OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

italic>Platycodon grandiflorum (Jacq.) A. DC is one of the most commonly used bulk medicinal herbs. It has important value in the fields of medicine, food and cosmetics, and its market demand is increasing year by year, and it has a good development prospect. In this study, based on 403 distribution records and 8 environmental variables, we used Maxent model to predict the potential distribution of P. grandiflorum under climate change. The results showed that the model simulation effect was the best when the Maxent parameter was FC (feature combination) = LQPH (L: linear features; Q: quadratic features; P: product features; H: hinge features) and RM (regularization multiplier) = 2.1, AUC (area under curve) = 0.901, and the model prediction showed that P. grandiflorum was widely distributed in 28 provinces of China under the current climate conditions, with a suitable area of 2 337 419.98 km². Under the influence of climate change in the future, the area of suitable habitat of P. grandiflorum showed a decreasing trend, and the distribution center as a whole showed a trend of northward and eastward shift. The distribution area of P. grandiflorum in the three main producing areas is affected by climate change, and the overall trend is that the future suitable distribution area of Chifeng in Inner Mongolia increases, while the future suitable distribution area of Zibo in Shandong and Taihe, Bozhou in Anhui decreases or even disappears under the SSP5-8.5 scenario (shared socioeconomic pathways). It is suggested to maintain and protect the ecological environment and germplasm resources of the reserved area suitable for the growth of P. grandiflorum, and increase the cultivation research in the expansion area of P. grandiflorum, so as to lay a foundation for the subsequent expansion of P. grandiflorum planting and to promote the protection and sustainable development of P. grandiflorum resources.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Objective To investigate the risk factors for bronchopulmonary dysplasia(BPD)in twin preterm infants with a gestational age of<34 weeks,and to provide a basis for early identification of BPD in twin preterm infants in clinical practice.Methods A retrospective analysis was performed for the twin preterm infants with a gestational age of<34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020.According to their conditions,they were divided into group A(both twins had BPD),group B(only one twin had BPD),and group C(neither twin had BPD).The risk factors for BPD in twin preterm infants were analyzed.Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins.Results A total of 904 pairs of twins with a gestational age of<34 weeks were included in this study.The multivariate logistic regression analysis showed that compared with group C,birth weight discordance of>25%between the twins was an independent risk factor for BPD in one of the twins(OR=3.370,95%CI:1.500-7.568,P<0.05),and high gestational age at birth was a protective factor against BPD(P<0.05).The conditional logistic regression analysis of group B showed that small-for-gestational-age(SGA)birth was an independent risk factor for BPD in individual twins(OR=5.017,95%CI:1.040-24.190,P<0.05).Conclusions The development of BPD in twin preterm infants is associated with gestational age,birth weight discordance between the twins,and SGA birth.

Objective To observe the effects of whole-course epidural analgesia with ropivacaine injection and sufentanil injection on hemodynamics,stress response and postoperative pain in patients undergoing thoracoscopic lobectomy.Methods Patients who underwent thoracoscopic lobectomy were divided into the treatment group and the control group according to the cohort method.Both groups underwent epidural puncture and catheterization before surgery.The control group was given bolus injection of 10 mg of 0.125％ropivacaine hydrochloride injection and 0 9％NaCl injection(8 mL in total)via epidural catheter.The treatment group was given bolus injection of 10 mg of 0.125％ropivacaine hydrochloride injection and 4 μg of 0.5 μg·mL-1 sufentanil citrate injection(8 mL in total)via epidural catheter.Analgesia was maintained with the same concentration of drugs during the surgery.The epidural analgesia pump was used before closing the pleura.The analgesic formula for the control group consisted of 400 mg of 0.125％ropivacaine hydrochloride injection,and the analgesic formula for the treatment group consisted of 400 mg of 0.125％ropivacaine hydrochloride injection and 0.5 mg of 0.5 μg·mL-1 sufentanil citrate injection.Changes in hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP)],serum epinephrine(E),norepinephrine(NE)and cortisol(Cor)during surgery,occurrence of postoperative acute pain,postoperative remedial analgesia,and chronic pain were compared between the two groups.Safety was evaluated.Results A total of 80 patients were enrolled in the study,with 38 in the control group and 42 in the treatment group.The heart rates(HR)of the treatment and control groups were(80.35±9.62)and(88.24±10.35)beat·min-1 at immediate tracheal intubation(T1);and their mean arterial pressures(MAP)were(95.07±8.51)and(98.46±9.05)mmHg respectively.At skin incision(T2),HR of the treatment and control groups were(75.33±9.21)and(80.65±10.63)beat·min-1,respectively;MAP were(94.33±8.43)and(99.06±6.58)mmHg,respectively.Post-operation(T4),serum levels of E in the treatment and control groups were(53.17±9.79)and(60.79±8.58)ng·L-1;NE levels were(52.33±8.22)and(59.96±8.89)ng·L-1;Cor levels were(22.75±4.63)and(28.64±5.02)mg·L-1.At 24 hours post-operation(T5),serum levels of E in the treatment and control groups were(54.27±9.15)and(62.28±8.33)ng·L-1;NE levels were(55.34±9.18)and(62.07±9.58)ng·L-1;Cor levels were(24.19±4.52)and(30.57±4.79)mg·L-1.The incidences of agitation post-operation were 7.14％(3 cases/42 cases)and 23.68％(9 cases/38 cases),and the time to patient controlled epidural analgesia(PCEA)press was(13.67±2.74)and(11.35±2.28)h,respectively.The cumulative rescue analgesic dose within 72 h post-operation were(120.73±34.36)and(156.35±36.79)mg,respectively.Statistical analysis showed significant differences between the treatment and control groups in all these indicators(all P＜0.05).The total incidences of adverse drug reactions in the treatment group and the control group were 30.95％(13 cases/42 cases)and 23.68％(9 cases/38 cases),without statistically significant difference between the groups(all P＞0.05).Conclusion Applying ropivacaine combined with sufentanil in whole-course epidural analgesia for patients undergoing thoracoscopic lobectomy is conducive to maintaining perioperative hemodynamic stability,alleviating surgical stress and postoperative pain,and reduce the incidence of postoperative agitation.

Objective To observe the effects of whole-course epidural analgesia with ropivacaine injection and sufentanil injection on hemodynamics,stress response and postoperative pain in patients undergoing thoracoscopic lobectomy.Methods Patients who underwent thoracoscopic lobectomy were divided into the treatment group and the control group according to the cohort method.Both groups underwent epidural puncture and catheterization before surgery.The control group was given bolus injection of 10 mg of 0.125％ropivacaine hydrochloride injection and 0 9％NaCl injection(8 mL in total)via epidural catheter.The treatment group was given bolus injection of 10 mg of 0.125％ropivacaine hydrochloride injection and 4 μg of 0.5 μg·mL-1 sufentanil citrate injection(8 mL in total)via epidural catheter.Analgesia was maintained with the same concentration of drugs during the surgery.The epidural analgesia pump was used before closing the pleura.The analgesic formula for the control group consisted of 400 mg of 0.125％ropivacaine hydrochloride injection,and the analgesic formula for the treatment group consisted of 400 mg of 0.125％ropivacaine hydrochloride injection and 0.5 mg of 0.5 μg·mL-1 sufentanil citrate injection.Changes in hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP)],serum epinephrine(E),norepinephrine(NE)and cortisol(Cor)during surgery,occurrence of postoperative acute pain,postoperative remedial analgesia,and chronic pain were compared between the two groups.Safety was evaluated.Results A total of 80 patients were enrolled in the study,with 38 in the control group and 42 in the treatment group.The heart rates(HR)of the treatment and control groups were(80.35±9.62)and(88.24±10.35)beat·min-1 at immediate tracheal intubation(T1);and their mean arterial pressures(MAP)were(95.07±8.51)and(98.46±9.05)mmHg respectively.At skin incision(T2),HR of the treatment and control groups were(75.33±9.21)and(80.65±10.63)beat·min-1,respectively;MAP were(94.33±8.43)and(99.06±6.58)mmHg,respectively.Post-operation(T4),serum levels of E in the treatment and control groups were(53.17±9.79)and(60.79±8.58)ng·L-1;NE levels were(52.33±8.22)and(59.96±8.89)ng·L-1;Cor levels were(22.75±4.63)and(28.64±5.02)mg·L-1.At 24 hours post-operation(T5),serum levels of E in the treatment and control groups were(54.27±9.15)and(62.28±8.33)ng·L-1;NE levels were(55.34±9.18)and(62.07±9.58)ng·L-1;Cor levels were(24.19±4.52)and(30.57±4.79)mg·L-1.The incidences of agitation post-operation were 7.14％(3 cases/42 cases)and 23.68％(9 cases/38 cases),and the time to patient controlled epidural analgesia(PCEA)press was(13.67±2.74)and(11.35±2.28)h,respectively.The cumulative rescue analgesic dose within 72 h post-operation were(120.73±34.36)and(156.35±36.79)mg,respectively.Statistical analysis showed significant differences between the treatment and control groups in all these indicators(all P＜0.05).The total incidences of adverse drug reactions in the treatment group and the control group were 30.95％(13 cases/42 cases)and 23.68％(9 cases/38 cases),without statistically significant difference between the groups(all P＞0.05).Conclusion Applying ropivacaine combined with sufentanil in whole-course epidural analgesia for patients undergoing thoracoscopic lobectomy is conducive to maintaining perioperative hemodynamic stability,alleviating surgical stress and postoperative pain,and reduce the incidence of postoperative agitation.

This paper introduced the overview of the "eight trends" of Chinese medicinal materials(CMM) industry in 2021, analyzed the problems of CMM production, and put forward development suggestions. Specifically, "eight trends" could be summarized as follows.(1) The growing area of CMM tended to be stable, and some provinces began to release the local catalog of Dao-di herbs.(2) The protection process of new varieties accelerated, and a number of excellent varieties were bred.(3) The theory of ecological cultivation was further enriched, and the demonstration effect of ecological cultivation technology was prominent.(4) Some CMM realized complete mechanization and formed typical model cases.(5) The number of cultivation bases using the traceability platform increased, and provincial internet trading platforms were set up.(6) The construction of CMM industrial clusters accelerated, and the number of provincial-level regional brands increased rapidly.(7) Many new agricultural business entities were founded nationwide, and a variety of methods were used to drive the intensified development of CMM.(8) A number of local TCM laws were promulgated, and the management regulation of food and medicine homology substances catalogs was issued. On this basis, four suggestions for CMM production were proposed.(1) It is suggested to speed up the formulation of the national catalog of Dao-di herbs and carry out the certification of Dao-di herbs production bases.(2) Ecological planting of forest and grassland medicine should be further strengthened in terms of technical research and promotion based on the principle of ecological priority.(3) The basic work of disaster prevention should be paid more attention and technical measures for disaster mitigation should be developed.(4) The planted area of commonly used CMM should be incorporated into the national regular statistical system.
Agriculture ; Certification ; Commerce ; Industry ; China

Along with the progress of pharmaceutical science in the past century, the theme of pharmacology has gone through pseudo agent scheme, to ligand-receptor model, and then to the theory of targeted therapy today. Due to the success of drug R&D, current drug research keeps its focus mainly on drugs with single target and precise treatment, in which the molecular mechanism is relatively clear but the therapeutic efficacy is often limited. Thus, there is a big space for exploration in the field of pharmacology. In the past 30 years, several novel chemical drugs, originated from traditional Chinese medicine, have been identified and then used in clinic, provoking a strong interest to explore new theory for pharmacology, of which the term of "Biao Ben Jian Zhi" (treating diseases by directing symptoms and root causes) has demonstrated a promising nature. We consider this concept useful for future drug discovery, drug design and clinical therapy. In this review, example drugs such as berberine, metformin and azvudine, are discussed, and "drug Cloud" (dCloud) model is introduced to elaborate the mechanism of treating diseases by directing symptoms and root causes of diseases.

Objective: To analyze and compare therapy responses, outcomes, and incidence of severe hematologic adverse events of flumatinib and imatinib in patients newly diagnosed with chronic phase chronic myeloid leukemia (CML) . Methods: Data of patients with chronic phase CML diagnosed between January 2006 and November 2022 from 76 centers, aged ≥18 years, and received initial flumatinib or imatinib therapy within 6 months after diagnosis in China were retrospectively interrogated. Propensity score matching (PSM) analysis was performed to reduce the bias of the initial TKI selection, and the therapy responses and outcomes of patients receiving initial flumatinib or imatinib therapy were compared. Results: A total of 4 833 adult patients with CML receiving initial imatinib (n=4 380) or flumatinib (n=453) therapy were included in the study. In the imatinib cohort, the median follow-up time was 54 [interquartile range (IQR), 31-85] months, and the 7-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.2%, 88.4%, 78.3%, and 63.0%, respectively. The 7-year FFS, PFS, and OS rates were 71.8%, 93.0%, and 96.9%, respectively. With the median follow-up of 18 (IQR, 13-25) months in the flumatinib cohort, the 2-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.4%, 86.5%, 58.4%, and 46.6%, respectively. The 2-year FFS, PFS, and OS rates were 80.1%, 95.0%, and 99.5%, respectively. The PSM analysis indicated that patients receiving initial flumatinib therapy had significantly higher cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) and higher probabilities of FFS than those receiving the initial imatinib therapy (all P<0.001), whereas the PFS (P=0.230) and OS (P=0.268) were comparable between the two cohorts. The incidence of severe hematologic adverse events (grade≥Ⅲ) was comparable in the two cohorts. Conclusion: Patients receiving initial flumatinib therapy had higher cumulative incidences of therapy responses and higher probability of FFS than those receiving initial imatinib therapy, whereas the incidence of severe hematologic adverse events was comparable between the two cohorts.
Adult ; Humans ; Adolescent ; Imatinib Mesylate/adverse effects* ; Incidence ; Antineoplastic Agents/adverse effects* ; Retrospective Studies ; Pyrimidines/adverse effects* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy* ; Treatment Outcome ; Benzamides/adverse effects* ; Leukemia, Myeloid, Chronic-Phase/drug therapy* ; Aminopyridines/therapeutic use* ; Protein Kinase Inhibitors/therapeutic use*

Objective: To investigate the clinical characteristics and maternal and fetal prognosis of pregnant women with acute fatty liver of pregnancy (AFLP). Methods: The clinical data of 86 AFLP pregnant women admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to August 2022 were collected, and their general data, clinical characteristics, laboratory tests and maternal and fetal outcomes were retrospectively analyzed. Results: (1) General information: the age of the 86 pregnant women with AFLP was (30.8±5.4) years, and the body mass index was (21.0±2.5) kg/m². There were 50 primiparas (58.1%, 50/86) and 36 multiparas (41.9%, 36/86). There were 64 singleton pregnancies (74.4%, 64/86) and 22 twin pregnancies (25.6%, 22/86). (2) Clinical characteristics: the main complaints of AFLP pregnant women were gastrointestinal symptoms, including epigastric pain (68.6%, 59/86), nausea (47.7%, 41/86), anorexia (46.5%, 40/86), vomiting (39.5%, 34/86). The main non-gastrointestinal symptoms were jaundice of skin and/or scleral (54.7%, 47/86), edema (38.4%, 33/86), fatigue (19.8%, 17/86), bleeding tendency (16.3%, 14/86), polydipsia or polyuria (14.0%, 12/86), skin itching (8.1%, 7/86), and 17.4% (15/86) AFLP pregnant women had no obvious symptoms. (3) Laboratory tests: the incidence of liver and kidney dysfunction and abnormal coagulation function in AFLP pregnant women was high, and the levels of blood ammonia, lactate dehydrogenase and lactic acid were increased, and the levels of hemoglobin, platelet and albumin decreased. However, only 24 cases (27.9%, 24/86) of AFLP pregnant women showed fatty liver by imageology examination. (4) Pregnancy outcomes: ① AFLP pregnant women had a high incidence of pregnancy complications, mainly including renal insufficiency (95.3%, 82/86), preterm birth (46.5%, 40/86), hypertensive disorders in pregnancy (30.2%, 26/86), gestational diabetes mellitus (36.0%, 31/86), fetal distress (24.4%, 21/86), pulmonary infection (23.3%, 20/86), disseminated intravascular coagulation (16.3%, 14/86), multiple organ dysfunction syndrome (16.3%, 14/86), hepatic encephalopathy (9.3%, 8/86), and intrauterine fetal death (2.3%, 2/86). ② Treatment and outcome of AFLP pregnant women: the intensive care unit transfer rate of AFLP pregnant women was 66.3% (57/86). 82 cases were improved and discharged after treatment, 2 cases were transferred to other hospitals for follow-up treatment, and 2 cases (2.3%, 2/86) died. ③ Neonatal outcomes: except for 2 cases of intrauterine death, a total of 106 neonates were delivered, including 39 cases (36.8%, 39/106) of neonatal asphyxia, 63 cases (59.4%, 63/106) of neonatal intensive care unit admission, and 3 cases (2.8%, 3/106) of neonatal death. Conclusions: AFLP is a severe obstetric complication, which is harmful to mother and fetus. In the process of clinical diagnosis and treatment, attention should be paid to the clinical manifestations and laboratory tests of pregnant women, early diagnosis and active treatment, so as to improve maternal and fetal outcomes.
Pregnancy ; Infant, Newborn ; Female ; Humans ; Adult ; Retrospective Studies ; Premature Birth/epidemiology* ; Pregnancy Complications/diagnosis* ; Fatty Liver/diagnosis* ; Fetal Death ; Stillbirth