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 investigate the epidemiological characteristics and mutation spectrum of monogenic diseases in Chinese population through a large-scale,multicenter carrier screening.Methods This study was conducted among a total of 33 104 participants(16 610 females)from 12 clinical centers across China.Carrier status for 223 genes was analyzed using high-throughput sequencing and different PCR methods.Results The overall combined carrier frequency was 55.58%for 197 autosomal genes and 1.84%for 26 X-linked genes in these participants.Among the 16 669 families,874 at-risk couples(5.24%)were identified.Specifically,584 couples(3.50%)were at risk for autosomal genes,306(1.84%)for X-linked genes,and 16 for both autosomal and X-linked genes.The most frequently detected autosomal at-risk genes included GJB2(autosomal recessive deafness type 1A,393 couples),HBA1/HBA2(α-thalassemia,36 couples),PAH(phenylketonuria,14 couples),and SMN1(spinal muscular atrophy,14 couples).The most frequently detected X-linked at-risk genes were G6PD(G6PD deficiency,236 couples),DMD(Duchenne muscular dystrophy,23 couples),and FMR1(fragile X syndrome,17 couples).After excluding GJB2 c.109G>A,the detection rate of at-risk couples was 3.91%(651/16 669),which was lowered to 1.72%(287/16 669)after further excluding G6PD.The theoretical incidence rate of severe monogenic birth defects was approximately 4.35‰(72.5/16 669).Screening for a battery of the top 22 most frequent genes in the at-risk couples could detect over 95%of at-risk couples,while screening for the top 54 genes further increased the detection rate to over 99%.Conclusion This study reveals the carrier frequencies of 223 monogenic genetic disorders in the Chinese population and provides evidence for carrier screening strategy development and panel design tailored to the Chinese population.In carrier testing,genetic counseling for specific genes or gene variants can be challenging,and the couples need to be informed of these difficulties before testing and provided with options for not screening these genes or gene variants.

Objective:To discuss the postoperative survival of the gastric cancer patients with different expression levels of myeloid ecotropic viral integration site 1(MEIS1),and to analyze the predictive value of MEIS1 expression in the prognosis evaluation of gastric cancer.Methods:In a gastric cancer survival cohort,215 patients who underwent radical gastrectomy were selected.Immunohistochemical staining was used to detect the expression levels of MEIS1 in both gastric cancer and adjacent normal tissues.The relationship between expression level of MEIS1 and the clinicopathological characteristics of the patients were analyzed by x2 test or Fisher's exact probability method;survival curves were plotted by Kaplan-Meier method;the differences in survival of the patients between MEIS1 high expression group and MEIS1 low expression group were compared by Log-rank test;multivariate Cox proportional hazards regression model was used to calculate the hazard ratios(HR)and 95％confidence intervals(CI)to assess the relationship between MEIS1 expression level and the survival of the gastric cancer patients.Results:The immunohistochemical staining result showed that the expression level of MEIS1 in gastric cancer tissue was decreased.The univariate analysis results showed that the patients with high MEIS1 expression had a longer overall survival than those with low expression(P=0.049),and had a better prognosis.The multivariate Cox proprotional hazards regression analysis results showed that the low MEIS1 expression and high TNM stage were the independent risk factors for poor prognosis of the patients with gastric cancer(HR=1.577,95％CI:1.011-2.460,P=0.045;HR=2.709,95％CI:1.708-4.297,P＜0.001).Conclusion:The gastric cancer patients with low expression of ME1S1 have a shorter postoperative overall survival;MEIS1 is a promising biomarker for prognosis assessment of the patients after radical gastrectomy.

To investigate the role of the nucleotide-binding domain and leucine-rich-repeat-contai-ning family member X1(NLRX1)in the replication of Newcastle disease virus(NDV),the ex-pression level of NLRX1 was examined following infection of 10-day-old specific pathogen-free(SPF)chicks and HD11 cells with the NDV NA-1 strain.Additionally,the proliferation of NDV,the expression of pro-inflammatory cytokines in HD11 cells,and the oxidative stress status were e-valuated in the presence of either overexpressed or underexpressed NLRX1.The results demonstra-ted that NA-1 infection led to an increase in NLRX1 expression both in vivo and in vitro.Further-more,overexpression of NLRX1 inhibited viral proliferation,enhanced the expression of cellularIL-1β,IL-6,and IFN-β,without affecting levels of autophagy or apoptotic cells.However,NLRX1 elevation resulted in elevated mRNA levels of iNOS,Keap1,Nrf2,NQO1,and HO-1 within 24 h.In conclusion,NLRX1 suppresses NDV proliferation by promoting early ROS production.

Objective To investigate the epidemiological characteristics and mutation spectrum of monogenic diseases in Chinese population through a large-scale,multicenter carrier screening.Methods This study was conducted among a total of 33 104 participants(16 610 females)from 12 clinical centers across China.Carrier status for 223 genes was analyzed using high-throughput sequencing and different PCR methods.Results The overall combined carrier frequency was 55.58%for 197 autosomal genes and 1.84%for 26 X-linked genes in these participants.Among the 16 669 families,874 at-risk couples(5.24%)were identified.Specifically,584 couples(3.50%)were at risk for autosomal genes,306(1.84%)for X-linked genes,and 16 for both autosomal and X-linked genes.The most frequently detected autosomal at-risk genes included GJB2(autosomal recessive deafness type 1A,393 couples),HBA1/HBA2(α-thalassemia,36 couples),PAH(phenylketonuria,14 couples),and SMN1(spinal muscular atrophy,14 couples).The most frequently detected X-linked at-risk genes were G6PD(G6PD deficiency,236 couples),DMD(Duchenne muscular dystrophy,23 couples),and FMR1(fragile X syndrome,17 couples).After excluding GJB2 c.109G>A,the detection rate of at-risk couples was 3.91%(651/16 669),which was lowered to 1.72%(287/16 669)after further excluding G6PD.The theoretical incidence rate of severe monogenic birth defects was approximately 4.35‰(72.5/16 669).Screening for a battery of the top 22 most frequent genes in the at-risk couples could detect over 95%of at-risk couples,while screening for the top 54 genes further increased the detection rate to over 99%.Conclusion This study reveals the carrier frequencies of 223 monogenic genetic disorders in the Chinese population and provides evidence for carrier screening strategy development and panel design tailored to the Chinese population.In carrier testing,genetic counseling for specific genes or gene variants can be challenging,and the couples need to be informed of these difficulties before testing and provided with options for not screening these genes or gene variants.

Objective:To explore the effect of continuous nursing based on Siebens domain management model in patients with Parkinson's disease after deep brain stimulation.Methods:From January 2021 to June 2022, convenience sampling was used to select 169 Parkinson's disease patients who underwent deep brain electrical stimulation in the Functional Neurosurgery of Beijing Tiantan Hospital as the study subject. The patients were divided into a control group of 84 cases and an observation group of 85 cases using the random number table method. The control group received routine continuous nursing, while the observation group received the continuous nursing based on Siebens domain management model on the basis of the control group. This study compared the Activity of Daily Living (ADL) Scale, Morisky Medication Adherence Scale (MMAS), 39-item Parkinson Disease Questionnaire (PDQ-39), Parkinson's Disease Sleep Scale (PDSS) scores, and unexpected program control rate between two groups of patients after six months of discharge.Results:After six months of discharge, the ability of daily living score, quality of life score, and sleep quality score of both groups of patients improved compared to before intervention ( P<0.05), and the medication adherence of the observation group patients improved compared to before intervention ( P<0.05), and the differences were statistically significant. The ability of daily living score, medication adherence, quality of life score, and sleep quality score of the observation group patients after six months were higher than those of the control group, and the differences were statistically significant ( P<0.05). Within six months after discharge, the unexpected program control rate of the observation group was statistically lower than that of the control group ( P<0.05) . Conclusions:In the treatment and discharge rehabilitation process of Parkinson's patients treated with deep brain electrical stimulation, adopting continuous nursing based on the Siebens domain management model can help ensure patient medication compliance, improve postoperative sleep quality and quality of life, reduce unexpected program control frequency, and have certain clinical practice value.

Objective To investigate the cognition of colorectal cancer-related knowledge and influencing factors of patients with middle- and advanced-stage colorectal cancer in ethnic minority areas of Inner Mongolia. Methods According to the national population and the prevalence of colorectal cancer, 277 patients with colorectal cancer were selected by stratified and random sampling in Inner Mongolia. The patients were surveyed in Baotou, Chifeng, Bayannaoer, and other hospitals. The questionnaire included patients' basic information, cognition of colorectal cancer risk factors and screening knowledge, screening information, etc. Results Before suffering from the disease, the patients' knowledge of colorectal cancer (risk factors, early screening knowledge, treatment methods) was low. About 54.9% of patients were unaware of high risk factors for colorectal cancer, 75.8% of patients did not understand the knowledge of early screening of colorectal cancer, and 37.5% of patients did not underst and the treatment of colorectal cancer. The main influencing factors of colorectal cancer cognition were education level and occupation. Patients who work in institutions and enterprises and with higher education level had better cognition. Conclusion Patients with middle- and advanced-stage colorectal cancer in Inner Mongolia have poor knowledge and awareness of risk factors and screening of colorectal cancer before diagnosis. Education level and occupation are factors influencing colorectal cancer cognition, therefore, people with low knowledge rate of colorectal cancer and low education level as well as unemployed laid-off people should be given priority intervention.

Objective:To observe the effect of Ba Duan Jin(Eight-brocade Exercise)plus Tuina(Chinese therapeutic massage)in treating primary dysmenorrhea due to cold-induced blood stasis in female college students and on the score of fatigue scale-14(FS-14). Methods:Seventy-two female college students with primary dysmenorrhea due to cold-induced blood stasis were randomized into a Tuina group and a joint group,with 36 cases in each group.The Tuina group only received Tuina manipulations.In the joint group,besides the same Tuina manipulations,patients practiced Ba Duan Jin.For both groups,the once-daily intervention was conducted from 6 d before the menstrual period until menstrual day 1 for 3 menstrual cycles.Changes in the scores of COX menstrual symptom scale(CMSS),visual analog scale(VAS),and FS-14 after the intervention were observed.Clinical efficacy was also estimated. Results:During the process,1 case dropped out in the Tuina group,and 35 cases completed the intervention;2 cases dropped out in the joint group,and 34 cases completed the intervention.The total effective rate was 94.1%in the joint group,higher than 88.6%in the Tuina group(P<0.05).After treatment,the symptom duration and intensity scores in the scores of CMSS,VAS,and FS-14 declined in both groups(P<0.05 or P<0.01);the CMSS symptom duration score and FS-14 score were lower in the joint group than in the Tuina group(P<0.05). Conclusion:Tuina manipulations alone or combined with Ba Duan Jin practice can effectively treat primary dysmenorrhea due to cold-induced blood stasis in female college students;when combined with Ba Duan Jin practice,Tuina manipulations can more significantly improve pain duration and fatigue,suggesting the advantages of combining Tuina Gongfa and manipulations.

OBJECTIVE To quantitatively evaluate the existing payment policies of diagnosis-related groups （DRGs）in China ， so as to provide reference for the formulation and improvement of policies. METHODS Totally 58 documents related to DRGs payment issued by the national and provincial medical security bureaus from 2017 to 2022 were processed by text mining method. PMC index evaluation model of DRGs payment policy was established. Nine typical DRGs payment policies were quantitatively evaluated and analyzed by 10 primary variables and 40 secondary variables. RESULTS Among the 9 policies，5 were excellent and 4 were acceptable. The average score of PMC index was 6.882. Generally ，there was still room for improvement because of the acceptable level. By comparing the two representative policies ，it was found that the main reasons was a lack of consideration in terms of supervision and management ，incentives and constraints when facing policy changes ，reason of the lower level of urban development. CONCLUSIONS Although DRGs payment policy in China is basically perfect ，there is still a lot of room for improvement in terms of extending the time limit of the policy ，summarizing and spreading the successful experience of pilot cities.

Objective:To explore the application of speckle tracking imaging (STI) stratification strain technique in the assessment of circumferential myocardial function and the myocardial protection of ATP-postconditioning (ATP-PostC) in a rabbit model of acute myocardial infarction.Methods:A total of 40 rabbits were randomly divided into 2 groups: pure ischemia reperfusion group (IR group)and ATP-PostC group. STI images were recorded before and 45 min after occlusion of coronary artery, post low-dose dobutamine stress echocardiography, 60 and 120 min after reperfusion, respectively. The following parameters were obtained: left ventricular ejection fraction(LVEF), heart rate (HR), endocardial circumferential systolic strain (CSsys-endo), mid-myocardial circumferential systolic strain (CSsys-mid) and epicardial circumferential systolic strain (CSsys-epi) at left ventricular short-axis level. At different time points after occlusion and reperfusion, 5 experimental rabbits were killed in each group for pathological examination.Results:①Forty-five min after coronary artery occlusion in both groups, the values of LVEF and HR were decreased( P<0.05), and the absolute values of CSsys-endo, CSsys-mid and CSsys-epi were significantly reduced( P<0.01). After LDDSE, the absolute values of CSsys-endo, CSsys-mid and CSsys-epi were increased, which were different from those after blockade( P<0.05). ②After reperfusion, the circumferential strains were not significantly different from those after blockade in IR group ( P>0.05). After blockade, the absolute values of circumferential strains were increased significantly in the ATP-PostC group compared with IR group( P<0.05). In the ATP-PostC group, the absolute values of CSsys-endo at different time points after reperfusion increased significantly compared with that after blockade ( P<0.05). The absolute values of CSsys-endo and CSsys-mid 120 min after reperfusion continued to increase significantly compared with those 60 min after reperfusion( P<0.05). ③Pathological examination: After 60 min of blockade, there was no significant difference in myocardial infarction area between the IR group and the ATP-PostC group( P>0.05). The percentage of infarct areas at each time point of reperfusion in the ATP-PostC group was decreased compared with that after blockade( P<0.05). Compared with the IR group, the percentage of infarct area in the ATP-PostC group was smaller after 120 minutes of reperfusion and the difference was statistically significant ( P<0.05). Conclusions:The applications of STI stratification strain technique and LDDSE can assess left ventricular circumferential strains at each of myocardial layers before and after reperfusion in rabbit myocardial ischemia ATP-PostC model, identify and evaluate the function of viable myocardium, and exhibit the significant protective effects of ATP-PostC on myocardial reperfusion injury.