BACKGROUND:Rheumatoid arthritis is a chronic autoimmune disease characterized by joint pain,swelling,and dysfunction.Acupuncture,as a traditional medical treatment,has proved its effectiveness and safety in many diseases.However,the efficacy of acupuncture in the treatment of rheumatoid arthritis remains controversial.Therefore,the purpose of this study is to evaluate and explore the effect of Tiaodu Tongmai acupuncture in the treatment of preclinical rheumatoid arthritis of different ages through the generalized estimating equation,and to provide a basis for the application of acupuncture in rheumatoid arthritis. OBJECTIVE:To investigate the effect of Tiaodu Tongmai acupuncture therapy on preclinical rheumatoid arthritis(pre-RA)patients at different ages based on generalized estimating equation. METHODS:A total of 123 patients with preclinical rheumatoid arthritis treated from January to September 2023 were selected as the study objects and divided into study group(n=64)and control group(n=59)according to different treatment methods.The study group was given Tiaodu Tongmai acupuncture treatment,and the control group was given acetaminophen tablets.The baseline balance was adjusted by propensity score matching method.The clinical efficacy and cytokine levels before and after treatment between the two groups were compared.The generalized estimating equation model was established to evaluate the efficacy of Tiaodu Tongmai acupuncture therapy on preclinical rheumatoid arthritis patients at different ages. RESULTS AND CONCLUSION:(1)After 0 days of treatment,there were significant differences in joint pain and C-reactive protein expression between study and control groups(P＜0.05).After 4 weeks of treatment,there were significant differences in visual analogue scale scores,joint pain,C-reactive protein and erythrocyte sedimentation rate between the two groups(P＜0.05).After 8 weeks of treatment,there were significant differences in visual analogue scale scores,C-reactive protein and erythrocyte sedimentation rate between the two groups(P＜0.05).After 12 weeks of treatment,there were significant differences in visual analogue scale scores,C-reactive protein and erythrocyte sedimentation rate between the two groups(P＜0.05).(2)The total effective rate of the study group was 93.75%,while that of the control group was 79.17%.The clinical efficacy of the study group was significantly better than that of the control group(P＜0.05).(3)There were significant differences in interleukin-6,interferon-γ,macrophage migration inhibitory factor,rheumatoid factor IgA,rheumatoid factor IgM,metallomatrix proteinase 3,metallomatrix proteinase 9,and anti-cyclic citrulline antibody in the study group before and after treatment(P＜0.05).The levels of interleukin-6,interferon-γ,rheumatoid factor IgA,rheumatoid factor IgM,metallomatrix proteinase 3,metallomatrix proteinase 9,and anti-cyclic citrulline antibody in the control group after treatment were significantly different from those before treatment(P＜0.05).There were significant differences in interleukin-6,interferon-γ,macrophage migration inhibitory factor,rheumatoid factor IgA,rheumatoid factor IgM,metallomatrix proteinase 3,and anti-cyclic citrulline antibody between the two groups after treatment(P＜0.05).(4)After 12 weeks of treatment,the comprehensive efficacy of patients of all ages in the study group was better than that of the control group(P＜0.05).After 8 weeks of treatment,the comprehensive efficacy of patients aged 23-35,36-50,and 51-60 years old in the study group was better than that of the control group(P＜0.05),and the comprehensive efficacy of patients aged 18-22 years old was comparable between the two groups.After 4 weeks of treatment,the comprehensive efficacy of patients aged 36-50 and 51-60 years old in the study group was better than that of the control group(P＜0.05),and the comprehensive efficacy was comparable between the two groups of patients aged 18-22 and 23-35 years.Overall,Tiaodu Tongmai acupuncture therapy has advantages in treating preclinical rheumatoid arthritis patients aged 36-50 and 51-60 years.

OBJECTIVE: To establish a high-performance liquid chromatographic method (HPLC) for the simultaneous determination of 16 compounds from Artemisia ordosica. METHODS: HPLC was used to analyze 16 quality indicators of A. ordosica. The HPLC conditions were as follows: Agilent Eclipse Plus C₁₈ column (250 mm × 4.6 mm, 5 μm) with acetonitrile (A)-water (B) as mobile phase, gradient elution: 0-10 min, 75%-65% B; 10-30 min, 65%-35% B; and finally 30-40 min, 35%-15% B. The flow rate was 1.0 mL/min, the column temperature was 40 °C, the injection volume was 10 μL, and monitored by absorbance at 285 nm for compounds 1- 10, 12 and 225 nm for compounds 11, 13- 16. RESULTS: Under the selected experimental chromatographic conditions, compounds 1- 16 showed good linearity (r > 0.9993) in a wide concentration range. Their average recoveries were 99.50%, 95.38%, 97.75%, 96.00%, 98.20%, 97.50%, 95.50%, 99.33%, 96.75%, 96.50%, 98.50%, 97.83%, 99.20%, 95.33%, 97.33% and 96.30%, respectively, and the RSD were 1.99%, 1.81%, 1.63%, 1.98%, 1.67%, 1.92%, 1.74%, 1.67%, 1.90%, 1.72%, 1.88%, 1.83%, 1.79%, 1.76%, 1.81% and 1.96%, respectively. CONCLUSION Based on the results of the HPLC analysis, it was concluded that p-hydroxycinnamic acid ( 1), O-hydroxycinnamic acid ( 2), coniferyl alcohol ( 5), 5,4'-dihydroxy-7,3'-dimethoxyflavanone ( 8), 5,4'-dihydroxy-7-methoxyflavanone ( 9), 5-hydroxy-7,4'-dimethoxyflavanone ( 12), dehydrofalcarindiol ( 13), arteordoyn A ( 14), dehydrofalcarinol ( 15) and capillarin ( 16) are best suited for the role of quality indicators of A. ordosica grown in different ecological environments.

Objective:To evaluate the value of systematic education for primiparas undergoing epidural labor analgesia.Methods:A total of 240 primiparas who were suitable and voluntarily requested epidural labor analgesia, aged 20-35 yr, at 37-41 + 6 weeks gestation, with a singleton fetus, in vertex presentation without fetal abnormality, were selected.According to whether the primiparas and their accompanying family members had received systematic education on epidural labor analgesia during pregnancy, the primiparas were divided into 2 groups ( n=120 each): education group and control group.When the uterine contraction was regular and the diameter of the uterine orifice reached 2 cm or more, epidural labor analgesia was carried out.Before the begining of epidural puncture, the degree of anxiety of pregnant women was evaluated using the self-rating anxiety scale.The time of communication before analgesia, time of placing body position, and satisfaction of puerperae and their family members with labor analgesia were observed and recorded. Results:Compared with control group, the self-rating anxiety scale score was significantly decreased, the time of communication before analgesia and time of placing body position were shortened, and the rate of satisfaction of puerperae and their family members with labor analgesia was increased in education group ( P<0.05). Conclusions:Systematic education is helpful in relieving the anxiety of primiparas during epidural labor analgesia, increasing the efficiency of analgesia implementation and improving the delivery experience of puerperae.

Objective:To observe the effects of intervention based on self-regulation mode on illness perception, medical coping styles and quality of life of patients with psoriasis.Methods:Eighty patients with psoriasis from February 2018 to August 2019 in Qinhuangdao First Hospital were selected and divided into two groups by random digits table method, 40 patients in each group. The control group was given routine intervention, and the experimental group was given intervention based on self-regulation mode. The Illness Perception Questionnaire-Revised (IPQ-R) scores, Medical Coping Modes Questionnaire (MCMQ) scores, dermatologylifequalityindex (DLQI) scores and compliance of the two groups were compared before and after intervention.Results:There was no significant difference in the score of IPQ-R, MCMQ, DLQI before intervention between the two groups( P>0.05). After intervention, scores of symptoms, disease perception and causes of the disease in IPQ-R were (7.24±0.75), (162.34±20.35), (76.23±8.65) points in the experimental group and (6.08±0.72), (123.26±18.57), (52.79±7.84) points in the control group, there were significant differences between the two groups ( t values were 7.057, 8.972, 12.699, P<0.01). In the MCMQ, facing score,avoidance score and yielding score were (25.67±2.83), (12.26±1.84), (9.12±1.24) points in the experimental group, (21.76±3.89), (14.35±2.48), (10.45±1.68) points in the control group, there were significant differences between the two groups ( t values were 5.141, -4.280, -4.028, P<0.01). The DLQI scores of experimental group were significantly higher than those of control group ( t values were 2.648-8.244, P<0.05 or 0.01), and compliance of experimental group (97.5%, 39/40) was significantly better than control group (80.00%, 32/40) with statistically significant( Z value was 40.000, P<0.01). Conclusions:Intervention based on self-regulation mode can effectively reduce negative emotions of patients with psoriasis, increase their illness perception and compliance, improve their medical coping styles, self-management ability and quality of life, with positive application value.

Objective:To explore the application effect of global trigger tool (GTT) in detecting adverse events in ICU patients.Methods:According to contents of triggers in the GTT white paper, combined with the scope of domestic adverse event reporting and some ICU indexes, 16 triggers were established. A total of 1 683 medical records were collected from ICU of the Second People's Hospital of Liaocheng in Shandong Province from July 2018 to June 2019. According to the inclusion/exclusion criteria, 421 medical records of discharged patients were randomly selected according to the number of sampling intervals and 420 medical records were reviewed after eliminating repeated medical records. GTT method was used for retrospective analysis.Results:Of the 420 medical records actually used for review, 14 of the 16 triggers were positive, and the positive frequency of triggers was 128 cases, involving 62 patients. Adverse events were identified 51 times, involving 43 patients, with a detection rate of 10.24% (43/420) . Among the 51 cases of adverse events, 37 cases (72.55%) were Grade E, 13 cases (25.49%) were Grade F, and 1 case (1.96%) was Grade H. No Grade G or I was found. In the same year, 18 cases of adverse events were reported voluntarily in ICU, the reporting rate was 1.07% (18/1 683) .Conclusions:GTT can be effectively applied to the detection of adverse events in ICU patients, and a properly designed trigger can improve the detection rate.

Objective To explore the clinical distribution and significant of 23 kinds of human papillomavir-us(HPV)genetypes in normal cells and atypical squamous cells(ASC-US),meanwhile analysis result of cervi-cal histological pathology diagnosis in cases of ASC-US.Methods A total of 1 000 women with normal cells specimens were recruited into control group,and 236 women with ASC-US were selected into the ASC-US group.Polymerase chain reaction(PCR)and gene-chips technology were utilized for the detection of 23 kinds of HPV genetypes,all cases of ASC-US diagnosis of cervical pathological histology.Results A total of 106 ca-ses of HPV infection were detected in the control group,as the total HPV infection rate was 10.6%,in which the single genotypes infection rate was 9.3% and the multiple genotypes infection rate was 1.3%.A total of 139 cases of HPV infection were detected in ASC-US group,as the total HPV infection rate was 58.9%,in which the single genotypes infection rate was 38.1%,and the multiple genotypes infection rate was 20.8%. There were significant differences on the total HPV infection rate,the infection rates of type 1 and multiple geontypes between the control group and ASC-US group(P<0.05).The top six of constituent ratio in the control group were type 43,16,58,33,52,18,42,those in the ASC-US group were type 16,18,52,58,33,51,66.Conclusion PCR combined with the gene-chip technology could be used in the HPV genotypes detection in cervical cells,which has important clinical significance on the further distribution management of ASC-US,and should be draw great attention.

Objective To detect the anti EZH2 autoantibodies IgG expression in hepatocellular carcinoma patient's serum samples and investigate the relationship of anti EZH2 autoantibodies IgG expression with clinicopathological parameters.Methods ELISA method was used to detect the anti EZH2 autoantibodies in serum of 120 cases of HCC patients and compared with 115 healthy controls.Results Serum anti EZH2 antibodies in patients with hepatocellular carcinoma group the content of IgG was 2.015±0.568 μg/ml group,anti EZH2 antibodies IgG content control health was 1.185±0.289 μg/ml.There was significant difference between two groups (t=12.48,P＜0.001).Anti EZH2 antibodies of IgG in serum of pa ticnts with hepatocellular carcinoma was up-regulated and the degree of tumor size,tumor the degree of differentiation,TNM grading and intrahepatic metastasis (t=8.485 ～ 57.93,P＜0.001).And age,sex,drinking,whether HBV infection had no significant difference (t=1.22～5.20,P＞0.05).Conclusion The expression of anti EZH2 autoantibodies in serum was related to the occurrence and development of hepatocellular carcinoma,and the detection of serum anti EZH2 autoantibodies in serum of liver cancer may be helpful to judge the malignant behavior and prognosis of hepatocellular carcinoma (HCC).which may be used as a refcrcnce for the evaluation of the prognosis of HCC patients with IgG antibody against IgG.

Objective To investigate serum anti-insulin-like growth factor-Ⅱ mRNA binding protein1(IMP1) autoantibody IgG expression in hepatocellular carcinoma(HCC) patient and its relationship with clinicopathological parameters.Methods ELISA method was used to detect serum anti-IMP1 autoantibody IgG in 120 cases of HCC,then the detection results were compared those in 115 healthy individuals(control group).The relationship between serum anti-IMP1 autoantibody IgG level with clinicopathological parameters in HCC patients was analyzed.Results The serum anti-IMP1 autoantibody IgG levels in the HCC group and control group were(1.512±0.685),(1.080±0.301)μg/mL respectively,the HCC group was significantly higher than the control group with statistical difference(P<0.001);serum anti-IMP1 autoantibody IgG in HCC patients was related with the tumor size,tumor differentiation degree,TNM grade and intrahepatic metastasis(P<0.001),and had no obvious relation with the age,sex,drinking and HBV infection(P>0.05).Conclusion Serum anti-IMP1 autoantibody IgG expression increased is increased in HCC patient.The detection of serum anti-IgG autoantibody IMP1 level in HCC is conducive to judge the malignancy degree of HCC.

Objective To explore the clinical distribution states of human papillomavirus genotypes in tissues of 691 women with vulva condyloma acuminates in Nanjing city and Zhenjiang city in Jiangsu Province and genotyping clinical significance.Methods Polymerase chain reaction(PCR)and gene-chips technology were utilized for the detection of 23 kinds of HPV genotypes in tissue specimens from 619 women of vulva condyloma acuminates in Nanjing city and Zhenjiang city in Jiangsu Province.And related materials of all subjects were analyzed.Results In 691 women of vulva condyloma acuminates,597 women of HPV infecton,total infection rate of HPV was 86.40％(597/691),including single genotype infection rate of HPV was 51.38％(355/691),11、6 and 16 genotypes are the most common in single genotypes,they are successively 51.55％(183/355)、41.97％(149/355)and 3.38％(12/355).multiple genotypes infection rate of HPV was 35.02％(242/691),6+11、11+18、6+16 and 11+16 genotypes are the most common in multiple genotypes,they are successively 9.92％(24/242)、9.09％(22/242)、4.96％(12/242)and 4.13％(10/242).Conclusion The low-risk HPV types are the main factors to cause the female vulva CA,a few high-risk HPV types may cause warts as well in tissues of women with vulva condyloma acuminates in Nanjing city and Zhenjiang city in Jiangsu Province.The vulva examine of HPV types should be held to the vulva CA patients.This precaution will has extremely important meaning to the prevention and treatment of the female vulva CA and cervical lesion in our nation.

Objective To study the distribution status and clinical significance of human papillomavirus(HPV) infection geno‐types in condyloma acuminate(CA) tissues of vulva ,vagina and cervix .Methods The gene‐chips combined with polymerase chain reaction (PCR) technology were utilized for detecting 23 kinds of HPV genotypes in tissue specimens from 63 cases of vulval CA , 61 cases of vaginal CA and 65 cases of cervical CA .Their clinical pathological data were analyzed .Results In 63 cases of vulval CA ,56 cases were HPV positive with the HPV infection rate of 88 .89% (56/63) ,in 61 cases of vaginal CA ,55 cases were HPV positive with the HPV infection rate of 90 .16% (55/61) ,and in 65 cases of cervical CA ,62 cases were HPV positive with the HPV infection rate of 95 .39% (62/65) .Conclusion HPV infection is closely related to the CA pathgenesis in vulva ,vagina and cervix . HPV6 and HPV 11 are main stream genotypes ,in which vulval CA is most common .The gene‐chips combined with PCR technology is a method suitable for HPV typing diagnosis ,and has the characteristics of good sensitivity and high specificity ,which has an im‐portant significance for clinical diagnosis ,treatment and vaccine study of CA in femal vulva ,vagina and cervix .