Recurrent spontaneous abortion （RSA） is a common gynecological disease during pregnancy， clinically characterized by repeated spontaneous abortions， yet its pathological mechanism remains incompletely understood. Traditional Chinese medicine attributes the pathogenesis of RSA to the deficiency of Chong Ren and the lack of fetal solidity. It has amassed experience in treating RSA， with Shoutaiwan being widely utilized for addressing miscarriage symptoms such as habitual abortion due to kidney deficiency， bleeding during pregnancy， and fetal movement. In recent years， there has been a gradual increase in experimental studies on the application of Shoutaiwan in treating RSA and on related experiments. These studies have demonstrated that Shoutaiwan preserves the fetus mainly by modulating hormone balance， alleviating immune inflammation， and enhancing blood coagulation equilibrium during pregnancy. Besides， through the modulation of key signaling pathways such as nuclear factor， erythroid 2 like 2 （Nrf2）/heme oxygenase-1 （HO-1） and Janus kinase 1 （JAK1）/signal transducer and activator of transcription （STAT）， as well as mitogen-activated protein kinase （MAPK）， Shoutaiwan has improved cellular antioxidant capacity， adjusted the phenotype of trophoblast and metaphase cells， and inhibited immune rejection， thus improving the pregnancy success rate. These findings not only elucidate the diverse biological foundations underlying Shoutaiwan's efficacy in treating RSA but also offer a scientific rationale for its clinical application and further mechanism research. Nonetheless， there remains a dearth of systematic reviews on RSA treatment with Shoutaiwan. Therefore， this review summarizes and synthesizes existing research findings to systematically analyze existing literature and studies， delving deeply into the principal pharmacological effects and associated signaling pathways of Shoutaiwan in regulating RSA. It aims to establish crucial reference points for its clinical application in RSA treatment and future experiments and research.

OBJECTIVES: Rheumatoid arthritis (RA) imposes a heavy burden on individuals, families, and society. This study analyzed the incidence and mortality trends of RA in China from 1990 to 2023 to provide epidemiological evidence for precise prevention and control. METHODS: Data on RA incidence, age-standardized incidence rate (ASIR), deaths, and age-standardized mortality rate (ASMR) in China by sex and age group from 1900 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression was used to analyze trends in ASIR and ASMR. An age-period-cohort model was constructed using R4.3.1 to evaluate longitudinal age trends and estimate relative risk (RR) values for period and cohort effects. RESULTS: In 2021, the number of RA cases, ASIR, deaths, and ASMR in China were 247 300, 13.70 per 100 000, 10 300, and 0.54 per 100 000, respectively. From 1990 to 2021, the ASIR of RA increased annually among both females and males, with average annual percentage changes (AAPCs) of 0.44% and 0.72%, respectively. Over the same period, ASMR declined in the total population and among females, with AAPCs of -0.78% and -1.19%, while the change in males was not statistically significant. Age-period-cohort analysis showed that the peak incidence occurred in women aged 60-64 years and men aged 75-79 years, and mortality increased with age. The period effect for incidence rose in both sexes, reaching 1.10 [95% confidence interval (CI) 0.94 to 1.27] for females and 1.14 (95% CI 1.02 to 1.27) for males during 2017 to 2021, compared with 2002 to 2006. The mortality period effect RR exhibited a downward-upward-downward pattern, decreasing to 0.56 (95% CI 0.52 to 0.61) in females and 0.75 (95% CI 0.68 to 0.82) in males in 2017 to 2021. Cohort analysis indicated that the highest incidence risk occurred in individuals born during 2012 to 2016, while the cohort effect RR for female RA mortality showed a continuous decline beginning with the 1922 to 1926 birth cohort. CONCLUSIONS The incidence and mortality risks of RA in China have continued to decline. However, with the aging of the population, the incidence and mortality risks among the elderly have increased. Middle-aged women and elderly men should receive focused attention. Health authorities should strengthen education, prevention, and screening among middle-aged women and enhance disease monitoring in elderly populations to reduce the national burden of RA.
Humans ; China/epidemiology* ; Arthritis, Rheumatoid/epidemiology* ; Incidence ; Male ; Female ; Middle Aged ; Adult ; Aged ; Cohort Studies ; Mortality/trends* ; Age Distribution ; Age Factors ; Aged, 80 and over ; Adolescent

Objective To explore the risk factors of upper limb lymphedema after breast cancer surgery and to construct and validate a risk prediction visualized model.Methods A retrospective analysis was performed on the clinical data of 528 breast cancer patients who underwent surgery.The patients were randomly divided into training set(352 cases)and validation set(176 cases).The train-ing set patients were divided into lymphedema group(67 cases)and non-lymphedema group(285 ca-ses)based on whether they had upper limb lymphedema.Logistic regression analysis was used to screen risk factors for upper limb lymphedema after breast cancer surgery.A risk prediction visualized model was constructed and validated using R software.Results The incidence of upper limb lymphedema after breast cancer surgery was 20.08％(106/528).Multivariate Logistic regression a-nalysis showed that high body mass index(BMI),hypertension,TNM stage Ⅲ a,bilateral lesions,level Ⅲ of axillary lymph node dissection,and postoperative radiotherapy and chemotherapy were inde-pendent risk factors for upper limb lymphedema after breast cancer surgery(P＜0.05).A risk predic-tion nomogram model was constructed based on above six independent risk factors.The calibration curve of the model in the training set and validation set both fitted the ideal curve well;the receiver operating characteristic curve analysis showed that the area under the curve of the nomogram model in the training set and validation set for predicting upper limb lymphedema after surgery was 0.950 and 0.886,respectively;the decision curve analysis showed that the overall net benefitof the model in predicting upper limb lymphedema after surgery in the training set and validation set was higher than that of all patients receiving full intervention or no intervention.Conclusion High BMI,hyperten-sion,stage Ⅲ a of TNM,bilateral lesions,level Ⅲ of axillary lymph node dissection,and postoper-ative radiotherapy and chemotherapy are independent risk factors for upper limb lymphedema after breast cancer surgery.The risk prediction nomogram model constructed based on these factors has good predictive performance.

Objective To explore the risk factors of upper limb lymphedema after breast cancer surgery and to construct and validate a risk prediction visualized model.Methods A retrospective analysis was performed on the clinical data of 528 breast cancer patients who underwent surgery.The patients were randomly divided into training set(352 cases)and validation set(176 cases).The train-ing set patients were divided into lymphedema group(67 cases)and non-lymphedema group(285 ca-ses)based on whether they had upper limb lymphedema.Logistic regression analysis was used to screen risk factors for upper limb lymphedema after breast cancer surgery.A risk prediction visualized model was constructed and validated using R software.Results The incidence of upper limb lymphedema after breast cancer surgery was 20.08％(106/528).Multivariate Logistic regression a-nalysis showed that high body mass index(BMI),hypertension,TNM stage Ⅲ a,bilateral lesions,level Ⅲ of axillary lymph node dissection,and postoperative radiotherapy and chemotherapy were inde-pendent risk factors for upper limb lymphedema after breast cancer surgery(P＜0.05).A risk predic-tion nomogram model was constructed based on above six independent risk factors.The calibration curve of the model in the training set and validation set both fitted the ideal curve well;the receiver operating characteristic curve analysis showed that the area under the curve of the nomogram model in the training set and validation set for predicting upper limb lymphedema after surgery was 0.950 and 0.886,respectively;the decision curve analysis showed that the overall net benefitof the model in predicting upper limb lymphedema after surgery in the training set and validation set was higher than that of all patients receiving full intervention or no intervention.Conclusion High BMI,hyperten-sion,stage Ⅲ a of TNM,bilateral lesions,level Ⅲ of axillary lymph node dissection,and postoper-ative radiotherapy and chemotherapy are independent risk factors for upper limb lymphedema after breast cancer surgery.The risk prediction nomogram model constructed based on these factors has good predictive performance.

Objective:To investigate the etiology of necrotizing pneumonia (NP) in children and the clinical characteristics of NP caused by different pathogens in China.Methods:A retrospective, case-control study was performed in children with NP who were admitted to 13 hospitals in China from January 2008 to December 2019. The demographic and clinical information, laboratory data, etiological and radiological findings were analyzed. The data were divided into three groups based on the following years: 2008-2011, 2012-2015 and 2016-2019, and the distribution characteristics of the pathogens in different period were compared. Meanwhile, the pathogens of pediatric NP in the southern and northern China were compared. And the clinical characteristics of the Mycoplasma pneumoniae (MP) NP and the bacterial NP were also compared. T-test or Mann-Whitney nonparametric test was used for comparison of numerical variables, and χ 2 test was used for categorical variables. Results:A total of 494 children with NP were enrolled, the median ages were 4.7 (0.1-15.3) years, including 272 boys and 222 girls. Among these patients, pathogens were identified in 347 cases and the pathogen was unclear in the remaining 147 cases. The main pathogens were MP (238 cases), Streptococcus pneumoniae (SP) (61 cases), Staphylococcus aureus (SA) (51 cases), Pseudomonas aeruginosa (13 cases), Haemophilus influenzae (10 cases), adenovirus (10 cases), and influenza virus A (7 cases), respectively. MP was the most common pathogen in all three periods and the proportion increased yearly. The proportion of MP in 2016-2019 was significantly higher than that in 2012-2015 (52.1% (197/378) vs. 36.8% (32/87), χ 2= 6.654, P=0.010), while there was no significant difference in the proportion of MP in 2012-2015 and that in 2008-2011 (36.8% (32/87) vs. 31.0% (9/29), χ2=0.314, P=0.575).Regarding the regional distribution, 342 cases were in the southern China and 152 in the northern China. Also, MP was the most common pathogen in both regions, but the proportion of MP was higher and the proportion of SP was lower in the north than those in the south (60.5% (92/152) vs. 42.7% (146/342), χ 2=13.409, P<0.010; 7.9% (12/152) vs. 14.3% (49/342), χ 2= 4.023, P=0.045). Comparing the clinical characteristics of different pathogens, we found that fever and cough were the common symptoms in both single MP and single bacterial groups, but chest pain was more common (17.0% (34/200) vs. 6.1% (6/98), χ 2=6.697, P=0.010) while shortness of breath and wheezing were less common in MP group (16.0% (32/200) vs. 60.2% (59/98), χ 2=60.688, P<0.01; 4.5% (9/200) vs. 21.4% (21/98), χ 2=20.819, P<0.01, respectively). The white blood cell count, C-reactive protein and procalcitonin in the bacterial group were significantly higher than those in the MP group (14.7 (1.0-67.1)×10 9/L vs. 10.5 (2.5-32.2)×10 9/L, 122.5 (0.5-277.3) mg/L vs. 51.4 (0.5-200.0) g/L, 2.13 (0.05-100.00) μg/L vs. 0.24 (0.01-18.85) μg/L, Z=-3.719, -5.901 and -7.765, all P<0.01). Conclusions:The prevalence of pediatric NP in China shows an increasing trend during the past years. MP, SP and SA are the main pathogens of NP, and the most common clinical symptoms are fever and cough. The WBC count, C-reactive protein and procalcitonin in bacterial NP are significantly higher than those caused by MP.

Objective To reduce the screening positive rate (SPR) and improve clinical efficiency of maternal serum screening for Down's syndrome.Methods Nine thousand and thirty-three cases of second trimester maternal serum screening for Down's syndrome were included from Apr.2013 to Apr.2014 in the present study.The screening results,all basic data and equation curves were analyzed retrospectively.Based on the data from the authors' laboratory,the important adjustment parameters were simulated.Combined with postnatal follow-up results,the quality and clinical performance of second trimester serum screening for Down's syndrome were evaluated.Results The SPR of second trimester serum screening for Down's syndrome was 6.69％(604/9033),the detection rate (DR) was 75％(3/4),and FPR was 6.65％(601/9033).The median multiple of median (MOM) of alpha-fetoprotein (AFP) was low and SPR was high,and MOM of free human chorionic gonadotropin β subunit (free hCGβ) were high and SPR was high,while MOM of unconjugated estriol (uE3) were a little bit low,and SPR was slightly high.Considering these three factors,it is believed that the screening positive rate is high.By the simulation adjustments of MOM value equations (AFP and free hCGβ) and weight correction equation,the SPR reduced to 4.11％(371/9033) after recalculating the risk,FPR declined to 4.07％(368/9033),and no more Down's syndrome fetus were missed compared with postnatal follow-up results.Conclusion Based on a localized setting depending on the local laboratory data,we suggest that the MOM value distributions(AFP,free hCGβ and uE3) and maternal weight should be regularly adjusted since it is a useful way to reduce the false-positive rate and improve clinical efficiency of maternal serum screening for Down's syndrome.

Objective To search for the methods of inducing the high stability rat middle cerebral artery occlusion (MCAO) model and to noninvasively assess the method of model effect. Methods Six kinds of filaments with different diameters were used to induce rat MCAO models and their success rate, incidence of subarachnoid hemorrhage, and infarct volume were compared. The model scores were performed to assess the model effect after the operation and at 24 hours after reperfusion. Results Higher model success rate and lower incidence of subarachnoid hemorrhage were achieved when the 0. 28 mm in diameter and 0.32-0.34 mm in tip diameter filaments were used. 1he sensibility and specificity were higher when the model scores were performed at 24 hours after reperfusion. Conclusions Using the filaments of 0.28 mm in diameter and 0. 32-0. 34 mm in tip diameter for intraluminal thread could improved the stability of the models. The model scores at 24 hours after reperfusion could noninvasively assess the model effect.

BACKGROUND: Previous studies have demonstrated that Yiqihuoxue recipe (Buyanghuanwu decoction) can inhibit cell apoptosis and antagonize free radical injury in cerebral ischemia/reperfusion models. However, there have been few reports regarding the effects of Yiqihuoxue recipe on stem cell differentiation. OBJECTIVE: To observe the effects of Yiqihuoxue recipe on the differentiation of rat bone marrow mesenchymal stem cells (MSCs) towards neurons. DESIGN, TIME AND SETTING: The present controlled observational expedment based on cells was performed at the Henan University of Traditional Chinese Medicine, i.e., the Third-Grade Laboratory of the State Administration of Traditional Chinese Medicine between March 2006 and February 2008.MATERIALS: Twenty clean Sprague-Dawley (SD) rats, aged 1-2 months, weighing 100-150 g, of either gender, were included in this study. The Chinese medicine compound Yiqihuoxue recipe was made in the Manufacturing Laboratory of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine as follows. 60 g Danggui (Radix Angelicae Sinensis), 30 g Taoren(Semen Persicae), 30 g Chuanxiong(Szechwan Lovage Rhizome) were selected and mixed in 720 mL water for extract volatile oil for later use. The remaining gruffs and extract were supplemented with 1 200 g Huangqi(Radix Astragali), 60 g Chishao (Radix Paeoniae Rubra), 30 g Dilong(Lumbricus), 30 g Honghua(Flos Carthami) before 920 mL water was added. After I hour of decoction and filtering, the gruffs were decocted for another 1 hour after adding 8 640 mL water. Then all decocted liquid was merged and condensed to 600 mL and mixed with 3 mL of volatile oil and tween-80. After high-temperature and high-pressure stedlization, the products were preserved for future use. 1 mL of drug was equal to 2.4 g raw herbs. METHODS: Bone marrow mononuclear cells were isolated by density gradient centrifugation. After culture, bone marrow MSCs were amplified and purified. Passage 10 cell suspension was inoculated into a 40 mm-diameter plastic culture dish. Dulbecco's modified eagle's medium supplemented with 0.1 volume fraction of fetal bovine serum and basic fibroblast growth factors was added for 24 hours of culture when adherent cells reached 60%-90% confluence in each group. Thereafter, the "Yiqihuoxue" group was incubated for 5 hours using medium containing DMSO, butylated hydroxyanisole, 13-mercaptoethanol, and Yiqihuoxue recipe; simultaneously, the control group was treated for 5 hours with fluid containing DMSO, butylated hydroxyanisole, and β- mercaptoethanol.MAIN OUTCOME MEASURES: Identification of bone marrow MSCs by flow cytometry; Detection of Nestin-, and neuron specific enolase(NSE)-, and glial fibrillary acidic protein(GFAP)-positive expression by immunohistochemistry. RESULTS: Flow cytometery results demonstrated that cell surface marker CD90 and CD106 expression was positive, while CD45 and CD34 expression was negative. Immunohistochemistry results showed that the numbers of Nestin-positive cells (1 and 3 hours after induction) and NSE- and GFAP-positive cells (5 hours after induction) were significantly greater in the Yiqihuoxue group than in the control group (P < 0.01). CONCLUSION: Yiqihuoxue recipe can induce the differentiation of bone marrow MSCs towards neurons in vitro.

OBJECTIVE To analyze and review the antibiotics utilization for the perioperative inpatients in our orthopedics department,and to evaluate the rationality of the utilization.METHODS Totally 267 cases of inpatients receiving operations from Sep to Nov,2008 were selected in our orthopedics department,then the methods of drug use review and drug frequency analysis were applied to analyze and review the effects of antibiotics utilization with retrospective statistics.RESULTS All of the 267 inpatients have taken antibiotics,of which the cephalosporins were the most frequently used.The antibiotics commonly used were cefminox,cefmetazole,and cefuroxime.The antibiotics of the highest daily defined dose(DDD) costs and total costs were cefamandole,flomoxef,etc.The average days of antibiotics utilization for clean operations,clean-contaminated operations,and contaminated operations were 7 days,8 days,and 9 days,respectively and 86% of the patients were antibiotic combination usage.CONCLUSIONS There is inappropriateness in the antibiotics utilization during perioperations of orthopedics.Guidelines of drug use must be followed to improve the drug usage.