Objective To investigate the expression characteristics and clinical diagnostic value of programmed death receptor 1(PD-1)and its corresponding ligand(PD-L1)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods One hundred and sixty COPD patients who visited Dongzhimen Hospital of Beijing University of Chinese Medicine from April 2024 to November 2024 were included and divided into an acute exacerbation group of 100 cases and a stable group of 60 cases according to the severity of the disease.Additionally,40 healthy volunteers during the same period were recruited as the control group.The general clinical data of the patients were collected.Chronic Obstructive Pulmonary Disease Assessment Test(CAT)and Modified Medical Research Council Dyspnea Questionnaire(mMRC)Scale were used to test the severity of the disease;respiratory function testing was performed and fasting venous blood was collected for serum PD-1 and PD-L1 testing.Pearson correlation was used to analyze the correlation between serum PD-1,PD-L1,CAT,and mMRC,and multiple logistic regression analysis to identify the influencing factors of AECOPD.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of serum PD-1 and PD-L1 level for AECOPD.Results Serum PD-1 level in the stable COPD group and AECOPD group was significantly increased compared with that in the control group,while serum PD-L1 level was significantly decreased,showing statistical significance(P<0.05);The level of PD-1 gradually increased with the grading of lung function and the deterioration of AECOPD,with statistical significance(P<0.05);Pearson correlation showed that serum PD-1 level was positively correlated with CAT scores in COPD patients,while negatively with CAT scores,showing statistical significance(P<0.05);Multiple logistic regression analysis showed that elevated levels of serum inter-leukin-6(IL-6),neutrophil to lymphocyte ratio(NLR),and PD-1 were risk factors for AECOPD,while elevated level of PD-L1 was protective factor for AECOPD(P<0.05);ROC curve showed that the levels of PD-1,PD-L1,IL-6,NLR,and the area under the ROC curve(AUC)for their combined prediction of AECOPD diagnosis were 0.884,0.867,0.868,0.802,and 0.995,respectively.Conclusion Serum PD-1 and PD-L1 in AECOPD patients have presented certain expression characteristics,with elevated PD-1 level while decreased PD-L1 level.Both have good clinical diagnostic value for AECOPD.

Objective To explore the clinical effect of transcranial direct current stimulation(tDCS)treatment strategy based on bi-modal balance model on upper limb dysfunction after ischemic stroke.Methods From October,2023 to December,2024,60 patients with ischemic stroke in General Hospital of Ningxia Medi-cal University were randomly divided into control group(n=30)and experimental group(n=30).Both groups received basic rehabilitation,the control group received tDCS based on the theory of interhemispheric competi-tion model,and the experimental group received tDCS based on the theory of bimodal equilibrium model,for four weeks.Before and after intervention,the effect of both groups was evaluated using Fugl-Meyer Assessment-Upper Extremities(FMA-UE),modified Ashworth Scale(MAS),Action Research Arm Test(ARAT)and modi-fied Barthel Index(MBI).Neurophysiological parameters such as cortical latency(CL)and central motor conduc-tion time(CMCT)were detected and correlated analysis was performed.Results Two cases in the control group and one in the experimental group dropped down.After intervention,the scores of FMA-UE,ARAT and MBI increased in both groups(|t|>13.748,P<0.001),and the above scores were higher in the experimental group than in the control group(|t|>2.321,P<0.05);the MAS grade of the elbow flexor muscle group improved in the experimental group(|Z|=2.095,P<0.05).The CL and CMCT in both groups de-creased(|t|>2.752,P<0.001),and they were better in the experimental group than in the control group(|t|>2.082,P<0.05).There was a correlation between FMA-UE and CMCT(r=-0.433,P<0.05).Conclusion tDCS based on bimodal balance model can improve upper limb dysfunction more effectively in patients with ischemic stroke.

Objective To explore the clinical effect of transcranial direct current stimulation(tDCS)treatment strategy based on bi-modal balance model on upper limb dysfunction after ischemic stroke.Methods From October,2023 to December,2024,60 patients with ischemic stroke in General Hospital of Ningxia Medi-cal University were randomly divided into control group(n=30)and experimental group(n=30).Both groups received basic rehabilitation,the control group received tDCS based on the theory of interhemispheric competi-tion model,and the experimental group received tDCS based on the theory of bimodal equilibrium model,for four weeks.Before and after intervention,the effect of both groups was evaluated using Fugl-Meyer Assessment-Upper Extremities(FMA-UE),modified Ashworth Scale(MAS),Action Research Arm Test(ARAT)and modi-fied Barthel Index(MBI).Neurophysiological parameters such as cortical latency(CL)and central motor conduc-tion time(CMCT)were detected and correlated analysis was performed.Results Two cases in the control group and one in the experimental group dropped down.After intervention,the scores of FMA-UE,ARAT and MBI increased in both groups(|t|>13.748,P<0.001),and the above scores were higher in the experimental group than in the control group(|t|>2.321,P<0.05);the MAS grade of the elbow flexor muscle group improved in the experimental group(|Z|=2.095,P<0.05).The CL and CMCT in both groups de-creased(|t|>2.752,P<0.001),and they were better in the experimental group than in the control group(|t|>2.082,P<0.05).There was a correlation between FMA-UE and CMCT(r=-0.433,P<0.05).Conclusion tDCS based on bimodal balance model can improve upper limb dysfunction more effectively in patients with ischemic stroke.

Objective To investigate the expression characteristics and clinical diagnostic value of programmed death receptor 1(PD-1)and its corresponding ligand(PD-L1)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods One hundred and sixty COPD patients who visited Dongzhimen Hospital of Beijing University of Chinese Medicine from April 2024 to November 2024 were included and divided into an acute exacerbation group of 100 cases and a stable group of 60 cases according to the severity of the disease.Additionally,40 healthy volunteers during the same period were recruited as the control group.The general clinical data of the patients were collected.Chronic Obstructive Pulmonary Disease Assessment Test(CAT)and Modified Medical Research Council Dyspnea Questionnaire(mMRC)Scale were used to test the severity of the disease;respiratory function testing was performed and fasting venous blood was collected for serum PD-1 and PD-L1 testing.Pearson correlation was used to analyze the correlation between serum PD-1,PD-L1,CAT,and mMRC,and multiple logistic regression analysis to identify the influencing factors of AECOPD.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of serum PD-1 and PD-L1 level for AECOPD.Results Serum PD-1 level in the stable COPD group and AECOPD group was significantly increased compared with that in the control group,while serum PD-L1 level was significantly decreased,showing statistical significance(P<0.05);The level of PD-1 gradually increased with the grading of lung function and the deterioration of AECOPD,with statistical significance(P<0.05);Pearson correlation showed that serum PD-1 level was positively correlated with CAT scores in COPD patients,while negatively with CAT scores,showing statistical significance(P<0.05);Multiple logistic regression analysis showed that elevated levels of serum inter-leukin-6(IL-6),neutrophil to lymphocyte ratio(NLR),and PD-1 were risk factors for AECOPD,while elevated level of PD-L1 was protective factor for AECOPD(P<0.05);ROC curve showed that the levels of PD-1,PD-L1,IL-6,NLR,and the area under the ROC curve(AUC)for their combined prediction of AECOPD diagnosis were 0.884,0.867,0.868,0.802,and 0.995,respectively.Conclusion Serum PD-1 and PD-L1 in AECOPD patients have presented certain expression characteristics,with elevated PD-1 level while decreased PD-L1 level.Both have good clinical diagnostic value for AECOPD.

OBJECTIVE To evaluate the impact of the specialized centralized procurement policy for insulin on daily cost and affordability of insulin,and provide data support for the enhancement of relevant policies.METHODS In this research,the insulin purchasing data were obtained from provincial centralized procurement platforms in provinces before and after the specialized centralized procurement of insulin(October-December 2021 and October-December 2022),and the cost variations of insulin before and after the centralized procurement were analyzed by the defined daily dose cost(DDDc)of various types of insulins.The changes in the affordability of various types of insulins before and after the specialized centralized procurement were evaluated,using the percentage of annual expenditure on various types of insulins relative to annual per capita disposable income(i.e.the proportion of annual expenditure)as an indicator.RESULTS After the specialized centralized procurement,DDDc of various types of insulins decreased by 20.7%-71.8%,with an average reduction of 45.7%.Moreover,the reduction in DDDc for third-generation insulin exceeded that for second-generation insulin.The reduction in the proportion of annual expenditure on insulin ranged from 24.3%to 73.4%,with an average decrease of 48.5%.Premixed insulin analogs experienced the greatest reduction(73.4%).Following the specialized centralized procurement,DDDc of insulin decreased in all provinces.Except for Guangxi(10.2%),the average proportion of annual expenditure on insulin in the remaining provinces dropped to below 10%.CONCLUSIONS The specialized centralized procurement policy for insulin has significantly reduced insulin costs and improved affordability,thereby alleviating the economic pressure on patients with diabetes.There are notable cost disparities among provinces and among insulin categories,which require attention.

OBJECTIVE To investigate and analyze the use of acetaminophen in primary medical institutions of Shaanxi province， and to provide evidence for promoting the standardized and rational use of acetaminophen. METHODS According to the method of cluster stratified random sampling， all prescriptions of acetaminophen issued by primary medical institutions in one district and one county （or two districts） were randomly selected from 10 provincial cities of Shaanxi province from 2020 to 2023； the existing clinical diagnoses were classified by using the International Classification of Diseases （ICD） code， and the drug information of collected prescriptions was analyzed descriptively. SPSS 25.0 software was used for single-factor analysis and Logistic regression analysis to find out the key factors affecting the duration of medication ＞10 d. RESULTS A total of 7 375 valid prescriptions for acetaminophen were collected in this study. The patients who used acetaminophen were mainly female （52.11%） and aged 19-64 （66.73%）. Based on the ICD code， the disease categories most involved in the use of acetaminophen were musculoskeletal system， connective tissue diseases or symptoms and signs （43.48%）； the top 3 clinical diagnoses were joint disease （25.59%）， fracture （9.95%）， and toothache （8.58%）. Among the 7 175 prescriptions with clear drug usage and dosage， 3 366 were in line with the recommendation of acetaminophen instruction， and 5.63% of the prescriptions exceeded the maximum dose limit of acetaminophen 2.0 g/d. There were 4 051 prescriptions exceeding the conventional limit of treatment duration （7 d）， and 1 336 prescriptions exceeding the limit of treatment duration （10 d）. The main factors affecting the duration of drug treatment ＞10 d were the region and type of medical institutions， the gender and age of patients， and the phenomenon of the duration of drug treatment ＞10 d was common in the primary medical institutions from southern Shaanxi， township health centers， the elderly and female patients. CONCLUSIONS There are some unreasonable clinical applications of acetaminophen in primary medical institutions of Shaanxi province， which are mainly manifested in inappropriate usage and dosage， unsuitable clinical diagnosis and drug duration. The region， type of medical institution， age and gender of patients will affect the duration of this drug prescription.

Objective:The changes of serum inflammatory factors in patients with chronic obstructive pulmonary disease (COPD) with different traditional Chinese medicine (TCM) syndrome types were compared, and the characteristics and significance of inflammatory factors in COPD were discussed from the perspective of traditional Chinese and western medicine.Methods:A total of 100 patients with COPD who met the inclusion criteria and were admitted to Dongzhimen Hospital of Beijing University of Chinese Medicine from September 2021 to September 2022 were selected and divided into phlegm turbation obstructing lung group ( n=50) and lung and kidney qi deficiency group ( n=50) according to TCM syndrome types. Twenty healthy subjects in the same period were selected as control group. Serum levels of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and other inflammatory factors were compared in each group. Results:The MCP-1, IL-6, ESR, CRP, white blood cell count (WBC) and procalcitonin (PCT) of COPD patients in phlegm turbation obstructing lung group were significantly higher than those in lung and kidney qi deficiency group (all P<0.05). The WBC, MCP-1, MIP-1α, IL-6, ESR and CRP of COPD patients in the lung and kidney qi deficiency group were significantly higher than those in the control group (all P<0.05). In the phlegm turbation obstructing lung group, the MIP-1α, MCP-1, IL-6, ESR, CRP, WBC, and PCT were significantly higher than those in the control group (all P<0.05). Conclusions:Patients with COPD have inflammatory reactions, and the inflammatory reactions of patients with phlegm turbation obstructing lung syndrome are more obvious than those with lung and kidney qi deficiency syndrome. The inflammatory factors MCP-1, MIP-1α, IL-6, ESR, CRP, WBC, PCT and other indicators could be used to judge the degree of COPD inflammation, which had certain clinical guiding significance for different syndrome types of COPD patients.

Objective:To analyze the mechanism of Danpi-Chishao in treatment of sepsis based on network pharmacology.Methods:The corresponding targets of Danpi-Chishao and sepsis were carried out through TCMSP database, OMIM database and Genecards database. Cystoscope 3.8.2 software was used to construct the " Chinese medicine-active components-target-disease" network diagram. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were carried out by DAVID database. Weisheng cloud platform was used to draw bubble map.Results:A total of 36 effective components of Danpi-Chishao was obtained, mainly including quercetin, kaempferol, baicalin, β-sitosterol, stigmasterol, paeoniflorin and so on. There were 96 potential common key targets between Danpi-Chishao and sepsis, such as prostaglandin-endoperoxide synthase 2 (PTGS2), transcription factor p65 (RELA), phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit gamma (PIK3CG), B-cell lymphoma 2 (BCL-2)-associated X (BAX), BCL-2, Caspase-3 (CASP3) with a degree value>4.9. The result of protein-protein interaction (PPI) network analysis showed that there were 10 important target proteins, including alpha serine/threonine-protein kinase (AKT1), interleukin-6 (IL-6), tumor necrosis factor (TNF), interleukin-1β (IL-1β), vascular endothelial growth factor A (VEGFA), cellular tumor antigen p53 (TP53), matrix metalloproteinase-9 (MMP9), CASP3, PTGS2, C-C motif chemokine ligand 2 (CCL2). The pathways obtained by GO and KEGG enrichment analysis included atherosclerosis pathway, advanced glycation end products (AGE)-receptor for advanced glycation end products (RAGE) signal pathway, cancer pathway, tumor necrosis factor signal pathway, hypoxia-inducible factor (HIF) signal pathway, IL-17 signal pathway and other pathway.Conclusions:The mechanism of the intervention effect of Danpi-Chishao on sepsis may be that the active components such as quercetin, kaempferol, paeoniflorin act on target proteins such as PTGS2, RELA, PIK3CG, BAX, BCL2, CASP3, and through TNF-related signal pathway, HIF-1 signal pathway, IL-17 signal pathway, etc. Nonetheless, the conclusion needs further experimental verification.

Objective:To compare the efficacy of conventional Western medicine alone and acupuncture combined with acupoint application in treating intestinal dysfunction secondary to mechanical ventilation in elderly patients with emergency sepsis.Methods:A retrospective analysis was performed on 111 elderly patients with mechanical ventilation for sepsis admitted to the emergency department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2019 to June 2021. They were divided into two groups according to the time of admission: Western medicine treatment group alone (patients from January 2019 to December 2019, n=47) and acupuncture combined with acupoint application group (patients from January 2020 to June 2021, n=64). Acupuncture combined with acupoint application group was treated with acupuncture combined with acupoint application on the basis of conventional Western medicine. The intestinal dysfunction score, abdominal circumference and mortality after 4 weeks were compared between the two groups. Results:The abdominal circumference and intestinal dysfunction score in acupuncture combined with acupoint application group were significantly lower than those before treatment [(100.56±9.34)cm vs (106.25±9.74)cm; (0.92±0.72)point vs (2.31±0.69)point, all P< 0.05], while there was no significant difference in the above indexes before and after treatment in the Western medicine treatment group (all P>0.05). The abdominal circumference, intestinal dysfunction score and mortality after 4 weeks in the acupuncture combined with acupoint application group were significantly lower than those in the Western medicine treatment group [(100.56±9.34)cm vs (108.09±10.52)cm; (0.92±0.72)point vs (2.43±0.62)point; (29.7%, 19/64) vs (48.9%, 23/47), all P<0.05]. Conclusions:The curative effect of acupuncture combined with acupoint application in the treatment of intestinal dysfunction secondary to mechanical ventilation in elderly patients with sepsis in emergency is better than that of routine treatment of Western medicine alone. The gastrointestinal function and prognosis of patients have been significantly improved, which is worthy of clinical promotion.

Microbial ecosystem comprises a complex community in which bacteria interact with each other. The potential roles of the intestinal microbiome play in human health have gained considerable attention. The imbalance of gut microbial community has been looked to multiple chronic diseases. Cardiovascular diseases (CVDs) are leading causes of morbidity worldwide and are influenced by genetic and environmental factors. Recent advances have provided scientific evidence that CVD may also be attributed to gut microbiome. In this review, we highlight the complex interplay between microbes, their metabolites, and the potential influence on the generation and development of CVDs. The therapeutic potential of using intestinal microbiomes to treat CVD is also discussed. It is quite possible that gut microbes may be used for clinical treatments of CVD in the near future.