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

Sishen Pills and its separated prescriptions are classic prescriptions of traditional Chinese medicine to treat intestinal diseases. In this study, a high-performance liquid chromatography-electrospray ionization tandem mass spectrometry(HPLC-ESI-MS/MS) technology was used to identify the components of Sishen Pills, Ershen Pills, and Wuweizi Powder. The positive and negative ion sources of electrospray ionization were simultaneously collected by mass spectrometry. A total of 11 effective components were detected in Sishen Pills, with four effective components detected in Ershen Pills and eight effective components detected in Wuweizi Powder, respectively. To explore the effects of Sishen Pills and its separated prescriptions on the human intestinal flora, an in vitro anaerobic fermentation model was established, and the human intestinal flora was incubated with Sishen Pills, Ershen Pills, and Wuweizi Powder in vitro. The 16S rDNA sequencing technology was used to analyze the changes in the intestinal flora. The results showed that compared with the control group, Sishen Pills, and its separated prescriptions could decrease the intestinal flora abundance and increase the Shannon index after fermentation. The abundance of Bifidobacterium was significantly increased in the Sishen Pills and Ershen Pills groups. However, the abundance of Lactobacillus, Weissella, and Pediococcus was significantly increased in the Wuweizi Powder group. After fermentation for 12 h, the pH of the fermentation solution of three kinds of liquids with feces gradually decreased and was lower than that of the control group. The decreasing amplitude in the Wuweizi Powder group was the most obvious. The single-bacteria fermentation experiments further confirmed that Sishen Pills and Wuweizi Powder had inhibitory effects on Escherichia coli, Staphylococcus aureus, and Enterococcus faecalis, and the antibacterial activity of Wuweizi Powder was stronger than that of Sishen Pills. Both Sishen Pills and Ershen Pills could promote the growth of Lactobacillus brevis, and Ershen Pills could promote the growth of Bifidobacterium adolescentis. This study provided a more sufficient theoretical basis for the clinical application of Sishen Pills and its separated prescriptions.
Humans ; Gastrointestinal Microbiome/drug effects* ; Drugs, Chinese Herbal/chemistry* ; Fermentation/drug effects* ; Bacteria/drug effects* ; Chromatography, High Pressure Liquid ; Tandem Mass Spectrometry ; Intestines/microbiology*

OBJECTIVE: To prepare clinical-grade human umbilical cord-derived mesenchymal stem cells (hUC-MSC) with high expression of hematopoietic supporting factors and evaluate their stem cell characteristics. METHODS: Fetal umbilical cord tissues were collected from healthy postpartum women during full-term cesarean section. Wharton's jelly was mechanically separated and hUC-MSCs were obtained by explant culture method and enzyme digestion method in an animal serum-free culture system with addition of human platelet lysate. The phenotypic characteristics of hUC-MSCs obtained by two methods were detected by flow cytometry. The differences in proliferation ability between the two groups of hUC-MSCs were identified through CCK-8 assay and colony forming unit-fibroblast (CFU-F) assay. The differences in multilineage differentiation potential between the two groups of hUC-MSCs were identified through induction of adipogenic, osteogenic, and chondrogenic differentiation. The mRNA expression levels of hematopoietic supporting factors such as SCF, IL-3, CXCL12, VCAM1 and ANGPT1 in the two groups of hUC-MSCs were identified by real-time fluorescence quantiative PCR(RT-qPCR). RESULTS: The results of flow cytometry showed that hUC-MSCs obtained by the two methods both expressed high levels of CD73, CD90 and CD105, while lowly expressed CD31, CD45 and HLA-DR. The results of CCK-8 and CFU-F assay showed that the proliferation ability of hUC-MSCs obtained by explant culture method was better than those obtained by enzyme digestion method. The results of the triple lineage differentiation experiment showed that there was no significant difference in multilineage differentiation potential between the two grous of hUC-MSCs. The results of RT-qPCR showed that the mRNA expression levels of hematopoietic supporting factors SCF, IL-3, CXCL12, VCAM1 and ANGPT1 in hUC-MSCs obtained by explant cultrue method were higher than those obtained by enzyme digestion method. CONCLUSION Clinical-grade hUC-MSCs with high expression levels of hematopoietic supporting factors were successfully cultured in an animal serum-free culture system.
Humans ; Mesenchymal Stem Cells/metabolism* ; Umbilical Cord/cytology* ; Cell Differentiation ; Female ; Cell Proliferation ; Cells, Cultured ; Chemokine CXCL12/metabolism* ; Angiopoietin-1/metabolism* ; Vascular Cell Adhesion Molecule-1/metabolism* ; Stem Cell Factor/metabolism* ; Flow Cytometry ; Pregnancy

Objective To explore the predictive value of dose surface histogram(DSH)in image guided radiotherapy(IGRT)for radiotherapy-induced acute radiation proctitis(ARP)in cervical cancer(CCA).Methods Totally 380 patients with CCA IGRT admitted to some hospital from May 2019 to May 2023 were selected prospectively and randomly divided into a control group(n=1 80)and an experimental group(n=200).The patients in the 2 groups were followed up and the incidence rates of ARP were counted,and rectal dose distribution was evaluated using dose volume histogram(DVH)in the control group and DSH in the experimental group.The predictive values of DVH and DSH for ARP were evaluated and compared using ROC curves.Statistical analysis was performed using SPSS 21.0 software.Results The two groups did not have statistically significant difference in the incidence rate of ARP(P＞0.05),while there were significant differences in the evaluation indicators of the rectal dose distribution(P＜0.05).V40,V50,S40 and S50 proved to have low predictive values for grade Ⅰ-Ⅳ ARP with AUC 0.700(P＜0.05);V60 and S60 had moderate predictive values for grade Ⅰ-Ⅳ ARP with AUC greater than 0.700 and less than or equal to 0.900(P＜0.05);V70,V78,S70 and S7s showed high predictive values for grade Ⅰ-Ⅳ ARP with AUC higher than 0.900(P＜0.05).Delong's test results indicated that DVH and DSH had no significant differences in AUC when used to predict gradeⅠ-Ⅳ ARP(allP＞0.05).Conclusion DSH is essentially the same as DVH when used for the prediction of grade Ⅰ-Ⅳ ARP due to CCA IGRT,and thus can be used for the supplementation and optimization of radiotherapy planning systems.[Chinese Medical Equipment Journal,2025,46(3):48-53]

Objective:To analyze the colonization rate and molecular types of Staphylococcus aureus (SA) on the tracheotomy wounds of neonates at early postoperative stage in neonatal intensive care unit (NICU). Methods:This was a case series study. Patients who were admitted and underwent tracheotomy in NICU of Beijing Children′s Hospital, Capital Medical University from January 1 st 2020 to December 31 st 2023 were enrolled. Swabs on the skin around the incision or on the nasal mucosa were collected and cultured at 24, 72 and 168 h after operation. Coagulase test and Staphytect Plus kits were used for SA identification. The nuc gene amplification and molecular types of SA were assessed by PCR. The patients were divided into SA colonization group and non-colonization group based on the presence or absence of SA colonization, and into infection group and non-infection group based on the presence or absence of infection. Demographic data, hospitalization information, colonization and infection status of SA were collected from the digital medical record system of the hospital. Differences between groups were analyzed using the independent sample t test or Fisher exact test. Results:Totally 19 patients were enrolled, among whom 13 were male. The gestation age was 39.0 (38.1, 40.0) weeks, and the birth weight was 3 150 (2 600, 3 400) g. Tracheotomy was done at 8.2(4.1, 19.6) days after diagnosis and indication confirmed. Corrected gestational age of patients on the operation day was 43.6 (42.2, 45.4) weeks. The NICU stay time was (34.0±3.1) days. SA colonization was confirmed around the incision of 8 patients. Out of the 18 strains of colonized bacteria, 10 were methicillin-resistant Staphylococcus aureus (MRSA). The most common molecular type of MRSA was ST59-SCCmec Ⅳ-t437 strain (8 strains). A total of 10 patients presented typical clinical manifestations of bacterial infection at the lungs, 3 patients in the blood stream and 2 patients in the central nervous system. Among 10 patients with bacterial infection, 3 patients were MRSA positive by boby fluid culture and affected by the ST59-SCCmec Ⅳ-t437 strain. The infection rate was different between patients with or without SA colonization on the tracheotomy incision (7/8 vs. 3/11, P=0.020). Conclusions:The colonization rate and infection rate were high on the tracheotomy incision in neonates. The major type was MRSA, and the most common molecular strain was ST59-SCCmec Ⅳ-t437 .

Objective:To develop PixelSIFT-UNet, a novel semantic segmentation model that integrates deep learning with scale-invariant feature transform (SIFT) algorithm to improve the segmentation accuracy of oral mucosal lesions.Methods:This investigation utilized 838 standard clinical white light images of oral mucosal diseases acquired from January 2020 to December 2022 at the Stomatology Hospital Zhejiang University School of Medicine. Randomization was achieved through Python′s random.seed function implementation. The random sample function was subsequently applied for sampling distribution. The dataset was stratified into three subsets with a 6∶2∶2 ratio: training ( n=506), validation ( n=166), and testing ( n=166). Lesion boundaries were annotated using Labelme software, and a PixelSIFT-UNet-based deep learning model was developed with VGG-16 and ResNet-50 backbone networks. Model parameters were optimized using the validation set, and performance metrics [including Dice coefficient, mean intersection over union (mIoU), mean pixel accuracy (mPA), and Precision] were assessed on the test set. The model′s performance was benchmarked against conventional semantic segmentation frameworks (U-Net and PSPNet). Results:The developed PixelSIFT-UNet model could achieve precise segmentation of three common oral mucosal lesions: oral lichen planus, oral leukoplakia, and oral submucous fibrosis. Utilizing VGG-16 as the backbone network, the model achieved Dice coefficient, mIoU, mPA, and Precision values of 0.642, 0.699, 0.836, and 0.792, respectively. Implementation with ResNet-50 backbone network yielded metrics of 0.668, 0.733, 0.872 and 0.817, demonstrating significant improvements across all performance indicators compared to conventional U-Net model (relevant metrics: 0.662, 0.717, 0.861 and 0.809) and PSPNet model (relevant metrics: 0.671, 0.721, 0.858 and 0.813).Conclusions:The proposed PixelSIFT-UNet architecture demonstrates superior performance in oral mucosal lesion segmentation tasks, surpassing conventional semantic segmentation models and providing robust quantitative improvements in segmentation accuracy.

Objective:To analyze the colonization rate and molecular types of Staphylococcus aureus (SA) on the tracheotomy wounds of neonates at early postoperative stage in neonatal intensive care unit (NICU). Methods:This was a case series study. Patients who were admitted and underwent tracheotomy in NICU of Beijing Children′s Hospital, Capital Medical University from January 1 st 2020 to December 31 st 2023 were enrolled. Swabs on the skin around the incision or on the nasal mucosa were collected and cultured at 24, 72 and 168 h after operation. Coagulase test and Staphytect Plus kits were used for SA identification. The nuc gene amplification and molecular types of SA were assessed by PCR. The patients were divided into SA colonization group and non-colonization group based on the presence or absence of SA colonization, and into infection group and non-infection group based on the presence or absence of infection. Demographic data, hospitalization information, colonization and infection status of SA were collected from the digital medical record system of the hospital. Differences between groups were analyzed using the independent sample t test or Fisher exact test. Results:Totally 19 patients were enrolled, among whom 13 were male. The gestation age was 39.0 (38.1, 40.0) weeks, and the birth weight was 3 150 (2 600, 3 400) g. Tracheotomy was done at 8.2 (4.1, 19.6) days after diagnosis and indication confirmed. Corrected gestational age of patients on the operation day was 43.6 (42.2, 45.4) weeks. The NICU stay time was (34.0±3.1) days. SA colonization was confirmed around the incision of 8 patients. Out of the 18 strains of colonized bacteria, 10 were methicillin-resistant Staphylococcus aureus (MRSA). The most common molecular type of MRSA was ST59-SCCmec Ⅳ-t437 strain (8 strains). A total of 10 patients presented typical clinical manifestations of bacterial infection at the lungs, 3 patients in the blood stream and 2 patients in the central nervous system. Among 10 patients with bacterial infection, 3 patients were MRSA positive by boby fluid culture and affected by the ST59-SCCmec Ⅳ-t437 strain. The infection rate was different between patients with or without SA colonization on the tracheotomy incision (7/8 vs. 3/11, P=0.020). Conclusions:The colonization rate and infection rate are high on the tracheotomy incision in neonates. The major type is MRSA, and the most common molecular strain is ST59-SCCmec Ⅳ-t437 .

Fetal ultrasound standard plane detection was introduced in terms of its importance and problems encountered.The deep learning techniques applied in fetal standard plane detection were reviewed,including transfer learning,modified basic network,hybrid network and multi-task network.The problems encountered by the deep learning techniques during the application were analyzed,and the future research directions were envisioned.[Chinese Medical Equipment Journal,2025,46(5):91-101]