Based on spleen deficiency-phlegm dampness as the core pathogenesis of obesity， and integrating recent advances in modern medicine regarding the key role of immune inflammation in obesity， this paper proposes a multidimensional pathogenic network of "obesity-spleen deficiency-phlegm dampness-immune imbalance". Various traditional Chinese medicine （TCM） herbs that strengthen the spleen， regulate qi， and resolve phlegm and dampness can treat obesity by improving spleen-stomach transport and transformation， promoting water-damp metabolism， and regulating immune homeostasis. This highlights immune inflammation as an important entry point to elucidate the TCM concepts of "spleen deficiency-phlegm dampness" and the therapeutic principle of "strengthening the spleen and eliminating dampness to treat obesity". By systematically analyzing the intrinsic connection between "spleen deficiency generating dampness， internal accumulation of phlegm dampness" and immune dysregulation in obesity， this paper aims to provide theoretical support for TCM treatment of obesity based on dampness.

BACKGROUND: Changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels may not fully translate into patient-reported health status in patients with heart failure (HF). We aimed to evaluate the correlation between NT-proBNP levels and patient-reported health status changes at one month after discharge of patients, and their associations with risk of death and rehospitalization in patients with acute HF. METHODS: We used data from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (PEACE 5p-HF Study). Patient-reported health status was measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Patients who were hospitalized for HF and completed the KCCQ-12 and NT-proBNP tests before and one month after discharge were eligible in our study. We stratified patients into different groups based on NT-proBNP levels (i.e., improved, stable, and deteriorated) and KCCQ-12 scores (i.e., not deteriorated and deteriorated). We also examined the associations of the joint NT-proBNP and KCCQ-12 change with the risk of one-year and four-year clinical outcomes. RESULTS: A total of 2461 patients were included in the analysis. The mean age was 64.06 ± 13.51 years, and 36.37% (895/2461) of the study population were female. Among patients with improved NT-proBNP levels, 115 (10.95%) patients had deteriorated KCCQ-12 scores. The correlation between the change in the KCCQ-12 score and NT-proBNP level was weak ( r2 = 0.002, P = 0.013). Stratification by changes in the KCCQ-12 score revealed subgroups with distinctive risks, such that patients with deteriorated KCCQ-12 scores in any of the NT-proBNP change groups exhibited an increased risk of one-year all-cause death than participants with not deteriorated KCCQ-12 scores in any of the NT-proBNP change groups. Patients with improved NT-proBNP levels and deteriorated KCCQ-12 scores presented greater risks of one-year all-cause death (hazard ratio [HR]: 2.45, 95% confidence interval [CI]: 1.34-4.48) than patients with stable NT-proBNP levels and not deteriorated KCCQ-12 scores (HR [95% CI], 1.77 [1.25-2.53]). CONCLUSIONS: A discrepancy between changes in NT-proBNP levels and KCCQ-12 scores was common. The change in NT-proBNP levels was not sufficient to characterize critical aspects related to HF during one month after discharge of patients. Changes in the KCCQ-12 score exhibit complementary information to NT-proBNP levels for the prediction of clinical outcomes in patients with acute HF. REGISTRATION www.clinicaltrials.gov (No. NCT02878811).
Aged ; Female ; Humans ; Male ; Middle Aged ; Health Status ; Heart Failure/metabolism* ; Natriuretic Peptide, Brain/metabolism* ; Peptide Fragments/metabolism* ; Prospective Studies

[This corrects the article DOI: 10.1016/j.apsb.2019.01.013.].

Objective To explore the molecular mechanism of Xiaojin Pills in the treatment of breast cancer using an integrated network pharmacology and experimental verification.Methods The chemical components and potential targets of Xiaojin Pills were obtained from TCMSP,TCM-ID,ETCM and SwissTargetPrediction databases.Breast cancer related targets were collected from GeneCards,OMIM and KEGG databases.The overlapped targets were imported into STRING database to analysis a protein-protein interaction(PPI).The key targets of PPI networks were screened based on node topology parameter values through Cytoscape 3.8.0.DAVID database was used to analyze the GO and KEGG pathway enrichment to build drug-chemical components-key targets-signaling pathway network.The breast cancer cell lines MDA-MB-231 and SK-BR-3 were used to study the effects of Xiaojin Pills extract on cell apoptosis,migration and invasion,and to verify the key pathway obtained by enrichment analysis.Results Totally 181 chemical components in Xiaojin Pills were obtained,including quercetin,myricetin,pinocembrin and β-sitosterol.615 potential targets were identified for the anti-breast cancer effects of Xiaojin Pills.After overlapping,170 key targets against breast cancer were identified based on the topological analysis,which included SRC,ERK1/2,AKT1,EGFR,etc.KEGG analysis enriched pathways including pathways in cancer,MAPK signaling pathway,endocrine resistance,PI3K-AKT signaling pathway,EGFR tyrosine kinase inhibitor resistance,apoptosis,and HIF-1 signaling pathway,which may play important roles in the therapeutic effects of Xiaojin Pills against breast cancer.GO enrichment was involved in protein phosphorylation,inflammatory response,negative regulation of apoptosis,and positive regulation of ERK1 and ERK2 cascades.Cell experiments showed that Xiaojin Pills further induced mitochondria-dependent apoptosis by inhibiting the activation of MAPK and PI3K-AKT pathways.At the same time,the expressions of ZO-1 and β-catenin increased,and the epithelial-mesenchymal transformation process was reversed to inhibit the metastasis of breast cancer cells.Conclusion The key targets and signaling pathways of Xiaojin Pills in the treatment of breast cancer are studied through network pharmacology combined with in vitro experiments,which provided a basis for further study of its pharmacodynamic material basis,mechanism of action and clinical application.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Objective : To investigate the expression and mechanism of long non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and microRNA 181 a ( miR 181 a ) in a myocardial cell oxidative stress model. Methods : The expression of MALAT1 and miR 181 a in peripheral blood of 30 patients with acute myocardial infarction ( AMI group) and 30 healthy controls ( Normal group) was detected by qRT PCR. Pearson correlation analysis was performed to determine the correlation between MALAT1 and miR 181 a in AMI . The binding sites between MALAT1 and miR-181a were predicted using the lncBase online prediction database and validated by dual luciferase reporter assay. An oxidative stress model of myocardial cells was established by hydro gen peroxide (H2O2 ) treatment in AC16 human myocardial cell line . siRNA targeting MALAT1 ( si-MALAT) and negative control siRNA ( si-NC) were transfected into AC16 cells , and the cells were divided into H2O2 treatment (H2O2 ) group , H2 O2 + si NC group , and H2O2 + si-MALAT group . Cell proliferation activity was detected by CCK-8 assay , cell apoptosis was assessed by TUNEL assay , and the expression levels of cleaved caspase-3 , Bcl-2 associated X protein (Bax ) , and B cell lymphoma-2 ( Bcl-2) were determined by Western blot. Results : Compared to the Normal group , the expression of MALAT1 was upregulated and the expression of miR-181a was down regulated in the AMI group (P < 0.05) , and there was a negative correlation between MALAT1 and miR-181a expression. The lncBase online prediction database and dual-luciferase reporter assay results had proven that MAL AT1 could target and regulate the expression of miR 181 a. Compared to the H2O2 group, the H2O2 + si MALAT group showed increased cell viability (P < 0.05) , decreased TUNEL positive rate (P < 0.05) , decreased expres sion levels of cleaved caspase-3 and Bax (P < 0.05) , and increased expression level of Bcl-2 (P < 0.05) , while the H2O2 + si NC group showed no significant changes (P > 0.05) . Conclusion LncRNA MALAT1 expression is elevated in AMI patients , which could promote oxidative stress induced myocardial cell damage through targeted inhibition of miR-181a.

Objective:To explore the effectiveness of patient participation and Internet plus in fall prevention management strategies of elderly inpatients and analyze the causes of falls, so as to provide a basis for continuous improvement in fall prevention to investigate their continuous improvement.Methods:A pre- and post-control study was conducted. Totally 8 480 elderly inpatients hospitalized in the Department of Internal Medicine from 1 June 2020 to 31 May 2021 in Chenzhou NO. 1 People′s Hospital were selected by convenient sampling as the control group, and 8 662 elderly inpatients hospitalized in the Department of Internal Medicine from 1 June 2021 to 31 May 2022 were in the experimental group. The routine fall prevention measures were used in the control group, and on this basis, the experimental group formulated and implemented fall prevention management strategies involving patients based on the patient participation framework "informing, participating, empowering, cooperating, and electronic information support" and introduced Internet plus. Then the differences between the two groups in terms of the incidence of falls and the satisfaction rate of nursing care were compared.Results:The experimental group included 8 662 cases (5 110 males and 3 552 females) with (73.96 ± 8.78) years old, while the control group included 8 480 cases (4 918 males and 3 562 females) with (74.11 ± 8.59) years old. The incidence of falls in experimental group (0.092%, 8/8 662) was lower than that in control group (0.224%, 19/8 480), and the difference was statistically significant ( χ 2=4.71, P<0.05); the nursing care satisfaction rate of experimental group (98.880%, 8 565/8 662) was higher than that of control group (96.450%, 8 179/8 480), and the difference also was statistically significant ( χ 2=106.50, P<0.01); the analysis of the fall causes of the patients revealed that the toilet squatting commode was an important hidden risk of falls in elderly patients. Conclusions:Fall prevention management strategies based on patient participation can reduce the incidence of falls in elderly patients and improve the satisfaction rate of nursing care. Patient participation introduced "Internet plus" can prevent patient falls. The root causes of patient falls will continue to change, and care managers should continually track real-time changes in the root causes of falls to identify problems, develop and adjust prevention strategies accordingly, and pay attention to the importance of infrastructure in the safety of older patients.

With the acceleration of the aging process of the population,more and more elderly pa-tients need to receive surgical treatment,and studies have found that elderly patients are prone to periopera-tive neurocognitive disorders(PND).PND may effects patients'postoperative rehabilitation.Therefore,early identification of high-risk patients with PND and strengthening preoperative prehabilitation are extremely important for perioperative brain health and postoperative rehabilitation of patients.In this paper,preoperative risk factors,simple assessment methods and prehabilitation strategies of perioperative neurocog-nitive disorders in elderly patients were summarized,so as to provide references for clinical screening and prehabilitation of high-risk elderly patients.

Objective To investigate the relationship between daily intake of B vitamins(vitamins Bl,B2,B6 and niacin)and chronic constipation and chronic diarrhea.Methods Data of 3 durations(2005-2006,2007-2008 and 2009-2010)from National Health and Nutrition Examination Survey(NHANES)database were collected and retrospectively analyzed.For the 13 788 participants,their intake of vitamin B1,B2,B6,and niacin were assessed through a 24-hour dietary recall interview.Multivariate logistic regression analysis was employed to explore the correlation between B vitamins and chronic constipation and chronic diarrhea.Additionally,sensitivity analysis and curve fitting correlation analysis were conducted to further elucidate the observed relationships.Results Among the subjects who were enrolled in the study,2 520(18.28％)were diagnosed with chronic constipation,while 2 138(15.51％)were diagnosed with chronic diarrhea.Multivariate logistic regression analysis and sensitivity analysis indicated linear correlations between the intake of vitamin B1,niacin and vitamin B6 and the occurrence of chronic constipation and chronic diarrhea.An increase in the daily intake of these nutrients potentially reduced the risk of chronic constipation,but also increased the risk of chronic diarrhea(P＜0.05).Conclusion Daily intake of vitamins B1,B2,B6 and niacin is correlated with the occurrence of chronic constipation and chronic diarrhea.