Following the principles of evidence-based medicine,in accordance with the structure and drafting rules of standardized documents,based on literature research,according to the characteristics of chronic cough in children and issues that need to form a consensus,the TCM Guidelines for Diagnosis and Treatment of Chronic Cough in Children was formulated based on the Delphi method,expert discussion meetings,and public solicitation of opinions.The guideline includes scope of application,terms and definitions,eti-ology and diagnosis,auxiliary examination,treatment,prevention and care.The aim is to clarify the optimal treatment plan of Chinese medicine in the diagnosis and treatment of this disease,and to provide guidance for improving the clinical diagnosis and treatment of chronic cough in children with Chinese medicine.

Objective:To explore the application effect of transitional care based on Siebens domain management model in patients with atrial fibrillation.Methods:Using the convenient sampling method, a total of 150 atrial fibrillation patients who were admitted to Nanyang Central Hospital from October 2021 to December 2022 were selected as the research objects. Patients were divided into the study group and the control group using the random number table method, with 75 cases in each group. The control group received routine transitional care, while the study group received transitional care based on the Siebens domain management model. The intervention effect was evaluated using Morisky Medication Adherence Scale and Atrial Fibrillation Self Care Ability Scale.Results:There was no statistically significant difference in scores of Morisky Medication Adherence Scale and Atrial Fibrillation Self Care Ability Scale of patients between the two groups before intervention ( P>0.05). After intervention, scores of Morisky Medication Adherence Scale and Atrial Fibrillation Self Care Ability Scale of patients in the study group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Transitional care based on Siebens domain management model can improve medication adherence and self-care ability of atrial fibrillation patients.

Objective:To investigate the effects of carnosine(CAR)on the spatial learning and memory abilities of rats with vascular cognitive impairment(VCI),and to explore the roles of the Akt/mTOR pathway and autophagy in this process.Methods:Fifty male Sprague-Dawley(SD)rats were randomly divided into sham-operated(Sham)group,VCI group,VCI+CAR-L group,VCI+CAR-M group,and VCI+CAR-H group.The spatial learning and memory abilities of rats were evaluated by the Morris water maze experiment;Nissl staining was used to detect the damage in the hippocampal CA1 region;the nitroblue tetrazolium and thiobarbituric acid methods were used to measure the activities of superoxide dismutase(SOD)and malondialdehyde(MDA)content in hippocampal tissue;Western Blot was performed to determine the expression of p-Akt,p-mTOR,Beclin-1,and LC3B proteins,and immunofluorescent staining was con-ducted to detect changes in LC3B expression in the CA1 region.SH-SY5Y cells were divided into control group,oxy-gen-glucose deprivation/reperfusion(OGD/R)group,OGD/R+rapamycin(RAPA),OGD/R+CAR(1.2 mmol/L)group,and OGD/R+CAR+RAPA group.Methyl thiazolyl tetrazolium assay was used to detect neuronal survival rate;Western Blot was used to detect the levels of p-mTOR,Beclin-1,and LC3B in neuronal cells;immunofluorescent stai-ning was performed to assess the degree of autophagy.Results:CAR could improve the learning and memory abilities of VCI rats,reduce hippocampal tissue cell damage,and inhibit oxidative stress(P＜0.01).CAR increased the expres-sion of p-Akt,p-mTOR,and p62 proteins(P＜0.01 or P＜0.05)and decreased the expression of Beclin-1 and the ra-tio of LC3B Ⅱ/Ⅰ(P＜0.01 or P＜0.05).CAR significantly increased the survival rate of SH-SY5Y cells after OGD/R(P＜0.01)and inhibited autophagy in hippocampal neurons.Furthermore,the intervention with RAPA counteracted the therapeutic effect of CAR,reduced the survival rate of SH-SY5Y groups(P＜0.01),and enhanced autophagy.Conclusion:CAR can improve rat VCI injury,and its mechanism may involve inhibiting oxidative stress,activating the Akt/mTOR signaling pathway in neuronal cells,and thereby inhibiting excessive autophagy to exert a protective effect.

Objective:To investigate the effects of carnosine(CAR)on the spatial learning and memory abilities of rats with vascular cognitive impairment(VCI),and to explore the roles of the Akt/mTOR pathway and autophagy in this process.Methods:Fifty male Sprague-Dawley(SD)rats were randomly divided into sham-operated(Sham)group,VCI group,VCI+CAR-L group,VCI+CAR-M group,and VCI+CAR-H group.The spatial learning and memory abilities of rats were evaluated by the Morris water maze experiment;Nissl staining was used to detect the damage in the hippocampal CA1 region;the nitroblue tetrazolium and thiobarbituric acid methods were used to measure the activities of superoxide dismutase(SOD)and malondialdehyde(MDA)content in hippocampal tissue;Western Blot was performed to determine the expression of p-Akt,p-mTOR,Beclin-1,and LC3B proteins,and immunofluorescent staining was con-ducted to detect changes in LC3B expression in the CA1 region.SH-SY5Y cells were divided into control group,oxy-gen-glucose deprivation/reperfusion(OGD/R)group,OGD/R+rapamycin(RAPA),OGD/R+CAR(1.2 mmol/L)group,and OGD/R+CAR+RAPA group.Methyl thiazolyl tetrazolium assay was used to detect neuronal survival rate;Western Blot was used to detect the levels of p-mTOR,Beclin-1,and LC3B in neuronal cells;immunofluorescent stai-ning was performed to assess the degree of autophagy.Results:CAR could improve the learning and memory abilities of VCI rats,reduce hippocampal tissue cell damage,and inhibit oxidative stress(P＜0.01).CAR increased the expres-sion of p-Akt,p-mTOR,and p62 proteins(P＜0.01 or P＜0.05)and decreased the expression of Beclin-1 and the ra-tio of LC3B Ⅱ/Ⅰ(P＜0.01 or P＜0.05).CAR significantly increased the survival rate of SH-SY5Y cells after OGD/R(P＜0.01)and inhibited autophagy in hippocampal neurons.Furthermore,the intervention with RAPA counteracted the therapeutic effect of CAR,reduced the survival rate of SH-SY5Y groups(P＜0.01),and enhanced autophagy.Conclusion:CAR can improve rat VCI injury,and its mechanism may involve inhibiting oxidative stress,activating the Akt/mTOR signaling pathway in neuronal cells,and thereby inhibiting excessive autophagy to exert a protective effect.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To study the material basis of the drug effect of the raw material of lamb′s tripe and vitamin B12 capsule.Methods:Rennet and pepsin were extracted with 0.9% sodium chloride and were purified by saturated ammonium sulfate precipitation, diethylaminoethyl-cellulose 52 and high pressure chromatography (HPLC) chromatography. Relative molecular weight was determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) electrophoresis and liquid chromatography-triple quadrupole mass spectrometer. The amino acid composition and antioxidant activity of raw materials were analyzed with HPLC. The raw materials were completely extracted with water, phosphate buffer and sodium bicarbonate in turn, and in vitro 1, 1-diphenyl-2-picrylhydrazyl radil 2, 2-diphenyl-1-(2, 4, 6-trinitrophenyl)hydrazyl (DPPH) and 2, 2′-azinobis-(3-ethylbenzthiazoline-6-sulphonate) (ABTS) radical activity were measured. Glycoprotein from raw material was extracted with hot water and determined its growth-promoting activity gaginst Bifidobacterium adolescentis , Lactobacillus delbrueckii subsp. Bulgaricus and Enterococcus faecalis was measured. The composition of amino acid and monosaccharide were analyzed by HPLC and gas chromatography-mass spectrometry, respectively. Results:The enzyme activity of two purified rennet F6-2 and F7-2 which had different ionic strengths and pepsin F7-1 were 27 557.10, 17 532.60 and 17 728.15 U/g, respectively. The results of SDS-PAGE indicated that the molecular weights of three enzymes were similar, ranging from 35 000 to 40 000. The raw material contained 16 kinds of amino acids, of which hydrophobic amino acids accounted for 33.03% of the total amino acid content. When the sample concentration was 5 mg/mL, ABTS free radical scavenging activity of the three extracts was (37.80±0.45)%, (23.20±0.78)% and (62.80±0.74)%; DPPH free radical scavenging activity was (57.87±0.55)%, (5.03±0.25)% and (26.67±3.10)%, respectively. Glycoprotein extracts had promoted the growth of Bifidobacterium adolescentis, Lactobacillus delbrueckii subsp. Bulgaricus and Enterococcus faecalis, and there was statistically significant difference in the promotion of Lactobacillus delbrueckii subsp. Bulgaricus and Enterococcus faecalis ( P<0.05). The protein chain of glycoprotein was composed of 15 amino acids and the polysaccharide chain was composed of two monosaccharides, glucose and lactose. Conclusions:Two rennet and one pepsin are isolated and analyzed from raw material of lamb abomasum by various chromatographic methods. The raw material is rich in antioxidant active ingredients. The glycoprotein components of lamb abomasum has the activity of promoting the growth of probiotics.

Objective:To investigate the association between systemic inflammation response index (SIRI) and early neurological deterioration (END) in patients with basal ganglia hemorrhage (BGH), and then set up a prediction Nomogram model for END.Methods:The retrospective cohort study was conducted. A total of 146 patients with BGH from January 2016 to December 2018 were chosen in the Affiliated Jiangyin Hospital of Southeast University Medical College. The patients were divided into the END group ( n=34) and non-END group ( n=112), according to whether END occurred or not. The normally distributed data were presented as the mean±standard deviation ( Mean± SD), and the groups were compared using the t test. The non-normally distributed data were expressed as M ( P25, P75), and this data was analysed via the Kruskal-Wallis test. Categorical variables were described as numbers of patients (%) and compared using chi-square analysis or Fisher exact test, as appropriate. Univariate analysis and multivariate logistic regression analysis were used to identify the risk factors of END occurrence, and the relationship with SIRI. Then, each factor was scored by Nomogram method to construct the prediction model. Receiver operating characteristic curve (ROC) was drawn to assess the predictive value of SIRI and Nomogram model in the occurrence of END. Results:Univariate analysis showed that the occurrence of END was associated with hematoma volume, presence of intraventricular hemorrhage, blood glucose, lymphocyte count and SIRI ( P<0.05). Multivariate logistic regression analysis showed that hematoma volume ( P<0.001), presence of intraventricular hemorrhage ( P=0.012) and SIRI ( P=0.023) are independent risk factors for END occurrence. ROC curve analysis showed that SIRI has certain predictive value for END occurrence, and the optimal cut-off value was SIRI=5.40×10 9/L. Then these risk factors were incorporated into the Nomogram. Statistically analysis showed the model had a good predictive value, and the model combining the SIRI and other prognostic factors (AUC=0.869, 95% CI: 0.804-0.935, P<0.001) showed more favorable discriminative ability than the model without the SIRI (AUC=0.811, 95% CI: 0.734-0.889, P<0.001) and the model using the SIRI only (AUC=0.716, 95% CI: 0.622-0.810, P<0.001). Conclusion:SIRI is closely correlated with the occurrence of END in patients with BGH, and the nomogram model combining the SIRI has a more accurately predictive value, which improved the early identification and screening of END, and patient outcomes.

Objective: To evaluate the efficacy and safety of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) 25/150/100 mg once daily and dasabuvir (DSV) 250 mg twice daily combined with ribavirin in adult patients of Mainland China with chronic HCV genotype 1b infection and compensated cirrhosis. Methods: An open-label, multicenter, phase 3 clinical trial study was conducted in mainland China, Taiwan, and South Korea. Adult patients with compensated cirrhosis (Metavir score =F4) who were newly diagnosed and treated for hepatitis C virus genotype 1b infection with ombitasvir/paritaprevir/ritonavir and dasabuvir combined with ribavirin for 12 weeks were included. Assessed SVR rate of patients obtained at 12 and 24 weeks after drug withdrawal. Efficacy and safety were evaluated in patients who received at least one time study drugs. Results: A total of 63 patients from mainland China were enrolled, 62 of whom (98.4%) had a baseline Child-Pugh score of 5 points. The overall rate of SVR12 and SVR24 in patients was 100% (95% CI: 94.3% to 100.0%). Most of the adverse events that occurred were mild. The incidence of common (≥10%) adverse events and laboratory abnormalities included elevated total bilirubin (36.5%), weakness (19.0%), elevated unconjugated bilirubin (19.0%) and conjugated bilirubin (17.5%), and anemia (14.3%). Three cases (4.8%) of patients experienced Grade ≥ 3 adverse events that were considered by the investigators to be unrelated to the study drug. None patients had adverse events leading to premature drug withdrawal. Conclusion Mainland Chinese patients with chronic HCV genotype 1b infection and compensated cirrhosis who were treated with OBV/PTV/r plus DSV combined with RBV for 12 weeks achieved 100 % SVR at 12 and 24 weeks after drug withdrawal. Tolerability and safety were good, and majority of adverse events were mild.

Objective To investigate the efficacy of super selective intra-arterial infusion of verapamil for the treatment of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH).Methods From January 2013 to February 2016,the clinical data of 15 patients with subarachnoid hemorrhage (SAH) who had CVS after intracranial aneurysm clipping (n=8) or endovascular treatment (n=7) were analyzed retrospectively.All patients received whole brain digital subtraction angiography (DSA).Microcatheter super selection to spastic arteries was used and verapamil (11.1±3.4 mg) was infused.The findings of whole brain DSA before and after treatments were compared.The blood pressure and heart rate were collected during the treatment and the findings of transcranial Doppler ultrasonography were recorded.The patients were followed up for 6 months and the Glasgow outcome scale (GCS) scores were obtained.Results (1) A total of 20 intra-arterial infusion treatments were performed in 15 cases.They were compared before and after perfusion.CVS was improved on DSA in 14 cases,there was no significant change in on cases.(2) Transcranial Doppler ultrasonography showed that the mean blood flow velocity (mBFV) of the middle cerebral artery was decreased from 181±4 cm/s before the super selective intra-arterial infusion to 126±4 cm/s within 1 hour after treatment.There was significant difference (t=42.46,P<0.01).No complications associated with the use of microcatheters were observed.(3) The right upper arm blood pressure of the patients was monitored in the process of perfusion.The systolic pressure was 138±8 mmHg at the beginning of the perfusion,it was 135±10 mmHg at the end of the perfusion,and it was 137±7 mmHg at 1 h after the perfusion.The heart rate was 83±6/min at the beginning of the operation,it was 79±8/min at the end of the operation,and it was 80±5/min at 1 h after the operation.There were no significant differences (P>0.05).(4) All patients were followed up for 6 months.The GOS score at 6 months:good recovery in 9 cases,moderate disability but could take care of themselves in 3 cases,severe disability and could not take care of themselves in 3 cases,no persistent vegetative state or death.Conclusion Super selective intra-arterial infusion of verapamil can effectively improve the treatment of aneurysmal SAH caused CVS.At the same time,it has no obvious effect on blood pressure and heart rate.

Objective: To investigate the efficacy and safety of IA regimen which contains idarubicin (IDA) 8 mg/m², 10 mg/m² or 12 mg/m² as induction chemotherapy for adult patients with de-novo acute myeloid leukemia (AML) . Methods: A total of 1 215 newly diagnosed adult AML patients, ranging from May 2011 to March 2015 in the First Affiliated Hospital of Soochow University and other 36 clinical blood centers in China were enrolled in the multicenter, single-blind, non-randomized, clinical controlled study. To compare the response rate of complete remission (CR) , adverse events between different dose idarubicin combined with cytarabine (100 mg/m²) as induction chemotherapy in newly diagnosed patients of adult AML. Results: Of 1 207 evaluable AML patients were assigned to this analysis of CR rate. The CR rates of IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 73.6% (215/292) , 84.1% (662/787) and 86.7% (111/128) , respectively (P<0.001) . After adjusted for age, blast ratio of bone marrow, FAB classification and risk stratification, the odds ratios (95% CI) of IDA 10 mg/m² group and IDA 12 mg/m² group were 0.49 (0.34-0.70) and 0.36 (0.18-0.71) , as compared with the IDA 8 mg/m² group (P<0.001, P=0.003) . In the intermediate and favorable groups, CR rates was 76.5% (163/213) , 86.9% (506/582) and 86.1% (68/79) in different doses of IDA (P=0.007) . Interestingly, IA regimen with IDA 10 mg/m² was the only beneficial factor affecting CR in this group after adjusted for age, blast ratio of bone marrow and FAB classification[OR=0.47 (95% CI 0.31-0.71) , P<0.001]. CR rates in adverse group was 50.0% (18/36) , 60.6% (43/71) and 81.8% (18/22) respectively (P=0.089) . However, the odds ratios (95% CI) of IDA 12 mg/m² when compared with the IDA 8 mg/m² was 0.22 (0.06-0.80) , after adjusted for age, blast ratio of bone marrow and FAB classification. The median time (days) of neutrophil count less than 0.5×10⁹/L in IDA 8 mg/m² group, IDA 10 mg/m² group and IDA 12 mg/m² group were 14 (11-18) , 15 (11-20) and 18 (14-22) , respectively (P=0.012) and of platelet count lower than 20×10⁹/L were 14 (7-17) , 15 (11-20) and 17 (15-21) , respectively (P=0.001) . The incidences of lung infection in the three groups were 9.8%, 13.5% and 25.2%, respectively (P<0.001) . Conclusions For young adult patients (aged 18-60 years) with AML in China, intensifying induction therapy with idarubicin 10 mg/m² is clinically superior to IDA 8 mg/m² and IDA 12 mg/m² in favorable intermediate AML subgroup. However, idarubicin 12 mg/m² is more suitable to adverse AML subgroup.