Acute rheumatic feve and post-streptococcal reactive arthritis are known to be immune-mediated consequences of streptococcal infection, whereas the dangers of streptococcal infection in rheumatoid arthritis have rarely been reported, and the present study evaluated the relationship of streptococcal infection on readmission in patients with RA.
To investigate the relationship between traditional Chinese medicine and the readmission rate of patients with rheumatoid arthritis combined with streptococcal infection (RA-ASO) through a retrospective cohort study.
We used the information system (HIS) database of the First Affiliated Hospital of Anhui University of Chinese Medicine to select the data of RA patients from June 2013 to June 2021. A total of 1 233 RA patients were included, and patients were categorized into RA-only group (989 patients) and RA-ASO group (244 patients) according to whether they were combined with ASO (streptococcus>50 kU/L). Patients′ medication use and readmissions were collected by telephone follow-up as of 2022-06-01. The RA-ASO patients were then divided into the herbal medicine group (113 cases) and the non-herbal medicine group (113 cases) using the 1∶1 propensity score matching principle. Univariate and multivariate Cox regression analyses and Kaplan-Meier survival curve analyses were used to explore the risk factors for readmission in RA-ASO patients. The top 20 herbal medicines used in 113 patients in the TCM group were also clustered by clustering and analyzed by association rule with the reduction of readmission.
The results showed that the mean age of patients and the percentage of elderly people aged 60-89 years were lower in the RA-ASO group than in the RA-only group, and the rates of slow-acting antirheumatic drugs, glucocorticoid use, readmission, and streptococci were higher than in the RA-only group (P<0.05). One-way Cox proportional risk regression analysis showed that men (HR=1.01, 95%CI=1.01-1.01, P<0.01), osteoarthritis (HR=1.65, 95%CI=1.07-2.54, P=0.02), and interstitial pneumonia (HR=1.63, 95%CI=1.11-2.39, P=0.01), RA-ASO patients with glucocorticoid use (HR=1.51, 95%CI=1.02-2.22, P=0.04) had an elevated risk of readmission, and the use of traditional Chinese medicine (HR=0.57, 95%CI=0.39-0.83, P<0.01) of RA-ASO patients had a reduced risk of readmission. Multifactorial Cox proportional risk regression analysis showed that RA-ASO patients with interstitial pneumonia (HR=1.54, 95%CI=1.02-2.32, P=0.04) and elevated erythrocyte sedimentation rate (HR=1.78, 95%CI=1.06-3.00, P=0.03) had an increased risk of readmission; patients with traditional Chinese medicine (HR=0.48, 95%CI=0.31-0.75, P<0.01) had a decreased risk of readmission in RA-ASO patients. The results of Kaplan-Meier survival curve analysis showed that the readmission rate of RA-ASO patients in the Chinese medicine group was lower than that in the non-Chinese medicine group (χ2=10.989, P<0.001), and that the readmission rate of RA-ASO patients in the Chinese medicine group was lower than that of female patients in the non-Chinese medicine group (χ2=4.118, P=0.042). Among them, the reduction of readmission was strongly associated with the Chinese medicines of zedoary, peach kernel, and dandelion.
This study found that TCM treatment may be associated with a lower readmission rate in RA-ASO patients. For patients with RA-ASO, TCM treatment may be considered to reduce patient readmission.
Skin flap transplantation is a common method for surgical repair of various types of wounds. The temperature of the skin flap reflects the blood supply and venous reflux of it, which can help detect vascular crises in the early stage. However, how to accurately measure the temperature of skin flap and its specific predictive role in vascular crises remains unclear.
To explore the difference in flap temperature between the "five points" and "single point" flaps and their accuracy and optimal cut-off values in predicting vascular crisis.
Adult inpatients who underwent flap transplantation surgery from January 2021 to July 2023 were included. Beginning on day 1 after surgery, non-contact infrared thermometers were used every 2 hours to measure the skin flap temperature using the "five points method" at the center point, edge at 12 o'clock, 3 o'clock, 6 o'clock, and 9 o'clock of the skin flap, the temperature readings were obtained by pausing for 3 seconds at a distance of 3cm from each site, and the average temperature of the "five points" was taken to compare with the center single point temperature of the skin flap. The "cotton buds-press method" was simultaneously used to monitor the capillary response of the skin flap and observe the color of skin flap for 5 consecutive days.
A total of 66 patients with various types of skin flap surgeries were included, with males and females accounting for 59.09% (39/66), and 40.91% (27/66), respectively. The average age was (45.03±17.00) years old. The changes of the "five points" flap temperature and the "single point" flap temperature from 1-5 days after surgery were the lowest on the first day after surgery, and gradually increased thereafter. The incidence of vascular crisis was 15.15% (n=10) and, which occurred mainly within 3 days after surgery, and the "five points" flap temperature was lower than the "single point" flap temperature (P<0.001). The receiver operating characteristic (ROC) curves of "five points" flap temperature and "single point" flap temperature predicting vascular crisis were plotted and the results showed that the area under curve (AUC) of "five points" flap temperature predicting vascular crisis was 0.87 (95%CI=0.74-0.99), the sensitivity and specificity were 90% and 75%, the Youden index was 0.65, and the optimal cut-off value was 35.96℃. The AUC of "single point" flap temperature predicting vascular crisis was 0.76 (95%CI=0.61-0.91), the sensitivity and specificity were 70% and 71%, the Youden index was 0.41, and the optimal cut-off value was 36.18 ℃.
The "five points" flap temperature was lower than that of the "single point" flap temperature, the accuracy and authenticity of the former is slightly better than the latter in predicting vascular crisis.
Alzheimer's disease (AD) is a type of neurodegenerative disorder primarily characterized by learning and memory impairments, posing a significant burden to families and society. Traditional Chinese Medicine (TCM) holds considerable potential in preventing and treating AD, and it is crucial to actively explore effective therapeutic methods from the treasury of TCM.
This study aimed to investigate the effects of the compatibility extract of Huangjing pill (CHP) on the proliferation of stem cells in the dentate gyrus (DG) region of the hippocampus in rats with learning and memory impairments induced by D-galactose combined with scopolamine.
From January to December 2023, 90 male SD rats were randomly divided into a normal control group, an AD model group, a donepezil group, and CHP low, medium, and high dose groups, with 15 rats in each group. The donepezil group was given 0.5 mg·kg-1·d-1 donepezil by gavage. The CHP low, medium, and high dose groups were given 1, 3 and 9 g·kg-1·d-1 doses of the combined extract of CHP by gavage respectively. The intervention lasted for 8 weeks. The AD rat model was prepared by subcutaneous injection of 1% D-galactose solution combined with scopolamine. The learning and memory capabilities were assessed through the step-down test. After sampling, the expression levels of hippocampal cell cycle protein D1 (CyclinD1) and nestin mRNA were measured by real-time fluorescent quantitative polymerase chain reaction (RT-qPCR), and the expression levels of CyclinD1 and nestin proteins were detected by Western blot. The number of immunopositive cells was determined by 5-bromo-2-deoxyuridine (BrdU) immunohistochemistry and immunofluorescence.
The step-down test showed that the reaction time was prolonged, the number of errors in step-down learning and memory scores increased, and the latency time significantly decreased in the AD model group compared to the normal control group. The donepezil group and each dosage group of CHP significantly reduced the reaction time and the number of errors in step-down learning and memory scores, and significantly increased the latency time compared to the AD model group (P<0.05). RT-qPCR results indicated that the expression levels of CyclinD1 and nestin mRNA in the hippocampus of the AD model group were significantly lower than those in the normal control group. The donepezil group and each dosage group of CHP showed increased expression levels of hippocampal CyclinD1 and nestin mRNA compared to the AD model group, with the high dosage group of CHP showing higher levels than the normal control group (P<0.05). Western blot results mirrored these findings, with significant increases in the expression levels of CyclinD1 and nestin proteins in the donepezil group and each dosage group of CHP compared to the AD model group, especially in the high dosage group of CHP, which were higher than those in the normal control group (P<0.05). BrdU immunohistochemistry and immunofluorescence showed that the number of positive cells in the hippocampal DG region significantly decreased in the AD model group compared to the normal control group; however, it significantly increased in the donepezil group and each dosage group of CHP, with the medium and high dosage groups of CHP having higher numbers than the normal control group (P<0.05) .
CHP can promote the proliferation of neural stem cells in the hippocampus of rats with learning and memory impairments, facilitating the recovery of hippocampal neural functions and thereby improving cognitive impairments in AD, which highlights its value for clinical application.
