OBJECTIVE To evaluate the efficacy and safety of rituximab （RTX） in the treatment of primary Sjögren syndrome （pSS）. METHODS Randomized controlled trials （RCTs） on the effects of RTX （trial group） versus placebo （control group） in the treatment of pSS were searched from the Cochran Library， PubMed， Embase， Medline， Web of Science， VIP， CNKI， Wanfang， and other databases during the inception to February 2024. After literature screening and quality evaluation， meta-analysis was performed by using RevMan 5.3 software. RESULTS Seven RCTs were finally included， involving a total of 518 patients. Results of meta-analysis showed that European League Against Rheumatism Sjögren syndrome disease activity index （ESSDAI） score [MD＝－1.17， 95%CI（－1.52， －0.82）， P＜0.000 01] and oral dryness visual analogue scale （VAS） score [MD＝－3.97， 95%CI （－5.08， －2.86）， P＜0.000 01] in the trial group were significantly lower than the control group； unstimulated salivary flow rate [SMD＝0.64， 95%CI（0.41， 0.87）， P＜0.000 01] and Schirmer score [MD＝0.19， 95%CI（0.18， 0.20）， P＜0.000 01] were significantly higher than the control group. There was no statistical significance in response rate [RD＝0.10， 95%CI（－0.04， 0.23）， P＝0.16]， fatigue VAS score [MD＝－12.50， 95%CI（－35.14， 10.15）， P＝0.28]， European League Against Rheumatism Sjögren syndrome patient reported index （ESSPRI） score [MD＝0.33， 95%CI（－0.53， 1.18）， P＝0.46]， Short-form 36 health survey physical component summary （SF36-PCS） score [MD＝0.90， 95%CI（－2.97， 4.78）， P＝0.65]， SF-36 mental component summary （SF36-MCS） score [MD＝0.11， 95%CI（－0.41， 0.63）， P＝0.68]， total salivary gland ultrasound score [SMD＝－1.91， 95%CI（－4.01， 0.19）， P＝0.07] or the incidence of adverse drug reactions [OR＝1.15，95%CI（0.62，2.13），P＝0.66] between 2 groups. CONCLUSIONS RTX has advantages in the improvement of ESSDAI score， unstimulated salivary flow rate， Schirmer score and oral dryness VAS score in pSS patients， and has a good safety profile. However， it did not exhibit significant improvement in fatigue VAS score， ESSPRI score， SF36-PCS score， SF36-MCS score or response rates.

Enhanced recovery after surgery (ERAS) has been proven to reduce surgical injuries, promote recovery, and improve postoperative outcomes in different types of surgeries. A core principle of ERAS is to provide programmatic evidence-based perioperative interventions. An international multidisciplinary expert group provided a statement on clinical practice in each thematic area of ERAS by obtaining a list of potential ERAS elements, and reviewing literature. The version 2024 of "Perioperative care in cardiac surgery: A joint consensus statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and the Society of Thoracic Surgeons (STS)" is developed from the version 2019 of "Guidelines for perioperative care in cardiac surgery: Enhanced Recovery after Surgery Society recommendations". The consensus statement group was composed of multidisciplinary experts such as cardiac surgeons, anesthesiologists, intensive care physicians, and nurses, based on personal ERAS knowledge and experience. This article interprets the changes and new statements in the 2024 consensus, which can provide a foundation for the best perioperative practices for adult cardiac surgery patients.

Objective To explore the risk factors and potential mechanisms of hypertension events on the same day after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis. Methods Clinical data of patients who underwent TAVI for severe aortic stenosis at Department of Structural Heart Disease, Fuwai Hospital from December 2023 to February 2024 were retrospectively collected. According to the peak systolic blood pressure on the same day after surgery, patients were divided into a hypertension group (≥140 mm Hg) and a normal blood pressure group (<140 mm Hg). Logistic regression model was used to analyze the risk factors for hypertension on the same day after TAVI. Results A total of 54 patients after TAVI were included, with 41 patients in the hypertension group, including 18 males and 23 females, with an average age of (72.83±6.78) years; 13 patients in the normal blood pressure group, including 9 males and 4 females, with an average age of (70.00±7.57) years. Univariate analysis found that there were statistical differences in interventricular septal thickness [(13.71±1.98) mm vs. (12.23±1.59) mm, P=0.018], preoperative left ventricular ejection fraction (LVEF)>55% [33 (80.5%) vs. 6 (46.2%), P=0.040], and postoperative same-day LVEF>55% [33 (80.5%) vs. 4 (30.8%), P=0.003]. Multivariate logistic regression analysis found that postoperative same-day LVEF>55% [OR=10.173, 95%CI (1.044, 99.115), P=0.046] was an independent risk factor for hypertension on the same day after TAVI. Conclusion Myocardial contractility mainly participates in the occurrence of hypertension on the same day after TAVI. This study can not only improve our understanding of early hemodynamic changes after TAVI, but also provide a basis for the formulation of early hypertension treatment plans after TAVI to improve the short- and long-term prognosis of patients.

Objective To investigate the value of tranexamic acid combined with aspirin,low molecular weight heparin calcium in regulating inflammatory mediators and TEG in blood management of Total knee arthroplast(TKA).Methods 120 elderly patients with TKA in our hospital from January 2020 to October 2022 were randomly divided into group A(n=60)and group B(n=60).They were given tranexamic acid+aspirin and tranexamic acid+low molecular weight heparin calcium,respectively,for 2 weeks.Perioperative indexes,complications[lower limb deep vein thrombosis(DVT),intermuscular vein thrombosis(MCVT),incision infection],blood transfusion rate,adverse reactions(gastrointestinal discomfort,subcutaneous ecchymosis),TEG parameters[coagulation reaction time(R),blood coagulation time(K),maximum amplitude(MA),coagulation angle(α)],inflammatory mediators[soluble CD40 ligand(sCD40L),Toll-like receptor 4(TLR4),tumor necrosis factor(TNF-α)],vascular endothelial injury factors[soluble thromboregulatory protein(sTM),vascular endothelial cell growth factor(VEGF),E-selectin]were compared between the two groups.Results There was no significant difference in the 24 h postoperative drainage volume,latent blood loss,total blood loss,intraoperative blood loss,Hb and HCT levels 72 h after surgery between the two groups(P＞0.05).There was no statistically significant difference in TEG parameters between the two groups,at different time points,and between groups at different time points(P＞0.05);The serum levels of TLR4,sCD40L and TNF-α in group A were lower than those in group B 2 weeks after surgery(P＜0.05).The levels of plasma sTM and serum VEGF and E-selectin in group A were lower than those in group B 2 weeks after surgery(P＜0.05).There was no significant difference in the incidence of deep vein thrombosis(DVT),intermuscular vein thrombosis(MCVT),incision infection and blood transfusion rate between group A and group B(P＞0.05).There was no significant difference in the total incidence of adverse reactions between group A and group B(P＞0.05).Conclusion Compared with the combination of low molecular weight heparin calcium,the combination of tranexamic acid and aspirin can protect vascular endothelium and inhibit inflammatory response.However,both can maintain the patient's coagulation function and avoid massive blood loss or thrombosis.There is no significant difference in safety and effectiveness.

Objective To explore the effects of Zengye Runzao Decoction on mRNAs and proteins related to submandibular gland tissue and the expression of Th17/Treg in peripheral blood of Sj?gren syndrome(SS)model mice.Methods SPF Balb/c mice were randomly divided into control group and modeling group,the modeling group established an SS mouse model through immune induction,while the control group was not treated.The modeled mice were randomly divided into model group,total glucosides of Paeoniae Radix Alba group and Zengye Runzao Decoction low-,medium-and high-dosage groups,with 3 mice in each group.The total glucosides of Paeoniae Radix Alba group was given 0.234 mg/g total glucosides of Paeoniae Radix Alba solution by gavage,Zengye Runzao Decoction low-,medium-and high-dosage groups were given 4,8,12 mg/g Zengye Runzao Decoction by gavage,and the control group and model group were given the same volume of distilled water by gavage,once a day for 60 consecutive days.The daily water intake,salivary flow rate and submandibular index were calculated,the tissue morphology of submandibular gland was observed by HE staining,the expressions of HOXA1,STAT3,IL-17,FOXP3 mRNA and miR-181c-3p in submandibular gland tissue were detected by qPCR,Western blot was used to detect the expressions of HOXA1,STAT3,p-STAT3,IL-17 and FOXP3 protein in submandibular gland tissue,the proportion of Th17 and Treg cells in peripheral blood was detected by flow cytometer.Results Compared with the control group,the daily water intake of the model group mice increased,saliva flow rate and submandibular gland index decreased,lymphocyte infiltration in submandibular gland tissue was significant,the expressions of HOXA1,STAT3,IL-17 mRNA increased,the expressions of FOXP3 mRNA and miR-181c-3p decreased,the expressions of HOXA1,STAT3,p-STAT3,IL-17 protein increased,FOXP3 protein expression decreased,Th17 ratio and Th17/Treg increased,and Treg ratio decreased,with statistical significance(P<0.05).Compared with the model group,the daily water intake of Zengye Runzao Decoction groups decreased,the saliva flow rate increased,and the infiltration of lymphocytes in the submandibular gland tissue was reduced to varying degrees,the expressions of HOXA1 and IL-17 mRNA decreased,while the expressions of FOXP3 mRNA and miR-181c-3p increased,the expression of HOXA1 protein decreased,while the expression of FOXP3 protein increased,the ratio of Th17 and Th17/Treg decreased,and the Treg ratio increased.The submandibular gland index increased in Zengye Runzao Decoction high-dosage group,and the expressions of STAT3 mRNA and protein,as well as p-STAT3 and IL-17 protein decreased,with statistical significance(P<0.05).Conclusion Zengye Runzao Decoction may regulate Th17/Treg cell imbalance by up-regulating the expressions of miR-181c-3p,FOXP3 and down-regulating the expressions of HOXA1,p-STAT3,STAT3 and IL-17,and then improve the function and tissue injury of submandibular gland caused by SS.

Objective:To evaluate the efficacy and safety of febuxostat in the treatment of hyperuricemia with hypertension.Methods:Randomized controlled trials (RCT) on the treatment of hyperuricemia with hypertension using febuxostat were retrieved from Medline, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database from January 2013 to July 2023, according to the retrieval strategy. Two trained researchers completed the literature screening, quality evaluation, and data extraction. Meta-analysis was performed using RevMan 5.3. The fixed-effect model or random-effects model was used to analyze the research data, and subgroup analysis was conducted to identify the source of heterogeneity.Results:A total of 5 RCTs involving 456 patients (228 in the experimental group and 228 in the control group) were included in the meta-analysis, all of which were English-language literatures and foreign studies. In the treatment of hyperuricemia with hypertension, febuxostat showed a statistically significant difference in reducing serum uric acid (sUA) levels compared to control drugs [MD(95% CI)=-1.31(-2.55, -0.07), P=0.040]; there was no statistically significant difference in reducing systolic blood pressure (SBP) [SMD(95% CI)=-0.12(-0.51, 0.27), P=0.540] or diastolic blood pressure (DBP) [SMD(95% CI)=-0.15(-0.40, 0.09), P=0.220]. Subgroup analysis showed that the difference in intervention drugs in the control group may be the cause of heterogeneity in sUA levels, and the difference in intervention time may be the cause of heterogeneity in SBP levels among different studies. There was no statistically significant difference in the incidence of adverse reactions between the febuxostat group and the control group [RD (95% CI) =-0.01(-0.08, 0.06), P=0.770]. Conclusion:Febuxostat has a significant advantage in improving sUA levels and is relatively safe in the treatment of hyperuricemia with hypertension, but it does not show significant advantages in blood pressure control.

Lycophytes and seed plants constitute the typical vascular plants. Lycophytes have been thought to have no paleo-polyploidization although the event is known to be critical for the fast expansion of seed plants. Here, genomic analyses including the homologous gene dot plot analysis detected multiple paleo-polyploidization events, with one occurring approximately 13-15 million years ago (MYA) and another about 125-142 MYA, during the evolution of the genome of Selaginella moellendorffii, a model lycophyte. In addition, comparative analysis of reconstructed ancestral genomes of lycophytes and angiosperms suggested that lycophytes were affected by more paleo-polyploidization events than seed plants. Results from the present genomic analyses indicate that paleo-polyploidization has contributed to the successful establishment of both lineages-lycophytes and seed plants-of vascular plants.
Evolution, Molecular ; Genome, Plant ; Genomics ; Phylogeny ; Polyploidy ; Selaginellaceae/genetics*

Objective Nowdays,infants with low age,low weight and complicated symptoms are appropriate candidates for cardiac surgery of congenital heart disease.However,surgical strike and multiorgan immaturity have already increased the difficulty of postoperative care.With invasive assessments,we can just assess the real-time condition.But noninvasive assess ment has been proved the positive correlations between the assessment and postoperative outcomes.Therefore,surgeons and intensivists modify treatment in insidious onset,prevent the exacerbation and improve the long-term survival rate.

BACKGROUNDTo study the association between psychosocial factors and the development of lung cancer.

METHODSCase-control matched study was employed in the study. A standardized life event, social support and defense mechanisms interview was administered respectively. Total 118 lung cancer patients who were diagnosed pathologically were chosen as case group, and 118 matched healthy people were as control group. The pair had the same gender, the same race, and the same occupation, and lived in the same area, and the age difference between the two groups was ±3 years.

RESULTSUnivariate analysis showed that smoking, defect of sleeping, alcohol consuming, smoking and drinking during meal, preserved food consuming, irregularity of life increased the risk of lung cancer development (P < 0.05). The scores of life events, social support had no significant difference between two groups (P > 0.05), but the scores of stress life events was higher in cancer group than that in control group. The immature factors of defense mechanisms in cancer group were higher than those in control group (P < 0.05). Multiple qualified logistic regression showed that smoking and defect of sleeping were the main risk factors of lung cancer genesis.

CONCLUSIONSThere is certain association between psychosocial factors and lung cancer development. The immature defensive factor is the psychosocial factor of lung cancer genesis, and smoking, defect of sleeping, alcohol consuming, smoking and drinking during meal, preserved food consuming, irregularity of life are the risk factors of lung cancer.

Objective. To study the role of endogenous carbon monoxide (CO) in endotoxin shock. Methods. The changes of CO levels and the effects of zinc protoporphyrin IX (ZnPP),an inhibitor of heme-oxygenase (HO), in endotoxin shock and the efficacy of hemin,an inducer of HO were investigated.Results. The plasma CO levels were found to be significantly increased during the course of endotoxin shock. Injection of ZnPP was shown to abrogate the endotoxin-induced hypotension and metabolic derangements markedly. Administration of hemin to healthy rabbits revealed the hypotension and metabolic derangements similar to the animals given endotoxin.Conclusion.CO is a newly found endogenously produced mediator which may play an important role in the pathogenesis of endotoxin shock.