OBJECTIVE To explore the efficacy and safe ty of Tripterygium wilfordii polyglycoside combined with finerenone in the treatment of diabetic nephropathy （DN）. METHODS This study selected 104 DN patients admitted to the Nephrology Department of Handan Central Hospital from January 2023 to May 2024 as the subjects and randomly assigned them into the control group （52 cases） and the combination group （52 cases）. All patients received basic treatment such as lipid-lowering and blood glucose control. On this basis， patients in the control group received finerenone， while those in the combination group received a combination therapy of T. wilfordii polyglycoside and finerenone. Both groups underwent treatment for a duration of three months. The two groups were compared in terms of clinical efficacy， renal function indicators [24-hour urine protein excretion （24 h UPE）， urinary albumin-to-creatinine ratio （UACR）， urinary albumin excretion rate （UAER） ] ， inflammatory factors [high mobility group box 1 protein （HMGB1）， interleukin-6 （IL-6）， nuclear factor-κB （NF-κB）， high-sensitivity C reactive protein （hs-CRP） ] ， and oxidative stress indicators [total antioxidant capacity （T-AOC）， superoxide dismutase （SOD）， advanced oxidation protein products （AOPP）， malondialdehyde （MDA） ] before and after treatment. Additionally， the occurrence of adverse drug reactions was recorded. RESULTS In terms of efficacy， the total effective rate of patients in the combination group was higher than that of the control group （ P ＜0.05）. After treatment， the levels of 24-h UPE， UACR， UAER， HMGB1， IL-6， NF-κB， hs-CRP， AOPP and MDA in the two groups were significantly lower than those in the same group before treatment； the levels of T-AOC and SOD in the two groups were significantly higher than those in the same group before treatment， with the combination group showing superior changes in the above indicators compared to the control group at the corresponding time point （ P ＜0.05）. In terms of safety， there was no statistical significance in the total incidence of adverse drug reactions between the two groups （ P ＞0.05）. CONCLUSIONS Compared to finerenone monotherapy， the combination therapy of T. wilfordii polyglycoside and finerenone demonstrates significant efficacy in treating DN. It effectively reduces proteinuria levels， alleviates inflammatory reaction， mitigates oxidative stress， and does not increase the risk of adverse reactions.

OBJECTIVE To investigate the regulatory effects of tofacitinib combined with methotrexate （MTX） on gut microbiota and the clinical efficacy of this regimen in patients with rheumatoid arthritis （RA）. METHODS A retrospective analysis was conducted on the clinical data of 182 patients with RA admitted to Xingtai People’s Hospital from January 2022 to June 2025. The patients were divided into a control group （ n ＝88， treated with MTX monotherapy） and an observation group （ n ＝94， treated with tofacitinib combined w ith MTX） based on their treatment regimen. Gut microbiota abundance， inflammatory and immunological indicators [C-reactive protein （CRP）， erythrocyte sedimentation rate （ESR）， rheumatoid factor （RF）， and anti-cyclic citrullinated peptide antibody （anti-CCP） ] ， clinical efficacy indicators [American College of Rheumatology 20% response rate （ACR20）， Disease Activity Score in 28 Joints （DAS28）， and Health Assessment Questionnaire （HAQ） score ] ， and adverse reactions during treatment were compared between the two groups before and after 12 weeks of treatment. RESULTS After treatment， the abundance of Lactobacillus and Bifidobacterium were significantly increased in both groups compared with before treatment， whereas the abundances of Enterococcus and Enterobacter ， as well as the levels of CRP， ESR， RF， anti-CCP， DAS28 score， and HAQ score， were significantly decreased （ P ＜0.05）. The degree of improvement in the observation group was significantly greater than that in the control group （ P ＜0.05）. The ACR20 response rate in the observation group was significantly higher than that in the control group （81.91% vs. 56.82%， P ＜0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups （ P ＞0.05）， and the main adverse reactions were gastrointestinal reactions and abnormal liver function. CONCLUSIONS Tofacitinib combined with MTX can effectively improve gut microbiota balance in patients with RA by increasing the abundance of probiotics and reducing the abundance of opportunistic pathogenic bacteria， thereby improving immune and inflammatory status. In addition， this combination regimen can enhance clinical efficacy， reduce disease activity， and improve functional status， with a favorable safety profile.

Objective To investigate the biomechanical characteristics of clear aligners combined with Class Ⅱelastics during retraction of upper anterior teeth,and compare the differences between two traction methods.Methods A case with a molar distal relationship and extraction of four first premolars was selected.The finite element method was applied to analyze tooth displacement,force distribution,and periodontal ligament(PDL)stress during 0.2 mm en-masse retraction of the anterior teeth.Three working conditions were defined:en-masse retraction without elastics(Condition 1),120 g Class Ⅱ elastics with aligner-cut hooks on upper canines and lower first molars(Condition 2),120 g Class Ⅱ elastics with aligner windows and bonded buttons on upper canines and lower first molars(Condition 3).Results Class Ⅱ elastics significantly enhanced lingual movement of the upper anterior teeth and mesial movement of the lower posterior teeth,while reducing mesial movement of the upper posterior teeth and lingual movement of the lower anterior teeth.In the transverse direction,the forces exerted on the teeth in all three conditions were minimal.In the sagittal direction,in Condition 2,the mesial force of the upper posterior teeth was effectively reduced by an average of 0.13 N,and the mesial force of the lower posterior teeth was increased by an average of 0.31 N.In Condition 3,the distal force of the upper canine teeth and the mesial force of the lower first molar were significantly increased by 0.40 N and 1.14 N,respectively.In the vertical direction,In condition 2,the average extrusive force of the upper teeth and the extrusive force of the lower molars were increased by 0.22 N and 0.20 N,respectively.In Condition 3,the upper canine extrusive force was increased by 0.91 N,while the lower molar intrusive force and the second molar extrusive force were reduced by 0.27 N and 0.25 N,respectively.The PDL stress distribution in the three conditions was generally similar.In Condition 3,the maximum principal stress distribution area on the lower first molars expanded slightly,but the magnitude did not increase significantly.Conclusions Condition 2 optimized the lower posterior teeth mesialization through balanced force distribution and protected the upper posterior teeth anchorage.Condition 3 significantly increased extrusive and distal forces on the upper canines and mesial forces on the lower first molars but did not substantially elevate periodontal risks for these teeth.

Objective To investigate the biomechanical characteristics of clear aligners combined with Class Ⅱelastics during retraction of upper anterior teeth,and compare the differences between two traction methods.Methods A case with a molar distal relationship and extraction of four first premolars was selected.The finite element method was applied to analyze tooth displacement,force distribution,and periodontal ligament(PDL)stress during 0.2 mm en-masse retraction of the anterior teeth.Three working conditions were defined:en-masse retraction without elastics(Condition 1),120 g Class Ⅱ elastics with aligner-cut hooks on upper canines and lower first molars(Condition 2),120 g Class Ⅱ elastics with aligner windows and bonded buttons on upper canines and lower first molars(Condition 3).Results Class Ⅱ elastics significantly enhanced lingual movement of the upper anterior teeth and mesial movement of the lower posterior teeth,while reducing mesial movement of the upper posterior teeth and lingual movement of the lower anterior teeth.In the transverse direction,the forces exerted on the teeth in all three conditions were minimal.In the sagittal direction,in Condition 2,the mesial force of the upper posterior teeth was effectively reduced by an average of 0.13 N,and the mesial force of the lower posterior teeth was increased by an average of 0.31 N.In Condition 3,the distal force of the upper canine teeth and the mesial force of the lower first molar were significantly increased by 0.40 N and 1.14 N,respectively.In the vertical direction,In condition 2,the average extrusive force of the upper teeth and the extrusive force of the lower molars were increased by 0.22 N and 0.20 N,respectively.In Condition 3,the upper canine extrusive force was increased by 0.91 N,while the lower molar intrusive force and the second molar extrusive force were reduced by 0.27 N and 0.25 N,respectively.The PDL stress distribution in the three conditions was generally similar.In Condition 3,the maximum principal stress distribution area on the lower first molars expanded slightly,but the magnitude did not increase significantly.Conclusions Condition 2 optimized the lower posterior teeth mesialization through balanced force distribution and protected the upper posterior teeth anchorage.Condition 3 significantly increased extrusive and distal forces on the upper canines and mesial forces on the lower first molars but did not substantially elevate periodontal risks for these teeth.

OBJECTIVE To investigate the protective effect and mechanism of quercetin on the cardiac and renal functions of rats with cardiorenal syndrome （CRS） based on the phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt）/nuclear factor kappa- B （NF-κB） signaling pathway. METHODS CRS model of SD rats was induced by left anterior descending coronary artery ligation combined with acute renal ischemia-reperfusion. Model rats were randomly separated into model group， quercetin low-dose group （35 mg/kg）， quercetin high-dose group （70 mg/kg）， high-dose of quercetin+740Y-P group （70 mg/kg quercetin+3.5 mg/kg PI3K/Akt/ NF-κB signaling pathway activator 740Y-P）， with 12 rats in each group. Another 12 normal rats were selected as sham operation group. They were given relevant drugs， once a day， for 14 consecutive days. After administration， the cardiac function indexes [left ventricular ejection fraction （LVEF）， end-diastolic volume （EDV）， isovolumic relaxation time （IVRT）] and renal function indicators [blood urea nitrogen （BUN）， 24-hour urine protein， and serum creatinine （Scr）] were detected， and fibrosis in the cardiac and renal tissues was observed； the levels of inflammatory indexes [interleukin-1β （IL-1β） and tumor necrosis factor-α （TNF-α）] in the serum and cardiac and renal tissues as well as the expression of PI3K/Akt/NF-κB pathway-related proteins in the cardiac and renal tissues were detected. RESULTS Compared with sham operation group， the levels of BUN， 24-hour urine protein and Scr， collagen volume fraction of cardiac and renal tissues， the levels of IL-1β and TNF-α in serum and cardiac and renal tissues， and the phosphorylation of PI3K， Akt and NF-κB p65 protein in cardiac and renal tissues were increased significantly in model group （P＜0.05）； the levels of LVEF， IVRT and EDV were reduced significantly （P＜0.05）. Compared with the model group， the above indexes were reversed significantly in quercetin low-dose and high-dose groups （P＜0.05）， and the reversal effect was better in the high-dose group （P＜0.05）. 740Y-P restored the reverse effect of high-dose quercetin on the indexes （P＜0.05）. CONCLUSIONS Quercetin can alleviate cardiac and renal fibrosis and function injury， the mechanism of which may be 20232016） associated with inhibiting the activation of the PI3K/Akt/NF-κB signaling pathway.

【Objective】 To comprehensively explore the serological characteristics of anti-PP1P^k and potential therapeutic strategies for recurrent miscarriage in p-blood type pregnant women. 【Methods】 Neutralization with pigeon egg white and human plasma, disruption of IgM antibodies by 2-mercaptoethanol reagent, and complement adding were conducted. Anti-PP1P^k titers under different processing conditions, media and temperatures were determined, and neutralizing effect of human plasma on anti-PP1P^k and its sensitization complement ability were analyzed. 【Results】 The titers of anti-PP1P^k in saline and column agglutination were 4 and 8, respectively. Low temperature increased titers, while β-mercaptoethanol treatment significantly reduced them. Pigeon egg white partially neutralized anti-PP1P^k antibodies. Human plasma was also capable of reducing anti-PP1P^k titers with neutralization capability surpassing that of pigeon egg white, and there were individual differences in neutralization capability. 【Conclusion】 The anti-PP1P^k was a blend of antibodies encompassing both IgM and IgG types, exhibiting cold reactivity, and having the potential for complement activation. Human plasma emerges as an effective modulator for diminishing the efficacy of anti-PP1P^k. Plasma transfusion holds promise as a therapeutic avenue for addressing recurrent miscarriages in pregnant individuals with the p phenotype.

OBJECTIVE: To construct a risk prediction model for elderly severe patients with pneumonia infection, and analyze the prevention effect of 1M3S nursing plan under early warning mode. METHODS: Firstly, 180 elderly severe patients admitted to the department of intensive care unit (ICU) of the Second Affiliated Hospital of Xingtai Medical College from September 2020 to September 2021 were enrolled. Their clinical data were collected and retrospectively analyzed, and they were divided into infected group and non-infected group according to whether they developed severe pneumonia. The risk factors affecting severe pneumonia in elderly severe patients were screened by univariate and multifactorial analysis methods, and the risk prediction model was constructed. The predictive efficiency of the model was analyzed by receiver operator characteristic curve (ROC curve). Then the risk prediction model was applied to prospectively include 60 high-risk elderly patients with severe pneumonia admitted from December 2021 to August 2022. The patients were randomly divided into study group and control group by envelope method, with 30 cases in each group. Both groups were given routine nursing. On this basis, the study group adopted 1M3S nursing scheme [standardized nursing management (1M), improving nursing skills (S1), optimizing nursing service (S2), ensuring nursing safety (S3)] in the early warning mode for intervention. Acute physiology and chronic health evaluation II (APACHE II) and Murray lung injury score were compared between the two groups before intervention and 7 days after intervention. RESULTS: Among 180 elderly severe patients, 34 cases were infected with pneumonia (18.89%). The proportion of patients with Glasgow coma scale (GCS) ≤ 8, duration of mechanical ventilation > 7 days, use of antibiotics, poor oral hygiene, hospital stay > 15 days and albumin ≤ 30 g/L in the infected group were significantly higher than those in the non-infected group. Multivariate Logistic regression analysis showed that duration of mechanical ventilation > 7 days, use of antibiotics, GCS score≤ 8, hospital stay > 15 days, albumin ≤ 30 g/L and poor oral hygiene were all independent risk factors for severe pneumonia in elderly severe patients. The odds ratio (OR) values were 3.180, 3.394, 1.108, 1.881, 1.517 and 2.512 (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of the prediction model to predict severe pneumonia in elderly severe patients was 0.838, 95% confidence interval was 0.748-0.927, sensitivity and specificity were 81.25% and 72.57%, respectively, and the Youden index was 0.538. (2) There was no significantly difference in general data between the study group and the control group, which was comparable. After intervention, the APACHE II score and Murray lung injury score of the two groups were significantly decreased, and the APACHE II score and Murray lung injury score of the study group were significantly lower than those of the control group (APACHE II score: 3.15±1.02 vs. 3.81±0.25, Murray lung injury score: 5.01±1.12 vs. 6.55±0.21, both P < 0.01). CONCLUSIONS There are many risk factors affecting the development of severe pneumonia in elderly severe patients. The risk prediction model based on duration of mechanical ventilation > 7 days, hospital stay > 15 days, GCS score≤ 8, albumin ≤ 30 g/L, poor oral hygiene and history of combined antibacterial use has high predictive efficacy. The intervention of 1M3S nursing scheme in the early warning mode can effectively reduce the risk of severe pneumonia in elderly severe patients, and significantly improve the pathophysiological status.
Humans ; Pneumonia/diagnosis* ; Aged ; Risk Factors ; Retrospective Studies ; Intensive Care Units ; Female ; Male ; ROC Curve ; Risk Assessment/methods*

BACKGROUND: LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer. METHODS: We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels. RESULTS: On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs . 1.4% [2/145]). CONCLUSION: LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile. TRIAL REGISTRATION ClinicalTrials.gov, NCT04563936.
Humans ; Male ; Antineoplastic Agents, Hormonal/therapeutic use* ; East Asian People ; Gonadotropin-Releasing Hormone/agonists* ; Goserelin/therapeutic use* ; Prostate-Specific Antigen ; Prostatic Neoplasms/drug therapy* ; Testosterone

Objective: To analyze the flow field characteristics of the upper airway in patients with different adenoid hypertrophy using computational fluid dynamics (CFD). Methods: From November 2020 to November 2021, the cone-beam CT (CBCT) data of 4 patients [2 males and 2 females,age range 5-7 years, mean (6.0±1.2) years] with adenoid hypertrophy who were hospitalized in the Department of Orthodontics and the Department of Otolaryngology at Hebei Eye Hospital were selected. The degree of adenoid hypertrophy in the 4 patients was divided into normal S1 (A/N<0.6), mild hypertrophy S2 (0.6≤A/N<0.7), moderate hypertrophy S3 (0.7≤A/N<0.9) and severe hypertrophy S4 (A/N≥0.9) according to the ratio of adenoid thickness to the width of nasopharyngeal cavity (A/N). The CFD model of the upper airway was established using ANSYS 2019 R1 software, and the internal flow field of the CFD model was numerically simulated. Eight sections were selected as observation and measurement planes for flow field information. Relevant flow field information includes airflow distribution, velocity variation, and pressure variation. Results: In the S1 model, the maximum pressure difference occurred in the 4th and 5th observation planes (ΔP=27.98). The lowest pressures and the maximum flow rates of S2 and S3 were located in the 6th observation plane. The airflow in S1 and S2 models completely passed through the nasal cavity. In the S3 model, the mouth-to-nasal airflow ratio was close to 2∶1. In S4 model, the airflow completely passed through the mouth; in the S1 and S2 models, hard palates were subjected to a downward positive pressure with a pressure difference of 38.34 and 23.31 Pa, respectively. The hard palates in S3 and S4 models were subjected to a downward negative pressure with a pressure difference of -2.95 and -21.81 Pa, respectively. Conclusions: The CFD model can objectively and quantitatively describe the upper airway airflow field information in patients with adenoid hypertrophy. With the increasing degree of adenoid hypertrophy, the nasal ventilation volume gradually decreased, whereas the oral space ventilation volume gradually increased, and the pressure difference between the upper and lower surfaces of the palate gradually decreased until the pressure became negative.