ObjectiveTo evaluate the clinical efficacy of modified Houpo Dahuangtang in moderate and severe acute respiratory distress syndrome （ARDS） patients with phlegm-heat accumulation，and monitor the pulmonary ventilation changes of patients before and after treatment by electrical impedance tomography（EIT）. MethodThe 62 cases of moderate and severe ARDS patients with phlegm-heat accumulation who required mechanical ventilation in the department of intensive care unit （ICU） in Chongqing Hospital of Traditional Chinese Medicine from September 2021 to June 2022 were selected，and divided into an experimental group（31 cases）and a control group（31 cases）using a random number table. On the basis of regular Western medicine treatment，the experimental group received modified Houpo Dahuangtang and the control group received warm water by a nasogastric tube for seven days. The changes in the clinical efficacy of traditional Chinese medicine（TCM），the oxygenation index［arterial oxygen partial pressure （PaO₂）/fractional inspired oxygen（FiO₂），P/F］，lactic acid（Lac），acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score，compliance，plateau pressure，gas distribution parameters monitored by EIT（Z1，Z2，Z3 and Z4），inflammatory factors［interleukin-6 （IL-6），IL-10， tumor necrosis factor-α （TNF-α） and C-reactive protein （CRP）］ of both groups before and after treatment were recorded. Besides， the mechanical ventilation time， length of stay in ICU， 28-day mortality and incidence of adverse reactions（delirium，abdominal pain and diarrhea）in the two groups were also observed. ResultThere was no significant difference in the baseline indexes of patients in the two groups，and thus the two groups were comparable. After treatment for one week， the total effective rate for TCM syndromes in the experimental group was 90.30%（28/31）， higher than the 67.74%（21/31）in the control group（Z=-2.415，P<0.05）.Compared with the same group before treatment， the plateau pressure and Lac decreased （P<0.01）and the compliance and P/F increased （P<0.01） in experimental group， while the Lac decreased （P<0.05）and the P/F increased （P<0.05）， and the compliance and plateau pressure did not change significantly in the control group. After treatment，the plateau pressure and inflammatory factors in the experimental group were lower than those in the control group（P<0.05）， but the compliance and P/F in the experimental group were higher than those in the control group（P<0.05）， and the gas distribution parameters Z1，Z2，Z3，Z4，Z1+Z2，and Z3+Z4 monitored by EIT in the experimental group were all higher than those in the control group （P<0.05）. There was no significant difference in mechanical ventilation time， ICU hospitalization time， 28-day mortality， delirium， abdominal pain， diarrhea and other adverse reactions between the two groups. ConclusionModified Houpo Dahuangtang can significantly improve the P/F，pulmonary ventilation in gravity-dependent regions and pulmonary compliance，reduce the release of inflammatory factors in moderate and severe ARDS patients. Compared with conventional methods，EIT can timely monitor the pulmonary ventilation changes in ARDS patients，which suggests its clinical feasibility.

Improving the reproducibility of biomedical research results is a major challenge. Transparent and accurate reporting of the research process enables readers to evaluate the reliability of the research results and further explore the experiment by repeating it or building upon its findings. The ARRIVE 2.0 guidelines, released in 2019 by the UK National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), provide a checklist that is applicable to any in vivo animal research report. These guidelines aim to improve the standardization of experimental design, implementation, and reporting, as well as enhance the reliability, repeatability, and clinical translation of animal experimental results. The use of the ARRIVE 2.0 guidelines not only enriches the details of animal experimental research reports, ensuring that information on animal experimental results is fully evaluated and utilized, but also enables readers to understand the content expressed by the author accurately and clearly, promoting the transparency and completeness of the fundamental research review process. At present, the ARRIVE 2.0 guidelines have been widely adopted by international biomedical journals. This article is based on the best practices following the ARRIVE 2.0 guidelines in international journals, and it interprets, explains, and elaborates in Chinese the fifth part of the comprehensive version of the ARRIVE 2.0 guidelines published in PLoS Biology in 2020 (the original text can be found at https://arriveguidelines.org). This section includes the items 6-11 of Recommended 11 section, covering "Animal Care and Monitoring", "Interpretation/Scientific Implications", "Generalisability/Translation", "Protocol Registration", "Data Access" and "Declaration of Interests". Its aim is to promote a comprehensive understanding and use of the ARRIVE 2.0 guidelines among domestic researchers, to enhance the standardization of experimental animal research and reporting, and to promote high-quality development of experimental animal sciences and comparative medicine research in China.

Dysfunction of nuclear receptors(NRs),which are critical for maintaining renal lipid homeostasis,largely contributes to the progression of diabetic nephropathy(DN)by promoting renal lipid accumulation.However,there are few thera-pies in modern medicine that effectively inhibit re-nal lipid accumulation by modulating NRs.In this review,we first summarize recent advances in NRs-mediated renal lipid accumulation in DN.Then,we summarize recent studies on the effects and mech-anisms of Chinese herbal medicines on DN and highlight the effects of Chinese herbal medicines on renal lipid accumulation via NRs.In addition,the advantages and limitations of traditional Chi-nese medicine in the treatment of DN via NRs-me-diated renal lipid accumulation are analyzed,and the modulation of renal lipid accumulation via NRs is emphasized as a promising therapeutic strategy for the treatment of DN.

Objective:To investigate the predictive value of thrombus enhancement (TE) and thrombus permeability in cardioembolic thrombus with acute middle cerebral artery occlusion based on CT.Methods:The clinical and image data of 93 patients with acute middle cerebral artery occlusion who were admitted to the First Affiliated Hospital of Soochow University within 12 hours after onset from January 2020 to July 2022 were retrospectively analyzed. According to the TOAST criteria, the patients were divided into the cardioembolism (CE) group (43 cases) and the large artery atherosclerosis (LAA) group (50 cases). All patients received noncontrast CT and CT angiography, and then thrombus permeability [thrombus attenuation increase (TAI), void fraction (ε)] and TE were assessed. Independent sample t-test, Mann-Whitney U test and χ2 test were used in univariable analysis between two groups. Multivariable logistic regression analysis was used to explore the independent influencing factors for cardioembolic stroke and establish a logistic model. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive value of TAI, ε, TE and the logistic model in cardioembolic thrombus with acute middle cerebral artery occlusion. Results:There were statistically significant differences in sex, atrial fibrillation, hypertension, diabetes mellitus, smoking, baseline National Institutes of health stroke scale (NIHSS), TAI, ε and TE between the CE group and the LAA group ( P<0.05). Binary logistics regression analysis showed that TAI (OR=1.300, 95%CI 1.147-1.473, P<0.001), hypertension (OR=0.116, 95%CI 0.025-0.535, P=0.006) and baseline NIHSS (OR=1.165, 95%CI 1.040-1.304, P=0.008) were independent influencing factors for cardioembolic thrombus. The ROC curve indicated that the logistic model predicted cardioembolic thrombus with the highest AUC of 0.907 (95%CI 0.848-0.966). TE predicted cardioembolic thrombus with the highest sensitivity of 90.7%. Conclusion:TE and thrombus permeability have application value for predicting cardioembolic thrombus with acute middle cerebral artery occlusion based on CT.

Improving the reproducibility of biomedical research results is a major challenge.Researchers reporting their research process transparently and accurately can help readers evaluate the reliability of the research results and further explore the experiment by repeating it or building upon its findings. The ARRIVE 2.0 guidelines, released in 2019 by the UK National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), provide a checklist applicable to any in vivo animal research report. These guidelines aim to improve the standardization of experimental design, implementation, and reporting, as well as the reliability, repeatability, and clinical translatability of animal experimental results. The use of ARRIVE 2.0 guidelines not only enriches the details of animal experimental research reports, ensuring that information on animal experimental results is fully evaluated and utilized, but also enables readers to understand the content expressed by the author accurately and clearly, promoting the transparency and integrity of the fundamental research review process. At present, the ARRIVE 2.0 guidelines have been widely adopted by international biomedical journals. This article is a Chinese translation based on the best practices of international journals following the ARRIVE 2.0 guidelines in international journals, specifically for the complete interpretation of the ARRIVE 2.0 guidelines published in the PLoS Biology journal in 2020 (original text can be found at https://arriveguidelines.org). The third part of the article includes the items 8-10 of ARRIVE 2.0 Essential 10, which covers "experimental animals" "experimental procedures" and "results". Its aim is to promote the full understanding and use of the ARRIVE 2.0 guidelines by domestic researchers, enhance the standardization of experimental animal research and reporting, and promote the high-quality development of experimental animal technology and comparative medicine research in China.

ObjectiveTo investigate the efficacy of Bushen Shengxue prescription and Yiqi Yangxue prescription in the treatment of chronic aplastic anemia and the effect on T cell subsets and the expression of T-box expressed in T cells （T-bet） and GATA binding protein 3 （GATA3）. MethodA total of 585 patients with chronic aplastic anemia who were treated in 19 hospitals in China from May 2018 to June 2021 were enrolled. With the prospective， double-blind and randomized control methods， the patients were randomized into three groups： kidney deficiency group， Qi and blood deficiency group， and control group. The three groups were respectively treated with Bushen Shengxue prescription granule， Yiqi Yangxue prescription granule， and Placebo （half the dose of Bushen Shengxue formula granules）. In addition， all of them were given oral cyclosporin and androgen. The treatment lasted 6 months， with 3 months as a course. The blood routine indexes， T cell subsets， and fusion genes T-bet and GATA3 before and after treatment were analyzed， and the safety indexes were monitored. ResultDuring the observation， a total of 75 cases dropped out and 18 were rejected. Finally， 161 cases in the kidney deficiency group， 164 in the Qi and blood deficiency group， and 167 in the control group were included. After 6 months of treatment， the total effective rate was 98.8% （159/161） in the kidney deficiency group， which was higher than the 79.9% （131/164） in the Qi and blood deficiency group （χ²=30.135， P<0.01） and the 61.7% （103/167） in the control group （χ²=70.126， P<0.01）. The total effective rate was higher in the Qi and blood deficiency group than in the control group （χ²=13.232， P<0.01）. After treatment， the hemoglobin （HGB） content increased significantly in three groups （P<0.05） as compared with that before treatment， particularly the kidney deficiency group （P<0.01）. After treatment， the white blood cell （WBC） count and platelet （PLT） count in the kidney deficiency group and the control group increased compared with those in the Qi and blood deficiency group （P<0.01）. There was no specific difference in neutrophils （ANC） after treatment among the three groups. At the same time point， the level of T helper type 1 （Th1） cells， Th1/Th2 ratio （P<0.05）， level of CD4⁺， and CD4⁺/CD8⁺ ratio （P<0.05） were significantly low in the kidney deficiency group among three groups. There was no significant difference in CD19^-， HLA/DR⁺， and CD25⁺ between the kidney deficiency group and the other two groups， but the T-bet of the kidney deficiency group and the control group was lower than that of the Qi and blood deficiency group （P<0.05）. ConclusionBushen Shengxue prescription exerts therapeutic effect on the aplastic anemia by improving the immunoregulatory mechanism， inhibiting the activity of immune system， modulating T cell subsets， suppressing Th1 and CD4⁺， and promoting bone marrow hematopoiesis. Moreover， it is safe with little side effects， which is worthy of further promotion.

Tocilizumab has been reported to attenuate the "cytokine storm" in COVID-19 patients. We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment. We conducted a randomized, controlled, open-label multicenter trial among COVID-19 patients. The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone. The cure rate, changes of oxygen saturation and interference, and inflammation biomarkers were observed. Thirty-three patients were randomized to the tocilizumab group, and 32 patients to the control group. The cure rate in the tocilizumab group was higher than that in the control group, but the difference was not statistically significant (94.12% vs. 87.10%, rate difference 95% CI-7.19%-21.23%, P = 0.4133). The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12 (P = 0.0359). In moderate disease patients with bilateral pulmonary lesions, the hypoxia ameliorated earlier after tocilizumab treatment, and less patients (1/12, 8.33%) needed an increase of inhaled oxygen concentration compared with the controls (4/6, 66.67%; rate difference 95% CI-99.17% to-17.50%, P = 0.0217). No severe adverse events occurred. More mild temporary adverse events were recorded in tocilizumab recipients (20/34, 58.82%) than the controls (4/31, 12.90%). Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative. For patients with bilateral pulmonary lesions and elevated IL-6 levels, tocilizumab could be recommended to improve outcome.
Antibodies, Monoclonal, Humanized ; COVID-19/drug therapy* ; Humans ; SARS-CoV-2 ; Treatment Outcome

Objective: To explore the expression of amphiregulin (AREG) in nasal polyps patients with different degrees of eosinophil infiltration, and to analyze the correlation between AREG and tissue remodeling. Methods: Forty-eight patients underwent endoscopic sinus surgery in the Department of Otorhinolaryngology Head and Neck Surgery, Remin Hospital, Wuhan University from July 2017 to August 2018 were recruited, including 40 males and 8 females, aged from 16 to 60 years old. The subjects were divided into three groups: control group (n=14), eosinophilic chronic sinusitis with nasal polyps (ECRSwNP) group (n=19) and noneosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP) group (n=15). The relative expression of AREG in nasal mucosa was detected by Western blot assay and immunohistochemical staining. Tissue remodeling was detected by HE staining, AB-PAS staining and Masson staining. Kruskal-Wallis test was used for comparison among multiple groups, and Spearman correlation analysis was conducted between the expression level of AREG and the related indexes of tissue remodeling. Results: The expression of AREG in ECRSwNP group was significantly higher than that in non-ECRSwNP group and control group (median protein expression of Western blot was 1.592 vs 0.617 vs0.582, all P<0.05). The degree of epithelial injury and goblet cell metaplasia in ECRSwNP group was significantly higher than that in control group (all P<0.05), the percentage of collagen fibrosis area in ECRSwNP group was significantly lower than that in control group (P=0.01). In chronic rhinosinusitis with nasal polyps (CRSwNP) patients, the area of mucous glands was negatively correlated with the expression of AREG (r=-0.616, P<0.05), and the percentage of collagen fibrosis area was negatively correlated with the expression of AREG (r=-0.738, P<0.05). Conclusion The expression of AREG is higher in ECRSwNP patients, which is related to the process of tissue remodeling.

Objective To investigate the CT imaging features of basal cell adenoma in the parotid gland and thus to improve the preoperative diagnostic accuracy.Methods The clinical materials and image findings of 8 cases with parotid basal cell tumor,which were proved by pathology,were retrospectively studied.Results All 8 patients had solitary BCA lesion,which involved both the superficial and deep lobe(n =1) and located at the superficial lobe of parotid gland(n =7).All the 6 tumors were clear boundary and round shape without lobular appearance.The diameters of the max lesions ranged from 10.3-27.6 mm.CT scan showed that all lesions were solid nodules with uniform or uneven density.Cystic degeneration was displayed in 5 lesions,among them,cystic area was ≥90％ in 1 lesion.At enhanced scanning phase,most tumors showed a strong enhancement at the arterial phase and a pattern of persistent strong enhancement or slow decline at the venous phase.Conclusion The multi-slice CT imaging features of BCA in parotid gland are characteristic,which is helpful to make qualitative diagnosis in combination with clinical materials.

Objective To study the distribution characteristics of intraperitoneal free gas and the location value of the site of gastrointestinal perforation using multi-slice CT (MSCT).Methods 60 cases of gastrointestinal perforation were retrospectively collected.The distribution of the intraperitoneal free gas in CT image was analyzed and observed.The digestive tract were divided to the upper digestive tract and the lower digestive tract by Treitz ligament.The distribution of the intraperitoneal free gas was analyzed using χ2 test.The distribution of the intraperitoneal free gas between each different perforational site was analyzed.Results 38 cases of the site of gastrointestinal perforation located in upper gastrointestinal tract and 22 cases located in lower gastrointestinal tract,there was statistically significant difference between the upper digestive tract and the lower digestive tract about the distribution of the intraperitoneal free gas(χ2=22.33,P<0.001).In the cases of upper gastrointestinal tract perforation,13 cases of the site located in stomach and 25 cases located in doudenum,there was no statistically significant difference between stomach and duodenum(χ2=1.97,P>0.05).In the cases of lower gastrointestinal tract perforation,11 cases of the site located in bowel and 11 cases located in colon,there was statistically significant difference between bowel and colon(χ2=8.98,P<0.05).Conclusion The MSCT distribution of the intraperitoneal free gas has important value in localization diagnosis of gastrointestinal perforation.