ObjectiveThis study aimed to evaluate the clinical efficacy of Ruyi Zhenbaowan（RYZBW）in the treatment of initial and early knee osteoarthritis （KOA） through a prospective multicenter，randomized，double-blind，and placebo-parallel controlled trial. MethodFrom October 13^th， 2021 to December 25^th， 2021， 240 KOA subjects meeting the acceptance criteria were enrolled in 15 sub-centers including Wangjing Hospital， Chinese Academy of Chinese Medical Sciences， and they were randomly divided into observation group and control group， with 120 cases in each group. The intervention measures for the observation group were RYZBW + health education， and the intervention measures for the control group were RYZBW placebo + health education. The intervention period in both groups was four weeks， and they were followed up for four weeks after the intervention. The primary outcome measure was the total score of Western Ontario and McMaster University Osteoarthritis Index score （WOMAC score）， and the secondary outcome measures were the response rate of visual scale （VAS） pain score， WOMAC sub item scores （joint pain， joint stiffness， and joint function）， quality of life （SF-12） score， and traditional Chinese medicine （TCM） syndrome score. Result（1） Efficacy evaluation. The marginal model results showed that the observation group was better than the control group in improving the WOMAC total score and WOMAC pain score in the treatment of KOA with RYZBW， and the difference was statistically significant （P<0.05）. There was no significant difference between the two groups in improving VAS score response rate， WOMAC function score， WOMAC stiffness score， SF12-PCS （quality of life-physical health） score， SF12-MCS （quality of life-mental health） score， and TCM syndrome score. （2） Subgroup analysis. ① In terms of VAS score response rate， the response rate of the observation group was higher than that of the control group for subjects with baseline VAS score of （4， 5］， and the difference was statistically significant （P<0.05）. ② In terms of TCM syndrome score， for subjects aged ［56， 60］ and ［61， 65］， the decrease in total TCM syndrome score in the observation group was better than that in the control group， and the difference was statistically significant （P<0.05）. ConclusionTibetan medicine RYZBW has good clinical efficacy in improving WOMAC total score， VAS score response rate， WOMAC pain score， WOMAC function score， and TCM syndrome score for patients with initial and early KOA， which can fill the lack of Tibetan medicine RYZBW in the treatment of KOA and make a demonstration study for the inheritance and development of ethnic medicine.

Objective To study the effects of Guizhi Shaoyao Zhimu Decoction on factors related to bone destruction and bone protection in rats with collagen-induced arthritis(CIA)based on osteopro-tegerin(OPG)/receptor activator of NF-κB ligand(RANKL)/receptor activator of NF-κB(RANK)signaling pathway.Methods According to the body weight,60 female Wistar rats were randomly di-vided into the following six groups:the normal group,the model group,the Triperygium wilfordii mul-tiglucoside group(0.01 g/kg),the Guizhi Shaoyao Zhimu Decoction low-dose group(8.6 g/kg),the Guizhi Shaoyao Zhimu Decoction medium-dose group(17.2 g/kg),and the Guizhi Shaoyao Zhimu Decoction high-dose group(34.4 g/kg)(n=10 rats per group).The rats in all groups except for the normal group were given 100 μg bovine type Ⅱ collagen on the 1st and 8th days to establish the CIA model,and was injected into the left foot sole and tail root of the rats.After the successful modeling,the rats were treated by gavage for 4 weeks.The general state,body weight,and arthritis index(AI)score of rats were recorded,and the contents of RANKL and OPG in rat serum were determined by enzyme-linked immunosorbent assay.The mRNA and protein expressions of RANKL,RANK,and OPG in the ankle joint were determined through real-time PCR and Western blotting,respectively.Results Com-pared with the normal group,the general state of the model group was poor,the toe swelling was obvious,the AI score was increased,the serum RANKL content was increased,the serum OPG content was de-creased,and the mRNA and protein expressions of RANKL and RANK in the ankle joint were increased(P＜0.05).Compared with the model group,the degree of toe swelling and the AI score of rats in the Guizhi Shaoyao Zhimu Decoction low-,medium-,and high-dose groups were decreased,the serum RANKL content was decreased,the serum OPG content was increased,the mRNA and protein expres-sions of RANKL and RANK in the ankle joint were decreased,the mRNA and protein expressions of OPG were increased,and the RANKL/OPG ratio of the ankle joint was decreased(P＜0.05).Conclusion Guizhi Shaoyao Zhimu Decoction can improve the destruction of joint bone in CIA rats,and its mecha-nism of action may be related to reducing RANKL level,reducing RANKL/OPG ratio,and regulating bone balance.

Objective To observe the clinical effect of traditional Chinese medicine bone-setting technique using spinal,pelvi-lower extremity line to treat patients with knee osteoarthritis(KOA).Methods 426 patients with KOA were all from the First Affiliated Hospital of Hebei University of Traditional Chinese Medicine.They were randomly divided into experimental group(384 cases,57 cases of elimination,shedding and termination)by computer generated sequence.Traditional Chinese bone setting techniques were applied with spinal-pelvic-lower limb force line(divided into three parts:lumbar fixed point reduction method,hip joint push-pull and extension method and knee peripheral tendon recovery method every 3 days.2 weeks)treatment;The control group was the waiting treatment group(48 cases,6 cases were eliminated,abscission,termination),which was only used for clinical observation for 2 weeks.The main outcome index was WOMAC pain score.Secondary outcome measures were WOMAC stiffness score,functional score,standardized score and quality of life score(SF-12).The test time points were baseline,2 weeks after enrollment,and follow-up(14 weeks after enrollment).The control group was at baseline and 2 weeks after enrollment.Results Compared with baseline,WOMAC pain score,stiffness score,functional score and standardized score were all decreased in 2 groups 2 weeks after enrollment(P<0.05),but the experimental group was significantly decreased compared with the control group(P<0.001).SF-12 quality of life scores were all higher than before(P<0.001),but the experimental group was significantly higher than the control group(P<0.001).At follow-up,compared with 2 weeks after enrollment,WOMAC pain scores were increased(P<0.001),WOMAC stiffness,joint function and standardized scores were decreased(P<0.001),and SF-12 scores were increased(P<0.001).Conclusion The use of spinal-pelvi-lower extremity line of traditional Chinese medicine bone-setting technique in the treatment of KOA is effective in improving the knee joint function and improving the quality of life of patients,but the short-term effect of pain relief is good,and the long-term effect is not good.Its safety is good,and it can be considered in clinical application for KOA patients with joint dysfunction as the main manifestation.

Electrocardiogram (ECG) signal is an important basis for the diagnosis of arrhythmia and myocardial infarction. In order to further improve the classification effect of arrhythmia and myocardial infarction, an ECG classification algorithm based on Convolutional vision Transformer (CvT) and multimodal image fusion was proposed. Through Gramian summation angular field (GASF), Gramian difference angular field (GADF) and recurrence plot (RP), the one-dimensional ECG signal was converted into three different modes of two-dimensional images, and fused into a multimodal fusion image containing more features. The CvT-13 model could take into account local and global information when processing the fused image, thus effectively improving the classification performance. On the MIT-BIH arrhythmia dataset and the PTB myocardial infarction dataset, the algorithm achieved a combined accuracy of 99.9% for the classification of five arrhythmias and 99.8% for the classification of myocardial infarction. The experiments show that the high-precision computer-assisted intelligent classification method is superior and can effectively improve the diagnostic efficiency of arrhythmia as well as myocardial infarction and other cardiac diseases.
Humans ; Electrocardiography ; Heart Diseases ; Myocardial Infarction/diagnostic imaging* ; Algorithms ; Electric Power Supplies

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable common chronic airway disease. As the gatekeeper of health care, general practitioners should play a key roles in prevention and management of COPD; however, the ability of COPD prevention and management is generally limited among general practitioners, so that the training for them is essential. At present there is no unified training program and standard for COPD prevention and management in China, the training contents and methods are various, and the training facilities and capacity are inadequate, particularly in grass-roots institutions, all these restrain the development of effective training. This articles reviews the status quo of COPD prevention and management training for general practitioners at home and abroad, and suggests to construct a network for chronic respiratory diseases management and a training system for primary care health workers to improve the prevention and management of COPD in China.

Multiple chronic conditions have become prominent health problems nowadays. There is a positive correlation between the number of chronic diseases and the risk of sleep disorders. Patients with sleep disorders will also be more difficult to control chronic diseases they have. Therefore, more attention should be paid to the sleep problems in patients with multimorbidity. This article discusses the interrelation between multimorbidity and sleep disorders from various dimensions, to provide a new vision for the prevention and treatment of sleep disorders in patients with multimorbidity.

AIM: To introduce the entry point of clinical pharmacists on developing pharmaceutical care in the department of nephrology to further explore more pharmaceutical care entry point and to better promote rational drug use. METHODS: To summarize the work of the clinical pharmacists participate in the formulation and optimization of anti-infection therapy; participate in the formulation of parenteral nutrition program; conduct medication and adherence education; conduct pharmaceutical monitoring; provide evidence-based medical analysis for the off-label drug use in the department of nephrology by case sharing. RESULTS: Clinical pharmacists provide pharmaceutical care in the department of nephrology. This improves the medication compliance, avoids adverse reactions, optimize therapeutic regimen. CONCLUSION: Developing various pharmaceutical care in the department of nephrology will be safe, effective and economic for drug application.

Objective:To study the medication rules of treating cervical spondylosis by National TCM master Liu Bailing based on data mining and network pharmacology, and explore the potential action mechanism of its core compounds.Methods:By collecting the prescriptions of National TCM master Liu Bailing treating cervical spondylosis in the past 8 years, this paper analyses the frequency, nature, flavor, meridian, hierarchical clustering and association rules of those prescriptions by RStudio to obtain the core prescription. Then, the effective components of the core prescription were collected by using TCMSP, and the network of "medicine-component-target" was constructed by using Cytoscape 3.8.0; by searching for databases like GEO, DisGeNET, TTD HPO and Genecards were retrieved to obtain the target data set of cervical spondylosis; by using STRING 11.0 platform to construct protein interaction network; by using DAVID platform to cary out gene ontology (GO) and KEGG pathway enrichment analysis; by using Auto Dock software for molecular docking.Results:In the 844 prescriptions, there are 199 Chinese medicines and the properties are mainly warm, plain and cold; the flavors were mainly sweet, pungent and bitter; mainly belong to the liver, spleen, and kidney meridians. The Association Rule shows that the core compound is made up of Salvia miltiorrhiza, Gastrodia elata, Rhizoma corydalis, Alisma rhizoma, centipede, Astragalus membranaceus and Rhizome of Pueraria. Besides, 140 effective constituents and 247 targets of the core prescription were screened, and the main constituents were quercetin, kamanol, luteolin, tanshinone ⅡA, β-sitosterol, etc. 13 core targets among the core prescription treating cervical spondylosis were obtained, which were enriched into 30 pathways including toll-like receptor signaling pathway, TNF signaling pathway and HIF-1 signaling pathway. Conclusion:National TCM master Liu Bailing treatment of cervical spondylosis mainly focuses on expelling wind and relieving pain, dredging meridians and soothing tendons, and the mechanism of action of the core prescription may focus on inhibiting inflammatory response and relieving oxidative stress, providing guidance and reference for the clinical treatment of cervical spondylosis.

The incidence of colorectal polyp shows an upward trend, and some types of colorectal polyps, may evolve into colorectal cancer. Dyslipidemia is not only related to the occurrence of cardiovascular diseases, but also related to the occurrence and development of colorectal polyps. Hyperlipidemia can directly or indirectly stimulate the proliferation of colorectal mucosal cells and lead to tumorigenesis. Exploring the factors affecting the occurrence and recurrence of colorectal polyps may be conducive to prevent and manage the disease. General practitioners should pay attention to the high-risk group of colorectal polyps, and timely health education and colonoscopy screening are important measures to prevent its occurrence and further cancer development.

Objective:To examine the association between baseline serum albumin level and short-term, long-term outcomes in patients with systemic sclerosis associated interstitial lung disease (SSc-ILD).Methods:A total of 259 patients with SSc-ILD who were hospitalized in West China Hospital of Sichuan University from January 2008 to December 2018 were enrolled. The data of serum albumin, demographic characteristics, peripheral blood hemoglobin at admission, and treatment plan were obtained from the hospital information management system, and the survival of the patients were followed up to June 1, 2019. The mean baseline serum albumin of 259 patients was 37.67 g/L, there were 118 patients with serum albumin ≤37.67 g/L (low protein group) and 141 patients with serum albumin>37.67 g/L (high protein group).Results:There were 64 males and 195 females with a mean age of 50.0(41.0, 61.0) years. The follow-up time was 627(61, 1 426) days. Compared to high protein group, the low protein group had higher proportion of male patients [30.5%(36/118) and 19.9%(28/141),χ 2=3.92, P=0.048], and higher levels of the erythrocyte sedimentation rate [45.0(27.0,69.0) vs. 29.0 (19.0,46.0)mm/1 h,χ 2=4.07, P<0.001], neutrophil percentage [71.50(63.35,77.13) vs. 65.60(59.50,72.50)%,χ 2=3.65, P<0.001], platelet [196(140,273) vs. 172(126,240)×10 9/L,χ 2=1.99, P=0.046], nutrophil/lymphocyte ratio [33.85(2.53,5.28) vs. 2.61(1.97,3.83),χ 2=4.57, P<0.001], platelet/lymphocyte ratio [149.0(112.0,216.8) vs. 113.5(72.76,158.8),χ 2=4.98, P<0.001], aspartate aminotransferase [27.0(21.0,39.0) vs. 23.0 (19.5,30.0) IU/L,χ 2=2.93, P=0.003], globulin [31.20(26.90,36.83) vs. 29.50(25.65,32.80) g/L,χ 2=2.28, P=0.023], serum cystatin C[1.14(0.98,1.33) vs. 1.02(0.88,1.16) mg/L,χ 2=3.80, P<0.001], IgA[2 710 (1 965,3 505) vs. 2 460 (1 862,3 105) mg/L,χ 2=2.13, P=0.033], IgG[15.05(12.83,21.08) vs. 13.60(11.53,17.23)g/L,χ 2=3.24, P=0.001], IgE[60.44(24.92,197.99) vs. 34.82(14.72,85.04) kIU/L,χ 2=3.33, P=0.001] and circulating immune complex [0.13(0.08,0.19) vs. 0.10(0.08,0.13)O.D,χ 2=2.60, P=0.009]; and lower levels of hemoglobin [121.5(101.8,132.0) vs. 129.0(119.0,142.0) g/L,χ 2=5.05, P<0.001], albumin [(33.28±3.49) vs.(41.34±2.95) g/L,χ 2=20.17, P<0.001] and IgM[1 320 (932,1 745) vs.1 560(1 170,2 030) mg/L, χ 2=2.63, P=0.009]. The utilization rate of antibiotics was higher in the low protein group (60 vs. 43 cases, χ 2=11.10, P=0.001). The number of patients followed up to 1, 5, and 10 years were 248, 245, and 244, respectively. The 1-year, 5-year, and 10-year cumulative survival rates of patients in low protein group and high protein group were(91.0% vs. 98.4%, χ 2=6.23, P=0.013;87.0% vs. 97.1%, χ 2=6.15, P=0.013; 81.6% vs. 97.1%, χ 2=7.00, P=0.008) respectively. Conclusions:Patients with scleroderma-associated interstitial lung disease have an increased risk of poorer prognosis when serum albumin ≤37.67 g/L.