OBJECTIVE To explore the mechanism of joint injection of Caulophyllum robustum Maxim in the treatment of rheumatoid arthritis （RA）. METHODS The targets of main saponins in C. robustum Maxim were obtained from Swiss Target Prediction， and the RA treatment targets collected from the GeneCards and OMIM database were intercrossed to establish an interaction network based on network pharmacology. Gene ontology analysis and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway analysis were performed. RA model was established by injecting complete Freund’s adjuvant into the back of rabbits for verification. The arthritis index score， knee diameter and pain threshold of rabbits were compared. Pathological examination of rabbit synovial tissue was carried out. The levels of tumor necrosis factor α （TNF-α）， interleukin-1β （IL-1β） and IL-6 in rabbit serum and synovial fluid were detected. The phosphorylation levels of tyrosine protein Janus kinase 2 （JAK2） and signal transducer and activator of transcription 3 （STAT3） proteins in rabbit synovium were detected. RESULTS Network pharmacology identified 143 intersection targets between the drug and RA. After the construction of the “drug-component-target” network， the core components of the network were echinocystic acid， oleanolic acid， hederagenin， cauloside A and cauloside C， etc. Additionally， the top 10 core targets of PPI network were SRC， STAT3， MAPK1， EGFR， PIK3CA， MAPK3， GRB2， JUN， PTPN11 and JAK2. The results of KEGG pathway analysis showed that the JAK/STAT signaling pathway was mainly involved in the treatment of RA by joint injection of C. robustum Maxim. Results of validation test showed that compared with model group， joint injection of C. robustum Maxim could reduce the swelling of rabbit knee joint， relieve the hyperplasia of synovial layer， reduce the hyperplasia of lower connective tissue， and reduce the number of inflammatory cells and capillaries. The arthritis index score （excluding low-dose group of C. robustum Maxim）， knee diameter， the levels of TNF-α， IL-1β and IL-6 in serum and synovial fluid， and the protein phosphorylation levels of JAK2 and STAT3 were decreased significantly （P＜0.05 of P＜0.01）， while the pain threshold were reduced significantly （P＜0.01）. CONCLUSIONS The core components that may alleviate the inflammatory response of RA in joint injection of C. robustum Maxim could include echinocystic acid， oleanolic acid， hederagenin， cauloside A， and cauloside C. Its mechanism may be related to the inhibition of JAK/STAT signaling pathway and the reduction of inflammatory responses.

Autoimmune hepatitis （AIH） is an autoimmune disease characterized by chronic liver inflammation， with a gradually increasing incidence rate， and its social and medical burdens cannot be neglected. Intestinal microecology is becoming a research hotspot in the field of autoimmune disease. In recent years， it has been believed that changes in intestinal microecology can cause changes in autoimmune state， microbial metabolites， and intestinal barrier， which is one of the driving factors for the onset of AIH. Early diagnosis and correct treatment can help to improve the prognosis of AIH patients. This article introduces the characteristics of gut microbiota in AIH patients， elaborates on the impact of intestinal microflora imbalance on the pathogenesis of AIH， and briefly describes related treatment regimens from the perspective of intestinal microecology， so as to comprehensively understand and explain the role of intestinal microecology in AIH and the impact of intestinal microecology balance on the pathogenesis， diagnosis， and treatment of AIH.

Objective To investigate the effect of the protein kinase RNA-like endoplasmic reticulum kinase(PERK)/eukaryotic initiation factor 2α(eIF2α)pathway in endoplasmic reticulum stress on the activation of hepatic stellate cells(HSC).Methods Pathological sections of normal liver tissue after surgery were collected from 11 patients with hepatic fibrosis(S1-S4)and 9 patients with hepatic hemangioma and hepatic adenoma confirmed by liver biopsy,and immunohistochemistry was used to measure the protein expression levels of PERK,eIF2α,and C/EBP homologous protein(CHOP).Human HSC-LX2 cells were treated with different concentrations of the endoplasmic reticulum stress inducer thapsigargin(0,125,250,500,and 1 000 nmol/L),and qRT-PCR was used to measure the mRNA expression level of PERK,while Western blot was used to measure the protein expression levels of PERK,inositol requiring protein 1(IRE1),activating transcription factor 6(ATF6),CHOP,and α-smooth muscle actin(α-SMA).The method of lentivirus transfection was used to construct a PERK stable overexpression LX-2 group and a control group;qRT-PCR was used to measure the mRNA expression levels of PERK,eIF2α,and α-SMA,Western blot was used to measure the protein expression levels of PERK,phosphorylated eIF2α(p-eIF2α),and α-SMA,and immunofluorescence assay was used to measure the expression of collagen type Ⅰ alpha 1(COL1A1).The independent samples t-test was used for comparison of normally distributed continuous data between two groups;a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups.The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.Results Compared with normal liver tissue,the liver tissue of patients with hepatic fibrosis had significantly higher expression levels of PERK,eIF2α,and CHOP(Z=-3.56,t=-5.75,Z=-3.52,all P<0.001).Compared with the solvent group,the groups treated with different concentrations of thapsigargin had significant increases in the expression levels of the endoplasmic reticulum-associated proteins PERK,CHOP,IRE1,ATF6,and α-SMA(all P<0.05).Compared with the control group,the PERK stable overexpression group had significant increases in the mRNA expression levels of PERK,eIF2α,and α-SMA and the protein expression levels of PERK,p-eIF2α,and α-SMA(all P<0.05),and immunofluorescence assay showed a significant increase in the expression level of COL1A1 in the PERK stable overexpression group(P<0.05).Conclusion PERK overexpression can induce the expression of α-SMA and COL1A1 in LX-2 cells,suggesting that the PERK signaling pathway might be one of the important mechanisms of HSC activation.

Objective To evaluate the effectiveness and safety of ultrasound-guided microwave ablation technique in the treatment of benign thyroid nodules.Methods A total of 3985 nodules in 2913 patients with pathologically confirmed benign thyroid nodules during 2016-2023 were analyzed retrospectively.The one-time ablation success rate,incidence rate of postoperative complications and side effects were evaluated.For 1890 ablation nodules in 1449 patients with a median follow-up period of 12 months,the nodule volume re-duction rate (VRR),recurrence rate,re-ablation rate and technical effective ablation rate were evaluated in postoperative 1,3,6,12,24 months and more.Results The success rate of one-time ablation in all patients was 99.7％ (3972/3985),the technical effective ablation rate was 88.6％ (535/604),the recurrence rate was 3.1％ (59/1890) and the re-ablation rate was 0.7％ (13/1890).In the follow-up nodules,VRR in postopera-tive 1,3,6,12,24 months and more was (-17±430)％ (n=727),(48±152)％ (n=643),(72±38)％ (n=573),(83±20)％ (n=604),(88±18)％ (n=279),respectively.In all patients,the incidence rate of major complications was 2.57％,the incidence rate of minor complications was 2.06％,and the incidence of side effects was 3.09％.Conclusion Ultrasound-guided microwave ablation of thyroid nodules is an effective and safe method for the treatment of benign thyroid nodules.

Objective To explore the mediating effect of triglyceride-glucose(TyG)index on the risk of proteinuria in patients with type 2 diabetes mellitus(T2DM).Methods 734 patients with T2DM who underwent routine physical examination in Quyang Road Community Health Service Center,Shanghai from March 2023 to May 2023 were enrolled.The results of basic information,biochemical indicators,abdominal ultrasound and other results were collected.All patients were divided into the normal group,microproteinuria group,and massiveproteinuria group,and stratification analyses were underwent according to glycated hemoglobin(HbA1c),body mass index(BMI),TyG index,and presence or absence of non-alcoholic fatty liver disease(NAFLD).Factors affecting proteinuria in T2DM patients were analyzed.Multivariate logistic regression was used to analyze the impact of TyG index and NAFLD on proteinuria in type 2 diabetes population.Regression coefficient sequential test was used to analyze whether TyG mediates NAFLD associated proteinuria.Results There were statistically significant differences in age,BMI,urinary creatinine,HbA1c,TyG index,etc.among the normal group,microproteinuria group,and massiveproteinuria group(all P＜0.05);there was no statistically significant difference in gender among the three groups.Multivariate logistic regression analysis showed that taking the HbA1c＜7％and BMI＜24 kg/m2 group as a reference,the patients with HbA1c≥7％and BMI≥24 kg/m2 had the highest risk of proteinuria(P=0.022),followed by the HbA1c≥7％and BMI＜24 kg/m2 group(P=0.039).Taking the TyG index(7.65-8.69)as a reference,the risk of proteinuria in the(9.45-11.90)group was 3.321 times(P＜0.001).The mediation effect analysis showed that the TyG mediated NAFLD associated proteinuria(P＜0.001),with the mediation effect accounting for 55.70％of the total effect.Conclusion TyG index may be an independent risk factor for proteinuria in patients with T2DM,and the prevalence of proteinuria is high in patients with poor control in HbA1c and excessive BMI,and TyG may partially mediate the risk of proteinuria in patients with T2DM.

Objective To investigate the distribution characteristics and risk factors of type 2 diabetes mellitus(T2DM)in rural residents of Yangqu county,Shanxi province.Methods In October 2020,a total of 5028 residents aged 18 years and above in rural are-as of Yangqu county,Shanxi province were selected as the research subjects by multi-stage stratified cluster random sampling.Question-naire survey and physical examination were used to conduct the study.Unconditional Logistic regression was used to analyze the risk factors for T2DM.Results In rural areas of Yangqu county,Shanxi province,11.8％(95％CI:10.9％-12.6％)of residents who were aged 18 years and above had T2DM.The prevalence of females was 14.1％(95％Cl:12.9％-15.4％)and males was 8.6％(95％CI:7.4％-9.8％).The results of unconditional Logistic regression showed that female(OR=1.619,95％CI:1.324-1.981),advanced age(OR=5.909,95％CI:2.893-12.072;OR=9.575,95％CI:4.802-19.095;OR=11.779,95％CI:5.896-23.535;OR=8.793,95％CI:4.238-18.244),hypertension(OR=2.468,95％CI:2.013-3.027),hyperlipidemia(OR=2.968,95％CI:2.232-3.947),and family history of diabetes mellitus(OR=7.253,95％CI:5.434-9.682)were significantly associated with T2DM.Conclusion Female,advanced age,hypertension,hyperlipidemia,and family history of diabetes mellitus were the risk factors of T2DM in rural residents of Yangqu county,Shanxi province.

Objective: To investigate the current status and influencing factors of knowledge, attitude, and practice of hypertension prevention and control among rural residents in Shanxi Province, so as to provide insights into implementation of health education pertaining to hypertension control in rural areas. Methods: A total of 7 403 residents were sampled using a multi-stage cluster random sampling method from rural areas of Yangqu, Daning, and Yonghe counties of Shanxi Province from November 2020 to July 2021 for face-to-face questionnaire surveys and physical examinations. Residents' basic characteristics, knowledge, attitude, and practice of hypertension prevention and control, and height, weight, blood pressure were collected, and factors affecting knowledge, attitude, and practice of hypertension prevention and control were identified using a generalized linear model. Results: A total of 7 403 questionnaires were allocated, and 7 031 effective questionnaires were recovered, with an effective response rate of 94.98%. The respondents included 3 035 men (43.17%) and 3 996 women (56.83%), and had a mean age of (58.45±13.75) years. The median scores of hypertension prevention and control knowledge, attitude and practice were 5 (interquartile range, 4), 16 (interquartile range, 5) and 14 (interquartile range, 7) points, with scoring percentages of 48.40%, 80.55% and 54.41%, respectively. Generalized linear model analysis showed that an educational level of junior high school and above, annual family income per capita of ≥4 000 RMB, family history of hypertension, development of hypertension among family members or friends, overweight/obesity and presence of depression resulted in high scores for hypertension prevention and control knowledge; annual family income per capita of ≥10 000 RMB, family history of hypertension, presence of hypertension among family members or friends, mild/severe insomnia and presence of depression resulted in high scores for hypertension prevention and control attitude, while age of ≥65 years and blood pressure of ≥140/≥90 mmHg resulted in low scores for attitude; females, age of ≥45 years, an educational level of junior high school and above, blood pressure of ≥140/≥90 mmHg, family history of hypertension, presence of hypertension among family members or friends and overweight/obesity resulted in high scores for hypertension prevention and control practice, and residents had a low body weight had a low score for practice (all P<0.05). Conclusions The hypertension prevention and control attitude is satisfactory among rural residents in Shanxi Province; however, the hypertension prevention and control knowledge and practice are poor. Health education pertaining to hypertension prevention and control should be strengthened, and personalized health education is needed targeting individuals with a low educational level and low income.

Objective To analyze the influencing factors and principal components of care needs outside hospital for acute leukemia patients with chemotherapy.Methods A total of 240 acute leu-kemia patients with chemotherapy in authors'hospital from January 2021 to December 2022 were se-lected as research objects,and the patients were divided into no demand group and unsatisfied group according to score of the Supportive Care Needs Questionnaire.The survey questionnaire was used to collect the related materials of patients;the influencing factors were analyzed by Logistic regression coefficient;the principal component analysis(PCA)was used to extract the principal components of influencing factors.Results A total of 240 patients completed the Supportive Care Needs Questionnaire assessment,of which 132 cases(55.00％)had a need for health information,121 cases(50.42％)had a need for care and support,101 cases(42.08％)had a need for psychology,86 cases(35.83％)had a need for physiology and daily life,and 31 cases(12.92％)had a need for sexual support.There were significant differences in gender,age,educational level,average household income and payment method between the two groups(P＜0.05);there were significant differences in the course of dis-ease,patterns of activity and comorbidity of symptoms between the two groups(P＜0.05).Univari-ate Logistic regression analysis showed that gender,age,education level,payment method,average household income,course of disease,patterns of activity and comorbidity of symptoms were the influencing factors of care needs(P＜0.05).Principal component analysis extracted three principal components:payment method,syndrome merging status,anddisease course,with a cumulative con-tribution rate of 63.556％.Conclusion Acute leukemia patients have the highest proportion of health information needs and the lowest proportion of sexual support needs.Payment methods,comor-bidity of symptoms and the course of disease show significant impacts on the care needs of patients.

Objective To analyze the influencing factors and principal components of care needs outside hospital for acute leukemia patients with chemotherapy.Methods A total of 240 acute leu-kemia patients with chemotherapy in authors'hospital from January 2021 to December 2022 were se-lected as research objects,and the patients were divided into no demand group and unsatisfied group according to score of the Supportive Care Needs Questionnaire.The survey questionnaire was used to collect the related materials of patients;the influencing factors were analyzed by Logistic regression coefficient;the principal component analysis(PCA)was used to extract the principal components of influencing factors.Results A total of 240 patients completed the Supportive Care Needs Questionnaire assessment,of which 132 cases(55.00％)had a need for health information,121 cases(50.42％)had a need for care and support,101 cases(42.08％)had a need for psychology,86 cases(35.83％)had a need for physiology and daily life,and 31 cases(12.92％)had a need for sexual support.There were significant differences in gender,age,educational level,average household income and payment method between the two groups(P＜0.05);there were significant differences in the course of dis-ease,patterns of activity and comorbidity of symptoms between the two groups(P＜0.05).Univari-ate Logistic regression analysis showed that gender,age,education level,payment method,average household income,course of disease,patterns of activity and comorbidity of symptoms were the influencing factors of care needs(P＜0.05).Principal component analysis extracted three principal components:payment method,syndrome merging status,anddisease course,with a cumulative con-tribution rate of 63.556％.Conclusion Acute leukemia patients have the highest proportion of health information needs and the lowest proportion of sexual support needs.Payment methods,comor-bidity of symptoms and the course of disease show significant impacts on the care needs of patients.

Gambogic acid is the main active component of Garcinia hanburyi Hook. f. ，which can inhibit the growth of a variety of tumor cells. However ，its low solubility ，short half-life and poor stability limit its clinical application to a certain extent. In order to improve the above shortcomings and improve the bioavailability of gambogic acid ，many studies have used covalent binding and physical encapsulation methods to obtain a new gambogic acid delivery system with targeting ，high permeability ，stability， biocompatibility，in vivo long circulation and other properties ，such as polymer prodrug delivery system ，anoxic prodrug delivery system，magnetic field responsive prodrug delivery system ，multi environment sensitive prodrug delivery system ，bionic nano drug delivery system. This paper reviews the new drug delivery system and its characteristics of gambogic acid. The results show that the design of drug carrier has greatly improved the defects of gambogic acid ，and the introduction of more responsive groups into gambogic acid drug carrier may make it achieve better antitumor effect.