Pyoderma gangrenosum(PG)is a rare autoinflammatory disease,characterized mainly by painful and necrotic skin ulcers.The etiology of PG is unknown,and its treatment is quite challenging.This article reports a case of recurrent pyoderma gangrenosum successfully treated with adalimumab combined with tofacitinib,along with a review of relevant literature.The patient,a 54-year-old male,presented with scrotal ulcers accompanied by pain for 20 days,worsening and involving the groin area for 5 days,and fever for 1 day.Dermatological examination revealed two painful ulcers on the scrotum with raised edges,clear boundaries,and a small amount of purulent discharge on the surface;the right groin area and the medial left thigh showed irregular infiltrative erythematous plaques,with scattered clustered pustules on them,central necrosis appearing purplish-brown,surrounded by a red halo with clear boundaries.Based on the patient's past medical history,clinical manifestations,and auxiliary examinations,the diagnosis was consistent with pyoderma gangrenosum.After treatment with adalimumab combined with tofacitinib,the patient's symptoms were significantly improved,and the ulcers healed.At the 6-month follow-up,the skin lesions had not recurred.For refractory PG that is ineffective to conventional treatments,adalimumab combined with tofacitinib is an effective and safe treatment option,providing a new combination therapy regimen for PG.

Objective:To investigate the characteristics of cell subsets in rheumatoid arthritis patients complicated with interstitial lung disease (RA-ILD).Methods:The clinical data of 344 patients with RA admitted to the Affiliated Hospital of Nantong University from June 2022 to November 2023 were analyzed. The patients were categorized into two groups based on the diagnostic criteria of ILD: 120 cases in the RA associated with ILD group (RA-ILD group) were included and 224 cases in the RA without ILD group (RA group), the clinical characteristics were compared between the RA-ILD group and the RA group. The influence factors of RA-ILD were analyzed by univariate and multivariate logistic regression.Results:Compared with RA patients, RA-ILD patients were more common in males, with older age, longer course of disease, and higher smoking rate ( P<0.05). The high titer anti-cyclic citrullinated peptide (CCP) antibody, white blood cells, neutrophil, neutrophil to lymphocyte count ratio, aspartate aminotr-ansferase(AST), creatinine (Cr) and lactate dehydrogenase (LDH) levels in RA-ILD patients were higher than those in RA patients. The triglyceride level was lower than that of RA patients ( P<0.05). The percentage of total T cells in peripheral blood lymphocyte subsets in RA-ILD patients [68.65%(62.22%, 76.78%)] was lower than that in RA patients [71.88%(65.83%, 78.39%)] ( Z=-2.26, P=0.024). The percentage of CD4 +T cells [40.2% (32.10%, 45.23%)] was lower than that of RA patients [46.5% (39.74%, 53.19%)] ( Z=-6.29, P<0.001). CD4 +T cell count [486.50 (324.25, 636.75)cells/μl] was lower than that of RA patients [564.50 (438.25, 752.00)cells/μl] ( Z=-4.50, P<0.001). CD4 +/CD8 + levels [1.86 (1.26, 2.18)] were lower than those of RA patients [2.03 (1.40, 2.94)] ( Z=-2.79, P=0.005). B cell count [127.00 (78.00, 207.25)cells/μl] was lower than that of RA patients [163.50 (91.25, 231.50)cells/μl] ( Z=-2.11, P=0.035), The percentage of NK cells in peripheral blood lymphocyte subsets in RA-ILD patients [19.72%(13.14%, 25.83%)] was higher than that in RA patients [12.55% (8.23%, 17.80%)] ( Z=6.13, P<0.001). NK cell count [182.50 (109.00, 293.75)cells/μl] was higher than that of RA patients [156.00 (89.00, 194.75)cells/μl] ( Z=3.17, P=0.002). The percentage of CD8 +T cells [25.10 %(18.74%, 29.86%)] was higher than that of RA patients [22.27% (17.32%, 29.21%)] ( Z=2.00, P=0.046). Imaging types of RA-ILD patients showed that usual interstitial pneumonia (UIP) was more common, followed by non-specific interstitial pneumonia (NSIP). CD8 + T cell count and percentage expression level in UIP were higher than NSIP, and CD4 +/CD8 + expression level was lower than NSIP ( P<0.05). Multivariate logistic regression analysis of indicators with statistical differences were male gender [ OR(95% CI)=2.888 (1.556, 5.360), P=0.001], age [ OR(95% CI)=1.065 (1.033, 1.098), P<0.001], disease duration [ OR(95% CI)=1.004 (1.001, 1.007), P=0.013], high titer anti-CCP antibody [ OR(95% CI)=2.764 (1.214, 6.292), P=0.015], LDH [ OR(95% CI)=1.006 (1.002, 1.009), P=0.001], CD4 +T cell percentage [ OR(95% CI)=0.964 (0.929, 1.000), P=0.049], CD4 +T cell count [ OR(95% CI)=0.998 (0.996, 1.000), P=0.011] and NK cell count [ OR(95% CI)=1.004 (1.001, 1.007), P=0.003]. These indicators were correlated factors for RA-ILD. Conclusion:Male patients with older age, history of smoking and a long disease course are more likely to develop ILD. Male gender with older, long disease course, high titer anti-CCP antibody, increased LDH and NK cell count, CD4 +T cell percentage and decreased CD4 +T cell count are correlation factors for RA-ILD, which may help RA patients to recognize ILD early.

Objective:To summarize the clinical characteristics and key points of diagnosis and treatment in children with TCF3::HLF fusion gene-positive acute lymphoblastic leukemia (ALL).Methods:A case series study was conducted. Clinical data of 8 children diagnosed with TCF3::HLF positive ALL at the Hematology Center of Beijing Children′s Hospital, Capital Medical University and the Hematology Oncology Department of Henan Children′s Hospital between January 2019 and January 2024 were collected. Descriptive analysis was performed on their clinical features, laboratory findings, treatment regimens and prognosis.Results:The cohort included 8 children (3 males and 5 females) with the age of 5.5 (3.5, 7.0) years. Bone pain was the primary clinical manifestation in 4 cases, with multi-site skeletal involvement in 4 cases, hypercalcemia in 5 cases, and coagulation abnormalities in 6 cases. Immunophenotyping revealed common B-cell lineage with myeloid markers in 7 cases and common B-cell phenotype in 1 case. All 8 children were positive for the TCF3::HLF fusion gene. Regarding treatment, 1 case abandoned therapy after diagnosis, while the remaining 7 cases received chemotherapy following the Chinese Children′s Leukemia Group-ALL2018 high-risk protocol. Only 1 case achieved minimal residual disease (MRD) negativity by day 33 of induction therapy. Among the 3 cases with MRD negativity before consolidation therapy, 1 case achieved it via conventional chemotherapy, while 2 cases required additional agents (venetoclax or blinatumomab). One case failed to achieve MRD negativity after consolidation therapy and later discontinued treatment (survival periods: 7months).Of the 4 cases who achieved MRD negativity after consolidation, 2 cases received conventional chemotherapy and 2 cases achieved negativity following chimeric antigen receptor T-cell therapy (CART). All 4 cases underwent hematopoietic stem cell transplantation (HSCT). Two cases in the CART combined with HSCT group survived as of the last follow-up (survival periods: 22 and 13 months). In the conventional chemotherapy combined HSCT group, 1 case relapsed and died (survival: 38 months), and 1 case died from transplant complications (survival: 11 months). The other 2 cases achieved MRD negativity before consolidation therapy but did not receive regular subsequent chemotherapy. After MRD recurrence, they underwent CART therapy without HSCT and remained alive at the last follow-up (survival periods: 49 and 12 months).Conclusions:Children with TCF3::HLF positive ALL often present with bone destruction accompanied by hypercalcemia and coagulopathy at initial diagnosis. This subtype of ALL shows poor response to conventional chemotherapy regimens, characterized by low early remission rates and high relapse risk even after HSCT. Better therapeutic outcomes have been observed with small molecule targeted drugs, immunotherapy and CART therapy.

Triglyceride(TG)is transported in the blood as specific triglyceride-rich lipoprotein(TRL).When TRL is overproduced or the catabolism is not timely,cholesterol ester-rich residues is formed.Both TRL and its residues contribute to the development of atherosclerosis(As)through various direct and indirect mechanisms.Currently,the combination of lifestyle interventions and Western medicines is considered the preferred treatment strategy for As.Howev-er,lipid-lowering therapy alone cannot fully eliminate the residual risk of As.In contrast,traditional Chinese medicine emphasizes the holistic regulation of bodily functions to prevent and treat As.This paper will begin by examining the met-abolic mechanisms of TRL,elucidate the role of TRL and its residues in the risk of As occurrence,and summarize current strategies targeting the TRL metabolic pathway to reduce the incidence of As.

OBJECTIVE: To evaluate the effect of palliative care on drug use, medical service utilization and medical expenditure of patients with advanced cancer. METHODS: A cohort of patients including pal-liative care and standard care was constructed using the medical records of the patients in Peking University Cancer Hospital from 2018 to 2020, and coarsened exact matching was used to match the two groups of patients. The average monthly opioid consumption, hospitalization rate, intensive care unit (ICU) rate and operation rate, and the average monthly total cost were selected to evaluate drug use, medical service utilization and medical expenditure. Chi-square test and Wilcoxon signed rank test were used to compare the differences between the two groups before and after exposure and the change in the palliative care group. The net impact of palliative care on the patients was calculated using the difference-in-differences analysis. RESULTS: In this study, 180 patients in the palliative care group and 3 101 patients in the stan-dard care group were finally included in the matching, and the matching effect of the two groups was good (L₁ < 0.1). Before and after exposure, the average monthly opioid consumption in the palliative care group was significantly higher than that in the standard care group (Before exposure: 0.3 DDD/person-month vs. 0.1 DDD/person-month, P < 0.01; After exposure: 0.7 DDD/person-month vs. 0.1 DDD/person-month, P < 0.01; DDD refers to defined daily dose), palliative care significantly increased the average monthly opioid consumption in the patients (0.3 DDD/person-month, P < 0.01). The hospitalization rate (48.9% vs. 74.3%, P < 0.01) and operation rate (3.9% vs. 8.8%, P < 0.01) of the patients in palliative care group were significantly lower than those in standard care group, and the ICU rate became similar between the two groups (1.1% vs. 1.6%, P=0.634). Palliative care significantly reduced the patients ' hospitalization rate (-25.6%, P < 0.01), ICU rate (-4.9%, P < 0.01) and operation rate (-14.5%, P < 0.01). Before and after exposure, the average monthly total costs of pal-liative care group were slightly higher than those of standard care group (Before exposure: 20 092.3 yuan vs. 19 132.8 yuan, P=0.725; After exposure: 9 719.8 yuan vs. 8 818.8 yuan, P=0.165). Palliative care increased the average monthly total cost by 2 208.8 yuan, but it was not statistically significant (P=0.316). CONCLUSION Palliative care can increase the opioid consumption in advanced cancer patients, reduce the rates of hospitalization, ICU and surgery, but has no significant effect on medical expenditure.
Humans ; Palliative Care/economics* ; Neoplasms/drug therapy* ; Analgesics, Opioid/economics* ; Male ; Female ; Middle Aged ; Aged ; Hospitalization/economics* ; Intensive Care Units/statistics & numerical data* ; Health Expenditures/statistics & numerical data* ; Adult ; Drug Utilization/statistics & numerical data* ; Patient Acceptance of Health Care/statistics & numerical data*

ObjectiveTo clarify the graded quantitative diagnostic characteristics of lung qi deficiency syndrome in chronic obstructive pulmonary disease （COPD） based on latent class analysis combined with a hidden structure model. MethodsClinical data， including the four diagnostic methods of traditional Chinese medicine （TCM）， were collected from 745 COPD patients with lung qi deficiency syndrome. Latent class modeling was performed using R 4.1.2 software， and each patient was classified into one of three severity categories （mild， moderate， or severe） based on probabilistic parameterization， parameter estimation， and model fitting. A database was established for different severity levels of lung qi deficiency syndrome. Based on this， Lantern 5.0 software was used to construct hidden structure models for mild， moderate， and severe lung qi deficiency syndrome， and syndrome differentiation rules were developed through comprehensive clustering. ResultsA latent class model was constructed using 28 symptoms and signs with a frequency greater than 10%. Considering TCM theory and model simplicity， the optimal model was determined when the number of latent classes was three， categorizing lung qi deficiency syndrome into mild （298 cases）， moderate （164 cases）， and severe （283 cases）. Hidden structure models were separately developed for each severity level， and syndrome differentiation rules were established. A comparison of common symptoms in the syndrome differentiation rules for mild and moderate lung qi deficiency syndrome showed no statistically significant differences in diagnostic values and weights （P＞0.05）， leading to their combined analysis and the development of a unified syndrome differentiation rule. Value and weight of quantitative diagnosis of mild-to-moderate lung qi deficiency syndrome were as followed： shortness of breath （diagnostic value 9.3， diagnostic weight 86.92%）， dyspnea on exertion （8.2， 76.64%）， low voice and reluctance to speak （6.7， 62.62%）， poor appetite （4.0， 37.38%）， loose stools （4.0， 37.38%）， weak cough sound （2.9， 27.10%）， wheezing （2.3， 21.50%）， fatigue （1.8， 16.82%）， spontaneous sweating （1.7， 15.89%）， susceptibility to colds （1.6， 14.95%）， swollen tongue （1.4， 13.08%）， teeth marks on the tongue edge （1.2， 11.21%）， deep pulse （1.6， 14.95%）， with a diagnostic threshold of 10.3. Value and weight of quantitative diagnosis of severe lung qi deficiency syndrome were as followed： weak cough sound （15.1， 61.13%）， soreness and weakness of the waist and knees （12.6， 51.01%）， shortness of breath （11.1， 44.94%）， low voice and reluctance to speak （8.3， 33.60%）， frequent nocturia （6.1， 24.70%）， spontaneous sweating （3.7， 14.98%）， susceptibility to colds （3.5， 14.17%）， teeth marks on the tongue edge （7.8， 31.58%）， pale tongue body （1.9， 7.69%）， white tongue coating （5.5， 22.27%）， thin pulse （1.5， 6.07%）， with a diagnostic threshold of 23.7. ConclusionThe combination of latent class analysis and a hideen structure model effectively clarified the graded quantitative diagnostic characteristics of lung qi deficiency syndrome， providing a reference for the quantitative diagnosis of other fundamental syndromes in TCM.

ObjectiveTo investigate the awareness and clinical practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. MethodsFrom July 19 to December 31， 2024， a self-designed electronic questionnaire was distributed via the WeChat mini program to collect related data from 1 588 clinicians nationwide， including their awareness and practice based on 18 questions regarding testing and referral， diagnosis and treatment， and follow-up. ResultsAmong all respondents， only 350 clinicians correctly understood all the updated key points of antiviral indications and treatment for special populations in the 2022 edition of guidelines for the prevention and treatment of chronic hepatitis B， with an overall awareness rate of 22.0%. Only 20% ‍—‍ ‍40% of the patients with positive HBV DNA and an age of >30 years receive antiviral therapy， while 80% ‍—‍ ‍100% of the patients with positive HBV DNA and a family history of hepatitis B cirrhosis or hepatocellular carcinoma receive antiviral therapy. The median follow-up rates at 1 year， 3 years， and 5 years were 67.5% 57.5% and 47.5%，respectively， showing a trend of gradual reduction， which might be associated with the influencing factors such as insufficient time for follow-up management by clinicians， insufficient awareness of the disease among patients， and poor adherence to follow-up. ConclusionThere is a gap between the awareness and practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. It is recommended to further strengthen training and focus on the whole process of “detection， diagnosis， treatment， and management” for patients with chronic hepatitis B in healthcare institutions， in order to promote the implementation of the guidelines.

Objective To provide methodological examples for related research,the influencing factors of the evolution of Qi deficiency syndrome in chronic obstructive pulmonary disease(COPD)based on a nonlinear mixed effects model was explored.Methods A research questionnaire on the influencing factors of the evolution of Qi deficiency syndrome in chronic obstructive pulmonary disease was developed,and clinical data of 650 COPD patients on the 1st and 14th day of acute exacerbation,the 1st and 28th day of risk window,the first day of stable period,and the 90th day were dynamically collected from 10 tertiary hospitals across the country.8 baseline data including gender and age were collected through the PROC NLMIXED process by SAS 9.4 software.Coronary heart disease,diabetes and hypertension accounted for the highest proportion.Nine concurrent syndromes including wind cold syndrome and phlegm heat syndrome were used as fixed effects,and individual level was used as random effects to gradually fit the model and screen the influencing factors of Qi deficiency syndrome in the entire process of disease occurrence and development.Results A total of 637 eligible cases were included,and clinical datas were dynamically collected on the 1st and 14th day of acute exacerbation,the 1st and 28th day of the risk window,the 1st and 90th day of the stable period.It was found that the number of acute exacerbations,alcohol consumption,concomitant hypertension,coronary heart disease,blood stasis syndrome,yin deficiency syndrome,yang deficiency syndrome,6-minute walking distance,and the modified Medical Research Council Dyspnea Questionnaire(mMRC)had an impact on the evolution of Qi deficiency syndrome in the previous year(P<0.05).Conclusion The use of a nonlinear mixed effects model revealed the relevant factors affecting the evolution of Qi deficiency syndrome from complex multi temporal dynamic data,providing methodological references for other related studies.

Objective To investigate the predictive value of PCSK9 gene rs562556 polymorphism for major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in patients with type 2 diabetes mellitus(T2DM)complicated by acute myocardial infarction(AMI).Methods A total of 97 patients were involved in this study with T2DM complicated by AMI,who underwent PCI at The Third Affiliated Hospital of Qiqihar Medical University between January 2019 and December 2021.Based on MACE occurrence during a 2-year follow-up period,patients were divided into non-MACE group and MACE group(n=57 and 40,respectively).Clinical biochemical parameters,including blood glucose and lipid levels,were recorded.Plasma PCSK9 levels were assessed using enzyme-linked immunosorbent assay.Plasma PCSK9 gene rs562556 polymorphism was detected through sequencing.Kaplan-Meier curve analysis was performed to assess how rs562556 polymorphism impacts MACE incidence post-PCI.Multivariate logistic regression was applied to identify independent MACE-associated risk factors.ROC curve analysis was performed to evaluate the predictive value of rs562556 poly-morphism and key clinical variables for MACE occurrence post-PCI.Results Compared to the non-MACE group,patients in the MACE group exhibited significantly higher age,heart rate,creatinine,NT-proBNP,LDL-C,and plasma PCSK9 levels,along with higher hyper-tension and coronary atherosclerotic heart disease prevalence,and lower diastolic blood pressure(all P＜0.05).In patients with T2DM and AMI,the rs562556 genotype AA of the PCSK9 gene positively correlated with plasma PSCK9 levels(r=0.61,P＜0.000 1).The frequen-cies of the rs562556 genotype AA and allele A were significantly higher in the MACE compared to the non-MACE group(P＜0.05).The AA genotype of the PCSK9 gene rs562556 was associated with an increased risk of MACE during follow-up in patients with T2DM and AMI(P＜0.05).After adjusting for other confounding variables,advanced age,increased NT-proBNP and PCSK9 levels,and the rs562556 AA genotype were identified as independent risk factors for MACE post-PCI in this patient population.Combined analysis of these factors demonstrated superior predictive value for MACE occurrence compared to individual markers.Conclusion The PCSK9 gene rs562556 genotype AA is associated with a significantly increased risk of MACE within two years post-PCI in patients with T2DM and AMI,sug-gesting that it could serve as a promising predictive biomarker for post-PCI MACE in the given population.

Objective:To investigate the impact of day 3 embryo quality on pregnancy outcomes in frozen-thawed single blastocyst transfer cycles and analyze its value in embryo selection.Methods:A retrospective cohort study was conducted on clinical data from patients undergoing frozen-thawed single blastocyst transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2020 to December 2023. A total of 4 691 cycles of high-quality day 3 embryo (H-D3) group and 2 598 cycles of low-quality day 3 embryo (L-D3) group in the same period were included. Multivariate logistic regression was used to analyze the effects of day 3 embryo quality on clinical pregnancy rate (CPR) and live birth rate (LBR). All the cycles were stratified according to developmental day and quality of blastocyst: 3 920 cycles of high-quality day 5 blastocysts (H-D5), 1 271 cycles of low-quality day 5 blastocysts (L-D5), 834 cycles of H-D6 group and 1 264 cycles of L-D6, the influence of day 3 embryo quality was subsequently analyzed under different conditions.Results:1) Significant differences were observed between H-D3 and L-D3 groups in female age [(31.79±4.42) years vs. (32.28±4.43) years, P<0.001], basal follicle-stimulating hormone levels [6.24 (5.32,7.35) U/L vs. 6.48 (5.42,7.62) U/L, P<0.001], proportion of primary infertility [35.86% (1 682/4 691) vs. 31.99% (831/2 598), P<0.001], proportion of ≥2 prior failed embryo transfer cycles [3.77% (177/4 691) vs. 5.93% (154/2 598), P<0.001], proportion of gonadotropin-releasing hormone agonist/antagonist controlled ovarian hyperstimulation protocol in fresh cycles [93.33% (4 378/4 691) vs. 89.80%(2 333/2 598), P<0.001], embryo cryopreservation duration [3.10 (2.23,7.27) months vs. 3.60 (2.30,15.40) months, P<0.001], proportion of day 5 blastocyst transfers [74.82% (3 510/4 691) vs. 64.70% (1 681/2 598), P<0.001] and proportion of high-quality blastocyst transfers [72.59% (3 405/4 691) vs. 51.92% (1 349/2 598), P<0.001]. No significant differences were found in body mass index, infertility duration, endometrial preparation program or endometrial thickness on transfer day (all P>0.05). 2) Multivariable logistic regression analysis demonstrated that the L-D3 group had significantly lower CPR ( OR=0.837, 95% CI: 0.754-0.929, P<0.001) and LBR ( OR=0.880, 95% CI: 0.794-0.974, P=0.014) compared with the H-D3 group. 3) In H-D5 and L-D5 cycles, L-D3 did not significantly affect CPR ( aOR=0.941, 95% CI: 0.805-1.101, P=0.449; aOR=0.910, 95% CI: 0.724-1.142, P=0.415) or LBR ( aOR=1.034, 95% CI: 0.893-1.196, P=0.657; aOR=0.917, 95% CI: 0.729-1.153, P=0.457). However, in D6-H and D6-L cycles, L-D3 significantly reduced CPR ( aOR=0.732, 95% CI: 0.542-0.987, P=0.041; aOR=0.648, 95% CI: 0.515-0.815, P<0.001) and LBR ( aOR=0.645, 95% CI: 0.479-0.869, P=0.004; aOR=0.670, 95% CI: 0.526-0.854, P=0.001). Conclusion:Day 3 embryo quality significantly impacts both CPR and LBR in frozen-thawed day 6 single blastocyst transfer cycles. This suggests that day 3 embryo quality retains clinical relevance as a selection criterion when prioritizing day 6 blastocysts for transfer.