OBJECTIVE To evaluate the efficacy and safety of rituximab （RTX） in the treatment of primary Sjögren syndrome （pSS）. METHODS Randomized controlled trials （RCTs） on the effects of RTX （trial group） versus placebo （control group） in the treatment of pSS were searched from the Cochran Library， PubMed， Embase， Medline， Web of Science， VIP， CNKI， Wanfang， and other databases during the inception to February 2024. After literature screening and quality evaluation， meta-analysis was performed by using RevMan 5.3 software. RESULTS Seven RCTs were finally included， involving a total of 518 patients. Results of meta-analysis showed that European League Against Rheumatism Sjögren syndrome disease activity index （ESSDAI） score [MD＝－1.17， 95%CI（－1.52， －0.82）， P＜0.000 01] and oral dryness visual analogue scale （VAS） score [MD＝－3.97， 95%CI （－5.08， －2.86）， P＜0.000 01] in the trial group were significantly lower than the control group； unstimulated salivary flow rate [SMD＝0.64， 95%CI（0.41， 0.87）， P＜0.000 01] and Schirmer score [MD＝0.19， 95%CI（0.18， 0.20）， P＜0.000 01] were significantly higher than the control group. There was no statistical significance in response rate [RD＝0.10， 95%CI（－0.04， 0.23）， P＝0.16]， fatigue VAS score [MD＝－12.50， 95%CI（－35.14， 10.15）， P＝0.28]， European League Against Rheumatism Sjögren syndrome patient reported index （ESSPRI） score [MD＝0.33， 95%CI（－0.53， 1.18）， P＝0.46]， Short-form 36 health survey physical component summary （SF36-PCS） score [MD＝0.90， 95%CI（－2.97， 4.78）， P＝0.65]， SF-36 mental component summary （SF36-MCS） score [MD＝0.11， 95%CI（－0.41， 0.63）， P＝0.68]， total salivary gland ultrasound score [SMD＝－1.91， 95%CI（－4.01， 0.19）， P＝0.07] or the incidence of adverse drug reactions [OR＝1.15，95%CI（0.62，2.13），P＝0.66] between 2 groups. CONCLUSIONS RTX has advantages in the improvement of ESSDAI score， unstimulated salivary flow rate， Schirmer score and oral dryness VAS score in pSS patients， and has a good safety profile. However， it did not exhibit significant improvement in fatigue VAS score， ESSPRI score， SF36-PCS score， SF36-MCS score or response rates.

Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing,standardize the limb management of patients with transvenous temporary cardiac pacing,and reduce complications related to the limb.Methods Using evidence-based methods,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality,and then the first draft of the consensus was formed.From December 2023 to January 2024,through 2 rounds of expert consultation and 4 rounds of expert meetings,the content was adjusted and the consensus was reached.Results Totally 16 experts participated in the consultation.The positive coefficient is 100%;the authoritative coefficient is 0.847 and 0.836;the average value of each index is more than＞3.8;the coefficient of variation is less than 0.21.The Kendall's harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314,respectively,which were statistically significant.The consensus covers the preoperative,intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing.Totally 11 themes were involved,including the preoperative preparation,position and catheter fixation in operation,position and catheter fixation in postoperative,activity,turn and transfer,duty shift on limb,nursing care after withdrawal of the catheter,prevention of deep vein thrombosis of the operative limb and prevent infection.Conclusion The consensus is highly scientific,and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.

Abstract: As the scale and volume of China-African cooperation continue to expand, the opportunities inherent in China-African public health cooperation are also on the rise. Malaria prevention and control is one of the primary domains of China-African public health cooperation. Especially after China's elimination of malaria, incorporating China's experience into the local context to accelerate the control and elimination of malaria in Africa, is a critical scientific problem. This article retrospectively analyses the historical China-African cooperative projects on malaria prevention and control such as the artemisinin compound project for rapid clearance of malaria, the China-UK-Tanzania pilot project, and the institution-based network of China-Africa cooperation on malaria elimination (INCAM), cooperation with the World Health Organization, and the contribution of domestic non-governmental organizations. The article also examines the challenges faced in the China-African cooperation for controlling and eliminating malaria and envisions future cooperation directions.

Objective: To explore the influence of adverse childhood experiences (ACEs) on pubertal development of boys and girls and to provide a reference for the development of intervention measures. Methods: A stratified cluster sampling method was used to select a total of 1 156 students in grades three and four in the boarding school system and public primary schools in Huangshan City and surrounding towns in September 2018, using the Childhood Trauma Questionnaire (CTQ) and the Pubertal Development Scale (PDS). For the baseline self-assessment survey, according to different dimensions, abuse children score no exposure groups. Children were divided into an exposure group and a high exposure level group, according to their childhood experiences. PDS self-report questionnaire was administered two years later, and an analysis of ACE type and severity of the continuous impact of youth development was conducted. Results: In the baseline survey, there were 53 girls (11.32%) and 51 boys (7.41%) who developed earlier. The rate of early development in girls was higher than that of boys, and the difference was statistically significant(χ 2=5.21, P<0.05). Univariate analysis showed gender differences in the effects of type and severity of ACEs and abuse on adolescent development at both baseline and follow-up. There were gender differences in the rate of early development between boys and girls at baseline and at follow-up between the exposure groups. Regression analysis showed that the higher the degree of emotional abuse, emotional neglect, and sexual abuse in girls, the higher the PDS score(B=0.22, 0.15, 0.08, P<0.05). In boys, the more severe the emotional abuse experienced, the higher the PDS score, and the more severe the physical abuse experienced, the lower the PDS score(B=0.20, 0.04, P<0.05). Conclusion Attention should be paid to the influence of ACEs and gender differences during youth development among male and female students, and more longterm studies should also be carried out.

Objective: To investigate the clinicopathologic features of microcystic, elongated and fragmented (MELF) pattern invasion of endometrial adenocarcinoma. Methods: HE and immunohistochemistry staining method were used to analysis morphologic features and immunophenotype of 72 patients of endometrial adenocarcinoma with MELF pattern invasion, and chi-square test was used to analysis the clinicopathologic features. Results: The mean age of 72 patients was 54 years (40 to 70 years). Thirty-two patients were pre-menopausal and 40 were post-menopausal. According to the FIGO staging system (2014), 32 cases(44.4%)were at stage Ⅰ, 22 cases(30.6%)at stage Ⅱ, 17 cases(23.6%)at stage Ⅲ and 1 case(1.4%) at stage Ⅳ. Microscopically, MELF invasion showed microcystic, elongated slit-like or fragmented glands in myometrium and their lining cells usually were cube or flat, as well as the single or clusters of eosinophilic tumor cells mimicking histocytes. In addition, a fibromyxoid or inflammatory stromal response was often present.Immunohistochemical staining showed that MELF invasion was positive for p16, CA125 and CA19-9, but negative for ER, PR and p53.Compared with non-MELF pattern invasion, significant differences were noted in menopause pausimenia, FIGO stages, deep invasion into myometrium, lymph metastasis, lymphovascular space invasion (LVSL), serum CA125 and CA19-9 in patients with MELF pattern invasion (all P<0.05). Conclusions MELF pattern invasion of endometrial adenocarcinoma is characterized by advanced FIGO stage, deep myoinvasion, high metastasis rate to lymph node and LVSL. Pathologists should recognize the MELF invasion and evaluate the depth of myometrium of infiltration and LVSL with special attention to the presence of MELF invasion with necessary immunohistochemistry for more accurate pathological diagnosis.

Objective To analyze the characteristic of some important clinical indicators, including carotid artery intima-middle thickness ( IMT) , peripheral blood Fib levels, serum IL-18 concentrations and serum MMP-9 con-centrations of acute coronary syndrome ( ACS) patients. On the other hand, to investigate the correlation among those indicators and major adverse cardiac events ( MACE) , and further to evaluate the value of those indicators in early prediction and prognosis judgement of ACS patients with diabetes( DM) in clinic. Methods This study en-rolled 120 ACS patients who had received coronary arteriography( CAG) examination. Among them, 60 cases had DM. Meanwhile, 60 cases who had DM were selected as DM group,60 cases of healthy people who received physi-cal health examination were selected as the control group. Carotid artery IMT was determined by color doppler ultra-sonography. The levels of Fib in peripheral blood were detected by solidification method. Immune turbidimetric method and ELISA were used to measure the concentrations of serum IL-18 and MMP-9 respectively. The CAG re-sults, complications and in-hospital mortality of ACS patients were also collected and analyzed. Results Carotid artery IMT, peripheral blood Fib levels, serum IL-18 concentrations and serum MMP-9 concentrations of ACS pa-tients were significantly increased compared with healthy control(P<0. 01). A comparison of those clinical indica-tors of ACS patients between with DM group and without 2 diabetes group showed a significant increase in ACS pa-tients with DM group. Carotid artery IMT, plasma Fib, serum IL-18, MMP-9 and Gensini score in ACS patients were positively correlated. The incidence of multi-vessel diseases of coronary artery was more frequent in ACS pa-tients with DM versus without DM ( 61. 7%) , while one or two vessel diseases of coronary artery was much more common in ACS patients without DM (61. 7%) . The Gensini score of ACS patients with DM group was much high-er than that of ACS patients without DM group ( P<0. 01 );severe and extremely severe lesions occurred more fre-quently in ACS patients with DM group (73. 3%) ,while mild-to-moderate lesions occurred more frequently in ACS patients without DM group (56. 7%) . Peripheral blood Fib levels, serum IL-18 and MMP-9 concentrations were significantly higher in ACS patients with MACEs compared to ACS patients without MACEs. Peripheral blood Fib levels, serum IL-18 concentrations and serum MMP-9 concentrations of ACS diabetes mellitus extended the down-ward trend with the treatment time after standardized treatment show time-effect relationship. Conclusion Carotid artery IMT, peripheral blood Fib levels, serum IL-18 concentration and serum MMP-9 concentrations have great po-tential to become effective clinical indicators, which could be used to quantitatively predict coronary atherosclero-sis,and further to determine the risk degree and short-term prognosis of ACS patients with DM.

Objective To investigate the variation and clinical significance of serum levels of inflammatory cyto-kines after percutaneous coronary intervention (PCI)treatment in acute myocardial infarction (AMI)patients. Methods 118 incipient AMI patients with successful underwent PCI (Defined as treatment group,blood samples were collected from pre-operation,12 h after operation,24 h after operation,48 h after operation and 90 d postop-erative follow-up period)and 52 AMI patients with diagnostic coronary angiography (CAG)(Defined as control group,blood samples were collected prior to CAG,12 h after CAG,24 h after CAG,48 h after CAG and 90 d fol-low-up period)were enrolled in this study.Serum levels of IL-6,IL-18,hs-CRP,TNF-αand MMP-9 were detec-ted in all the subjects by enzyme-linked immune sorbent assay(ELISA)and major adverse cardiac events(MACE) occurrence rate was analyzed in 90 days followed-up cases.Results No significant differences in baseline levels of IL-6,IL-18,hs-CRP,TNF-αand MMP-9 were found in the two study groups(P >0.05).No significant differences of levels of IL-6,IL-18,hs-CRP,TNF-αand MMP-9 were found after CAG in control group (P >0.05).The serum levels of IL-6,IL-18,hs-CRP and TNF-αafter PCI were significantly increased (P <0.01 )while no significant differences were found in level of MMP-9 (P >0.05)in PCI group.There were significant differences of levels of IL-6,IL-18,hs-CRP and TNF-αbetween MACE group and without MACE group after PCI.The multivariable lo-gistic analysis showed that IL-6,IL-18,hs-CRP and TNF-αwere risk factors of MACE after 90 days follow-up. Conclusion The concentrations of serum IL-6,IL-18,hs-CRP and TNF-αare significantly increased in AMI pa-tients treated with PCI.PCI operation may induce inflammatory reaction.High serum levels of peripheral inflamma-tory cytokines IL-6,IL-18,hs-CRP and TNF-αhave an important role in major adverse cardiac events(MACE)and short-term prognosis in the first AMI patients treated with successful primary PCI.

Objective To investigate the expression and genetic alterations of KLF6 in hepatocellular carcinoma (HCC) and explore their functional mechanisms in the oncogenesis and development of HCC. Methods Real-time quantitative-PCR, direct sequencing and LOH approaches were used to detect KLF6 genetic abnormalities in HCC. The experiment had 2 groups, an experimental group and a control group. In the experimental group, the transfected plasmid pcDNA3.0 was recombined with KLF6 and tranfected into HCC HepG2 cells. MTT, flow cytometry and Western blotting were used to observe the effect of anti-oncogene wild type KLF6 on HepG2 cells by transgenic method for 48 h.Results Expression levels of KLF6 were significantly downregulated in HCCs(P＜0. 01), as detected by qRT-PCR. LOH occurred in 11 (52%) of the 21 tumors, and all the samples with LOH showed KLF6 down-regulation. The mutational frequency was 29%, and sequence changes located in activation domain of KLF6. Meanwhile, MTT assay showed a significant antiproliferative effect of the transfected wtKLF6 on HepG2 cells(42.7%, P＜0.05). Fluorescence-activated cell sorting analysis revealed that KLF6 induced apoptosis. Conclusion The deregulation of KLF6 together with genetic abnormalities of allelic imbalance and mutations may play an important role in HCC pathogenesis.

Objective To evaluate the clinical significance of intercellular space diameters (ISD)of squamous epithelium by light microscopy (LM) in lower esophagus of erosive reflux esophagitis (ERD),non-erosive reflux disease ( NERD), Barrett esophagus (BE) and healthy controls. Methods A total of 21 ERD and 21 NERD patients with reflux symptoms and confirmed with 24-hour esophageal pH monitoring, 13 BE patients diagnosed by gastroscopy and biopsy, and 20 other healthy controls were enrolled in the study.Samples of ERD, NERD and control group were collected at 2 cm above dentate line, and made HE slides in the conventional way. Images for measurement of ICS were acquired with oil lens ( × 1000). ICS of squamous epithelium was quantitatively measured by computer-assisted morphometry. Ten cells were taken for each sample, 10 consecutive ISD for each cell, i.e. 100 ISD for each subject. Mean ISD was calculated.Results Mean ISDs by LM in control, BE, ERD, and NERD groups were 0. 59, 0. 99, 1.29 and 1.06 μm, respectively. The mean ISDs in BE, ERD, and NERD group were much greater than that in control (P＜0. 05). The mean, maximal and minimal ISDs of group ERD were greater than those of NERD and BE (P = 0. 000). However, the ISDs of NERD and BE are of no significant difference ( P ＞ 0. 05 ). The cut-off value of mean ISD for diagnosis of gastro-esophageal reflux disease (GERD) was 0. 85 μm. Diagnostic sensitivity and specificity for ERD, NERD and BE were 89. 1% and 100. 0%, with reference to clinical symptoms, endoscopy and ISDs above the cut-off value. Conclusion Larger ISDs in lower esophagus by using LM will be found in all subgroups of GERD, including ERD, NERD and BE. Increased ISDs may be one of the markers for diagnosis of ERD, NERD and BE.

Objective To assess the clinical presentations and treatment of neurosyphilis with mania as the first manifestation. Methods A retrospective study was performed. Clinical data on neurosyphilis patients with mania as the first manifestation collected from July 2009 to June 2010 were analyzed. Results Twenty cases of neurosyphilis were included in this study, which were all misdiagnosed as schizophrenia, anxiety,cerebral infarction, etc. All the patients had manic symptoms at onset, such as irritability, bad temper, impulsive behavior, disturbance in thinking, and so on. Some patients also suffered from a marked decrease in memory, calculation and cognitive ability. Rapid plasma reagin (RPR) test, Treponema pallidum hemagglutination (TPHA)test and cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test were positive in all the patients. Varying degrees of symptomatic improvement was achieved after anti-syphilis and anti-psychotic treatment. CSF was retested in 13 patients 3 months after the end of treatment, and CSF VDRL titer decreased in 10 patients, remained unchanged in 2 patients, and turned negative in 1 patient. Conclusions Neurosyphilis lacks distinctive clinical characteristics. For patients with poor response to conventional antipsychotic therapy,neurosyphilis should be considered, and serology and cerebrospinal fluid tests for syphilis are warranted.