Objective To investigate the therapeutic effects and mechanisms of Yishen Shengyang formula in allergic rhinitis(AR)by regulating the transcription factor BTB and CNC homology 2(Bach2)to promote regulatory T cell(Treg cell)differentiation.Methods AR mouse models were established via ovalbumin(OVA)sensitization and randomly divided into control group,AR model group(AR group),Yishen Shengyang formula group and dexamethasone group.Nasal symptoms were evaluated using behavioral scores;Histopathological changes in nasal mucosa were observed via hematoxylin-eosin and periodic acid Schiff stain;Serum levels of OVA-specific immunoglobulin E(sIgE),interleukin-4(IL-4),and transforming growth factor-β(TGF-β)were measured by enzyme linked immunosorbent assay;Splenic Treg proportions were analyzed via flow cytometry;Bach2 protein expression was assessed by Western blot.Results Compared with control group,AR group mice showed significantly increased behavioral scores(P<0.05),goblet cell hyperplasia,inflammatory infiltration,elevated OVA-sIgE and IL-4 levels(P<0.05),reduced TGF-β(P<0.05),and decreased splenic Treg proportions and Bach2 expression(P<0.05).Yishen Shengyang formula treatment alleviated nasal symptoms(P<0.05),mitigated mucosal damage,decreased OVA-sIgE and IL-4,increased TGF-β(P<0.05),and upregulated Treg proportions and Bach2 expression(P<0.05),with efficacy comparable to dexamethasone.Conclusion Yishen Shengyang formula demonstrates potential therapeutic effects on allergic rhinitis by upregulating Bach2 expression and promoting Treg cell differentiation.This study provides a novel strategy and experimental basis for the traditional Chinese medicine treatment of AR.

Objective To investigate the therapeutic effects and mechanisms of Yishen Shengyang formula in allergic rhinitis(AR)by regulating the transcription factor BTB and CNC homology 2(Bach2)to promote regulatory T cell(Treg cell)differentiation.Methods AR mouse models were established via ovalbumin(OVA)sensitization and randomly divided into control group,AR model group(AR group),Yishen Shengyang formula group and dexamethasone group.Nasal symptoms were evaluated using behavioral scores;Histopathological changes in nasal mucosa were observed via hematoxylin-eosin and periodic acid Schiff stain;Serum levels of OVA-specific immunoglobulin E(sIgE),interleukin-4(IL-4),and transforming growth factor-β(TGF-β)were measured by enzyme linked immunosorbent assay;Splenic Treg proportions were analyzed via flow cytometry;Bach2 protein expression was assessed by Western blot.Results Compared with control group,AR group mice showed significantly increased behavioral scores(P<0.05),goblet cell hyperplasia,inflammatory infiltration,elevated OVA-sIgE and IL-4 levels(P<0.05),reduced TGF-β(P<0.05),and decreased splenic Treg proportions and Bach2 expression(P<0.05).Yishen Shengyang formula treatment alleviated nasal symptoms(P<0.05),mitigated mucosal damage,decreased OVA-sIgE and IL-4,increased TGF-β(P<0.05),and upregulated Treg proportions and Bach2 expression(P<0.05),with efficacy comparable to dexamethasone.Conclusion Yishen Shengyang formula demonstrates potential therapeutic effects on allergic rhinitis by upregulating Bach2 expression and promoting Treg cell differentiation.This study provides a novel strategy and experimental basis for the traditional Chinese medicine treatment of AR.

Objective:To evaluate the efficacy of dupilumab in the treatment of moderate to severe atopic dermatitis (AD) in children, and to analyze its influencing factors.Methods:A retrospective analysis was carried out on the demographic and clinical data collected from children with moderate to severe AD, who were treated with dupilumab in the Department of Dermatology, Xiangya Hospital, Central South University from October 2020 to October 2022. The initial dose (200 - 600 mg) of dupilumab was administered based on children's age and weight, followed by 200 - 300 mg every 2 - 3 weeks. The curative efficacy and quality of life were evaluated using the Investigator's Global Assessment (IGA), Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Peak Pruritus Numerical Rating Scale (PP-NRS), Patient-Oriented Eczema Measure (POEM), and the Children's Dermatology Life Quality Index (CDLQI) /Infants' Dermatitis Quality of Life Index (IDQoL) before treatment, and at weeks 4, 12, and 16 after treatment. Adverse events during the treatment period were also recorded. The main outcome indicators were the proportion of patients achieving IGA0/1 and EASI75 (≥ 75% improvement from baseline in EASI score) at week 16. Changes in the clinical scores and laboratory parameters at different time points after the treatment with dupilumab were analyzed using generalized estimating equations, and a logistic regression model was used to identify the influencing factors for EASI75 response at week 16.Results:A total of 136 children aged 2 - 11 years met the diagnosis of moderate to severe AD and received at least one dose of dupilumab, among whom 123 children met the inclusion criteria for this analysis. IGA, EASI, SCORAD, POEM, CDLQI/IDQoL, and PP-NRS scores were significantly improved at weeks 4, 12, and 16 after dupilumab therapy compared with baseline scores (all P < 0.01). At week 16, the proportions of patients achieving IGA0/1, EASI50, EASI75, EASI90, CDLQI/IDQoL improvement ≥ 4 points, and PP-NRS improvement ≥ 4 points were 44.6% (33/74), 86.5% (64/74), 70.3% (52/74), 48.7% (36/74), 56.8% (42/74), and 77.0% (57/74), respectively; the eosinophil counts significantly decreased compared with the baseline level ( P = 0.001). The total IgE levels at different time points after treatment did not differ from the baseline level ( P > 0.01). At week 16, the related factors for the response to dupilumab were relatively low ages (compared with the children aged 6 - 11 years, those aged 2 - 5 years showed lower EASI75 response rates: OR = 0.148, 95% CI: 0.027 - 0.823, P = 0.029) and having a family history of urticaria ( OR = 0.033, 95% CI: 0.002 - 0.601, P = 0.021), while gender, AD duration, subtypes and main clinical phenotypes of AD, allergic history, family history of atopic diseases, presence of serum allergen-specific IgE antibodies, serum total IgE levels, or eosinophil counts did not affect the efficacy of dupilumab (all P > 0.05). During the 16-week treatment, 3 children discontinued the dupilumab treatment due to disease exacerbation, and 1 child developed conjunctivitis. Conclusions:Dupilumab could effectively improve the symptoms and signs of children with moderate to severe AD whose condition was poorly controlled by conventional treatments, with a low incidence rate of adverse reactions. Relatively low ages and having a family history of urticaria may be negative factors influencing the efficacy of dupilumab in children with moderate to severe AD at week 16.

This study searched the clinical researches on traditional Chinese medicine （TCM） for cardiovascular diseases registered in Chinese Clinical Trial Registry and the US Clinical Trial Registry， the cardiovascular disease-related studies funded by the National Natural Science Foundation of China， as well as those published in China National Knowledge Infrastructure （CNKI）， Wanfang database， VIP.com， China Biology Medicine disc （CBMdisc）， Embase， Medline， Cochrane Library， and other databases published cardiovascular disease-related studies from 1 January 2021 to 30 June 2023. In order to analyse and evaluate the research progress of TCM treatment for coronary heart disease， hypertension， heart failure， and arrhythmia， this study aimed at recent research hotspots and research direction. It is found that the research on TCM for cardiovascular diseases was gradually deepening and the high-quality evidence continued to emerge. It is believed that studies related to the prevention and treatment of common cardiovascular diseases by TCM reflected the multi-angle integration of modern technology and pattern differentiation and treatment， closer integration of clinical and basic research， and further optimisation of pattern identification and interventions. On this basis， the research programme and implementation process should be further standardized， and the translation of research results should be emphasized to promote the standardized application and promotion of TCM diagnosis and treatment of cardiovascular diseases.

Objective:To evaluate the efficacy of dupilumab in the treatment of moderate to severe atopic dermatitis (AD) in children, and to analyze its influencing factors.Methods:A retrospective analysis was carried out on the demographic and clinical data collected from children with moderate to severe AD, who were treated with dupilumab in the Department of Dermatology, Xiangya Hospital, Central South University from October 2020 to October 2022. The initial dose (200 - 600 mg) of dupilumab was administered based on children's age and weight, followed by 200 - 300 mg every 2 - 3 weeks. The curative efficacy and quality of life were evaluated using the Investigator's Global Assessment (IGA), Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Peak Pruritus Numerical Rating Scale (PP-NRS), Patient-Oriented Eczema Measure (POEM), and the Children's Dermatology Life Quality Index (CDLQI) /Infants' Dermatitis Quality of Life Index (IDQoL) before treatment, and at weeks 4, 12, and 16 after treatment. Adverse events during the treatment period were also recorded. The main outcome indicators were the proportion of patients achieving IGA0/1 and EASI75 (≥ 75% improvement from baseline in EASI score) at week 16. Changes in the clinical scores and laboratory parameters at different time points after the treatment with dupilumab were analyzed using generalized estimating equations, and a logistic regression model was used to identify the influencing factors for EASI75 response at week 16.Results:A total of 136 children aged 2 - 11 years met the diagnosis of moderate to severe AD and received at least one dose of dupilumab, among whom 123 children met the inclusion criteria for this analysis. IGA, EASI, SCORAD, POEM, CDLQI/IDQoL, and PP-NRS scores were significantly improved at weeks 4, 12, and 16 after dupilumab therapy compared with baseline scores (all P < 0.01). At week 16, the proportions of patients achieving IGA0/1, EASI50, EASI75, EASI90, CDLQI/IDQoL improvement ≥ 4 points, and PP-NRS improvement ≥ 4 points were 44.6% (33/74), 86.5% (64/74), 70.3% (52/74), 48.7% (36/74), 56.8% (42/74), and 77.0% (57/74), respectively; the eosinophil counts significantly decreased compared with the baseline level ( P = 0.001). The total IgE levels at different time points after treatment did not differ from the baseline level ( P > 0.01). At week 16, the related factors for the response to dupilumab were relatively low ages (compared with the children aged 6 - 11 years, those aged 2 - 5 years showed lower EASI75 response rates: OR = 0.148, 95% CI: 0.027 - 0.823, P = 0.029) and having a family history of urticaria ( OR = 0.033, 95% CI: 0.002 - 0.601, P = 0.021), while gender, AD duration, subtypes and main clinical phenotypes of AD, allergic history, family history of atopic diseases, presence of serum allergen-specific IgE antibodies, serum total IgE levels, or eosinophil counts did not affect the efficacy of dupilumab (all P > 0.05). During the 16-week treatment, 3 children discontinued the dupilumab treatment due to disease exacerbation, and 1 child developed conjunctivitis. Conclusions:Dupilumab could effectively improve the symptoms and signs of children with moderate to severe AD whose condition was poorly controlled by conventional treatments, with a low incidence rate of adverse reactions. Relatively low ages and having a family history of urticaria may be negative factors influencing the efficacy of dupilumab in children with moderate to severe AD at week 16.

Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.

Objective:To evaluate the clinical efficacy of endoscopy for early cancer of duodenal papilla.Methods:A retrospective analysis was performed on data collected from 23 consecutive patients with early cancer of duodenal papilla, who underwent endoscopic treatment from January 2015 to January 2021 in Beijing Friendship Hospital. Baseline data, endoscopic and pathological data, occurrence and outcome of complications were studied.Results:Twenty-three patients successfully received endoscopic treatment. The maximal diameter of lesions evaluated under endoscopy was 1.90±0.83 cm. Among the 23 cases, 20 underwent endoscopic mucosal resection and 3 underwent endoscopic piecemeal mucosal resection. Delayed bleeding occurred in 5 cases (21.7%), 3 patients (13.0%) developed postoperative hyperamylasemia, 6 patients (26.1%) developed mild acute pancreatitis, and 1 patient (4.3%) had pancreatic duct stent displacement after the operation, which improved after medical or endoscopic treatment. No perforation occurred during the perioperative period. In terms of final pathology, the en bloc resection rate was 82.6% (19/23), and the complete resection rate was 78.3% (18/23). Preoperative endoscopic ultrasonography showed that 19 lesions were confined to the mucosal layer, which were all demonstrated by postoperative pathology. Four other cases were suspected to be involved in the submucosa or the end of the pancreaticobiliary duct under endoscopic ultrasonography, two of which were confined to the mucosal layer, and the other 2 cases involved the submucosal layer, so additional surgery was performed. A total of 18 patients were followed up, among whom 14 achieved complete resection of postoperative pathology, and 2 patients (14.3%, 2/14) were found to have recurrence at 12 and 51 months respectively after the treatment and did not relapse after surgical treatment and endoscopic treatment respectively. Among 4 other patients of follow-up whose pathology did not achieve complete resection, 1 had no recurrence, and the other 3 received additional surgical treatment without recurrence.Conclusion:Endoscopic treatment for early cancer of duodenal papilla is safe and effective. It is necessary to improve preoperative evaluation, stay alert to perioperative complications, and pay attention to regular postoperative endoscopic follow-up.

Objective:To evaluate the clinical efficacy of endoscopic treatment for early nonampullary duodenal cancer.Methods:Data of patients with early nonampullary duodenal cancer, who underwent endoscopic treatment from January 2015 to January 2021 at Beijing Friendship Hospital were retrospectively analyzed. Baseline data, endoscopic treatment methods, wound closure, pathology, the occurrence and outcome of complications of patients were studied.Results:A total of 47 patients who successfully went through endoscopic treatment were enrolled. Seventeen cases received endoscopic mucosal resection (EMR), 5 cases received endoscopic submucosal dissection (ESD), and 7 cases received ESD+EMR (hybrid ESD). Six cases were converted to hybrid ESD due to difficulty in ESD. Four cases received full-thickness resection with over-the-scope clip system (OTSC), and 8 cases received endoscopic piecemeal mucosal resection (EPMR). Among the 47 cases of early cancer, the en bloc resection rate was 83.0% (39/47), and the complete resection rate was 85.1% (40/47). Four patients (8.5%) had perforation which occurred at the duodenal descending part during the perioperative period, among whom, 2 patients (4.3%) recovered after endoscopic treatment, 2 others (4.3%) recovered after surgical intervention. There were no complications such as postoperative bleeding or infection during the perioperative period.Conclusion:Endoscopic treatment for early nonampullary duodenal cancer is safe and effective. A specific treatment plan can be selected according to the location, size and specific conditions of the lesion. For the operation of the descending part, it is necessary to be more vigilant to against the occurrence of perforation complications.

Objective:To analyze the adverse reactions of patients with multidrug-resistant pulmonary tuberculosis treated with linezolid, and to provide reference for clinical rational use of drugs.Methods:A total of 189 patients with multidrug-resistant pulmonary tuberculosis who were admitted to Hunan Chest Hospital between June 2019 and June 2020 were retrospectively included, and were divided into the linezolid group and the control group. The control group was given a standardized anti-tuberculosis treatment without linezolid, and the linezolid group was given linezolid in addition to standardized regimens. The occurrences of hematological toxicity, peripheral neuritis, optic neuritis and other adverse reactions in the two groups after anti-tuberculosis treatment were recorded. The risk factors for adverse reactions of linezolid were analyzed. Statistical analysis was performed using independent samples t test and chi-square test, and logistic regression was used to analyze the risk factors for adverse reactions of linezolid. Results:A total of 189 patients with MDR-TB were included in this study, including 108 in the linezolid group and 81 in the control group. There were no significant differences in baseline characteristics between the linezolid and control groups. The frequencies of leukopenia, anemia, thrombocytopenia, peripheral neuritis and optic neuritis in the linezolid group were 20.4%(22/108), 47.2%(51/108), 21.3%(23/108), 20.4%(22/108) and 13.9%(15/108), respectively, which were all significantly higher than those in the control group (8.6%(7/81), 27.2%(22/81), 9.9%(8/81), 1.2%(1/81) and 4.9%(4/81), respectively), and the differences were all statistically significant ( χ2=4.90, 7.86, 4.40, 15.86 and 4.10, respectively, all P<0.050). Patients older than 45 years of age was independent risk factor for leukopenia (odds ratio ( OR)=3.08, 95% confidence interval ( CI) 1.03 to 9.25, P<0.050) and thrombocytopenia ( OR=2.41, 95% CI 1.09 to 5.35, P<0.050) after linezolid administration. The higher value of white blood cell at baseline ( OR=0.48, 95% CI 0.30 to 0.76, P=0.002) was an independent protective factor for leukopenia associated with linezolid. Conclusions:Pancytopenia, peripheral neuritis and optic neuritis are prone to appear when linezolid is used to treat patients with multidrug-resistant pulmonary tuberculosis. In clinical practice, closely monitoring the adverse reactions during the use of linezolid for anti-tuberculosis treatment is needed.

The aim of this study was to investigate the preventive effect of pancreatic duct stent on acute pancreatitis after endoscopic retrograde cholangiopancreatography. A retrospective analysis of the case data of patients who first underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis in the Beijing Friendship Hospital from January 2015 to December 2019 for 5 years. According to whether the pancreatic duct stent was indwelled during the operation, they were divided into pancreatic duct stent group (147 cases) and non-indwelling pancreatic duct stent group (192 cases). The incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography was compared between the two groups according to COTTON criteria. Independent sample t test, Pearson Chi-square test (χ 2) and Fisher′s exact test were used to compare groups′ differences. There were 2 cases of acute pancreatitis in the pancreatic duct stent group, all of which improved after 48 hours. There were 22 cases of acute pancreatitis in the non-indwelling pancreatic duct stent group, of which 20 cases improved within 48 hours, and the other 2 cases had severe pancreatitis, which improved and discharged after 30 days of treatment. There was significant difference in the incidence of acute pancreatitis between the pancreatic duct stenting group (1.4%) and the group without placement of pancreatic duct stents (11.5%) (χ2=12.905, P<0.001). In conclusion, Pancreatic duct stent may be an effective method to prevent PEP.