OBJECTIVE To compare the antihypertensive efficacy of sacubitril/valsartan versus benazepril in patients with perimenopausal hypertension， as well as their impacts on ventricular remodeling and inflammatory fibrosis. METHODS A total of 206 perimenopausal hypertensive patients in our hospital from January 1， 2023 to December 30， 2024 were retrospectively included.These patients were enrolled and divided into benazepril group （105 cases） and sacubitril/valsartan group （101 cases）. Benazepril group received Benazepril hydrochloride tablet， and sacubitril/valsartan group received Sacubitril valsartan sodium tablet. All patients were treated for 6 months. The blood pressure（systolic blood pressure and diastolic blood pressure） and blood pressure control status before and after treatment， echocardiographic indicators （left ventricular ejection fraction， left ventricular mass index， relative wall thickness， and early-diastolic peak transmitral flow velocity/early-diastolic peak velocity of the mitral annulus）， inflammatory fibrosis related indicators（high-sensitivity C-reactive protein，ratio of monocytes to lymphocytes，and ratio of neutrophils to lymphocytes）， as well as the occurrence of adverse reactions（hypotension，hyperkalemia，and angioedema） were observed in both groups before and after treatment. RESULTS The blood pressure control rate was significantly higher in the sacubitril/valsartan group than in benazepril group （ P ＜0.05）. After treatment， the blood pressure， echocardiographic indicators（except for left ventricular ejection fraction） ，and inflammatory fibrosis related indicators were significantly lower than those before treatment within the same group， and the sacubitril/valsartan group were significantly lower than the benazepril group （ P ＜0.05）. There were no statistically significant differences in the incidence of hypotension， hyperkalemia， angioedema， and overall adverse drug reactions between the two groups （ P ＞0.05）. CONCLUSIONS Compared with benazepril， sacubitril/valsartan provides superior blood-pressure control， reverses ventricular remodeling， attenuates inflammatory fibrosis in perimenopausal hypertensive patients， while maintaining a similar safety profile.

Objective: To explore the relationship between socio ecological risk factors (SERF), physical activity (PA) developmental trajectories, and depressive symptoms among junior and senior high school students in Tianjin, in order to provide theoretical support for comprehensive interventions for adolescent depression. Methods: A longitudinal follow up design was adopted. In September 2022, a baseline survey was conducted using a stratified cluster random sampling method in two junior high schools and two senior high schools in Tianjin, collecting data on students basic information, SERF, PA, and depressive symptoms. Two follow up surveys were conducted in September 2023 and 2024, yielding 588 valid participants. Latent class growth analysis (LCGA) was used to identify PA developmental trajectory categories among junior and senior high school students. Logistic regression was applied to examine the associations between depressive symptoms and SERF as well as PA trajectories. Results: The detection rates of depressive symptoms among Tianjin junior and senior high school students over the three years were 26.53%, 20.24%, and 21.26 %, respectively. Depressive symptoms were positively correlated with SERF ( OR=1.04, 95%CI=1.03-1.05, P <0.05). The highest risks were observed in the individual dimension and family dimension ( OR =1.28, 1.21, both P <0.05). LCGA identified three PA trajectory groups:persistently low level (80.65%), persistently high level (4.58%), and slowly increasing group ( 14.77 %). Multivariate regression analysis showed that compared with the persistently low level PA, the slowly increasing PA significantly reduced the risk of depressive symptoms ( OR=0.44, 95%CI =0.20-0.88), while SERF still increased the risk of depressive symptoms ( OR=1.04, 95%CI =1.03-1.05) (both P <0.05). Conclusion SERF are risk factors for depression symptoms among junior and senior high school students, whereas slowly increasing PA development trajectory demonstrates a protective effect.

ObjectiveTo analyze the reported incidence rate of pulmonary tuberculosis and diagnosis and treatment of pulmonary tuberculosis patients in Jing’an District, Shanghai from 2018 to 2023, and to provide a reference basis for the prevention and treatment of pulmonary tuberculosis. MethodsMedical records, including demographic information, diagnosis and treatment information, laboratory testing results, treatment outcomes, patient prognoses, and etc., of all the patients registered for first-time management, with the disease type of pulmonary tuberculosis in Jing’an District from January 1, 2018 to December 31, 2023 were extracted from the Tuberculosis Management Information System of China’s Disease Control and Prevention Information System.The reported incidence rate of pulmonary tuberculosis from 2018 to 2023 was analyzed. Additionally, the delay rate for medical consultation, diagnostic delay rate, prevalence of pulmonary cavity, rate of sputum smear-positive, sputum conversion rate of smear-positive patients after 2 months, proportion of deaths attributable to pulmonary tuberculosis or other causes, and the proportion of patients with treatment duration >1 year in 2018‒2019, 2020‒2022, and 2023 were compared, respectively. ResultsA total of 1 378 pulmonary tuberculosis patients were registered for management in Jing’an District in 2018‒2023, with a reported incidence rate of 25.97/100 000, 25.72/100 000, 23.93/100 000, 22.36/100 000, 18.18/100 000, and 22.32/100 000, respectively. Meanwhile, the overall reported incidence rates in 2018‒2019, 2020‒2022, and 2023 were 25.84/100 000, 21.53/100 000, and 22.32/100 000, respectively. The median age of the patients was 56 (33, 67) years, with a male-to-female ratio of 1.94∶1. The patients with a household registration of Shanghai accounted for 70.75%, among whom those aged between 61‒<71 years were the majority. Whereas, those aged between 31‒<41 years accounted for a higher proportion in the long-term resident population. The median delay times of patient’s medical consultation, diagnosis, and case-finding were 25 (19, 33) days, 29 (21, 43) days, and 41 (32, 66) days, respectively. The delay rate for medical consultation was higher in 2020‒2022 (47.99%) and 2023 (46.89%), but lower in 2018‒2019 (31.02%). In 2018‒2019, 2020‒2022, and 2023, the diagnostic delay rate was 12.41% (68/548), 13.53% (84/621), and 16.75% (35/209), respectively. Besides, during the same time the delay rate in case-finding was 19.53%, 27.05% and 34.45%, respectively, all exhibited an increasing trend. Furthermore, the rate of patients with pulmonary cavity was 16.06%, 14.98%, and 11.00%, respectively, showing a decreasing trend. Furthermore, the rate of sputum smear-positive was 27.19%, 33.33% and 32.54%, while the sputum conversion rate of smear-positive patients after 2 months was 81.21%, 85.02% and 89.71%. The mortality rates due to tuberculosis and other causes were 3.10%, 5.64%, and 3.83%, respectively. The proportion of patients with a treatment duration of ≥365 days was 44.27% in 2018‒2019, 39.93% in 2020‒2022 and 26.60% in 2023. ConclusionThe overall reported incidence rate of pulmonary tuberculosis in Jing’an District showed a decline trend from 2018‒2022, with a slight rebound in 2023. Targeted interventions should be prioritized for the elderly with local household registration and young permanent residents without Shanghai household registration.

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

[摘 要] 目的：探讨甲硫氨酸限制对肺腺癌（LUAD）细胞增殖、凋亡及磷酸戊糖途径的影响。方法：将H1299、A549细胞分为Met+组和Met−组，分别用含100 μmol/L或不含甲硫氨酸的培养基连续培养4 d，采用细胞计数法评估甲硫氨酸处理对H1299和A549细胞增殖的影响，PI染色法检测细胞周期分布，Annexin Ⅴ-PE/7AAD标记细胞凋亡，利用DCFH-DA探针检测细胞内ROS水平，WST-8法和DTNB法分别测定细胞内NADPH与GSH含量；通过癌症基因组图谱（TCGA）数据库分析葡萄糖-6-磷酸脱氢酶（G6PD）和6-磷酸葡萄糖酸脱氢酶（6PGD）表达与甲硫氨酸代谢通路的关系；采用WB法检测甲硫氨酸处理及回补甲硫氨酸下游代谢产物S-腺苷甲硫氨酸（SAM）对LUAD细胞中磷酸戊糖途径关键酶G6PD和6PGD表达的影响。结果：甲硫氨酸限制显著抑制H1299和A549细胞增殖（均P < 0.01），将细胞周期阻滞于G2/M期（均P < 0.05），显著升高细胞内总ROS水平（均P < 0.001）并促进细胞凋亡（均P < 0.001）；同时，甲硫氨酸限制显著降低了细胞内NADPH和GSH水平（均P < 0.01），抑制DNA合成（均P < 0.01）。分析TCAG数据发现，G6PD和6PGD表达水平与甲硫氨酸代谢通路呈正相关（均P < 0.001），甲硫氨酸限制下调G6PD和6PGD蛋白表达（均P < 0.01），而回补SAM可部分逆转甲硫氨酸限制对G6PD和6PGD的表达的抑制（均P < 0.01），提示甲硫氨酸通过SAM合成调控磷酸戊糖途径。结论：甲硫氨酸限制通过抑制磷酸戊糖途径抑制LUAD细胞增殖，为甲硫氨酸限制疗法治疗LUAD提供实验依据。

ObjectiveTo observe the effects of Tongluo Baoshen prescription （TLBS）-containing serum on the rat podocyte injury induced by lipopolysaccharide （LPS） and explore the potential mechanisms. MethodsSD rats were used to prepare the blank serum， losartan potassium-containing serum， and low-， medium-， and high-dose TLBS-containing sera. Rat podocytes were cultured in vitro， and the effects of drug-containing sera on podocyte viability were detected by the cell counting kit-8 （CKK-8） method. The optimal intervention volume fraction of drug-containing sera and the optimal concentration of LPS for inducing the podocyte injury were determined. Rat podocytes were grouped as follows： normal control （NC， 10% blank serum）， model control （MC， 20.00 mg·L^-1 LPS+10% black serum）， losartan potassium （LP， 20.00 mg·L^-1 LPS+10% losartan potassium-containing serum）， low-dose TLBS （TLBS-L， 20.00 mg·L^-1 LPS+10% low-dose TLBS-containing serum）， medium-dose TLBS （TLBS-M， 20.00 mg·L^-1 LPS+10% medium-dose TLBS-containing serum）， and high-dose TLBS （TLBS-H， 20.00 mg·L^-1 LPS+10% high-dose TLBS-containing serum）， and the interventions lasted for 48 h. The ultrastructure of podocytes was observed under a transmission electron microscope. The podocyte apoptosis was detected by the terminal deoxynucleoitidyl transferase mediated nick-end labeling （TUNEL） kit. Immunofluorescence was used to detect the expression of gasdermin D N-terminal fragment （GSDMD-NT） in podocytes. The mRNA and protein levels of G protein-coupled receptor family C group 5 member B （GPRC5B）， nuclear factor-κB （NF-κB） p50， NF-κB p52， NF-κB p65， Rel B， c-Rel， NOD-like receptor protein 3 （NLRP3）， cysteinyl aspartate-specific protease-1 （Caspase-1）， GSDMD-NT， interleukin （IL）-1β， IL-18， nephrin， integrin α₃， and integrin β₁ in podocytes were determined by real-time quaritiative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultsCompared with the NC group， the MC group showed reduced podocyte protrusions and organelles， segmental missing of cell membranes， increased and swollen mitochondria， irregular nuclear membranes， light chromatin， increased TUNEL fluorescence-positive nuclei （P<0.01）， obviously enhanced fluorescence intensity of GSDMD-NT， up-regulated mRNA and protein levels of GPRC5B， NF-κB p50， NF-κB p52， NF-κB p65， Rel B， c-Rel， NLRP3， caspase-1， GSDMD-NT， IL-1β， and IL-18 （P<0.01）， and down-regulated mRNA and protein levels of nephrin， integrin α₃， and integrin β₁ （P<0.01） in podocytes. Compared with the MC group， the LP， TLBS-M， and TLBS-H groups showed improved ultrastructure of podocytes with increased protrusions， intact cell membranes， reduced organelles， and alleviated mitochondrial swelling， decreased TUNEL fluorescence-positive nuclei （P<0.01）， weakened fluorescence intensity of GSDMD-NT， down-regulated mRNA and protein levels of GPRC5B， NF-κB p50， NF-κB p52， NF-κB p65， Rel B， c-Rel， NLRP3， caspase-1， GSDMD-NT， IL-1β， and IL-18 （P<0.01）， and up-regulated mRNA and protein levels of nephrin， integrin α₃， and integrin β₁ （P<0.05， P<0.01）. Moreover， the changes above were the most obvious in the TLBS-H group. ConclusionThe TLBS-containing serum can regulate the GPRC5B/NF-κB/NLRP3 pathway to inhibit pyroptosis， thereby ameliorating the podocyte injury induced by LPS.

Objective:To explore the effects of simultaneous transplantation of multiple foot flaps in repairing defects of varying degrees on the palmar side of multiple fingers.Methods:This study was a retrospective observational study. From February 2020 to March 2023, 11 patients aged 23-52 years with defects on the palmar side of multiple fingers (with 38 affected fingers) meeting the inclusion criteria were hospitalized at Longgang Orthopedics Hospital of Shenzhen, including 8 males (with 31 affected fingers) and 3 females (with 7 affected fingers). All affected fingers sustained skin and soft tissue defects, along with exposed deep tissue such as finger bones and tendons, and 2 thumbs exhibited nail bed and distal phalanx defects. The defect area of each finger ranged from 1.5 cm×1.0 cm to 5.5 cm×3.0 cm. Foot flaps were designed based on the area and depth of the finger defects, and multiple foot flaps were transplanted simultaneously to repair the wounds of fingers. The area of single flap resected ranged from 2.0 cm×1.0 cm to 5.5 cm×3.0 cm. Donor site wounds were closed directly or covered using artificial dermis or split-thickness skin grafts. The number of resected flaps, the number of affected fingers repaired, and the surgical duration were recorded. The flap survival and foot donor site wound healing were observed postoperatively. The flap and donor and recipient sites recovery were observed during follow-up. At the final follow-up, the functional recovery of affected fingers was evaluated based on the trial criteria of the Chinese Medical Association's Hand Surgery Society for function evaluation of thumb and finger reconstruction, the sensory function of the flaps was assessed by the sensory function evaluation standard of the British Medical Research Council, the cold tolerance of the affected hands was evaluated with the Cold Intolerance Severity Scale, the scars at the recipient and donor sites were assessed using the Vancouver scar scale (VSS), and the function recovery of flap donor foot was evaluated with the Maryland Foot Score criteria.Results:Donor sites were selected from 16 feet with 2-4 flaps harvested from each foot. Specifically, skin and soft tissue defects in 27 affected fingers were repaired using free lateral toe flaps, skin and soft tissue defects in 9 affected fingers were repaired using free medial foot flaps, and skin and soft tissue defects with finger bone defects in 2 affected fingers were repaired using free toenail osteocutaneous flaps. The surgical duration ranged from 5.60 to 9.25 hours. Postoperatively, all transplanted flaps in affected fingers survived, and all foot donor site wounds healed. Follow-up for 12-25 months showed that the appearance, color, and texture of the flaps were similar to the surrounding normal skin. The affected finger pulp was full with the fingertip having restored pain and touch sensation. There was no pain in the donor site of foot, and the walking ability of patients was not affected. At the final follow-up, the functional recovery was evaluated as excellent for 36 affected fingers and good for 2 affected fingers. The sensory function rating of the flaps was graded as S3-S4, and all affected fingers were mild intolerant to cold. VSS scores of the scars at the recipient sites ranged from 1-3, and VSS scores of the scars at the donor sites ranged from 1-5. The functional recovery of all flap donor feet was excellent.Conclusions:Simultaneous transplantation of multiple foot flaps is an effective treatment method for repairing defects of varying degrees on the palmar side of multiple fingers, resulting in excellent aesthetic and functional recovery of the affected fingers while causing minimal damage to the donor site.

Objective:To examine the effect of antidepressant treatment on the longitudinal depressive burden in patients with bipolar depression.Methods:Subjects were recruited from a national multicenter, naturalistic observational project: Comprehensive Assessment and Follow-up Descriptive Study on Bipolar Disorder study (CAFE-BD). A total of 110 patients with bipolar depression (51 males, 59 females; aged 18-64 years, mean age 34.4±11.1 years) were consecutively enrolled between January 2012 and December 2013 from outpatients and inpatients of nine medical institutions, including six psychiatric hospitals and three general hospitals. Based on the use of antidepressants as defined in this study, patients were classified into a medicated group (Ads, n=74) and a non-medicated group (nAds, n=36). Diagnosis of bipolar depression was confirmed using the MINI (Chinese version), and baseline and follow-up assessments were conducted using the Assessment of Mood Disorders Evaluation (ADE) and the Clinical Monitoring Form (CMF). Depression burden indicators, including aggregate depression scores (SUM-D), number of depressive symptoms (NUM-D), and total depression burden, were compared between the Ads group and nAds group at mid-term (the 6 th month) and endpoint (the 12 nd month). Longitudinal changes in these indicators were also analyzed. Results:The proportion of bipolar depressive patients on antidepressants was 67% (74/110). Among them, 85% (63/74) were taking antidepressants at baseline; this dropped to 76% (56/74) at mid-term, and 64% (47/74) at the endpoint. SUM-D were higher in the Ads group than in the nAds group at baseline (9 (6.5, 11) vs 7.38 (5.5, 9.0); W=1 712.00, P=0.015), and there was no statistically significant difference in NUM-D and total depressive burden between two groups at any time points ( P>0.05). Compared to baseline, the Ads group had significantly lower SUM-D (0.5 (0, 1), 1.33 (0.5, 2.5) vs. 9 (6.5, 11); W=2 770.00, 2 743.00), NUM-D (0 (0, 0), 0 (0, 1) vs. 7 (5, 8); W=2 621.00, 2 601.50) and total depressive burden (c 2=64.36, 59.00) at both mid-term and endpoint (all P<0.001); While SUM-D (0.59 (0.4, 0.7), 1 (0.8, 2.5) vs. 7.38 (5.5, 9.0); W=664.50, W=666.00), NUM-D (0 (0, 0), 0 (0, 1) vs. 6 (4, 7); W=527.00, 528.00) and total depression burden ( χ 2=31.00, 31.00) in the nAds group were also significantly decreased at both mid-term and endpoint (all P<0.001). There were no statistically significant differences in the changes in depression burden indicators between the two groups from baseline to mid-follow-up or endpoint, nor from mid-follow-up to endpoint ( P>0.05). Conclusion:In a 12-month real-world naturalistic follow-up study, both medicated and non-medicated bipolar depression groups experienced significant and similar reductions in depression burden.

OBJECTIVE To investigate the effect and mechanism of Jingangteng capsules in the treatment of non-alcoholic fatty liver disease （NAFLD）. METHODS Thirty-two SD rats were randomly divided into normal group and modeling group. The modeling group was fed a high-fat diet to establish a NAFLD model. The successfully modeled rats were then randomly divided into model group， atorvastatin group[positive control， 2 mg/（kg·d）]， and Jingangteng capsules low- and high-dose groups [0.63 and 2.52 mg/（kg·d）]， with 6 rats in each group. The pathological changes of the liver were observed by hematoxylin-eosin staining and oil red O staining. Enzyme-linked immunosorbent assay was performed to determine the serum levels of triglycerides （TG）， total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， alanine transaminase （ALT）， aspartate transaminase （AST）， tumour necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， IL-6， IL-18. 16S rDNA amplicon sequencing and metabolomics techniques were applied to explore the effects of Jingangteng capsules on gut microbiota and metabolisms in NAFLD rats. Based on the E-mail：591146765@qq.com metabolomics results， Western blot analysis was performed to detect proteins related to the nuclear factor kappa-B （NF-κB）/NOD-like receptor family protein 3 （NLRP3） signaling pathway in the livers of NAFLD rats. RESULTS The experimental results showed that Jingangteng capsules could significantly reduce the serum levels of TG， TC， LDL-C， AST， ALT， TNF-α， IL-1β， IL-6， IL-18， while increased the level of HDL-C， and alleviated the hepatic cellular steatosis and inflammatory infiltration in NAFLD rats. They could regulate the gut microbiota disorders in NAFLD rats， significantly increased the relative abundance of Romboutsia and Oscillospira， and significantly decreased the relative abundance of Blautia （P＜0.05）. They also regulated metabolic disorders primarily by affecting secondary bile acid biosynthesis， fatty acid degradation， O-antigen nucleotide sugar biosynthesis， etc. Results of Western blot assay showed that they significantly reduced the phosphorylation levels of NF-κB p65 and NF-κB inhibitor α， and the protein expression levels of NLRP3， caspase-1 and ASC （P＜0.05 or P＜0.01）. CONCLUSIONS Jingangteng capsules could improve inflammation， lipid accumulation and liver injury in NAFLD rats， regulate the disorders of gut microbiota and metabolisms， and inhibit NF-κB/NLRP3 signaling pathway. Their therapeutic effects against NAFLD are mediated through the inhibition of the NF-κB/NLRP3 signaling pathway.