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

Evading host immunity killing is a critical step for virus survival. Inhibiting viral immune escape is crucial for the treatment of viral diseases. Serine/threonine kinase 39 (STK39) was reported to play an essential role in ion homeostasis. However, its potential role and mechanism in viral infection remain unknown. In this study, we found that viral infection promoted STK39 expression. Consequently, overexpressed STK39 inhibited the phosphorylation of interferon regulatory factor 3 (IRF3) and the production of type I interferon, which led to viral replication and immune escape. Genetic ablation or pharmacological inhibition of STK39 significantly protected mice from viral infection. Mechanistically, mass spectrometry and immunoprecipitation assays identified that STK39 interacted with PPP2R1A (a scaffold subunit of protein phosphatase 2A (PP2A)) in a kinase activity-dependent manner. This interaction inhibited DDB1 and CUL4 associated factor 1 (DCAF1)-mediated PPP2R1A degradation, maintained the stabilization and phosphatase activity of PP2A, which, in turn, suppressed the phosphorylation of IRF3, decreased the production of type I interferon, and then strengthened viral replication. Thus, our study provides a novel theoretical basis for viral immune escape, and STK39 may be a potential therapeutic target for viral infectious diseases.

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

BACKGROUND:The proliferation and phenotypic maintenance of chondrocytes are limited under two-dimensional culture conditions.Porous microspheres serve as scaffolds,providing a three-dimensional culture environment that better mimics in vivo growth conditions.Stromal cell derived factor-1,a homeostatic cytokine with potent chemotactic effects,facilitates cell adhesion and proliferation.OBJECTIVE:To investigate the impact of stromal cell derived factor-1 grafted poly-L-lactic acid porous microspheres on the biological characteristics of chondrocytes and the formation of cartilage tissue.METHODS:(1)The effects of different concentrations of stromal cell derived factor-1 on rabbit chondrocyte proliferation,migration,and phenotypic maintenance were investigated in an in vitro setting.(2)Poly-L-lactic acid porous microspheres were prepared by double emulsion method.Stromal cell derived factor-1 was grafted onto poly-L-lactic acid porous microspheres through carbodiimide reaction.The grafting was verified by enzyme-linked immunosorbent assay and incubation with stromal cell derived factor-1-specific fluorescent antibodies.(3)Rabbit chondrocytes were inoculated on poly-L-lactic acid porous microspheres and grafted on stromal cell derived factor-1 poly-L-lactic acid porous microspheres to detect cell proliferation and adhesion.(4)The methylacrylamide-gelatin-chondrocyte complex(control group),poly-L-lactic acid porous microsphere-methylacrylamide-gelatin-chondrocyte complex(porous microsphere group),and grafted stromal cell derived factor-1 poly-L-lactic acid porous microsphere-methylacrylamide-gelatin-chondrocyte complex(porous microsphere modified group)were implanted under the skin of the back of nude mice,respectively.Samples were collected 8 weeks later and detected using histological staining and qRT-PCR for chondroblast related genes.RESULTS AND CONCLUSION:(1)Compared with 0 and 1 000 ng/mL stromal cell derived factor-1,1 and 500 ng/mL stromal cell derived factor 1 could promote the proliferation and migration of chondrocytes,and enhance the mRNA expression levels of type Ⅱ collagen,elastin,proliferating cell nuclear antigen,and Bcl-2 in chondrocytes.(2)Stromal cell derived factor-1 was successfully grafted onto poly-L-lactic acid porous microspheres with a grafting rate of 93.75%.(3)Compared with poly-L-lactic acid porous microspheres,grafted stromal cell derived factor-1 poly-L-lactic acid porous microspheres promoted the proliferation and adhesion of chondrocytes.(4)After 8 weeks of subcutaneous implantation in nude mice,compared with the control group and the porous microsphere group,the porous microsphere modified group had clearer cartilage lacunae structure,more chondro-specific matrix and type Ⅱ collagen deposition,and increased expression of elastin,type Ⅱ collagen,proliferating cell nuclear antigen,and Bcl-2 mRNA.These findings indicate that stromal cell derived factor-1 grafted poly-L-lactic acid porous microspheres are beneficial to chondrocyte adhesion,proliferation,phenotypic maintenance,and the formation of cartilage tissue in vivo.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

OBJECTIVE: We aimed to investigate the patterns of fasting blood glucose (FBG) trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers. METHODS: The study cohort included 3,728 workers who met the selection criteria for the Tanggang Occupational Cohort (TGOC) between 2017 and 2022. A group-based trajectory model was used to identify the FBG trajectories. Environmental risk scores (ERS) were constructed using regression coefficients from the occupational hazard model as weights. Univariate and multivariate logistic regression analyses were performed to explore the effects of occupational hazard factors using the ERS on FBG trajectories. RESULTS: FBG trajectories were categorized into three groups. An association was observed between high temperature, noise exposure, and FBG trajectory ( P < 0.05). Using the first quartile group of ERS1 as a reference, the fourth quartile group of ERS1 had an increased risk of medium and high FBG by 1.90 and 2.21 times, respectively (odds ratio [ OR] = 1.90, 95% confidence interval [ CI]: 1.17-3.10; OR = 2.21, 95% CI: 1.09-4.45). CONCLUSION An association was observed between occupational hazards based on ERS and FBG trajectories. The risk of FBG trajectory levels increase with an increase in ERS.
Humans ; Male ; Adult ; Blood Glucose/analysis* ; China ; Prospective Studies ; Occupational Exposure/adverse effects* ; Risk Factors ; Middle Aged ; Steel ; Fasting/blood* ; Metal Workers ; East Asian People

Adverse pregnancy outcome (APO) refers to any pregnancy outcome other than a normal live birth, mainly including preeclampsia, fetal growth restriction, recurrent pregnancy loss, etc., which seriously threaten the health of both the mother and the fetus. Most APOs originate from abnormal uterine endometrial microenvironment before pregnancy. Once a woman confirms pregnancy, intervening in the uterine endometrium at this stage is often too late. The uterine endometrium, as a key site for embryo implantation and development, its abnormal microenvironment can lead to APO. Therefore, in-depth exploration of the relationship between the pre-pregnancy uterine endometrial microenvironment and APO is helpful for clarifying the mechanism of APO occurrence and providing key ideas and methods for early prevention and treatment. This article reviews the latest research on the mechanism of action between uterine endometrial microenvironment and APO, systematically summarizing the research progress and main conclusions in this field from several aspects such as immune imbalance, inflammatory response, abnormal energy metabolism, and senescence of uterine endometrial stromal cells.

Adverse pregnancy outcome (APO) refers to any pregnancy outcome other than a normal live birth, mainly including preeclampsia, fetal growth restriction, recurrent pregnancy loss, etc., which seriously threaten the health of both the mother and the fetus. Most APOs originate from abnormal uterine endometrial microenvironment before pregnancy. Once a woman confirms pregnancy, intervening in the uterine endometrium at this stage is often too late. The uterine endometrium, as a key site for embryo implantation and development, its abnormal microenvironment can lead to APO. Therefore, in-depth exploration of the relationship between the pre-pregnancy uterine endometrial microenvironment and APO is helpful for clarifying the mechanism of APO occurrence and providing key ideas and methods for early prevention and treatment. This article reviews the latest research on the mechanism of action between uterine endometrial microenvironment and APO, systematically summarizing the research progress and main conclusions in this field from several aspects such as immune imbalance, inflammatory response, abnormal energy metabolism, and senescence of uterine endometrial stromal cells.

Objective:To Investigate the impact of blood glucose fluctuations within 24 hours of admission on the short-term (3-month) prognosis of patients with acute pancreatitis.Methods:A total of 416 patients with acute pancreatitis admitted to the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University from November 2022 to October 2023 were enrolled as the research subjects. According to whether re-admission occurred within 3 months after discharge, they were divided into good prognosis group ( n=352) and poor prognosis group ( n=64). General data, laboratory indicators, and blood glucose values within 24 hours of admission [including initial blood glucose, 24-hour average blood glucose, maximum blood glucose, minimum blood glucose, standard deviation of blood glucose (SDBG), and largest amplitude of glycemic excursion (LAGE)] were compared between the two groups. Logistic regression analysis was used to identify risk factors affecting the prognosis of patients with acute pancreatitis. Receiver operating characteristic curves (ROC) were plotted and the area under the curve (AUC), sensitivity, and specificity were calculated, so as to evaluate the predictive efficacy of each indicator for the prognosis of patients with acute pancreatitis. Results:Compared with the good prognosis group, the poor prognosis group showed significantly higher levels of initial blood glucose [12.80(7.13, 17.75) mmol/L vs 8.90(6.80, 11.60) mmol/L], maximum blood glucose [16.15(13.45, 21.10) mmol/L vs 11.2(9.10, 14.40) mmol/L], SDBG [4.19(2.47, 5.03) mmol/L vs 1.79(1.15, 2.81) mmol/L], and LAGE [5.15(3.58,7.65) mmol/L vs 4.05(2.40, 5.70) mmol/L], as well as a significantly longer length of hospital stay [10.5(6, 26.75) days vs 9(6, 15) days], with all differences being statistically significant (all P value <0.05). Multivariate logistic regression analysis showed that initial blood glucose ( OR=1.201, 95% CI 1.099-1.313), SDBG ( OR=1.681, 95% CI 1.306-2.164), LAGE ( OR=1.848, 95% CI 1.524-2.240), and length of hospital stay ( OR=1.136, 95% CI 1.082-1.193) were influencing factors for the prognosis of patients with acute pancreatitis. ROC analysis showed that the AUC values for initial blood glucose, SDBG, LAGE, and length of hospital stay were 0.741(0.676-0.806), 0.794 (0.728-0.860), 0.836(95% CI 0.793-0.879), and 0.847(95% CI 0.807-0.887), respectively, with sensitivities of 80.1%, 91.8%, 60.8%, and 64.8%, and specificities of 56.3%, 56.3%, 93.8%, and 93.8%. Conclusions:Blood glucose fluctuations within 24 hours of admission are risk factors for poor prognosis in patients with acute pancreatitis.