1.Role of NLRP3/Caspase-1/IL-1β inflammasome pathway in formation of aortic dissection in mice
Jun XIANG ; Ling HE ; Hongzhi XU ; Weiwei LIANG ; Tailuan PENG ; Shuliang WEI
Journal of Army Medical University 2024;46(7):705-714
Objective To investigate the role and mechanism of NLRP3/Caspase-1/IL-1 β inflammasome pathway in the formation of aortic dissection in mice.Methods Fifty male C57BL/6 mice(3 weeks old,body weight 10~13 g)were divided into control group(n =10,normal diet),β-aminopropionitrile(BAPN)group[n =20,drink water containing 1 g/(kg·d)BAPN],and BAPN+MCC950 group[n=20,drink water containing 1 g/(kg·d)BAPN and intraperitoneal injection of 20 mg/(kg·d)NLRP3 inhibitor,MCC950]by random sampling.Water intake,body weight,incidence of aortic dissection and aortic dissection-related mortality were recorded.The inflammatory infiltration in the aorta was observed with HE staining,elastic fiber breakage was observed by elastic Van Gieson(EVG)staining,average fluorescence intensity of NLRP3,IL-1β,α-SMA and OPN was detected by immunofluorescence assay,and protein expression levels of NLRP3,Caspase-1,ASC,IL-1β,α-SMA and OPN were measured with Western blotting.Results No aortic dissection or death was observed in the control group.The BAPN group had an incidence of aortic dissection of 80%,aortic dissection-related mortality of 35%,and obvious broken elastic fibers and inflammatory infiltrate in the aortic wall,and increased expression levels of NLRP3,Caspase-1,ASC and IL-1 β,decreased contractile α-SMA and increased synthetic protein OPN when compared with the control group(P<0.05).While MCC950 treatment decreased the incidence of aortic dissection(80%vs 35%,P=0.004)and aortic dissection-related mortality(35%vs 15%,P=0.144),alleviated the broken elastic fibers and inflammatory infiltrate in the aortic wall,and down-regulated the expression of NLRP3,Caspase-1,ASC and IL-1β,enhanced contractile α-SMA and decreased the synthetic protein when compared with the BAPN group(P<0.05).Conclusion The occurrence of aortic dissection in mice is associated with activation of NLRP3/Caspase-1/IL-1 β inflammasome pathway.NLRP3 inhibitor,MCC950,can reduce the occurrence of aortic dissection and show a protective effect on blood vessels.
2.Effects of Electroacupuncture at "Neiguan" (PC6) - "Zhongwan" (RN12) for Rats with Functional Dyspepsia on Gastric Motility and Metabolites of Antral Tissue
Jingying ZHOU ; Hongzhi YIN ; Qian LIU ; Xuan XU ; Yitian LAI ; Guoshan ZHANG ; Huan ZHONG ; Mi LIU
Journal of Traditional Chinese Medicine 2024;65(14):1478-1487
ObjectiveTo investigate the possible mechanism of electroacupuncture at "Neiguan" (PC6) and "Zhongwan" (RN12) in the treatment of functional dyspepsia (FD). MethodsSPF male SD rats were randomly divided into model group, Neiguan (PC6) group, Zhongwan (RN12) group, and Neiguan-Zhongwan (PC6-RN12) group, with 8 rats in each group. Except for the normal group, the other groups of rats were cogavaged with 0.1% sucrose iodoacetamide solution combined with small platform standing training to establish FD rat models. After successful modeling, the rats in the normal group and model group were tied up for 30 min/d for 7 days; the Neiguan group, Zhongwan group, and Neiguan-Zhongwan group were treated with electroacupuncture intervention at "Neiguan" (PC6), "Zhongwan" (RN12), and "Neiguan" - "Zhongwan" (PC6-RN12) acupoints, respectively, using continuous wave, frequency of 2 Hz, current intensity of 1 mA, 30 min/d, and continuous intervention for 7 days. The general condition of rats in each group was observed. After treatment, the body weight and food intake of rats were measured, and the gastric emptying rate was calculated; HE staining was performed on the gastric antrum tissue of rats to observe the histopathologic changes; the expressions of calcitonin gene-related peptide (CGRP) and Ghrelin protein in gastric antrum were detected by Western Blot; the metabolites in gastric antrum tissues were detected by liquid chromatography-mass spectrometry (LC-MS), and differential metabolites were screened by correlation analysis, then Metabo Analyst 5.0 and KEGG databases were used for metabolic pathway analysis. ResultsUnder light microscope, the gastric antrum structure was complete and the glands were abundant. No obvious inflammation and edema were found in gastric mucosa. Compared with the normal group, the body weight, food intake, and gastric emptie rate of rats in model group decreased, the expression of Ghrelin protein decreased and the expression of CGRP protein increased in gastric antrum tissue (P<0.01). Compared with model group, the body weight, food intake, and gastric emptance rate of rats in Neiguan group, Zhongwan group and Neiguan-Zhongwan group all increased, CGRP protein expression decreased in Neiguan group, and Ghrelin protein expression increased and CGRP protein expression decreased in Zhongwan group and Neiguan-Zhongwan group (P<0.01 or P<0.05). Compared with Neiguan-Zhongwan group, Ghrelin protein expression decreased and CGRP protein expression increased in Neiguan group and Zhongwan group (P<0.05 or P<0.01). Metabolomics results showed that compared with normal group, the content of metabolites adenosine diphosphate ribose, adenosine monophosphate and adenosine diphosphate in gastric antrum tissue of model group decreased; compared with model group, the contents of adenosine diphosphate, adenosine diphosphate and citicoline in Neiguan group increased, the contents of nicotine adenine dinucleotide, cytidine diphosphate ethanolamine and citicoline in Zhongwan group increased, and the contents of adenosine diphosphate, cytidine diphosphate and citicoline in Neiguan-Zhongwan group increased (P<0.05 or P<0.01). Compared with model group, the main metabolic pathways of different metabolites in PC6-RN12 group were glycerophospholipid metabolism, taurine and hypotaurine metabolism, purine metabolism, starch and sucrose metabolism. ConclusionElectroacupuncture at “Neiguan” and “Zhongwan” acupoints can effectively regulate gastrointestinal motility and improve FD symptoms in FD rats, and the effect is better than that of "Neiguan" or "Zhongwan" acupoints alone. The mechanism may be related to the influence of related metabolites on energy metabolism, glucose metabolism and nucleotide metabolism, thereby regulating gastrointestinal motility hormones.
3.Effects of bisdemethoxycurcumin promoting neuronal differentiation of neuroblastoma cells in mice and its mechanism
Jiaxin WANG ; Hongzhi FANG ; Min WU ; Zejie YANG ; Wenbo XU ; Shuang ZHANG ; Shali LI ; Genyun TANG
China Pharmacy 2024;35(5):578-583
OBJECTIVE To study the effects of the curcumin derivative bisdemethoxycurcumin (BC) promoting neuronal differentiation of neuroblastoma cells Neuro-2a (N2a) in mice and its mechanism. METHODS The effects of BC (1, 2, 4, 6, 8, 10 μmol/L) on the viability of N2a cells were detected by MTT assay to determine the concentration range of drug treatment. The control group, retinoic acid (RA) group (10 μmol/L) and BC groups (1, 2 and 4 μmol/L) were set up, and the length of neural protrusions of the differentiated cells was measured and the cell differentiation rate was calculated after 48 h and 72 h of culture. Compared with 0 min group, Western blot was used to detect the phosphorylation levels of protein kinase B (Akt), extracellular- signal regulated kinase 1/2 (ERK1/2), and p38 mitogen-activated protein kinase (p38) proteins in cells treated by 4 μmol/L BC for 5, 15, 30, 60, 120 min. After intervention with inhibitors LY294002 (LY) and PD98059 (PD), the effects of BC on Akt and ERK1/2 protein phosphorylation levels and promoting neural differentiation were further validated. RESULTS According to the MTT experiment, the BC concentrations for subsequent induction of cell differentiation were determined to be 1, 2, and 4 μmol/L. After 48 hours of differentiation, compared with the control group, the cell differentiation rate in RA group and BC 1, 2 and 4 μmol/L groups, the length of cellular neural processes wjxhhxx413@163.com in the BC 4 μmol/L group significantly increased (P<0.05 or P<0.01);after inducing differentiation of BC for 72 hours,compared with the control group, the cell differentiation rate and the length of cellular neural processes in the RA group, the cell differentiation rate in the BC 4 μmol/L group, and the length of cellular neural processes in the BC 2 μmol/L group all significantly increased (P<0.05 or P<0.01).Compared with the 0 min group, the phosphorylation levels of Akt, ERK1/2, and p38 proteins in cells of the 5, 15, 30, 60 and 120 min groups increased to varying degrees after treated by 4 μmol/L BC, and some differences were statistically significant (P<0.05 or P<0.01). After adding the inhibitor LY/PD, compared with the BC group, the phosphorylation level of ERK1/2 protein in the PD+BC group cells were significantly reduced (P<0.01), and the cell differentiation rates in the LY group, LY+BC group, PD group, and PD+BC group was significantly reduced (P<0.01). CONCLUSIONS BC promotes N2a cell differentiation mainly by increasing cell differentiation rate and neural protrusion length. The mechanism may be related to the activation of mitogen-activated protein kinase/ ERK and PI3K/Akt signaling pathways.
4.Correlation Between Expression of HIF-1α and Prognosis of Arsenic-containing Chinese Herbal Compound in Treatment of Myelodysplastic Syndrome
Peizhen JIANG ; Xiupeng YANG ; Dexiu WANG ; Wenru WANG ; Yan LYU ; Weiyi LIU ; Zhuo CHEN ; Hongzhi WANG ; Xiaoqing GUO ; Shanshan ZHANG ; Yonggang XU ; Xudong TANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(9):101-107
ObjectiveMyelodysplastic syndromes (MDS) is a group of clonal hematopoietic stem cell disorders,and this study aims to investigate the expression of hypoxia-inducible factor-1α(HIF-1α) in the bone marrow cells of patients with MDS and its correlation with the clinical features of MDS,the therapeutic efficacy of arsenic-containing Chineseherbal compound,and the survival prognosis. MethodAccording to the inclusion and exclusion criteria,27 MDS patients treated with arsenic-containing Chinese herbal compound in the Department of Hematology,Xiyuan Hospital,China Academy of Chinese Medical Sciences from January 2022 to September 2022 were included,and their bone marrow samples were collected by myelotomy. HIF-1α expression level in bone marrow cells was detected by real-time polymerase chain reaction (PCR) to analyze its correlation with clinical features,and logistic and Cox regression was used to analyze the risk factors affecting the efficacy and prognostic survival of MDS patients. ResultThe HIF-1α mRNA expression level was lower in bone marrow cells of MDS patients than in healthy subjects. HIF-1α was positively correlated with the degree of myelodysplasia(r=0.384,P<0.05) and bone marrow granulocytic system%(G%)(r=0.560,P<0.01). Logistic regression showed that HIF-1α was a risk factor for the prognosis in the follow-up of the efficacy of treatment(P<0.05)and Cox regression showed that HIF-1α was an independent factor affecting the survival prognosis of MDS patients [odds ratio(OR)=398.968,95% confidence interval(CI)(1.281,116 858.743),P<0.05]. ConclusionThe level of HIF-1α expression in bone marrow cells of MDS patients was closely related to the degree of clinical myelodysplasia and G%,and HIF-1α was a risk factor for the efficacy for and survival prognosis of MDS patients.
5.Development of a Traditional Chinese Medicine syndrome diagnosis scale for long-term simulated weightlessness experiments
Hongzhi SHI ; Chong XU ; Jiatuo XU ; Quanchun FAN ; Junlian LIU ; Liping TU ; Xiaojuan HU ; Chengpu ZHANG ; Shuang ZHAO ; Tao MI ; Yongzhi LI ; Yinghui LI
Space Medicine & Medical Engineering 2024;35(1):8-14
Objective To develop a Traditional Chinese Medicine(TCM)syndrome diagnosis scale suitable for evaluating the overall health status of participants in long-term simulated weightlessness experiments,and preliminarily evaluate its reliability and validity.Methods Based on the understanding of the pathogenesis of TCM in different stages of long-term manned spaceflight,a scale was developed through literature research and expert consultation.Test-retest reliability and internal consistency coefficient were used to test the reliability of the scale.Item analysis and factor principal component analysis were used to evaluate the validity of the scale,and a rotating component matrix was used to analyze the correlation between each item and dimension using 36 volunteers in a 90 days head down bed rest experiment as the research subjects.Results The scale contains eight dimensions and 57 items.The reliability analysis showed that the correlation coefficient of the total score of the scale for the first and second tests of 30 participants was 0.889,indicating high stability of the scale.The Cronbach coefficient of the scale was 0.934,indicating very good internal consistency.The split half reliability after correction was 0.858,indicating a high reliability of the scale.The validity analysis showed that the difference between the high score group and the low score one for each of the 57 items was statistically significant(P<0.01),and the Pearson correlation coefficient between each item and the total score of the scale was greater than 0.4(P<0.001).The cumulative contribution rate of 8 common factors extracted using principal component factor analysis was 55.293%,and the results of rotating component matrix analysis,after applying TCM theory and expert feedback,had a coincidence of up to 87.5%with the initial 8 dimensions,indicating good structural validity of the scale.Conclusion The scale has good reliability and validity,and can diagnose TCM syndromes.It is suitable for long-term simulated weightlessness experiment and provides an objective and quantitative new method for evaluating the subjective feelings of participants.
6.A Real-world Study on Bushen Jiedu Huayu Method in the Treatment of Higher-risk Myelodysplastic Syndromes
Jian LIU ; Rui LI ; Xiupeng YANG ; Hongzhi WANG ; Yonggang XU ; Zhuo CHEN ; Dexiu WANG ; Haiyan XIAO ; Xudong TANG
Chinese Journal of Information on Traditional Chinese Medicine 2024;31(9):145-151
Objective To explore the performance of routine blood test parameters,bone marrow parameters and the risk factors of leukemia conversion in higher-risk patients with myelodysplastic syndrome(MDS)treated with Bushen Jiedu Huayu Method in the real world.Methods The clinical data of 162 patients with higher-risk MDS who were admitted to the Department of Hematology,Xiyuan Hospital,China Academy of Chinese Medical Sciences from September 2017 to September 2022 were collected,and their clinical data,blood routine parameters,and bone marrow parameters were analyzed.Results A total of 162 higher-risk MDS patients were included,and the overall effective rate of the combination of traditional Chinese and Western medicine treatment,mainly using Bushen Jiedu Huayu Method being 48.8%.Patients with higher-risk MDS who were younger than 70 years old were more likely to obtain curative effect when treated with Bushen Jiedu Huayu Method combined with chemotherapy(P<0.05).After treatment with Bushen Jiedu Huayu Method,PLT levels in higher-risk MDS patients were significantly higher than those before treatment(P<0.05),and PLT levels in the ineffective group increased more significantly(P<0.05).After treatment,the HGB level in the effective group significantly increased(P<0.05).After treatment,the proportion of bone marrow granulocytes,megakaryocytes and lymphocytes in higher-risk MDS patients were significantly higher than those before treatment(P<0.05).Conclusion Bushen Jiedu Huayu Method,mainly using arsenic containing TCM compound,can treat higher-risk MDS.It can increase the HGB content and PLT level of patients,increase the proportion of bone marrow granulocytes,megakaryocytes and lymphocytes,and also play a certain role in reducing the proportion of bone marrow primitive cells,namely demethylation.
7.Characteristics of whole blood donors from 26 blood stations before and after the outbreak of COVID-19:a multicenter study
Peng LI ; Youhua SHEN ; Wei GAO ; Wei ZHANG ; Jianling ZHONG ; Hao LI ; Lin BAO ; Ying WANG ; Xuefang FENG ; Tao SUN ; Xiaoqin CHEN ; Li LI ; Hongzhi JIA ; Shouguang XU ; Xiaobo CAI ; Wen ZHANG ; Qunying LAI ; Zhiqiang YU ; Zhenxing WANG ; Yanjun ZHOU ; Peng WANG ; Yanhua ZHANG ; Guoqiang ZHANG ; Haiying NIU ; Hongli JING
Chinese Journal of Blood Transfusion 2023;36(10):907-912
【Objective】 To analyze the basic characteristics of whole blood donors from blood stations before and after the outbreak of COVID-19. 【Methods】 After excluding invalid data, data related to the basic characteristics of whole blood donors collected from 26 blood stations in China during 2018 to 2021 were statistically analyzed, including the trend of total whole blood donors, the number of repeated blood donors, the frequency of blood donation, the average age of donors and the recruitment of first-time blood donors. 【Results】 Affected by the epidemic, 8 out of 14 indicators were with large variations, accounting for 57%. The overall growth rate of total whole blood donors during the epidemic was higher than before the epidemic (P<0.05).The number of repeated blood donors has shown an increased trend, with a higher number during the epidemic than before (P<0.05). The frequency of blood donation was lower during the epidemic than before(P<0.05).Average ages of blood donors and female blood donors fluctuated widely during the epidemic, both higher than those before the epidemic(P<0.05).The donation rate of first-time blood donors <25 years old and ≥25 years old varied widely and irregularly during the epidemic (both P<0.05). The percentage of first-time blood donors fluctuated irregularly during the epidemic, with overall percentage lower than that before the epidemic(P<0.05). 【Conclusion】 Whole blood donors from 26 blood stations increased after the outbreak of COVID-19, and some indicators in certain areas showed significant fluctuations during the epidemic.
8.Bushen Jianpi Prescription Regulates Autophagy in Patients with Aplastic Anemia
Wenru WANG ; Xiaoqing DING ; Xiupeng YANG ; Yonggang XU ; Hongzhi WANG ; Xudong TANG
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(14):80-87
ObjectiveTo explore the effects of Bushen Jianpi prescription on the autophagy and phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) signaling pathway in the patients with aplastic anemia (AA). MethodA total of 30 AA patients admitted to Xiyuan Hospital and 6 healthy donors who were prepared to undergo peripheral blood hematopoietic stem cell transplantation in 304 Hospital from September 2020 to August 2021 were enrolled and assigned into an AA group and a control group. The AA group was treated with Bushen Jianpi prescription combined with cyclosporin A (CsA) and androgen for 3 months. The mononuclear cells from bone marrow in the AA group before and after treatment and the peripheral blood of the control group were collected. Transmission electron microscopy was then employed to detect autophagosomes. Western blotting was employed to determine the protein levels of microtuble-associated protein 1 light chain 3 (LC3)Ⅰ, LC3Ⅱ, mTOR, phosphorylated (p)-mTOR, Akt, p-Akt, PI3K, and p-PI3K, and real-time polymerase chain reaction (PCR) to determine the mRNA levels of LC3, mTOR, Akt, and PI3K. ResultIn the AA group, the treatment was completed in 29 patients, and the total response rate was 51.72% (15/29). ① The AA group showed lower levels of white blood cell (WBC), hemoglobin (HGB), platelet (PLT), and absolute neutrophil count (ANC) in the peripheral blood (P<0.01) and lower number of intracellular autophagosomes than the control group before treatment. Moreover, the AA group showed lower mRNA level of LC3 (P<0.01) and protein levels of LC3Ⅰ and LC3Ⅱ (P<0.01) and higher mRNA levels of mTOR, Akt, and PI3Kα (P<0.01) and protein levels of Akt, p-Akt, PI3K, p-PI3K, mTOR, and p-mTOR (P<0.01) than the control group. ② In AA group, the levels of HGB and PLT elevated (P<0.05) and the number of intracellular autophagosomes increased after treatment compared with those before treatment. Moreover, the mRNA level of LC3 and the protein levels of LC3Ⅰ and LC3Ⅱ were up-regulated (P<0.01), the mRNA levels of mTOR, Akt, and PI3Kα (P<0.01) and the protein levels of Akt, p-PI3K (P<0.01), p-Akt, PI3K, mTOR, p-mTOR (P<0.05) were down-regulated after treatment. ConclusionAA patients show lower autophagy levels, while Bushen Jianpi prescription can effectively improve the autophagy level and down-regulated the expression of PI3K/Akt/mTOR signaling pathway in AA patients.
9.Analysis of clinical characteristics of 362 vaccinated or unvaccinated patients infected by novel coronavirus Omicron variant
Quansheng FENG ; Zhiyong WANG ; Hongzhi YU ; Lixia SHI ; Lei XU
Chinese Critical Care Medicine 2022;34(5):459-464
Objective:To analyze the epidemiological and clinical characteristics of patients infected by novel coronavirus Omicron variant, and also to analyze whether vaccination against novel coronavirus has an impact on the severity and prognosis of Omicron patients.Methods:A prospective, single-center observational study was conducted to collect data of consecutive patients with Omicron variant infection admitted to the designated hospital for coronavirus disease 2019 (COVID-19) charged by Tianjin COVID-19 rescue medical team of Tianjin Third Central Hospital, from January 8 to February 2, 2022. The clinical characteristics of the patients were analyzed, and the influence of whether the patients were inoculated with booster vaccination on the condition and outcome was analyzed. Data were collected including epidemiological, clinical features, laboratory and imaging examination, treatment measures and clinical outcomes, and difference between groups was analyzed.Results:A total of 362 patients were included, including 136 cases (37.57%) in the booster group, 190 cases (52.49%) in the routine vaccination group, and 36 cases (9.94%) in the unvaccinated group. There was a trend of concentrated distribution of patients, of which 171 cases (47.24%) patients showed family clustering, involving 69 families. Seventy-four cases (20.44%) of the 362 patients had one or more underlying diseases, mainly hypertension (64 cases, 17.68%), diabetes mellitus (23 cases, 6.35%), and coronary heart disease (18 cases, 4.97%); 215 patients (59.39%) had one or more discomfort symptoms, mainly cough (158 cases, 43.65%), pharyngeal discomfort (154 cases, 42.54%) and fever (136 cases, 37.57%). The diagnostic typing was mild type in 194 cases (53.59%), moderate type in 165 cases (45.58%) and severe type in 3 cases (0.83%). The patients had elevated immunoglobulin G (IgG) antibody titers to the novel coronavirus on admission [23.17 (3.08, 60.77)]. Patients were medically isolated and the main treatment measures included traditional Chinese medicine identification (Chinese medicine or tonics) in 265 cases (73.20%), prone treatment in 188 cases (51.93%), anticoagulation with low-molecular heparin in 106 cases (29.28%), immunomodulatory therapy with thymofacine in 21 cases (5.80%), antimicrobial drugs in 20 cases (5.52%), transnasal high-flow oxygen therapy in 12 cases (3.31%), glucocorticoids in 5 cases (1.38%), non-invasive mechanical ventilation in 1 case (0.28%), and invasive mechanical ventilation in 1 case (0.28%). A total of 362 patients were discharged with no deaths, of which 12 patients (3.31%) were admitted to the intensive care unit (ICU). The median duration of illness was 13 (10, 15) days, the median length of hospitalization was 13 (11, 15) days, and the median time to nucleic acid conversion was 13 (10, 15) days. Compared with the unvaccinated group, the IgG antibody titers of patients in the booster and routine vaccination groups [41.49 (20.32, 81.38), 19.94 (2.33, 49.25) vs. 0.16 (0.07, 1.94)] and the proportion of mild patients [66.91% (91/136), 48.94% (93/190) vs. 27.28% (10/36)] were higher, which were also higher in the booster vaccination group than in the conventional vaccination group (all P < 0.05). Compared to the conventional and booster vaccination groups, the unvaccinated group had a higher proportion of severe patients [5.56% (2/36) vs. 0.53% (1/190), 0 (1/136)], longer time to nucleic acid conversion [days: 15 (11, 16) vs.12 (10, 15), 13 (11, 15)], and longer disease duration [days: 15 (11, 16) vs. 12 (10, 15), 13 (11, 15)], and a higher percentage of ICU admissions [16.67% (6/36) vs. 2.63% (5/190), 0.74% (1/136)], with statistically significant differences among the three groups (all P < 0.05). Conclusions:Omicron variant is extremely infectious with aggregated onset, but its clinical symptoms are mild. The vaccine, especially the booster vaccination, remains effective in preventing severe-stage progression and improving prognosis in patients with Omicron variant infection.
10.Clinical study of awake prone positioning treatment in patients with common coronavirus disease 2019 caused by Omicron variant
Zhiyong WANG ; Quansheng FENG ; Hongzhi YU ; Lixia SHI ; Lei XU
Chinese Critical Care Medicine 2022;34(6):576-580
Objective:To evaluate the clinical effect of awake prone positioning (APP) for common coronavirus disease 2019 (COVID-19) caused by Omicron variant.Methods:Retrospectively analyze the clinical data of patients with COVID-19 caused by Omicron variant admitted by medical team of Tianjin Third Central Hospital during the period of supporting Tianjin COVID-19 designated hospital from January 8 to February 20, 2022. Patients who met the diagnostic criteria for common COVID-19 and had risk factors for developing severe disease or had pulse oxygen saturation (SpO 2) ≤0.93 after exercise without supplementary oxygen were enrolled. Patients were divided into APP group and control group according to whether they completed the daily 12-hours APP in the first three days after enrollment. Demographic characteristics, clinical symptoms, COVID-19 vaccination status, laboratory examination, disease progression (progression to severe), time to nucleic acid negative conversion, length of hospital stay, and adverse reactions and tolerability [visual analog scale (VAS) score (the higher the score, the worse the tolerability] during APP were evaluated in two groups. Interleukin-6 (IL-6), C-reactive protein (CRP), SpO 2/inhaled oxygen concentration (FiO 2) ratio and ROX index (ROXI) were compared between two groups at enrollment, 3rd and 7th day after enrollment. Results:There were no significant differences in demographic characteristics, clinical symptoms, vaccination rates of COVID-19 and laboratory tests between the two groups. There were no statistically significant differences in IL-6, CRP, SpO 2/FiO 2 ratio and ROXI between two groups at the time of enrollment. Compared with the group at the time of enrollment, SpO 2/FiO 2 ratio and ROXI in APP group increased significantly at the 3rd day after enrollment [SpO 2/FiO 2 ratio: 461.90 (457.10, 466.70) vs. 446.67 (437.14, 457.10), ROXI: 25.40 (23.33, 25.93) vs. 22.57 (21.86, 24.40), all P < 0.05], and the levels of IL-6 and CRP in control group were significantly increased [IL-6 (ng/L): 18.30 (6.50, 37.75) vs. 7.40 (5.10, 11.15), CRP (mg/L): 11.46 (2.11, 17.96) vs. 4.11 (1.72, 9.05), all P < 0.05]. At the 3rd day of enrollment, the levels of IL-6 and CRP in APP group were significantly lower than those in control group [IL-6 (ng/L): 7.35 (4.35, 12.80) vs. 18.30 (6.50, 37.75), CRP (mg/L): 4.52 (1.98, 9.66) vs. 11.46 (2.11, 17.96), all P < 0.05], while SpO 2/FiO 2 ratio and ROXI were significantly higher than those in control group [SpO 2/FiO 2 ratio: 461.90 (457.10, 466.70) vs. 446.67 (441.90, 459.52), ROXI: 25.40 (23.33, 25.93) vs. 23.31 (22.10, 24.66), all P < 0.05]. At the 7th day of enrollment,there were no significant differences in IL-6, CRP, SpO 2/FiO 2 ratio and ROXI between two groups. There were no severe cases in both groups. The time of nucleic acid negative conversion and length of hospital stay in APP group were significantly shorter than those in control group [10.0 (8.0, 12.0) days vs. 11.0 (9.0, 13.0) days, 12.0 (10.0, 14.0) days vs. 14.0 (12.0, 16.0) days, respectively, all P < 0.05]. The main adverse reaction during APP was back pain, and the incidence in APP group was slightly lower than that in control group, but the difference was not statistically significant [17.9% (17/95) vs. 26.5% (27/102), P = 0.149]. VAS score in control group was significantly higher than that in APP group [score: 2.5 (2.0, 4.0) vs. 2.0 (1.0, 3.0), P = 0.004]. Conclusions:In common COVID-19 patients caused by Omicron variant with high risk factors for progression to severe disease or decreased oxygen reserve capacity, early APP can shorten the time of nucleic acid negative conversion and the length of hospital stay, but its effect on preventing disease progression cannot be determined.

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