Objective To provide basis for the formation of acute exacerbation of chronic obstructive pulmonary disease(AECOPD-STES),the item weight of the syndrome therapeutic evaluation scale for AECOPD-STES was determined.Methods Based on the clinical survey data of 387 AECOPD patients,the random forest method was adopted,and the Spyder integrated development environment.Anaconda navigator software was used to call the"random forest Classifier"in the sklearn package to establish the initial random forest model and calculate the item weights.Factor analysis was used to extract common factors with cumulative variance contribution>80%,and the item weight was calculated according to the cumulative variance contribution and component score coefficient of common factors.The percentage weight method was used to calculate the item weight based on the importance score of each item by 29 experts.Finally,40%,30%and 30%of the above three methods were given respectively to determine the final weight of the items.Results The random forest method showed that the weights of wind cold syndrome,cold Yin syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.014-0.170,0.076-0.194,0.017-0.183,0.010-0.183 and 0.069-0.298,respectively.Factor analysis showed that the weights of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.030-0.111,0.100-0.182,0.037-0.095,0.022-0.141 and 0.054-0.185,respectively.The percentage weight method shows that the weight ranges of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.072-0.102,0.146-0.182,0.057-0.077,0.075-0.111 and 0.115-0.185,respectively.According to the three methods,the weights of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.050-0.121,0.117-0.174,0.040-0.117,0.056-0.130 and 0.092-0.188,respectively.Conclusion This study determined the weight of each item of AECOPD-STES,providing a basis for the calculation of syndrome score.

IgA nephropathy (IgAN) is a glomerulonephritis characterized by diffuse deposition of immune complexes mainly composed of IgA in the mesangial area of the glomerulus. However, some patients show monotypic IgA deposits in the immunofluorescence examination, and its clinicopathological significance is not yet clear. The renal pathological changes of IgAN with monotypic IgA deposition are similar to those of proliferative glomerulonephritis with monoclonal IgA deposit (IgA-PGNMID), which has a risk of progressing to hematological malignancies and a worse clinical prognosis. It is necessary to differentiate them based on clinical pathological manifestations and hematological examinations. Based on previous literature reports and the research results of our research group, this review summarizes and analyzes the mechanism, clinical and pathological characteristics, and prognosis of IgAN with monotypic IgA deposition, and the relationship between IgAN with monotypic IgA deposition and IgA-PGNMID, to improve clinical doctors' understanding of IgAN with monotypic IgA deposition, reduce missed diagnosis and misdiagnosis, and improve patients' prognosis.

Objective To provide basis for the formation of acute exacerbation of chronic obstructive pulmonary disease(AECOPD-STES),the item weight of the syndrome therapeutic evaluation scale for AECOPD-STES was determined.Methods Based on the clinical survey data of 387 AECOPD patients,the random forest method was adopted,and the Spyder integrated development environment.Anaconda navigator software was used to call the"random forest Classifier"in the sklearn package to establish the initial random forest model and calculate the item weights.Factor analysis was used to extract common factors with cumulative variance contribution>80%,and the item weight was calculated according to the cumulative variance contribution and component score coefficient of common factors.The percentage weight method was used to calculate the item weight based on the importance score of each item by 29 experts.Finally,40%,30%and 30%of the above three methods were given respectively to determine the final weight of the items.Results The random forest method showed that the weights of wind cold syndrome,cold Yin syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.014-0.170,0.076-0.194,0.017-0.183,0.010-0.183 and 0.069-0.298,respectively.Factor analysis showed that the weights of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.030-0.111,0.100-0.182,0.037-0.095,0.022-0.141 and 0.054-0.185,respectively.The percentage weight method shows that the weight ranges of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.072-0.102,0.146-0.182,0.057-0.077,0.075-0.111 and 0.115-0.185,respectively.According to the three methods,the weights of wind cold syndrome,cold yin Syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome were 0.050-0.121,0.117-0.174,0.040-0.117,0.056-0.130 and 0.092-0.188,respectively.Conclusion This study determined the weight of each item of AECOPD-STES,providing a basis for the calculation of syndrome score.

IgA nephropathy (IgAN) is a glomerulonephritis characterized by diffuse deposition of immune complexes mainly composed of IgA in the mesangial area of the glomerulus. However, some patients show monotypic IgA deposits in the immunofluorescence examination, and its clinicopathological significance is not yet clear. The renal pathological changes of IgAN with monotypic IgA deposition are similar to those of proliferative glomerulonephritis with monoclonal IgA deposit (IgA-PGNMID), which has a risk of progressing to hematological malignancies and a worse clinical prognosis. It is necessary to differentiate them based on clinical pathological manifestations and hematological examinations. Based on previous literature reports and the research results of our research group, this review summarizes and analyzes the mechanism, clinical and pathological characteristics, and prognosis of IgAN with monotypic IgA deposition, and the relationship between IgAN with monotypic IgA deposition and IgA-PGNMID, to improve clinical doctors' understanding of IgAN with monotypic IgA deposition, reduce missed diagnosis and misdiagnosis, and improve patients' prognosis.

AIM:To establish a mouse model of chronic obstructive pulmonary disease(COPD)induced by cigarette smoke(CS)exposure combined with polyinosinic-polycytidylic acid(Poly I:C)nasal drip,and to investigate the mechanism of airway epithelial barrier injury in COPD.METHODS:(1)Ninety-six male BALB/c mice were randomly divided into control group,CS group,Poly I:C group,and CS+Poly I:C group(n=24).The model was established from week 1 to week 8,with pulmonary function tested every 4 weeks.Six mice from each group were sacrificed at the end of weeks 4,8,16,and 24.Changes in minute volume(MV),enhanced pause(Penh),mean linear intercept(MLI)and bronchial wall thickness(BWT)were observed.The protein levels of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),zonula occludens-1(ZO-1)and E-cadherin(E-Cad)in the lung were detected.(2)Human bronchial epithe-lial BEAS-2B cells were stimulated with CS extract(CSE)combined with Poly I:C for 24 h,and then the protein levels of occludin(Occ),ZO-1,and phosphorylated epidermal growth factor receptor(EGFR),P38 and extracellular signal-regu-lated kinase(ERK)1/2 were analyzed.RESULTS:(1)Compared with control group,at the 8th week,the mice in CS and CS+Poly I:C groups showed typical pathological changes in lung tissues,including significant inflammatory cell infil-tration,alveolar cavity expansion,alveolar wall rupture and fusion,and airway wall thickening.The Penh,BWT,MLI,and lung IL-1β and TNF-α levels were significantly increased(P<0.05 or P<0.01),while MV and lung ZO-1 and E-Cad levels were remarkably decreased(P<0.05 or P<0.01).By the 24th week,these pathological changes remained relative-ly stable in CS+Poly I:C group.(2)Compared with control group,CSE and its combination with Poly I:C dramatically in-duced a reduction in ZO-1 and Occ protein expression in BEAS-2B cells(P<0.05 or P<0.01),and increased the levels of phosphorylated EGFR,P38 and ERK1/2(P<0.01).The effects in CSE combined with Poly I:C group were considerably superior to those in CSE or Poly I:C group alone.CONCLUSION:Poly I:C can enhance the pathological changes and airway epithelial barrier damage induced by CS in a mouse model of COPD,which may be related to the activation of EGFR/ERK/P38 signaling pathway.

Chronic obstructive pulmonary disease(COPD)poses a serious threat to human health and carries a heavy burden of disease.The disease burden mainly includes traditional epidemiological indicators such as morbidity,disability rate,and mortality rate,as well as economic burden evaluation indicators such as direct economic burden,indirect economic burden,and intangible economic burden,as well as social/health burden evaluation indicators such as potential years of life reduction,disability adjusted life years,and quality adjusted life years.It summarized the existing methods for evaluating the burden of COPD diseases and proposed the following suggestions:(1)enriching economic burden research methods to comprehensively and accurately evaluate direct economic burden;(2)expanding the scope of economic burden research and improve the economic burden research of COPD;(3)strengthening information management and enhance the accuracy of disease burden data;(4)exploring multidimensional indicators and establish a COPD disease burden evaluation system;(5)strengthening relevant research and highlight the health economics advantages of traditional Chinese medicine intervention in COPD.It can provide references for establishing a COPD disease burden evaluation system and policy formulation.

ObjectiveTo analyze the development status and quality of clinical practice guidelines for the treatment of dominant diseases with Chinese patent medicines （CPMs）. MethodsDatabases were searched from Jan. 2019 to Dec.2023 to collect the published clinical practice guidelines of CPMs for the treatment of dominant diseases. The information about the title， the participants， clinical problems， outcomes， evidence grade， recommendations， and recommendation strength in the included clinical practice guidelines were collected， for which the development status was analyzed， and the quality was evaluated with the Scientific， Transparent and Applicable Rankings （STAR） tool for clinical practice guidelines. ResultsTotally， 34 guidelines were included， involving 273 kinds of CPMs. One to ten （with the medium five） clinical problems were proposed from 29 clinical practice guidelines respectively. All the guidelines divided the evidence into four grades according to Grade of Recommendation Assessment， Deve-lopement an Evaluation. And 28 guidelines had five levels of recommendation strength. A total of 344 recommendations were extracted， including 86 strong-recommendations， 191 weak-recommendations （including 36 weak recommendations only based on expert consensus） and 67 recommendations with unclear recommendation strength. All guidelines had high scores in the three areas of “clinical questions （94.20%）”， “evidence （91.45%）” and “recommendations （89.06%）”， while the scores in the three areas of “registry （22.06%）”， “protocol （19.00%）” and “accessibility （31.51%）” were low. The STAR recommended stars of 8 guidelines were 5.0~4.0 stars， while that of 18 guidelines were 3.5~2.5 stars， and 8 guidelines were 2.0~1.0 stars. The three guidelines with the highest recommended stars were depressive disorder， community-acquired pneumonia， and influenza in adult. ConclusionThere is a certain gap in the quality of the published clinical practice guidelines of CPMs， and the quality of the guidelines could be further improved in registry， protocols， funds， and accessibility.

After systematically reviewing the syndrome distribution， evolution， diagnostic criteria， effectiveness evaluation and genomics study on acute exacerbation of chronic obstructive pulmonary disease （AECOPD） in the past decade， we found that there are problems such as inconsistency in the nomenclature of syndrome， lack of quantitative diagnostic tools for syndrome， less developed evaluation tools for syndrome efficacy， and singularity of genomics technique. Based on this， it was proposed that we should pay attention to the standardisation of syndrome naming， strengthen the research on quantitative diagnostic methods， establish standardised and quantitative diagnostic tools， further improve the existing assessment tools of syndrome effectiveness， and integrate the existing genomics techniques to conduct research， so as to support the further research on AECOPD syndromes.

Objective:To explore the diagnostic value of virtual monoenergetic image (VMI) and electron density map (EDM) generated by non-contrast dual-layer spectral detector CT in acute pulmonary embolism(APE).Methods:The clinical and imaging data of 27 patients (41 lesions) who underwent CT pulmonary angiography (CTPA) using dual-layer spectral detector CT and were diagnosed with APE in the Third Affiliated Hospital of Sun Yat-sen University from October 2022 to May 2023 were retrospectively analyzed. All patients received a dual-layer spectral detector CT non-contrast scan. Based on the non-contrast scan data, conventional 120 kVp polyenergetic images (PI), virtual monoenergetic images (40, 70, 100 keV VMI), electron density maps (EDM), and effective atomic number maps (Z eff) were respectively reconstructed. Taking CTPA as the gold standard, the detection rate of APE in different reconstruction images of non-contrast scan were evaluated. The vascular lesion was used as the pulmonary embolism group and the corresponding position of the normal vessel at the same level of the diseased vessel as the control group, and the Wilcoxon rank-sum test was used to compare the differences of CT values on PI and 40, 70, and 100 keV VMI (CT PI, CT 40 keV, CT 70 keV, CT 100 keV) as well as the ED values on the EDM, and the Z eff value on the Z eff images between the 2 groups. Parameters with statistically significant differences were included in a multifactor logistic regression, resulting in the construction of a logistic regression model. Receiver operator characteristic curve and area under curve (AUC) were applied to evaluate the diagnostic efficiency of different spectral quantitative parameters and logistic regression model in identifying pulmonary embolism group from normal control group. Results:The detection rates of APE on PI, EDM, Z eff map, and EDM and Z eff map fusion images were 14.6% (6/41), 82.9% (34/41), 51.2% (21/41), and 97.6% (40/41), respectively. CT PI, ED, CT 40 keV, CT 70 keV and CT 100 keV in pulmonary embolism group were statistically higher than those in control group ( Z values were 1 009.00, 1 024.50, 1 038.00, 1 079.00 and 1 076.00, respectively, P<0.05). Finally, CT PI, CT 40 keV, and CT 100 keV were selected to construct the logistic regression model. The AUC, sensitivity, specificity, and accuracy of the logistic regression model for distinguishing the embolism group from the control group were 0.771, 0.769, 0.744, and 0.756, respectively. Conclusion:Non-contrast images of dual-layer spectral detector CT VMI and EDM have some clinical value in detecting and diagnosing APE.