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Sichuan Da Xue Xue Bao. Yi Xue Ban = Journal Of Sichuan University. Medical Science Edition[JOURNAL]
Sichuan Da Xue Xue Bao. Yi Xue Ban = Journal Of Sichuan University. Medical Science Edition[JOURNAL]
Sun
200 papers
[Effects and Mechanisms of Yangyin Yiqi Huoxue Formula on the Oral Microecology in Sjögren's Syndrome Model Mice].
Wu F, Lu W, Wu D … +4 more , Zhou Y, Lu H, Ying L, Wu G
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536683 · Full text
OBJECTIVE: To investigate the effect of the Yangyin Yiqi Huoxue formula on the oral microecology in a mouse model of Sjögren's syndrome (SS), and to explore the underlying mechanisms. METHODS: A total of 12 8-week-old no...
OBJECTIVE: To investigate the effect of the Yangyin Yiqi Huoxue formula on the oral microecology in a mouse model of Sjögren's syndrome (SS), and to explore the underlying mechanisms. METHODS: A total of 12 8-week-old non-obese diabetic (NOD) mice were randomly assigned to a model group, a traditional Chinese medicine (TCM) group, and a hydroxychloroquine (HCQ) group, with 4 mice in each group. In addition, 4 BALB/c mice were used as the normal control group. The TCM group was administered Yangyin Yiqi Huoxue formula (15 g/[kg·d]) via gavage and the HCQ group received HCQ (0.08 g/[kg·d]) via gavage. The normal control and model groups were maintained under standard feeding conditions without intervention. After 8 weeks of treatment, saliva samples were collected for 16S rRNA gene sequencing to analyze the oral microbiota. Alpha diversity, beta diversity, and functional prediction analyses were performed. RESULTS: Alpha diversity analysis showed that the Yangyin Yiqi Huoxue formula significantly increased oral microbiome diversity in NOD mice ( < 0.05). Species composition analysis indicated that the formula increased the abundance of the phylum Proteobacteria and decreased the abundance of the phylum Firmicutes ( < 0.01), while HCQ led to an abnormal decrease in the abundance of the phylum Firmicutes. Beta diversity analysis revealed distinct microbial clustering in the treatment groups and the model group, with the TCM group showing clustering in the phylum Proteobacteria and exhibiting lower intragroup dispersion than the HCQ group did. According to the functional prediction analysis, both the TCM and HCQ groups demonstrated regulatory potential in terms of amino acid transport and metabolism, transcription, and other related functions. KEGG analysis found greater microbial enrichment in cellular processes, environmental information processing, and disease-related pathways in the TCM group compared to the HCQ group ( < 0.05). CONCLUSION: The Yangyin Yiqi Huoxue formula can restore oral microbiome diversity and improve the colony structure in in a mouse model of SS, providing experimental evidence for the advantages of TCM in regulating oral microecological functions.
[Expert Consensus on the Clinical Practice of Child Life Services].
Nursing Group Of Chinese Pediatric Society Chinese Medical Association, Nursing Branch China Maternal And Child Health A
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536682 · Full text
As an integral component of modern pediatric healthcare, child life services are designed to address the psychosocial issues that children may encounter during hospitalization and other medical care processes, and to mit...
As an integral component of modern pediatric healthcare, child life services are designed to address the psychosocial issues that children may encounter during hospitalization and other medical care processes, and to mitigate the negative impacts of stressful experiences. Given that child life services in China are still in an early exploratory stage and lack unified and standardized clinical practice guidelines, a multidisciplinary expert consensus development group was jointly established by West China Second University Hospital, Sichuan University, Children's Hospital, Zhejiang University School of Medicine, Shenzhen Children's Hospital, Children's Hospital of Fudan University, and the Children's Cancer Foundation of the Hong Kong Special Administrative Region. Through a systematic literature review and expert deliberations, this consensus has been formulated. This consensus covers the target population, applicable settings, implementation environments, selection criteria for practitioners, training and assessment of practitioners, practice principles, core service content, implementation processes, and outcome evaluation, providing effective clinical practice guidance for child life services practitioners.
[Relationship Between Neonatal Outcomes and Changes in Serum Platelet-Activating Factor, Fibulin-3, and Umbilical Artery Blood Flow During Late Pregnancy in Pregnant Women With Gestational Hypertension].
Sun Y, Zhang H, Sun L
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536681 · Full text
OBJECTIVE: To analyze the relationship between changes in platelet-activating factor (PAF), fibulin-3, and umbilical artery blood flow during late pregnancy in pregnant women with gestational hypertension (GH) and neonat...
OBJECTIVE: To analyze the relationship between changes in platelet-activating factor (PAF), fibulin-3, and umbilical artery blood flow during late pregnancy in pregnant women with gestational hypertension (GH) and neonatal outcomes. METHODS: The data of 420 pregnant women with GH who underwent regular prenatal examinations and who delivered at our hospital between January 2020 and December 2024 were collected. The pregnant women were divided into a good outcome group ( = 319) and a poor outcome group ( = 101) according to the neonatal outcomes. Univariate and multivariate logistic regression analyses were performed to identify the risk factors of adverse neonatal outcomes, and a prediction model was constructed based on the results of risk factors analysis. The receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow test were adopted to evaluate the discrimination ability and calibration ability of the model. RESULTS: Statistically significant differences were observed between the poor outcome group and the good outcome group in terms of age, pre-pregnancy body mass index (BMI), severe GH, PAF, fibulin-3, and umbilical artery blood flow parameters (ratio of peak systolic velocity to end-diastolic maximum velocity [S/D], pulsatility index [PI], and resistance index [RI]) ( < 0.05). Multivariate logistic regression analysis showed that elevated serum PAF, decreased fibulin-3, and increased umbilical artery S/D, PI, and RI were independent risk factors for adverse neonatal outcomes in pregnant women with GH ( < 0.05). A prediction model was constructed based on the results of the multivariate analysis, and the model formula was manifested as Logit () = 1.364 × S/D + 4.199 × PI + 5.303 × RI + 0.534 × PAF (μg/L) － 0.229 × fibulin-3 (ng/mL) － 7.996. ROC curve analysis revealed that the area under the curve (AUC), sensitivity, and specificity of the model were 0.945 (95% CI: 0.923-0.898), 85.90%, and 89.10%, respectively. The Hosmer-Lemeshow goodness-of-fit test revealed = 12.538 and = 0.129. CONCLUSION: Changes in serum PAF, fibulin-3, and umbilical artery blood flow parameters in pregnant women with GH are associated with neonatal outcomes. Increased fibulin-3 is a protective factor, whereas decreased serum PAF level and decreased umbilical artery S/D, PI, and RI are risk factors. The prediction model based on fibulin-3, PAF, S/D, PI, and RI in this study demonstrates high clinical applicability and potential for broader use.
[Application of Child Life Services in Alleviating Medical Fear Among Children in Emergency Care Settings].
Zhou X, Gao J, Zhao X … +1 more , Hu J
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536680 · Full text
OBJECTIVE: To investigate the effectiveness of child life services in alleviating medical fear among pediatric patients in emergency care settings. METHODS: A convenience sampling method was employed to select 85 pediatr...
OBJECTIVE: To investigate the effectiveness of child life services in alleviating medical fear among pediatric patients in emergency care settings. METHODS: A convenience sampling method was employed to select 85 pediatric patients admitted to the Emergency Department of West China Second University Hospital, Sichuan University, between January 2022 and December 2024. A self-controlled before-and-after study design was adopted, wherein child life interventions were administered to all participants. The Children's Fear Scale was utilized to assess fear levels pre- and post-intervention, and then to compare the differences. RESULTS: After the child life intervention, 69 patients exhibited a score reduction > 0, yielding an intervention efficacy rate of 81.18%. The median (interquartile range) fear score decreased significantly from 3 (2-4) pre-intervention to 1 (1-2) post-intervention ( = －7.329, < 0.001). The proportion of participants with severe or extreme fear (≥ 3 points) declined markedly post-intervention, showing statistical significance (11.76% vs. 80.00%, = 33.029, < 0.001). Intervention efficacy varied significantly among subgroups with different levels of fear ( < 0.01), with better effectiveness observed in cohorts with higher levels of fear. CONCLUSION: Child life services significantly reduce the levels of medical fear among pediatric patients in emergency care settings and provide comprehensive psychosocial support. It can also serve as an effective measure for establishing a humanistic emergency care environment.
[Clinicopathological Characteristics of Cervical Neuroendocrine Carcinoma and Their Relationship With Prognosis].
Lan T, Yao X, Zhou X … +5 more , Shi L, Hou J, Zhou C, Liu Y, Shi M
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536679 · Full text
OBJECTIVE: To investigate the clinicopathological characteristics and prognostic factors of cervical neuroendocrine carcinoma (NEC), and to clarify the independent prognostic value of the histological subtypes-mixed NEC...
OBJECTIVE: To investigate the clinicopathological characteristics and prognostic factors of cervical neuroendocrine carcinoma (NEC), and to clarify the independent prognostic value of the histological subtypes-mixed NEC (MiNEC) and pure NEC. METHODS: A total of 45 cases of cervical NEC treated with radical surgery plus concurrent chemoradiotherapy at our institution between 2015 and 2024 were enrolled. Their clinicopathological features and prognosis were evaluated using immunohistochemistry, HPV RNAScope hybridization, and survival analysis. After 1∶1 propensity score-matched calibration for FIGO staging, 17 balanced cohorts were obtained. The overall survival (OS) and disease-free survival (DFS) were compared between the MiNEC ( = 22) and pure-NEC ( = 23) cases using the Kaplan-Meier analysis and the Cox model. RESULTS: The median patient age was 49 years (26-75 years) and the median follow-up was 24 months. The 1-, 3-, and 5-year OS rates were 75%, 61%, and 56%, respectively. According to the univariate analysis, FIGO stages Ⅲ and Ⅳ (hazards ratio [HR] = 3.78, 95% CI: 1.27-11.29, = 0.017) and lymph node metastasis (HR = 3.72, 95% CI: 1.13-12.19, = 0.030) were identified as adverse factors for OS. After propensity score matching, the difference in prognosis between MiNEC and pure-NEC was not statistically significant (HR = 0.80, 95% CI: 0.20-3.21, = 0.583). CONCLUSION: Under a treatment regimen of radical surgery combined with concurrent platinum-etoposide chemoradiotherapy, the FIGO stage is an independent prognostic factor for OS in cervical NEC. Due to the limited sample size, the association between histologic subtypes (MiNEC vs. pure-NEC) and long-term survival requires further validation with larger samples.
[Underlying Mechanism of the circ_0011462/miRNA-1200/SP1 Axis in Regulating Inflammatory Response, Apoptosis, and Neural Regeneration in a Spinal Cord Injury Model].
Li M, Qin S, Ping W … +3 more , Zhang C, Duan J, Li J
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536678 · Full text
OBJECTIVE: To investigate the regulatory mechanism of a circular RNA (circRNA), circ_001146, on the miR-1200/SP1 axis in spinal cord injury (SCI). METHODS: In the animal model, male Sprague-Dawley rats of 8 weeks old, we...
OBJECTIVE: To investigate the regulatory mechanism of a circular RNA (circRNA), circ_001146, on the miR-1200/SP1 axis in spinal cord injury (SCI). METHODS: In the animal model, male Sprague-Dawley rats of 8 weeks old, weighing 220-250 g, were randomly assigned to 5 groups ( = 5 per group), including the sham-operated (SHAM) group, SCI group, circ_0011462 knockdown (sh-circ_0011462) group, circ_0011462 knockdown + empty plasmid control (NC) group, and circ_0011462 knockdown + SP1 overexpression (overexpression-SP1) group. Motor function recovery of the rats in different groups was evaluated at multiple time points using the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale, tail-flick latency (TFL) test, and grid walking test. Nissl staining was performed to measure the number of motor neurons in the anterior horn of the spinal cord. Immunohistochemistry assays were performed to determine the expression of pNF and synaptophysin in the spinal tissue. The quantity of M1-type microglia was assessed using multiplex immunofluorescence. Enzyme-linked immunosorbent assay (ELISA) was performed to measure the levels of IL-1β, IL-6, and TNF-α in peripheral blood across the groups. In addition, cellular experiments included qPCR to determine the mRNA levels of circ_001146, miR-1200, and SP1 in different groups, Western blot (WB) to detect the protein levels of SP1, BCL-2, and Caspase-3, flow cytometry to assess cell apoptosis rates, and phase-contrast microscopy to observe cell morphological changes. RESULTS: In the animal experiment, at 21 and 28 days post surgery, the sh-circ_0011462 group exhibited significantly higher BBB scores (7.00 ± 1.20 and 10.00 ± 2.21) and TFL scores (1.21 ± 0.41 and 1.19 ± 0.31) compared with the SP1 overexpression group (BBB: 5.00 ± 0.60 and 6.00 ± 0.80; TFL: 0.80 ± 0.25 and 0.70 ± 0.20) and the SCI group (BBB: 4.00 ± 0.60 and 5.00 ± 0.70; TFL: 0.60 ± 0.21 and 0.50 ± 0.18) (all < 0.05). In contrast, Gridwalk scores in the sh-circ_0011462 group (1.38 ± 0.31 and 1.22 ± 0.33) were significantly lower than those in the overexpression-SP1 group (2.32 ± 0.37 and 2.40 ± 0.41) and the SCI group (2.72 ± 0.45 and 2.80 ± 0.42) ( < 0.05 for all comparisons). At day 28 post-surgery, the levels of IL-1β, IL-6, and TNF-α in the sham group were lower than those in all other groups ( < 0.05). The SCI and overexpression-SP1 groups showed elevated levels of these cytokines, all of which were significantly higher than those in the sh-circ_0011462 group (all < 0.05). Immunostaining revealed that the number of iNOS-positive cells in the sh-circ_0011462 group was significantly lower than that in the SCI group and the overexpression-SP1 group ( < 0.05). Moreover, the number of motor neurons, axonal length, and synapse density in the anterior horn of rats in the sh-circ_0011462 group were all significantly greater than those in the SCI and overexpression-SP1 groups (all < 0.05). In cellular experiments, qPCR and Western blot assays showed that circ_0011462 knockdown resulted in increased expression of miR-1200, decreased mRNA and protein levels of SP1, downregulation of Caspase-3, upregulation of Bcl-2, reduced apoptosis rate and enhanced axonal growth in PC12 cells. These effects were reversed by transfection with the miR-1200 inhibitor or the overexpression-SP1 plasmid. Transfection with the miR-1200 mimic produced effects similar to those of circ_0011462 knockdown, while co-transfection with the SP1 plasmid attenuated these effects. Flow cytometry further confirmed that apoptosis rates in PC12 cells treated with H₂O₂ or NC vectors were significantly higher than those in the control group (all < 0.05). In the sh-circ_0011462 group, apoptosis rates significantly decreased ( < 0.05). When the miR-1200 inhibitor or the SP1 plasmid was transfected into the sh-circ_0011462 group, apoptosis rates increased again ( < 0.05). Moreover, co-transfection with SP1 plasmid increased the apoptosis rate, which was higher than that in the pcDNA vector control group ( < 0.05). Dual-luciferase reporter assays confirmed that miR-1200 directly targeted circ_0011462 and SP1. Compared with the miR-NC group, miR-1200 mimic significantly reduced the luciferase activity of circ_0011462-wt and SP1-wt ( < 0.05), while no significant changes were observed in their respective mutant constructs ( > 0.05). CONCLUSION: circ_001146 may target and modulate the miR-1200/SP1 axis to ameliorate the pathological conditions of SCI, thereby reducing inflammatory responses, inhibiting neuronal apoptosis, and promoting neural regeneration.
[Role and Mechanism of High Mobility Group Box 1 in Mediating Depression-Like Behaviors in Mice via Regulation of the 5-Hydroxytryptamine Receptor 7 Signaling Pathway].
DU O, Duan S, Tang L … +1 more , DU J
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536677 · Full text
OBJECTIVE: To investigate the regulatory effects and underlying mechanisms of high mobility group box 1 (HMGB1) and 5-hydroxytryptamine receptor 7 (5-HT7R) on depressive-like behaviors in mice. METHODS: knockout ( ) mic...
OBJECTIVE: To investigate the regulatory effects and underlying mechanisms of high mobility group box 1 (HMGB1) and 5-hydroxytryptamine receptor 7 (5-HT7R) on depressive-like behaviors in mice. METHODS: knockout ( ) mice and their wild-type (WT) littermates were assigned to 4 groups, including the WT/control virus (AAV-Scramble), /AAV-Scramble, WT/HMGB1 overexpression virus (AAV-HMGB1), and /AAV-HMGB1 groups. Mice in the AAV-Scramble and AAV-HMGB1 groups received hippocampal injections of control virus and AAV-HMGB1, respectively. Three weeks later, the depression state of the mice were assessed with depressive behavior tests, the neuronal damage in the hippocampus was evaluated using immunofluorescence staining, and the ratio of reduced glutathione to oxidized glutathione (GSH/GSSG), the levels of Fe and malondialdehyde (MDA), and superoxide dismutase (SOD) activity in the hippocampus were measured using commercial kits. Additionally, Western blot and ELISA were used to determine the levels of the 5-HT7R/cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) signaling pathway and the nuclear factor erythroid 2-related factor 2 (Nrf2)/cystine-glutamate exchanger (xCT)/glutathione peroxidase 4 (GPX4) signaling pathway in the hippocampus. Immunofluorescence double staining was performed to assess M2 microglial ferroptosis in the hippocampus. Finally, the mRNA levels of pro-inflammatory cytokines, interleukin (IL)-1β and tumor necrosis factor-α (TNF-α), and anti-inflammatory cytokines, IL-10 and arginase-1 (Arg-1), in the hippocampus was measuring using qRT-PCR. RESULTS: Compared with the AAV-Scramble group, hippocampal HMGB1 overexpression induced depressive-like behaviors and neuronal damage ( < 0.01), while knockout alleviated these pathological phenotypes ( < 0.01). Compared with the AAV-Scramble group, HMGB1 overexpression reduced the GSH/GSSG ratio and SOD activity (both < 0.01) and increased Fe and MDA levels (both < 0.01) in the hippocampus, whereas knockout improved these ferroptosis-related indicators ( < 0.01). Compared with the AAV-Scramble group, HMGB1 overexpression upregulated 5-HT7R expression ( < 0.01) and downregulated the cAMP/PKA and Nrf2/xCT/GPX4 signaling pathways ( < 0.01) in the hippocampus, whereas knockout ameliorated the reduction in these signaling pathways ( < 0.01). Compared with the AAV-Scramble group, HMGB1 overexpression upregulated the expression of 5-HT7R and ferritin heavy chain (FTH) in microglia ( < 0.01), downregulated Nrf2 expression ( < 0.01), and induced colocalization of FTH and CD206 ( < 0.01). knockout reversed the changes in FTH and Nrf2 expression in microglia ( < 0.01) and reduced the colocalization of FTH and CD206 ( < 0.01). Furthermore, HMGB1 overexpression promoted the polarization of microglia to both the M1 and M2 types ( < 0.01) and upregulated the mRNA levels of pro-inflammatory ( and ) and anti-inflammatory ( and ) cytokines ( < 0.01), whereas knockout attenuated microglial M1-type polarization and reduced the mRNA levels of the aforementioned pro-inflammatory cytokine ( < 0.01) while promoting microglial M2-type polarization and increasing the mRNA levels of the aforementioned anti-inflammatory cytokines ( < 0.01). CONCLUSION: HMGB1 activates 5-HT7R and downregulates the cAMP/PKA/AKT/Nrf2/GPX4 signaling pathways, thereby mediating M2 microglial ferroptosis and neuroinflammation, ultimately promoting depressive-like behaviors in mice.
[Identification and Underlying Mechanisms of Immune Cell- and Senescence-Related Biomarkers in Atrial Fibrillation].
Huang W, Liu E, Fu H
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536676 · Full text
OBJECTIVE: To investigate the molecular mechanisms of immune cells (ICs)- and senescence-related biomarkers in atrial fibrillation (AF). METHODS: In this study, immune cell-related genes (ICRGs) were obtained using weigh...
OBJECTIVE: To investigate the molecular mechanisms of immune cells (ICs)- and senescence-related biomarkers in atrial fibrillation (AF). METHODS: In this study, immune cell-related genes (ICRGs) were obtained using weighted gene co-expression network analysis (WGCNA) based on the GSE2240 dataset. Subsequently, the intersection of ICRGs, senescence-related genes (SRGs), and differentially expressed genes (DEGs) derived from differential expression analysis between AF and sinus rhythm (SR) groups was obtained to screen candidate genes. Biomarkers were further identified using the least absolute shrinkage and selection operator (LASSO) algorithm and validated in the GSE115571 dataset. Gene set enrichment analysis (GSEA), GeneMANIA network construction, molecular regulatory network construction, and molecular docking were performed to investigate the molecular mechanisms of the biomarkers in AF. A total of 8 male Sprague-Dawley rats of 87 weeks old and weighing 632-656 g were randomly assigned to the AF group and the sinus rhythm (SR) group ( = 4 per group). An AF rat model was established. The mRNA expression levels of myosin light chain kinase (MYLK) and insulin-like growth factor binding protein 2 (IGFBP2) in rat myocardial tissue were measured using reverse transcription quantitative polymerase chain reaction (RT-qPCR). RESULTS: Two biomarkers, MYLK and IGFBP2, were identified. GSEA revealed that MYLK was significantly enriched in the olfactory transduction pathway, whereas IGFBP2 was significantly enriched in the extracellular matrix-receptor interaction pathway. The GeneMANIA network demonstrated functional similarity between these biomarkers and 20 other genes. In addition, MYLK was regulated by 28 transcription factors (TFs) and 41 microRNAs (miRNAs), whereas IGFBP2 was regulated by 63 TFs and 4 miRNAs, including TAF1 and MIRT020526. Drug prediction analysis indicated that only MYLK had potential interactions with 3 drugs, among which Tozasertib exhibited the strongest binding affinity to MYLK, with a binding energy of －7.8 kcal/mol. RT-qPCR results showed that mRNA expression was upregulated and mRNA expression was downregulated in myocardial tissue of rats in the AF group compared with the SR group (both < 0.05). CONCLUSION: In this study, MYLK and IGFBP2 are identified as AF-related biomarkers, and their potential molecular mechanisms are elucidated, providing new theoretical insights into AF research.
[Effects of Physical Exercise Intervention on Mild-to-Moderate Depression in College Students].
Mu P, Wu Y, Xu T … +2 more , Wang J, Fu Q
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536675 · Full text
OBJECTIVE: To explore the effect of physical exercise intervention on mild-to-moderate depression in college students, and to provide empirical evidence for informing treatment. METHODS: A total of 108 college students w...
OBJECTIVE: To explore the effect of physical exercise intervention on mild-to-moderate depression in college students, and to provide empirical evidence for informing treatment. METHODS: A total of 108 college students with mild-to-moderate depression receiving care at the outpatient department and inpatient department of the Second Affiliated Hospital, Xinxiang Medical University between January 2022 and March 2024 were enrolled. The participants were divided into a control group ( = 54) and a physical exercise group ( = 54) according to the time of consultation. The control group received conventional drug therapy, whereas the physical exercise group was an aerobic exercise intervention regimen in addition to the routine drug therapy. Both groups were treated for 8 weeks. The primary outcome indicator (clinical efficacy) and secondary outcome indicators, including the 24-Item Hamilton Depression Rating Scale (HAMD-24) score, the Pittsburgh Sleep Quality Index (PSQI) score, the P300 component of the event-related potential (latency and amplitude), the serum levels of hypothalamic-pituitary-adrenal (HPA) axis-related indicators (adrenocorticotropic hormone [ACTH] and cortisol [Cor]), and the World Health Organization Quality of Life-Brief scale (WHOQOL-BREF) score, before and after intervention were measured and compared between the two groups. RESULTS: Comparison of the primary outcome indicator revealed that, after treatment, the efficacy grading in the physical exercise group was better than that in the control group ( = 2.546, = 0.011). Regarding secondary outcomes, both groups showed significant reductions in HAMD-24 and PSQI scores after treatment ( < 0.05), with the physical exercise group demonstrating lower scores than the control group ( < 0.05). Event-related potential P300 latency was shortened in both groups, and the reduction was greater in the physical exercise group ( < 0.05). P300 amplitude increased in both groups, with a larger increase observed in the physical exercise group ( < 0.05). Levels of ACTH and cortisol decreased across groups, with lower values in the physical exercise group compared with controls ( < 0.05). Quality-of-life scores improved in both groups, with the physical exercise group reporting higher scores than the control group ( < 0.05). CONCLUSION: Physical exercise can regulate the function of the HPA axis of college students with mild-to-moderate depression, alleviate their depressive symptoms, promote the recovery of cognitive function, and improve the sleep quality and quality of life of patients.
[Relationship Between Nonsuicidal Self-Injury and Family Resilience Among Adolescents: A Moderated Mediation Model].
Wang Y, Li H, Shi D … +7 more , Tan X, Li X, Zhu X, Liu M, Shi W, Jiang L, Zhao L
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536674 · Full text
OBJECTIVE: To examine the mediating role of life satisfaction and the moderating role of social support in the relationship between family resilience and non-suicidal self-injury (NSSI) among adolescents. METHODS: A tota...
OBJECTIVE: To examine the mediating role of life satisfaction and the moderating role of social support in the relationship between family resilience and non-suicidal self-injury (NSSI) among adolescents. METHODS: A total of 8372 adolescents from the fourth wave (June 2022) of the Chengdu Positive Child Development (CPCD) cohort were included. Data were collected using questionnaires assessing NSSI, family resilience, life satisfaction, social support, and demographic characteristics. Chi-square tests and independent samples t-tests were used to analyze inter-group differences. Pearson correlation analysis was conducted to examine the associations among variables. Binary logistic regression was performed to identify factors associated with NSSI among adolescents. Structural equation modeling was conducted using Mplus 7.0. RESULTS: The prevalence of NSSI among the participants was 23.7%. Logistic regression analysis showed that higher family resilience (odds ratio [OR] = 0.932, 95% CI: 0.895-0.970), being female (OR = 0.873, 95% CI: 0.784-0.972), higher parental education level (OR = 0.816, 95% CI: 0.686-0.971), greater social support (OR = 0.801, 95% CI: 0.735-0.873), and higher life satisfaction (OR = 0.558, 95% CI: 0.532-0.587) were all significant protective factors against NSSI. Structural equation modeling further demonstrated that family resilience affected NSSI among adolescents indirectly ( = －0.031, 95% CI: －0.053 to －0.011]) and indirectly through the mediating effect of life satisfaction (indirect effect: = －0.048, 95% CI:－0.057 to －0.039]). The interaction between family resilience and social support had a negative predictive effect on life satisfaction ( = －0.037, 95% CI: －0.059 to －0.014) and a positive predictive effect on NSSI ( = 0.024, 95% CI: 0.002-0.047), indicating that social support played a moderating role in the pathways from family resilience to life satisfaction and NSSI. CONCLUSION: Family resilience influences adolescent NSSI both directly and indirectly through the mediating role of life satisfaction and the moderating effect of social support. These findings highlight the importance of enhancing family resilience, as well as promoting adolescents' life satisfaction and perceived social support, in the development of effective interventions to prevent NSSI.
[Association Between Obesity and the Risk of Obstructive Sleep Apnea Combined With Hypertension].
Zhao X, Shu M, Li X … +2 more , Peng L, Zhang X
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536673 · Full text
OBJECTIVE: To explore the effect of obesity on obstructive sleep apnea (OSA) combined with hypertension and the associated risks, to clarify the value of different obesity assessment indicators (body mass index [BMI], ne...
OBJECTIVE: To explore the effect of obesity on obstructive sleep apnea (OSA) combined with hypertension and the associated risks, to clarify the value of different obesity assessment indicators (body mass index [BMI], neck circumference [NC], waist circumference [WC], body fat percentage [BF%], and visceral adiposity index [VAI]) in predicting hypertension risk in OSA patients, and to provide regional evidence for hypertension risk stratification of OSA patients in Southwest China. METHODS: A total of 299 OSA patients were enrolled at the Sleep Medicine Center, West China Fourth Hospital, Sichuan University in 2024. The participants were divided into a simple OSA group (179 cases) and a group of those with OSA combined with hypertension (120 cases) according to their hypertension diagnosis. Logistic regression was performed to assess the risk association between obesity indicators and OSA combined with hypertension. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of each indicator, and age stratification (≤ 45 years or > 45 years) was performed to analyze risk differences. RESULTS: Significant differences were observed between the two groups (the OSA combined with hypertension group and the OSA-only group) in terms of age (the proportion of middle-aged and older adults, 65.0% and 38.5%, respectively), educational attainment (high school or below, 37.5% and 22.9%, respectively), and family history of hypertension (60.0% and 33.0%, respectively) ( < 0.01). All obesity indicators were positively correlated with the risk of OSA combined with hypertension, with progressively increasing risk observed across higher indicator categories. VAI exhibited the most pronounced risk gradient: the risk for participants with VAI ≥ P was 45.96 times that for those with VAI < P (odds ratio [OR] = 45.96, 95% CI: 15.46-136.59), and the risk for participants with VAI between P and P was 8.06 times that for those with VAI < P (OR = 8.06, 95% CI: 2.86-22.73). VAI demonstrated the best predictive performance (area under the curve [AUC] = 0.856; 95% CI: 0.819-0.893), outperforming traditional indicators (AUC = 0.821, 95% CI: 0.782-0.860; AUC = 0.799, 95% CI: 0.760-0.838). The hypertension risk associated with each obesity indicator in the middle-aged and older adult group was higher than that in the younger group. CONCLUSION: Obesity is a key risk factor for OSA combined with hypertension. VAI demonstrates the best predictive performance for the risk of OSA combined with hypertension and can be used as a priority indicator for hypertension screening in OSA patients in Southwest China. Age and obesity indicators exhibit a cumulative risk effect, which highlights the need to strengthen obesity management in middle-aged and older populations with OSA.
[Construction and Clinical Validation of a Risk Early Warning Model for Mechanical Ventilation-Associated Pneumonia in Older Patients With Lung Cancer].
Wang Z, Shi M, Zhao P … +4 more , Zhou Y, Zhang Z, Qu G, Fang X
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536672 · Full text
OBJECTIVE: To establish and validate a risk prediction model for mechanical ventilator-associated pneumonia (VAP) in older patients with lung cancer. METHODS: A total of 548 older patients with lung cancer were enrolled...
OBJECTIVE: To establish and validate a risk prediction model for mechanical ventilator-associated pneumonia (VAP) in older patients with lung cancer. METHODS: A total of 548 older patients with lung cancer were enrolled between January 2022 and May 2025. Subsequently, the patients were divided into a training set ( = 384) and a validation set ( = 164) at a ratio of 7∶3. According to whether the patients developed VAP, the training set was further divided into a non-VAP subgroup ( = 231) and a VAP subgroup ( = 153), and the validation set was divided into a non-VAP subgroup ( = 99) and a VAP subgroup ( = 65). Multivariate stepwise logistic regression was conducted to identify the predictors of VAP in older patients with lung cancer, and a nomogram model was established accordingly. The model was validated using the receiver operating characteristic (ROC) curve and the calibration curve. RESULTS: A total of 153 participants (39.84%) in the training set and 65 participants (39.63%) in the validation set developed VAP. Univariate analysis revealed that such factors as age, lung cancer stage, mechanical ventilation duration, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) Ⅱ score, procalcitonin (PCT), pentraxin 3 (PTX3), retinol-binding protein (RBP), soluble triggering receptor expressed on myeloid cells-1 (STREM-1), and human cartilage glycoprotein-39 (YKL-40) were associated with VAP in older lung cancer patients ( < 0.05), and there was no multicollinearity. Multivariate logistic stepwise regression revealed that age (odds ratio [OR] = 1.182, 95% CI: 1.014-1.377), mechanical ventilation duration (OR = 3.929, 95% CI: 1.374-11.233), APACHE Ⅱ (OR = 1.770, 95% CI: 1.296-2.416), PTX3 (OR = 1.019, 95% CI: 1.007-1.030), RBP (OR = 1.150, 95% CI: 1.083-1.260), STREM-1 (OR = 1.168, 95% CI: 1.083-1.260) were predictors of VAP in older lung cancer patients ( < 0.05). A nomogram model was constructed with the following equation: Prob = 1/(1 + e), Y = －43.147 + 0.167 × age + 1.368× mechanical ventilation duration + 0.571 × APACHE Ⅱ score + 0.019 × PTX3 + 0.140 × RBP + 0.155 × STREM-1. The area under the curve (AUC) of the ROC in the training set was 0.909 (95% CI: 0.878-0.940), and the AUC of the validation set was 0.843 (95% CI: 0.776-0.910). The average absolute error tested by the Bootstrap method was 0.03, indicating that the model showed a certain level of consistency during both the training and validation processes. CONCLUSION: Age, mechanical ventilation duration, APACHE Ⅱ score, and serum levels of PTX3, RBP, and STREM-1 are all predictors for the occurrence of VAP in older lung cancer patients. The nomogram model constructed based on these factors demonstrates acceptable predictive performance.
[Targeting Regulatory T Cells to Remodel Peripheral Immune Tolerance: Research Advances and Future Directions].
Zhang W, Li Z, Liang H … +2 more , Cheng H, Zhang D
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536671 · Full text
Regulatory T cells (Tregs) are the most important population of immune cells in maintaining peripheral immune tolerance in the body. Targeting Tregs to rebuild peripheral immune tolerance has shown broad potential for ap...
Regulatory T cells (Tregs) are the most important population of immune cells in maintaining peripheral immune tolerance in the body. Targeting Tregs to rebuild peripheral immune tolerance has shown broad potential for application in the treatment of various inflammatory diseases, such as autoimmune diseases, allergic disorders, graft-versus-host disease, and organ transplant rejection. However, substantial challenges remain in translating Treg-based therapies into clinical practice. In this review, we first summarize the discovery of Tregs and the principal mechanisms through which Tregs inhibit immune responses. Then, the research progress in polyclonal Treg-based therapy, antigen-specific Treg-based therapy, and low-dose interleukin-2 (IL-2) therapy and the implementation status of clinical trials of Treg therapies were comprehensively summarized. Finally, four issues, including maintaining the stability of Tregs, preparing autoantigen-specific Tregs, such as chimeric antigen receptor (CAR)-Tregs and T-cell receptor (TCR)-Tregs, reshaping the inflammatory microenvironment of diseases, and minimizing the potential adverse effects of Treg therapies, were highlighted as the bottleneck problems in the clinical translation of Treg therapies and priority directions for future research.
[Analysis of Plasma Metabolic Profile Characteristics in Gouty Arthritis With Dampness Syndrome].
Zhu F, Shen Z, Xiao Y … +7 more , Wu X, Mei L, DU H, Xu Y, Chen X, Wang M, Huang R
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536670 · Full text
OBJECTIVE: To investigate the metabolic characteristics of gouty arthritis (GA) with dampness syndrome (GA-DS), to identify potential diagnostic and recurrence-predictive biomarkers, and to preliminarily elucidate the un...
OBJECTIVE: To investigate the metabolic characteristics of gouty arthritis (GA) with dampness syndrome (GA-DS), to identify potential diagnostic and recurrence-predictive biomarkers, and to preliminarily elucidate the underlying mechanisms of the effect of traditional Chinese medicine (TCM) dampness syndrome on metabolic abnormalities in patients with gout. METHODS: The study was conducted as part of a clinical trial-Clinical Cohort Construction and Efficacy Evaluation of Gouty Arthritis With Dampness Syndrome, which has been registered in the Chinese Clinical Trial Registry (ChiCTR) and assigned the registration number of ChiCTR2000038969. Healthy controls (HC), patients with GA-DS, and those with GA with non-dampness syndrome (GA-NDS) were enrolled. Clinical assessments of metabolic and inflammatory parameters were performed, and targeted metabolomic profiling of plasma samples was conducted. Diagnostic and recurrence prediction models were constructed using random forest and logistic regression, and the efficacy of the recurrence model was validated in an independent cohort. RESULTS: GA-DS patients exhibited significant metabolic disturbances, with significantly elevated levels of body mass index (BMI), serum uric acid (SUA), and lipid metabolism indicators. Metabolomic analysis revealed significantly elevated plasma acetovanillone and cyclic adenosine monophosphate (cAMP) in the GA-DS group compared with those in the HC and GA-NDS groups (all < 0.05). These two metabolites were significantly correlated with SUA and the inflammatory marker C-reactive protein levels ( = 0.50 and = 0.48, respectively; both < 0.05). A logistic regression model based on acetovanillone and cAMP effectively distinguished GA-DS patients from HC and GA-NDS patients (out-of-bag error: 0.158 ± 0.038; accuracy: [84.2 ± 6.6]%; adjusted < 0.001 for both indicators vs. those of the other models). Further analysis showed that cAMP and ureidosuccinic acid levels increased in patients who later experienced GA recurrence ( < 0.05), with detectable changes as early as 24 weeks before recurrence. A recurrence prediction model combining cAMP and creatine kinase-MB (CK-MB) achieved the best performance and was validated in an independent cohort (accuracy: 67.39%, 95% CI: 52.0%-80.5%; area under the curve [AUC] = 0.803, 95% CI: 0.676-0.930). CONCLUSION: GA-DS patients display distinct metabolic abnormalities. Acetovanillone and cAMP hold promise as diagnostic biomarkers, while cAMP in combination with CK-MB can be used for the early prediction of the risk of GA-DS recurrence. These findings provide novel insights into the metabolic basis of TCM dampness syndrome and offer potential biomarkers for early diagnosis and stratification of recurrence risk in GA.
[Optimization of Comprehensive Prevention and Control Strategies for Myopia From the Persepctive of the Social Ecological Systems Theory].
Chen Z, Zhu M, Yue L
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536669 · Full text
Myopia is a global public health challenge. It is projected that the myopia rate in China will reach 80% by 2050, which will cause visual impairment, psychological problems, and economic burdens. The effective prevention...
Myopia is a global public health challenge. It is projected that the myopia rate in China will reach 80% by 2050, which will cause visual impairment, psychological problems, and economic burdens. The effective prevention and control of myopia are critical for improving the health of children and adolescents and reducing socioeconomic burdens. The existing myopia prevention and control strategies include individual interventions and school-based group interventions, which have shown remarkable results. However, limitations such as insufficient compliance, high technical costs, and regional differences have limited their effects. The policy-advocated five-in-one prevention and control system (consisting of the government, schools, families, health care, and society) faces challenges in effectively integrating multi-field strategies due to poor interdepartmental coordination, uneven resource distribution, and the lack of assessment mechanisms. Through a systematic literature review, this paper examines research on myopia prevention and control across multiple fields such as medicine, education, technology, and policy. Based on the micro, meso, and macro perspectives of the Social Ecological Systems Theory (SET), the advantages and limitations of strategies are analyzed, and optimization pathways are explored.
[Factors Influencing All-Cause and Specific-Cause Deaths Among Community-Dwelling Schizophrenia Patients in a Region of Western China].
Lei X, Fan R, Chen S … +4 more , Liu J, Liu X, Liu Y, Yang X
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536668 · Full text
OBJECTIVE: To investigate the factors influencing all-cause and specific cause deaths in community-dwelling patients with schizophrenia. METHODS: The data analyzed in this study were obtained from the integrated manageme...
OBJECTIVE: To investigate the factors influencing all-cause and specific cause deaths in community-dwelling patients with schizophrenia. METHODS: The data analyzed in this study were obtained from the integrated management information platform for severe mental disorders in a region in western China. The Kaplan-Meier method and log-rank test were used to estimate and compare the cumulative incidence curves of patient deaths. Risk factors for all-cause and specific cause deaths were explored using the Cox proportional hazards regression model and Fine-Gray competing risk model, respectively. RESULTS: A total of 207638 schizophrenia patients were included in the study, with a median follow-up period of 3.98 years and a maximum follow-up period of 12.35 years. A total of 15062 (7.3%) patients died during the follow-up period, including 8758 (4.2%) due to physical illnesses, 563 (0.3%) due to suicide, 1337 (0.6%) due to accidents, 1193 (0.6%) due to mental illness-related complications, and 3211 (1.6%) due to other causes. Multivariate Cox regression analysis revealed that age (hazard ratio [HR] = 3.65, 95% CI: 3.49-3.81), sex (HR = 0.78, 95% CI: 0.75-0.81), ethnicity (HR = 0.78, 95% CI: 0.61-0.99), marital status (HR = 1.24, 95% CI: 1.19-1.28), economic status (HR = 1.67, 95% CI: 1.61-1.74), educational attainment (HR = 0.69, 95% CI: 0.66-0.72), family history of psychiatric illness (HR = 0.90, 95% CI: 0.83-0.98), and the duration of illness (10-19 years [HR = 0.82, 95% CI: 0.79-0.85] and 20-29 years [HR = 0.79, 95% CI: 0.76-0.83]) were influencing factors for all-cause deaths in patients with schizophrenia. The results of the Fine‒Gray model indicated that older age, male sex, lower educational attainment, and poverty are common risk factors for patient deaths due to physical illnesses, accidents, mental illness-related complications, and other causes. Being single, divorced, or widowed and having a shorter duration of illness are common risk factors for mortality due to physical illnesses, accidents, and other causes. Poor medication adherence was a risk factor for patient deaths due to mental illness-related complications and other causes. Additionally, for deaths due to physical illnesses, Han ethnicity and the absence of a family history of psychiatric illness were associated with a higher mortality risk. Regarding suicide deaths, higher educational attainment, poverty, shorter duration of illness, and good medication adherence were identified as risk factors. CONCLUSION: Targeted management and interventions should be implemented based on the different mortality risks in schizophrenia patients to improve their survival rates.
[Guardians of Immune Tolerance: Regulatory T Cells].
Ming K, Zhang H, Hu H
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536667 · Full text
Shimon Sakaguchi, a Japanese scientist, together with Mary E. Brunkow and Fred Ramsdell, American scientists, were jointly awarded the 2025 Nobel Prize in Physiology or Medicine for their pioneering discoveries in the fi...
Shimon Sakaguchi, a Japanese scientist, together with Mary E. Brunkow and Fred Ramsdell, American scientists, were jointly awarded the 2025 Nobel Prize in Physiology or Medicine for their pioneering discoveries in the field of peripheral immune tolerance. This review summarizes the Nobel Prize-winning research on immune tolerance and discusses the development, functions, and therapeutic applications of regulatory T cell (Treg)-based interventions. These seminal studies on immune tolerance underscore a central immunological concept-a healthy immune system relies not only on its robust capacity to eliminate pathogens and mutated cells, but also on the precise inhibitory (or "brake") and tolerance mechanisms. This concept will help deepen our understanding of key medical challenges such as autoimmune diseases, transplant rejection, and tumor immunity. It will spur the development of a series of therapeutic strategies targeting peripheral immune tolerance and Treg cells and advance research in precision immune regulation.
[Exploration and Practice of Constructing a New Ecology of Experimental Stomatology Practice Teaching Driven by Digital Intelligence].
Zhang Y, Zheng Q, Wang Y … +5 more , Zhang M, Shen J, Hao A, Han X, Ye L
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536666 · Full text
The innovative development of integrating digital technology with education has created a new framework and ecosystem for stomatology education. Taking the innovative ecological construction of experimental teaching at W...
The innovative development of integrating digital technology with education has created a new framework and ecosystem for stomatology education. Taking the innovative ecological construction of experimental teaching at West China School of Stomatology, Sichuan University as a representative case, we systematically explored the innovative pathways and practical paradigms for experimental teaching in stomatology empowered by digital intelligence across multiple dimensions, including knowledge acquisition, clinical competency development, and evaluation of experimental teaching. A 4-wheel-driven stomatology experimental teaching system comprising intelligent-guided learning, intelligence-enhanced critical thinking, intelligence-enabled practice, and intelligent evaluation was established by West China School of Stomatology. By organically integrating technologies such as artificial intelligence, virtual simulation, and mixed reality, this system promotes a shift in the teaching paradigm from a "credit-oriented" approach to a "competency-oriented" paradigm. This transformation helps achieve seamless integration and a closed-loop process encompassing knowledge internalization, clinical reasoning, skills training, and comprehensive evaluation in experimental teaching. Practice demonstrates that this system effectively enhances students' self-directed learning skills, precision in clinical operations, and interdisciplinary diagnostic reasoning, providing valuable insights and references for advancing the application of digital technologies in the training of stomatology professionals.
[Innovative Mechanisms of Medical Care and Prevention Integration in Compact County-Level Medical Alliances From the Perspective of Collaborative Governance-A Case Study of Luojiang District, Deyang City, China].
Chen X, Lai H, Wu K … +1 more , Pan J
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536665 · Full text
OBJECTIVE: Taking the county-level medical alliance in Luojiang District, Deyang City, Sichuan Province as an example, we analyzed the innovative mechanisms and implementation pathways of medical care and prevention inte...
OBJECTIVE: Taking the county-level medical alliance in Luojiang District, Deyang City, Sichuan Province as an example, we analyzed the innovative mechanisms and implementation pathways of medical care and prevention integration of the county-level medical alliance, aiming to provide theoretical and empirical support for promoting the integration of treatment and prevention. METHODS: Using the SFIC model of the collaborative governance theory as the main analytical framework, we systematically analyzed the innovative practices and mechanisms of medical and preventive integration within the county-level medical alliance in Luojiang District from 4 dimensions, including starting conditions (S), facilitative leadership (F), institutional design (I), and collaborative process (C), and evaluated their operational effectiveness. RESULTS: The county-level medical alliance of Luojiang District has achieved enhanced effectiveness in medical care and prevention integration through top-level design, institutional restructuring, the empowerment of information platforms with digital intelligence technology, and the incentivization of multiple stakeholders to participate in the collaborative process. In 2024, the severe case rates of 2 chronic diseases (hypertension and diabetes mellitus) and the premature mortality rates of 4 chronic diseases (cardiovascular and cerebrovascular diseases, cancer, chronic respiratory diseases, and diabetes mellitus) in Luojiang District decreased by 4.4% and 5.53%, respectively, compared to those in 2023. The total medical insurance fund expenditure in the district in 2024 decreased by 9.13% compared to that in 2023. CONCLUSION: According to the analysis based on the SFIC model, future efforts in medical care and prevention integration should focus on collaborative innovation at four levels-individual, community, institutional, and system-to further advance the transition toward a service model centered on population health.
[Role of Trained Immunity in the Association Between Periodontitis and Rheumatoid Arthritis].
You R, Cui Y, Sun J
Sichuan Da Xue Xue Bao Yi Xue Ban · 2025 Nov · PMID 41536664 · Full text
Trained immunity is a state of enhanced immune responsiveness based on innate immune (epigenetic) memory. It has recently been reported that trained immunity plays an important role in the comorbidity of periodontitis an...
Trained immunity is a state of enhanced immune responsiveness based on innate immune (epigenetic) memory. It has recently been reported that trained immunity plays an important role in the comorbidity of periodontitis and rheumatoid arthritis (RA). Epigenetic modifications in hematopoietic stem and progenitor cells (HSPCs) can activate trained immunity in bone marrow-derived cells, a mechanism closely associated with the onset and progression of periodontitis and other related systemic diseases. Exhibiting hyper-reactivity, trained immune cells are capable of migrating to distant joint sites and eliciting a more intense inflammatory response upon external stimulation. This review focuses on the underlying mechanisms of trained immunity and its involvement in both periodontitis and RA. Understanding the role of trained immunity in the association between periodontitis and RA provides valuable insights for further research and the development of therapeutic strategies for inflammatory comorbidities, such as periodontitis and RA.
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