ObjectiveTo explore the mechanism of modified Xiehuangsan in treating tic disorders （TD） based on microglial polarization and the Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor （NF）-κB pathway. MethodsSeventy-two Sprague-Dawley （SD） rats were randomly assigned into six groups： control， model， tiapride （0.025 g·kg^-1）， and low-， medium-， and high-dose （12， 24， 48 g·kg^-1， respectively） modified Xiehuangsan， with 12 rats in each group. Except the control group， the other groups received intraperitoneal injection of 3，3'-iminodipropionitrile （IDPN） for 7 consecutive days for the modeling of TD. After successful modeling， the control and model groups were given normal saline via gavage， and the other groups were administrated with corresponding drugs by gavage. After 28 days of continuous intervention， rat behaviors were observed， and the modified Xiehuangsan group showing the best anti-TD effect was selected for deciphering the treatment mechanism. Hematoxylin and eosin staining was conducted to observe morphological changes in the rat striatum. Immunohistochemistry was employed to detect the expression of CD16 and CD206 in the striatum. Real-time PCR was employed to measure the mRNA levels of interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， IL-4， TLR4， MyD88， and NF-κB p65 in the striatum. Western blot was employed to determine the protein levels of ionized calcium-binding adapter molecule 1 （Iba1）， Fc receptor family for immunoglobulin （Ig）G type Ⅲ （CD16）， mannose receptor （CD206）， TLR4， MyD88， and NF-κB p65 in the striatum. ResultsCompared with the control group， the model group showed increased stereotyped behaviors， locomotor activity， total movement distance， and movement speed， shortened resting time （P<0.01）， and noticeable pathological changes in the striatum. Compared with the model group， the tiapride group and modified Xiehuangsan groups exhibited reduced stereotyped behavior， locomotor activity， total movement distance， and movement speed， prolonged resting time （P<0.05， P<0.01）， and alleviated pathological changes in the striatum. Among the modified Xiehuangsan groups， the high-dose group had the best intervention effect and the mildest pathological changes. Therefore， the high-dose group was selected for further research. Compared with the control group， the modeling of TD increased Iba1 and CD16 expression （P<0.05， P<0.01）， up-regulated the mRNA levels of IL-1β and TNF-α （P<0.05， P<0.01）， down-regulated the mRNA level of IL-4 （P<0.05）， up-regulated the mRNA and protein levels of TLR4 and MyD88 （P<0.05， P<0.01）， and up-regulated the protein level of NF-κB p65 （P<0.01）. Compared with the model group， modified Xiehuangsan reduced Iba1 and CD16 expression （P<0.05， P<0.01）， up-regulated the protein level of CD206 （P<0.05， P<0.01）， down-regulated the mRNA levels of IL-1β and TNF-α （P<0.05）， up-regulated the mRNA level of IL-4 （P<0.01）， and down-regulated the mRNA and protein levels of TLR4， MyD88， and NF-κB p65 （P<0.05， P<0.01）. ConclusionModified Xiehuangsan demonstrated a definite therapeutic effect on TD in rats. It may reduce neuroinflammation in TD rats by regulating the polarization of microglia in the striatum via the TLR4/MyD88/NF-κB signaling pathway.

The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

Objective:To investigate the prevalence of adult skeletal fluorosis caused by drinking tea-type endemic fluorosis in Yushu Tibetan Autonomous Prefecture (hereinafter referred to as Yushu Prefecture), Qinghai Province, and provide scientific basis for prevention and control of the disease.Methods:In August 2021, one village was selected as a survey site in six counties (cities) in Yushu Prefecture, including Nangqian, Chindu, Yushu, Zadoi, Qumarlêb, and Zhiduo. Drinking water samples and 10 brick tea samples were collected from each village to determine the fluoride content in water and brick tea; at least 100 permanent residents aged ≥ 25, who had a habit of drinking brick tea and had lived in the local area for more than 5 years, were selected for X-ray imaging to examine the prevalence of adult skeletal fluorosis.Results:A total of 75 samples of residential drinking water were collected, with a fluoride content of (0.21 ± 0.05) mg/L, ranging from 0.11 to 0.34 mg/L; 60 samples of brick tea, with a fluoride content of (626.70 ± 157.27) mg/kg, ranging from 324.00 to 2 102.00 mg/kg. A total of 1 136 adults were examined, and 318 cases of skeletal fluorosis were diagnosed, with a detection rate of 27.99%. Among them, the detection rates of mild, moderate, and severe skeletal fluorosis were 20.95% (238/1 136), 6.07% (69/1 136), and 0.97% (11/1 136), respectively, with mild symptoms being the main. The detection rates of skeletal fluorosis in males and females were 29.09% (121/416) and 27.36% (197/720), respectively, with no statistically significant difference between the gender (χ 2 = 0.39, P = 0.533). Comparison of the skeletal fluorosis in different gender, the differences were statistically significant (χ 2 = 22.31, P < 0.001). The detection rates of skeletal fluorosis in the age groups of 25 - 35, 36 - 45, 46 - 55, 56 - 65, 66 - 75, and ≥76 years old were 6.86% (7/102), 22.37% (51/228), 24.02% (92/383), 37.44% (73/195), 43.48% (70/161), and 37.31% (25/67), respectively. The differences between the groups were statistically significant (χ 2 = 59.84, P < 0.001). Moreover, there was a statistically significant difference in the composition of skeletal fluorosis among different age groups ( H = 37.66, P < 0.001). The Spearman correlation analysis results showed that the severity of adult skeletal fluorosis was positively correlated with age ( r = 0.34, P < 0.001). Conclusions:There is a certain degree of prevalence of adult skeletal fluorosis in Yushu Prefecture. And as age increases, the condition of skeletal fluorosis becomes more severe.

Objective To evaluate the clinical screening value of the Epworth sleepiness scale(ESS)for patients with type 2 diabetes mellitus(T2DM)and obstructive sleep apnea hypopnea syndrome(OSAHS).Methods A total of 399 hospitalized T2DM patients were selected for portable monitoring(PM)and ESS assessment.Based on the presence or absence of OSAHS,the study was divided into a simple T2DM group(T2DM,n=143)and a group with comorbid OSAHS(OSAHS,n=256).According to the apnea-hypopnea index(AHI),the study participants were categorized into a normal group(AHI<5 times/h,n=143),a mild OSAHS group(AHI 5～15 times/h,n=147),a moderate OSAHS group(AHI>15～30 times/h,n=69),and a severe OSAHS group(AHI>30 times/h,n=40).Differences in ESS scores across various OSAHS severity groups were compared.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the screening value of ESS for OSAHS.Results Body mass index,proportion of obesity,proportion of central obesity,serum creatinine and fasting C-peptide were significantly higher the OSAHS group compared to the non-OSAHS group(P<0.05).Significant statistical differences in ESS scores were observed between the severe and mild OSAHS groups(P=0.006).When an ESS score of≥9 was used as the threshold for screening OSAHS,the concordance rate with PM diagnosis was 40.6%.ROC curve analysis revealed that the area under the curve(AUC)for ESS screening for OSAHS,moderate-to-severe OSAHS,and severe OSAHS,and their respective optimal thresholds(95%CI),were as follows 0.518(95%CI 0.459～0.577,P=0.545),0.571(95%CI 0.507～0.635,P=0.029)and 0.624(95%CI 0.531～0.718,P=0.010),with cutoffs of≥2 points,≥3 points,and≥4 points,respectively.Conclusions An increased ESS score in T2DM patients significantly indicates the likelihood of severe OSAHS.Using an ESS score of≥9 as a threshold to screen for OSAHS is ineffective,whereas an ESS score of≥3 for screening moderate-to-severe OSAHS and≥4 for severe OSAHS has some reference value.

Objective:To learn about the detection quality and external quality control assessment of fluoride and arsenic in laboratories at all levels in Qinghai Province.Methods:The Z-score method was used to analyze and evaluate the evaluation results of 1 provincial, 8 municipal and 43 county level laboratories of disease prevention and control institutions participating in the external quality control assessment of water fluoride and brick tea fluoride in Qinghai Province in 2021, as well as 1 provincial, 1 municipal and 2 county level laboratories of disease prevention and control institutions participating in the external quality control assessment of water arsenic and urine arsenic. The feedback rate and qualification rate of external quality control of each assessment laboratory were calculated.Results:In 2021, the feedback rate of external quality control of water fluoride, brick tea fluoride, water arsenic and urine arsenic in provincial and municipal level laboratories of Qinghai Province were 100.00%; except that the qualified rate of water fluoride was 7/9, the qualified rate of external quality control of other projects was 100.00%. The feedback rate of external quality control of water fluoride, brick tea fluoride, water arsenic and urine arsenic in county level laboratories was 100.00%; except that the qualified rate of water fluoride was 86.05% (37/43), the qualified rate of external quality control of other projects was 100.00%. In the specific assessment results of the laboratory, the assessment results of water fluoride sample FS20210101 from 1 provincial, 1 municipal and 2 county level laboratories, and FS20210102 from 1 county level laboratory were suspicious; the assessment results of water fluoride sample FS20210101 from 3 county level laboratories were not satisfactory; the assessment results of fluoride and arsenic sample in other laboratories were satisfactory.Conclusions:The qualified rate of external quality control of fluoride and arsenic in laboratories at all levels in Qinghai Province is relatively high, but some county level laboratories are still dissatisfied with the assessment results of water fluoride. Therefore, it is necessary to strengthen the detection level of water fluoride in laboratories.

Respiratory diseases are common， frequently-occurring clinical diseases. As the prevalence rate is increasing year by year， they have become a problem that seriously affects public health. The diseases are mainly located in the lung by traditional Chinese medicine （TCM） syndrome differentiation. Lung governs Qi and controls breathing and is also an organ for the storage of phlegm. Clinically， phlegm and Qi are often used for the treatment. Banxia Houputang （BHT）， originated from Synopsis of the Golden Chamber （《金匮要略》）， was used to treat plum-stone Ai （globus hystericus） at first. It is composed of Rhizoma Pinelliae， Cortex Magnoliae Offcinalis， Poria， Rhizoma Zingiberis Recens， and Folium Perillae， and treats diseases with the core pathogensis of mutual obstruction of phlegm and Qi. BHT has the effects of moving Qi， dissipating mass， descending adverse Qi， and resolving phlegm， which basically correspond to the pathological characteristics of the lungs. Clinical studies have confirmed that modified BHT can be used either alone or in combination with western medicine to treat chronic pharyngitis， asthma， chronic obstructive pulmonary disease， pneumonia， obstructive sleep apnea， upper airway cough syndrome and other respiratory diseases， with significant effects. It effectively improves the symptoms and signs of the diseases and reduces the recurrence rate. Basic research has shown that BHT plays anti-inflammatory， anti-oxidative stress， anti-apoptotic， autophagy-regulating， and iron overload-regulating roles by regulating the targets in multiple pathways. This paper， by combing the relevant literature in recent years， conducted a systematic review on BHT from the three aspects of syndrome analysis， clinical treatment research and mechanism research， with a view to providing theoretical basis and reference for the mechanism research of BHT in treating respiratory diseases and for expanding its clinical application.

Objective:To evaluate the water fluoride detection ability of county (city, district) level (referred to as the county-level) laboratories in Qinghai Province.Methods:During the "13th Five-Year Plan" period (2016 - 2020), 4, 4, 4, 43, 43 county-level laboratories in Qinghai Province were organized to participate in the national water fluoride external quality control assessment, and the assessment results were evaluated by Z-ratio scoring method.Results:The response rate of county-level laboratories was 86.05% (37/43) in 2019, and 100.00% in other years. The qualified rate of county-level laboratories was 100.00% from 2016 to 2018; in 2019 and 2020, the assessment was fully covered, and the qualified rate was 81.40% (35/43) and 95.35% (41/43), respectively. Compared with 2019, the response rate and qualified rate in 2020 increased significantly, and the differences were statistically significant (χ 2 = 6.450, 4.074, P < 0.05). In the past 5 years, two assessment samples│Z│ < 1 in each laboratory were the most common, but with two assessment samples 2≤│Z│ < 3 in some qualified laboratories. Conclusion:The consistency of water fluoride determination in Qinghai Province is not very ideal, and the detection ability of county-level laboratories still needs to be strengthened.

Objective:To analyze the external quality control assessment results of fluoride in brick tea in the provincial, city (prefecture) and county (city, district)-level endemic fluorosis laboratories in Qinghai Province, and to evaluate the testing capabilities of laboratories at all levels.Methods:The Z-score method was used to analyze and evaluate the results of provincial, city (prefecture) and county (city, district)-level laboratories that participated in the external quality control assessment of fluoride in brick tea in Qinghai Province from 2014 to 2020, and│Z│≤2 was qualified; 2 <│Z│ < 3 was basic qualified; │Z│≥3 was unqualified.Results:From the feedback, the feedback rate of external quality control of fluoride in brick tea in provincial and city (prefecture)-level laboratories in Qinghai Province from 2014 to 2020 was 100.00%; the feedback rate of county (city, district)-level laboratories from 2014 to 2018 was 100.00%, and there were no feedback units in 2019 and 2020. From the assessment of qualification, the qualification rate of provincial, city (prefecture)-level laboratories was 100.00% in all other years except one unit failed in 2017; the qualification rate of county (city, district)-level laboratories was 100.00% in 2014, 2015, 2016 and 2019, and there were 6 unqualified units in other years.Conclusions:From 2014 to 2020, some endemic fluorosis laboratories in Qinghai Province still fail to pass the external quality control assessment of fluoride in brick tea. In the future, it will be the focus of work to strengthen personnel training and improve the detection ability.

Objective:To study the epidemic status of drinking tea type endemic fluorosis in Qinghai Province.Methods:In 2019, in counties (cities, districts, referred to as counties) that had the habit of drinking brick tea in 8 cities (prefectures) of Qinghai Province, epidemiological investigation of drinking tea type endemic fluorosis was carried out in villages. Ten households were randomly selected from each village, to investigate the demographic data of each household and the drinking situation of brick tea, residents' drinking water and brick tea samples were collected to determine the fluorine content, and calculate the daily per capita tea fluorine intake. At the same time, skeletal fluorosis was examined in all adults over 25 years old, and dental fluorosis was examined in all children aged 8 to 12 years old in survey sites. The content of fluorine in tea and water was detected by ion selective electrode method; the diagnosis of skeletal fluorosis was based on "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008), the diagnosis of dental fluorosis was based on "Diagnosis of Dental Fluorosis" (WS/T 208-2011).Results:The mean (range) of fluorine of the 3 602 water samples was 0.31 (0.20 - 1.00) mg/L. The geometric mean (range) of fluorine of the 31 067 brick tea samples was 646 (40 - 2 295) mg/kg, the fluorine content of the brick tea ≤300 mg/kg accounted for 7.80% (2 422/31 067) of the total samples. The proportion of drinking Fu brick-tea was 89.97% (27 952/31 067); and the daily per capita tea fluorine intake was 1.93 mg, the daily per capita tea fluorine intake in Guoluo, Yushu and Hainan prefectures were higher than the health standard (3.50 mg). The detection rate of skeletal fluorosis in adults was 0.16% (2 357/1 484 907), Yushu Prefecture was the highest [29.23% (592/2 025)], followed by Guoluo Prefecture, which was 8.21% (771/9 393). The detection rate of dental fluorosis in children was 4.79% (8 076/168 623), Yushu Prefecture was the highest [32.61% (1 562/4 790)].Conclusion:Drinking tea type endemic fluorosis is prevalent in Qinghai Province, with obvious regional characteristics, covering a large population. The disease is relatively popular in Yushu Prefecture and Guoluo Prefecture.

Objective:To understand the situation of drinking water-borne endemic fluorosis (short for drinking water fluorosis) in Huangzhong, Ping'an and Ledu districts of Qinghai Province and operation status of water improvement projects, and to evaluate the effect of control measures.Methods:In historical drinking water fluorosis villages of Huangzhong, Ping'an and Ledu districts of Qinghai Province in 2018, the status of water improvement, the operation of water improvement projects and the content of water fluoride were investigated; the dental fluorosis of 8-12 years old children in all investigated villages was checked; 3 villages from 3 districts were selected, X-ray examination for skeletal fluorosis and urinary fluoride detection of adults over 25 years old of age were performed.Results:Eight-two historical drinking water fluorosis villages in 3 districts were investigated and all the villages had water improvement projects, in addition, the water improvement projects were operating normally, and the water fluoride content ranged from 0.10 to 0.37 mg/L, which were in line with the drinking water fluoride content standard (< 1.2 mg/L). Totally 2 503 children aged 8-12 years old were examined, the detection rate of dental fluorosis was 6.03% (151/2 503), the index of dental fluorosis was 0.13, the epidemic intensity was negative; the detection rates of dental fluorosis in 3 districts were 6.24% (129/2 068), 4.05% (7/173), 5.73% (15/262), respectively, reaching the control standard (< 30%), and the detection rate of dental fluorosis in 81 villages was less than 30%; 198 adults over 25 years old were examined, the detection rate of skeletal fluorosis was 5.05% (10/198), the geometric mean of urinary fluoride was 0.81 mg/L, and skeletal fluorosis cases were mainly in the age group over 40 years old, all of them were mild cases.Conclusions:The fluoride content in drinking water and the detection rate of children's dental fluorosis are all up to the control standard, and the condition of skeletal fluorosis is significantly reduced after the implementation of water improvement measures in Huangzhong, Ping'an and Ledu districts. It can be seen that the prevention and control of drinking water fluorosis in Huangzhong, Ping'an and Ledu districts have achieved good results, but later management and condition monitoring of water improvement projects should be strengthened to prevent the disease from rebounding.