The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

ObjectiveTo explore the sequential effects of hypoxic exercising on miR-27/PPARγ and lipid metabolism target gene and protein expression levels in the obesity rats’ liver. Methods13-week-old male diet-induced obesity rats were randomly divided into three groups (n＝10): normal oxygen concentration quiet group (N), hypoxia quiet group (H), hypoxic exercise group (HE). Exercise training on the horizontal animal treadmill for 1 h/d, 5 d/week for a total of 4 week, and the intensity of horizontal treadmill training was 20 m/min (hypoxic concentration was 13.6%). Comparison of the weights of perirenal fat and epididymal fat in rats across different groups and calculation of Lee’s index based on body weight and body length of rats in each group were done. And the serum concentrations of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) levels were detected. RT-PCR and Western Blot were used to detect the levels of miR-27, PPARγ, CYP7A1 and CD36. ResultsHypoxic exercise decreased the expression levels of miR-27 in the obese rats’ liver, however, the expression level of PPARγ was gradually increased. The expression levels of miR-27 in HE group were significantly lower than N group (P<0.05). The expression levels of PPARγ mRNA in N group were significantly lower than H group (P<0.05), especially lower than HE group (P<0.01). The protein expression of PPARγ protein in N group was significantly lower than that other groups (P<0.01). The expression of lipid metabolism-related genes and proteins increased in the obese rats’ liver. The expression of CYP7A1 mRNA in N group was significantly lower than H group (P<0.05), especially lower than HE group (P<0.01). The expression of CYP7A1 protein in the obese rats’ liver in N group was extremely lower than H group and HE group (P<0.01). The protein expression of CD36 in N group was significantly lower than that in HE group (P<0.05). Hypoxia exercise improved the related physiological and biochemical indexes of lipid metabolism disorder. The perirenal fat weight of obese rats in HE group was extremely lower than N group and H group (P<0.01), and the perirenal fat weight in N group was significantly higher than H group (P<0.05). The epididymal fat weight in N group was significantly higher than H group (P<0.05), and extremely higher than HE group (P<0.01). The Lee’s index in HE group was extremely lower than N group and H group (P<0.01). The serum concentration of TC in obese rats in HE group was extremely lower than N group and H group (P<0.01). The serum concentration of TG in HE group was extremely lower than N group and H group (P<0.01). The serum concentration of LDL-C in N group was extremely higher than HE group (P<0.01). The serum concentration of HDL-C in N group was extremely lower than H group (P<0.01). ConclusionHypoxia and hypoxia exercise may negatively regulate the levels of PPARγ by inhibiting miR-27 in the obese rats’ liver, thereby affecting the expression of downstream target genes CYP7A1 and CD36, and promoting cholesterol, fatty acid oxidation and HDL-C transport in the liver, and ultimately the lipid levels in obese rats were improved. The effect of hypoxia exercise on improving blood lipid is better than simple hypoxia intervention.

Objective To investigate the spatial distribution of Aedes albopictus in China at different time periods from 2000 to 2019, so as to provide insights into precise management of Ae. albopictus in China. Methods Data pertaining to the distribution of Ae. albopictus in China from 2000 to 2019 were collected through literature retrieval with terms of “Aedes albopictus”, “monitoring”, “survey”, “density”, “distribution”, and “outbreak” in national and international databases. The title and time of the publication, sampling sites, sampling time, mosquito capture methods, and mosquito species and density were extracted, and the longitude and latitude of sampling sites were obtained through Baidu Map. Meteorological element data at meteorological observation stations within China were obtained from the National Climatic Data Center of the United States, and the annual maximum temperature, annual minimum temperature, average temperature in January, average temperature in July, annual temperature range, daily temperature range and relative humidity were calculated and subjected to Kriging interpolation. Monthly cumulative precipitation grid data and monthly average temperature grid data with a resolution of 1 km for China from 2000 to 2019 were obtained from the National Tibetan Plateau Scientific Data Center, and the annual precipitation and annual average temperature were calculated cumulatively. Population density data in China from 2000 to 2019 were obtained from the WorldPop Hub, and the gross domestic product (GDP) in China was obtained from the Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences. The above data were divided into 5-year intervals to calculate data during the periods from 2000 to 2004, from 2005 to 2009, from 2010 to 2014, and from 2015 to 2019. Ae. albopictus distribution data were modeled in China from 2000 to 2019 and during each period with the classification random forest (RF) model, to predict the distribution of Ae. albopictus across the country and analyze the distribution of Ae. albopictus based on the seven major climate zones in China. The performance of RF models was evaluated by accuracy, precision, recall, and area under the receiver operating characteristic curve (AUC), and the importance of each feature in the RF model was evaluated with mean decrease accuracy (MDA). Results A total of 1 191 Chinese publictions and 391 English publications were retrieved, among which 580 articles provided detailed data on the sampling sites of Ae. albopictus and specific sampling years, meeting the inclusion criteria. A total of 2 234 Ae. albopictus sampling sites were included in China from 2000 to 2019, and RF modeling results showed that the overall Ae. Albopictus distribution area was mainly found in southeastern and southwestern provinces of China from 2000 to 2019, with scattered distribution in coastal areas of northeastern provinces, such as Liaoning Province. The accuracy, precision, recall and AUC of the RF model were 0.915 to 0.947, 0.933 to 0.975, 0.898 to 0.978, and 0.902 to 0.932 for the distribution of Ae. albopictus at different time periods from 2000 to 2019. Among all features in the RF models, population density was the most contributing factor to the distribution of Ae. albopictus in China, followed by GDP, and all meteorological variables contributed relatively less to the predictive power of the RF model. In China’s seven major climate zones, Ae. albopictus was almost entirely distributed in the marginal tropical humid region, the north subtropical humid region, and the warm temperate semi-humid region. The combined distribution area of these three zones accounted for 100.0% of the national distribution area from 2000 to 2004, from 2005 to 2009, and from 2010 to 2014, and 99.9% from 2015 to 2019, and the proportion of Ae. albopictus distribution area in the warm temperate semihumid region increased gradually from 20.2% to 30.2%. Conclusions Ae. albopictus is mainly distributed in the southeastern and southwestern provinces of China and is greatly influenced by population and economic factors. The warm temperate semi-humid region in China is gradually becoming a hot spot for the distribution of Ae. albopictus.

Objective To understand the individual radiation dose levels and changes of occupational external exposure among radiation workers in a steel group from 2020 to 2023, and to provide a basis for strengthening radiation protection in the group. Methods According to the Specifications for individual monitoring of occupational external exposure (GBZ 128-2019), individual monitoring was conducted using a thermoluminescent dosimeter, with each monitoring cycle lasting 90 days, totaling four cycles per year. Individual monitoring data of occupational external exposure among radiation workers in the steel group from 2020 to 2023 were collected for statistical analysis. Results A total of 5889 monitoring records were collected from radiation workers across 37 affiliated units of the steel group during the period of 2020-2023. The average annual effective dose was 0.150 mSv, the maximum annual effective dose was 3.84 mSv, and 0.3% monitored workers showed annual effective doses exceeding 1 mSv. The average annual effective dose in 2023 was 0.146 mSv, which was lower than in 2020 but higher than in 2021 and 2022 (Z = −6.657 to 14.129, P < 0.001). The number of monitored workers in industrial and medical sectors accounted for 86.9% and 13.1%, respectively. Their average annual effective doses were 0.152 mSv and 0.140 mSv, respectively, and the difference was statistically significant (Z = −7.969, P < 0.001). In the industrial sector, the average annual effective dose for the monitored workers in industrial radiography was significantly higher than other occupations (Z = −8.094, P < 0.001). There was a significant difference in average annual effective dose among workers of different occupational categories in the medical sector (H = 67.040, P < 0.001). The average annual effective doses were relatively high for diagnostic radiology and nuclear medicine. Additionally, the average annual effective doses for male and female radiation workers were 0.150 mSv and 0.152 mSv, respectively (P > 0.05). Conclusion The average annual effective dose of radiation workers in the steel group was at low levels for four consecutive years, which meet the requirements of the national standard. However, to maintain the individual radiation dose levels of radiation workers as low as reasonably achievable, it remains necessary to strengthen radiation protection management in the steel group.

Hypoxia-inducible factor (HIF-1α), a core transcription factor responding to changes in cellular oxygen levels, is closely associated with a wide range of physiological and pathological conditions. However, its differential impacts on vascular cell types and molecular programs modulating human vascular homeostasis and regeneration remain largely elusive. Here, we applied CRISPR/Cas9-mediated gene editing of human embryonic stem cells and directed differentiation to generate HIF-1α-deficient human vascular cells including vascular endothelial cells, vascular smooth muscle cells, and mesenchymal stem cells (MSCs), as a platform for discovering cell type-specific hypoxia-induced response mechanisms. Through comparative molecular profiling across cell types under normoxic and hypoxic conditions, we provide insight into the indispensable role of HIF-1α in the promotion of ischemic vascular regeneration. We found human MSCs to be the vascular cell type most susceptible to HIF-1α deficiency, and that transcriptional inactivation of ANKZF1, an effector of HIF-1α, impaired pro-angiogenic processes. Altogether, our findings deepen the understanding of HIF-1α in human angiogenesis and support further explorations of novel therapeutic strategies of vascular regeneration against ischemic damage.
Humans ; Vascular Endothelial Growth Factor A/metabolism* ; Endothelial Cells/metabolism* ; Transcription Factors/metabolism* ; Gene Expression Regulation ; Hypoxia/metabolism* ; Cell Hypoxia/physiology*

Objective To investigate the value of qualitative and quantitative characteristics of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI in preoperative prediction of vessels encapsulating tumor clusters(VETC)pattern in hepatocellular carcinoma(HCC).Methods A total of 234 patients diagnosed with HCC by pathology were analyzed retrospectively.A total of 101 VETC-positive HCC patients and 133 VETC-negative HCC patients were included.All patients were divided into training group and validation group according to 7︰3.The training group data were used to construct a prediction model for VETC-positive HCC.Receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to verify the diagnostic efficiency of the model.Calibration curve was drawn to verify the calibration of the model.Results Multivariate logistic regression analysis predicted the independent risk factors for VETC-positive HCC:portal phase peripheral washout[odds ratio(OR)6.493],necrosis or severe ischemia(OR 4.756),targetoid transitional phase or hepatobiliary phase(OR 0.307),and lesion to liver signal intensity ratio(LLR)on arterial phase(OR 0.074).The AUC of the training group in predicting VETC-positive HCC was 0.790[95%confidence interval(CI)0.720-0.859].The AUC of the validation group in predicting VETC-positive HCC was 0.779(95%CI 0.668-0.889).The calibration curve diagram showed that the calibration curve(the slope was 0.91)almost coincides with the ideal curve,indicating that the prediction model had better calibration.Conclusion The qualitative and quantitative characteristics of Gd-EOB-DTPA enhanced MRI can be used to predict VETC-positive HCC preoperatively,the independent risk factors of VETC include portal phase peripheral washout,necrosis or severe ischemia,targetoid transitional phase or hepatobiliary phase,and LLR on arterial phase.

Objective To study the population distribution characteristics and follow-up results of a health examination institution in Xinjiang.Methods 65 045 subjects who took physical examination in the Health Management Center of Xinjiang Medical University in 2022,and 4 665 subjects with important abnormal results were selected.The follow-up rules of important abnormal results class B were formulated,telephone notification and follow-up in January and June,and follow-up were recorded by follow-up information system.Results Of the 4665 cases,447 cases(9.58% )had important abnormal results of class A and 4 218 cases(90.42% )had important abnormal results of class B;there were 2 815 males(60.34% )and 1 850 females(39.66% ),indicating cases were higher in males than in females(P＜0.05);there was a correlation between age and impor-tant abnormal results(P＜0.05).The number of abnormal results in important sections of 41-50 years old(1 114 cases)and 51-60 years old(1 211 cases)accounted for a high proportion.4 457 cases(95.54% )were effectively notified,4 397 cases(98.65% )were effectively followed up after notification,and 60 cases(1.35% )lost follow-up.After telephone follow-up,2118 cases(48.17% )were treated and 2 279 cases(51.83% )were not treated.1 562(58.57% )ofmales who did not see a doctor,compared with 717(41.45% )of females,and there was statistical significance between sex and whether they saw a doc-tor or not(P＜0.05).There were 1 194 cases(56.40% )of non-tumor diseases,97 cases(4.5% )of malignant diseases and 827 cases(39.1% )of undefined diseases.Conclusion Significant abnormal results are higher in men than women,and the in-cidence of significant abnormalities increases with age.The notification and follow-up success rate in the implementation of the follow-up pathway should also be improved.The subjects did not fully understand and paid enough attention to the important abnormal outcome indicators(60.44% )or see a doctor in time according to the follow-up recommendations.Health education needs to be strengthened to improve their health awareness and urge them to get timely treatment,which was of great significance to improve the"early screening,early evaluation and early intervention"of the disease.

Objective:To assess the effect of low-dose esketamine on postoperative cognitive function in elderly patients undergoing non-cardiac surgery.Methods:One hundred and twenty-four patients, aged 65-80 yr, regardless of gender, with a body mass index of 18-35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, were assigned to either esketamine group (group E, n=64) or control group (group C, n=60) using a random number table method. Group E received intravenous esketamine at a dose of 0.5 mg/kg, while group C received an equal volume of normal saline intravenously. Anesthesia was induced with intravenous fentanyl, propofol and rocuronium and maintained using combined intravenous-inhalational anesthesia in both groups. Patient-controlled analgesia was carried out postoperatively. Cognitive function tests including a simple mental state examination, auditory word learning test, tracking connection test A and B, number symbol replacement test, Boston naming test and complex graph test were performed at 1 day before surgery and 30 days after surgery, and postoperative cognitive dysfunction was determined using Z-score method. Delirium was assessed using Confusion Assessment Method from 1 to 7 days after operation. The operative hypotension, postoperative delayed emergence, nausea and vomiting, and hallucinations were recorded. The recovery time of spontaneous breathing, eye opening to verbal command and extubation time were recorded. Results:Compared with group C, the incidence of cognitive dysfunction at 30 days after surgery and intraoperative hypotension was significantly decreased ( P<0.05), and no significant change was found in the recovery time of spontaneous breathing, eye opening to verbal command, extubation time, incidence of postoperative delayed emergence, delirium, nausea and vomiting, and hallucinations in group E ( P>0.05). Conclusions:Low-dose esketamine can improve postoperative cognitive function in elderly patients undergoing non-cardiac surgery.

Objective:To evaluate the role of aquaporin 4 (AQP4) in dexmedetomidine-induced reduction of blood-brain barrier permeability in mechanically ventilated mice and the relationship with protein kinase C (PKC).Methods:One hundred and fifty clean-grade healthy male C57BL6 mice, weighing 20-25 g, aged 8-12 weeks, were divided into 5 groups ( n=30 each) using a random number table method: control group (group C), mechanical ventilation group (group V), LY317615 group (group L), dexmedetomidine group (group D), and dexmedetomidine+ PMA group (group DP). Group C spontaneously breathed air for 6 h. The animals were mechanically ventilated for 6 h in group V. PKC inhibitor LY3176 15 μg/kg was intraperitoneally injected at 30 min before mechanical ventilation in group L. Dexmedetomidine 50 μg/kg was intraperitoneally injected at 30 min before mechanical ventilation in D and DP groups. PKC activator PMA 15 μg/kg was intraperitoneally injected at 60 min before mechanical ventilation in group DP. Mice were anesthetized at 1 day after mechanical ventilation, then sacrificed and hippocampal tissues were taken for microscopic examination of pathological changes in the hippocampal CA1 and CA3 areas (with a light microscope). Brain tissues were also taken to measure the water content and content of Evans blue (EB) and to detect the expression of PKC and AQP4 (by Western blot). The cognitive function was evaluated using a novel object recognition task at 3 days after mechanical ventilation. Results:Compared with group C, the water content and EB content of brain tissues were significantly increased after mechanical ventilation, the expression of PKC and AQP4 in brain tissues was up-regulated, the percentage of novel object exploration and discrimination index were decreased ( P<0.05), and the histopathological damage in the hippocampal CA1 and CA3 areas was aggravated in group V and group DP. Compared with group V, the water content and EB content of brain tissues were significantly decreased after mechanical ventilation, the expression of PKC and AQP4 in brain tissues was down-regulated, the percentage of novel object exploration and discrimination index were increased ( P<0.05), and the histopathological damage in the hippocampal CA1 and CA3 areas was significantly attenuated in group D and group L. Compared with group D, the water content and EB content of brain tissues were significantly increased after mechanical ventilation, the expression of PKC and AQP4 in brain tissues was up-regulated, the percentage of novel object exploration and discrimination index were decreased ( P<0.05), and the histopathological damage in the hippocampal CA1 and CA3 areas was aggravated in group DP. Conclusions:AQP4 is involved in dexmedetomidine-induced reduction of blood-brain barrier permeability in mechanically ventilated mice, and the mechanism is related to inhibiting activation of PKC.

BACKGROUND:Talus cartilage injury is a common motor system disease.This type of injury will affect the patient's daily life and work ability,and may worsen the condition if left untreated.Surgical treatment is commonly used,but the selection of surgical methods and the evaluation of medium-and long-term follow-up results have always been difficult clinical problems. OBJECTIVE:To explore the influence of T1ρ technique on the range of quantitative evaluation of talus osteochondral injury on the choice of surgical method and the results of medium-and long-term follow-up. METHODS:A total of 154 patients with osteochondral injury of talus admitted to The Second Hospital of Tangshan from January 2019 to August 2022 were retrospectively selected as the study subjects.The lesion site of talus was examined by MRI before operation,and the T1ρ and T2 values of different types were compared.Different surgical methods were selected according to the different T1ρ values.Group A(n=73)was treated with microfracture surgery with T1ρ<45 ms;group B(n=81)was treated with autogenous bone and cartilage transplantation with T1ρ≥45 ms.The general clinical characteristics and curative effects of patients under different surgical methods were compared;the important factors of postoperative recurrence were analyzed by multivariate Logistic regression,and the relationship between T1ρ value and postoperative recurrence was analyzed by restricted cubic spline graph,y=1-1/(1+e-z)regression equation to build a prediction model.The stability of the model was verified by cross-checking method. RESULTS AND CONCLUSION:(1)Classification of talus osteochondral injury in 154 patients(type Ⅰ:36 cases;type Ⅱ:37 cases;type Ⅲ:40 cases;type Ⅳ:41 cases),T1ρ and T2 values of the four groups were statistically significant(P<0.05);pairwise comparison was also statistically significant(all P<0.05).(2)After treatment of 154 patients,7 cases(4.6％)had local swelling,3 cases(2.0％)had pain aggravation,and 5 cases(3.3％)had wound infection.There were 2 cases(1.3％)with poor cartilage healing.(3)After treatment,there were statistically significant differences between groups A and B in terms of American Orthopaedic Foot&Ankle Society score,visual analog scale score,plantar flexor motion range,dorsoextension motion range,subchondral bone marrow edema volume,interleukin-6,interleukin-8,C-reactive protein,procalcitonin,platelet-derived growth factor,transforming growth factor-β1,and efficacy(P<0.05).The total effective rate of group B(90％)was higher than that of group A(85％)(P<0.05).(4)Age(OR=1.589,95％CI:0.305-1.252,P=0.036),interleukin-6(OR=1.737,95％CI:0.974-5.254,P=0.049),interleukin-8(OR=1.385,95％CI:1.066-4.355,P=0.034),C-reactive protein(OR=1.957,95％CI:1.323-2.178,P=0.035),transforming growth factor-β1(OR=1.459,95％CI:0.897-2.455,P=0.038),T1-ρ(OR=1.687,95％CI:0.854-3.321,P=0.026),T2(OR=1.843,95％CI:0.657-2.454,P=0.036),complications(OR=1.719,95％CI:0.654-3.464,P=0.019),and classification of osteochondral injury of talus(OR=3.789,95％CI:1.023-5.897,P=0.028)were independent risk factors for postoperative recurrence.Microfracture surgery(OR=0.751,95％CI:0.321-1.264,P=0.012)and autogenous bone and cartilage grafting(OR=0.649,95％CI:0.246-1.356,P=0.023)were independent protective factors for recurrence after medium-and long-term follow-up.(5)When T1ρ value≤35 ms,the risk of postoperative recurrence decreased rapidly,and when T1ρ value>35 ms,the risk of postoperative recurrence increased rapidly.(6)Further stepwise regression analysis showed that these nine risk factors were most closely associated with postoperative recurrence,and the formula for postoperative recurrence was obtained.The probability of postoperative recurrence was calculated using the regression equation.When P=0.75,the maximum value of Jorden index was 77.728,indicating that the model has a better prediction effect.(7)It is indicated that the quantitative evaluation of T1ρ before operation can effectively guide the selection of surgical methods,improve the success rate of surgery and the quality of life of patients.