Chronic obstructive pulmonary disease （COPD） is a heterogeneous disease characterized by incompletely reversible airflow limitation that progresses over time. Its recurrent and incurable nature imposes a significant health burden on patients. The pathogenesis of COPD is complex and has not been fully elucidated. Currently， Western medicine is commonly used in clinical treatment， which often yield suboptimal results and may lead to adverse reactions and drug resistance. Therefore， finding an effective and safe treatment method is a crucial focus in medical research. With the ongoing advancement in disease research， many scholars have discovered that traditional Chinese medicine （TCM） can target various signaling pathways such as nuclear factor-kappa B （NF-κB）， phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， mitogen-activated protein kinase （MAPK）， neurogenic locus notch homolog protein （Notch）， Janus kinase （JAK）/signal transducer and activator of transcription （STAT）， transforming growth factor-β （TGF-β）/Smad， secreted glycoprotein （Wnt）， Hippo， and nuclear factor erythroid 2-related factor 2 （Nrf2）. By influencing these pathways， TCM can affect airway mucus secretion， inhibit inflammation and oxidative stress， alleviate airway and microvascular remodeling， and regulate apoptosis and autophagy， ultimately reducing disease symptoms and improving lung function. TCM has thousands of years of clinical practice experience in treating COPD， demonstrating significant efficacy. Therefore， delving deeply into this from a cellular and molecular perspective can provide a reliable theoretical basis for the clinical application of TCM in treating COPD. However， systematic summaries of how TCM regulates COPD-related signaling pathways are scarce. This article aimed to extensively review and summarize recent literature in China and abroad on interventions of TCM monomers or compound prescriptions in COPD， identifying multiple related pathways to provide new insights for future clinical formulation and experimental research. Integrating basic TCM theories with modern pharmacological research mechanisms can jointly propel the development of TCM in the prevention and treatment of COPD.

Objective:To explore whether sivelestat sodium could reduce the expression of mucin 5AC (MUC5AC) in intrahepatic bile duct epithelial cells by inhibiting neutrophil elastase (NE) and thus provide new potential therapeutic ideas for the treatment of intrahepatic bile duct stone (IBDS).Methods:①Bioinformatics analysis: differential gene analysis was performed on gallbladder stone cholecystitis sequencing data based on the gene expression omnibus (GEO) to screen for significantly different genes related to neutrophils and mucins. The search tool for the retrieval of interacting genes database (STRING) was used for protein interaction analysis to predict whether there was an interaction between NE and MUC5AC genes. ②Animal experiment: a total of 18 male SD rats were divided into the sham-operated group, cholangitis model group and sivelestat sodium treatment group according to the random number table method, with 6 rats in each group. The cholangitis rat model was established by a one-time injection of 1.25 mg/kg lipopolysaccharide (LPS) into the right anterior lobe of the liver of rats in combination with the pre-experiment; the liver of the sham-operated group was injected with an equal volume of saline. After the modelling, 100 mg/kg of sivelestat sodium was injected into the tail vein of the cevalexin treatment group once a day for 5 days, and an equal volume of saline was injected into the tail vein of the sham-operated group and the cholangitis model group. Two weeks later, the rats were euthanized and their liver and bile duct tissues were taken. The pathological changes in the liver and bile duct tissues were observed under the light microscope. Immunohistochemical staining was used to detect the expressions of NE and MUC5AC in liver and bile duct tissues. The protein expressions of NE, MUC5AC and Toll-like receptor 4 (TLR4) were detected by Western blotting. ③Cell experiment: primary human intrahepatic biliary epithelial cell line (HiBEpiC) was divided into blank control group, NE group (10 nmol/L NE), NE+sivelestat sodium low dose group (10 nmol/L NE+1×10 -8 g/L sivelestat sodium 1 mL), NE+sivelestat sodium medium dose group (10 nmol/L NE+1×10 -7 g/L sivelestat sodium 1 mL), NE+sivelestat sodium high dose group (10 nmol/L NE+1×10 -6 g/L sivelestat sodium 1 mL). Cells were collected after 48 hours of culture, and EdU was performed to detect the proliferative activity of cells; enzyme linked immunosorbent assay (ELISA) and Western blotting were performed to detect the expression of MUC5AC in cells. Results:①Bioinformatics analysis: the NE gene (ELANE) had a reciprocal relationship with MUC5AC. ②Animal experiment: light microscopy showed that hepatocyte edema, hepatocyte diffuse point and focal necrosis, confluent area fibrous tissue and intrahepatic bile ducts hyperplasia and inflammatory cell infiltration in the cholangitis model group; hepatic lobule structure of sivelestat sodium treatment group was clear, and the degree of peripheral inflammatory cell infiltration was reduced compared with the cholangitis model group. Immunohistochemical staining showed that the expressions of NE and MUC5AC were increased in the cholangitis model group compared with the sham-operated group, and the expressions of NE and MUC5AC were decreased in the sivelestat sodium group compared with the cholangitis model group [NE ( A value): 5.23±2.02 vs. 116.67±23.06, MUC5AC ( A value): 5.40±3.09 vs. 23.81±7.09, both P < 0.05]. Western blotting showed that the protein expressions of NE, MUC5AC, and TLR4 in the hepatic biliary tissues of the cholangitis model group were significantly higher than those of the sham-operated group; and the protein expressions of NE, MUC5AC, and TLR4 in the liver biliary tissues of the sivelestat sodium treatment group were significantly higher than those of the sham-operated group (NE/β-actin: 0.38±0.04 vs. 0.70±0.10, MUC5AC/β-actin: 0.37±0.03 vs. 0.61±0.05, TLR4/β-actin: 0.39±0.10 vs. 0.93±0.15, all P < 0.05). ③Cell experiment: fluorescence microscopy showed that the proliferation of HiBEpiC cells in each group was good, and there was no significant difference in the proportion of positive cells. ELISA and Western blotting showed that the expressions of MUC5AC in cells of the NE group were significantly higher than those of the blank control group. The expressions of MUC5AC in the NE+different dose of sivelestat sodium group were significantly lower than those in the NE group, and showed a decreasing trend with the increase of sevastatin sodium concentration, especially in the highest dose group [MUC5AC (μg/L): 3.46±0.20 vs. 6.33±0.52, MUC5AC/β-actin: 0.45±0.07 vs. 1.75±0.10, both P < 0.05]. Conclusion:LPS can upregulate the expression of NE and MUC5AC in rats with cholangitis, while sodium sivelestat can reduce the expression of MUC5AC in in intrahepatic biliary epithelial cells by inhibiting NE, providing a new direction for the treatment of IBDS.

ObjectiveThrough a randomized， double-blind， double-simulation， positive-control， multicenter design， this study aimed to analyze the relationship between the dosage， efficacy， and safety of Pudilan anti-inflammatory oral liquid in treating acute pharyngitis/tonsillitis in adults caused by bacterial infection and validate the regulatory effect of Pudilan anti-inflammatory oral liquid on inflammatory markers such as serum amyloid A （SAA）， C-reactive protein （CRP）， white blood cells （WBC）， neutrophil percentage （NE%）， and erythrocyte sedimentation rate （ESR）， thereby exploring the feasibility of using Pudilan anti-inflammatory oral liquid as a substitute for antibiotics in the treatment of infectious diseases and providing a basis for rational clinical medication. MethodUsing a stratified randomized， double-blind， double-simulation， positive-control， multicenter design， 220 participants were enrolled from nine centers. The participants were randomly divided into three groups at 1∶1∶1 — a Pudilan anti-inflammatory oral liquid 20 mL group （73 cases）， a Pudilan anti-inflammatory oral liquid 10 mL group （73 cases）， and a control group （amoxicillin group， 74 cases）. The treatment course was 7 days. The study observed parameters including the total effective rate of sore throat， onset and disappearance time of sore throat， health status score， treatment time， and inflammation markers. Result①Dataset division： The 211 cases were included in the full analysis dataset （FAS）， 208 cases were included in the per-protocol dataset （PPS）， and 218 cases were included in the safety dataset （SS）. ② Efficacy evaluation： There were statistically significant differences （P<0.05） in the comparison of the three groups regarding the total effective rate of sore throat， disappearance time of sore throat， and health status. Both the 20 mL and 10 mL groups were non-inferior to the control group， and there was a statistically significant difference between the 20 mL and 10 mL dosage groups （P<0.05）. There was no statistically significant difference in the comparison of onset time of sore throat among the groups. CRP， WBC， and NE% of patients in all three groups significantly decreased on the 7^th day of treatment compared with those before treatment （P<0.01）. ③Safety evaluation： Adverse events mainly occurred in various examination indicators. There were no statistically significant differences in the comparison between groups， and no adverse reactions or serious adverse events occurred. ④Economic evaluation： The increased cost of the 10 mL and 20 mL dosage groups was entirely justified as compared with that in the control group. When comparing the 10 mL and 20 mL dosage groups， the 10 mL dosage group was deemed less advantageous. ConclusionPudilan anti-inflammatory oral liquid can be used alone as an alternative to antibiotics in the treatment of acute pharyngitis/tonsillitis caused by bacterial infection. It demonstrates good safety and can lower inflammation markers such as CRP， WBC， and NE%， suggesting its potential to reduce the body's inflammatory response. Its mechanism of action may be related to its multi-target regulatory mechanism.

Objective:To investigate the application effect of the blended teaching model of "intelligent teaching" and "wisdom learning" in the practice teaching of integrated traditional Chinese and Western medicine in internal medicine.Methods:According to the principle of randomization, 54 interns in Class 1 of integrated traditional Chinese and Western medicine in the grade of 2019 were selected as control group and received traditional teaching, and 56 interns in Class 2 were selected as observation group and received blended teaching with "intelligent teaching" and "wisdom learning". After 6 months of internship, the two groups were compared in terms of the scores of theoretical assessment (basic theoretical knowledge and professional theoretical knowledge), clinical practice ability [Leicester Assessment Package (LAP)], and degree of satisfaction with teaching. SPSS 17.0 was used to perform the t-test and the chi-square test. Results:At the end of internship, compared with the control group, the observation group had significantly higher score of basic theoretical knowledge (41.53±3.42 vs. 38.71±3.38, P<0.05), score of professional theoretical knowledge (39.49±3.14 vs. 37.85±3.07, P<0.05), LAP score (84.32±6.65 vs. 78.46±6.17, P<0.05), and degree of satisfaction with teaching ( P<0.05). Conclusion:For interns majoring in integrated traditional Chinese and Western medicine, the blended teaching model of "intelligent teaching" and "wisdom learning" can strengthen their mastery of theoretical knowledge, enhance their clinical practice ability, and improve their degree of satisfaction with teaching.

Bronchial asthma is a common heterogeneous chronic inflammatory disorder of airways characterized by airway hyperreactivity， mucus hypersecretion， and airflow obstruction. The incidence of asthma has been on the rise worldwide， and about 45.7 million adults in China suffer from asthma. Asthma is considered a costly disease， resulting in a significant economic and social burden. microRNAs （miRNAs） are long noncoding RNAs that regulate gene expression. They play a role in asthma through their activity in multiple immune and non-immune cell subsets. They impact multiple facets of critical cell function including cell survival， proliferation， and differentiation， which in turn induce the occurrence of airway spasm， mucus hypersecretion， and asthma symptoms. Traditional Chinese medicine has a long history in the treatment of asthma. Over the past a few decades， a growing number of herbs have proven effective in treating asthma in clinical trials or asthma inflammation in animal models. Chinese medicine has the features of multiple components and multiple targets. Evidence suggests that Chinese medicine and components of Chinese medicine can regulate immune homeostasis， improve airway inflammation and airway remodeling by modulating microRNA expression for asthma treatment. However， there is a lack of systematic and detailed reviews on the regulation of asthma-related microRNA expression by Chinese medicine. The article aims to review the correlation between microRNAs and asthma in animal experiments and clinical trials in recent years， as well as the mechanism of microRNA regulation by Chinese medicine in the treatment of asthma， with the intention of providing a reference for basic research and clinical application.

Pediatric cough is a heterogeneous condition in terms of symptoms and the underlying disease mechanisms. Symptom phenotypes hold complicated interactions between each other to form an intricate network structure. This study aims to investigate whether the network structure of pediatric cough symptoms is associated with the prognosis and outcome of patients. A total of 384 cases were derived from the electronic medical records of a highly experienced traditional Chinese medicine (TCM) physician. The data were divided into two groups according to the therapeutic effect, namely, an invalid group (group A with 40 cases of poor efficacy) and a valid group (group B with 344 cases of good efficacy). Several well-established analysis methods, namely, statistical test, correlation analysis, and complex network analysis, were used to analyze the data. This study reports that symptom networks of patients with pediatric cough are related to the effectiveness of treatment: a dense network of symptoms is associated with great difficulty in treatment. Interventions with the most different symptoms in the symptom network may have improved therapeutic effects.

OBJECTIVE: To assess the value of copy number variation analysis based on next generation sequencing (CNV-seq) in prenatal diagnosis for women at advanced maternal age. METHODS: A prospective analysis was carried out for women who underwent amniocentesis at 18~36 weeks of gestation for fetal CNV-seq for advanced maternal age. RESULTS: For 1461 unrelated Chinese women with a singleton pregnancy, CNV-seq was performed for all samples successfully. The proportion of chromosomal abnormalities was 2.3% (34/1461), of which 44.12% were submicroscopic copy number variations (<5 Mb). CONCLUSION Pregnant women at an advanced maternal age should be informed for not only common trisomies but all pathogenic chromosomal aberrations. NGS was a sensitive and accurate approach for detecting CNVs.
Chromosome Aberrations ; Chromosome Disorders ; DNA Copy Number Variations ; Female ; Humans ; Maternal Age ; Pregnancy ; Prenatal Diagnosis ; Prospective Studies

Objective To evaluate the effect of weak laser on treating hypertension,hyperglycemia,and hyperlipidemia.Methods A questionnaire-based survey was carrried out nationwide among the users of wrist-band weak laser irradiation.Changes in blood pressure,blood lipids,and blood glucose were analyzed before and after treatment.The influencial factors of antihypertensive effect of weak laser irradiation were analyzed by univariate and multivariate linear regression method.Results Questionnaire forms were returned from 5801 users,among whom 1335 patients with hypertension,180 patients with hyperglycemia,and 129 patients with hyperlipidemia entered the final analysis.After treatment,systolic blood pressure (SBP) (t =53.16,P ＜0.001),diastolic blood pressure (DBP) (t =34.17,P ＜ 0.001),triglycerides (TG) (t =7.87,P ＜0.001),total cholesterol (TC) (t =8.78,P ＜ 0.001),and fasting blood glucose (FBG) (t =11.64,P ＜0.001) were significantly decreased (compared with pre-treatment levels).Compared with the baseline,SBP,DBP,TG,TC and FBG fell by 23.3 mmHg (14.50％) (1 mmHg =0.133 kPa),10.6 mmHg (11.40％),0.86mmol/L (28.70％),1.11 mmol/L (18.00％),and 3.64 mmol/L (34.40％).The decrease of DBP in patients without insomnia was significantly higher than that in insomnia patients (F =9.54,P =0.00),and the decrease of DBP in non-drinkers was significantly higher than that in drinkers (F =5.08,P =0.02).The decrease of TG was significantly higher in males than in females (Z =2.48,P =0.01),in patients with mental stress than in those without stress (Z =-2.16,P =0.03),and in smokers than non-smokers (Z =-2.17,P =0.03).The median irradation time was 616 d (1-5479d).According to the irradiation time,the patients were further divided into four group:＜ 272d,272-698d,699-1435d,and ＞ 1437d.The SBP declined by (-22.25±16.22),(-21.59±15.24),(-24.96±16.82),and (-24.66±15.88) mmHg,respectively,in these four groups (F =3.55,P =0.01).Multivariate linear regression analysis showed that the influencial factors of SBP variation included gender (β =-0.08,P =0.0178) and irradiation time (β =-0.09,P =0.0016).The factors influencing the change of DBP were gender (β =-0.10,P =0.0039),insomnia (β =0.09,P =0.0015),and alcohol consumption (β =0.10,P =0.0033).Conclusion Long-time weak laser external irradiation has certain effectiveness in treating hypertension,hyperglycemia,and hyperlipidemia.

Objective To analyze the clinical features and risk factors of death in pediatric trauma,in order to provide preventing strategies and reduce mortality.Methods A retrospective study of 7936 traumatic children admitted to the emergency department of our hospital from April 2014 to March 2016 was conducted.We retrospectively summarized the clinical features and Logistic regression analysis was used to analyze the risk factors of death in children with trauma.Results Compared to females,male patients contributed higher percentages(1.73∶1).There were more migrant children(5535 cases) than local ones(2 401 cases)(χ2=14.314,P＜0.05).Children in infancy stage(2 024 cases)and toddler period(3 097 cases) were more than in the other periods.Limb[41.9%(3 324/7 936)] and skin injuries[38.5%(3 058 324/7 936)] were the most common.Children trauma causes varied with age,fall,tumble and traffic accidents were common causes of children trauma.Pediatric trauma score of surviving group(n=1933),death group(n=5),general ward group(n=1852) and ICU group(n=86) were 8.53± 2.17,3.17± 1.29,9.72± 1.25,5.23± 1.84,respectively.Shock decompensation,mechanical ventilation,Glasgow coma scale ≤7 and pediatric trauma score＜8 were the risk factors which caused the death of trauma.Conclusion Parents should improve the security sense,strengthen the care of children and obey the traffic rules to reduce the rate of children trauma.Clinicians should pay attention to shock decompensation,mechanical ventilation,Glasgow coma scale and pediatric trauma score in order to identify critically ill patients in early stage and improve the success rate of rescue.

Shuangdan oral liquid (SDO) containing radix Salviae miltiorrhizae (Chinese name Danshen) and cortex moutan (Chinese name Mudanpi) is a traditional Chinese medicine using for treating vascular diseases. Danshensu (DSS) is a main effective monomer composition derived from radix Salviae miltiorrhizae and paeonol (Pae) from cortex moutan. Although the two herbs are widely used in traditional Chinese medicine, the pharmacological functions of their active compositions were not reported. Therefore, the research of DSS and Pae in mechanisms and pharmacodynamics interaction can provide scientific evidence to support clinical application. The diabetic nephropathy (DN) rats which were induced by streptozotocin (STZ) were treated with SDO, DSS, Pae, and DSS+Pae for eight weeks. The positive effects on DN animal models were investigated by detection of physiological and biochemical indexes and oxidative stress markers, within five treatments: SDO, DSS, Pae, DSS+Pae and insulin group. Compared with the model group, the DSS+Pae group improved the renal function, blood lipid metabolism and blood viscosity, increased the vitality of T-SOD or T-AOC and decreased the level of MDA or NO after the treatment. The study was successfully showed that the DSS+Pae group could delay the process of DN, especially in the renal injury part of histopathology changes. Our results suggest that the co-administration of DSS and Pae significantly may play a protective role in DN rats through decreasing the oxidative stress and improving the blood lipid metabolism mechanisms.
Animals ; Blood Viscosity ; Diabetic Nephropathies* ; Insulin ; Lipid Metabolism ; Medicine, Chinese Traditional ; Models, Animal ; Oxidative Stress ; Rats* ; Salvia ; Streptozocin ; Vascular Diseases