BACKGROUND:Fibromyalgia syndrome,as a common rheumatic disease,is related to central sensitization and immune abnormalities.However,the specific mechanism has not been elucidated,and there is a lack of specific diagnostic markers.Exploring the possible pathogenesis of this disease has important clinical significance. OBJECTIVE:To screen the potential diagnostic marker genes of fibromyalgia syndrome and analyze the possible immune infiltration characteristics based on bioinformatics methods,such as weighted gene co-expression network analysis(WGCNA),and machine learning. METHODS:Gene expression profiles in peripheral serum of fibromyalgia syndrome patients and healthy controls were obtained from the gene expression omnibus(GEO)database.The differentially co-expressed genes were screened in the expression profile by differential analysis and WGCNA analysis.Least absolute shrinkage and selection operator(LASSO)and support vector machine-recursive feature elimination(SVM-RFE)machine learning algorithm were further used to identify hub biomarkers,and draw receiver operating characteristic curve(ROC)to evaluate the accuracy of diagnosing fibromyalgia syndrome.Finally,single sample gene set enrichment analysis(ssGSEA)and gene set enrichment analysis(GSEA)were used to evaluate the immune cell infiltration and pathway enrichment in patients with fibromyalgia syndrome. RESULTS AND CONCLUSION:Eight down-regulated differentially expressed genes(DEGs)were obtained after differential analysis of the GSE67311 dataset according to the conditions of log2|(FC)|>0 and P<0.05.After WGCNA analysis,497 genes were included in the module(MEdarkviolet)with the highest positive correlation(r=0.22,P=0.04),and 19 genes were included in the module(MEsalmon2)with the highest negative correlation(r=-0.41,P=6×10-5).After intersecting DEGs and the module genes of WGCNA,seven genes were obtained.Four genes were screened out by LASSO regression algorithm and five genes were screened out by SVM-RFE machine learning algorithm.After the intersection of the two,three core genes were identified,which were germinal center associated signaling and motility like,integrin beta-8,and carboxypeptidase A3.The areas under the ROC curve of the three core genes were 0.744,0.739,and 0.734,respectively,indicating that they have good diagnostic value and can be used as biomarkers for fibromyalgia syndrome.The results of immune infiltration analysis showed that memory B cells,CD56 bright NK cells,and mast cells were significantly down-regulated in patients with fibromyalgia syndrome compared with the control group(P<0.05),and were significantly positively correlated with the above three biomarkers(P<0.05).The enrichment analysis suggested that there were nine fibromyalgia syndrome enrichment pathways,mainly related to olfactory transduction pathway,neuroactive ligand-receptor interaction,and infection pathway.The above results showed that the occurrence and development of fibromyalgia syndrome are related to the involvement of multiple genes,abnormal immune regulation,and multiple pathways imbalance.However,the interactions between these genes and immune cells,as well as their relationships with various pathways need to be further investigated.

Herpes simplex viruses type 1(HSV1)is among the most ubiquitous human pathogens that cause a wide variety of disease states.The latent infection of the central nervous system and sporadically reactivation is the central part of HSV1 pathogenesis,which also brings challenges to antiviral therapies.At present,the mechanism of establishing,maintaining and reactivation of HSV1 has not been fully clarified,whereas it has been generally accepted that the epigenetic regulation may play an important role.Accumulating researches have also indicated that the lytic and latent viral genomes exhibit the different chromatin structures,and the accumulation of diverse post-translational modifies the histones endow viral genes with transcriptional activation or repression features.In addition,the latency-associate transcripts of virus may also participate in the genome epigenetic modification.In this review,we summarize the research progress of epigenetic regulation of HSV1 and highlight the critical role of chromatin remodeling in HSV1 lytic proliferation and establishment of latent infection.

Purpose To investigate the value of ultrasound radiomics nomogram in predicting lymph node metastasis(LNM)of papillary thyroid carcinoma(PTC).Materials and Methods A retrospective analysis was conducted on 400 cases of PTC in the First Hospital of Shanxi Medical University from March 2021 to January 2022 confirmed by surgery and pathology,all of which underwent preoperative ultrasound examination,and were randomly divided into training cohort(n=280)and testing cohort(n=120)in a ratio of 7∶3.The relationship between ultrasound clinical features and LNM was evaluated via univariate analysis and a clinical model was established via multivariable Logistic regression.A total of 3 348 features were extracted from preoperative ultrasound images.Pearson correlation coefficient was used to screen the features,and Logistic regression was used to establish the radiomics model.Clinical risk factors and rad scores were combined to construct the nomogram,and the receiver operating characteristic curves and decision curve analysis were applied to evaluate the predictive efficacy and clinical benefit of each model for LNM of PTC.Results Age,primary lesion size,C-TIRADS and ultrasound-reported LNM were the independent risk factors for LNM(t/χ2=2.938,55.923,30.081,34.639,all P<0.05).The area under the curve of ultrasound radiomics nomogram to predict LNM of PTC in the training cohort and the testing cohort was 0.860 and 0.847,respectively;the combined model in 43%-85%had the highest clinical benefit.Conclusion Ultrasound radiomics nomogram has a certain value in predicting LNM of PTC.

BACKGROUND:Rheumatoid arthritis is a chronic systemic autoimmune disease.It is important to study the immunological changes involved in it for diagnosis and treatment. OBJECTIVE:To identify immune-related biomarkers associated with rheumatoid arthritis utilizing bioinformatics techniques and examine alterations in immune cell infiltration as well as the relationship between immune cells and biomarkers. METHODS:Differential expression analysis was used to identify the immune-related genes that were up-regulated in rheumatoid arthritis based on the GEO and Immport databases.Kyoto encyclopedia of genes and genomes(KEGG)and gene ontology(GO)enrichment analyses were used to investigate the possible function of these elevated genes.The immunological characteristic genes associated with rheumatoid arthritis were screened using least absolute shrinkage and selection operator(Lasso)and support vector machine recursive feature elimination(SVM-RFE).Independent datasets were used for difference validation,and the diagnostic performance was evaluated by plotting receiver operating characteristic curves for feature genes.Immune cell infiltration was used to analyze the differential profile of immune cells in rheumatoid arthritis and the correlation between the characterized genes and immune cells.In order to ascertain the causal relationship between monocytes and rheumatoid arthritis in immune cells,Mendelian randomization analysis was ultimately employed. RESULTS AND CONCLUSION:There were 39 upregulated differentially expressed genes in rheumatoid arthritis.The genes were primarily enriched in chemotaxis,cytokine activity,and immune receptor activity,according to GO enrichment analysis,while kEGG enrichment analysis revealed that the genes were considerably enriched in the tumor necrosis factor signaling pathway and peripheral leukocyte migration.Lasso and SVM-RFE identified five feature genes:CXCL13,SDC1,IGLC1,PLXNC1,and SLC29A3.Independent dataset validation of the feature genes found them to be similarly highly expressed in rheumatoid arthritis samples,with area under the curve values greater than 0.8 for all five feature genes in both datasets.Immune cell infiltration indicated that most immune cells,including natural killer cells and monocytes,exhibited increased levels of infiltration in rheumatoid arthritis samples.The correlation analysis revealed a significant positive correlation between memory B cells and immature B cells and these five feature genes.Correlation analysis showed that the five feature genes were positively correlated with memory B cells and immature B cells.The inverse variance weighting method revealed that monocytes were associated with the risk of developing rheumatoid arthritis.

Objective To search and summarize the de-implementation strategy of low-value care and describe the specific elements of de-implementation strategies.Methods PubMed,ProQuest,CINAHL,China Biomedical Literature Service System database,CNKI,Wanfang and VIP database were searched until May 10,2023.Literature of de-implementation strategies was screened.Specific elements of the de-implementation strategies(i.e.,actors,actions,temporality,dose,action target,affected implementation outcome and justification)were extracted.Results A total of 20 pieces of the literature were included,of which 18 used multiple strategies and 2 used single strategy.A total of 65 strategies were extracted,and the education strategy was applied 15 times,the assessment and feedback strategy were applied 14 times,and the specific elements of only 3 strategies were fully described.Conclusion Education,assessment and feedback strategies are commonly used in de-implementation of low-value care studies.Future studies should clearly describe the specific elements of de-implementation strategies,in order to promote replication,improvement,and clinical application of strategies.

Objective To construct an evidence-based practice model for nurses in preventing deep vein thrombosis(DVT)and provide a scientific and targeted theoretical basis for nurses to carry out evidence-based nursing practice in DVT prevention.Methods Based on the previous evidence-based nursing practice project on DVT prevention after hip and knee arthroplasty,the research team used theoretical analysis and brainstorming to develop a draft of the work model.Expert meetings were organized to validate the content of the draft using the Delphi method,leading to the finalization of the evidence-based practice model for nurses in preventing DVT.Results The Knowledge-to-Action(KTA)framework was selected as the basic framework for constructing the evidence-based nursing practice model for preventing DVT.Theoretical Domain Framework,Theory of Planned Behavior,and Social Cognitive Theory were chosen to explore the influencing factors of nurses'behavior change in preventing DVT through evidence-based practice.The authority coefficient of the participating experts was 0.904,indicating high reliability.The final model consisted of 6 key components:knowledge generation,problem identification,localization and adaptation,knowledge application,sustained knowledge use,and conceptual framework for behavior change through evidence-based practice.Conclusion Based on theoretical analysis and clinical practice,this study developed an evidence-based practice model for nurses in preventing DVT using the expert meeting.The research methodology was scientific,and the content was reliable,providing a theoretical basis for nurses to engage in evidence-based nursing practice for DVT prevention.

Objective:To develop the Self-Stigma Scale for Drug Addicts(SSSDA),and test its validity and reliability.Methods:On the basis of literature analysis,open questionnaire survey,semi-structured interview and ex-pert consultation,the theoretical structure of the questionnaire was developed,and 943 drug addicts were test-ed.Sample 1(n=483)was used for item analysis and exploratory factor analysis,and sample 2(n=460)was used for confirmatory factor analysis,criterion related validity and internal consistency reliability analysis.Sixty-four drug addicts were retested 4 weeks later for test-retest reliability test.The criterion related validity was tested with the Drug Stereotype Threat Scale.Results:The scale consisted of 6 dimensions and 31 items,including self-negative cognition,stereotype identity,confidentiality,social avoidance,stigma experience,and stigma experience in the process of detoxification(factor loadings were from 0.41 to 0.81),which explained 64.09％of the total vari-ance.The 6-factor structure model fitted the data well(x2/df=2.82,RMSEA=0.06,CFI=0.92,GFI=0.85,TLI=0.91).The total scores and factor scores of the SSSDA were positively correlated with the DSTS scores(ICC=0.10-0.22,Ps＜0.05).The Cronbach α coefficients for the total scale and each dimension were between 0.80 and 0.95,and the test-retest reliability coefficients(ICC)were between 0.82 and 0.94.Conclusion:The Self-stigma Scale for Drug Addicts(SSSDA)initially developed in this study has satisfactory reliability and validity.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Objective:To explore the predictive value of transrectal multimodal ultrasound and prostate specific antigen (PSA) in clinically organ-confined prostate cancer.Methods:It was a cross-sectional study. The clinical data of patients with suspected prostate nodules treated in the First Hospital of Shanxi Medical University from May 2014 to April 2020 were analyzed retrospectively. Of the patients, 48 cases of clinically organ-confined prostate cancer and 51 cases of benign prostatic hyperplasia confirmed by clinical data and pathology were selected as research objects. The characteristics of transrectal multimodal ultrasound in the two groups were compared. Combined with PSA, logistic regression analysis was applied to screen the statistically significant features, and then the diagnosis model was established, and odds ratio of the variables were compared. The receiver operating characteristic (ROC) curve was constructed to analyze the predicting ability of the diagnosis model.Results:Four features were obtained with logistic regression analysis finally, including enhancement type, enhancement degree, elastography mode and PSA. The odds ratio of enhancement degree was higher than those of the other independent variables. The area under ROC curve of the diagnosis model was 0.868 ( P<0.01), the cut-off value was 0.514. The sensitivity and specificity of the diagnosis model in predicting clinically organ-confined prostate cancer was 79.2% and 80.4%, respectively. Conclusions:This combined diagnosis model of transrectal multimodal ultrasound and PSA has a certain clinical value in predicting clinically organ-confined prostate cancer.