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

Objective To evaluate the registration accuracy of progressive biomechanical shrinkage set of MIM system to provide registration evaluation data support for registration demand scenarios such as treatment response feedback and dose stacking in tumor adaptive radiotherapy.Methods The CT images of a fresh pork liver with 60 gold markers in different shrinkage states at different heating time were used as the phantom images containing gold markers,and the phantom images without gold markers were obtained by replacing the pixel values at the high-density points containing the gold markers with the pixel averages of the pork liver tissue near the gold marker points.Secondly,the two types of phantom images were introduced into MIM system for registration by two methods of deformable image registration(DIR)and contour boundary-based hybrid deformable image registration(HY-DIR).Finally,the mean values of target registration errors(TRE)were cal-culated between the real gold marker points and the ones by registrating respectively all the gold marker points,23 internal points and 37 superfacial points.The Dice coefficients and Hausdorff distances were computed,and correlation and difference analyses were carried out between four groups of DIR with gold marker,HY-DIR with gold marker,DIR without gold marker and HY-DIR without gold marker.SPSS 25.0 software was used for statistical analysis.Results At 30 s time-phase,the mean values of TRE ranged from 2.14 to 2.20 mm,and the Dice coefficients were all 0.94;at 60-90 s time-phase,the mean values of TRE were from 3.02 to 5.32 mm,and the Dice coefficients were restricted between 0.95 and 0.97;at 110-200 s time-phase,the mean values of TRE were higher than 4 mm,and the Dice coefficients were from 0.93 to 0.96.The Hausdorff distance had high mean value at 30-200 s time-phase,with a minimum value of 3.85 mm and a maximum value of 17.91 mm.The mean value and standard deviation of TRE of the superfacial gold marker points were all higher than those of the internal points.In case of registration by DIR the Dice coefficients had medium-strength correlations with the TRE mean values of the internal points and all the points(0.4＜r＜0.6).In case of registration by HY-DIR the Dice coefficients did not correlated with the TRE mean values(r＜0.2).In terms of TRE mean value there were significant difference between DIR with gold marker group and HY-DIR with gold marker group(P=0.026)and between DIR with gold marker group and DIR without gold marker group(P=0.036).Conclusion When MMI software is used for self-addaptive radiotherapy registration,satisfactory results are obtained at 30 s time-phase;at 60-90 s time-phase(volume shrinkage lower than 20％),some low registration errors occur and need artificial correction;at 100-200 s time-phase(volume shrinkage higher than 20％),high registration errors appear while the registration with gold markers be haves better than that without gold markers and DIR gains advantages over HY-DIR.[Chinese Medical Equipment Journal,2025,46(2):49-55]

Objective:To construct a key item checklist for the Mini-HTA report specification,providing scientific guidance for drafting each section of Mini-HTA research reports,enhancing their standardization,scientific rigor,and completeness,thereby improving the efficiency and quality of health decision-making.Methods:Based on preliminary literature review and qualitative systematic review,a pool of problem items for the Mini-HTA report specification was formed.Delphi questionnaires were distributed,and the Delphi technique was employed through two rounds of expert consultation to optimize and select key items.Results:Through two rounds of Delphi expert consultation,the initial Mini-HTA report specification item checklist was screened,integrated,and supplemented.A finalized key item checklist was constructed,comprising 8 first-level items(Title,Abstract,Introduction,Methods,Results,Discussion,Conclusion,and Other Relevant Information)and 48 second-level items.Conclusion:The constructed key item checklist for the Mini-HTA report specification provides scientific guidance for drafting Mini-HTA research reports.It helps enhance the standardization and transparency of the assessment process and the reliability of results,thereby optimizing the efficiency and quality of health decision-making.

Objective To evaluate the registration accuracy of progressive biomechanical shrinkage set of MIM system to provide registration evaluation data support for registration demand scenarios such as treatment response feedback and dose stacking in tumor adaptive radiotherapy.Methods The CT images of a fresh pork liver with 60 gold markers in different shrinkage states at different heating time were used as the phantom images containing gold markers,and the phantom images without gold markers were obtained by replacing the pixel values at the high-density points containing the gold markers with the pixel averages of the pork liver tissue near the gold marker points.Secondly,the two types of phantom images were introduced into MIM system for registration by two methods of deformable image registration(DIR)and contour boundary-based hybrid deformable image registration(HY-DIR).Finally,the mean values of target registration errors(TRE)were cal-culated between the real gold marker points and the ones by registrating respectively all the gold marker points,23 internal points and 37 superfacial points.The Dice coefficients and Hausdorff distances were computed,and correlation and difference analyses were carried out between four groups of DIR with gold marker,HY-DIR with gold marker,DIR without gold marker and HY-DIR without gold marker.SPSS 25.0 software was used for statistical analysis.Results At 30 s time-phase,the mean values of TRE ranged from 2.14 to 2.20 mm,and the Dice coefficients were all 0.94;at 60-90 s time-phase,the mean values of TRE were from 3.02 to 5.32 mm,and the Dice coefficients were restricted between 0.95 and 0.97;at 110-200 s time-phase,the mean values of TRE were higher than 4 mm,and the Dice coefficients were from 0.93 to 0.96.The Hausdorff distance had high mean value at 30-200 s time-phase,with a minimum value of 3.85 mm and a maximum value of 17.91 mm.The mean value and standard deviation of TRE of the superfacial gold marker points were all higher than those of the internal points.In case of registration by DIR the Dice coefficients had medium-strength correlations with the TRE mean values of the internal points and all the points(0.4＜r＜0.6).In case of registration by HY-DIR the Dice coefficients did not correlated with the TRE mean values(r＜0.2).In terms of TRE mean value there were significant difference between DIR with gold marker group and HY-DIR with gold marker group(P=0.026)and between DIR with gold marker group and DIR without gold marker group(P=0.036).Conclusion When MMI software is used for self-addaptive radiotherapy registration,satisfactory results are obtained at 30 s time-phase;at 60-90 s time-phase(volume shrinkage lower than 20％),some low registration errors occur and need artificial correction;at 100-200 s time-phase(volume shrinkage higher than 20％),high registration errors appear while the registration with gold markers be haves better than that without gold markers and DIR gains advantages over HY-DIR.[Chinese Medical Equipment Journal,2025,46(2):49-55]

Objective:To construct a key item checklist for the Mini-HTA report specification,providing scientific guidance for drafting each section of Mini-HTA research reports,enhancing their standardization,scientific rigor,and completeness,thereby improving the efficiency and quality of health decision-making.Methods:Based on preliminary literature review and qualitative systematic review,a pool of problem items for the Mini-HTA report specification was formed.Delphi questionnaires were distributed,and the Delphi technique was employed through two rounds of expert consultation to optimize and select key items.Results:Through two rounds of Delphi expert consultation,the initial Mini-HTA report specification item checklist was screened,integrated,and supplemented.A finalized key item checklist was constructed,comprising 8 first-level items(Title,Abstract,Introduction,Methods,Results,Discussion,Conclusion,and Other Relevant Information)and 48 second-level items.Conclusion:The constructed key item checklist for the Mini-HTA report specification provides scientific guidance for drafting Mini-HTA research reports.It helps enhance the standardization and transparency of the assessment process and the reliability of results,thereby optimizing the efficiency and quality of health decision-making.

Objective:To investigate the clinical significance of genetic and molecular changes in primary myeloid sarcoma(MS).Methods:Fourteen patients with primary MS were selected in Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences,The First People's Hospital of Lianyungang from September 2010 to December 2021.AML1-ETO fusion,PML-RARα fusion and CBFβ breakage were detected by fluorescence in situ hybridization(FISH),and the mutations of NPM1,CEBPA,FLT3,RUNX1,ASXL1,KIT and TP53 genes were detected by new generation sequencing(NGS).Results:Among 14 patients,the MS occurred in bone,breast,epididymis,lung,chest wall,cervix,small intestine,ovary,lymph nodes and central nervous system.The tumor cells expressed MPO(13 cases),CD34(7 cases),CD43(8 cases),CD68(7 cases),CD99(8 cases)and CD117(6 cases).Cytogenetic abnormalities were observed in 4 cases,including 3 cases of AML1-ETO fusion and 1 case of CBF β breakage,while no PML-RAR α fusion was detected.There were no significant differences in overall survival(OS)and leukemia-free survival(LFS)between patients with and without AML1-ETO fusion/CBFβ breakage(both P＞0.05).Among the 14 patients,the number of NPM1,CEBPA,FLT3-ITD,RUNX1,ASXL1,KIT and TP53 gene mutations was 5,3,5,3,2,2,1.respectively,of which 7 cases had at least one mutation in FLT3-ITD,RUNX1,ASXL1 and TP53 gene.The OS and LFS of patients with FLT3-ITD,RUNX1,ASXL1 or TP53 mutation were shorter than those without mutations(both P＜0.01).Conclusion:The genetic and molecular abnormalities of primary MS can be detected by FISH and NGS techniques.FLT3-ITD,RUNX1,ASXL1 or TP53 mutation indicates a worse prognosis,but further clinical studies are needed to confirm it.

Objective:To analyze the clinical characteristics and prognosis of patients with CD5+diffuse large B-cell lymphoma(DLBCL).Methods:The clinical data of 161 newly treated DLBCL patients in Gansu Provincial Hospital from January 2013 to January 2020 were retrospectively analyzed.According to CD5 expression,the patients were divided into CD5+group and CD5-group.The clinical characteristics and prognosis of the two groups were statistically analyzed.Results:The median age of patients in CD5+group was 62 years,which was higher than 56 years in CD5-group(P=0.048).The proportion of women in CD5+group was 62.96％,which was significantly higher than 41.79％in CD5-group(P=0.043).The proportion of patients with IPI score＞2 in CD5+group was 62.96％,which was higher than 40.30％in CD5-group(P=0.031).Survival analysis showed that the median overall survival and progression-free survival time of patients in CD5+group were 27(3-77)and 31(3-76)months,respectively,which were both shorter than 30(5-84)and 32.5(4-83)months in CD5-group(P=0.047,P=0.026).Univariate analysis showed that advanced age,positive CD5 expression,triple or double hit at initial diagnosis,high IPI score and no use of rituximab during chemotherapy were risk factors for the prognosis of DLBCL patients.Further Cox multivariate regression analysis showed that these factors were also independent risk factors except for advanced age.Conclusion:CD5+DLBCL patients have a worse prognosis than CD5-DLBCL patients.Such patients are more common in females,with advanced age and high IPI score,which is a special subtype of DLBCL.

Objective To investigate the risk factors for bronchopulmonary dysplasia(BPD)in twin preterm infants with a gestational age of<34 weeks,and to provide a basis for early identification of BPD in twin preterm infants in clinical practice.Methods A retrospective analysis was performed for the twin preterm infants with a gestational age of<34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020.According to their conditions,they were divided into group A(both twins had BPD),group B(only one twin had BPD),and group C(neither twin had BPD).The risk factors for BPD in twin preterm infants were analyzed.Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins.Results A total of 904 pairs of twins with a gestational age of<34 weeks were included in this study.The multivariate logistic regression analysis showed that compared with group C,birth weight discordance of>25%between the twins was an independent risk factor for BPD in one of the twins(OR=3.370,95%CI:1.500-7.568,P<0.05),and high gestational age at birth was a protective factor against BPD(P<0.05).The conditional logistic regression analysis of group B showed that small-for-gestational-age(SGA)birth was an independent risk factor for BPD in individual twins(OR=5.017,95%CI:1.040-24.190,P<0.05).Conclusions The development of BPD in twin preterm infants is associated with gestational age,birth weight discordance between the twins,and SGA birth.

Molecular imprinting is a biomimetic technique that simulates the specific recognition of biological macromolecules such as antibody. Based on molecular imprinting and high-specificity affinity analysis,the biomimetic imprinting affinity analysis (BIA) possesses many advantages such as high sensitivity,strong tolerance,good specificity and low cost,and thus,it has shown excellent prospects in food safety detection,pharmaceutical analysis and environmental pollution monitoring. In this review,the construction methods of recognition interfaces for BIA were summarized,including bulk polymerization,electro-polymerization and surface molecular imprinting. The application of molecularly imprinted polymers in different analysis methods,such as radiolabeled affinity analysis,enzyme-labeled affinity analysis,fluorescence-labeled affinity analysis,chemiluminescence affinity analysis and electrochemical immunosensor was mainly discussed. Furthermore,the challenges and future development trends of BIA in practical application were elucidated. This review might provide new reference ideas and technical supports for the further development of BIA technique.

As artificial intelligence technology rapidly advances, its deployment within the medical sector presents substantial ethical challenges. Consequently, it becomes crucial to create a standardized, transparent, and secure framework for processing medical data. This includes setting the ethical boundaries for medical artificial intelligence and safeguarding both patient rights and data integrity. This consensus governs every facet of medical data handling through artificial intelligence, encompassing data gathering, processing, storage, transmission, utilization, and sharing. Its purpose is to ensure the management of medical data adheres to ethical standards and legal requirements, while safeguarding patient privacy and data security. Concurrently, the principles of compliance with the law, patient privacy respect, patient interest protection, and safety and reliability are underscored. Key issues such as informed consent, data usage, intellectual property protection, conflict of interest, and benefit sharing are examined in depth. The enactment of this expert consensus is intended to foster the profound integration and sustainable advancement of artificial intelligence within the medical domain, while simultaneously ensuring that artificial intelligence adheres strictly to the relevant ethical norms and legal frameworks during the processing of medical data.
Artificial Intelligence/legislation & jurisprudence* ; Humans ; Consensus ; Computer Security/standards* ; Confidentiality/ethics* ; Informed Consent/ethics*