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.

Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing,standardize the limb management of patients with transvenous temporary cardiac pacing,and reduce complications related to the limb.Methods Using evidence-based methods,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality,and then the first draft of the consensus was formed.From December 2023 to January 2024,through 2 rounds of expert consultation and 4 rounds of expert meetings,the content was adjusted and the consensus was reached.Results Totally 16 experts participated in the consultation.The positive coefficient is 100%;the authoritative coefficient is 0.847 and 0.836;the average value of each index is more than＞3.8;the coefficient of variation is less than 0.21.The Kendall's harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314,respectively,which were statistically significant.The consensus covers the preoperative,intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing.Totally 11 themes were involved,including the preoperative preparation,position and catheter fixation in operation,position and catheter fixation in postoperative,activity,turn and transfer,duty shift on limb,nursing care after withdrawal of the catheter,prevention of deep vein thrombosis of the operative limb and prevent infection.Conclusion The consensus is highly scientific,and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.

Objective:To assess the quality of low-keV monoenergetic images using deep learning image reconstruction (DLIR) algorithm combined with dual energy CT (DECT) in gastric cancer and to compare them with images from the conventional adaptive statistical iterative reconstruction (ASiR-V) algorithm.Methods:In this cross-sectional study, DECT images of 31 gastric cancer patients in the First Affiliated Hospital of Zhengzhou University were prospectively collected from September 2022 to March 2023. The 55 keV monoenergy images were reconstructed using the DLIR algorithm at low-, medium-, and high-intensity levels (DLIR-L, DLIR-M, and DLIR-H) based on arterial phase and venous phase images, respectively. The 70 keV 40% mixing coefficient (ASiR-V40%) images were reconstructed using the ASiR-V algorithm. In the objective evaluation of images, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for both lesions and muscle were calculated across four sets of reconstructed images. In the subjective evaluation of images, scores were assigned to the overall image quality, lesion visibility, and diagnostic confidence for each set of reconstructed images. Comparisons of SNR and CNR between the 4 groups were made by One-way repeated-measures ANOVA or Friedman′s test. Comparisons of scores were made by Friedman′s test. The P value of pairwise comparison was adjusted using Bonferroni correction methods. Results:In the objective evaluations, CNR lesion, SNR lesion and SNR muscle were highest on the 55 keV DLIR-H images in the arterial and venous phases, and showed a gradually increasing trend on the 70 keV ASiR-V40%, 55 keV DLIR-L, DLIR-M, DLIR-H images ( P<0.05). In subjective evaluations, compared to the 70 keV ASiR-V40% images, overall image quality scores were numerically higher for the 55 keV DLIR-H ( P>0.05), similar or slightly worse for the 55 keV DLIR-M, and significantly lower for the 55 keV DLIR-L ( P<0.05). The lesion visibility and diagnostic confidence on the 55 keV DLIR reconstruction images were higher in both arterial and venous phases than 70 keV ASiR-V40% images ( P<0.05). Conclusions:Compared to the conventional 70 keV ASiR-V40% images, the 55 keV DLIR-H images had higher lesion contrast and diagnostic confidence with lower image noise. The 55 keV DLIR-M images had comparable overall image quality to 70 keV ASiR-V40% images, but the former had higher lesion contrast and diagnostic confidence. The 55 keV DLIR-L was unable to improve image quality to the level of 70 keV ASiR-V40%.

Objective: To investigate the expression of Apelin and Snail proteins in breast cancer and their relationship with the clinicopathological features and prognosis. Methods: The expression of Apelin and Snail proteins was detected by immunohistochemistry in 89 cases of breast cancer and 50 cases of mammary adenosis collected from January to June in 2008 at Fujian Cancer Hospital; the expression was correlated with the clinicopathological features and outcome of the patients. Results: Apelin and Snail were expressed in 42 cases(47.2%)and 36 cases(40.4%)of breast cancers, respectively, and the expression was higher than that of control group (P<0.01). The expression of Apelin was positively correlated with Snail (r=0.230, P<0.05). Apelin expression was associated with lymph node metastasis and TNM staging(P<0.05). Snail expression was associated with lymph node metastasis(P<0.05). Kaplan-Meier survival curve showed that the prognosis of Apelin positive group was worse than that of Apelin negative group (P<0.01). There was no significant difference in prognosis between Snail negative and positive groups (P>0.05). The prognosis of Apelin and Snail in both positive groups was worse than that of Apelin and Snail both negative groups (P<0.01). Multivariate COX regression analysis showed that Apelin and TNM staging could be used as independent prognostic factors for breast cancer (P<0.05). Conclusions Apelin and Snail are highly expressed in breast cancer, and associated with lymph node metastasis and TNM stage. There is a positive correlation between Apelin and Snail expression, which may suggest a role in breast carcinogenesis. The prognosis of breast cancer with expression of Apelin and co-expression of Apelin and Snail is poor. Therefore, Apelin may be used as an effective indicator to evaluate the prognosis of breast cancer patients.

Objective To investigate clinical manifestation of unspecified functional bowel disorder (UFBD), the features of coexistence with functional gastrointestinal disorder (FGID) and its relationship with psychological factors and sleep disturbance in the Chinese Army servicemen.Methodsc FGIDs were diagnosed based on the RomeⅢ Modular Questionnaire. The subjects were 189 servicemen with UFBD (UFBD group) and 372 without FGID (control group). All subjects completed symptom checklist 90 (SCL-90) and Pittsburgh Sleep Quality Index (PSQI) questionnaire.Results'Have to rush to the toilet when having a desire to defecate' was the most frequent symptom of UFBD (93.7%). More than one half of UFBD patients had the symptom 'a feeling of incomplete emptying as bowel movements' or 'straining during bowel movements'. Twenty-eight percent of UFBD subjects had combined FGID (namely cFGID). Among them, the most frequent was proctalgia fugax (7.9%), followed by cyclic vomiting syndrome (6.3%), functional fecal incontinence (6.3%), functional dyspepsia (4.8%) and belching (4.8%). The UFBD group scored significantly higher than the control group in the global severity index (GSI) and in all SCL-90 subscales (P<0.05). The scores of the four domains (sleep quality, sleep latency , sleep disturbance and daytime function disorder), total PSQI score and proportion of poor sleeping quality were significantly higher in the UFBD group than in the control group (P<0.05). The subjects scored significantly higher in combined FGID group than in UFBD group in GSI and in all of SCL-90 subscales, except for phobic anxiety subscales (P<0.05). However, there was no significant difference in each domain, total PSQI and proportion of poor sleeping quality between the cFGID group and UFBD group (P>0.05).ConclusionPathogenesis of UFBD may be closely correlated with psychiatric and psychological factors and sleep disturbance. cFGID are associated with an increased severity of psychopathological features.

Objective: To explore the correlation among plasma fibrinogen (Fg), serum uric acid (SUA) level, severity of premature coronary heart disease (PCHD) and major adverse cardiovascular events (MACE).Methods:A total of 195 PCHD patients diagnosed by coronary angiography (CAG) were selected, including 72 cases with stable angina pectoris (SAP), 67 cases with unstable angina pectoris (UAP) and 56 cases with acute myocardial infarction (AMI).Another 75 healthy subjects were enrolled as normal control group.Plasma Fg and serum urea acid(SUA)levels were compared among four groups, and their relationship with coronary disease severity and incidence of MACE during six-month follow-up were analyzed.Then ROC curve was used to assess predictive value of plasma Fg and SUA levels for PCHD.Results: Compared with normal control group and SAP group, there were significant rise in levels of plasma Fg[(2.80±0.26) g/L, (2.85±0.32) g/L vs.(3.44±0.32) g/L, (4.25±0.35) g/L]and SUA[(306.56±15.55) μmol/L, (308.81±16.77) μmol/L vs.(349.48±15.59) μmol/L, (368.86±20.72) μmol/L]in UAP group and AMI group (P<0.05 or <0.01), and those of AMI group were significantly higher than those of UAP group (P<0.05 both);Spearman correlation analysis indicated that plasma Fg and SUA levels were significant positively correlated with Gensini score (r=0.750, 0.743, P<0.01 both);levels of plasma Fg and SUA in those suffering from MACE during follow-up were significantly higher than those of patients without MACE, P<0.05 or <0.01.Meanwhile, ROC curve suggested that plasma Fg and SUA possessed certain diagnostic value for PCHD[area under the curve (AUC) =0.867, 0.736].Conclusion: Plasma fibrinogen and serum uric acid detection can provide certain evidence for diagnosing PCHD and determining disease severity.

Objective To determine the accuracy of femoral components sizing predicted by standardized digital templating in total knee arthroplasty (TKA).Methods Fifty consecutive patients (50 knees),who underwent primary TKAs for endstage osteoarthritis,were prospectively studied.The intra-operative and radiographic data were collected.All operations were performed by the same surgical techniques with PS type,open box Vanguard Complete Knee System.All patients underwent lateral and AP radiography of the involved knee under fluoroscopy before and after surgery.The distal femoral anteroposterior dimension (DFAP) were measured and the femoral components size were predicted on preoperative radiographs by two different methods:measurement of DFAP did not include (group A) the cartilage thickness of the medial posterior condyle or included that (group B).Cutting errors were corrected gradually,and DFAP was measured consequently.The most appropriate size was chose after each step respectively based on postoperative radiographs.The accuracy of femoral size predicted under different conditions was compared within two groups.Results During correction of cutting errors,the correct rate ranged from 18％ to 44％ in group A and from 26％ to 34％ in group B,the accuracy within one size ranged from 54％ to 84％ in group A and from 58％ to 84％ in group B.The cartilage thickness of medial posterior condylar,external rotation of femoral component,under-resected of anterior condylar,flexion of femoral component,and over-resected of posterior condylar can change the DFAP by 1.97±0.85 mm,1.56±2.06 mm,1.15±1.31 mm,-2.86±1.52 mm,and-0.87±0.77 mm,respectively.Conclusion Variation of intraoperative cutting errors and the cartilage thickness of medial posterior condyles can influence the accuracy of templating to some extent.Standardized digital radiography templating cannot predict femoral sizes accurately.

Objective:To establish a Mongolian gerbils model by long-term infection of Helicobacter py-lori (Hp) with highly-expressed thioredoxin-1 (Trx1 ) gene and to investigate the histopathological findings of gastric mucosa in Mongolian gerbils.Methods:In this study,75 healthy male Mongolian ger-bils were randomly divided into 3 groups:Hp with highly-expressed Trx1 gene group (n =30),Hp with lowly-expressed Trx1 gene group (n =30),and control group (n =15).The animals underwent gastric perfusion of Hp suspension once a week for 5 weeks.The animals were sacrificed at the end of 4,20, 34,48,70,and 90 weeks after inoculation for detecting Hp colonization by rapid urease test and War-thin-Starry silver staining and histological examination,respectively.Results:(1)The Mongolian gerbil model of long-term infection of Hp with highly-expressed Trx1 gene and lowly-expressed Trx1 gene were successfully established.(2)The macroscopic mucosal lesions,including erythema,uneven,erosion, nodules,etc.could be observed in experimental groups.The severity of lesions and the time when lesions occurred in Hp with highly-expressed Trx1 gene group were heavier/earlier than that in Hp with lowly-ex-pressed Trx1 gene group.(3)Histopathologically,the gastric mucosa of Hp with highly-expressed Trx1 gene group showed the mild dysplastic hyperplasia of epithelial cells 34 weeks after the Hp inoculation, and the time was in the 48th week in Hp with lowly-expressed Trx1 gene group.At the end of the 90th week after Hp inoculation,the gastric adenocarcinoma could be detected in the two experimental groups (71.4% vs.42.8%).The difference between the two experimental groups did not reach statistical sig-nificance (P =0.592),which might be due to the small sample capacity and /or short observation time. In addition,there were 2 cases with severe epithelial dysplastic hyperplasia in Hp with highly-expressed Trx1 gene group,and only 3 cases with moderate epithelial dysplastic hyperplasia in Hp with lowly-ex-pressed Trx1 gene group.The uninfected control animals showed no abnormal findings throughout the en-tire observation period.Conclusion:Hp with highly-expressed /lowly-expressed Trx1 gene colonizes stab-ly in the glandular gastric mucosa of Mongolian gerbils.The histological changes after infection are similar to those of the Hp infected human being,and Hp with highly-expressed Trx1 gene cause the injury of gas-tric mucosa and the occurrence of gastric adenocarcinoma.Trx1 maybe the virulence factor that partici-pates in the pathogenesis of gastric cancer and Hp expressing high levels of Trx1 should be highly toxic for gastric diseases in China.

Objective To investigate the effects and mechanism of glucagon-like peptide-1 ( GLP-1 ) receptor agonist liraglutide on the proliferation and apoptosis of human pancreatic cancer cells. Methods The human pancreatic cancer cell line MIA PaCa-2 was incubated for 24 h with liraglutide at various concentrations (10-1 000 nmol/ L), or with 100 nmol/ L liraglutide for various durations (0-72 h). Cell proliferation was determined by Cell Counting Kit-8 (CCK-8) analysis. RT-PCR and Western blot were used to detect the mRNA and protein expression levels of related genes. Results GLP-1 receptor was expressed in the MIA PaCa-2 cells. Liraglutide suppressed cell proliferation, up-regulated the expression levels of pro-apoptotic protein Bax and down-regulated the expression levels of anti-apoptotic protein Bcl2 in human pancreatic cancer cells in a dose- and time-dependent manner. Meanwhile, liraglutide down-regulated the expression levels of insulin receptor (INSR) and insulin-like growth factor-1 receptor (IGF-1R), and the phosphorylation levels of their downstream signaling proteins Erk1 / 2 and Akt, in a dose- and time-dependent way. Conclusion Liraglutide inhibits proliferation and promotes apoptosis of human pancreatic cancer cells; the process may be mediated via suppressing the expression of INSR and IGF-1R and inhibiting activation of the downstream MEK/ Erk1 / 2 and PI3k/ Akt pathways.

Objective To study the effects of Yizhichan moxibustion on chronic fatigue syndrome (CFS) athletes.Methods 143 patients of CFS were blind randomly devided into3 groups, which were moxibustion of Yizhichan (56 cases) group, general moxibustion group (42 cases), and normal group (45 cases).The normal group was treated by passive massage for relaxation, the moxibustion of Yizhichan group was treated by specific acupoints application of moxibustion of Yizhichan in addition to passive massage;and the general moxibustion groupwas treated by general moxibustion in addition to passive massage.All sample were treated once a day for 6 days in a week.3 weeks was a period of treatment, and the total time of treatment was 15 weeks.Results After treatment, the sleep quality (1.73 ± 0.73, 1.54 ± 0.85 vs.0.83 ± 0.52, F=14.130), time for sleep (1.57 ± 0.60, 1.35 ± 0.60 vs.1.03 ± 0.54, F=5.386), sleep time (1.78 ± 0.71, 1.77 ± 0.61 vs.0.67 ± 0.65, F=19.811), daytime dysfunction (0.78 ± 0.83, 1.64 ± 0.83 vs.1.03 ± 0.83, F=4.798) in the control group, moxibustion of Yizhichan group and a general moxibustion group were statistically significant(P＜0.05).The total effective rate of the moxibustion of Yizhichan group was better than the control group and the general moxibustion group (83.8％, 42.2％ vs.63.6％;x2=13.973, P=0.001).Conclusion Specific acupoints moxibustion of Yizhichan is a beneficial exploration of moxibustion methods of traditional Chinese medicine, and can improve CFS athletes level of physical health, attention and sleep quality.