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Yajing Liu,1 Chunming Li,2 Xiaoya Yang,1 Shufen Guo,1 Zhaobo Cui,1 Hongshan Kang,1 Zhen Ma,1 Huiqing Wang1 1Intensive Care Unit, Hengshui People’s Hospital (Harrison International Peace Hospital), Hengshui, 053000, People’s Republic of China; 2Department of Pain, Hengshui Second People’s Hospital, Hengshui, 053000, People’s Republic of ChinaCorrespondence: Yajing Liu; Hongshan Kang, Intensive Care Unit, Hengshui People’s Hospital (Harrison International Peace Hospital), 180 Renmin East Road, Taocheng District, Hengshui, Hebei, 053000, People’s Republic of China, Tel +8618732891639, Email liuyajingbs@163.com; kanghongshan@163.comObjective: We assessed the predictive value of blood neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) in predicting the onset of acute kidney injury (AKI) in sepsis patients in the intensive care unit (ICU).Methods: In this retrospective analysis, we examined the medical records of sepsis patients admitted to the ICU. After ICU admission, blood samples were taken at 0 h, 6 h, 12 h, 24 h, and 48 h. Using an enzyme-linked immunosorbent assay, the concentrations of serum creatinine, NGAL, and IL-18 were determined.Results: This study comprised a total of 197 participants, 104 of whom had AKI and 93 of whom did not. Blood concentrations of NGAL and IL-18 increased prior to serum creatinine levels. Between 6– 48 hours after ICU administration, NGAL and IL-18 levels in the AKI group were considerably higher than those in the non-AKI group, and creatinine levels between the two groups were significantly different after 48 hours. Based on receiver operating characteristic (ROC) curve analysis, the area under the curve of NGAL and IL-18 for predicting AKI was 0.781 and 0.883, respectively.Conclusion: Blood NGAL and IL-18 are potential biomarkers for the early prediction of AKI in sepsis patients in the ICU.Keywords: acute kidney injury, intensive care unit, interleukin-18, neutrophil gelatinase-associated lipocalin sepsis

Shichao Zhao,1 Zhaofei Ma,1 Hongyu Li,1 Zhanning Wang,1 Ying Wang,2,&ast; Huifen Ma3,&ast; 1School of Public Administration, Shandong Normal University, Jinan, Shandong, People’s Republic of China; 2School of Health Management, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China; 3School of Medical Management, Shandong First Medical University, Jinan, Shandong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ying Wang, School of Health Management, Shandong University of Traditional Chinese Medicine, No. 4655 University Road, Jinan, Shandong, 250355, People’s Republic of China, Tel/Fax +0086-13869161627, Email yingwang_2016@163.com Huifen Ma, School of Medical Management, Shandong First Medical University, No. 6699 Qingdao Road, Jinan, Shandong, 250117, People’s Republic of China, Tel/Fax +0086-15600684995, Email hfma@sdfmu.edu.cnBackground: Adequate staffing of primary healthcare workers (PHCWs) is essential for strengthening healthcare systems, yet high turnover intention among these workers presents a significant challenge. While existing strategies primarily target economic incentives and career progression, this study proposes that enhancing organizational justice could offer a novel and impactful approach to retention. Drawing on equity theory and self-determination theory, the study examines how organizational justice influences turnover intention and the mediating roles of both the intensity and type of work motivation.Methods: This is a cross-sectional study design. A multi-stage cluster sampling method was utilized to administer a questionnaire survey to 1,200 PHCWs from 36 primary health institutions in Shandong Province, China.Results: Multivariate linear regression analysis revealed that organizational justice significantly reduces turnover intention among PHCWs (β = − 0.435, p < 0.001). Among its three dimensions, distributive justice (β = − 0.203, p < 0.001) and procedural justice (β = − 0.177, p < 0.01) had significant impacts on turnover intention, whereas interactional justice did not. The study also confirmed the mediating role of work motivation, with work motivation type accounting for 18.2% of the total effect, exerting a greater influence than work motivation intensity, which accounted for 13.8% of the total effect.Conclusion: This study finds that organizational justice, especially distributive and procedural justice, reduces turnover intention among PHCWs in China. Work motivation mediates this effect, with motivation type having a stronger influence than motivation intensity. Enhancing organizational justice through transparent systems for compensation, promotion, and inclusive decision-making can foster the internalization of work motivation, providing a sustainable approach to improving retention and supporting the stability of the primary healthcare workforce.Keywords: organizational justice, turnover intention, work motivation, primary healthcare worker

Baocheng Liu,1,&ast; Yaqi Zhao,2,&ast; Dongxia Liu,1 Xinya Li,1 Zhenzhen Ma,1,2 Qingrui Yang1,2 1Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China; 2Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhenzhen Ma; Qingrui Yang, Email mazhenzhendz@163.com; qryang720@163.comIntroduction: Humoral immunity plays a key role in the pathogenesis of autoimmune diseases, and B-lymphocyte activating factor (BAFF) and a proliferation-inducing ligand (APRIL) are essential for the maintenance of B-lymphocyte reservoirs and humoral immunity. In March 2021, telitacicept, the world’s first dual target three-channel biologic, was approved in China for the treatment of SLE and is currently in clinical trials exploring multiple indications for other autoimmune diseases.Areas Covered: This article summarizes the mechanism of action, pharmacokinetics, and clinical efficacy of telitacicept for the treatment of multiple autoimmune diseases.Expert Opinion: So far, the efficacy and safety of telitacicept in autoimmune diseases have been fully demonstrated in clinical practice. There are still many unresolved issues regarding the timing of initiation and discontinuation, still needs to be evaluated in future studies.Keywords: biological therapy, autoimmune disease, B lymphocytes, telitacicept, immunology

Lijuan Xia,1,2,&ast; Fanxing Yang,3,&ast; Naoko Hayashi,2,&ast; Yuan Ma,4 Bin Yan,4 Yingxin Du,5 Sujuan Chen,1 Yuke Xia,4 Fang Feng,6 Zhifang Ma1 1Department of Radiotherapy, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China; 2Department of Oncology Nursing and Palliative Care/ Chronic Illness and Conditions Nursing, St. Luke’s International University, Tokyo, Japan; 3Department of Labor Delivery Recovery Postpartum, People’s Hospital of Zhengzhou, Zhengzhou, Henan, People’s Republic of China; 4Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China; 5Department of Clinical Nutrition, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China; 6Department of Rheumatology and Immunology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lijuan Xia, Department of Radiotherapy, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan City, Ningxia, 750004, People’s Republic of China, Email 24DN009@slcn.ac.jp; 974286683@qq.com, Fang Feng, Email 13995409352@163.comIntroduction: Nutritional status is a critical indicator of overall health and immune function, significantly influencing treatment outcomes. Despite its importance, the nutritional status of patients with systemic lupus erythematosus (SLE) often receives insufficient attention. This study aims to evaluate the nutritional status of patients with SLE, identify factors associated with malnutrition, and develop a risk prediction model for malnutrition in this population.Methods: We collected clinical data from a convenience sample of SLE patients at a general hospital in Ningxia Province, China, between January and December 2022. Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for malnutrition. A risk prediction model was constructed and evaluated using the receiver operating characteristic (ROC) curve.Results: This study included 420 patients with SLE (mean age: 41.43 years, 91.7% women), of whom 46.2% were malnourished based on their serum albumin levels. Multivariate logistic regression analysis identified monthly income (OR=0.192, P< 0.05), sleep quality (OR=2.559, P< 0.05), kidney involvement (OR=4.269, P< 0.05), disease activity (OR=2.743, P< 0.05), leukocyte count (OR=1.576, P< 0.05), lymphocyte count (OR=0.393, P< 0.05), hemoglobin (OR=0.972, P< 0.05), complement C3 (OR=0.802, P< 0.05), and complement C4 (OR=0.493, P< 0.05) as independent risk factors for malnutrition. The prediction model showed good predictive value with an area under the ROC curve of 0.895 (95% CI: 0.823– 0.840), sensitivity of 0.907, and specificity of 0.827. The Hosmer-Lemeshow test indicated a good model fit (χ²=10.779, P=0.215).Discussion: Malnutrition is a significant concern among SLE patients, influenced by a range of socioeconomic and clinical factors. Our risk prediction model, with its high sensitivity and specificity, provides a robust tool for early identification of malnutrition in this population. Implementing this model in clinical practice can guide healthcare providers in prioritizing at-risk patients, enabling proactive nutritional interventions that could potentially improve clinical outcomes, enhance quality of life, and reduce healthcare costs associated with SLE.Keywords: systemic lupus erythematosus, nutritional status, associated factors, malnutrition, risk prediction model, nomogram

Xia Chen,1 Jianmin Zhang,1 Yuanru Tang,1 Yan Zhang,2 Ziwen Ma,2 Yifan Hu2 1Department of Gynecology, Waitan Street Community Health Service Center, Shanghai, People’s Republic of China; 2Department of Gynecology and Obstetrics, Pudong New Area Health Care Hospital for Women and Child Gynecological Clinic, Shanghai, People’s Republic of ChinaCorrespondence: Jianmin Zhang, Email 360032800@qq.comPurpose: This study explores the link between women’s pre-pregnancy overweight and obesity and glucose and lipid metabolism in their early pregnancy. It assesses how early pregnancy glucose and lipid levels predict gestational diabetes mellitus (GDM) risk, aiming to offer foundational weight management strategies for overweight and obese women to prevent GDM.Patients and Methods: This study analyzed 2172 pregnant women from 2017 to 2021 at Waitan Street Community Health Service Center, Shanghai, monitoring early pregnancy (7– 10 weeks) glucose and lipid levels (TG, TC, HDL-C, LDL-C, FBG, HbA1c) and 24-week OGTT values. Pre-pregnancy BMI categorized participants into overweight and obese, normal, and underweight groups. We compared early pregnancy glycemic and lipid metrics and GDM incidence across groups, examining the relationship between pre-pregnancy BMI and early pregnancy blood metrics. The overweight and obese cohort was further split into GDM and non-GDM groups, comparing early pregnancy glycolipid indicators and assessing their predictive value for GDM development.Results: In the overweight and obese group, maternal FBG, HbA1c, TG, and LDL-C were higher, while HDL-C was lower than in normal and underweight groups (P< 0.05), with a higher GDM incidence (P< 0.05). Pre-pregnancy BMI positively correlated with FBG, HbA1c, TG, and LDL-C levels (r=0.556, 0.567, 0.686, 0.214; P< 0.05) but not HDL-C. Each 1-unit BMI increase raised GDM risk by 0.204 times (P< 0.05). FBG, TG, and LDL-C had high predictive accuracy for GDM in overweight and obese women, with AUCs of 0.991, 0.994, and 0.935, respectively.Conclusion: Pre-pregnancy overweight and obesity can cause early pregnancy glucose and lipid abnormalities, raising GDM risk. Early testing in such women is a strong predictor for GDM.Keywords: pregnant women, overweight and obesity, pre-pregnancy body mass index, glucose and lipid metabolism, gestational diabetes mellitus

Tianlong Li,&ast; Nana Hou,&ast; Lili Mao, Fangmei Liu, Zilong Ma, Li Wang, Xiyue Xu, Guanghui Yan, Yujia Han, Jinxian Wei Department of Gynecology, Zhengzhou First People’s Hospital, Zhengzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinxian Wei, Email 13700887408@163.comBackground: Although there are many benign tumors in the ovarian adnexal area, the four most common types are still luteal cyst, ovarian mature cystic teratoma (OMCT), ovarian endometriosis, and benign epithelial tumors of the ovary.Purpose: This study aimed to examine the correlation between six tumor markers (CEA, AFP, CA125, CA19-9, SCC, HE4) in the differential diagnosis of female adnexal benign masses and assess their diagnostic value.Patients and Methods: In this study, 135 patients with adnexal benign masses were treated in Zhengzhou first people’s Hospital from January 2018 to January 2023. 135 patients were divided into four groups: luteal cyst (13.3%), OMCT (42.2%), ovarian endometriosis (23.7%) and benign epithelial tumors of the ovary (including mucinous cystadenoma and serous cystadenoma) in group D. The receiver-operating characteristic (ROC) curve was used to assess the diagnostic value of each marker and combined detection.Results: The diameter of luteal cysts was significantly smaller than that of benign ovarian tumors (p < 0.001). ROC analysis showed that the combination of AFP, CA125, CA19-9, and SCC had a higher diagnostic rate for luteal cysts (AUC=0.871; sensitivity: 71.8%; specificity: 88.9). The SCC level in OMCT was significantly higher than in other benign ovarian tumors (p=0.007). ROC analysis indicated that the combination of AFP, HE4, and SCC had a higher diagnostic rate for OMCT (AUC=0.753; sensitivity: 65.4%; specificity: 75.4%). The CA125 level in ovarian endometriosis was significantly higher than in other accessory benign tumors (p < 0.001). ROC analysis demonstrated that the combination of AFP, CA125, and CA19-9 had a higher diagnostic rate for ovarian endometriosis (AUC=0.935; sensitivity: 76.7%; specificity: 96.9%). The tumor diameter of benign epithelial tumors of the ovary was significantly larger than that of other benign ovarian tumors (p < 0.001). ROC analysis revealed that the combination of CA125 and CA19-9 had a higher diagnostic rate for benign epithelial tumors of the ovary (AUC=0.792; sensitivity: 64.5%; specificity: 85.7%).Conclusion: The findings of this study demonstrate that the combined use of tumor markers (CEA, AFP, CA125, CA19-9, SCC, and HE4) has value in diagnosing benign ovarian tumors, including luteal cysts, OMCT, ovarian endometriosis, and benign epithelial tumors of the ovary. However, it is important to acknowledge the limitations of this study, which include its single-center nature and the small sample size. Despite these limitations, the results highlight the potential utility of these markers in clinical practice.Keywords: luteal cyst, OMCT, ovarian endometriosis, ovarian epithelial benign tumors, tumor markers

Zijuan Ma,1,&ast; Yunge Fan,1,&ast; Zhijun Yu,1 Wenxuan Wu,1 Xiangting Zhang,1 Huolian Li,1 Shaochen Zhao,2 Yang Li,3 Yuanyuan Li,4 Dongfang Wang,1 Fang Fan1 1Center for Studies of Psychological Application, School of Psychology, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of China; 2Research Center for Guangdong-Hong Kong-Macao Policing Model Innovation, China People’s Police University, Guangzhou, People’s Republic of China; 3Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 4Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Dongfang Wang; Fang Fan, School of Psychology, South China Normal University, Shipai Road, Guangzhou, 510631, People’s Republic of China, Email wdfpsyc@126.com; fangfan@scnu.edu.cnPurpose: Although experimental psychopathology using PET, EEG, and fMRI is at the forefront of understanding the underlying mechanisms of sleep inertia, many questions concerning causality remain unanswerable due to ethical constraints and the use of small and heterogeneous samples in experimental methods. There is a pressing need for a novel perspective in a large and relatively homogeneous population to fully capture and elucidate longitudinal processes and dynamic causality that culminate in episodes of sleep inertia over time. Therefore, this study aimed to reveal the causal relationships between symptoms of sleep inertia across its distinct patterns.Patients and Methods: A total of 1636 intern nurses participated in the first survey (94.1% validity rate), then 1277 intern nurses were followed up (82.9% tracing rate). Symptoms of sleep inertia were self-reported using the Sleep Inertia Questionnaire. The cross-lagged panel network models were used to examine unique longitudinal relationships between symptoms of sleep inertia across distinct trajectories.Results: Four distinct trajectories of sleep inertia were established. Additionally, we found differences in those symptoms with the highest influence on other symptoms at the subsequent point across the networks of four trajectories, particularly, “Difficulty in concentrating” in the persistent-high group and “Feeling tense” in the deteriorating groups.Conclusion: The current study highlights changes in sleep inertia based on the long-term course over time. Notably, symptoms of “Difficulty in concentrating” and “Feeling tense” are imperative to address these specific symptoms within subpopulations.Keywords: sleep inertia, change patterns, network structures, intern nurse, shift work

Juying Zhang,1 Xia Luo,1 Xin Yang,1 Hanmei Li,1 Qiong Jiang,1 You Yang,1 Menglin Luo,1 Zijun Ma,1 Ping He,1 Linli Feng,1 Ling Li,1 Maochun Zhang,1 Yang Li,2,3 Jinhong Yu1,3 1Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Innovation Centre for Science and Technology of North Sichuan Medical College, Nanchong, Sichuan, 637000, People’s Republic of China; 2Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, People’s Republic of China; 3Department of Ultrasound, Yuechi People’s Hospital, Guangan, Sichuan, 638300, People’s Republic of ChinaCorrespondence: Jinhong Yu, Email yujinhong@nsmc.edu.cnPurpose: The incidence of hepatocellular carcinoma (HCC) is continuously increasing, and the mortality rate remains high. Thus, more effective strategies are needed to improve the treatment of HCC.Methods: In this study, we report the use of a visualized glypican-3 (GPC3)-targeting nanodelivery system (named GC-NBs) in combination with sonodynamic therapy (SDT) to enhance the therapeutic efficacy for treating HCC. The obtained nanodelivery system could actively target hepatocellular carcinoma cells and achieve ultrasound imaging through phase changes into nanobubbles under low-intensity ultrasound irradiation. Meanwhile, the released chlorine e6 (Ce6) after the nanobubbles collapse could lead to the generation of reactive oxygen species (ROS) under ultrasound irradiation to induce SDT.Results: Both in vitro and in vivo experiments have shown that GC-NBs can accumulate in tumour areas and achieve sonodynamic antitumour therapy under the navigation action of glypican-3-antibody (GPC3-Ab). Furthermore, in vitro and in vivo experiments did not show significant biological toxicity of the nanodelivery system. Moreover, GC-NBs can be imaged with ultrasound, providing personalized treatment monitoring.Conclusion: GC-NBs enable a visualized antitumour strategy from a targeted sonodynamic perspective by combining tumour-specific targeting and stimuli-responsive controlled release into a single system. Keywords: Glypican-3, nanodelivery system, ultrasound imaging, sonodynamic therapy, hepatocellular carcinoma

Jian Gao,1 Jiannan Li,2 Zengyou Luo,1 Hongyong Wang,3 Zhiming Ma1 1Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun, People’s Republic of China; 2Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, People’s Republic of China; 3Department of Radiotherapy, The Second Hospital of Jilin University, Changchun, People’s Republic of ChinaCorrespondence: Zhiming Ma, Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun, People’s Republic of China, Email mazhiming@jlu.edu.cnAbstract: Inflammatory bowel disease (IBD) is a chronic, non-specific inflammatory condition characterized by recurring inflammation of the intestinal mucosa. However, the existing IBD treatments are ineffective and have serious side effects. The etiology of IBD is multifactorial and encompasses immune, genetic, environmental, dietary, and microbial factors. The nanoparticles (NPs) developed based on specific targeting methodologies exhibit great potential as nanotechnology advances. Nanoparticles are defined as particles between 1 and 100 nm in size. Depending on their size and surface functionality, NPs exhibit different properties. A variety of nanoparticle types have been employed as drug carriers for the treatment of inflammatory bowel disease (IBD), with encouraging outcomes observed in experimental models. They increase the bioavailability of drugs and enable targeted drug delivery, promoting localized treatment and thus enhancing efficacy. Nevertheless, numerous challenges persist in the translation from nanomedicine to clinical application, including enhanced formulations and preparation techniques, enhanced drug safety profiles, and so forth. In the future, it will be necessary for scientists and clinicians to collaborate in order to study disease mechanisms, develop new drug delivery strategies, and screen new nanomedicines. Nevertheless, numerous challenges persist in the translation from nanomedicine to clinical application, including enhanced formulations and preparation techniques, enhanced drug safety profiles, and so forth. In the future, it will be necessary for scientists and clinicians to collaborate in order to study disease mechanisms, develop new drug delivery strategies, and screen new nanomedicines.Keywords: nanoparticles, inflammatory bowel diseases, targeted delivery, passive targeting, active targeting, drug delivery system

Pingyu An,1 Qiyue Zhao,2 Siyu Hao,3 Xiaodong Wang,4 Jiangtian Tian,5,6 Zhiqiang Ma3 1Basic Medical College, Harbin Medical University, Harbin, People’s Republic of China; 2School of Nursing, Southern Medical University, Guangzhou, People’s Republic of China; 3Department of Dermatology, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 4Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, People’s Republic of China; 5Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 6The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, People’s Republic of ChinaCorrespondence: Zhiqiang Ma, Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, 150081, People’s Republic of China, Tel +86 18845139619, Email zhiqiangma@hrbmu.edu.cnAbstract: Psoriasis is an immune-mediated inflammatory skin disease where topical therapy is crucial. While various dosage forms have enhanced the efficacy of current treatments, their limited permeability and lack of targeted delivery to the dermis and epidermis remain challenges. We reviewed the evolution of topical therapies for psoriasis and conducted a bibliometric analysis from 1993 to 2023 using a predictive linear regression model. This included a comprehensive statistical and visual evaluation of each model’s validity, literature profiles, citation patterns, and collaborations, assessing R variance and mean squared error (MSE). Furthermore, we detailed the structural features and penetration pathways of emerging drug delivery systems for topical treatment, such as lipid-based, polymer-based, metallic nanocarriers, and nanocrystals, highlighting their advantages. This systematic overview indicates that future research should focus on developing novel drug delivery systems characterized by enhanced stability, biocompatibility, and drug-carrying capacity.Keywords: psoriasis, bibliometric, drug delivery, topical treatment, nanoparticle, nanocarriers

Guo Chen,1 Duoduo Yu,2 Yichen Wang,1 Zou Ma,1 Mengna Bi,1 Lisha Lu,1 Shangshang Zhang,1 Jiaxin Liu,1 Hu Chen,1 Hai Shen,2 Huiwu Zhang,2 Xiaobing Luo,2 Yan Si,1 Peng Zhang1 1Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China; 2Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of ChinaCorrespondence: Peng Zhang, Tel +86-19980487275, Email yicoal@yeah.netPurpose: The aim of this study is to investigate the effects of a preoperative combined with postoperative moderate-intensity progressive resistance training (PRT) of the operative side in patients with hip osteoarthritis (HOA) who are undergoing total hip arthroplasty (THA). The study seeks to evaluate the impact of this combined intervention on muscle strength, gait, balance, and hip joint function in a controlled, measurable, and objective manner. Additionally, the study aims to compare the outcomes of this combined intervention with those of preoperative or postoperative muscle strength training conducted in isolation.Methods: A total of 90 patients with HOA scheduled for unilateral primary THA were randomly assigned to three groups: Pre group (preoperative PRT), Post group (postoperative PRT), and Pre& Post group (preoperative combined with postoperative PRT) focusing on hip flexion, extension, adduction, and abduction of operated side. Muscle strength, gait parameters, balance, and hip function were assessed at specific time points during a 12-month follow-up period.Results: All three groups showed significant improvements in muscle strength, with the Pre& Post group demonstrating the most pronounced and sustained gains. Gait velocity and cadence were significantly improved in the Pre& Post group at 1-month and 3-month postoperative follow-ups compared to the other groups. Similarly, the Pre& Post group exhibited superior balance performance at 3-month and 12-month postoperative follow-ups. The Harris Hip Score also showed better outcomes in the Pre& Post group at all follow-up intervals.Conclusion: Preoperative combined with postoperative moderate-intensity PRT in HOA patients undergoing THA led to superior improvements in muscle strength, gait, balance, and hip joint function compared to preoperative or postoperative PRT alone. This intervention shows significant promise in optimizing postoperative rehabilitation and enhancing patient outcomes following THA.Keywords: exercise therapy, muscle strength, progressive resistance training, total hip arthroplasty, gait variability

Zhengjun Ma,1 Yanmei Zhang,1 Yupu Zhu,2 Minxuan Cui,2 Yutao Liu,2 Yun-You Duan,1 Li Fan,2 Li Zhang1 1Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of China; 2Department of Pharmaceutical Chemistry and Analysis, School of Pharmacy, Air Force Medical University, Xi’an, People’s Republic of ChinaCorrespondence: Li Fan; Li Zhang, Email xxfanny@fmmu.edu.cn; lilyzhang319_20@hotmail.comIntroduction: Recently, nanobubbles (NBs) have gained significant traction in the field of tumor diagnosis and treatment owing to their distinctive advantages. However, the application of NBs is limited due to their restricted size and singular reflection section, resulting in low ultrasonic reflection.Methods: We synthesized a nano-scale ultrasound contrast agent (IR783-SiO2NPs@NB) by encapsulating SiO2 nanoparticles in an IR783-labeled lipid shell using an improved film hydration method. We characterized its physicochemical properties, examined its microscopic morphology, evaluated its stability and cytotoxicity, and assessed its contrast-enhanced ultrasound imaging capability both in vitro and in vivo.Results: The results show that IR783-SiO2NPs@NB had a “donut-type” composite microstructure, exhibited uniform particle size distribution (637.2 ± 86.4 nm), demonstrated excellent stability (30 min), high biocompatibility, remarkable tumor specific binding efficiency (99.78%), and an exceptional contrast-enhanced ultrasound imaging capability.Conclusion: Our newly developed multiple scattering NBs with tumor targeting capacity have excellent contrast-enhanced imaging capability, and they show relatively long contrast enhancement duration in solid tumors, thus providing a new approach to the structural design of NBs.Keywords: ultrasound contrast agents, nanobubbles, CEUS, scattering cross-section, SiO2 NPs

Boyong Qiu,1,2,&ast; Siyu Qiao,2,&ast; Xiujuan Shi,2 Lin Shen,2 Bing Deng,2 Zilin Ma,2 Duan Zhou,2 Yihong Wei2 1Heart Center/National Regional (Traditional Chinese Medicine) Cardiovascular Diagnosis and Treatment Center, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan, People’s Republic of China; 2Cardiovascular Department, Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yihong Wei; Duan Zhou, Email weiyihong2022@shutcm.edu.cn; zhouduan@126.comBackground: In China, Shen’ge formula (SGF), a Traditional Chinese Medicine blend crafted from ginseng and gecko, holds a revered place in the treatment of cardiovascular diseases. However, despite its prevalent use, the precise cardioprotective mechanisms of SGF remain largely uncharted. This study aims to fill this gap by delving deeper into SGF’s therapeutic potential and underlying action mechanism, thus giving its traditional use a solid scientific grounding.Methods: In this study, rats were subjected to abdominal aortic constriction (AAC) to generate pressure overload. Following AAC, we administered SGF and bisoprolol intragastrically at specified doses for two distinct durations: 8 and 24 weeks. The cardiac function post-treatment was thoroughly analyzed using echocardiography and histological examinations, offering insights into SGF’s influence on vital cardiovascular metrics, and signaling pathways central to cardiac health.Results: SGF exhibited promising results, significantly enhanced cardiac functions over both 8 and 24-week periods, evidenced by improved ejection fraction and fractional shortening while moderating left ventricular parameters. Noteworthy was SGF’s role in the significant mitigation of myocardial hypertrophy and in fostering the expression of vital proteins essential for heart health by the 24-week mark. This intervention markedly altered the dynamics of the Akt/HIF-1α/p53 pathway, inhibiting detrimental processes while promoting protective mechanisms.Conclusion: Our research casts SGF in a promising light as a cardioprotective agent in heart failure conditions induced by pressure overload in rats. Central to this protective shield is the modulation of the Akt/HIF-1α/p53 pathway, pointing to a therapeutic trajectory that leverages HIF-1α promotion and p53 nuclear transport inhibition. Keywords: Shen’ge formula, heart failure, hypertrophy, apoptosis, angiogenesis

Xin Liu,1,&ast; Fangchao Zhao,2,&ast; Xiaodan Wang,2,&ast; Zheng Ma,2 Hongjiang Yan,2 Xuchao Lu,2 Shujun Li,2 Haiyong Zhu,2,&ast; Shaolin Gao2 1Second Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China; 2Department of Thoracic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shaolin Gao, Department of Thoracic Surgery, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang, Hebei, People’s Republic of China, Tel/Fax +86-311-66003588, Email gaoshaolinHB2H@163.comBackground: Long non-coding RNAs (lncRNAs) were demonstrated to be key to cancer progression and highly associated with the tumor immune microenvironment. Oxidative stress and immune may modulate the biological behaviors of tumors. Therefore, biomarkers that combined oxidative stress, immune, and lncRNA can be a promising candidate bioindicator in clinical therapy of cancers.Methods: Immune-related genes (IRGs) and oxidative stress-related genes (ORGs) were identified based on a detailed review of published literatures. The transcriptome data and clinical information of lung adenocarcinoma (LUAD) patients were obtained from TCGA database. Lasso and Cox regression analyses were conducted to develop a prognostic model. Additionally, the link between immune checkpoints, immune cells, and the prognostic model was investigated, and predict the sensitivity of immunotherapy.Results: 2498 IRGs and 809 ORGs were extracted from previous studies, and 190 immune- and oxidative stress-related genes (IOGs) were acquired by overlapping the above genes. 658 immune- and oxidative stress-related lncRNAs (IOLs) were screened by Pearson correlation analysis. A total of 25 prognosis-related IOLs were screened by univariate regression analysis. Finally, LASSO Cox regression analysis was adopted for determining a 12-IOLs prognostic risk signature. The signature performance was confirmed in the training cohort and the testing cohort, and cases were classified into low- and high-risk groups by the risk score calculated from the signature. Patients in the high-risk group had poor prognoses and immunosuppression, while the risk score was significantly associated with tumor-infiltrating immune cells, immune checkpoint expression, and immunotherapy responses. In vitro experiments further confirmed the expression of key signature gene.Conclusion: Our new IOLs-related prognostic signature can be reliable prognostic tools and therapeutic targets for LUAD patients.Keywords: immune, oxidative stress, lung adenocarcinoma, prognostic model

Ying Chen,1 Tzu-Hsuan Liu,2 Yiwei Xia,3 Zhihao Ma4 1Sports Institute, Huaqiao University, Quanzhou, People’s Republic of China; 2School of Political Science and Public Administration, Huaqiao University, Quanzhou, People’s Republic of China; 3School of Law, Southwestern University of Finance and Economics, Chengdu, People’s Republic of China; 4Computational Communication Collaboratory, School of Journalism and Communication, Nanjing University, Nanjing, People’s Republic of ChinaCorrespondence: Zhihao Ma, Computational Communication Collaboratory, School of Journalism and Communication, Nanjing University, Room 362, Zijin Building, Nanjing University (Xianlin Campus), 163 Xianlin Road, Qixia District, Nanjing, Jiangsu, 210023, People’s Republic of China, Tel +86 17561538460, Email redclass@163.comBackground: This study assesses the psychometric properties of the Chinese version of the Zimbardo Time Perspective Inventory (C-ZTPI-20) in an adolescent population.Methods: The investigation encompasses a sample of 2634 middle school students from China and aims to evaluate the instrument’s reliability, structural validity, measurement invariance, criterion validity, and network structure attributes.Results: First, descriptive analysis revealed satisfactory reliabilities for four out of five C-ZTPI-20 dimensions, with Present Fatalistic (PF) exhibiting relatively low reliability. Moreover, Confirmatory Factor Analysis (CFA) supported the 5-dimensional structure across all samples and sexes, albeit with a modest Tucker-Lewis Index (TLI) for girls. Furthermore, measurement invariance analysis underscores unbiased assessment across sexes. Sex differences emerge in the Present Hedonistic (PH) dimension, where boys showed higher scores. Furthermore, criteria validity analysis revealed that Past Positive (PP) and Future (F) were positively associated with extraversion, agreeableness, conscientiousness, openness, grit, and mental health, while they were negatively associated with neuroticism. Past Negative (PN) and PF showed inverse trends, while PH perspective demonstrated complex, varied correlations with these psychological traits, underscoring the multifaceted nature of time perspectives. Finally, network analysis revealed positive inter-correlations within dimensions and significant edge differences between sexes, particularly in inter-dimension connections. Despite differing rankings, the most central and marginal items remained consistent between boys and girls in network models.Conclusion: These findings contribute to understanding the C-ZTPI-20’s effectiveness in assessing adolescent time perspectives and inform interventions promoting psychological well-being and coping strategies.Keywords: time perspective, Zimbardo Time Perspective Inventory, psychometric properties, measurement invariance, network analysis

Siyu Hao,1,2,&ast; Jiuyi Cong,1,&ast; Zhiqiang Ma,1,2 Yan Xia,3 Yu Zhang,1 Nannan Tong,1 Jiangtian Tian,2,4 Yuzhen Li1 1Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 2Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, People’s Republic of China; 3Scientific Research Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 4Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuzhen Li; Jiangtian Tian, Email liyuzhen@hrbum.edu.cn; tianjiangtian@126.comBackground: Psoriasis, a chronic inflammatory disorder with an unknown cause, significantly impacts the physical and psychological well-being of patients. However, current biomarkers related to psoriasis lack clinical specificity, sensitivity, and predictive ability.Methods: In this study, we collected skin lesion tissues from 20 psoriasis patients and 20 normal skin samples. Additionally, we obtained four datasets from the GEO database, which included human psoriasis and healthy specimens. We utilized SVM-RFE analysis and the LASSO regression model to identify potential biomarkers. Furthermore, we examined the composition of immune cell types in psoriasis and their correlation with specific genes.Results: Our investigation revealed 57 differentially expressed genes (DEGs), and we identified significantly enriched pathways through KEGG pathway analysis. The results of machine learning and WGCNA suggested that LCE3D and SPRR1B could potentially be used as marker genes for diagnosing psoriasis. RT-PCR and immunohistochemical detection confirmed the abnormally high expression of the SPRR1B gene in psoriasis. Analysis of immune cell infiltration revealed a strong positive correlation between SPRR1B and Macrophages M0 and T cells follicular helper, while showing the strongest negative correlation with resting Mast cells. In addition, we found that silencing SPRR1B in IFN-γ-treated HaCat cells could significantly reduce the increase in IL-17, IL-22, KRT6, and KRT16 caused by IFN-γ.Conclusion: These findings suggest that SPRR1B may have a significant role in the pathogenesis of psoriasis and could be employed as a novel immunomarker for its development.Keywords: psoriasis, SPRR1B, keratinocyte, immunomarkers, immunohistochemistry

Zhiqiang Wang,&ast; Xiaochun Li,&ast; Pengfei Yu,&ast; Yu Zhu, Feng Dai, Zhijia Ma, Xueqiang Shen, Hong Jiang, Jintao Liu Department of Orthopedic Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jintao Liu, Department of Orthopedic Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, No. 18 Yangsu Road, Canglang New Town, Suzhou, 215009, People’s Republic of China, Email okdoctor2@163.comAbstract: Intervertebral disc degeneration is a chronic degenerative disease caused by the interaction of genetic and environmental factors, mainly manifested as lower back pain. At present, the diagnosis of intervertebral disc degeneration mainly relies on imaging. However, early intervertebral disc degeneration is usually insidious, and there is currently a lack of relevant clinical biomarkers that can reliably reflect early disease progression. Pyroptosis is a regulatory form of cell death triggered by the activation of inflammatory bodies and caspase, which can induce the formation of plasma membrane pores and cell swelling or lysis. Previous studies have shown that during the progression of intervertebral disc degeneration, sustained activation of inflammasomes leads to nuclear cell pyroptosis, which can occur in the early stages of intervertebral disc degeneration. Moreover, intervertebral disc nucleus pulposus cells adapt to the external environment through autophagy and maintain cellular homeostasis and studying the mechanism of autophagy in IDD and intervening in its pathological and physiological processes can provide new ideas for the clinical treatment of IDD. This review analyzes the effects of pyroptosis and autophagy on IDD by reviewing relevant literature in recent years, in order to explore the relationship between pyroptosis, autophagy and IDD.Keywords: intervertebral disc degeneration, pyroptosis, autophagy

Bei Yuan, Shibei Song, Xiao Tang, Zhanqiang Ma Medical Department, The Second People’s Hospital of Guizhou Province (Guizhou Province Mental Health Center), Guizhou, Guiyang, 550001, People’s Republic of ChinaCorrespondence: Zhanqiang Ma, Medical Department, The Second People’s Hospital of Guizhou Province (Guizhou Province Mental Health Center), Guizhou, Guiyang, 550001, People’s Republic of China, Tel +86-13017432067, Email 13017432067@163.comPurpose: This study aims to investigate the impact of multidimensional quality management tools in establishing a medical adverse event management system, with the aim of continuously improving medical quality and safety while ensuring patient well-being.Methods: This study introduces risk management theories, such as the “Gray Rhino Theory”, and employs quality management tools like the Plan-Do-Check-Act (PDCA) cycle, Quality Control Circle (QCC), and Root Cause Analysis (RCA), to provide relevant quality management education and training to employees. This approach facilitates the establishment of a medical adverse event management system that encourages reporting and fosters a blame-free reporting culture, while simultaneously implementing quality management across the entire process. The regular utilization of the QCC facilitates ongoing quality improvement. Furthermore, for sentinel events and patient harm incidents with educational values, the study employs the Incident Decision Tree (IDT) to determine appropriate actions. Additionally, the hospital initiates RCA for system-wide improvements, focusing on areas such as management, institutional processes, and environmental aspects. Moreover, an internal medical quality improvement case competition is organized, with outstanding cases being selected to participate in the multidimensional quality management competition organized by the National Quality Management Alliance.Results: The study reveals a significant improvement in employees’ awareness of adverse events, the percentage of employees reporting adverse events increased significantly from 39.15% in 2019 to 49.77% in 2022, P=0.002. Furthermore, the adverse event reporting rate has risen significantly from 2.78% (2019) to 5.96% (2022), P=0.002. Additionally, each department has been able to utilize QCC or RCA tools for quality improvement, thereby further reinforcing the development of a patient safety culture.Conclusion: Multidimensional quality management tools play a crucial role in establishing a hospital’s adverse event management system, promoting continuous improvement in medical quality, ensuring patient safety, and effectively implementing a culture of patient safety.Keywords: multidimensional quality management tools, adverse events, management system, patient safety

Liu Yang, Zhe Ma Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan City, Shandong Province, People’s Republic of ChinaCorrespondence: Zhe Ma, Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan City, Shandong Province, 250014, People’s Republic of China, Tel +86-13969033555, Email mazhe315@163.comObjective: To establish a good predictive model using a deep-learning (DL)-based three-dimensional (3D) super-resolution ultrasound images for the diagnosis of benign and malignant breast lesions.Methods: This retrospective study included 333 patients with histopathologically confirmed breast lesions, randomly split into training (N=266) and testing (N=67) datasets. Eight models, including four deep learning models (ORResNet101, ORMobileNet_v2, SRResNet101, SRMobileNet_v2) and four machine learning models (OR_LR, OR_SVM, SR_LR, SR_SVM), were developed based on original and super-resolution images. The best performing model was SRMobileNet_v2, which was used to construct a nomogram integrating clinical factors. The performance of nomogram was evaluated using receiver operating characteristic (ROC) analysis, decision curve analysis (DCA), and calibration curves.Results: SRMobileNet_v2, MobileNet_V2 based on super-resolution ultrasound images, had the best predictive performance in four traditional machine learning models and four deep learning models, with AUC improvements of 0.089 and 0.031 in the training and testing sets, relative to the ORMobileNet_v2 model based on original ultrasound images. The deep-learning nomogram was constructed using the SRMobileNet_v2 model score, tumor size, and patient age, resulting in superior predictive efficacy compared to the nomogram without the SRMobileNet_v2 model score. Furthermore, it demonstrated favorable calibration, discrimination, and clinical utility in both cohorts.Conclusion: The diagnostic prediction model utilizing super-resolution reconstructed ultrasound images outperforms the model based on original images in distinguishing between benign and malignant breast lesions. The nomogram based on super-resolution ultrasound images has the potential to serve as a reliable auxiliary diagnostic tool for clinicians, exhibiting superior predictive performance in distinguishing between benign and malignant breast lesions.Keywords: deep learning, radiomics, machine learning, breast lesion, super-resolution

Ning Zhang,1,&ast; Tong Liu,1,&ast; Jianan Wang,2,&ast; Yingying Xiao,1 Ying Zhang,1 Jun Dai,1 Zhihong Ma,1,3 Donglai Ma4 1School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People’s Republic of China; 2Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People’s Republic of China; 3Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Shijiazhuang, Hebei, 050200, People’s Republic of China; 4School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhihong Ma; Donglai Ma, Hebei University of Chinese Medicine, Xingyuan Road 3, Shijiazhuang, Hebei, 050200, People’s Republic of China, Tel +86 31189926238, Email mazh1969@163.com; mdl_hebei@aliyun.comBackground: Metabolic associated fatty liver disease (MAFLD) is a chronic disease characterized by excessive lipid deposition in the liver without alcohol or other clear liver-damaging factors. AMP-activated protein kinase (AMPK)/silencing information regulator (SIRT)1 signaling pathway plays an important role in MAFLD development. Si-Ni-San (SNS), a traditional Chinese medicine, has shown reducing hepatic lipid deposition in MAFLD rats, however, the underlying mechanisms of SNS are barely understood.Purpose: The aim of this research was to investigate the mechanisms of SNS in reducing hepatic lipid deposition in MAFLD rats by regulating AMPK/SIRT1 signaling pathways.Methods: The components of SNS were determined by high performance liquid chromatography with mass spectrometry (HPLC-MS) analysis. MAFLD rats were induced by high-fat and high-cholesterol diet (HFHCD), and treated by SNS. SNS-containing serum and Compound C (AMPK inhibitor) were used to treat palmitic acid (PA)-induced HepG2 cells. To elucidate the potential mechanism, lipid synthesis-related proteins (SREBP-1c and FAS), fatty acid oxidation (PPARα and CPT-1), and AMPK/SIRT1 signaling pathway (p-AMPK and SIRT1) were assessed by Western blot.Results: SNS improved serum lipid levels, liver function and reduced hepatic lipid deposition in MAFLD rats. SNS-containing serum reduced lipid deposition in PA-induced HepG2 cells. SNS could up-regulate protein expressions of PPARα, CPT-1, p-AMPK and SIRT1, and down-regulate protein expressions of SREBP-1c and FAS. Similar effects of SNS-containing serum were observed in PA-induced HepG2 cells. Meanwhile, Compound C weakened the therapeutic effects of SNS-containing serum on lipid deposition.Conclusion: SNS could reduce hepatic lipid deposition by inhibiting lipid synthesis and promoting fatty acid oxidation, which might be related with activating the AMPK/SIRT1 signaling pathway. This study could provide a theoretical basis for the clinical use of SNS to treat MAFLD.Graphical Abstract: Keywords: Si-Ni-San, MAFLD, lipid deposition, lipid synthesis, fatty acid oxidation, AMPK

Ziyang Li, Zhiqiang Ma School of Management, Jiangsu University, Zhenjiang, People’s Republic of ChinaCorrespondence: Zhiqiang Ma, School of Management, Jiangsu University, Zhenjiang, People’s Republic of China, Tel +86 1 535 858 2636, Email 2111810005@stmail.ujs.edu.cnPurpose: The willingness to utilize primary care services is crucial in explaining residents’ healthcare-seeking behavior and decision-making in the context of the free choice of healthcare providers. This study examines China’s family doctor contracting services system to elucidate the conceptual structure of the willingness to utilize primary care services and develop a reliable measurement tool.Methods: The study was conducted in two phases. Firstly, in-depth interviews were conducted with community residents, resulting in 42 qualitative data sets. Subsequently, a measurement scale for the willingness to utilize family doctor contracting services was developed, and the scale was validated through two surveys using exploratory factor analysis (N = 250) and confirmatory factor analysis (N = 278), respectively.Results: By employing a grounded theory approach, this study analyzes the connotation of willingness to utilize family doctor contracting services. It constructs a conceptual framework for the willingness to utilize primary care services. This conceptual framework consists of three dimensions: perceived feasibility, perceived desirability, and perceived initiative. Based on this framework, a measurement scale comprising 14 items was developed and subjected to rigorous validation procedures to ensure its reliability and validity.Conclusion: This study extends prior research on healthcare service utilization willingness by elucidating the internal willingness structure for primary healthcare services. It enhances our understanding of the connotation of healthcare service utilization willingness and develops a scientifically rigorous measurement tool. The findings of this study provide valuable insights into improving both the willingness and behavior of utilizing primary care services in healthcare systems where the hierarchical referral system still needs to be fully developed.Keywords: family doctor contracting services, primary care utilization willingness, grounded theory, scale development

Xuejiao Liao,1,&ast; Yuan Guan,1,2,&ast; Zixun Lin,1 Qingrong Tang,3 Zhenghua Ma,1 Shuting Wu,1 Xiaobin Wang,1 Jingke Dong,1 Liping Zhang,1 Jiayu Deng,1 Zhonghui Liao,1,4 Sumei Yang,1,4 Cheng Wang,1,4 Shuo Song,1 Hongyang Yi,1 Song Wu,5 Tetsuya Asakawa,6 Hongzhou Lu1 1Institute for Hepatology, National Clinical Research Center for Infectious Disease, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China; 2Department of Epidemiology, School of Public Health Fudan University, Shanghai, People’s Republic of China; 3The First Hospital of Changsha, Infectious Diseases Department, Changsha, People’s Republic of China; 4School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China; 5Department of Central Laboratory, South China Hospital, Medical School, Shenzhen University, Shenzhen, People’s Republic of China; 6Institute of Neurology, National Clinical Research Center for Infectious Diseases, the Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hongzhou Lu, Institute for Hepatology, National Clinical Research Center for Infectious Disease, The Third People’s Hospital of Shenzhen, The Second Hospital Affiliated with the School of Medicine, Southern University of Science and Technology, No. 29 Bulan Road, Long Gang District, Shenzhen, Guangdong, 518112, People’s Republic of China, Email luhongzhou@fudan.edu.cn Tetsuya Asakawa, Institute of Neurology, National Clinical Research Center for Infectious Diseases, the Third People’s Hospital of Shenzhen, No. 29 Buji Bulan Road, Shenzhen, Guangdong, 518112, People’s Republic of China, Email asakawat1971@gmail.comPurpose: The purpose was to review relevant clinical data and formulate recommendations supporting the use of saline as a simple rinse for an early reassuring intervention to reduce the occurrence of re-positive COVID-19 patients.Methods: We conducted a single-centre retrospective cohort study, which enrolled patients with confirmed re-testing positive COVID-19 during 7– 60 days after discharge from Third People’s Hospital of Shenzhen. By one-to-two propensity score matching for age and sex, the control group of those not re-testing positive during the same period served as matched control.Results: A total of 223 patients were included in our study, 94 in re-positive group and 129 in non-re-positive group. The result shows that the rates of nasal douche treatment in the non-re-positive group were considerably higher than that of the re-positive group. And the Ct value of nasal douche group increased faster than that of non-nasal douche group after the Ct value reaching ≥ 35. Further analysis revealed that the higher the Ct value at the time of readmission, the shorter the time of average Ct values to reach ≥ 35.Conclusion: These findings suggest that nasal douche is beneficial to shorten the time of virus nucleic acid turning negative, thereby reducing the incidence of re-positive. The prevention and control of epidemics focuses on re-positive patients with Ct values < 35.Keywords: COVID-19, nasal douche, re-positive, RT-PCR

Ziwen Ma,1,&ast; Liming Chu,1,&ast; Yan Zhang,1,&ast; Fang Lu,2 Yun Zhu,1 Fei Wu,1 Zhiping Zhang1 1Department of Obstetrics and Gynecology, Shanghai Pudong New Area Healthcare Hospital for Women and Children, Shanghai, People’s Republic of China; 2Department of Obstetrics and Gynecology, Shanghai Forth People’s Hospital, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhiping Zhang, Email zzpdr@126.comPurpose: The aim of this study was to investigate the relationship between gestational diabetes mellitus (GDM) and Chemerin by analyzing chemerin levels in peripheral blood and cord blood, and chemerin mRNA and its protein expression in placenta and adipose tissue.Methods: A case-control study was conducted in 110 women with GDM and 110 controls without GDM who received regular prenatal services and delivered at Shanghai Pudong New Area Healthcare Hospital for Women and Children from June 2019 to December 2020.Results: The age, pre-pregnancy weight, pre-pregnancy BMI, antepartum BMI, TG/HDL ratio and TG levels in pregnant women with GDM were significantly higher than those in women without GDM, and HDL levels were significantly lower than those in the normal group. Chemerin in the umbilical cord blood of the GDM group was significantly higher than in that of the normal group, but there was no difference in chemerin levels in peripheral blood. In the two groups, the chemerin concentration in peripheral blood was significantly higher than that in umbilical cord blood (P< 0.001). The Chemerin mRNA and protein expression levels in the placenta and adipose tissue of pregnant women in the GDM group were significantly higher than those in the normal group (P < 0.001). In the GDM group, the expression of chemerin protein in adipose tissue was significantly higher than that in placental tissue. Regression analysis showed that the expression level of chemerin protein in placental tissue and adipose tissue was positively correlated with the risk of GDM.Conclusion: Elevated chemerin is closely related to the risk of GDM, and the placenta may be an important secretion of chemotactic factor sources in addition to adipose tissue and participate in the development of GDM.Keywords: chemerin, GDM, placenta, adipose

Yuan Wang,1– 3 Chengfeng Ma,1,2 Zhanbing Ma,1,2 Mengyi Yang,1,2 Jing Pu,1,2 Xiuhui Ma,1,2 Xi Wu,1,2 Liang Peng,1,2 Zhenghao Huo,1,2,&ast; Jie Dang1,2,&ast; 1School of Basic Medicine, Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China; 2Key Laboratory of Fertility Preservation and Maintenance of the Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China; 3Department of Dermatology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jie Dang; Zhenghao Huo, Department of Medical Genetics and Cell Biology, School of Basic Medicine, Ningxia Medical University, 1160 Shengli Street, Yinchuan, Ningxia, 750001, People’s Republic of China, Tel/Fax +86-951-6980049, Email djjune1978@163.comPurpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can cause systemic damage to multiple organs. This study aims to analyze the value and function of IFI44 in the diagnosis and pathology of SLE by bioinformatics and immune infiltration analysis.Patients and Methods: GSE49454 and GSE65391 of SLE were obtained from the GEO dataset, and R software was employed to identify DEGs and investigate their functions. The PPI network was utilized to identify hub genes associated with SLE. CIBERSORT was used to assess differences in immune cell infiltration in SLE patients and controls. ROC curve analysis was performed to evaluate the diagnostic value of IFI44 in SLE. The expression of IFI44 in PBMCs was detected by RT-qPCR, and the correlation between IFI44 expression and SLE-related clinical indicators was analyzed.Results: A total of 65 DEGs were identified from the GSE49454 and GSE65391 databases. Through PPI analysis, IFI44 and RSAD2 were identified as significantly aberrantly expressed in SLE patients. SLE patients and controls showed a significant difference in the proportion of immune cell infiltration. IFI44 expression was positively correlated with activated DCs, monocytes, PCs, neutrophils, and activated memory CD4+T cells, while negatively correlated with M0 and CD8+T cells. The expression of IFI44 was significantly higher in SLE patients (P< 0.01), especially in male patients (P=0.0376). ROC curve analysis demonstrated that IFI44 had a high diagnostic value for SLE. Correlation analysis indicated that IFI44 expression was correlated with levels of RBC, HGB, HCT, IgA, ESR, UPRO, C3, C4, and ENA in SLE patients.Conclusion: IFI44 may play a role in the pathogenesis of SLE by influencing the immune microenvironment of SLE patients, and thus has the potential to serve as a diagnostic marker and therapeutic target for SLE.Keywords: systemic lupus erythematosus, IFI44, bioinformatics, immune cell infiltration, sexual dimorphism

Dongxia Liu,1 Liya Wang,1,2 Zhongdan Hu,3 Zhenzhen Ma,1 Qingrui Yang1 1Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China; 2Department of Rheumatology and Immunology, Heze Medical College, Heze, 274000, People’s Republic of China; 3Tianjin Zhonghe Clinic Co. Ltd. of Heping District, Tianjin, 300450, People’s Republic of ChinaCorrespondence: Liya Wang; Zhongdan Hu, Email Liyawangdoctor@126.com; huhu081015@126.comObjective: We explore the association of polymorphisms in Secreted protein acidic and rich in cysteine (SPARC) with ankylosing spondylitis (AS) and detect SPARC mRNA and protein expression in a Chinese Han population.Methods: Nine single-nucleotide polymorphisms (SNPs) of SPARC were genotyped in 768 AS patients and 768 controls by TaqMan genotyping assay. mRNA expression of SPARC was detected by real-time polymerase chain reaction (RT-PCR), and serum level of SPARC protein was detected by ELISA.Results: The frequency of A allele of rs171121187 was significantly higher in AS patients than in controls (Pc=0.003, odds ratio [OR]=1.45, 95% confidence interval [95% CI] = 1.18– 1.77), the AA and AC genotypes increased the risk of AS when compared with CC genotype (Pc=0.003, OR=3.96, 95% CI=1.80– 8.75, and Pc=0.003, OR=1.27, 95% CI=1.01– 1.61, respectively). The frequency of G allele of rs4958487 was significantly lower in AS than in controls (Pc=0.001, OR=0.60, 95% CI=0.47– 0.68), the GG and GA genotypes reduced the risk of AS when compared with AA genotype (Pc=0.005, OR=0.46, 95% CI 0.18– 1.14, and Pc=0.005, OR=0.60, 95% CI=0.45– 0.79, respectively). The haplotype AA of rs17112187/rs4958487 significantly increased the risk of AS (P=2.31E-5, OR=1.60, 95% CI=1.28– 1.98), while haplotype CG decreased the risk of AS (P=5.42E-5, OR=0.55, 95% CI=0.41– 0.74). Expression levels of SPARC mRNA were significantly lower in both Peripheral blood mononuclear cells (PBMC) and granulocytes in AS patients than in controls (P=0.008 and P=0.005, respectively). SPARC protein levels were also reduced in AS patients versus the controls (P= 0.002).Conclusion: This study indicates that polymorphisms in SPARC are associated with AS susceptibility, and both mRNA and protein levels of SPARC are decreased in AS patients in a Chinese Han population.Keywords: secreted protein acidic and rich in cysteine, SPARC, ankylosing spondylitis, single nucleotide polymorphism, SNP, case–control study

Jingjing He, Yifei Guo, Yao Zhang, Jiajia Han, Jingwen Chen, Yidi Jia, Zhenxuan Ma, Jingwen Wu, Shenyan Zhang, Fahong Li, Richeng Mao, Jiming Zhang Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Shanghai Institute of Infectious Diseases and Biosecurity, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaCorrespondence: Jiming Zhang; Richeng Mao, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Shanghai Institute of Infectious Diseases and Biosecurity, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Room 510, Building 5, 12 Middle Wulumuqi Road, Shanghai, People’s Republic of China, Email jmzhang@fudan.edu.cn; richengmao@gmail.comPurpose: The study aims to evaluate the effectiveness of a tenofovir alafenamide fumarate (TAF) and pegylated interferon alfa (PegIFN-α) regimen compared to a tenofovir disoproxil fumarate (TDF) and PegIFN-α therapy in patients with chronic hepatitis B (CHB).Patients and Methods: Patients who were treated with PegIFN-α in combination with TAF or TDF were retrospectively enrolled. The primary outcome measured was the HBsAg loss rate. The rates of virological response, serological response for HBeAg, and normalization of alanine aminotransferase (ALT) were also calculated. The cumulative incidences of response rates were compared between the two groups using Kaplan–Meier analysis.Results: A total of 114 patients were retrospectively enrolled in the study, with 33 receiving TAF plus PegIFN-α treatment and 81 receiving TDF plus PegIFN-α treatment. The HBsAg loss rate for the TAF plus PegIFN-α group was 15.2% at 24 weeks and 21.2% at 48 weeks, while the TDF plus PegIFN-α group had rates of 7.4% at 24 weeks and 12.3% at 48 weeks (P=0.204 at 24 weeks, P=0.228 at 48 weeks). In subgroup analysis of HBeAg positive patients, the TAF group had a higher HBsAg loss rate of 25% at week 48, compared to 3.8% in the TDF group (P=0.033). According to Kaplan–Meier analysis, the TAF plus PegIFN-α group achieved virological response more quickly than the TDF plus PegIFN-α group (p=0.013). There was no statistical difference in HBeAg serological rate or ALT normalization rate.Conclusion: There was no significant difference in the HBsAg loss between the two groups. However, subgroup analysis revealed that TAF plus PegIFN-α treatment had a higher HBsAg loss rate than TDF plus PegIFN-α treatment in HBeAg-positive patients. Additionally, TAF plus PegIFN-α treatment demonstrated better virological suppression for CHB patients. Therefore, TAF plus PegIFN-α treatment regimen is recommended for CHB patients who aim to achieve functional cure.Keywords: hepatitis B virus infection, tenofovir alafenamide fumarate, tenofovir disoproxil fumarate, interferon, functional cure, combination therapy