Urticarial vasculitis is a skin disease with urticaria-like lesions and a histopathological pattern of leukocytoclastic vasculitis. It is considered a "hidden rash" in traditional Chinese medicine. Xuanfu is the portal that regulates qi, blood, fluid, and the ascending, descending, exiting, and entering of nutrition qi and defensive qi. Collaterals are the pathways for the circulation of qi and blood. The two accompany each other, connecting zang-fu organs, reaching the surfaces of the skin, hair, and external body, circulating qi and fluid, and moistening and protecting the skin. Based on the theory of Xuanfu-collateral, this study aimed to clarify the etiology, pathogenesis, and treatment method of urticarial vasculitis. External assault by wind and Xuanfu blockage are believed to be the initiating factors of this disease. The malnutrition of Xuanfu and collaterals and accumulated dampness-heat are important links in the occurrence and development of urticarial vasculitis. It spreads from Xuanfu to the collaterals, and blockage of the collaterals is the immanent trend of this disease. Clinically, by closely adhering to the core pathogenesis of blockage of Xuanfu-collateral, treatment method such as using wind medicinals to open Xuanfu with pungent and dispersing properties, using the method of supplement deficiency and removing the blockage, and using medicinals to promote blood circulation and remove blood stasis to unblock the blocked collaterals. The herbs are flexibly added or subtracted to unblock Xuanfu and collaterals, harmonize qi and blood, thus all symptoms can be relieved. We hope that this study will provide new ideas for the treatment of urticarial vasculitis with traditional Chinese medicine.

Objective To examine the association between sleep and depressive symptoms among community-dwelling older adults and whether loneliness mediates this association.Methods Using a multistage sampling approach,we enrolled participants aged 60 years or older from two communities in Chengdu,China.A questionnaire was used to collect basic information,including age,sex,etc.,from the participants.In addition,loneliness,depressive symptoms,and sleep quality were assessed using a short-form University of California Los Angeles Loneliness Scale(ULS-8),the 10-item version of Center of Epidemiologic Studies Depression Scale(CESD-10),and the Pittsburgh Sleep Quality Index(PSQI),respectively.The Spearman rank correlation coefficient was employed to assess the correlations among social sleep,loneliness,and depression symptoms.Generalized structural equation modeling was used to assess the mediating effect of loneliness between sleep and depressive symptoms.Results Of the 1377 participants,32.03％(441)experienced loneliness and 30.57％(421)had depressive symptoms,with the median and interquartile range of their sleep quality being 6(3,9).Correlation analysis revealed statistically significant associations between sleep quality,loneliness,and depressive symptoms(P＜0.001).Generalized structural equation modeling analysis revealed that loneliness had a partial mediation effect on the association between sleep quality and depressive symptoms(b=0.075;95％CI,0.025-0.125;P＜0.05),accounting for 44.38％of the total effect(95％CI,0.258-0.630;P＜0.001).Conclusion Poor sleep quality is associated with a higher risk of depressive symptoms in community-dwelling older adults,with loneliness mediating the association.Further research on improving the sleep quality to mitigate depressive symptoms in older adults is warranted.Special attention should be given to older adults experiencing both poor sleep and loneliness.

Objective:To explore the effects of anhedonia, childhood abuse, and depression on suicidal ideation, and the mediating role of anhedonia in adolescents.Methods:A total of 7 431 middle school students were invited to participate in the study. Suicidal ideation, depression, childhood abuse, and anhedonia were assessed by the Positive and Negative Suicide Ideation Scale (PANSI), Self-Rating Depression Scale (SDS), Childhood Trauma Questionnaire (CTQ) and Temporal Experience of Pleasure Scale (TEPS); according to the score of suicidal ideation, a total score of 36 was used as the cut-off score, all students were divided into the group with suicidal ideation ( n=1 265) and the group without suicidal ideation ( n=6 166). Difference test was performed using independent sample t-test and χ 2 test; Correlation analysis was performed by Pearson correlation; The process macro program compiled by Hayes was used to conduct the regulated mediation model analysis; The mediation effect values and 95%bootstrap confidence intervals of depressive symptoms between childhood maltreatment and suicidal ideation were analyzed by the bootstrap method; Simple slope analysis was utilized to examine the interaction effects for depression and anhedonia. Results:The detection rate of adolescent suicidal ideation was 17.02% (1 265/7 431);Childhood abuse significantly positively predicted depression ( β=0.56, P<0.001); depression significantly positively predicted suicidal ideation ( β=0.59, P<0.001); depression and anhedonia interaction significantly predicted suicidal ideation ( β=-0.05, P<0.001); simple slope analysis indicates that low anhedonia depression predicted suicidal ideation ( β=0.51, P<0.001) than the high anhedonia group ( β=0.47, P<0.001). Conclusion:Depression partially mediates the effects of childhood abuse on suicidal ideation, and anhedonia modulates the effects of childhood abuse on suicidal ideation. As the level of anhedonia gradually increases, the predictive effect of depression on suicidal ideation gradually decreases.

Objective:To explore the effects of anhedonia, childhood abuse, and depression on suicidal ideation, and the mediating role of anhedonia in adolescents.Methods:A total of 7 431 middle school students were invited to participate in the study. Suicidal ideation, depression, childhood abuse, and anhedonia were assessed by the Positive and Negative Suicide Ideation Scale (PANSI), Self-Rating Depression Scale (SDS), Childhood Trauma Questionnaire (CTQ) and Temporal Experience of Pleasure Scale (TEPS); according to the score of suicidal ideation, a total score of 36 was used as the cut-off score, all students were divided into the group with suicidal ideation ( n=1 265) and the group without suicidal ideation ( n=6 166). Difference test was performed using independent sample t-test and χ 2 test; Correlation analysis was performed by Pearson correlation; The process macro program compiled by Hayes was used to conduct the regulated mediation model analysis; The mediation effect values and 95%bootstrap confidence intervals of depressive symptoms between childhood maltreatment and suicidal ideation were analyzed by the bootstrap method; Simple slope analysis was utilized to examine the interaction effects for depression and anhedonia. Results:The detection rate of adolescent suicidal ideation was 17.02% (1 265/7 431);Childhood abuse significantly positively predicted depression ( β=0.56, P<0.001); depression significantly positively predicted suicidal ideation ( β=0.59, P<0.001); depression and anhedonia interaction significantly predicted suicidal ideation ( β=-0.05, P<0.001); simple slope analysis indicates that low anhedonia depression predicted suicidal ideation ( β=0.51, P<0.001) than the high anhedonia group ( β=0.47, P<0.001). Conclusion:Depression partially mediates the effects of childhood abuse on suicidal ideation, and anhedonia modulates the effects of childhood abuse on suicidal ideation. As the level of anhedonia gradually increases, the predictive effect of depression on suicidal ideation gradually decreases.

Few studies have described the key features and prognostic roles of lung microbiota in patients with severe community-acquired pneumonia (SCAP). We prospectively enrolled consecutive SCAP patients admitted to ICU. Bronchoscopy was performed at bedside within 48 h of ICU admission, and 16S rRNA gene sequencing was applied to the collected bronchoalveolar lavage fluid. The primary outcome was clinical improvements defined as a decrease of 2 categories and above on a 7-category ordinal scale within 14 days following bronchoscopy. Sixty-seven patients were included. Multivariable permutational multivariate analysis of variance found that positive bacteria lab test results had the strongest independent association with lung microbiota (R² = 0.033; P = 0.018), followed by acute kidney injury (AKI; R² = 0.032; P = 0.011) and plasma MIP-1β level (R² = 0.027; P = 0.044). Random forest identified that the families Prevotellaceae, Moraxellaceae, and Staphylococcaceae were the biomarkers related to the positive bacteria lab test results. Multivariable Cox regression showed that the increase in α-diversity and the abundance of the families Prevotellaceae and Actinomycetaceae were associated with clinical improvements. The positive bacteria lab test results, AKI, and plasma MIP-1β level were associated with patients' lung microbiota composition on ICU admission. The families Prevotellaceae and Actinomycetaceae on admission predicted clinical improvements.
Acute Kidney Injury/complications* ; Bacteria/classification* ; Chemokine CCL4/blood* ; Community-Acquired Infections/microbiology* ; Humans ; Lung ; Microbiota/genetics* ; Pneumonia, Bacterial/diagnosis* ; Prognosis ; RNA, Ribosomal, 16S/genetics*

Objective:To investigate the effect and necessity of fine operation on the improvement of the preparation outcome of paclitaxel (albumin-binding) intravenous infusion for injection.Methods:The detailed refinement of the preparation method in the specification of paclitaxel (albumin-binding) for injection was developed. The fine operation of paclitaxel (albumin-binding) for injection mainly consists of two parts: The mixing method of solvent and drug: including syringe needle length into drug vial, solvent injection speed, state of drug waiting for dissolution, and the shaking speed of the drug vial. The method of extracting the dissolved liquid in the drug vial and injecting it into a 100 ml sterile empty 0.9% sodium chloride injection bottle: including the speed of refilling the 100 ml sterile empty 0.9% sodium chloride injection bottle, and restoring the pressure balance inside and outside the infusion bottle. The effect of fine operation on the preparation of paclitaxel (albumin-binding) for injection was evaluated by comparing the production of foam and the preparation time before and after the implementation of fine operation.Results:Before and after the implementation of fine operation, the foaming rate of the foam in the drug vial decreased from 28.57% (10/35) to 12.50% (12/96), the difference was statistically significant ( χ2 value was 4.471, P=0.029); and the foaming rate of the mixed liquid from the drug vial into the 100 ml sterile empty 0.9% sodium chloride injection bottle decreased from 46.15% (6/13) to 9.09% (3/33), the difference was statistically significant ( χ2 value was 8.140, P value was 0.004); and the preparation time of single drug was reduced by 3.37 minutes after the implementation of fine operation, the difference was statistically significant ( t value was 79.744, P<0.05). Conclusion:The preparation method of fine operation of paclitaxel (albumin-binding) for injection is operable, safe and reliable. After implementation, it can effectively reduce the production of foam in the drug vial and infusion bottle, improve the stability of drug preparation, shorten the preparation time, and ensure the safe, timely and effective medication for patients.

Objective To explore the relationship of quality of life with optimisms and sense of coherence in adult kidney transplant recipients. Method A total of 295 kidney transplant recipients participated in the study by a self-designed general questionnaire, revised life orientation test (LOT-R), sense of coherence (SOC-13) and the MOS 36-item short form health survey (MOS SF-36). Results The mean score of mental health scale (PCS) was 47.02±7.30, which differed with different age, employment status and transplant vintage (P ＜0.01). The mean score of phyical health scale (MCS) was 46.87 ±11.14, which differed with education, economic burden and transplant vintage (P ＜0.05). PCS and MCS were positively correlated with the total score of sense of coherence (52.05％) and optimism (23.45％) (P＜0.001). Optimism played a partially mediating role in the relationship between sense of coherence and quality of life. Conclusions The quality of life of kidney transplant recipients needs to be improved, which was at a low level.Optimism (medium to high level) and sense of coherence (medium to low level) are influencing factors of the quality of life. Improving accessment of mental state of patients with kidney transplant receients, paying more atentent and support to their mental change can improve their optimism and sense of coheherce and then life quiality.

Objective To detect the role of PAR2-PKA/PKCε signaling pathway in periphery neurons in the tran-sition from acute to chronic pain,and investigate the possible approach to prevent both acute and chronic pain simultane-ously. Methods SD rats were randomly divided into control group,sham model group,model group,iPAR2-1 group and iPAR2-2 group. The hyperalgesia priming model was established by injection of carrageenan and PGE2 into the left hind-paw except control and sham model group. PGE2 was administrated at 7 days after carrageenan injection. The PAR2 inhibi-tor was administrated before and after PGE2 injection separately in the iPAR2-1 group and iPAR2-2 group. The paw with-drawal thresholds(PWTs)of rats in each group was detected before and at 5 h,3 d,6 d,7 d 0.5 h,7 d 4 h,7 d 24 h after carrageenan injection. The expression level of PAR2, PKA and PKCε proteins in the dorsal root ganglion(DRG) were detected at 24 h after carrageenan injection. Results The hyperalgesia priming model was successfully generated. When PGE2 was administrated at 7 days after carrageenan injection, the hyperalgesia induced by PGE2 was significantly prolonged. The PWTs of rats in the model group were significantly lower than that of the control and sham model groups(P<0.01),though the PWTs of sham model group had no significant difference with the control on 7 d 24 h after carrageenan injection(P>0.05). The expression level of PAR2 and PKCε in the ipsilateral DRG neurons were significantly increased on 7 d 24 h after carrageenan injection,when compared with the control and sham model groups(P<0.05). PAR2 inhibi-tor prevented the prolonged hyperalgesia induced by PGE2(P<0.05)and decreased the PKCε expression in DRG neurons whenever it was given(P<0.05). However,PAR2 inhibitor did not regulate the acute inflammatory pain of PGE2 and the expression of PKA in DRG neurons(P>0.05). Conclusions Inhibition of the expression of PAR2 can prevent the tran-sition from acute to chronic pain. This effect may be related with the inhibitory effect on the activation of PAR2-PKCε sig-naling pathway in DRG neurons. However,inhibition of PAR2 can not regulate the acute pain. These may because of that the PAR2-PKA signaling pathway does not play a role in acute pain.

Objective To explore the effect of low-frequency electroacupuncture (EA) on neuropathic pain induced by spinal nerve injury and its underlying mechanism.Methods Thirty-two male Sprague-Dawley rats were randomly divided into a normal group,a sham spared nerve injury (SNI) group,an SNI group and an SNI+EA group,each of 8.The rats in the SNI and SNI+EA groups were given SNI surgery,while those of the sham-SNI group only had the sciatic nerve and its branches exposed without any lesion.EA at 2 Hz was applied over the ipsilateral Zusanli and Kunlun acupoints daily for 14 days after the surgery.The ipsilateral paw withdrawal threshold (PWT) was measured,along with protein kinase A (PKA) levels in the dorsal horn of the spinal cord,calcitonin gene-related peptide (CGRP) and substance P (SP) levels along with transient receptor potential V1 (TRPV1).Results Compared to the normal group,the SNI groups all showed significant decreases in their PWTs on the affected side and significant increases in PKA,TRPV1,CGRP and substance P on the affected side.Compared to SNI group,the average ipsilateral PWT in the SNI+EA group increased significantly after EA treatment,while PKA levels,TRPV1,CGRP levels and SP expression all decreased significantly.Conclusion Electroacupuncture at low frequency can effectively relieve neuropathic pain,perhaps through down-regulation of PKA in the spinal cord and by decreasing pain hypersensitivity related to CGRP and SP.

Objective To investigate the therapeutic effects and mechanisms of curcumin derivatives C66 treatment on hepatic fibrosis .Methods Thirty three C57BL/6J mice were randomly divided into 3 groups:normal control group ,model control group and curcumin derivatives C66 treatment group .Nine mice in normal control group were fed with water and food .Hepatic fibrosis model was induced in 24 mice by intraperitoneal injection of 40% carbon tetrachloride at a dose of 4 mL/kg for the first time ,followed by 2 mL/kg twice a week for 6 weeks . At week 6 ,6 mice were randomly selected to perform pathological examination to evaluate whether the hepatic fibrosis were successfully induced .Mice with hepatic fibrosis were randomized into model control group and curcumin derivatives C66 treatment group with 9 mice in each group .From week 6 on ,mice in the treatment group were lavaged with curcumin derivatives C66 at a dosage of 10 mg ·/(kg · d) .The rest mice were administered with equivalent dosage of 0 .5% carboxymethylcellulose sodium .Serum alanine aminotransferase (ALT) ,aspartate aminotransferase (AST ) and liver hydroxyproline ( Hyp ) contents were detected , and the semi‐quantitative analysis of liver fibrosis was performed by pathological examination in hepatic tissue by hematoxylin and eosin (HE) and Masson staining .The expressions of collagen Ⅰ ,α‐smooth muscle actin (α‐SMA) mRNA and collagen Ⅰ ,α‐SMA ,nuclear factor‐kappa B p65 (NF‐κB p65) ,inhibitor kappa B alpha (IκBα) protein in each group were detected by quantitative real‐time polymerase chain reaction (RT‐PCR) and Western blot .Data were analyzed with one‐way ANOVA analysis .Results The serum levels of ALT and AST in model control group ,C66 treatment group and normal control group were (202 .71 ± 19 .66 ) U/L , (233 .42 ± 23 .97 ) U/L ;(102 .00 ± 11 .04 ) U/L , (120 .87 ± 13 .83 ) U/L ;(36 .66 ± 6 .37) U/L and (43 .33 ± 8 .08)U/L ,respectively .The differences between model and normal control group were both significant (t=23 .96 and 22 .39 ,respectively ;both P<0 .05) .The C66 treatment group showed significantly lower levels of serum ALT and AST in contrast with model control group (t =11 .56 and 10 .52 ,respectively ;both P<0 .05) .Compared to the model control group ,hepatic Hyp contents in normal control group and C66 treatment group were significantly different (t= 17 .50 , P< 0 .05;t=11 .45 ,P<0 .05) .Collagen Ⅰand α‐SMA mRNA expressions in C66 treatment group were remarkably lower in contrast with that in model control group (t= 7 .23 and 7 .95 ,respectively ;both P< 0 .05) . Protein levels of Collagen Ⅰ ,α‐SMA and NF‐κB p65 decreased in C66 treatment group ,while IκBαincreased significantly (all P<0 .05) .Conclusion The application of C66 can contribute to the regression of liver fibrosis and the mechanism may rely on the regulation of NF‐κB expression .