nkylosing spondylitis(AS) is an autoimmune disease mainly characterized by chronic inflammation of the axial spinal joints, and its onset is significantly correlated with genetic markers such as human leukocyte antigen B27. AS has the characteristics of multi-system involvement and can cause extra-articular manifestations such as gastrointestinal dysfunction, renal damage and skin and mucosal lesions. The clinical treatment drugs for AS mainly include three categories: non-steroidal anti-inflammatory drugs, glucocorticoids and antirheumatic drugs for improving the condition. With the breakthrough of biological targeted therapy, biological agents such AS tumor necrosis factor inhibitors and interleukin-17 inhibitors have become a new paradigm for the treatment of AS. This paper systematically reviewed the latest research on AS biological agents combined with AS physical rehabilitation, exercise therapy and other non-pharmaceutical intervention methods, aiming to provide evidence-based basis for optimizing the comprehensive management plan of AS.

Systemic lupus erythematosus(SLE) is is a chronic autoimmune disease characterized by multi-system involvement. The disease recurs repeatedly, often accompanied by infections and organ damage, which seriously threaten the quality of life of patients. With the breakthroughs of molecular immunology research, important progress has been made in the targeted treatment strategies for SLE. Based on evidence-based medical evidence, this paper systematically reviewed current drug treatment regimens for SLE, mainly including the optimized application of traditional drugs, as well as the clinical value of innovative therapies such as biological agents like belimumab and telitacicept, and novel treatment approaches such as chimeric antigen receptor T-cell immunotherapy, in order to provide evidence-based basis for individualized treatment decisions.

Rheumatoid arthritis(RA), a common chronic autoimmune disease. In addition to glucocorticoids, nonsteroidal anti-inflammatory drugs, and herbal medicines, the treatment drugs for this disease also include disease - modifying anti-rheumatic drugs(DMARDs). DMARDs include traditional DMARDs, biological disease-modifying antirheumatic drugs(bDMARDs) and targeted synthetic disease-modifying anti-rheumatic drugs(tsDMARDs). The latter two are also breakthrough therapeutic drugs for RA in recent years. This article provided a detailed introduction to bDMARDs and tsDMARDs, and briefly described other potential therapeutic drugs, to provide new ideas and directions for clinical medication.

Objective To investigate the effect and mechanism of Xiere Huazhuo decoction on weight reduction in diet-induced obesity rats. Methods A total of 60 SPF male SD rats were selected, 8 rats were randomly selected as the normal group, and the other 32 rats were used to establish the nutritional obesity model. Except for the normal group which was fed with ordinary feed, the others were fed with a mixture of high-fat and ordinary feed. A total of 24 rats were successfully modeled and randomly divided into the model group(without intervention), the orlistat group(orlistat suspension), and Xiere Huazhuo decoction group(Xiere Huazhuo concentrated decoction), once a day, with 8 rats in each group. The body weight, body fat mass, lipid metabolism indexes, interleukin(IL)-6, serum leptin level and the changes of adipocyte morphology were compared among the groups. Results Compared with the model group, the increase of the body weight in Xiere Huazhuo decoction group and the orlistat group was significantly reduced(P＜0.01). The serum leptin concentration in Xiere Huazhuo decoction group was significantly lower than that in the other two groups(P＜ 0.01). Compared with the orlistat group, the body fat mass in the Xiere Huazhuo decoction group decreased(P＜0.01).Compared with the model group, the blood lipid levels in both the Xiere Huazhuo decoction group and the orlistat group decreased, but there was no statistically significant difference(P＞0.05). The number of adipocytes increased but the area decreased, and the number and size of lipid droplets in hepatocytes decreased in both Xiere Huazhuo decoction group and orlistat group. Conclusion The Xiere Huazhuo decoction has a significant effect on reducing body weight, which may be related to multiple mechanisms such as improving lipid metabolism, inhibiting inflammatory responses, and regulating insulin resistance and leptin resistance.

Objective To explore whether Bushen Huoxue formua delays vascular aging in atherosclerotic(AS) mice by regulating autophagy mediated by the SIRT6. Methods A total of 96 9-week-old male ApoE-/- mice were selected and randomly divided into the model group, the Bushen Huoxue formula group, the statin group, and the Bushen Huoxue formula＋3-MA group, with 24 mice in each group. Twenty-four 9-week-old male C57BL/6 mice of the same strain were taken as the normal group. The morphological changes of aortic sinus cells, the changes in collagen fiber content, the overall lipid deposition in the aortic sinus and aorta, and the formation of autophagosomes and lipid droplets in endothelial cells in mice were observed. The serum lipid levels, as well as the expressions of p53, p21, p62, SIRT6 genes and MAPLC3 protein in the aorta were compared. Results Compared with the model group, AS in the aortic sinus was obviously alleviated and aortic aging delayed in the Bushen Huoxue formula group, and the levels of serum TG, LDL and TC decreased(P＜0.05), and the level of HDL increased(P＜0.05). In the Bushen Huoxue formula＋3-MA group, the levels of serum LDL and TC increased(P＜0.05), and the level of HDL decreased(P＜0.05). In the Bushen Huoxue formula group and the statin group, lipid deposition in the aortic sinus was significantly reduced(P＜0.01), and the content of collagen fibers in the aortic sinus was significantly decreased(P＜0.01), the expression levels of p53, p21 and p62 were decreased(P＜0.01), and the expression level of SIRT6 and LC3Ⅱ/Ⅰ was increased(P＜0.05). Compared with the Bushen Huoxue formula group, the lipid deposition in the aortic sinus and the content of collagen fibers in the aortic sinusin the Bushen Huoxue formula＋3-MA group increased significantly(P＜0.01), the expression levels of p53, p21 and p62 increased(P＜0.01), and the expression level of SIRT6 and LC3Ⅱ/Ⅰ decreased(P＜0.01). Conclusion Bushen Huoxue formula may delay vascular aging in atherosclerotic mice by regulating SIRT6-mediated autophagy.

Objective To investigate the clinical efficacy of Qili Qiangxin capsules combined with tolvaptan in the treatment of chronic heart failure(CHF) and its effects on serum N-terminal pro-brain natriuretic peptide(NT-proBNP) and high-sensitivity troponin T(hsTnT) levels. Methods A total of 118 CHF patients treated in our hospital were selected, and the patients were divided into the western medicine group and the Chinese and western medicine group using a simple sorting randomization scheme, with 59 cases in each group. The western medicine group received tolvaptan orally, the Chinese and western medicine group received tolvaptan orally combined with Qili Qiangxin capsules. The therapeutic effects and traditional Chinese medicine(TCM) syndrome scores of two groups were compared. The serum NT-proBNP, hsTnT, and heart function related indicators were detected in both groups before and after treatment, and the incidence of adverse reactions during treatment in both groups were recorded and statistically analyzed. Results The total effective rate in the Chinese and western medicine group was higher than the western medicine group(89.83% vs. 74.58%, P＜0.05). After treatment, the TCM syndrome scores, serum NT-proBNP, hsTnT, left ventricular end systolic diameter, and left ventricular end diastolic diameter in both groups were decreased compared to before treatment, and the Chinese and western group was lower than those in the western medicine group(P＜0.05). After treatment, the left ventricular ejection fraction in both groups was increased compared to before treatment, and the Chinese and western group was higher than that in the western medicine group(P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(15.25% vs. 8.47%, P＞0.05). Conclusion Qili Qiangxin capsules combined with tolvaptan can produce good clinical efficacy in the treatment of CHF patients, which can greatly improve TCM syndrome, reduce serum NT-proBNP and hsTnT levels, effectively inhibit myocardial injury, improve heart function, and has a high safety.

Objective To evaluate the effect of Zhichan granules on Parkinson's disease patients with liver and kidney deficiency and its influence on gut microbiota and metabolites. Methods A total of 74 patients were enrolled and randomly divided into treatment group and control group, with 37 cases in each group. The two groups received Zhichan granules and Zhichan granules placebo combined with conventional western medicine, respectively, for 12 weeks. The changes in the unified Parkinson's disease rating scale(UPDRS) and traditional Chinese medicine(TCM) syndrome scale scores were evaluated in both groups. The differences in gut microbiota and metabolites before and after treatment were observed and analyzed. Results After treatment, the scores of UPDRSⅠ, Ⅲ, and Ⅳ sections and the TCM syndrome scale in the treatment group were improved compared with those before treatment and the control group at the same time point, with statistically significant differences(P＜0.05). In the control group, there were no significant differences in the scores of UPDRSⅠ—Ⅳ sections and the TCM syndrome scale before and after treatment(P＞0.05). There was no significant difference in α and β diversity of intestinal flora between the two groups before and after treatment(P＞ 0.05). After treatment, the abundance of Pseudomonas, Prevotella, Morganella, Nocardioides and g_RCP2_54 increased in the treatment group. After treatment, 33 metabolites were up-regulated and 26 metabolites were down-regulated in the treatment group, while 2 metabolites were up-regulated and 8 metabolites were down-regulated in the control group. The pathway enrichment analysis showed that most of the differential metabolites in the treatment group may affect Parkinson's disease by regulating the biosynthesis of valine, leucine and isoleucine, linoleic acid metabolism and β-alanine metabolism. Conclusion After 12 weeks of administration, Zhichan granules can improve the mental and emotional state, motor ability and complications of PD patients, and also improve the TCM syndromes. Additionally, it can affect the gut microbiota and metabolites.

Objective To observe the effect of dexmedetomidine and propofol on postoperative delirium and sleep quality in elderly patients who undergoing hip arthroplasty. Methods A total of 200 elderly patients who undergoing total hip arthroplasty in Huangpu people's hospital from January 2023 to January 2024 were selected, and divided into the control group and the observation group, with 100 cases in each group. The control group were given propofol, the observation group were given dexmedetomidine combined with propofol during hip arthroplasty. The heart rates (HR) before operation(T0), after surgery(T1), 6 hours after surger(T2) and 24 hours after surgery(T3) between the two groups were compared. The incidences of delirium within 5 days after surgery and Pittsburgh sleep quality index(PSQI) scores on postoperative D1 and D5 between the two groups were compared. The adverse reactions of the two groups were compared. Results T1—T3, the HR of the observation group was lower than the control group(P＜0.05). The incidence of delirium within 5 days after surgery and PSQI score of D5 in the observation group were lower than those in the control group(P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P＞ 0.05). Conclusion Dexmedetomidine combined with propofol in elderly patients undergoing hip arthroplasty may reduce stress response and the occurrence of postoperative delirium, improve sleep quality, and do not increase the occurrence of postoperative adverse reactions.

Objective To explore the protective effect of Banxia Baizhu Tianma decoction combined with Taoren Honghua decoction on nerve function of patients with cerebral infarction of the wind-phlegm and blood stasis obstruction syndrome. Methods A total of 92 patients with cerebral infarction admitted to department of emergency, Guoyang hospital of traditional Chinese medicine(TCM), the first affiliated hospital of Anhui university of Chinese Medicine from January 2019 to September 2024 were selected and randomly divided into the observation group and the control group, with 46 cases in each group. The control group was given the conventional treatment, while the observation group was combined with Banxia Baizhu Tianma decoction and Taoren Honghua decoction. Both groups were treated for 4 weeks. The clinical efficacy, middle cerebral artery flow velocity(MCAFV), pulsatility index(PI), cerebral vascular resistance(CVR), coagulation function indicators, TCM syndrome score, National Institute of Health stroke scale(NIHSS) score, activity of daily living scale(ADL) score and the incidence of adverse reactions were compared between the two groups. Result After treatment, the total effective rate of the observation group was higher than that of the control group(89.13% vs. 71.74%, P＜0.05). The MCAFV and CVR in the observation group were higher than those of the control group(P＜0.05), and the PI was lower than that of the control group(P＜0.05). The improvement of coagulation function in the observation group was better than that of the control group(P＜0.05). The TCM syndrome scores and NIHSS in the observation group were lower than those in the control group(P＜0.05), and the ADL score was higher than that in the control group(P＜ 0.05). There was no statistically significant difference in safety between the two groups(P＞0.05). Conclusion Banxia Baizhu Tianma decoction combined with Taoren Honghua decoction has a significant therapeutic effect on patients with cerebral infarction of the wind-phlegm and blood stasis obstruction syndrome. It helps improve coagulation function and cerebrovascular reserve function, has a protective effect on neurological function, and does not increase adverse reactions.

Objective To explore the effect of osmanthus twig and keel oyster decoction as an adjuvant treatment for children with tic disorders. Methods A total of 82 children with tic disorders admitted to department of traditional Chinese medicine(TCM), the second affiliated hospital of Anhui medical university from December 2021 to February 2024 were selected for the study, the patients were divided into the control group(n＝40) and the study group(n＝42) by simple sorting random method. The control group was treated with aripiprazole, while the study group was treated with osmanthus twig and keel oyster decoction on the basis of the control group. Both groups were treated for 3 months. The clinical efficacy, the Yale global tic severity scale(YGTSS), TCM syndrome score, and the serum antinuclear antibody(ANAb), interleukin(IL)-6 and IL-12 before and after treatment were compared between the two groups. The incidences of drowsiness, nausea and loss of appetite during the treatment period in the two groups were recorded. Results After treatment, the clinical effective rate of the study group was higher than that of the control group(92.86% vs. 77.50%, P＜0.05). After the treatment, the YGTSS scores and TCM syndrome scores of the study group at 1, 2, and 3 months were all lower than those of the control group(P＜0.05). After the treatment, the levels of serum ANAb, IL-6 and IL-12 in the study group were all lower than those in the control group(P＜0.05). The total incidence of adverse reactions in the study group was lower than that in the control group(P＜0.05). Conclusion Osmanthus twig and keel oyster decoction has a significant effect on the adjuvant treatment of tic disorders in children, and can effectively improve clinical symptoms and the levels of serum ANAb, IL-6, and IL-12.

Objective To explore the effect of Xinkang capsules in patients with stable angina pectoris(SAP) of coronary atherosclerotic heart disease(CHD). Methods A total of 106 CHD-SAP patients with Qi and Yin deficiency and blood stasis syndrome admitted to our hospital from February 2023 to January 2025 were randomly divided into the control group(treated with conventional western medicine) and the combined group(combined with Xinkang capsules) by simple sorting random method, with 53 cases in each group. Both groups were treated for 8 weeks. The clinical efficacy, efficacy of traditional Chinese medicine(TCM) syndromes, angina pectoris attacks, hemorheological indicators, inflammatory response indicators[nucleotide-binding oligomerization domain-like receptor protein(NLRP)3, interleukin(IL)-18, monocyte chemotactic protein(MCP)-1], cardiac function [cardiac output(CO), left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVEDD), and adverse reactions after treatment were compared between the two groups. Results The total effective rate and the therapeutic effect of TCM syndromes in the combined group were both higher than those in the control group(P＜0.05). The duration and frequency of angina pectoris attacks, high shear viscosity of whole blood, low shear viscosity of whole blood, plasma viscosity and erythrocyte aggregation index in the combined group were all lower than those in the control group(P＜0.05). The levels of NLRP3, IL-18 and MCP-1 in the combined group were lower than those in the control group(P＜0.05). The improvement of CO, LVEF and LVEDD in the combined group was better than that in the control group(P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups during the treatment period(P＞0.05). Conclusion The adjuvant therapy of Xinkang capsules can improve the clinical efficacy of CHD-SAP patients with Qi and Yin deficiency and blood stasis, effectively relieve the attack of angina pectoris, reduce the inflammatory response, improve hemorheology and cardiac function, and has a relatively high safety.

Objective To compare the efficacy of methylphenidate and tomoxetine in the treatment of attention deficit hyperactivity disorder(ADHD) in children and their effects on corticosterone(CORT) and 25-hydroxyvitamin D [25-(OH)D]. Methods Children with ADHD who were treated in our hospital from January 2023 to June 2024 were selected and randomly divided into the experimental group(n＝51, treated with tomoxetine) and the control group(n＝ 50, treated with methylphenidate) by simple sorting random method. Two cases in the experimental group withdrew from the study midway, and three cases in the control group also withdrew from the study midway. The clinical efficacy, CORT, 25-(OH)D, the scores of integrated visual and auditory continuous performance test(IVA-CPT), the Chinese revision of the Wechsler intelligence scale for children(C-WISC), and the incidence of adverse reactions of the two groups were compared. Results After treatment, there was a significant difference in the total effective rate between the two groups(92.16% vs. 72.00%, P＜0.05). The CORT scores and 25-(OH)D in both groups of children were increased compared with those before treatment(P＜0.05), and the scores of the experimental group were higher than those of the control group(P＜0.05). The auditory response control quotient, visual response control quotient and C-WISC score of the experimental group were higher than those of the control group(P＜0.05). The SNAP-IV scores, hyperactivity index and efficacy assessment scale in both groups were lower than those before treatment(P＜0.05), and those in the experimental group were lower than those in the control group(P＜0.05). There was no significant difference in the occurrence of adverse reactions between the experimental group and the control group(3.92% vs. 10.00%, P＞0.05). Conclusion Tomoxetine has a better therapeutic effect than methylphenidate in the treatment of children with ADHD and can improve the levels of CORT and 25-(OH)D.

Objective To systematically evaluate the efficacy and safety of ustekinumab compared with other secondline drugs for Crohn's disease(CD). Methods A systematic search of PubMed, Embase, Cochrane Library, and other databases for cohort studies comparing ustekinumab with other second-line therapies for the treatment of CD. Metaanalysis was performed by Review Manager 5.4 software. Results A total of 10 literature studies were included, 1 222 patients in ustekinumab group and 949 patients in other drug groups. The results showed that the clinical remission rate[OR＝1.75, 95%CI: (1.38, 2.21), P＜0.001], steroid-free clinical remission rate[OR＝1.54, 95%CI: (1.17, 2.01), P＝0.002] and clinical response rate[OR＝2.69, 95%CI: (1.10, 6.58), P＝0.030] in ustekinumab group were higher than those of the other drug groups. In addition, the incidence of adverse events[OR＝0.29, 95%CI: (0.09, 0.96), P＝0.040] and discontinuation rate[OR＝0.28, 95%CI: (0.17, 0.46), P＜0.001] in ustekinumab group were lower than those of the other drug groups. Conclusion Ustekinumab is more effective and safer than the other second-line drugs for CD.

Objective To investigate the risk factors related to arterial stiffness in patients with obstructive sleep apnea(OSA) combined with non-dipper hypertension. Methods A total of 264 patients with hypertension admitted to the geriatrics department of Ruijin hospital, from July 2018 to December 2022 were enrolled. General clinical data and biochemical indicators were collected, and sleep opnea monitoring, 24-hour ambulatory blood pressure monitoring, and carotid-femoral pulse wave velocity(c-fPWV) measurements were performed. Patients were grouped based on ambulatory blood pressure and apnea-hypopnea index(AHI) to study the risk factors for arterial stiffness in patients with OSA combined with non-dipper hypertension. Result A total of 264 patients with OSA combined with hypertension carotidwere included, with an average age of(49.88±12.48) years, of which 195 patients had OSA combined with non-dipper hypertension, accounting for 73.86%. Patients with moderate to severe OSA combined with non-dipper hypertension were older[(52.33±12.78) years vs. (45.88±11.34) years, P＜0.001] and had a faster c-fPWV[(10.19±3.76) m/s vs. (7.76±1.55) m/s, P＜0.001]. The office pulse pressure in patients with moderate to severe OSA combined with non-dipper hypertension was significantly higher than that in patients with mild OSA combined with non-dipper hypertension[(57.00±20.00) mmHg vs. (51.00±11.00) mmHg, P＝0.031]. The c-fPWV in patients with OSA combined with non-dipper hypertension was positively correlated with the AHI, 24-hour systolic blood pressure, and office systolic blood pressure. Logistic regression analysis showed that AHI[odds ratio(OR)＝1.03, 95% confidence interval(CI): 1.01—1.06, P＜0.05], age(OR＝1.14, 95%CI: 1.06—1.12, P＜0.05), and office diastolic blood pressure(OR＝1.08, 95%CI: 1.01—1.16, P＜0.05) were independent risk factors for increased c-fPWV. Conclusion Patients with moderate to severe OSA combined with non-dipper hypertension exhibit significantly elevated c-fPWV, which is closely associated with the severity of OSA and blood pressure levels. AHI, age, and office diastolic blood pressure are independent risk factors for increased c-fPWV. Therefore, patients with OSA combined with non-dipper hypertension, particularly those with moderate to severe OSA, should focus on early screening and intervention for arterial stiffness to reduce the risk of cardiovascular events