ObjectiveTo investigate the effect and mechanism of Qingre Sanzhuo decoction in treating gouty arthritis （GA） combined with hyperuricaemia （HUA）. MethodsSixty male SD rats were randomized into normal， model， colchicine （0.5 mg·kg^-1）， and low-， medium-， and high-dose （17， 34， 68 g·kg^-1， respectively） Qingre Sanzhuo decoction groups （n=10）. The rats in other groups except the normal group were treated with the modified method for the modeling of GA combined with HUA. The drug intervention groups were administrated with corresponding drugs by gavage in the afternoon every day and the normal group and the model group were administrated with an equal volume of sterile normal saline by gavage. The level of uric acid （SUA） in the serum was measured 2 h after the last administration. The degree of ankle joint swelling was calculated 0.5， 12， 24， 48 h after modeling， and joint inflammation was scored. The pathological changes of ankle joints were observed by hematoxylin-eosin staining， and the serum levels of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， C reactive protein （CRP）， and interleukin-18 （IL-18） were measured by enzyme-linked immunosorbent assay. Real-time PCR was performed to determine the mRNA levels of NOD-like receptor protein 3 （NLRP3）， apoptosis-associated speck-like protein containing CARD （ASC）， cysteinyl aspartate-specific protease-1 （Caspase-1）， gasdermin D （GSDMD）， and nuclear factor-kappa B （NF-κB） in the synovial tissue of ankle joints. Western blot was employed to determine the protein levels of NLRP3， ASC， and Caspase-1 in ankle joints. The immunohistochemical method was used to detect the expression of GSDMD and NF-κB in the synovial tissue of ankle joints. ResultsCompared with the normal group， the model group showed increased SUA in the serum （P<0.05）， ankle joint swelling and joint inflammation （P<0.05）， increased number of blood vessels in the synovium， inflammatory cell foci in the synovial bursa， elevated serum levels of TNF-α， IL-1β， CRP， and IL-18 （P<0.05）， and up-regulated mRNA and protein levels of NLRP3， ASC， Caspase-1， GSDMD， and NF-κB in the synovial tissue of ankle joints （P<0.05）. Compared with the model group， the medium- and high-dose Qingre Sanzhuo decoction groups showed reduced SUA in the serum （P<0.05）， alleviated ankle joint swelling and joint inflammation （P<0.05）， lowered serum levels of TNF-α， IL-1β， CRP， and IL-18 （P<0.05）， and down-regulated mRNA and protein levels of NLRP3， ASC， Caspase-1， GSDMD， and NF-κB in the synovial tissue of ankle joints （P<0.05）. However， in terms of ameliorating the pathological changes of ankle joints， only the high-dose Qingre Sanzhuo decoction group showed normal morphology of the synovial membrane of ankle joints and no obvious lesion in the articular cartilage. ConclusionQingre Sanzhuo decoction may play a role in preventing and controlling GA combined with HUA by down-regulating the activity of NLRP3/ASC/Caspase-1 pathway and inhibiting the expression of inflammatory cytokines， such as TNF-α， IL-1β， CRP， and IL-18.

Rheumatoid arthritis(RA)is an autoimmune disease with the basic pathological manifestation of synovial inflammation.Symmetric poly-articular pain and swelling are the main symptoms in clinical practice,and even extra-articular manifestations and comorbidities such as interstitial fibrosis and coronary artery disease are triggered,which seriously affect the quality of life of patients.Traditional Chinese medicine(TCM)has achieved good clinical efficacy in the prevention and treatment of RA with the advantages of multi-pathway,multi-target,multi-component,and less toxic side effects,and plays an important role in the treatment of RA.Recently,many studies have demonstrated that Chinese medicine monomers and Chinese herbal compound can control inflammation,reduce angiogenesis,induce apoptosis of synovial fibroblasts,and inhibit their proliferation,invasion and migration by regulating the PI3K/Akt signaling pathway,so as to play a key role in the treatment of RA.For this reason,the article summarizes current knowledge regarding the PI3K/Akt signaling pathway and its role in RA,as well as summarizes the current research progress of TCM in the treatment of RA by regulating the PI3K/Akt signaling pathway.The aim of this review is to provide theoretical bases for the prevention and treatment of RA and the development of new drugs.

Ankylosing spondylitis （AS） is an inflammatory autoimmune disease with chronic low back pain as the main clinical manifestation， which mainly affects the axial joints， peripheral joints and various organs. In severe cases， the spine is stiff or deformed， which affects the quality of life and health of patients. The pathogenic factors of AS are complex， which are related to heredity， immunity and intestinal flora. The pathogenesis of AS is not clear yet. Among them， inflammatory reaction， bone destruction and heterotopic ossification are the main pathological features of AS， which play an important role in the disease process of AS. Traditional Chinese medicine has multi-target， multi-channel and multi-component pharmacological effects， which can prevent and treat AS by anti-inflammation， inhibiting bone destruction and preventing heterotopic ossification， and the clinical effect is remarkable， but there is no relevant literature report. Therefore， this review expounds the relationship between inflammatory reaction， bone destruction and heterotopic ossification and the occurrence and development of AS， and summarizes the latest research reports of traditional Chinese medicine in treating AS from anti-inflammatory， inhibiting bone destruction and preventing heterotopic ossification， aiming at providing reference and new ideas and directions for further research on the prevention and treatment of AS by traditional Chinese medicine.

Objective:To explore the effect of the medical alliance co-management hierarchical diagnosis and treatment model in the hospital-community comprehensive management of diabetic foot patients.Methods:From June to December 2020, convenience sampling was used to select 134 diabetic foot patients in the Endocrinology Department of the First Affiliated Hospital of Zhengzhou University as the research subject. According to the random number table method, the patients were divided into the control group and the observation group, 67 cases in each. The control group conducted routine management, while the observation group carried out hospital-community comprehensive management based on the medical alliance co-management hierarchical diagnosis and treatment model. Patients were surveyed using the Diabetic Foot Self-Care Questionnaire of the University of Malaga (DFSQ-UMA) . The Wagner grade and progression of diabetic foot, the risk factors of diabetic foot and the foot self-care were compared between the two groups.Results:After intervention, there were more patients with Wagner grade 0, 1 and 2 in the observation group than the control group, and fewer patients with Wagner grade 3, 4 and 5 than the control group. The number of diabetic foot progression cases in the observation group and the control group were 6 cases (8.96%) and 19 cases (28.36%) , respectively, and the difference was statistically significant (χ 2=8.310, P=0.004) . After intervention, the score of the Scale of High Risk Factors of Diabetic Foot of the observation group was lower than that of the control group, and was lower than the score before intervention, and the differences were statistically significant ( P<0.05) . After intervention, the DFSQ-UMA dimension scores in the observation group were higher than those in the control group, and were higher than those before intervention, and the differences were statistically significant ( P<0.05) . Conclusions:The hospital-community comprehensive management based on the medical alliance co-management hierarchical diagnosis and treatment model can effectively delay the progression of patients with diabetic foot, reduce the risk factors of diabetic foot, and improve the patients' foot self-care.

OBJECTIVE: To detect variant of TRNT1 gene in a child featuring sideroblastic anemia with B-cell immunodeficiency, periodic fever and developmental delay (SIFD). METHODS: The proband and his parents were analyzed through trio-whole exome sequencing. Sanger sequencing and bioinformatic analysis were carried out to verify the candidate variant sites associated with the clinical phenotype. RESULTS: Genetic testing showed that the proband has carried compound heterozygous variants of the TRNT1 gene, namely c.88A>G(p.Met30Val) and c.363G>T(p.Glu121Asp). Sanger sequencing confirmed that the variants were respectively inherited from his father and mother. The variants were unreported previously. By bioinformatic analysis, both variants were predicted to affect the stability of binding of the TRNT1 protein with tRNA. Based on the American College of Medical Genetics and Genomics standards and guidelines, c.88A>G and c.363G>T variants of TRNT1 gene were predicted to be uncertain significance (PM2+PP3+PP4) and likely pathogenic (PM1+PM2+PP3+PP4), respectively. CONCLUSION The c.88A>G (p.Met30Val) and c.363G>T(p.Glu121Asp) compound heterozygous variants of the TRNT1 gene probably underlay the disease in this patient. Above finding has enriched the spectrum of TRNT1 gene variants.
Genetic Testing ; Humans ; Nucleotidyltransferases

Objective:To investigate the composition of psychological symptom cluster of patients after plastic surgery and analyze the correlation between psychological symptom cluster and quality of life.Methods:Convenient sampling was performed to select 102 patients who were admitted to Department of Plastic Surgery of the First Affiliated Hospital of Zhengzhou University from April 2019 to July 2020. General information questionnaire, Profile of Mood States (POMS) and The World Health Organization Quality of Life-BREF (WHOQOL-BREF) were used to conduct the survey. Exploratory factor analysis was used to extract psychological symptom clusters and the correlation between the symptom clusters and quality of life was analyzed.Results:A total of 102 questionnaires were issued and 102 valid questionnaires were returned, with a valid recovery rate of 100%. A total of 30 psychological symptoms were selected, and the top 5 most frequently were anxiety, worry, tension, uncertainty and anger. Through exploratory factor analysis, three psychological symptom groups were obtained, including tension-anxiety symptom cluster (worry, tension, anxiety, restlessness) , information lack symptom cluster (uncertainty, confusion, helplessness, panic) and irritability symptom cluster (anger, anger, resentment) . After plastic surgery, the tension-anxiety symptom cluster, information lack symptom cluster and irritability symptom cluster were all negatively correlated with quality of life ( P<0.01) . Conclusions:The types of psychological symptom cluster of patients after plastic surgery are diverse and complex. Among them, the stress-anxiety symptom cluster, information lack symptom cluster and irritability symptom cluster are negatively related to quality of life, which aggravates the patient's symptom experience and affects their postoperative quality of life. Medical staff should pay attention to the occurrence and development of symptom cluster and formulate reasonable intervention measures from the perspective of psychological symptom group nursing to improve quality of life of patients.

Objective:To investigate the effects of histone deacetylase inhibitor Chidamide (CS055) and DNA methyltransferase inhibitor decitabine (DAC) on proliferation and apoptosis of acute myeloid leukemia cell line U937 and its possible mechanism.Methods:U937 cells were cultured in vitro and treated with CS055 (CS055 single drug group), DAC (DAC single drug group), combination (combined drug group)and a negative control group. Methyl thiazolyl tetrazolium (MTT) assay was used to detect the proliferation inhibition rate. The apoptosis rate was detected by flow cytometry.The mRNA expression of DNA methyltransferase 1 (DNMT1) was analyzed by real-time fluorescence quantitative polymerase chain reaction (qRT-PCR). Western blot was used to analyze the expression of acetylated histone H3 and DNMT1. Results:The proliferation inhibition rate of U937 cells treated with CS055 and DAC increased significantly in a time-dose-dependent manner. The inhibitory effect of the combination group was more obvious than that of the single drug group. Flow cytometry showed that the 72 h apoptotic rates in the control group, 0.25 μ mol/L CS055 group and 2.5 μ mol/L DAC group were (0.67±0.12)%, (23.43±0.50)%, (8.47±0.32)%, (32.73±0.42)%. The apoptotic rate was significantly increased in the combination group compared with the single drug group. qRT-PCR showed that the expression of DNMT1 mRNA was down-regulated after CS055 and DAC treat alone; the down-regulating effect of the combination group was more significant. Western blot showed that the up-regulation of Ac-H3 and the decrease of DNMT1 in the combination group were significantly higher than those in the single drug group.Conclusions:The application of CS055 and DAC alone could inhibit the proliferation and induce apoptosis of U937 cells. The combination of the two drugs has obvious synergistic effect. The mechanism is that histone deacetylase inhibitors have demethylation effects, and demethylation drugs also have the effect of histone deacetylase inhibitors, which in combination increases demethylation and increases histone deacetylation.

The nursing students of Grade 2009 to Grade 2016 were selected.Their skills,midterm,usual and final performances as well as comprehensive scores of normal human morphology course were analyzed by one-way ANOVA in combination with different stages of curriculum integration in order to compare the teaching effect between traditional teaching mode + evaluation system and mixed teaching mode + formative evaluation in the course of normal human morphology.Statistical analysis by SPSS 17.0 showed that the average score of formation stage (traditional teaching mode) was 67.55 ± 12.72,the average score of integration stage (mixed teaching mode) was 72.79 ± 10.93 and the average score of development stage (formative evaluation +mixed teaching mode) was 83.94 ± 9.58.After making comparisons,the P values of ANOVA of the course of normal human body morphology in all stages were all less than 0.001,having statistical significance.The results showed that the overall development of the curriculum is becoming mature and the new teaching model can help students who usually do not like to review.

Richter syndrome (RS) is a rare disease of the lymphohematopoietic system. It is defined as the transformation of a low-grade malignant lymphoproliferative disorder into a more aggressive lymphoproliferative disorder, most commonly, diffuse large B-cell lymphoma (DLBCL). The disease is rare in the clinic and has nonspecific clinical manifestations. An excisional lymph node biopsy is considered the gold standard for diagnosis of RS; 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) can help inform the optimal site for biopsy. The main treatment strategies are chemotherapy, hematopoietic stem cell transplantation (HSCT), participating in a clinical trial of a new medicine, and others, but the overall prognosis is poor. At present, there is no sufficient treatment for the disease. In order to improve the awareness of disease and identify it among a variety of similar diseases, while aiming to discuss treatment strategies, this article reviewed RS in terms of the risk factors, clinical manifestations, diagnosis, treatment, and prognosis.

Objective To investigate the safety and effectiveness of endoscopical therapy for small grastric stromal tumor( d<2 cm) . Methods Clinical records of 80 patients dignosed as having small grastric stromal tumor by pathology and immunohistochemistry were retrospectively analyzed. Endoscopic or laparo?scopic or open surgery was performed, so patients were divided into endoscopic treatment group ( n=37) and surgical treatment group ( n=43) accordingly. Perioperative period data, effectiveness and follow?up data were analysed. Results Thirty?five cases( 94?6%) of endoscopic treatment group were successfully treated by endoscopic surgery. Intraoperative perforation occurred in 8 cases, among which 2 cases transferred for conventional operations.Pneumoperitoneum occurred in 2 cases (better after symptomatic treatment), while no serious infection or perioperative death occurred. There were no significant differences in the complete re?section rate[ 91?89% ( 34/37) VS 100?0%( 43/43) , P=0?095) , the incidence of postoperative complica?tions[5?71%(2/35)VS 2?33%(1/43),P=0?855)or the improvement of postoperative symptoms[93?10%( 27/29) VS 85?71% ( 30/35) , P=0?589] ,while statistically significant differences were found in operation time[(37?41±13?45)min VS(84?56±38?37)min, P=0?000], intraoperative blood loss[(5?65±5?88)ml VS(31?48 ±39?57)ml, P=0?000], postoperative feeding time[(2?47±0?61)d VS(3?26 ±1?27)d, P=0?001], postoperative hospital stay[(5?76 ±2?28)d VS(7?64±2?99)d,P=0?022],and medical expenses [(18 554?4±9 736?45)yuan VS(31 138?11±1 206?24)yuan, P=0?000]. Conclusion Endoscopic re?section is safe and effective for small grastric stromal tumor with minimal invasion,simple procedure, faster recovery and less economic burden for the patients.