The Compilation Instructions for Expert Consensus on Clinical Application of Dieda Huoxue capsules systematically expound the development methods and evidence-based basis of this consensus. In view of the weak clinical application evidence and ambiguous indications of Dieda Huoxue capsules， the Institute of Basic Research in Clinical Medicine of the China Academy of Chinese Medical Sciences and Wangjing Hospital took the lead and collaborated with 33 experts from 28 medical institutions nationwide. They strictly followed the World Health Organization （WHO） guideline-making norms and the Grading of Recommendations Assessment， Development and Evaluations （GRADE） evidence-grading system and completed the compilation through multidisciplinary cooperation. The workflow included constructing clinical questions （19 items were screened by the nominal group technique）， retrieving evidence （from Chinese and English databases and grey literature）， assessing safety （integrating drug monitoring data and clinical investigations）， and forming recommendations and consensus suggestions （3 recommendations were reached via the GRADE grid method， and 16 consensus suggestions were reached by the majority vote rule）. The results indicate that the consensus clearly states that this medicine （Dieda Huoxue capsules） is applicable to conditions like traumatic injury， blood stasis-induced pain， and sudden lumbar sprains. The recommended dose is 6 capsules each time， twice a day. Combining oral administration with external application can enhance the efficacy， and elderly patients should take the medicine at intervals. Safety monitoring suggests that it should be used with caution in people with a bleeding tendency and those with an allergic constitution. The compilation process involved three rounds of reviews by internal and external experts. Literature analysis， the Delphi method， and clinical applicability tests were employed to ensure methodological rigor. The compilation instructions comprehensively present key aspects such as project approval and registration， conflict-of-interest statements， and evidence evaluation through 12 appendices， providing methodological support for the clinical translation of the consensus. In the future， it will be continuously improved through a dynamic revision mechanism.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Objective To investigate the cerebellar hemisphere homotopic functional connectivity in patients with concomitant exotropia(CE)based on voxel-mirrored homotopic connectivity(VMHC),aiming to provide a reference basis for the neuropathogenesis of CE.Methods A total of 36 CE patients who visited the Ophthalmology Department of Jian-gxi Provincial People's Hospital from October 2021 to October 2022 were included as the study group(CE group),while healthy volunteers who were recruited from society and matched in age and gender with the CE group were included as the control group(HC group).Subjects in both groups underwent 3.0T functional magnetic resonance imaging scans,and the magnetic resonance data were processed using DPABI_V4.0 software and SPM8 to compare the differences in VMHC values of various brain regions of subjects in the two groups.Results Compared with the HC group,the VMHC values in the cerebellar regions 6,8 and 9 on both sides and vermis cerebelli region 2 of subjects in the CE group were significantly re-duced(all P＜0.05).The difference pattern of VMHC values in cerebellar regions showed that compared with the HC group,the VMHC values in cerebellar regions 6,8,9 and vermis cerebelli region 2 of subjects in the CE group were signifi-cantly different,especially the VMHC value in cerebellar region 9.Conclusion Functional changes in the cerebellar hemisphere,especially in cerebellar hemisphere region 9,play an important role in the pathogenesis of CE,which may be closely related to eye position voxel control and fusion.

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO₂, NO₂, CO, PM_2.5, PM₁₀, and maximum 8 h O₃ concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM_2.5, NO₂, SO₂, and O₃ were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM_2.5, NO₂, SO₂ and O₃ were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

The vagina contains at least a billion microbial cells,dominated by lactobacilli.Here we perform metagenomic shotgun sequencing on cervical and fecal samples from a cohort of 516 Chinese women of reproductive age,as well as cervical,fecal,and salivary samples from a second cohort of 632 women.Factors such as pregnancy history,delivery history,cesarean section,and breastfeeding were all more important than menstrual cycle in shaping the microbiome,and such information would be necessary before trying to interpret differences between vagino-cervical micro-biome data.Greater proportion of Bifidobacterium breve was seen with older age at sexual debut.The relative abundance of lactobacilli especially Lactobacillus crispatus was negatively associated with pregnancy history.Potential markers for lack of menstrual regularity,heavy flow,dysmenor-rhea,and contraceptives were also identified.Lactobacilli were rare during breastfeeding or post-menopause.Other features such as mood fluctuations and facial speckles could potentially be predicted from the vagino-cervical microbiome.Gut and salivary microbiomes,plasma vitamins,metals,amino acids,and hormones showed associations with the vagino-cervical microbiome.Our results offer an unprecedented glimpse into the microbiota of the female reproductive tract and call for international collaborations to better understand its long-term health impact other than in the settings of infection or pre-term birth.

Objective To investigate the epidemiological characteristics of chronic obstructive pulmonary disease (COPD) in patients aged 65 years and above in Liaoning Province. Methods Between January 2019 and December 2020, a cluster random sampling method was used to investigate residents ≥ 65 years old in Sujiatun Community, Shenyang City, Liaoning Province. The pulmonary function tests of the selected residents were conducted. Questionnaire surveys were carried out and 5738 questionnaires with complete data were analyzed. Results A total of 620 COPD cases were diagnosed among 5738 people investigated in the present study, with a total prevalence rate of 10.81%, of which the prevalence rate in men was 12.58% (371/2950), and the prevalence rate in women was 8.93% (249/2950). According to the GOLD classification of lung function, 620 patients can be divided into 186 (30.49%) cases of grade I, 266 (43.61%) grade II, 118 (19.34%) grade III, and 50 (8.20%) cases of grade IV. The problem with lung function in males was more serious than that in females, which increased gradually with age (P<0.05). Multivariate logistic regression analysis showed that gender, age, BMI, smoking, childhood respiratory history, family history, occupational exposure, indoor oil fume and use of polluted fuel for heating were independent risk factors affecting the onset of COPD (P<0.05). Conclusion The prevalence of COPD in patients aged 65 years old and above in Liaoning is relatively high. Gender, age, BMI, smoking, childhood respiratory history, family history, occupational exposure, indoor oil fume, and use of polluted fuel for heating are related to the onset of COPD. Clinical attention should be paid to early screening and prevention of COPD in those populations to reduce the prevalence of COPD..

In order to explore the microbial communities and functions of activated sludge in an Anaerobic-anoxic-oxic (A²/O) process under the start-up of Actinic reaction enzyme system (ARES) system and to understand the impact of the ARES system in domestic sewage treatment process, the activated sludge microbial community structure in the A²/O process system before and after ARES system start-up was analyzed by Illumina-HiSeq 2000 high-throughput sequencing platform. By combining with the main parameters related to the effect of sewage treatment, we analyzed the environmental functions of the microbial communities. The microbial community structure of activated sludge was significantly different before and after the ARES system start-up. There were 9 main bacterial phyla in the system (average relative abundance ≥1%), accounting for 96%-98% of the total bacteria sequenced. After the ARES system was started, the relative abundance of Betaproteobacteria and Chlorobi increased by 3.45%-3.85% and 0.45%-2.61%, respectively. In the anaerobic unit, the relative abundance of Bacteroidetes increased by 12.97%, while the Actinobacteria and Firmicutes decreased by 9.60% and 1.45%, respectively. At the genus level of bacteria, the relative abundance of Denitratisoma increased by 0.80%-3.27%, while the Haliangium and Arcobacter decreased by 3.36%-4.52% and 1.48%-3.45%, respectively. The relative abundance of bacteria was significantly different before and after the ARES system start-up. There were 7 abundant fungi phyla (average relative abundance ≥1%) in the system. After the ARES system was started, the relative abundance of Rozellomycota decreased by 42.71%-46.77%. In the anaerobic unit, the relative abundance of Ascomycota decreased by 13.39%, while the relative abundance of Glomeromycota increased by 13.86%. At the genus level of fungi. The relative abundance of Entomophthoraceae sp. and Glomcromycota sp. increased by 31.35%-36.50% and 6.27%-13.84%, respectively, while the Rozellomycota sp. and Xylochrysis lucida decreased by 42.71%-46.77% and 3.67%-5.54%, respectively. Our results showed that the application of ARES system caused the response of the microbial community to environmental changes, especially for the fungi communities, in the meanwhile, improved the effluent quality, especially the removal rate of total nitrogen.
Anaerobiosis ; Ascomycota ; Bioreactors ; Microbiota ; Nitrogen ; Sewage ; Waste Disposal, Fluid

Vascular smooth muscle cells (VSMC) are the main cellular component of vessel wall. The changes of VSMC functions including phenotypic transformation and apoptosis play a critical role in the pathogenesis of intracranial aneurysm (IA). Autophagy can participate in the regulation of vascular function by regulating cell function. In the initial stage of IA, the activation of autophagy can accelerate the phenotypic transformation of VSMC and inhibit VSMC apoptosis. With the progress of IA, the relationship between autophagy and apoptosis changes from antagonism to synergy or promotion, and a large number of apoptotic VSMC lead to the rupture of IA. In this review, we describe the role of autophagy regulating the function of VSMC in the occurrence, development and rupture of IA, for further understanding the pathogenesis of IA and finding molecular targets to prevent the formation and rupture of IA.
Autophagy ; Humans ; Intracranial Aneurysm ; pathology ; Muscle, Smooth, Vascular ; cytology ; Myocytes, Smooth Muscle ; cytology

Studies have shown that chronic inflammatory response plays a key role in intracranial aneurysms (IA) formation and progression, and macrophages regulate the formation and progression of IA through a variety of pathways. Bone marrow monocyte-derived macrophages and resident-tissue macrophages infiltrate the vessel wall, after infiltration macrophages are polarized into various polarization phenotypes dominated by M1-like and M2-like cells. Polarized phenotypes of macrophages can regulate the formation and progression of intracranial aneurysms by releasing cytokines and regulating the inflammatory response of other immune cells, as well as release different cytokines to regulate the process of extracellular matrix remodeling. Some important progresses have been made in the clinical detection and treatment in targeting macrophages. This review provides a summary on the pathogenesis of IA and potential drug targets to prevent the formation and rupture of intracranial aneurysms.
Cytokines ; Disease Progression ; Humans ; Inflammation ; Intracranial Aneurysm ; complications ; drug therapy ; pathology ; Macrophages ; metabolism

OBJECTIVE:To investigate the effects of non-ionic polyacrylamide(model:NPAM 1400)alone or combined with nanoscale silica gel (nSiO2) on the stability of Glycyrrhetinic acid lipo-emulsion. METHODS:UV-spectrophotometer was used to determine absorbance of diluent at 500 nm before and after lipo-emulsion centrifugation. Using the preparation without stable excipient as blank,stability coefficient (KE) and it ratio (KE/KE blank) were calculated. Effects of different concentrations (200-600 mg/L) of non-ionic polyacrylamide on the stability of Glycyrrhetinic acid lipo-emulsion were evaluated. The optimal concentration of non-ionic polyacrylamide alone was determined primarily,and then the effects of it combined with different concentrations of hydrophilic nSiO2 (0.2％, 0.3％, 0.4％) or hydrophobic (0.2％, 0.3％, 0.5％) on the stability of Glycyrrhetinic acid lipo-emulsion were investigated. RESULTS:When adding non-ionic polyacrylamide alone,KE of Glycyrrhetinic acid lipo-emulsion mixed with 300 mg/L non-ionic polyacrylamide was the lowest,KE/KE blank was 0.22;when combined,KE of Glycyrrhetinic acid lipo-emulsion mixed with 300 mg/L non-ionic polyacrylamide and 0.2％ hydrophobic nSiO2 was the lowest,KE/KE blank was 0.27. CONCLUSIONS:Non-ionic polyacrylamide alone or combined with nSiO2 all can promote the stability of Glycyrrhetinic acid lipo-emulsion,among which 300 mg/L non-ionic polyacrylamide alone is the best.