1.Applicability of ratio of white blood cell-to-platelet counts in early screening for radiation-induced thymic lymphoma in mice
Ruoxi MENG ; Zhangyi OUYANG ; Yajun SHAN ; Xinyu LIU ; Yang CHEN ; Limei WANG ; Yuwen CONG
Military Medical Sciences 2024;48(5):340-346
		                        		
		                        			
		                        			Objective To evaluate the ability of the ratio of peripheral blood white blood cell(WBC)counts to platelet counts to predict the onset of radiation-induced thymic lymphoma(TL)in a mouse model.Methods Mice were subjected to fractionated total-body irradiation(TBI)to established a TL model before the changes of the WBC-to-platelet ratio during the development and progression of TL were investigated.Four-week-old male C57BL/6J mice were randomized into the normal(non-irradiation)group and radiation exposure group that was subjected to 1.8 Gy TBI once weekly for four consecutive weeks.The survival and TL-incidence of those two groups were compared within 370 days of TBI.Histomorphology and hematoxylin & eosin(H&E)staining of the thymus were used for definite diagnosis of TL while flow cytometry was adopted to detect the frequency changes of T cells in the thymus,bone marrow and spleen.Peripheral blood(PB)cell counts were measured to analyze the changes of peripheral hemogram during TL pathogenesis.Results No mice in the normal group were diagnosed with TL while 83%of the irradiated mic suffered from TL within 370 days of fractionated TBI(P<0.0001).Using histopathologic technology,medium-sized tumor cells were observed in the thymus of irradiated mice diagnosed with TL.Cytometric analysis showed decreased frequencies of CD4 mono-positive cells and increased frequencies of CD8 mono-positive cells in the thymus,bone marrow and spleen of mice diagnosed with TL.PB analysis displayed a significant increase in the WBC-to-platelet ratio one week prior to the TL-caused death in the irradiated mice(P<0.01).Conclusion Elevation of the peripheral blood WBC-to-platelet ratio can help predict the onset of IR-induced TL of mice.
		                        		
		                        		
		                        		
		                        	
2.Serum S100A4,FNDC5 levels in patients with gestational diabetes mellitus and their relationship with pregnancy outcome
Jing LIU ; Cong ZHOU ; Shan HE
International Journal of Laboratory Medicine 2024;45(13):1617-1621,1626
		                        		
		                        			
		                        			Objective To investigate the serum S100 calcium-binding protein A4(S100A4)and fibronectin type Ⅲ domain-containing 5(FNDC5)levels in patients with gestational diabetes mellitus(GDM)and their relationship with pregnancy outcomes.Methods From June 2020 to June 2022,a total of 126 patients with GDM in the hospital were included into GDM group,and 126 healthy pregnant women who underwent prena-tal check ups during the same period were selected as the control group.According to the pregnancy outcome of GDM patients,they were grouped into a good pregnancy outcome group(76 cases)and a adverse pregnancy outcome group(50 cases).The levels of S100A4 and FNDC5 were detected by enzyme linked immunosorbent assay(ELISA).Multivariate Logistic regression analysis was applied to analyze the influencing factors of pregnancy outcome in GDM pregnant women.Receiver operating characteristic(ROC)curve was applied to e-valuate the value of serum S100A4 and FNDC5 in predicting adverse pregnancy outcomes in GDM pregnant women.Spearman correlation analysis was applied to analyze the correlation between serum S100A4,FNDC5 and adverse pregnancy outcomes.Results The serum S100A4 level in GDM group was higher than that in control group(P<0.05),while the serum FNDC5 level was lower than that in control group(P<0.05).The serum S100A4 level in the good pregnancy outcome group was lower than that in the adverse pregnancy out-come group(P<0.05),while the serum FNDC5 level was higher than that in the adverse pregnancy outcome group(P<0.05).Spearman correlation analysis showed that serum S100A4 level in GDM patients was posi-tively correlated with adverse pregnancy outcomes(P<0.05),while FNDC5 level was negatively correlated with adverse pregnancy outcomes(P<0.05).Logistic regression analysis showed that serum S100A4,fasting blood glucose,and HOMA-IR were risk factors for adverse pregnancy outcomes in GDM patients(P<0.05),and FNDC5 was a protective factor for adverse pregnancy outcomes in GDM patients(P<0.05).The area un-der the curve of the combination of serum S100A4 and FNDC5 in predicting pregnancy outcomes in GDM was greater than that of S100A4 alone(Z=2.045,P=0.041)and FNDC5 alone(Z=2.010,P=0.044).Conclu-sion The level of S100A4 in the serum of GDM patients is high,and the level of FNDC5 is low.Both have certain reference value for evaluating the pregnancy outcome of GDM pregnant women.
		                        		
		                        		
		                        		
		                        	
3.Correlation between serum miR-29a-3p,THBS2 and cardiopulmonary function in children with chronic pulmonary heart disease
Rui LIU ; Yanli LUO ; Cong TIAN ; Lifen GAO ; Shan LI ; Yi HAN
International Journal of Laboratory Medicine 2024;45(17):2136-2140
		                        		
		                        			
		                        			Objective To explore the correlation between serum microRNA-29a-3p(miR-29a-3p),throm-bospondin 2(THBS2)and cardiopulmonary function in children with chronic pulmonary heart disease.Meth-ods A total of 136 children with chronic pulmonary heart disease treated in Shijiazhuang Hospital of Tradi-tional Chinese Medicine from July 2019 to September 2023 were selected as the study subjects.Based on their clinical signs,cardiopulmonary function,and symptoms,they were divided into a compensated group(74 ca-ses)and a decompensated group(62 cases).Real-time fluorescence quantitative PCR(RT-qPCR)method was applied to detect serum miR-29a-3p level,and enzyme-linked immunosorbent assay(ELISA)was applied to detect serum THBS2 level.Moreover,ultrasound diagnostic equipment was applied to detect cardiac function indicators such as left ventricular ejection fraction(LVEF)and cardiac output(CO).Creatine kinase isoenzyme(CK-MB)and troponin(cTnl)were detected by electroluminescence analysis.Pulmonary function indicators were detected by pulmonary artery systolic pressure(PASP),mean pulmonary artery pressure(MPAP)and pulmonary artery diastolic pressure(PADP).Pearson correlation was used to analyze the corre-lation between serum miR-29a-3p and THBS2 levels and cardiopulmonary function indexes in children with chronic pulmonary heart disease,and multivariate Logistic regression analysis was used to screen the influen-cing factors of the disease in children with chronic pulmonary heart disease.Receiver operating characteristic(ROC)curve was drawn to analyze the evaluation value of serum miR-29a-3p and THBS2 levels in children with chronic pulmonary heart disease.Results The THBS2,CK-MB,cTnI,PASP,MPAP,and PADP in the decompensated group were higher than those in the compensated group(P<0.05),while miR-29a-3p,LVEF,and CO were lower than those in the compensated group(P<0.05).Serum miR-29a-3p in children with chro-nic pulmonary heart disease was positively correlated with LVEF and CO(P<0.05),but negatively correla-ted with CK-MB,cTnI,PASP,MPAP,and PADP(P<0.05).THBS2 was negatively correlated with LVEF and CO(P<0.05),but positively correlated with CK-MB,cTnI,PASP,MPAP,and PADP(P<0.05).MiR-29a-3p was a protective factor for exacerbation of chronic pulmonary heart disease in children(P<0.05),while THBS2 was an independent risk factor for exacerbation of chronic pulmonary heart disease in children(P<0.05).ROC curve analysis results showed that the area under the curve(AUC)of serum miR-29a-3p and THBS2 levels alone and in combination for evaluating the severity of chronic pulmonary heart disease in children were 0.827,0.817 and 0.915,respectively.Conclusion Serum miR-29a-3p and THBS2 levels are both factors affecting the disease of children with chronic pulmonary heart disease,and are closely related to the disease and cardiopulmonary function of children with chronic pulmonary heart disease.
		                        		
		                        		
		                        		
		                        	
4.Effects of Licorice chalcone A on proliferation,migration,invasion and oxidative damage of glioma U87 cells through PI3K/Akt signaling pathway
Hong LI ; Shan-Shan WAN ; Zhi-Xin LIU ; Cong-Cong XUE ; Xue-Cheng LI ; Lei YAN
The Chinese Journal of Clinical Pharmacology 2024;40(5):678-682
		                        		
		                        			
		                        			Objective To investigate the effects of Licorice chalcone A(LCA)on proliferation,migration,invasion and antioxidant capacity of human glioma U87 cells and its mechanism.Methods Glioma U87 cells cultured in vitro were divided into 4 groups,blank control group(conventional culture)and experimental-L,-M,-H groups(5,10,20 μmol·L-1 LC A).Cell proliferation capacity was detected by cell counting kit-8,cell clonogenesis ability was detected by clonogenesis assay,cell migration ability was detected by scratch assay,and cell invasion ability was detected by Transwell assay.Colorimetric assay was used to detect total glutathione(T-GSH),malondialdehyde(MDA)and superoxide dismutase(SOD),and Western blotting was used to detect the protein expression levels of phosphatidylinositol 3-kinase/protein kinase B(PI3K/Akt).Results The cell proliferation activities of blank control group and experimental-L,-M,-H groups were(90.20±2.17)%,(79.06±1.57)%,(66.13±2.11)%and(49.52±1.82)%;cell clone formation rates were(76.83±2.30)%,(42.33±2.09)%,(17.71±1.84)%and(12.12±1.97)%;12 h cell mobility rates were(34.92±2.24)%,(27.90±1.89)%,(18.76±1.14)%and(14.87±0.82)%;24 h cell mobility rates were(50.37±2.61)%,(39.43±2.56)%,(21.11±2.33)%and(18.32±2.39)%;the number of perforated cells were 120.39±4.16,79.95±3.83,45.67±3.55 and 18.14±2.85;T-GSH levels were(71.43±2.39),(58.51±2.91),(49.43±2.78)and(35.44±2.76)μmol·L-1;MDA levels were(4.14±0.91),(7.23±1.75),(9.20±1.56)and(11.37±1.90)nmol·mL-1;SOD levels were(41.44±2.10),(35.43±2.91),(28.56±2.32)and(20.62±2.05)U·mg-1;the relative expression levels of p-Akt were 1.27±0.03,1.06±0.02,0.89±0.01 and 0.60±0.02,respectively.The above indexes were statistically significant between experimental-L,-M,-H groups and blank control group(all P<0.01).Conclusion LCA can inhibit the proliferation,migration,invasion and induce oxidative damage of glioma U87 cells,and its mechanism may be related to the down-regulation of p-Akt protein expression in PI3K/Akt signaling pathway.
		                        		
		                        		
		                        		
		                        	
5.Bis (2-butoxyethyl) Phthalate Delays Puberty Onset by Increasing Oxidative Stress and Apoptosis in Leydig Cells in Rats.
Miao Qing LIU ; Hai Qiong CHEN ; Hai Peng DAI ; Jing Jing LI ; Fu Hong TIAN ; Yi Yan WANG ; Cong De CHEN ; Xiao Heng LI ; Jun Wei LI ; Zhong Rong LI ; Ren Shan GE
Biomedical and Environmental Sciences 2023;36(1):60-75
		                        		
		                        			OBJECTIVE:
		                        			This study investigated the effects of bis (2-butoxyethyl) phthalate (BBOP) on the onset of male puberty by affecting Leydig cell development in rats.
		                        		
		                        			METHODS:
		                        			Thirty 35-day-old male Sprague-Dawley rats were randomly allocated to five groups mg/kg bw per day that were gavaged for 21 days with BBOP at 0, 10, 100, 250, or 500 mg/kg bw per day. The hormone profiles; Leydig cell morphological metrics; mRNA and protein levels; oxidative stress; and AKT, mTOR, ERK1/2, and GSK3β pathways were assessed.
		                        		
		                        			RESULTS:
		                        			BBOP at 250 and/or 500 mg/kg bw per day decreased serum testosterone, luteinizing hormone, and follicle-stimulating hormone levels mg/kg bw per day (P < 0.05). BBOP at 500 mg/kg bw per day decreased Leydig cell number mg/kg bw per day and downregulated Cyp11a1, Insl3, Hsd11b1, and Dhh in the testes, and Lhb and Fshb mRNAs in the pituitary gland (P < 0.05). The malondialdehyde content in the testis significantly increased, while Sod1 and Sod2 mRNAs were markedly down-regulated, by BBOP treatment at 250-500 mg/kg bw per day (P < 0.05). Furthermore, BBOP at 500 mg/kg bw per day decreased AKT1/AKT2, mTOR, and ERK1/2 phosphorylation, and GSK3β and SIRT1 levels mg/kg bw per day (P < 0.05). Finally, BBOP at 100 or 500 μmol/L induced ROS and apoptosis in Leydig cells after 24 h of treatment in vitro (P < 0.05).
		                        		
		                        			CONCLUSION:
		                        			BBOP delays puberty onset by increasing oxidative stress and apoptosis in Leydig cells in rats.
		                        		
		                        			UNLABELLED
		                        			The graphical abstract is available on the website www.besjournal.com.
		                        		
		                        		
		                        		
		                        			Rats
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Leydig Cells/metabolism*
		                        			;
		                        		
		                        			Testosterone
		                        			;
		                        		
		                        			Glycogen Synthase Kinase 3 beta/pharmacology*
		                        			;
		                        		
		                        			Rats, Sprague-Dawley
		                        			;
		                        		
		                        			Sexual Maturation
		                        			;
		                        		
		                        			Testis
		                        			;
		                        		
		                        			Oxidative Stress
		                        			;
		                        		
		                        			TOR Serine-Threonine Kinases/metabolism*
		                        			;
		                        		
		                        			Apoptosis
		                        			
		                        		
		                        	
6.Analysis and evaluation on Paeoniae Radix Alba from different cultivars by UPLC-Q-TOF-MS and HPLC.
Shuang YANG ; Qian-Qian DU ; Qian-Xia YUE ; Ye-Fen SUN ; Chuan-Shan JIN ; Wei ZHANG ; Lei MA ; Cong-Bin LIU ; Dong-Mei XIE
China Journal of Chinese Materia Medica 2023;48(3):715-724
		                        		
		                        			
		                        			In this study, an established ultra-high performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry(UPLC-Q-TOF-MS) method was combined with multivariate statistical analysis to investigate the commonality and difference of main chemical components in the medicinal parts of Paeonia lactiflora from different cultivars; in addition, a high performance liquid chromatography(HPLC) method was established to simultaneously determine the content of eight active components in Paeoniae Radix Alba. Non-targeted analysis was carried out by UPLC-Q-TOF-MS on a Waters ACQUITY UPLC BEH C_(18)(2.1 mm×100 mm, 1.7 μm) column with a gradient elution of 0.1% aqueous formic acid(A)-acetonitrile(B) as the mobile phase at a flow rate of 0.2 mL·min~(-1). The column temperature was 30 ℃, and an electrospray ionization source was used to acquire mass spectrometry data in positive and negative ion modes. According to the accurate molecular weight and fragment ion information provided by multi-stage mass spectrometry and by comparison with reference substances and literature reports, thirty-six identical components were identified in Paeoniae Radix Alba from different cultivars with positive and negative ion modes. In the negative ion mode, two groups of samples were well separated; specifically, seventeen components with significant differences in content were screened and identified, and one component unique in "Bobaishao" was obtained. Quantitative analysis was conducted by high-performance liquid chromatography(HPLC) on an Agilent HC-C_(18)(4.6 mm×250 mm, 5 μm) column with a gradient elution of 0.1% aqueous phosphoric acid(A)-acetonitrile(B) as the mobile phase at a flow rate of 1.0 mL·min~(-1). The column temperature was 30 ℃ and the detection wavelength was at 230 nm. An HPLC method was developed for the simultaneous determination of eight active components(gallic acid, oxypaeoniflorin, catechin, albiflorin, paeoniflorin, galloylpaeoniflorin, 1,2,3,4,6-O-pentagalloylglucose, benzoyl-paeoniflorin) in Paeoniae Radix Albaa from different cultivars. Satisfactory linearity was achieved within the investigated linear ranges and with fine coefficients(r>0.999 0), and the methodological investigation showed that the method had good precision, repeatability and stability. The mean recoveries were 90.61% to 101.7% with RSD of 0.12% to 3.6%(n=6). UPLC-Q-OF-MS provided a rapid and efficient qualitative analytical method for the identification of the chemical components in Paeoniae Radix Alba, and the developed HPLC method was simple, rapid and accurate, which could provide a scientific basis for the evaluation of the germplasm resources and herbal quality of Paeoniae Radix Alba from different cultivars.
		                        		
		                        		
		                        		
		                        			Chromatography, High Pressure Liquid
		                        			;
		                        		
		                        			Paeonia
		                        			;
		                        		
		                        			Acetonitriles
		                        			
		                        		
		                        	
7.Preparation of 3D printed metoprolol tartrate chewable tablets and optimization of printing process
Shan-shan WANG ; Xiao-lu HAN ; En LIANG ; Cong-hui LI ; Chun-yan LIU ; Ming-yuan LI ; Zeng-ming WANG ; Peng YU ; Ai-ping ZHENG
Acta Pharmaceutica Sinica 2023;58(9):2811-2817
		                        		
		                        			
		                        			 With the growing demand of personalized medicine for children, it is especially important to develop medicines for children. In this study, using metoprolol tartrate as model drug, we developed 3D printed chewable tablets suitable for children with automated dosage distribution using semi-solid extruded (SSE) 3D printing technology. Based on the quality by design concept, this study prepared a semi-solid material with good printability using gelatin as the substrate, constructed 3D models and printed tablets with the aid of computer-aided design. The printing parameters were optimized and determined as follows: print temperature of 35-37 ℃, print speed of 25 mm·s-1, fill rate of 15%, and number of outer profile layers of 2. Subsequently, the printing process and the quality uniformity of the tablets were verified, and a linear relationship between the dose and the number of model layers was obtained. Finally, 3D printed chewable tablets were superior in terms of appearance, dose accuracy and compliance compared with traditional split-dose commercially available tablets. In this study, 3D printed metoprolol tartrate chewable tablets with good performance were successfully prepared to address the personalized medication needs of pediatric patients. 
		                        		
		                        		
		                        		
		                        	
8.Related factors of acute exacerbation of chronic obstructive pulmonary disease and the value of inhaled glucocorticoid guided by eosinophil in peripheral blood
Chujuan TANG ; Cong LIU ; Wei CHENG ; Shan CAI ; Yan CHEN ; Ping CHEN
Journal of Chinese Physician 2023;25(7):970-976
		                        		
		                        			
		                        			Objective:To explore the risk factors of acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) and whether Eosinophil (EOS) in peripheral blood can guide the treatment of inhaled corticosteroids (ICS).Methods:This study was a single center, Prospective cohort study. The subjects of this study were from stable COPD patients who were treated in the Department of Respiratory Medicine of the Xiangya Second Hospital of Central South University from January 2020 to December 2021. Patient general information, past year AE status, exposure risk factors, modified version of the British Medical Research Council Respiratory Difficulty Questionnaire (mMRC) score, Chronic Obstructive Pulmonary Disease Assessment Questionnaire (CAT) score, ICS usage, lung function, blood routine, etc. were collected. We followed up the patient for one year. During the follow-up period, the clinical characteristics of patients with and without AE were compared to analyze the correlation between blood EOS and ICS use.Results:The median blood EOS of 617 stable COPD patients was 0.13×10 9/L, 289 patients (46.8%) with chronic obstructive pulmonary disease had a history of AE, and 207 patients (33.5%) experienced AE during 1-year follow-up. The results of univariate analysis showed that the future occurrence of AE in COPD was correlated with body mass index (BMI), AE history, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading, GOLD grouping, mMRC score, and CAT score (all P<0.05). The results of logistic multiple factor regression analysis showed that patients with BMI<24 kg/m 2, AE in the past year, severe AE in the past year, smoking history and other exposure factors, GOLD level 2 or above, GOLD C and D groups, and mMRC score≥ 2 had a higher risk of future AE (all P<0.05). There was no statistically significant difference in the incidence of AE between patients with COPD with different levels of EOS and those without ICS during a 1-year follow-up period (all P>0.05). Conclusions:The past 1-year AE history, BMI, exposure risk factors, degree of airflow restriction, and respiratory symptoms of patients with chronic obstructive pulmonary disease can predict future AE risk. There is no significant difference in future AE risk among patients with different levels of EOS, and EOS cannot guide ICS treatment to reduce AE risk.
		                        		
		                        		
		                        		
		                        	
9.Risk factors for and delayed recognition of genitourinary fistula following radical hysterectomy for cervical cancer: a population-based analysis
Cong LIANG ; Ping LIU ; Shan KANG ; Weili LI ; Biliang CHEN ; Mei JI ; Chunlin CHEN
Journal of Gynecologic Oncology 2023;34(2):e20-
		                        		
		                        			 Objective:
		                        			This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer. 
		                        		
		                        			Methods:
		                        			This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004–2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal–Wallis test. 
		                        		
		                        			Results:
		                        			In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women’s and children’s hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040). 
		                        		
		                        			Conclusion
		                        			Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF. 
		                        		
		                        		
		                        		
		                        	
10.Clinical characteristics and guideline compliance analysis of chronic obstructive pulmonary disease patients with initial triple therapy in real-life world
Yuqin ZENG ; Wei CHENG ; Qing SONG ; Cong LIU ; Shan CAI ; Yan CHEN ; Yi LIU ; Qimi LIU ; Zhiping YU ; Zhi XIANG ; Xin LI ; Yingqun ZHU ; Libing MA ; Ming CHEN ; Mingyan JIANG ; Weimin FENG ; Dan LIU ; Dingding DENG ; Ping CHEN
Journal of Chinese Physician 2022;24(7):976-980
		                        		
		                        			
		                        			Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.
		                        		
		                        		
		                        		
		                        	
            
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