Objective This study investigated whether gut microbiota and its metabolites are altered in myasthenia gravis(MG)patients.Methods We collected fresh stool specimens from MG patients and healthy controls.16S rRNA gene sequencing and gas chromatography-mass spectrometry were used to measure abundance of gut microbiota and metabolite levels in two groups,respectively.Clinical data of the subjects were also collected including quantitative MG score(QMGS),MG-activities of daily living(MG-ADL),MG-specific quality-of-life 15(MG-QOL15),manual muscle testing(MMT),and the acetylcholine receptor antibody(AchR-Ab)titers.The correlation between the differential microbiota and the clinical characteristics was investigated.Results A total of 50 MG patients and 15 healthy controls were recruited.Simpson's index was significantly higher in the MG group(0.936±0.041)than in the control group(0.888±0.123).Alpha diversity was significantly decreased in the MG group(t=2.349,P=0.022).There was a significant difference in microbial phenotype between the two groups(R=0.966,P=0.001,Adonis).The results of LEfSe showed that the abundance of Esherichia-Shigella,Succinivibrio,Fusobacterium,and Ruminococcus-gnavus-group were up-regulated while the abundance of Lachnospira,Roseburia,Desulfovibrio,and Coprococcus were down-regulated.The results showed that the metabolites of the MG group were significantly different from those of the control group.There were 28 metabolites up-regulated and 71 metabolites down-regulated in the MG patient group.Kyoto Encyclopedia of Genes and Genomes analyses demonstrated that the majority of metabolic pathways in which differential metabolites were involved were related to amino acid metabolism and nucleotide metabolism.61.2% (30/49)of bacterial amplicon sequence variant(ASV)were significantly associated with multiple metabolites(P<0.001).The relative abundance of Lachnospiraceae in the group with MG was negatively correlated with the QMGS(r=-0.496,P<0.001),MG-ADL(r=-0.542,P<0.001),MG-QOL15(r=-0.464,P=0.007),and the AchR-Ab(r=-0.315,P=0.026).The relative abundance of Lachnospiraceae in the group with MG was positively correlated with the MMT(r=0.374,P=0.008).Conclusion The intestinal flora of MG patients is down-regulated in the abundance of beneficial bacteria and up-regulated in the abundances of harmful bacteria.Disturbance of metabolites are also present in MG patients.Regulating gut microbiota in MG patients may be a new target for treating the disease.

Chronic cough is a common condition that imposes significant physical, psychological, and social burdens on patients. Although chronic cough is often associated with underlying conditions such as asthma, gastroesophageal reflux disease, and eosinophilic bronchitis, some patients experience uncontrollable coughing that is difficult to attribute to a specific cause. Many of these patients exhibit clinical features of cough hypersensitivity syndrome, providing new directions for research into the treatment of chronic cough. As the pathophysiological mechanisms of chronic cough are further elucidated, treatment approaches for chronic cough are entering a new stage of development. This article summarizes and discusses the mechanisms and clinical evidence of central neuromodulators used in the treatment of chronic cough, suggesting promising clinical applications for these drugs in the future.

Objective To analyze the correlation between inflammation,nutritional indicators and hy-poproteinemia in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Meth-ods The clinical data of patients with AECOPD admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2020 to September 2022 were ret-rospectively analyzed,and the patients were divided into the hypoproteinemia group(n=73)and the non-hy-poproteinemia group(n=141)according to whether the serum albumin(ALB)was lower than 35 g/L.The clinical data,inflammatory indicators and nutritional indicators of the two groups were compared,Spearman correlation analysis was performed,and binary logistic regression analysis was performed to analyze the influ-encing factors of patients with AECOPD complicated with hypoproteinemia.Results There were statistically significant differences in age,length of hospital stay,and body weight between the two groups(P＜0.05).There were no significant differences in gender,number of hospitalizations in the past 1 year,height,diabetes,hypertension and proportion of coronary heart disease(P＞0.05).Compared with the non-hypoproteinemia group,the hypoproteinemia group had longer hospital stays and higher levels of C-reactive protein,neutrophil/albumin ratio(NAR),neutrophil to lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),and systemic immunoinflammatory index(SII).The prognostic nutritional index(PNI),body mass index(BMI),hemoglo-bin and total protein levels were lower,and the difference was statistically significant(P＜0.05).Body weight,BMI,hemoglobin,total protein,PNI and AECOPD patients with hypoproteinemia were negatively cor-related(P＜0.05),while age,length of hospital stay,C-reactive protein,NAR,NLR,PLR,SII and AECOPD patients with hypoproteinemia were positively correlated(P＜0.05).Binary logistic regression analysis showed that PNI,SII and NLR were the influencing factors of hypoproteinemia in AECOPD patients.Conclusion In clinical practice,attention should be paid to and timely correction of hypoproteinemia in pa-tients with AECOPD,improvement of inflammatory indicators and nutritional status of patients,and preven-tion of acute exacerbation.

Chronic cough is a common condition that imposes significant physical,psychological,and social burdens on patients.Although chronic cough is often associated with underlying condi-tions such as asthma,gastroesophageal reflux dis-ease,and eosinophilic bronchitis,some patients ex-perience uncontrollable coughing that is difficult to attribute to a specific cause.Many of these pa-tients exhibit clinical features of cough hypersensi-tivity syndrome,providing new directions for re-search into the treatment of chronic cough.As the pathophysiological mechanisms of chronic cough are further elucidated,treatment approaches for chronic cough are entering a new stage of develop-ment.This article summarizes and discusses the mechanisms and clinical evidence of central neuro-modulators used in the treatment of chronic cough,suggesting promising clinical applications for these drugs in the future.

Chronic cough is a common condition that imposes significant physical,psychological,and social burdens on patients.Although chronic cough is often associated with underlying condi-tions such as asthma,gastroesophageal reflux dis-ease,and eosinophilic bronchitis,some patients ex-perience uncontrollable coughing that is difficult to attribute to a specific cause.Many of these pa-tients exhibit clinical features of cough hypersensi-tivity syndrome,providing new directions for re-search into the treatment of chronic cough.As the pathophysiological mechanisms of chronic cough are further elucidated,treatment approaches for chronic cough are entering a new stage of develop-ment.This article summarizes and discusses the mechanisms and clinical evidence of central neuro-modulators used in the treatment of chronic cough,suggesting promising clinical applications for these drugs in the future.

Chronic cough is a common condition that imposes significant physical,psychological,and social burdens on patients.Although chronic cough is often associated with underlying condi-tions such as asthma,gastroesophageal reflux dis-ease,and eosinophilic bronchitis,some patients ex-perience uncontrollable coughing that is difficult to attribute to a specific cause.Many of these pa-tients exhibit clinical features of cough hypersensi-tivity syndrome,providing new directions for re-search into the treatment of chronic cough.As the pathophysiological mechanisms of chronic cough are further elucidated,treatment approaches for chronic cough are entering a new stage of develop-ment.This article summarizes and discusses the mechanisms and clinical evidence of central neuro-modulators used in the treatment of chronic cough,suggesting promising clinical applications for these drugs in the future.

Chronic cough is a common condition that imposes significant physical,psychological,and social burdens on patients.Although chronic cough is often associated with underlying condi-tions such as asthma,gastroesophageal reflux dis-ease,and eosinophilic bronchitis,some patients ex-perience uncontrollable coughing that is difficult to attribute to a specific cause.Many of these pa-tients exhibit clinical features of cough hypersensi-tivity syndrome,providing new directions for re-search into the treatment of chronic cough.As the pathophysiological mechanisms of chronic cough are further elucidated,treatment approaches for chronic cough are entering a new stage of develop-ment.This article summarizes and discusses the mechanisms and clinical evidence of central neuro-modulators used in the treatment of chronic cough,suggesting promising clinical applications for these drugs in the future.

Chronic cough is a common condition that imposes significant physical,psychological,and social burdens on patients.Although chronic cough is often associated with underlying condi-tions such as asthma,gastroesophageal reflux dis-ease,and eosinophilic bronchitis,some patients ex-perience uncontrollable coughing that is difficult to attribute to a specific cause.Many of these pa-tients exhibit clinical features of cough hypersensi-tivity syndrome,providing new directions for re-search into the treatment of chronic cough.As the pathophysiological mechanisms of chronic cough are further elucidated,treatment approaches for chronic cough are entering a new stage of develop-ment.This article summarizes and discusses the mechanisms and clinical evidence of central neuro-modulators used in the treatment of chronic cough,suggesting promising clinical applications for these drugs in the future.

Chronic cough is a common condition that imposes significant physical,psychological,and social burdens on patients.Although chronic cough is often associated with underlying condi-tions such as asthma,gastroesophageal reflux dis-ease,and eosinophilic bronchitis,some patients ex-perience uncontrollable coughing that is difficult to attribute to a specific cause.Many of these pa-tients exhibit clinical features of cough hypersensi-tivity syndrome,providing new directions for re-search into the treatment of chronic cough.As the pathophysiological mechanisms of chronic cough are further elucidated,treatment approaches for chronic cough are entering a new stage of develop-ment.This article summarizes and discusses the mechanisms and clinical evidence of central neuro-modulators used in the treatment of chronic cough,suggesting promising clinical applications for these drugs in the future.

Chronic cough is a common condition that imposes significant physical,psychological,and social burdens on patients.Although chronic cough is often associated with underlying condi-tions such as asthma,gastroesophageal reflux dis-ease,and eosinophilic bronchitis,some patients ex-perience uncontrollable coughing that is difficult to attribute to a specific cause.Many of these pa-tients exhibit clinical features of cough hypersensi-tivity syndrome,providing new directions for re-search into the treatment of chronic cough.As the pathophysiological mechanisms of chronic cough are further elucidated,treatment approaches for chronic cough are entering a new stage of develop-ment.This article summarizes and discusses the mechanisms and clinical evidence of central neuro-modulators used in the treatment of chronic cough,suggesting promising clinical applications for these drugs in the future.