Objective: To investigate the distribution of pupil diameter and its association with myopia in school age children, providing ideas into the mechanisms of the role of pupil diameter in the onset and development of myopia. Methods: Adopting a combination of stratified cluster random sampling and convenience sampling method, 3 839 children from six schools in Shandong Province were included in September 2021. Pupil diameters distribution was analyzed by age, sex, and myopic status. Pearson correlation analysis was used to assess the relationship between pupil diameter and cycloplegic spherical equivalent (SE), as well as axial length (AL) and other variables. Propensity score matching (PSM) was applied to match myopic and non myopic children at a 1∶1 ratio based on age and sex. A generalized linear model (GLM) was constructed with pupil diameter as the dependent variable to identify independent factors influencing pupil size and its association with myopia. Results: The mean pupil diameter of school age children was (5.77±0.80)mm. Pupil diameter exhibited a significant increasing trend with age ( F =49.34， P trend ＜ 0.01). Myopic children had a significantly larger mean pupil diameter [(6.10±0.73)mm] compared to non myopic children [(5.62±0.79)mm] with a statistically significant difference( t=18.10, P <0.01). Multivariable GLM analysis, adjusted for age, amplitude of accommodation, and uncorrected visual acuity, revealed a negative correlation between pupil diameter and cycloplegic SE (before PSM: β =-0.089, after PSM: β =-0.063, both P ＜0.01). Conclusions Myopic school age children exhibite larger pupil diameters than their non myopic counterparts. Pupil diameter may serve as a potential indicator for monitoring myopia development in school age children.

ObjectiveTo analyze the correlation between the clinical symptoms， signs， syndrome characteristics and laboratory indicators of cough variant asthma （CVA） and deepen the understanding of the treatment of this disease based on the theory of "Fu Feng". MethodsAn observational study was conducted. A total of 207 CVA patients who visited the respiratory department of the Third Affiliated Hospital of Beijing University of Chinese Medicine from September 2022 to November 2023 were included. The information from the four diagnostic methods and the laboratory test results of patients were collected. Factor analysis was conducted on the information obtained through the four diagnostic methods in TCM， and the nature and location of CVA were extracted. Sample cluster analysis （Q clustering） and the K-means method were used for data clustering analysis to determine the syndrome types of CVA and analyze the syndrome characteristics and differences in laboratory indicators among different syndrome types. ResultsThe main symptom of CVA patients was cough， accompanied by symptoms such as itchy throat， foreign body sensation in the throat， dry throat， shortness of breath， dry mouth， chest tightness， hoarseness， bitter mouth， poor appetite， and skin itching. Factor analysis showed that the disease was located in the lung， involving the liver， spleen， and kidney. The pathological factors involved Yin deficiency， Yang deficiency， wind factor， dampness factor， Yin factor， and Qi stagnation. Cluster analysis revealed four syndrome types： Fengfu Yinshang syndrome， Shixie Neiyun syndrome， Tanyin Zufei syndrome， and Ganhuo Fanfei syndrome. Fengfu Yinshang syndrome accounted for the highest proportion， followed by Tanyin Zufei syndrome. There were no significant differences in eosinophil count and percentage， fractional nasal nitric oxide （FnNO） level， and pulmonary function indexes among the four syndromes. The levels of serum total IgE and fractional exhaled nitric oxide （FeNO） in patients with Fengfu Yinshang syndrome were significantly higher than those in patients with Shixie Neiyun syndrome and Tanyin Zufeisyndrome. ConclusionCough is the main symptom of CVA， accompanied by pharyngeal itching， foreign body sensation in the throat， dry throat， shortness of breath， dry mouth， and allergic manifestations. The disease involves the lung， liver， spleen， and kidneys. The essence of the pathogenesis lies in a latent dormant pathogen and a disorder of the pivot mechanism. The four common syndrome types are Fengfu Yinshang syndrome， Shixie Neiyun syndrome， Tanyin Zufei syndrome， and Ganhuo Fanfei syndrome. The TCM syndrome types are correlated with laboratory indexes. The serum total IgE and FeNO of patients with Fengfu Yinshang syndrome are worse.

ObjectiveTo observe the regulation effect of Sangmei Zhike granules on airway inflammation and cyclic adenosine monophosphate （cAMP）-protein kinase A （PKA）-cAMP response element binding protein （CREB） pathway in cough variant asthma （CVA） rats with Fengfu Yinshang syndrome. MethodsEight-week-old male rats were randomly divided into a blank group， model group， western medicine group， and traditional Chinese medicine （TCM） group. Except for the blank group， Fengfu Yinshang models of CVA were established in the other groups. On the 16th day of the experiment， the western medicine group was treated with budesonide aerosol inhalation （dosage of 0.5 g·L^-1）， and the TCM group was given Sangmei Zhike granules by gavage （dosage of 4.19 g·kg^-1·d^-1）， with each group treated once daily for 14 days. On the 30^th day of the experiment， lung function parameters were determined. Whole blood inflammatory cell detection， hematoxylin-eosin （HE） staining of lung tissue， and immunohistochemistry were used to detect the expression of CREB， phosphorylated CREB （pCREB）， and phosphorylated vasodilator-stimulated phosphoprotein （pVASP） proteins in rat lung tissue， and Reverse transcription quantitative polymerase chain reaction （Real-time PCR） was used to determine the protein expressions of cAMP， CREB， and PKA in rat lung tissue. Western blot （WB） was used to detect the expression of PKA， VASP， p-VASP， CREB， and p-CREB proteins. ResultsCompared with the model group， the average dynamic lung compliance （CDyn_average） in the TCM group increased （P0.05）. Compared with the model group， the TCM group showed a decrease in absolute and percentage values of neutrophils （NEUT%）， absolute values of lymphocytes （LYMPH）， absolute and percentage values of basophils （BASO%）， absolute values of monocytes （MONO）， absolute and percentage values of eosinophils （EOS%）， and white blood cells （WBC） （P0.05）. Compared with the western medicine group， the TCM group showed a decrease in MONO， EOS%， and LYMPH% and an increase in MONO% （P0.05）. ELISA results showed that compared with the model group， the TCM group had increased interferon-gamma （IFN-γ） and decreased interleukins （IL）-4， IL-5， IL-13， and total serum IgE， while the Western medicine group had increased IFN-γ and decreased IL-5， IL-13， and total serum IgE （P0.05）. Compared with the western medicine group， the TCM group had decreased IL-5 （P0.05）. HE staining results of rat lung tissue showed that the ciliated epithelium of the D bronchi in the TCM group recovered well. Mucous edema secretion decreased， and a small number of bronchiolar epithelial cells were shed， with reduced infiltration of inflammatory cells and the degree of epithelial injury. Immunohistochemical （IHC） results showed that compared with the model group， positive expressions of CREB， pCREB， and pVASP （brownish-yellow） were significantly increased in the TCM and western medicine groups. Real-time PCR results showed that compared with the model group， the relative expression levels of cAMP， CREB， and PKA in the TCM group were significantly increased （P0.05）， and compared with the western medicine group， the TCM group also showed significantly increased relative expression levels of cAMP， CREB， and PKA （P0.05）. WB results showed that compared with the model group， the expressions of PKA， VASP， p-VASP， CREB， p-CREB， and p-CREB/CREB proteins were increased in the TCM group， while p-VASP/VASP protein expression decreased （P0.05）. Compared with the western medicine group， the TCM group had increased expressions of PKA， VASP， and p-CREB proteins and decreased p-VASP/VASP expression （P0.05）. ConclusionSangmei Zhike granules have the effect of improving lung function and inhibiting airway inflammation in rats with CVA due to Fengfu Yinshang syndrome， possibly related to the activation of the cAMP/PKA/CREB pathway.

Cough variant asthma （CVA） is a special type of asthma and the most common cause of chronic cough in China. It has a relatively high incidence， seriously affects patients' quality of life， and in some cases may even progress to typical asthma， posing an important challenge in the field of health economics. At present， first-line treatment in Western medicine mainly consists of inhaled corticosteroids combined with bronchodilators. However， there remain many problems such as poor efficacy in some patients， frequent relapse after drug withdrawal， and poor compliance， making it urgent to improve treatment strategies. In-depth research on the pathogenesis is helpful for a comprehensive understanding and prevention of CVA. The pathogenesis of CVA is complex and involves multiple pathophysiological links. While similar to typical asthma， it still presents some differences. Traditional Chinese medicine （TCM） has unique advantages in the treatment of CVA. Guided by the theory of syndrome differentiation and treatment， TCM can not only improve the clinical symptoms of CVA but also prevent recurrence. In recent years， with the continuous deepening of research on the pathogenesis of CVA and on its treatment with TCM based on syndrome differentiation， related academic achievements have been updated year by year. A review of literature in China and abroad shows that the current pathogenesis of CVA can be summarized into six aspects： airway inflammation， airway remodeling， airway hyperresponsiveness， cough hypersensitivity， genetic factors， and imbalance of intestinal flora. TCM often differentiates and treats CVA from four perspectives： cause， disease location， disease nature， and disease tendency. This paper systematically summarizes the progress in the study of CVA pathogenesis， comprehensively collates the experience and clinical research evidence on its treatment with TCM based on syndrome differentiation， and discusses the problems existing in current research. On this basis， it puts forward suggestions and prospects for future research and development of TCM in the treatment of CVA， with a view to providing a theoretical basis and therapeutic approaches for its prevention and treatment.

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

In this study, araucarene diterpenes, characterized by a pimarene skeleton with a variably oxidized side chain at C-13, were investigated. A total of 16 araucarene diterpenoids and their derivatives were isolated from the woods of Agathis dammara, including 11 previously unreported compounds: dammaradione (1), dammarones D-G (2, 5, 14, 15), dammaric acids B-F (8-12), and dammarol (16). The structures of these new compounds were elucidated using high-resolution electrospray ionization mass spectroscopy (HR-ESI-MS) and one-dimensional/two-dimensional (1D/2D) nuclear magnetic resonance (NMR), while their absolute configurations were determined through the electronic circular dichroism (ECD) exciton chirality method and Snatzke's method. The hypoglycemic activity of all isolated compounds was evaluated using a transgenic zebrafish model, and a structure-activity relationship (SAR) analysis was conducted. Araucarone (3) and dammaric acid C (9), serving as representative compounds, demonstrated significant hypoglycemic effects on zebrafish. The primary mechanism involves the promotion of pancreatic β cell regeneration and glucose uptake. Specifically, these compounds enhance the differentiation of pancreatic endocrine precursor cells (PEP cells) into β cells in zebrafish.
Zebrafish ; Animals ; Diterpenes/isolation & purification* ; Insulin-Secreting Cells/cytology* ; Glucose/metabolism* ; Hypoglycemic Agents/isolation & purification* ; Molecular Structure ; Structure-Activity Relationship ; Plant Extracts/pharmacology* ; Regeneration/drug effects*

Objective: To explore the mechanism of the Peiyuan Jieyu formula in treating depression by assessing its impact on a lipopolysaccharide-induced (LPS-induced) depression mouse model. Methods: We created a mouse model of depression by exposing mice that had previously received chronic stress to intraperitoneal LPS injections. The mice were divided into the following groups: control, model, fluoxetine, Tiansi Yin, Sini powder, and low-, medium-, and high-dose Peiyuan Jieyu formula groups. Forced swim and tail suspension tests were used to assess the efficacy of the depression (despair) model, and weight gain rates were also measured. Furthermore, serum levels of various depression and inflammation-associated molecules, including tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), tryptophan, 5-hydroxytryptamine, kynurenine (KYN), and kynurenic acid (KA) were assessed. Furthermore, the expression levels of ionic calcium-binding adaptor molecule-1 (IBA-1) and indoleamine 2,3-dioxygenase (IDO) mRNA in hippocampal microglia were measured. Results: The model group displayed greater despair-associated immobility, which was shortened in response to various doses of Peiyuan Jieyu formula. Furthermore, formula administration significantly reduced serum TNF-α levels and hippocampal IDO mRNA expression. The high formula dose also reduced IFN-γ and IBA-1 levels, the latter was also decreased in response to the medium formula dose. However, the low formula dose reduced serum KYN level and KYN/tryptophan (TRP) and KYN/KA ratios. Conclusion The Peiyuan Jieyu formula holds immense potential in treating depression in a mouse model, potentially inhibiting inflammation and improving TRP-KYN metabolic disorders.

Vigilance is a sensitive ability to respond to small changes in the environment and it is a ma-jor component of various cognitive performance tasks.Professionals in a variety of fields require high physical and vigilance performance during the working process to ensure productivity,workplace safety,and their own safety.This article reviews the research progress in vigilance in terms of the examination methods,influencing factors,and drug treatment in recent years,aiming to improve the understanding of vigilance and provide support for the research on vigilance and clinical treatment of vigilance-related dysfunctions.

Objective:To analyze and evaluate the different methods in detecting anti-mitochondrial antibodies (AMA) for the diagnostic performance of primary biliary cholangitis (PBC).Methods:In this retrospective study, we collected serum samples of 37 PBC patients who were admitted to the Second Hospital of Jiaxing, from November 2022 to November 2023, 43 patients with other autoimmune diseases and 53 normal controls during the same time. The results of AMA were detected in parallel by indirect immunofluorescence assay (IIF), immunoblot tests (IB) and chemilluminescent microparticle immunoassay (CLIA). Fisher′s exact test was used to compare the count data between different groups, while a paired chi-square test was used to assess the results of the three test methods. We analyzed the performance of the three test methods; Venn diagram was used to show the consistency distribution of AMA results, the diagnostic performance of AMA for PBC were evaluated by area under receiver operating characteristic curve (ROC).Results:The positive rate of AMA in PBC group was significantly higher than that in the other two groups, and AMA was detected by CLIA which had higher positive rate (86.5%, 32/37) than the other two methods. As shown in the Venn diagram, the proportion of consistent AMA results among the three methods was 74.4%(99/133), and between IB and CLIA methods which used for detecting AMA-M2, the consistent proportion was 86.5%(115/133). Among comparison of the performance of three methods, the highest specificity (92.7%)was IIF method, and the highest sensitivity (86.5%) was CLIA method. The respective AUC of IIF, IB and CLIA methods were 0.801, 0.800 and 0.875. In the combined detection, the AUC of IIF+CLIA method was 0.942, which was better than the other two or triple combined method detection.Conclusion:For highly suspected PBC patients with negative IIF screening test, combined IB or CLIA could be used to detect AMA-M2. We recommended that clinicians should refer to the AMA results conducted by two or three methods, and preferentially recommended the IIF method combined with CLIA method for the detection of AMA.

Objective: To evaluate the prevalence and consistency of screening myopia, non-cycloplegic myopia and cycloplegic myopia in children and adolescents, and to provide references for exploring the factors affecting the consistency of different definition methods. Methods: A total of 3 868 children and adolescents aged 6 to 17 years from seven schools were included in a school based cross sectional study in Shandong Province in September 2020. The prevalence of screening myopia, non cycloplegic refraction, and cycloplegic refraction at different ages and all children and adolescents were analyzed. With cycloplegic spherical equivalent ≤-0.50 D as the gold standard for myopia, and Kappa test and area under the ROC curve were used to evaluate the consistency. Results: The prevalence of cycloplegic myopia and screening myopia were 36.7% and 38.3% among children and adolescents. The prevalence of non cycloplegic myopia was 62.4%, which was significantly higher than screening myopia and cycloplegic myopia two methods in primary and junior high schools. Among 3 868 subjects, there were 3 628 (93.8%) subjects with screening myopia and 2 862 (74.0%) subjects with non cycloplegic myopia who were consistent with the gold standard for myopia. The Kappa values of screening myopia and non cycloplegic myopia were 0.87 and 0.51, and the area under the ROC curve was 0.94 (95% CI =0.93-0.95) and 0.79 (95% CI =0.78-0.81). Compared with other groups, children and adolescents aged 8 to 17 years, in junior or high school, urban residence, better presenting distance visual acuity, and astigmatism ≤1.50 D had a higher consistency in the application of screening myopia ( P <0.05). Conclusion The consistency between screening myopia and cycloplegic myopia is high, and the consistency between non cycloplegic objective myopia is low.