OBJECTIVE To investigate the ameliorating effect and mechanism of the effective substance groups from Artemisia ordosica（Abbreviated as HSH） on rheumatoid arthritis （RA） based on cluster of differentiation 4/lymphocyte cell-specific protein- tyrosine kinase/zeta-chain-associated protein kinase of 70 kDa/interleukin-17（CD4/LCK/ZAP70/IL-17） signaling pathway. METHODS The rats were divided into normal group， model group， HSH low-dose， medium-dose and high-dose groups （2.7， 10.8， 21.6 mg/kg） and positive control group （Tripterygium glycosides tablet， 6.3 mg/kg）， with 10 rats in each group. Except for normal group， RA rat model was induced by complete Freund’s adjuvant in other groups. After modeling， each group was given relevant medicine or normal saline intragastrically， once a day， for 28 consecutive days. The changes in ankle joint swelling and arthritis index in rats were determined； the pathological changes of ankle joint tissue were observed； the levels of inflammatory factors [IL-1β， IL-21， IL-17A， IL-2， interferon-γ （IFN-γ） and IL-6] in serum and joint fluid of rats were determined； the levels of Th1， Th17 and Treg cells in the whole blood and spleen of rats were detected； protein and mRNA expressions of LCK， proto-oncogene tyrosine-protein kinase Fyn （Fyn）， ZAP70， CD45， RAR-related orphan receptor γt （RORγt）， and forkhead box protein 3 （Foxp3） in ankle synovial tissue were determined. RESULTS Compared with normal group， the changes in ankle joint swelling， arthritis index， the levels of IL-1β， IL-21， IL-17A， IL-2， IFN-γ and IL-6 in serum and joint fluid， the levels of Th1， Th17 cells and Th17/Treg value in whole blood and spleen， and the protein and mRNA expression levels of LCK， Fyn， ZAP70， CD45， and RORγt in ankle joint synovium were all significantly increased/elevated （P＜0.05）. The level of Treg cells in the spleen， as well as the protein and mRNA expression levels of Foxp3 in the ankle joint synovium were significantly decreased （P＜0.05）. Compared with model group， most of the above-mentioned indicators were significantly reversed in the positive control group and all dose groups of HSH （P＜0.05）. The degree of pathological changes in ankle joint tissues was markedly improved， and inflammation was alleviated. CONCLUSIONS HSH can regulate the cascade reactions in the CD4/LCK/ZAP70/IL-17 pathway within the T-cell receptor signaling pathway， thereby modulating the Th17/Treg balance. This leads to the suppression of inflammatory responses and the alleviation of synovial tissue damage in rats with RA.

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 explore the genetic basis for a patient with Familial hemophagocytic lymphohistiocytosis (FHL). METHODS: A 35-day-old male infant who was admitted to the Oriental Hospital Affiliated to Xiamen University on August 3, 2021 due to fever for over 7 hours was selected as the study subject. Whole exome sequencing (WES) was carried out for the proband and his parents, and candidate variants were selected based on the clinical phenotypes of the proband and confirmed by Sanger sequencing. RESULTS: WES and Sanger sequencing results revealed that the proband had harbored compound heterozygous c.67_71delinsGCCC and c.65delC variants of the PRF1 gene, which were respectively inherited from his mother and father. The c.67_71delinsGCCC variant was unreported previously. Based on the guidelines of American College of Medical Genetics and Genomics and clinical manifestations, it was classified as pathogenic (PVS1+PM2_Supporting+PM3+PP4). c.65delC was a known pathogenic variant (PVS1+PM2_Supporting+PM3_Strong+PP4). CONCLUSION The compound heterozygous variants of c.67_71delinsGCCC and c.65delC of the PRF1 gene probably underlay the disease in the proband. The identification of the novel variant has expanded the mutational spectrum of the PRF1 gene.
Male ; Female ; Humans ; Lymphohistiocytosis, Hemophagocytic/genetics* ; Genomics ; Mothers ; Mutation ; Phenotype

Objective To investigate the effect of silenced RBM8A gene on the biological behavior (proliferation, migration, and apoptosis) of human endometrial cancer HEC-1A cells and its possible mechanism. Methods The hairpin shRNA targeted by the RBM8A gene was designed, and the best shRNA silencing fragment was screened. The recombinant lentiviral interference vector carrying the target gene was constructed and used to infect HEC-1A cells. Cells with stable knockdown of RBM8A gene were screened by puromycin as the experimental group (shRBM8A), while the shRNA of nonsense sequence was designed as the control group (shControl). CCK-8 method was used to detect cell proliferation, and flow cytometry was used to detect cell apoptosis. Transwell assay was used to detect cell migration and invasion. Western blot was used to analyze the expression of apoptosis-related proteins and EMT signal transduction pathway related proteins. Results In comparison with the shControl group, after RBM8A knockdown, HEC-1A cell proliferation was reduced, apoptosis was increased, migration and invasion ability were significantly inhibited (P < 0.05), the expression of apoptosis-related proteins cleaved caspase 9 and caspase 3 increased, EMT-related protein E-cadherin expression increased, and Vimentin expression decreased. Conclusion RBM8A gene silencing can inhibit the proliferation, migration, and invasion and promote the apoptosis of endometrial cancer cells. The inhibition of EMT signal transduction pathway may be its mechanism.

Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.

Objective:To analyze the current situation of health education among medical staff at all levels of hospitals in Beijing, for references in improving the level of hospital health education.Methods:From July to November 2022, a stratified random sampling method was used to select medical staff from hospitals at all levels in Beijing as the survey subjects. A self-designed questionnaire was used to investigate the frequency of health education conducted by medical staff in six dimensions. The Likert 5-level scoring method was used to assign scores to the frequency of health education, and latent profile analysis was conducted on each score to explore the categories of health education conducted by medical staff.Results:2 792 questionnaires were effectively collected, among which 2 792 medical staff were surveyed, including 1 009 doctors, 1 609 nurses, and 174 technicians and pharmacists. The scores for the frequency of health education conducted in six dimensions: health education in the media or outside the hospital, health knowledge lectures in the hospital, outpatient health education, inpatient health education, health education during follow-up, and health prescriptions were (1.45±0.68) points, (1.68±1.01) points, (2.65±1.65) points, (2.76±1.74) points, (3.24±1.58) points, and (2.59±1.71) points respectively. According to latent profile analysis, healthcare personnel conducting health education could be divided into four categories: low development group (46.6%, 1 300 people), high development group (4.6%, 129 people), inpatient/follow-up development group (19.4%, 541 people), and outpatient/follow-up development group (29.4%, 822 people). The hospital level and profession of medical personnel in each category were different, and the differences were statistically significant( P<0.001). Conclusions:Medical staff in Beijing mainly carry out health education at such stages as patient follow-up, inpatient, and outpatient, but there is insufficient health education accessible in the media or outside the hospital. There are differences in the health education situation of medical personnel at different levels of hospitals and professions. It is recommended to build an efficient health education management system, actively explore new media-based health education channels, and reasonably allocate health education resources to comprehensively improve the health education of medical staff.

Objective : To investigate the correlation between vitamin D levels and the risk of early childhood caries (ECC), and to provide a reference for the primary prevention of ECC in children. Methods : A total of 389 children aged 6 months to 48 months were enrolled in this study. Data of feeding patterns and oral health behaviors were collected, and decayed-missing-filled teeth (dmft) were recorded. The children were divided into an ECC group (dmft > 0, n= 146) and a caries-free group (dmft=0, n=243). Peripheral blood of fingertips was collected to detect the active form of vitamin D--25(OH)D in vivo, and the cariogenic activity of dental plaque was analyzed with the Cariostat test. Logistic regression analysis was carried out to analyze the correlation among caries related factors such as 25(OH)D levels and caries risk in patients with ECC. Results: There was no significant difference in the prevalence of dental caries among 25(OH)D deficiency, insufficiency and normal children (χ2=2.320, P=0.313). There was no correlation between dmft and 25(OH)D levels (dmft=1-3, r < 0.001, P > 0.05; dmft > 3, r= 0.009, P > 0.05). The risk factors for ECC were age (OR=1.082, 95% CI: 1.045-1.121, P < 0.001), breastfeeding within 6 months after birth (OR=2.789, 95% CI: 1.581-4.921, P < 0.001), nighttime milk consumption or sleeping with a nipple (OR=4.187, 95% CI: 1.938-9.048, P < 0.001), and a high Cariostat value of 1.5-3.0 (OR=4.173, 95% CI: 2.014-8.646, P < 0.001). Conclusion There was no correlation between 25(OH)D level and caries in children aged 6-48 months. The risk factors for ECC are age, breastfeeding before 6 months old, nighttime milk consumption or sleeping with a nipple and high cariogenic activity (Cariostat value of 1.5-3.0). It is necessary to establish good feeding habits and oral hygiene habits for children while promoting breastfeeding.

Abstract Oral health problems is one of major public health problems that threatens children s overall health. Children s oral health is closely related to family parenting styles. Currently, grandparenting is becoming increasingly common in China, and its impact on children s oral health should not be underestimated. This article reviews the impacts of the oral health knowledge level, behavior habits, gender, socioeconomic status, and other factors related to grandparenting on children s oral health, in order to reduce the negative impact of grandparenting involvement on children s oral health, and to provide theoretical basis and guidance.

Objective:To explore the nursing effect of multidisciplinary rehabilitation training combined with motor imagery therapy in patients with Parkinson 's disease. Methods:Using the convenient sampling method, a total of 100 patients with Parkinson 's disease who were treated in Department of Neurology in Taizhou Hospital of Traditional Chinese Medicine from December 2017 to December 2020 were selected as the research objects. The patients were divided into the control group and the intervention group by random number table method, with 50 cases in each group. The cognitive ability, activity ability, psychological state and quality of life of patients of the two groups before and after the intervention were compared. Results:After the intervention, except for the dimension of abstract ability, the scores of each dimension of the Montreal Cognitive Assessment Scale in the intervention group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . The activity ability, depression and anxiety of patients in the intervention group were better than those in the control group, the quality of life was better than that in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The application of multidisciplinary rehabilitation training combined with motor imagery therapy in patients with Parkinson 's disease can significantly improve the cognitive ability of patients, improve their mobility and promote the improvement of quality of life.

Objective:To explore the effect of virtual reality (VR)-based baduanjin exercise on the cognition, physical functioning and life quality of elderly persons with mild cognitive impairment (MCI).Methods:Fifty-seven mildly impaired elderly persons were randomly divided into an observation group ( n=29) and a control group ( n=28). Both groups were given routine care and health education in their nursing homes, while the observation group additionally performed 50 minutes of VR baduanjin exercise three times a week for 24 weeks. Both groups were assessed using the Montreal cognitive assessment (MoCA), the Rivermead behavioural memory test (second edition) (RBMT-Ⅱ), a digit-symbol substitution test (DSST) and the Trail Making Test (TMT). The short physical performance battery (SPPB) and Alzheimer′s disease quality of life (QOL-AD) instrument were also administered before and after the 24-week intervention. Results:After the intervention the average MoCA, RBMT-Ⅱ, DSST, TMT-A, SPPB and QOL-AD results of the observation group were all significantly better than before the intervention and better than the control group′s averages. The observation group also performed better on the 5 times sit-to-stand test, the tandem standing test and a walking speed test after the intervention.Conclusions:VR-based baduanjin practice can effectively improve the cognition and physical functioning of mildly impaired elderly persons, as well as improving their quality of life.