Objective:To evaluate the efficacy and safety of obinutuzumab combined with glucocorticoid-based therapy in patients with relapsed immune thrombotic thrombocytopenic purpura (iTTP).Methods:This study analyzed the efficacy and adverse reactions of four patients with relapsed iTTP who were treated with a combination of obinutuzumab and glucocorticoids to assess the effectiveness and safety of the treatment.Results:All four patients had a history of multiple relapses and had previously undergone treatment with rituximab and bortezomib. Three patients exhibited additional autoantibodies. Following the combined therapy, all patients achieved clinical remission, with ADAMTS13 activity returning to normal levels and inhibitors testing negative. During a median follow-up period of 11 months (range: 3–17 months), all patients maintained sustained remission. No severe adverse events were reported during treatment or follow-up.Conclusion:The combination of obinutuzumab and glucocorticoid-based therapy is effective and safe for treating relapsed iTTP.

Objective:To evaluate the effect of Yiyiren Decoction on the prevention and treatment of collagen induced arthritis with syndrome of cold-dampness obstruction (CIA-CDO) its mechanism.Methods:A cold dampness obstruction type CIA rat model was prepared by injecting type Ⅱ collagen and simulating a cold and humid environment in an artificial climate chamber. The successfully modeled rats were randomly divided into a model group, a positive group, and Yiyiren Decoction high- and low-dosage groups according to a random number table method. Additionally, 8 normal rats were set as the blank group. The Yiyiren Decoction high- and low-dosage groups were orally administered with Yiyiren Decoction at dosages of 24 and 12 g/kg, the positive group was orally administered with leflunomide at a dosage of 10 mg/kg, and the blank group and model group were orally administered with equal volumes of normal saline once a day for 4 consecutive weeks. The overall signs of the rats were observed daily, and the arthritis index (AI) of the limbs and paws was assessed weekly; after 4 weeks of drug administration, the serum levels of pro-inflammatory cytokines (TNF-α and IL-1β) and anti-inflammatory cytokines (IL-4 and IL-10) were detected by ELISA, histopathology of the ankle joint sections was observed under the light microscope, and gene expressions of synovial MMP-3 and TIMP-1 were determined by RT-qPCR.Results:The overall physical signs and joint symptoms of rats in the Yiyiren Decoction high- and low-dosage group increased; compared with the model group, after 3 and 4 weeks of administration, the AI scores of the Yiyiren Decoction high- and low-dosage group and positive group decreased ( P<0.01); the Yiyiren Decoction high- and low-dosage group showed varying degrees of improvement in inflammatory cell infiltration, synovial/fibrous tissue proliferation, and bone and cartilage structure damage in the ankle joint; compared with the model group, the levels of pro-inflammatory cytokines TNF-α and IL-1β in the high and Yiyiren Decoction low-dosage groups decreased ( P<0.01), while the levels of IL-4 and IL-10 increased ( P<0.01); the mRNA level of MMP-3 in synovium decreased ( P<0.05 or P<0.01), while the mRNA level of TIMP-1 increased ( P<0.05 or P<0.01). Conclusion:Yiyiren Decoction can improve the joint symptoms of CIA rats with cold-dampness obstruction, and its preventive and therapeutic effects may be related to correcting the imbalance of pro-inflammatory/anti-inflammatory cytokines and MMP-3/TIMP-1, reducing the inflammatory reaction in the joint cavity and the whole body, and inhibiting the metabolic disorder of joint matrix.

Objective:To evaluate the efficacy and safety of obinutuzumab combined with glucocorticoid-based therapy in patients with relapsed immune thrombotic thrombocytopenic purpura (iTTP).Methods:This study analyzed the efficacy and adverse reactions of four patients with relapsed iTTP who were treated with a combination of obinutuzumab and glucocorticoids to assess the effectiveness and safety of the treatment.Results:All four patients had a history of multiple relapses and had previously undergone treatment with rituximab and bortezomib. Three patients exhibited additional autoantibodies. Following the combined therapy, all patients achieved clinical remission, with ADAMTS13 activity returning to normal levels and inhibitors testing negative. During a median follow-up period of 11 months (range: 3–17 months), all patients maintained sustained remission. No severe adverse events were reported during treatment or follow-up.Conclusion:The combination of obinutuzumab and glucocorticoid-based therapy is effective and safe for treating relapsed iTTP.

Objective To investigate the effect of individual exercise training on the rehabilitation of patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods A total of 81 patients between January 2021 and December 2023 were randomly allocated into an observation group(n=41)and a control group(n=40)using a simple random number Tab.method.The control group received routine post-operative rehabilitation intervention,while the observation group received individualized exercise training as the core component of cardiac rehabilitation intervention.The study compared the effects of rehabilitation,cardiac function parameters[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)],exercise endurance measures[6-minute walking distance(6MWD)],and quality of life assessed by Seattle Angina Pecina Scale(SAQ)scores between the two groups before and after a three-month intervention period.Results The total recovery response rate in the observation group was higher than that in the control group(P＜0.05).LVEF,LVEDD,6 MWD,maximum exercise load and SAQ scales(P＞0.05),LVEF were higher than before intervention(t=3.345,2.480,3.165,5.016,2.059,4.582,4.443,3.353,P＜0.05),and LVEDD was lower than before intervention(t=3.335,P＜0.05).Conclusion The individualized exercise training-based cardiac rehabili-tation program demonstrates potential for enhancing cardiac function and exercise endurance in patients with CHD following PCI,thereby improving their overall quality of life.This finding holds significant clinical implications.

Objective:To investigate the alterations in brain dynamic functional network connectivity (dFNC) and their significance in Parkinson's disease (PD) patients with postural instability/gait difficulty (PIGD).Methods:Ninety PD patients admitted to Department of Neurology, First Affiliated Hospital of Nanjing Medical University from May 2016 to August 2019 were recruited, and 54 healthy controls matched with gender and age were chosen; their clinical data and resting-state functional MRI (rs-fMRI) data were collected. PD patients were divided into PD with PIGD (PD-PIGD) group ( n=49) and PD without PIGD (PD-non-PIGD) group ( n=41) according to Unified Parkinson's Disease Rating Scale (UPDRS) scores. Independent component analysis (ICA), sliding window method and k-means clustering were used to analyze the dFNC and compare among groups. Correlations of dFNC alterations with clinical scales were verified by partial correlation analysis. Results:Four repeated recurring functional connectivity states were identified, and PD-PIGD patients had high frequency in state 3 (44%) and state 2 (23%) of the low dFNC. In terms of dFNC time attributes, PD-PIGD patients had longer mean dwell time in state 3 than PD-non-PIGD patients and had lower number of transitions in state 3 than PD-non-PIGD patients and healthy controls, with significant differences ( P<0.05); PD-PIGD patients had significantly higher fractional windows and statistically longer mean dwell time in state 2 than healthy controls ( P<0.05). In terms of dFNC strengths, compared with healthy controls, PD-PIGD patients showed significantly decreased functional connectivity within default mode network (DMN, between medial superior frontal gyrus and precuneus) and auditory network (AN, between superior temporal gyrus and middle temporal gyrus), but significantly increased functional connectivity between sensorimotor network (SMN, supplementary motor area) and DMN (precuneus) in state 2 ( P<0.05, false discovery rate [FDR]-corrected). Partial correlation analysis indicated positive correlation between mean dwell time in state 3 and PIGD scores in PD-PIGD patients ( r=0.450, P=0.039). Conclusion:PD-PIGD patients exhibit specific dFNC, mainly characterized by low connectivity of the brain functional network and prolonged dwell time; local functional network domains often separate between DMN, AN and SMN networks and within the networks.

Objective:To explore the value of jellyfish sign, an abnormal ultrasonographic sign, in predicting adverse perinatal outcomes of women with complete placenta previa combined with placenta accreta spectrum disorders (PAS).Methods:This retrospective study analyzed the ultrasound images of 72 singleton gravidas, diagnosed with complete placenta previa combined with PAS, who underwent cesarean section at the First Affiliated Hospital of Nanjing Medical University between January 2020 and February 2023. Based on the presence and absence of the jellyfish sign in ultrasound images, these gravidas were divided into the jellyfish-sign group (15 cases, 20.8%) and the non-jellyfish-sign group (57 cases, 79.2%). The clinical data and perinatal outcomes of the two groups were analyzed. The adverse perinatal outcomes encompassed conditions such as abdominal aorta balloon block, uterine artery embolism, hysterectomy, postpartum hemorrhage, and neonatal intensive care unit (NICU) admission of their neonates. Statistical analysis was performed using two independent samples t-test, the Mann-Whitney U test and the Chi-square (or Fisher's exact) test. Results:(1) The jellyfish-sign group exhibited a higher parity [(1.6±0.7) times vs (1.2±0.6) times, t=2.01] and higher prenatal scores of placenta accreta [(12.3±1.5) scores vs (8.6±2.9) scores, t=6.59] than those in the non-jellyfish-sign group (both P<0.05). Among the 57 cases in the non-jellyfish-sign group, there were 14 cases of placenta creta (24.6%), 40 cases of placenta increta (70.2%), and three cases of placenta percreta (5.3%). Among the 15 cases in the jellyfish-sign group, nine cases were diagnosed with placenta increta, six with placenta percreta, and none with placenta creta. The difference in distribution between the two groups was statistically significant (Fisher's exact test, P<0.001). (2) Intraoperative blood loss [(for those who accepted abdominal aorta balloon block, 1 973±1 057) ml vs (1 211±576) ml, t=2.55], red blood cells transfused [4.0 U (2.0-23.0 U) vs 2.5 U (0.0-11.0 U), Z=－2.53], postoperative hospitalization time [(9.7±2.4) vs (7.5±2.2) d, t=3.36], the incidence of abdominal aorta balloon block [15/15 vs 38.6% (22/57), χ2=17.92], uterine artery embolism [for those who accepted abdominal aorta balloon block, 3/15 vs 1.8% (1/57), Fisher's exact test], and requiring blood transfusion [15/15 vs 63.2% (36/57), Fisher's exact test] were higher in the jellyfish-sign group than those in the non-jellyfish-sign group. However, the non-jellyfish-sign group had lower gestational age at delivery [(33.6±1.5) weeks vs (35.2±1.8) weeks, t=－3.24], and lower neonatal Apgar score at 1 min and 5 min [1 min: 8 scores (3-10 scores) vs 9 scores (4-10 scores), Z=－2.46; 5 min: 9 scores (7-10 scores) vs 10 scores (6-10 scores), Z=－2.02] (all P<0.05). There were no significant differences in emergency surgery rate, 24 h postoperative blood loss, neonatal birth weight, and proportion of NICU admission between the two groups. Additionally, no cases of hysterectomy or death were observed in the two groups. Conclusions:Ultrasound examination revealing jellyfish signs in patients with complete placenta previa and PAS is associated with an increased likelihood of adverse perinatal outcomes. Consequently, the management of these patients should be given greater attention.

Objective:To observe the effect of positive psychological intervention based on PERMA model on core emergency competence and empathy of ICU nurses in infectious disease emergencies.Methods:From February to April 2020, a total of 136 ICU nurses from 3 ClassⅢ Grade A hospitals in Beijing were selected as the research objects. The patients were divided into the control group and the experimental group by the random number table method, with 68 cases in each group. The control group was given professional knowledge training, while the experimental group was given professional knowledge training combined with PERMA positive psychological intervention. The core emergency competence and compassion load of ICU nurses in the two groups before and after intervention were compared by using the Core Emergency Competence Questionnaire for Infectious Disease Emergencies and Nurses' Compassion Load Scale.Results:After intervention, scores of emergency competence of nurses in both groups were higher than before intervention, and the score of emergency competence in the experimental group was higher than that in control group, and the differences were statistically significant ( P<0.05) . After the intervention, the scores of the satisfaction subscale of helping and caring for others in Nurses' Compassion Load Scale in the experimental group were higher than those before the intervention, and the subscale scores of burnout and compassion fatigue were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Positive psychological intervention based on the PERMA model can effectively increase the core emergency competence of ICU nurses in infectious disease emergencies and reduce their psychological load.

Pyrrolizidine alkaloids (PAs) are the most common phytotoxins with documented human hepatotoxicity. PAs require metabolic activation by cytochromes P450 to generate toxic intermediates which bind to proteins and form protein adducts, thereby causing cytotoxicity. This study investigated the role of the gut-liver axis in PA intoxication and the underlying mechanisms. We exposed mice to retrorsine (RTS), a representative PA, and for the first time found RTS-induced intestinal epithelium damage and disruption to intestinal barrier function. Using mice with tissue-selective ablation of P450 activity, we found that hepatic P450s, but not intestinal P450s, were essential for PA bioactivation. Besides, in RTS-exposed, bile duct-cannulated rats, we found the liver-derived reactive PA metabolites were transported by bile into the intestine to exert enterotoxicity. The impact of gut-derived pathogenic factors in RTS-induced hepatotoxicity was further studied in mice with dextran sulfate sodium (DSS)-induced chronic colitis. DSS treatment increased the hepatic endotoxin level and depleted hepatic reduced glutathione, thereby suppressing the PA detoxification pathway. Compared to RTS-exposed normal mice, the colitic mice displayed more severe RTS-induced hepatic vasculature damage, fibrosis, and steatosis. Overall, our findings provide the first mode-of-action evidence of PA-induced enterotoxicity and highlight the importance of gut barrier function in PA-induced liver injury.

Objective: To study the influence of personality on the occurrence of dental trauma of school-aged children. Methods:The school-aged children with dental trauma who came to visit our department were randomly recruited. The Eysenck Personality Scale was used to test the subjects who met the inclusion criteria. Results: 306 children were included in the study. There was a statistically significant association between personality type and the number of traumatic teeth (P ＜ 0. 05) and the number of traumatic teeth in children with extroversion was higher than that of children with neutrality or introversion (P ＜ 0. 05) . Conclusion: Extroverted personality is a significant correlation factor affecting the severity of dental trauma in children, and it is of great significance to provide scientific guidance and warning for them to prevent tooth trauma.

Objective To evaluate the performance of domestic matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system Clin-TOF-Ⅱ MS with BioExplorer V2.3 database ( Clin-TOF MS system) on gram-negative bacteria identification.Methods This was a methodological comparison study.A total of 1 025 gram-negative strains of 32 genus, 56 species or species complex were included in this study from 1999 to 2000 and 2014 to 2016 in Peking Union Medical College Hospital.The Bruker Biotyper MS system ( Bruker MS system ) , Bruker Autoflex Speed with Biotyper v 3.1 database were used as control.Identification by both MALDI-TOF MS systems were parallel conducted by direct smear method.The 16S rDNA sequencing based identification was performed when either MALDI-TOF MS system gave“unbelievable result” or results from two systems were not consistent.Results Amongst the isolates studied, 98.05% (1 005/1 025) was correctly identified to species or species complex level by Clin-TOF MS system.Comparatively, 99.22%(1 017/1 025) was correctly identified by Bruker MS system.There were 17 isolates just identified to genus level and 2 isolates were “no identification” by Clin-TOF MS system, meanwhile 1 Pseudomonas monteilii misidentified as P.putida.There were only two 2 isolates identified to genus level and 3 isolates were“no identification” by Bruker MS system.But it misidentified all 3 Aeromonas hydrophila (2 isolates as A.caviae and 1 isolate as A.media).It′s noted that both MS systems identified 1 Chryseobacterium gleum and 1 C. bernardetii to genus level.Conclusion The identification capability of domestic Clin-TOF MS system was good on gram-negative bacteria.