Objective To investigate the similarity and difference in chronic obstructive pulmonary disease ( COPD) evaluation and drug selection that were compared between global initiative for chronic ob-structive lung disease (GOLD) 2011 and GOLD 2006, and to explore treatment adherence by doctors ac-cording to GOLD 2011.M ethods We collected 224 patients with COPD from Department of Respiratory Medicine at the Second Xiangya Hospital to investigate the differences in COPD evaluation and drug selec-tion according to GOLD 2011 and GOLD 2006 with treatment adherence by doctors according to GOLD 2011.Results ⑴According to GOLD 2006, there were 38 patients in the most severe stage, which was different from that (Group D, 147) according to GOLD 2011 ( P <0.01).⑵The risk stratification by u-sing pulmonary function assessment was significantly different from that by using exacerbation history.⑶Symptom assessment by using COPD assessment test ( CAT) was significantly different from that by using modified British medical research council ( mMRC) .The kappa coefficient of these two questionnaires was 0.466, suggesting moderate agreement.⑷ According to GOLD 2011, 224 (100%) patients were recom-mended to use inhaled long-acting bronchodilators, which was higher than that (213, 95.18%) according to GOLD2006 ( P <0.01).⑸The level of appropriated actual prescription was 161 (71.9%) according to GOLD 2011, which was significantly different from that (120,53.1%) according to GOLD 2006 ( P <0.01).Conclusions ⑴ Compared to GOLD 2006, GOLD 2011 categorized more patients into the most severe group.⑵The risk stratification of COPD by airflow limitation severity or exacerbation risk was not i-dentical.Discordance between CAT and mMRC was observed.⑶GOLD 2011 recommends a wider range of using long-acting bronchodilators.⑷The adherence to GOLD guideline in our hospital is still far from satis-faction.

Chronic obstructive pulmonary disease (COPD) is a common disease that can be prevented and treated with persistent respiratory symptoms and airflow limitation.Emphysema and small airway disease are important pathological features.Lung imaging technology can assess the patient's airway disease,and evaluate the prognosis.Chest CT examination can provide more information for early diagnosis in patients with COPD,and can objectively evaluate emphysema,small airway,pulmonary function,pulmonary blood vessels,and classify the patients into subgroup and make individual assessment of drug treatment;MRI examination can assess pulmonary microvascular blood flow (PMBF).Making full use of lung imaging examination could provide a reliable theoretical basis of the early diagnosis of COPD,disease assessment,and prognosis evaluation.This article made a review of the latest progress imaging based on the literature.

The overall impact of chronic obstructive pulmonary disease (COPD) on individuals is multifaceted and it causes impairment not only in lungs but also in other organs,and even in psychological conditions that result in multiple symptomatic effects and poorer quality of life.Therefore,it is critical to e valuate patients'quality of life in the clinical practice.Besides modified Medical British Research Council (mMRC) and COPD assessment test (CAT),the clinical COPD questionnaire (CCQ),a self-administered questionnaire was also recommended by GOLD2013 to assess patients'health status.Compared to the wide spread use of mMRC and CAT,CCQ was paid less attention in our clinical work.This study focused on the development,reliability,validity and responsiveness of the CCQ among subjects with COPD.We found that CCQ was easily understood with good reliability,validity and responsiveness and the use of the CCQ should be promoted as a health status measurement in more countries and regions.

Sarcoidosis is a granulomatous disease of unknown etiology that affects almost any organ. The clinical presentation, treatment responsiveness and outcome varies widely between patients. Patients with pulmonary sarcoidosis always need individualized treatment and should be monitored. In order to meet the above clinical needs, countries have successively formulated clinical diagnosis and treatment norms of sarcoidosis. This includes the clinical consensus on pulmonary sarcoidosis (BTS consensus) launched by the British Thoracic Society (BTS) in December 2020. This paper briefly describes the main parts of the BTS consensus to provide reference for the majority of clinical workers.

Asthma and chronic obstructive pulmonary disease overlap (ACO) is a hot topic in recent years. Although the precise definition of ACO is still controversial, scholars have found that the patients with overlapping features of asthma and COPD have a worse prognosis and increased medical cost than those with asthma or COPD alone. Thus, there is a big challenge to have a better understanding and to manage these patients in clinical practice. To strengthen awareness of this type of patients, the Global initiative for Chronic Obstructive Lung Disease (GOLD) and Global initiative for asthma (GINA) in 2014 named them as " Asthma Chronic Obstructive Lung Overlap Syndrome" (ACOS), which was further revised to the Asthma Chronic Obstructive Lung Overlap (ACO) in the follow-up GINA guidelines (2017). In the updated version, it emphasized that ACO was not a separate disease. However, although the research on ACO has increased significantly in recent years, there are still many controversies, which includes the definition, diagnostic criteria and treatment therapies. In this review, we provide the recent advances in the diagnosis and an overview of available treatment for of ACO.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to chronic airway inflammation. Individualized assessment and treatment for COPD has become significantly important. This paper describes the current status regarding individualized assessment and treatment for patients with COPD, in order to improve the understanding of the different characteristics between COPD individuals for physicians.

Objective:To investigate the effects of artesunate ( ART ) on neuronal apoptosis, inflammatory response after stroke in rats and microglia polarization.Methods:(1)Animal experiment: twenty-seven male SD rats of SPF grade were divided into sham operation group, model group and ART treatment group according to the random number table method, with 9 rats in each group.Rats in the model group and ART treatment group were used to establish a stroke model by middle cerebral artery occlusion (MCAO). And rats in the ART treatment group were intraperitoneally injected with ART (25 mg/kg) once a day for three days before modeling, while the rats in sham operation group and the model group were injected with the same amount of solvent.And 24 h after the modeling, TTC staining was used to evaluate the volume of cerebral infarction, Western blot was used to detect the expression of Bcl2 in the infarct area, penumbra and hippocampus, TUNEL method was used to detect neuronal apoptosis, and tissue immunofluorescence was used to observe the expression of tumor necrosis factor-α(TNF-α) in the penumbra region of cerebral cortex.(2)Cell experiments: microglia BV2 were cultured and divided into control group, oxygen-glucose deprivation/reoxygenation group, oxygen-glucose deprivation/reoxygenation + 0.05 μmol/L ART group, oxygen-glucose deprivation/reoxygenation + 0.1 μmol/L ART group and oxygen-glucose deprivation/reoxygenation + 0.5 μmol/L ART group.The levels of inflammatory factors interleukin-6(IL-6), interleukin-1β(IL-1β) and TNF-α were detected by qRT-PCR, the expressions of M2 type microglia marker protein CD206 and ARG1 were detected by Western blot, the BV2 cell medium after treatment in each of the above groups was collected as conditioned medium to culture HT22 hippocampal neuron cells and cell activity was measured by CCK8 method.GraphPad Prism 7 software was used for data analysis.One-way ANOVA was used for comparison of differences among multiple groups, and LSD was used for further two-by-two comparisons.Results:(1)Animal experiment results: TTC staining results showed that the percentage of cerebral infarction volume in the ART treatment group was smaller than that in the model group ((23.09±8.51)%, (39.63±5.71)%, t=33.93, P<0.01). The results of TUNEL staining showed that the number of apoptotic cells in the model group and ART treatment group was higher than that in the sham operation group ((638.90±177.82)cells/mm 2, (72.75±13.21) cells/mm 2, (16.16±2.73) cells/mm 2, both P<0.05), and the number of apoptotic cells in the ART treatment group was lower than that in the model group ( P<0.05). Western blot results showed that the levels of Bcl2 protein in penumbra and infarct area of the model group were both lower than those in sham group(both P<0.05). The levels of Bcl2 protein in penumbra, the hippocampus and infarcted area of the ART treatment group were significantly lower than those of the model group(all P<0.05). The results of tissue immunofluorescence showed that the fluorescence intensities of TNF-α in the model group and ART treatment group were higher than those in the sham group (all P<0.05), while the fluorescence intensity of TNF-α in the ART treatment group was lower than that in the model group ( P<0.05). (2)Cell experiment: qRT-PCR results showed that compared with the control group, the mRNA levels of IL-6, IL-1β and TNF-α (all P<0.05) in oxygen-glucose deprivation/reoxygenation group were significantly higher than those of the control group.And the mRNA levels of IL-1β, IL-6 and TNF-α in oxygen-glucose deprivation/reoxygenation + 0.05 μmol/L ART group, oxygen-glucose deprivation/reoxygenation + 0.1 μmol/L ART group and oxygen-glucose deprivation/reoxygenation + 0.5 μmol/L ART group were significantly lower than those of the oxygen-glucose deprivation/reoxygenation group (all P<0.05). Western blot results showed that compared with the control group, the expression of CD206 ((0.85±0.04), (1.07±0.07), P<0.05) was significantly down-regulated in the oxygen-glucose deprivation/reoxygenation group.The CD206 and ARG in oxygen-glucose deprivation/reoxygenation + 0.1 μmol/L ART group((1.22±0.06), (1.35±0.08)) and oxygen-glucose deprivation/reoxygenation + 0.5 μmol/L ART group((1.24±0.14), (1.14±0.07)) were significantly higer than those of oxygen-glucose deprivation/reoxygenation group((0.85±0.04), (0.85±0.05))(all P<0.05). The results of CCK8 showed that compared with the control group, the cell viability in the oxygen-glucose deprivation/reoxygenation group was significantly decreased( P<0.05). The cell viability of the oxygen-glucose deprivation/reoxygenation + 0.05 μmol/L ART group, the oxygen-glucose deprivation/reoxygenation + 0.1 μmol/L ART group, the oxygen-glucose deprivation/reoxygenation + 0.5 μmol/L ART group were all higher than those of oxygen-glucose deprivation/reoxygenation group(all P<0.05). Conclusion:ART reduces neuronal apoptosis after stroke, decreases the neuroinflammatory response after stroke, and promotes oxygen-glucose deprivation/reoxygenation-activated microglia BV2 polarization to the M2 type.

Some factors, such as age and gender, are common risks for the mild cognitive impairment (MCI) and late life depression. Multiple brain regions are involved in both MCI and late life depression. Late life depression is an early manifestation and risk factor for MCI. It is important to intervene early depressive symptoms.

【Objective】 In this study， reactive oxygen species （ROS） scavenger N-acetyl-L-cysteine （NAC） was used to explore the inhibitory effect and mechanism of artesunate （ART） on pancreatic carcinoma （PC） cells. 【Methods】 Different concentrations of ART interfered with 3 PC cell lines CFPAC-1， Capan-2 and BxPC3. Cell viability was measured by CCK8； cell migration ability was measured by Transwell method， and the expressions of migration-related proteins E-cadherin， N-cadherin and Vimentin were measured by Western blotting. ROS probe DCFH-DA was used to measure intracellular ROS； LC3 cell immunofluorescence （IF） was used to detect the formation of intracellular autophagosomes. After adding NAC or autophagy inhibitor 3-MA， the cell viability was tested again by CCK8， and the expressions of p-AMPK/ AMPK， p-mTOR/mTOR， p62 and LC3Ⅱ/Ⅰ were detected by Western blotting. 【Results】 ART inhibited the growth of CFPAC-1 and Capan-2 in a time- and dose-dependent manner. After treatment of CFPAC-1 and Capan-2 cells with 200 μmol/L of ART for 48 h， the expression of E-cadherin was upregulated， while N-cadherin and Vimentin were downregulated， and the cell migration ability was significantly reduced. ART significantly upregulated intracellular ROS level and promoted the formation of autophagosomes. NAC could reduce the inhibitory effect of ART on CFPAC-1 and Capan-2 cells， upregulate p-AMPK/AMPK， P62 and LC3Ⅱ/Ⅰ， downregulate the expression of p-mTOR/mTOR， and intensify autophagy. 3-MA could not reverse the inhibitory effect of ART on PC cells. 【Conclusion】 ART is dependent on ROS， but not on autophagy， in exerting an anti-pancreatic carcinoma effect. NAC attenuates the inhibitory effect of ART on PC cells by activating protective autophagy through AMPK/mTOR signaling pathway.

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.