the early development of myelin and oligodendrocyte differentiation.
Animals ; Cell Differentiation/physiology* ; Oligodendroglia/metabolism* ; Mice, Knockout ; Mice ; Male ; Myelin Sheath/metabolism* ; Humans ; Child ; Cells, Cultured ; Oligodendrocyte Precursor Cells/metabolism*

BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and joint destruction. Iguratimod (IGU) is a novel conventional synthetic disease-modifying antirheumatic drugs (csDMARD) with good efficacy and safety for the treatment of active RA in China and Japan. However, the long-term effects of IGU on the progression of bone destruction or radiographic progression in patients with active RA remain unknown. We aimed to investigate the efficacy and safety of iguratimod (IGU), a combination of methotrexate (MTX) and IGU, and IGU in patients with active rheumatoid arthritis (RA) who were naïve to MTX. METHODS: This multicenter, double-blind, randomized, non-inferiority clinical trial was conducted at 28 centers for over 52 weeks in China. In total, 911 patients were randomized (1:1:1) to receive MTX monotherapy (10-15 mg weekly, n = 293), IGU monotherapy (25 mg twice daily, n = 297), or IGU + MTX (10-15 mg weekly for MTX and 25 mg twice daily for IGU, n = 305) for 52 weeks. The patients' clinical characteristics, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), disease activity score in 28 joints-C-reactive protein (DAS28-CRP) level, and disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) were assessed at baseline. The primary endpoints were the proportion of patients with ≥20% improvement according to the American College of Rheumatology (ACR20) response and changes in the van der Heijde-modified total Sharp score (vdH-mTSS) at week 52. RESULTS: The proportions of patients achieving an ACR20 response at week 52 were 77.44%, 77.05 %, and 65.87% for IGU monotherapy, IGU + MTX, and MTX monotherapy, respectively. The non-inferiority of IGU monotherapy to MTX monotherapy was established with the ACR20 (11.57%; 95% confidence interval [CI], 4.35-18.79%; P <0.001) and vdH-mTSS (-0.37; 95% CI, -1.22-0.47; P = 0.022). IGU monotherapy was also superior to MTX monotherapy in terms of ACR20 ( P = 0.002) but not the vdH-mTSS. The superiority of IGU + MTX over MTX monotherapy was confirmed in terms of the ACR20 (11.18%; 95% CI, 3.99-18.37%; P = 0.003), but not in the vdH-mTSS (-0.68; 95% CI, -1.46-0.11; P = 0.091). However, the difference in the incidence rates of adverse events was not statistically significant. CONCLUSIONS: IGU monotherapy/IGU + MTX showed a more favorable clinical response than did MTX monotherapy. IGU may have some clinical benefits over MTX in terms of radiographic progression, implying that IGU may be considered as an initial therapeutic option for patients with active RA. TRIAL REGISTRATION https://classic.clinicaltrials.gov/ , NCT01548001.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Antirheumatic Agents/therapeutic use* ; Arthritis, Rheumatoid/drug therapy* ; Chromones/adverse effects* ; Double-Blind Method ; Drug Therapy, Combination ; Methotrexate/adverse effects* ; Treatment Outcome ; Sulfonamides

In recent years,public hesitancy to vaccinate has come to the fore and can hinder the advancement of immunization programs.It is important to increase public confidence in vaccines and to rationally and effectively promote the immunization behavior of the population.Based on behavioral economics theory,it combines the anchoring effect,loss aversion,two-systems theory,and the herd effect to explore the irrational factors and decision-making preferences behind the public's vaccination decisions,and then proposes discourse strategies for effective boosting to increase the public's confidence in vaccination.

In recent years,public hesitancy to vaccinate has come to the fore and can hinder the advancement of immunization programs.It is important to increase public confidence in vaccines and to rationally and effectively promote the immunization behavior of the population.Based on behavioral economics theory,it combines the anchoring effect,loss aversion,two-systems theory,and the herd effect to explore the irrational factors and decision-making preferences behind the public's vaccination decisions,and then proposes discourse strategies for effective boosting to increase the public's confidence in vaccination.

Objective To investigate the clinical significance of two-dimensional ultrasound parameters combined with transvaginal color doppler(TVCD)blood flow classification for evaluating cesarean scar pregnancy(CSP).Methods The clinical data of 81 patients with CSP who were diagnosed by pathology in operation from April 2020 to November 2021 were retrospectively analyzed.TVCD examina-tion was performed before operation.The patients were divided into successful group and failed group.The ultrasonic parameters including the length diameter of gestational sac,the remnant muscularis thickness(RMT)of the anterior isthmus,and the blood flow classification around the gestational sac of the two groups were compared.Receiver operating characteristic(ROC)curve were used for analysis and e-valuation.Results Among 81 CSP patients,66 patients were successful,and 15 patients were failure.with a success rate was 81.48％.The length diameter of gestational sac in the failed group was larger than that in the successful group,and RMT of the anterior isthmus was thinner than that in the successful group.The blood flow classification was mainly grade Ⅲ,and the differences were statistically signifi-cant(P＜0.05).ROC curve results for prediction of surgical efficacy showed that the predictive power of single index with blood flow classification was higher,and the combination of the three factors has the highest prediction efficiency.Conclusion Two-dimensional ultrasound parameters combined with TVCD blood flow classification have a certain value in predicting the curative effect of CSP surgery,which is helpful to improve the clinical curative effect and ensure medical safety.

Objective To explore the effect of urine mixing degree on 24-hour urinary total protein(24 h UTP)in patients with chronic kidney disease(CKD).Methods From October 1,2023 to December 31,2023,30 hospitalized patients who needed to complete 24 h UTP testing in Zhongshan Hospital,Fudan University were selected.A 5 L unified container was used to collect urine for 24 hours.After collection and one hour's standing,the urine sample was divided into upper,middle,and lower equal parts according to volume,which was defined as direct-sampling group.Then,the urine samples were fully mixed with a magnetic stirrer and sampled again according to the above-mentioned three-equal sampling method,which was defined as mixed-sampling group.The generalized estimating equation was used to compare the urinary protein concentration before and after mixing and at different sampling location.Results The results of generalized estimating equation showed that after controlling the variable"sampling position",there was no significant difference in urinary protein concentration between the direct-sampling group and the mixed-sampling group.After controlling the variable"mixing method",there was still no significant difference in urinary protein concentration at different sampling positions.After adjusting the covariates such as age,gender,and estimated glomerular filtration rate(eGFR),the results were consistent.Conclusions With standard protocol,the entire 24-hour urine sample is a relatively even-distributed solution.After the total urine collection is completed,the temporary sample can be directly extracted from any level of the original urine within 1 hour,and the urine protein concentration of the sample multiplied by the urine volume can reflect the 24 h UTR.

In recent years,public hesitancy to vaccinate has come to the fore and can hinder the advancement of immunization programs.It is important to increase public confidence in vaccines and to rationally and effectively promote the immunization behavior of the population.Based on behavioral economics theory,it combines the anchoring effect,loss aversion,two-systems theory,and the herd effect to explore the irrational factors and decision-making preferences behind the public's vaccination decisions,and then proposes discourse strategies for effective boosting to increase the public's confidence in vaccination.

In recent years,public hesitancy to vaccinate has come to the fore and can hinder the advancement of immunization programs.It is important to increase public confidence in vaccines and to rationally and effectively promote the immunization behavior of the population.Based on behavioral economics theory,it combines the anchoring effect,loss aversion,two-systems theory,and the herd effect to explore the irrational factors and decision-making preferences behind the public's vaccination decisions,and then proposes discourse strategies for effective boosting to increase the public's confidence in vaccination.

In recent years,public hesitancy to vaccinate has come to the fore and can hinder the advancement of immunization programs.It is important to increase public confidence in vaccines and to rationally and effectively promote the immunization behavior of the population.Based on behavioral economics theory,it combines the anchoring effect,loss aversion,two-systems theory,and the herd effect to explore the irrational factors and decision-making preferences behind the public's vaccination decisions,and then proposes discourse strategies for effective boosting to increase the public's confidence in vaccination.