Objective:To explore the diagnostic value of the macrophage activation syndrome/systemic juvenile idiopathic arthritis（MS）score in macrophage activation syndrome（MAS）associated with systemic juvenile idiopathic arthritis（sJIA），and to provide a reference for clinical work.Methods:This study was a retrospective case-control analysis，conducted on the patients initially diagnosed as sJIA-associated with MAS and admitted into the Department of Rheumatology and Immunology of Children's Hospital Affiliated to Xi 'an Jiaotong University from July 1st，2016 to June 30th，2023. All of the patients met the diagnostic criteria for patients with MAS associated with sJIA according to the 2016 European Alliance of Associations for Rheumatology（EULAR）/American College of Rheumatology（ACR）/Pediatric Rheumatology International Trials Organization（PRINTO）standards. The basic information at baseline，clinical manifestations，and auxiliary examination results were collected. The MS score was applied to re-evaluate the children diagnosed as sJIA-associated with MAS. When the MS score ≥-2.1，the possibility of sJIA with MAS was high. Thirty cases of sJIA without MAS were randomly selected as the control group.Results:There were 28 cases in the MAS group，including 13 males（46.43%）and 15 females（53.57%），with an average age of（7.51±4.01）years. Compared with the control group，the MAS group were significantly more likely to have high fever（ χ2=8.539， P=0.003），hepatomegaly（ χ2=11.621， P<0.001），splenomegaly（ χ2=11.710， P<0.001）and neurological involvement（ χ2=27.619， P<0.001），with the differences being statistically significant. Meanwhile，there were statistically significant differences between the two groups in terms of white blood cell count（ Z=-4.001， P<0.001），neutrophil count（ Z=-3.659， P<0.001），platelet count（ Z=-4.687， P<0.001），albumin level（ Z=-4.018， P<0.001），alanine aminotransferase（ Z=-3.846， P<0.001），aspartate aminotransferase（ Z=-5.932， P<0.001），lactate dehydrogenase（ Z=-6.150， P<0.001），triglycerides（ Z=-5.874， P<0.001），fibrinogen（ Z=-5.808， P<0.001），ferritin（ Z=-5.280， P<0.001），erythrocyte sedimentation rate（ Z=-3.971， P<0.001），ferritin/erythrocyte sedimentation rate（ Z=-5.433， P<0.001），reduction of two-line cells in blood（ χ2=11.408， P<0.001）and the presence of hemophagocytosis in bone marrow smears（ χ2=28.260， P<0.001）. Moreover，there was a statistically significant difference in MS scores between the two groups（ Z=-6.148， P<0.001），with higher MS scores in the MAS group. Nevertheless，this study showed the median MS scores of both groups ≥-2.1. Conclusion:The MS score was significant to a certain degree as reference for the diagnosis of MAS，and this study showed that the MS score in the MAS group was significantly higher than the control group. However，the median MS scores in both groups were no less than -2.1. This might be related to the influence of factors during the assessment，which made it necessary to optimize the cutoff values of the MS score. Therefore，prospective studies should be carried out on the role of MS score in early identification of MAS.

The study was conducted among 120 general practitioners (GPs) in Shanghai Fengxian District from August 2022 to March 2024, the participants were randomly divided into two age-matched groups with 60 GPs in each group. The intervention group completed a 3-month SPOC (Small Private Online Course)program, including two weeks of narrative medicine theory (concepts, questioning skills, parallel medical record writing, and professionalism) followed by monthly writing practices (three parallel records per month) and group discussions. Both groups performed routine clinical tasks, while the control group received no narrative medicine training. Baseline data were collected, Jefferson Empathy Scale scores, and Doctor-Patient Communication Skills Evaluation Scale scores were evaluated pre- and post-intervention. There were no significant differences in empathy ( P>0.05) or communication skills ( P>0.05) between two groups before the intervention. Post-intervention, both groups showed improved empathy (both P<0.05) and communication skills (both P<0.05) after intervention, while the intervention group were outperforming the control group in both measures ( P<0.05). These findings suggest that SPOC-based narrative competence training effectively enhances the empathy and doctor-patient communication abilities of general practitioners.

Objective:To explore the potential risk factors of recurrence in patients with systemic juvenile idiopathic arthritis (sJIA).Methods:We enrolled patients with sJIA admitted to the Department of Rheumatology and Immunology, Xi′an Children′s Hospital affiliated to Xi′an Jiaotong University from January 2018 to June 2024. Cox proportional hazard models were used to identify clinical features associated with risk of recurrence.Results:This study included a total of 108 children with sJIA, with a median onset age of 79.5 (53.0, 121.5) months. Among them, 52 were male (48.1%) and 56 were female (51.9%). The median time from disease onset to diagnosis was 29.5 (19.0, 57.0) days, and 105 children achieved clinical remission during follow-up. Out of 108 patients with sJIA, 105 patients who achieved clinical remission were enrolled with a median follow-up of 38.0 months. Among them, 28 (26.7%) patients had at least once recurrence. According to the multivariate analysis, macrophage activation syndrome [HR(95% CI)=2.375(1.096, 5.149), P=0.028] and alkaline phosphatase [HR(95% CI)=1.006(1.001, 1.010), P=0.017] were associated with increased risk of recurrence. Conclusion:Our study indicated that recurrence could appear in at least 26.7% patients with sJIA. The high alkaline phosphatase and MAS at initial attack may be independent risk factors of recurrence in patients with systemic Juvenile Idiopathic Arthritis.

Objective To investigate the relationship between the expression levels of mir-155/Th17 and mir-23b-3p/Tfh in peripheral blood and the prognostic value of secondary atopic dermatitis(AD)in AIDS patients.Methods In this study,80 AIDS patients were treated in our hospital from February 2021 to December 2023.The subjects were divided into AD group and non-AD group according to whether they had secondary AD.The levels of mir-155,Th17,mir-23b-3p and Tfh in peripheral blood of AD group and non-AD group were compared.Spearman method was used to analyze the relationship between levels of mir-155,Th17,mir-23b-3p and Tfh in peripheral blood and secondary AD in AIDS patients.At the same time,according to the prognosis of patients,the subjects were divided into good prognosis group and poor prognosis group,and the risk factors affecting the prognosis of patients were screened by Logistic regression analysis.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of peripheral blood mir-155,Th17,mir-23b-3p and Tfh levels on the prognosis of AIDS patients.Results Compared with non-AD group,the levels of miR-155,Th17 and Tfh in peripheral blood of AD group were higher(P＜0.05),and the levels of miR-23b-3p were lower(P＜0.05).The level of miR-155,Th17 and Tfh in peripheral blood were positively correlated with secondary AD of AIDS(r=0.487,0.492,0.495,P＜0.05),and the level of miR-23b-3p in peripheral blood was negatively correlated with secondary AD of AIDS(r=-0.503,P＜0.05).The levels of HIV load(high dose),lymphoma,PLT,NLR,CRP,miR-155,Th17 and Tfh in the poor prognosis group were higher than those in the good prognosis group(P＜0.05),while the levels of albumin and miR-23b-3p in the poor prognosis group were lower than those in the good prognosis group(P＜0.05).Logistic regression analysis showed that lymphoma,PLT,NLR,low albumin,CRP,miR-155,Th17,Tfh and low miR-23b-3p were all risk factors for poor prognosis of AIDS patients(P＜0.05).ROC curve results showed that the AUC(95％CI)and sensitivity of combined detection of peripheral blood miR-155,Th17,Tfh and miR-23b-3p in predicting poor prognosis of AIDS patients were 0.883(0.805～0.992)and 96.70％,respectively.All of them were higher than the above peripheral blood indexes alone(P＜0.05).Conclusion The abnormal expression of miR-155,Th17,Tfh,and miR-23b-3p in peripheral blood is closely related to secondary AD in AIDS patients,and is a risk factor affecting the poor prognosis of AIDS patients.The combined detection of these indicators has a high predictive value for the poor prognosis of AIDS patients.

Background and Aims:Elderly patients undergoing laparoscopic radical resection of colon cancer often experience decreased sleep quality,which may hinder postoperative recovery.Although pharmacological interventions are commonly used in clinical practice to improve postoperative sleep,conventional medications may lead to adverse effects such as delirium and dependence.This study aimed to evaluate the effect of a non-pharmacological intervention—buccal acupuncture combined with ultrasound-guided stellate ganglion block(SGB)—on postoperative sleep quality in elderly patients.Methods:A total of 60 elderly patients who underwent laparoscopic radical resection of colon cancer at the Forth Hospital of Changsha from February to August 2024 were enrolled.Using a random number table,the patients were divided into two groups:30 in the control group(SGB alone)and 30 in the study group(SGB combined with buccal acupuncture).Perioperative mean arterial pressure(MAP),heart rate(HR),postoperative visual analogue scale(VAS)scores,Pittsburgh Sleep Quality Index(PSQI)scores,and the incidence of adverse events were recorded and analyzed.Results:There were no statistically significant differences in baseline characteristics between the two groups(all P>0.05).The study group showed significantly lower intraoperative and postoperative HR and MAP compared to the control group(all P<0.05).VAS scores at 6,24,and 48 h postoperatively,as well as PSQI scores on postoperative days 1,3,and 5,were significantly lower in the study group(all P<0.05).Additionally,the incidence of drowsiness was significantly reduced(P<0.05).No significant differences were found between the two groups in terms of nausea,vomiting,or agitation(all P>0.05).Conclusion:The combination of buccal acupuncture and SGB during the perioperative period can effectively improve postoperative sleep quality,alleviate pain,and reduce adverse reactions in elderly patients undergoing laparoscopic radical resection of colon cancer.This safe and effective non-pharmacological intervention holds promising clinical application value.

Objective:To explore the factors influencing social avoidance in patients with dental arch deficiency.Methods:A purposive sampling method was used to select patients with dental arch deficiency who visited the Nanjing Medical University Affiliated Stomatological Hospital from July 2023 to February 2024. Data were collected through semi-structured interviews, and the Colaizzi 7-step method was used to analyze the interview data.Results:A total of 14 patients with dental arch deficiency were interviewed, aged 36 to 72 years; eight were male, and six were female. Three main themes and eight sub-themes were identified: body image dysregulation (speech impairment, chewing dysfunction, muscle imbalance, appearance pressure, and conflict with social identity) ; loss of self-identity (over-awareness of self, internalized social stigma, and catastrophic interpretation) ; lack of social support network (insufficient medical team support and lack of support from core social circles) .Conclusions:Healthcare providers can develop intervention measures based on the factors influencing social avoidance in patients with dental arch deficiency to help patients restore social functionality.

Background and Aims:Elderly patients undergoing laparoscopic radical resection of colon cancer often experience decreased sleep quality,which may hinder postoperative recovery.Although pharmacological interventions are commonly used in clinical practice to improve postoperative sleep,conventional medications may lead to adverse effects such as delirium and dependence.This study aimed to evaluate the effect of a non-pharmacological intervention—buccal acupuncture combined with ultrasound-guided stellate ganglion block(SGB)—on postoperative sleep quality in elderly patients.Methods:A total of 60 elderly patients who underwent laparoscopic radical resection of colon cancer at the Forth Hospital of Changsha from February to August 2024 were enrolled.Using a random number table,the patients were divided into two groups:30 in the control group(SGB alone)and 30 in the study group(SGB combined with buccal acupuncture).Perioperative mean arterial pressure(MAP),heart rate(HR),postoperative visual analogue scale(VAS)scores,Pittsburgh Sleep Quality Index(PSQI)scores,and the incidence of adverse events were recorded and analyzed.Results:There were no statistically significant differences in baseline characteristics between the two groups(all P>0.05).The study group showed significantly lower intraoperative and postoperative HR and MAP compared to the control group(all P<0.05).VAS scores at 6,24,and 48 h postoperatively,as well as PSQI scores on postoperative days 1,3,and 5,were significantly lower in the study group(all P<0.05).Additionally,the incidence of drowsiness was significantly reduced(P<0.05).No significant differences were found between the two groups in terms of nausea,vomiting,or agitation(all P>0.05).Conclusion:The combination of buccal acupuncture and SGB during the perioperative period can effectively improve postoperative sleep quality,alleviate pain,and reduce adverse reactions in elderly patients undergoing laparoscopic radical resection of colon cancer.This safe and effective non-pharmacological intervention holds promising clinical application value.

Objective To investigate the relationship between the expression levels of mir-155/Th17 and mir-23b-3p/Tfh in peripheral blood and the prognostic value of secondary atopic dermatitis(AD)in AIDS patients.Methods In this study,80 AIDS patients were treated in our hospital from February 2021 to December 2023.The subjects were divided into AD group and non-AD group according to whether they had secondary AD.The levels of mir-155,Th17,mir-23b-3p and Tfh in peripheral blood of AD group and non-AD group were compared.Spearman method was used to analyze the relationship between levels of mir-155,Th17,mir-23b-3p and Tfh in peripheral blood and secondary AD in AIDS patients.At the same time,according to the prognosis of patients,the subjects were divided into good prognosis group and poor prognosis group,and the risk factors affecting the prognosis of patients were screened by Logistic regression analysis.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of peripheral blood mir-155,Th17,mir-23b-3p and Tfh levels on the prognosis of AIDS patients.Results Compared with non-AD group,the levels of miR-155,Th17 and Tfh in peripheral blood of AD group were higher(P＜0.05),and the levels of miR-23b-3p were lower(P＜0.05).The level of miR-155,Th17 and Tfh in peripheral blood were positively correlated with secondary AD of AIDS(r=0.487,0.492,0.495,P＜0.05),and the level of miR-23b-3p in peripheral blood was negatively correlated with secondary AD of AIDS(r=-0.503,P＜0.05).The levels of HIV load(high dose),lymphoma,PLT,NLR,CRP,miR-155,Th17 and Tfh in the poor prognosis group were higher than those in the good prognosis group(P＜0.05),while the levels of albumin and miR-23b-3p in the poor prognosis group were lower than those in the good prognosis group(P＜0.05).Logistic regression analysis showed that lymphoma,PLT,NLR,low albumin,CRP,miR-155,Th17,Tfh and low miR-23b-3p were all risk factors for poor prognosis of AIDS patients(P＜0.05).ROC curve results showed that the AUC(95％CI)and sensitivity of combined detection of peripheral blood miR-155,Th17,Tfh and miR-23b-3p in predicting poor prognosis of AIDS patients were 0.883(0.805～0.992)and 96.70％,respectively.All of them were higher than the above peripheral blood indexes alone(P＜0.05).Conclusion The abnormal expression of miR-155,Th17,Tfh,and miR-23b-3p in peripheral blood is closely related to secondary AD in AIDS patients,and is a risk factor affecting the poor prognosis of AIDS patients.The combined detection of these indicators has a high predictive value for the poor prognosis of AIDS patients.

AIM:To investigate the antiviral effica-cy and mechanism of Qingre Xiaoyanning(QRXYN)in vivo,and provide experimental basis for their prevention and treatment of influenza A virus.METHODS:We constructed a mouse model infect-ed with influenza A H3N2 virus.To evaluate the therapeutic effect of QRXYN on influenza A virus,we measured the body weight changes,pathologi-cal changes in lung tissue,hemagglutination titer,and viral load in mouse.To evaluate the possible mechanism of QRXYN's anti influenza A virus infec-tion,we used the ELISA to measure the levels of TNF-α,IL-1β,IL-4,IFN-γ,and vascular cell adhesion molecule-1(VCAM-1)in mouse bronchoalveolar Ia-vage fluid;used flow cytometry to assess the pro-portions of macrophages(F4/80),helper T lympho-cytes(CD4+T lymphocytes),and natural killer(NK)cells in lung tissue;and used Western blotting to detect the expression of Toll-like receptor 4(TLR4),myeloid differentiation factor 88(MYD88),inhibitor of kappa B kinase-β(IKK-β),NF-kappa-B inhibitor al-pha(IκBα),and phospho-IKB alpha(p-IκBα)in lung tissue.RESULTS:Compared to the model group,both Oseltamivir and QRXYN can alleviate the se-verity of lung tissue lesions in mice,decrease the blood coagulation titer and viral load of mouse lung tissue(P＜0.01),lower the levels of TNF-α,IL-4,and VCAM-1 in bronchoalveolar lavage fluid(P＜0.05,P＜0.01),reduce the proportion of macro-phages(P＜0.05,P＜0.01),and increase the propor-tion of CD4+T lymphocytes and NK cells(P＜0.05,P＜0.01).Additionally,oseltamivir can reduce the ex-pression of MYD88 protein in mouse lungs(P＜0.05),while QRXYN can decrease the expression of IKK-β and P-IκBα proteins in mouse lungs(P＜0.05).CONCLUSION:QRXYN have good in vivo antiviral ef-fects against the influenza A virus,and their mecha-nism may be related to the regulation of the immu-nologic function and NF-κB signal pathway.

Objective:To explore the factors influencing social avoidance in patients with dental arch deficiency.Methods:A purposive sampling method was used to select patients with dental arch deficiency who visited the Nanjing Medical University Affiliated Stomatological Hospital from July 2023 to February 2024. Data were collected through semi-structured interviews, and the Colaizzi 7-step method was used to analyze the interview data.Results:A total of 14 patients with dental arch deficiency were interviewed, aged 36 to 72 years; eight were male, and six were female. Three main themes and eight sub-themes were identified: body image dysregulation (speech impairment, chewing dysfunction, muscle imbalance, appearance pressure, and conflict with social identity) ; loss of self-identity (over-awareness of self, internalized social stigma, and catastrophic interpretation) ; lack of social support network (insufficient medical team support and lack of support from core social circles) .Conclusions:Healthcare providers can develop intervention measures based on the factors influencing social avoidance in patients with dental arch deficiency to help patients restore social functionality.