Erchen Decoction is widely used to dampness-phlegm syndrome and it can be flexibly used in clinical application by my supervisor Professor OU Zheng-wu, especially in cough, pneumonia, asthma and influenza, which has obvious efficacy in treatment. This article reviewed five medical cases during the follow-up process with Professor OU in application of Erchen Decoction, with a purpose to share experience of famous doctors and improve TCM diagnosis and treatment level together.

Objective To observe the effect of Kechuanning Oral liquid on the expression of P13K in CD4+and CD8+T cells of asthma rats induced by respiratory syncytial virus (RSV), and explore its mechanism of preventing and treating asthma induced by virus. Methods SD rats were randomly divided into phosphate-buffered saline (PBS) control group, model group, dexamethasone and salbutamol group (positive drug group), and Kechuanning oral liquid group. Ovalbumin asthma rats model was built and induced by RSV. CD4+and CD8+T cells were separated by magnetic beads method. The expressive level of PI3K-110αin T cells was detected by immumofluorescence method with flow cytometry. Results Compared with PBS control group, positive drug group and Kechuanning oral liquid group, the CD4+and CD8+T cells percentage and the expression level of PI3K-110α in CD4+ and CD8+T cells of model group were significantly higher. The differences were statistically significant (P<0.01). The CD4+and CD8+T cells percentage was not associated with the expression level of PI3K-110α in CD4+ and CD8+T cells of each group by Pearson correlation analysis. Conclusion The CD4+ and CD8+T cells involve in the asthma immunity balanced modulation, and the level of PI3K expressed by CD4+ and CD8+T cells increase distinctly. Kechuanning oral liquid can restrain the expression of PI3K in CD4+ and CD8+T cells, which might be one of the immunologic mechanisms of treating asthma.

BACKGROUNDTo detect the micrometastases status in peripheral blood and regional lymph nodes of lung cancer patients by reverse transcription-polymerase chain reaction (RT-PCR).

METHODSCK19 mRNA expression in peripheral blood and regional lymph nodes was detected in 78 patients with lung cancer, and 30 patients with pulmonary benign lesions and 10 healthy volunteers as controls by RT-PCR. Meanwhile, all lymph nodes were also examined by traditional pathological method.

RESULTSThe positive rate of CK19 mRNA expression was 38.5% in peripheral blood of lung cancer patients, and 6.7% in patients with pulmonary benign lesions (6.7%) (Chi-square=10.505,P=0.001). No positive CK19 mRNA expression was found in peripheral blood of 10 healthy volunteers. The positive rates of CK19 mRNA of lymph nodes were 36.9% and 0 in lung cancer patients and pulmonary benign disease patients respectively (Fisher's exact=0.014). In lung cancer group, the metastatic rate of lymph nodes was 17.9% by traditional pathological examination, which was much lower than that by RT-PCR (Chi-square=7.664, P=0.006).

CONCLUSIONSRT-PCR amplification of CK19 mRNA is an sensitive method to detect early haematogenous and regional lymph nodes dissemination of cancer cells for patients with lung cancer. This method may lead to an earlier diagnosis and treatment of patients with subclinical metastasis in circulation and regional lymph nodes.

Objective:To identify the development trajectories of self-neglect behavior in older adults and explore the associated influencing factors.Methods:A fixed cohort was constructed based on the data from three surveys of Chinese longitudinal healthy longevity survey (CLHLS) from 2011 to 2018. A total of eight variables from 4 dimensions including living environment, lifestyle, social interaction, and health care were selected to evaluate self-neglect. Group-based trajectory model was used to identify the development trajectory of self-neglect behavior in the older adults, and polynomial Logistic regression model was used to explore its influencing factors by Stata 16.1.Results:Finally, 2 754 older adults aged 60 and above were included.The development trajectory of self-neglect behavior in older adults, based on the group-based trajectory model, can be classified into stable-low group ( n=268, 9.7%), descending-moderate group ( n=2 224, 80.8%), and decreasing-high group ( n=262, 9.5%). Polynomial Logistic regression showed that, compared with stable-low group, living in rural areas ( B=1.116, OR=3.053, 95% CI= 2.278-4.091) and higher activities of daily living scores( B=0.137, OR=1.147, 95% CI=1.046-1.258) were the risk factors of descending-moderate group. Education levels with 1-6 years( B=-0.398, OR=0.672, 95% CI=0.469-0.963), >6 years( B=-1.072, OR=0.342, 95% CI=0.229-0.513), being married( B=-0.476, OR=0.621, 95% CI=0.444-0.870), self-reported good health( B=-0.808, OR=0.446, 95% CI= 0.213-0.932), improved health status( B=-0.704, OR=0.495, 95% CI=0.320-0.766), self-reported average economic status( B=-1.065, OR=0.345, 95% CI=0.148-0.802), self-reported good economic status( B=-1.634, OR=0.195, 95% CI=0.082-0.467), and a higher cognition score( B=-0.142, OR=0.867, 95% CI=0.798-0.942) served as protective factors of descending-moderate group. In addition to the above factors, being in the age group of 75-89 years( B=0.481, OR=1.617, 95% CI=1.057-2.473) was a risk factor for decreasing-high group compared to stable-low group. Conclusions:Three types of self-neglect behavior trajectories among older adults were identified in this study, suggesting that physical health and economy are the influencing factors of the development trajectory of self-neglect of the elderly.

Objective:To explore the application effect of four-track teaching mode (LBL: lecture-based learning; CBL: case-based learning; PBL: problem-based learning) in pediatric teaching of integrated traditional Chinese and Western Medicine.Methods:175 integrated traditional Chinese and Western medical students in seven-year program were divided into experimental group and control group. The experimental group was taught by four-track teaching mode, while students in the control group. Were applied with traditional teaching method ("LBL+CBL").Results:Students in the experimental group highly rated the four-track teaching mode and were better than those in the control group in the following aspects: satisfaction with teaching methods, interest in learning, the ability of creative thinking, the thinking ability of clinical diagnosis and treatment, and memorization ( P<0.05). And students' mid-term, final and comprehensive scores in the experimental group were significantly higher than those in the control group ( P<0.05). Conclusion:Compared with traditional teaching methods, the four-track teaching mode can improve the quality of pediatric teaching of integrated traditional Chinese and Western medical students, which should be further integrated and perfected in the teaching practice.

OBJECTIVE To explore the effect of informationized closed-loop management in the consultation of over-dose narcotics. METHODS Since November 2021， the informationized consultation mode of over-dose narcotics had been established innovatively in our hospital on the basis of the previous process of over-dose narcotics use； the consultation mode of over-dose narcotics transformed from paper to information. The standardized rate of consultation for over-dose narcotics， the waiting time of consultation for patients using over-dose narcotics were compared before （from January to April 2021） and after the improvement （from November 2021 to February 2022）. RESULTS The informationized closed-loop management of over-dose narcotics consultation in our hospital was realized by improving hospital information system （maintaining basic information， embedding relevant reminder and consultation modules， and establishing query and statistics functions） and introducing mobile terminal. After establishing the mode， the standardized rate of the consultation increased from 55.56% to 93.75%； the waiting time for consultation was shortened from （20.61±9.77） min to （5.87±2.45） min. CONCLUSIONS The informationized closed-loop management can effectively improve the standardization rate of consultations for over-dose narcotics and reduce the waiting time for consultation for patients using over-dose narcotics.

Objective To explore the feasibility and technical tips of the reconstruction of defects around the knee using the reverse-flow thigh flaps based on different branches of the lateral circumflex femoral artery ( LCFA) .A classification method of these flaps was proposed .Methods According to the characteristics of the defects and the LCFA arborizing condition , an optimal reverse-flow thigh flap was chosen for defect reconstruction .Results From 2010 to 2016, 23 patients underwent defect reconstruction using the reverse-flow thigh flaps .The flaps were classified into four different types according to the origin of the perforating vessels on which the flap was based , including the descending ( typeⅠ) , oblique ( typeⅡ) , rectus femoris ( type Ⅲ) , and transverse branches ( type Ⅳ) .In our series of patients , 7 type Ⅰflaps, 10 typeⅡ, 5 typeⅢ, and 1 typeⅣwere included.The reverse flow from the rectus femoris branch was combined and a dual pedicle was formed in 5 patients.The flap size ranged from 8 cm ×7cm to 24 cm × 12 cm.The perforating vessels included septocutaneous in 7 cases and musculocutaneous in the remaining 16.The pedicle length and distance from the pivot point to the superolateral border of the patella were 8.5 cm to 25 cm (mean, 17 cm) and 5 cm to 16 cm (mean, 11.48 cm) respectively.Pre-transfer donor site expansion was conducted in 5 patients.The donor sites were managed by direct closure in 18 cases, free skin grafting in 4, and transferring a pedicled deep inferior epigastric artery perforator flap in the remaining 1.All flaps survived after the surgery except one in which the venous congestion of the flap occurred postoperatively , resolved after using conservative treatment .The patients were followed for 1 to 48 months, tumor recurrence was not noticed and all patients were satisfied with the reconstructive outcomes .Conclusions LCFA-based classification system of the reverse-flow thigh flaps would provide surgeons more options when a defect around knee needs to be reconstructed .

Objective To explore the feasibility and technical tips of the reconstruction of defects around the knee using the reverse-flow thigh flaps based on different branches of the lateral circumflex femoral artery ( LCFA) .A classification method of these flaps was proposed .Methods According to the characteristics of the defects and the LCFA arborizing condition , an optimal reverse-flow thigh flap was chosen for defect reconstruction .Results From 2010 to 2016, 23 patients underwent defect reconstruction using the reverse-flow thigh flaps .The flaps were classified into four different types according to the origin of the perforating vessels on which the flap was based , including the descending ( typeⅠ) , oblique ( typeⅡ) , rectus femoris ( type Ⅲ) , and transverse branches ( type Ⅳ) .In our series of patients , 7 type Ⅰflaps, 10 typeⅡ, 5 typeⅢ, and 1 typeⅣwere included.The reverse flow from the rectus femoris branch was combined and a dual pedicle was formed in 5 patients.The flap size ranged from 8 cm ×7cm to 24 cm × 12 cm.The perforating vessels included septocutaneous in 7 cases and musculocutaneous in the remaining 16.The pedicle length and distance from the pivot point to the superolateral border of the patella were 8.5 cm to 25 cm (mean, 17 cm) and 5 cm to 16 cm (mean, 11.48 cm) respectively.Pre-transfer donor site expansion was conducted in 5 patients.The donor sites were managed by direct closure in 18 cases, free skin grafting in 4, and transferring a pedicled deep inferior epigastric artery perforator flap in the remaining 1.All flaps survived after the surgery except one in which the venous congestion of the flap occurred postoperatively , resolved after using conservative treatment .The patients were followed for 1 to 48 months, tumor recurrence was not noticed and all patients were satisfied with the reconstructive outcomes .Conclusions LCFA-based classification system of the reverse-flow thigh flaps would provide surgeons more options when a defect around knee needs to be reconstructed .

Following the principles of evidence-based medicine,in accordance with the structure and drafting rules of standardized documents,based on literature research,according to the characteristics of chronic cough in children and issues that need to form a consensus,the TCM Guidelines for Diagnosis and Treatment of Chronic Cough in Children was formulated based on the Delphi method,expert discussion meetings,and public solicitation of opinions.The guideline includes scope of application,terms and definitions,eti-ology and diagnosis,auxiliary examination,treatment,prevention and care.The aim is to clarify the optimal treatment plan of Chinese medicine in the diagnosis and treatment of this disease,and to provide guidance for improving the clinical diagnosis and treatment of chronic cough in children with Chinese medicine.