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

BACKGROUND: Without timely and effective rehabilitation, hearing loss may profoundly affect human life quality. China has a large population of hearing-impaired individuals, which imposes a heavy health burden on society. Moreover, this population is projected to increase rapidly owing to China's aging society. METHODS: We used data from a population-representative epidemiological investigation of hearing loss and ear diseases in four Chinese provinces. We estimated the national prevalence using multiple linear regression of the age-group proportions and prevalence in 31 provinces with clustering analysis. We used years lived with disability (YLDs) to analyze the disease burden and forecasted the prevalence of hearing loss by 2060 in China. RESULTS: An estimated 115 million people had moderate-to-complete hearing loss in 2015 across the 31 provinces of China (8.4% of 1.37 billion people). Of these, 85.7% were older than age 50 years (99 million people) and 2.4% were younger than 20 years old (2.8 million people). Of all YLDs attributable to hearing loss, 68.9% were attributable to moderate-to-complete cases. By 2060, a projected 242 million people in China will have moderate-to-complete hearing loss, a 110.0% increase from 2015. CONCLUSIONS The hearing loss prevalence in China is high. Population aging and socioeconomic factors substantially affect the prevalence and severity of hearing loss and the disease burden. The prevalence and severity of hearing loss are unevenly distributed across different provinces. Future public health policies should take these trends and regional variations into account.
Humans ; China/epidemiology* ; Hearing Loss/epidemiology* ; Prevalence ; Middle Aged ; Male ; Female ; Adult ; Aged ; Adolescent ; Young Adult ; Child ; Child, Preschool ; Infant ; Aged, 80 and over ; Cost of Illness

Protrusive facial deformities, characterized by the forward displacement of the teeth and/or jaws beyond the normal range, affect a considerable portion of the population. The manifestations and morphological mechanisms of protrusive facial deformities are complex and diverse, requiring orthodontists to possess a high level of theoretical knowledge and practical experience in the relevant orthodontic field. To further optimize the correction of protrusive facial deformities, this consensus proposes that the morphological mechanisms and diagnosis of protrusive facial deformities should be analyzed and judged from multiple dimensions and factors to accurately formulate treatment plans. It emphasizes the use of orthodontic strategies, including jaw growth modification, tooth extraction or non-extraction for anterior teeth retraction, and maxillofacial vertical control. These strategies aim to reduce anterior teeth and lip protrusion, increase chin prominence, harmonize nasolabial and chin-lip relationships, and improve the facial profile of patients with protrusive facial deformities. For severe skeletal protrusive facial deformities, orthodontic-orthognathic combined treatment may be suggested. This consensus summarizes the theoretical knowledge and clinical experience of numerous renowned oral experts nationwide, offering reference strategies for the correction of protrusive facial deformities.
Humans ; Orthodontics, Corrective/methods* ; Consensus ; Malocclusion/therapy* ; Patient Care Planning ; Cephalometry

OBJECTIVE To establish HPLC fingerprint of Guzhecuoshang capsules, and its quality was evaluated by chemical pattern recognition. METHODS The HPLC-DAD method was used to establish the fingerprint of Guzhecuoshang capsules. The main chromatographic peaks were confirmed and assigned, and finally analyzed them through cluster analysis(CA), principal component analysis(PCA) and orthogonal partial least squares discriminant analysis(OPLS-DA) models. RESULTS The similarity of 75 batches of Guzhecuoshang capsules was covered from 0.685 to 0.986. A total of 26 common peaks were marked, and 6 components were identified respectively: hydroxysafflor yellow A(peak 1), ferulic acid(peak 6), aloeemodin(peak 15), emodin(peak 19), chrysophanol(peak 24) and physcion(peak 26). CA could be divided into five categories. The PCA and OPLS-DA screened out 13 main differentially contributing components, and it was indicated by the attribution of components that controlling the quality of safflower play an important role in ensuring the stability of the quality of Guzhecuoshang capsules. CONCLUSION The established HPLC fingerprint is relatively stable and reliable, which can basically reflect the characteristics of the chemical components in the compound, and can also provide a reference for the quality control and standard improvement of Guzhecuoshang capsules.

Objective:To establish a quantitative evaluation system for medical equipment procurement and to explore its application value in the allocation and management of hospital assets.Methods:Based on theoretical research and on-site evaluation,an evaluation index system was developed from four levels of clinical demand,technical level,procurement process and service capabilities.The quantitative evaluation of the procurement process was conducted by using covariance-analytic hierarchy process(Cov-AHP),and a"6-stage"optimization process of medical equipment procurement was developed.A total of 257 sets of medical equipment purchased by Beijing Shunyi Hospital from August 2019 to July 2023 were selected,and the expert demonstration model(126 units)and the quantitative evaluation model(131 units)were used for medical equipment asset allocation management.The standardization of the medical equipment procurement process,effectiveness of performance objectives and satisfaction of clinical services of medical equipment procurement under different management methods were compared.Results:The standardization degrees of the procurement process of the medical equipment in the quantitative evaluation model in terms of startup,demonstration,implementation,installation and use stages were(98.42±2.83)%,(98.97±2.45)%,(96.24±3.87)%,(96.42±2.54)% and(94.82±5.31)%,respectively,which were higher than those in the expert demonstration model,the difference was statistically significant(t=3.741,4.385,6.551,7.620,4.563,P<0.05).The achievement rates of quality index,progress index,social benefit index and cost-benefit index of medical equipment procurement in the quantitative evaluation model were(96.15±4.08)%,(96.41±2.37)%,(92.77±3.89)% and(93.06±4.33)%,respectively,which were higher than those in the expert demonstration model,the difference was statistically significant(t=4.156,4.562,5.014,4.069,P<0.05).The clinical satisfaction scores of medical equipment users of medical equipment in the quantitative evaluation model for large medical equipment,life support and first aid equipment,laboratory testing equipment,surgical treatment equipment and other medical equipment were(90.24±1.89)points,(93.45±2.64)points,(95.67±3.64)points and(93.82±2.55)points and(97.25±3.89)points,respectively,which were higher than those in the expert demonstration model,the difference was statistically significant(t=3.678,4.079,2.845,3.628,5.023,P<0.05).Conclusion:The quantitative evaluation system can standardize the procurement process of medical equipment,improve the achievement rate of the performance target of medical equipment procurement,and improve the clinical service level of medical equipment.

Objective:To describe the prevalence of food allergy among children aged 0-5 years in China and to explore related influencing factors.Methods:Multistage stratified random sampling method was used to collect data from 275 surveillance sites of the China National Nutrition and Health Survey of Chinese children and lactating mothers programs in 31 provinces (autonomous regions and municipalities) of China in 2016-2017. A total of 70 107 participants aged 0-5 years were included in this study. The study collected information of participants' demographic characteristics and food allergies by face-to-face questionnaire. The prevalence of food allergy was analyzed, using the complex data weighting method. The logistic regression models were used to analyze the influencing factors related to food allergy.Results:The overall prevalence of self-reported food allergy among children aged 0-5 years was 4.81%. Prevalence rates in infants aged 0-5 months, and 6-23 months and preschool children aged 2-5 years were 0.81%, 4.68% and 5.26%, respectively. The results of logistic analysis showed that there was a significantly positive correlation between factors including children from 6 months to 5 years old, urban area, southwest area, first-born, mothers with college education or above, and the prevalence of food allergy in children. Shrimp, poultry eggs, crab shellfish, fruit, milk and fish appeared the common allergic foods in children aged 0-5 years, with prevalence rates of self-reported food allergy as 1.55%, 1.25%, 0.99%, 0.97%, 0.87% and 0.86%, respectively. The proportion of single food allergy in children with allergies was 69.85%.Conclusions:Among children aged 0-5 years, the prevalence of self-reported food allergy increases with age, in China. Foods that is prone to allergies include fish, shrimp, crab, shellfish, poultry eggs, milk and fruits, etc. Most allergies were only caused by single food in children, under observation.

The survey on the hesitant status of rubella-containing vaccine (RCV) vaccination was conducted among 2 141 women of childbearing age in four provinces, Liaoning, Jiangsu, Zhejiang, and Anhui, from May 2017 to March 2018. Among the 2 141 study participants, a total of 38.21% (818) of women of childbearing age were aware of rubella and 21.25% (455) of women of childbearing age knew about RCV. Among the 455 women of childbearing age who were aware of RCV, 262 (57.58%) were willing to be vaccinated with RCV; 304 women of childbearing age (66.81%) tended to be vaccinated with RCV free of charge. Among the 193 women of childbearing age who did not want to be vaccinated or did not decide whether they preferred to be vaccinated with RCV, no one around them was vaccinated (89, 46.11%) and fear of vaccine safety (70, 36.27%) were the main reasons for hesitation to receive RCV.

Objective:To evaluate the optimization effects of serratus anterior plane block (SAPB) combined with general anesthesia for thoracoscopic surgical ablation of atrial fibrillation (TSAAF).Methods:Eighty American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients of either sex, aged >18 yr, with a body mass index of 18-30 kg/m 2, scheduled for elective TSAAF, were randomly assigned to either SAPB combined with general anesthesia group (SG group) or general anesthesia group (G group), with 40 cases in each group. SG group received ultrasound-guided bilateral SAPB with 0.375% ropivacaine 20 ml each before surgery, while G group did not receive block before operation. Both groups underwent general anesthesia. The time to the first analgesia pump use, the number of successfully delivered doses and requirement for rescue analgesia within 48 h after operation were recorded. Inspiratory spirometry was measured at preoperative day 1 (T 0), at the time of discharge from the recovery room (T 1), and at 24 and 48 h after operation (T 2, 3). The extubation time was also recorded. The usage of intraoperative remifentanil, norepinephrine and ephedrine, duration of recovery room stay, and occurrence of recurrent atrial fibrillation, delirium, respiratory depression, and nausea/vomiting within 48 h after operation, and length of postoperative hospital stay were recorded. Results:Compared to G group, the time to the first analgesia pump use was significantly prolonged, the number of successfully delivered doses was reduced within 48 h after operation, the rate of rescue analgesia was decreased, inspiratory spirometry was increased at T 1-3, the extubation time and length of postoperative hospital stay were shortened, and the recurrence rate of atrial fibrillation was decreased within 48 h after surgery in SG group ( P<0.05). No significant differences were found between the two groups regarding the intraoperative remifentanil consumption, usage rate of vasoactive drugs, and incidence of postoperative nausea/vomiting, delirium and respiratory depression ( P>0.05). Conclusions:Combination of SAPB and general anesthesia can effectively improve the postoperative analgesic effect and is helpful for the recovery in the patients undergoing TSAAF.

AIM To study the Chemical constituents from Rhinacanthus nasutus(L.)Kurz and their in vitro antitumor and lipid-lowering activities.METHODS The ethyl acetate fraction from R.nasutus was isolated and purified by normal phase,reverse phase silica gel column and semi-preparative HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The in vitro anti-tumor activity was determined by MTT assay,and the in vitro lipid-lowering activity was evaluated by oleic acid-induced HepG2 high-fat cell model.RESULTS Twenty compounds were isolated and identified as rhinacanthin A(1),rhinacanthin B(2),rhinacanthin C(3),rhinacanthin D(4),rhinacanthin E(5),rhinacanthin M(6),rhinacanthin N(7),rhinacanthin Q(8),rhinacanthin T(9),rhinacanthone(10),β-sitosterol(11),gallic acid(12),vanillic acid(13),syringic acid(14),lapachol(15),umbelliferone(16),sambucunlin A(17),17α,21-dihydroxy-1,4-pregnadiene-3,11,20-trione,21-acetate(18),1,8-dihydroxyanthraquinone(19),2,6-dimethoxy-1,4-benzoquinone(20).Compounds 3 and 7 inhibited the proliferation of HepG2,Hela,A549 and H22 tumor cells with IC50 values of(0.66±0.17)-(3.22±0.49)μmol/L in a time-and concentration-dependent manner.Compounds 3,7 and 9 had a lipid clearance rate of more than 50%in oleic acid-induced HepG2 high-fat cells.CONCLUSION Compounds 16-20 are isolated from this plant for the first time.Compounds 3 and 7 have good in vitro anti-tumor activities,and 3,7,9 have good in vitro lipid-lowering activities.