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 investigate the values of nucleoprotein transformation in sperm for predicting recurrent abortion.Methods A total of 521 infertile couples with complete test indicators on fertility were selected from the reproductive medical clinic of our hospital from 2019 to 2022,among which the ages of the male were from 23 to 56 years old.The following factors causing recurrent abortion were excluded,including the age of woman,body mass index,metabolic disease,antiphospholipid syndrome,uterine and accessory abnormalities,history of caesarean section and intrauterine myoma/cervical conectomy,peripheral blood chromosome abnormalities of both the couple,and adverse life history,such as smoking/alcohol abuse.According to the abortion situation,they were divided into the recurrent abortion group(&ge;two spontaneous abortions),one spontaneous abortion group and no abortion group.Tukey's multiple comparison was performed to compare the differences of nucleoprotein transformation of sperm in each group by using GraphPad6.0 sta-tistical software.The Pearson method was used to analyze the correlation between nucleoprotein transformation and recurrent abortion.The predictive values of nucleoprotein transformation in recurrent abortion were analyzed by the parameters of sensitivity,specificity,positive predictive value,negative predictive value,Youden index and odd ratio.Results The percentages of abnormal nucleoprotein transformation in recurrent abortion group[(33.31±13.83)％]were significantly higher than those in non-abortion group[(26.85± 15.38)％]and the one abortion group[(28.20±12.50)％,P＜0.05].Pearson correlation analysis showed that there was a significant positive correlation between abnormal nucleoprotein transformation and recurrent abortion.The sensitivity and specificity of nucleoprote-in transformation for predicting recurrent abortion were 45.24％and 73.64％,respectively.All of the data of positive predictive value(15.70％),negative predictive value(92.53％),Youden index(18.88％)and odd ratio(2.31)of nucleoprotein transformation in predicting recurrent abortion were higher than those of high DNA stainability(10.64％,90.31％,1.05％and 1.11).Conclusion In the spouses of patients with recurrent abortion,the immaturity of sperm nuclear protein is significantly increased and significantly posi-tively correlated with recurrent abortion.The abnormal nucleoprotein transformation of sperm may be the important factor of recurrent a-bortion in males,and it has high predictive value for recurrent spontaneous abortion in clinical practice.

OBJECTIVE: To investigate the regulatory role of the long non-coding RNA LINC00926 in pyroptosis of hypoxia-induced human umbilical vein vascular endothelial cells (HUVECs) and explore the molecular mechanism. METHODS: HUVECs were transfected with a LINC00926-overexpressing plasmid (OE-LINC00926), a siRNA targeting ELAVL1, or both, followed by exposure to hypoxia (5% O2) or normoxia. The expression of LINC00926 and ELAVL1 in hypoxia-treated HUVECs was detected using real-time quantitative PCR (RT-qPCR) and Western blotting. Cell proliferation was detected using Cell Counting Kit-8 (CCK-8), and the levels of IL-1β in the cell cultures was determined with ELISA. The protein expression levels of pyroptosis-related proteins (caspase-1, cleaved caspase-1 and NLRP3) in the treated cells were analyzed using Western blotting, and the binding between LINC00926 and ELAVL1 was verified with RNA immunoprecipitation (RIP) assay. RESULTS: Exposure to hypoxia obviously up-regulated the mRNA expression of LINC00926 and the protein expression of ELAVL1 in HUVECs, but did not affect the mRNA expression of ELAVL1. LINC00926 overexpression in the cells significantly inhibited cell proliferation, increased IL-1β level and enhanced the expressions of pyroptosis-related proteins (all P < 0.05). LINC00926 overexpression further up-regulated the protein expression of ELAVL1 in hypoxia-exposed HUVECs. The results of RIP assay confirmed the binding between LINC00926 and ELAVL1. ELAVL1 knockdown significantly decreased IL-1β level and the expressions of pyroptosis-related proteins in hypoxia-exposed HUVECs (P < 0.05), while LINC00926 overexpression partially reversed the effects of ELAVL1 knockdown. CONCLUSION LINC00926 promotes pyroptosis of hypoxia-induced HUVECs by recruiting ELAVL1.
Humans ; Caspase 1 ; ELAV-Like Protein 1 ; Human Umbilical Vein Endothelial Cells ; Pyroptosis ; RNA, Messenger ; RNA, Long Noncoding/genetics* ; Cell Hypoxia

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; &ge;80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.

Objective To investigate the trend and risk factors of leukemia disease burden in Chinese population from 1990 to 2019, and to provide new ideas for leukemia prevention. Methods The Global Burden of Disease (GBD) study data in 2019 were used for regression analysis through Joinpoint Regression Program. The leukemia incidence, mortality, disability adjusted life year (DALY), years of life lost (YLL), years lived with disability (YLD) and their corresponding age standardized rates were calculated and compared with global level and all Socio–Demographic Index (SDI) countries. Average annual percentage of change (AAPC) was calculated to reflect the trend of disease burden. The changes in disease burden attributable to each risk factor were calculated. Results From 1990 to 2019, the incidence of leukemia in China decreased from 12.06/100 000 to 10.87/100 000, the mortality decreased from 5.65/100 000 to 4.25/100 000 , and the DALY rate decreased from 328.95/100 000 to 162.36/100 000. The standardized incidence, standardized mortality and standardized DALY rates all decreased year by year, with AAPC being 0.6%, 1.8%, and 2.4%, respectively. In 2019, the disease burden of leukemia in China was higher than the global average, and the standardized DALY rate and standardized YLL rate were the highest among all SDI countries. Adolescents and children had the greatest decline in the disease burden index. Smoking was the main risk factor among the four risk factors collected, and the increase of body mass index (BMI) was also one of the important risk factors. Conclusion From 1990 to 2019, the disease burden of leukemia in China generally showed a downward trend. Smoking is the main risk factor of leukemia. At present, the disease burden of leukemia in China is still at a high level, and intervention should be strengthened for key populations.

Objective To investigate the effect of HQ on autophagy in human leukemia Jurkat T-cells and its mechanism. Methods (1) Exponentially growing Jurkat cells were cultured in vitro with HQ at the concentrations of 0 (control group), 12.5 and 25 mol·L^-1 for 24 hours. Western blotting was used to detect the protein levels of autophagy markers P62 and LC3II. Aggregations of LC3 fluorescent spots were determined by immunofluorescence technique. (2) Using the gene expression database, differentially expressed microRNAs (miRNAs) in CD34+ cells treated with HQ were selected to predict target genes through gene prediction tools such as TargetScan, miRBD and miRwalk. Enrichment analysis was conducted on these target genes to obtain relevant signal pathways. (3) Based on the results above, RT-PCR was used to examine the expression of Akt and Foxo3a genes in Akt/Foxo3a signal pathway, while western blotting was performed to determine protein expression levels of Akt, p-Akt, Foxo3a and p-Foxo3a in Jurkat cells exposed to HQ. Results (1) Compared with the control group, the expression of autophagy key protein P62 decreased in 25mol·L^-1 group, and the ratio of LC3II/LC3I increased in 12.5mol·L^-1 and 25mol·L^-1 groups (P<0.05). The results of immunofluorescence showed that the aggregation of LC3 fluorescent spots increased with the increase of HQ concentration. (2) Bioinformatic analysis revealed several autophagy-related signaling pathways including AMPK, MAPK, Hedgehog and PI3K/Akt signal pathways. (3) HQ treatment decreased gene expression levels of Akt and Foxo3a in Akt/Foxo3a signal pathway, and the protein levels of Akt, p-Akt, Foxo3a and p-Foxo3a were also significantly decreased in cells treated with HQ in a concentration dependent manner (P<0.05). Conclusion HQ may promote autophagy in Jurkat cells, which may be partly mediated through the inhibition of Akt/Foxo3a signal pathway..

Cervical cancer is a common malignant tumor in gynecology, and its morbidity and mortality rates rank the fourth among female malignant tumors. Lymph node metastasis is the most important pattern of metastasis and a critical independent prognostic factor for cervical cancer. Considering the high missed diagnosis rate of para-aortic lymph node metastasis, and the high treatment failure rate caused by para-aortic lymph node metastasis after cervical cancer treatment, a small number of clinicians have applied preventive extended-field radiotherapy in the treatment of patients with Ⅲ B and Ⅲ c1 cervical cancer in recent years. This article reviews the prognosis and side effects of preventive extended-field radiotherapy in patients with stage Ⅲ B and Ⅲ c1 cervical cancer.

Tissue engineering, as a new technology, provides a new avenue for the reconstruction of circumferential tracheal defects, which has always been a tremendous challenge for surgeons around the world. Recently, technologies such as decellularization, 3-dimensional printing, electrospinning and cell sheet have significantly enhanced the chondrification. Implantation of epithelial cells or transplantation of epithelial cell sheets also has accelerated the process of epithelialization. And pedicle muscle flap proved to be a reliable strategy for vascularization of tissue-engineered trachea. But it is still a huge challenge to achieve circumferential tracheal functional reconstruction. The key difficulty lies in how to simultaneously realize the functional regeneration of cartilage, blood vessels and epithelial tissues of tissue-engineered trachea. Therefore, how to integrate the above schemes and finally realize segmental tracheal reconstruction needs further research. This article reviews the research progress of repairing circumferential tracheal defects based on tissue engineering technology.
Printing, Three-Dimensional ; Reconstructive Surgical Procedures ; Tissue Engineering ; Tissue Scaffolds ; Trachea/surgery*

Objective To investigate the prevalence and changing trend of Enterobius vermicularis infections among children in Shandong Province, so as to provide the scientific evidence for the adjustment and development of the enterobiasis control strategy. Methods Soil-borne nematodiasis surveillance sites were assigned in 51 counties (districts, cities) in Shandong Province from 2016 to 2020, and the E. vermicularis infections were detected using a modified Kato-Katz technique and the cellophane tape method among children at ages of 3 to 9 years living in these surveillance sites. The epidemiological profiles of E. vermicularis-infected children were descriptively analyzed. Results A total of 5 060 children at ages of 3 to 9 years were detected in 51 soil-borne nematodiasis surveillance sites in Shandong Province from 2016 to 2020, and the overall prevalence of E. vermicularis infections was 2.23%. The annual prevalence of E. vermicularis infections was 3.99% (26/651), 1.70% (14/824), 0.96% (8/837), 2.90% (45/1 552) and 1.67% (20/1 196) from 2016 to 2020, respectively, with a significant difference detected among years ( χ² = 21.455, P < 0.01). The prevalence of E. vermicularis infections was 1.25% (15/1 198), 1.85% (14/755), 3.18% (84/2 640) and 0 (0/467) among children from central, eastern, southern and northern Shandong Province (χ² = 27.326, P < 0.01). In addition, there was no significant difference in the prevalence of E. vermicularis infections between male (1.98%, 56/2 831) and female children (2.56%, 57/2 229) (χ² = 1.916, P > 0.05); however, there was age-specific prevalence of E. vermicularis infections among children (χ² = 16.448, P < 0.05), with the greatest prevalence detected among children at ages of 6 years (3.18%, 25/786), and the lowest prevalence seen among children at ages of 3 years (0.75%, 6/800). Conclusions The prevalence of E. vermicularis infections remained at a medium level among children at ages of 3 to 9 years in Shandong Province from 2016 to 2020, with region-specific prevalence found across the province. An integrated strategy is required for enterobiasis control.