Bronchial asthma （asthma） is a heterogeneous disease characterized by airflow limitation， airway remodeling， and recurrent symptoms such as wheezing， shortness of breath， chest tightness， and cough. Its prevalence is gradually increasing， and a portion of patients are still poorly controlled， leading to a serious social and medical burden. Modern studies have proposed the concept of the "lung-gut axis"， which is based on the crosstalk between microorganisms and their metabolites in the lungs and large intestine， and have indicated that microbial dysbiosis in these organs may affect the onset and progression of asthma. Traditional Chinese medicine （TCM） has found the phenomenon of lung-intestinal comorbidity and put forward the importance of "lung-intestinal coordination therapy" in the treatment of lung-related diseases. It has been found that intestinal flora and their metabolites can modulate immune responses through the lung-gut axis， demonstrating great potential for predicting asthma susceptibility， anticipating phenotypes， assessing asthma severity， and guiding treatment. TCM comopunds that embody lung-intestinal coordination therapy， including herbal formulas， single herbs， acupuncture， moxibustion， acupoint application， and spinal pinching therapy， has been shown to regulate intestinal flora， improve metabolism， regulate immunity， alleviate lung inflammation， reduce mucus secretion， inhibit airway remodeling， effectively alleviate symptoms， and delay lung function decline. Based on "lung-intestinal coordination therapy"， this paper used intestinal flora as the entry point to summarize the underlying mechanisms of TCM in asthma treatment and highlighted the pivotal role of intestinal flora in asthma， providing a new idea for its clinical treatment through the intestinal flora .

Objective To analyze the differences in distribution of traditional Chinese medicine (TCM) syndrome elements and salivary microbiota between the individuals with pulmonary nodules and those without, and to explore the potential correlation between the distribution of TCM syndrome elements and salivary microbiota in patients with pulmonary nodules. Methods We retrospectively recruited 173 patients with pulmonary nodules (PN) and 40 healthy controls (HC). The four diagnostic information was collected from all participants, and syndrome differentiation method was used to analyze the distribution of TCM syndrome elements in both groups. Saliva samples were obtained from the subjects for 16S rRNA high-throughput sequencing to obtain differential microbiota and to explore the correlation between TCM syndrome elements and salivary microbiota in the evolution of the pulmonary nodule disease. Results The study found that in the PN group, the primary TCM syndrome elements related to disease location were the lung and liver, and the primary TCM syndrome elements related to disease nature were yin deficiency and phlegm. In the HC group, the primary TCM syndrome elements related to disease location were the lung and spleen, and the primary TCM syndrome elements related to disease nature were dampness and qi deficiency. There were differences between the two groups in the distribution of TCM syndrome elements related to disease location (lung, liver, kidney, exterior, heart) and disease nature (yin deficiency, phlegm, qi stagnation, qi deficiency, dampness, blood deficiency, heat, blood stasis) (P<0.05). The species abundance of the salivary microbiota was higher in the PN group than that in the HC group (P<0.05), and there was significant difference in community composition between the two groups (P<0.05). Correlation analysis using multiple methods, including Mantel test network heatmap analysis and Spearman correlation analysis and so on, the results showed that in the PN group, Prevotella and Porphyromonas were positively correlated with disease location in the lung, and Porphyromonas and Granulicatella were positively correlated with disease nature in yin deficiency (P<0.05). Conclusion The study concludes that there are notable differences in the distribution of TCM syndrome elements and the species abundance and composition of salivary microbiota between the patients with pulmonary nodules and the healthy individuals. The distinct external syndrome manifestations in patients with pulmonary nodules, compared to healthy individuals, may be a cascade event triggered by changes in the salivary microbiota. The dual correlation of Porphyromonas with both disease location and nature suggests that changes in its abundance may serve as an objective indicator for the improvement of symptoms in patients with yin deficiency-type pulmonary nodules.

Objective To construct a "disease-syndrome combination" mathematical representation model for pulmonary nodules based on oral microbiome data, utilizing a multimodal data algorithm framework centered on dynamic systems theory. Furthermore, to compare predictive models under various algorithmic frameworks and validate the efficacy of the optimal model in predicting the presence of pulmonary nodules. Methods A total of 213 subjects were prospectively enrolled from July 2022 to March 2023 at the Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Cancer Hospital, and the Chengdu Integrated Traditional Chinese and Western Medicine Hospital. This cohort included 173 patients with pulmonary nodules and 40 healthy subjects. A novel multimodal data algorithm framework centered on dynamic systems theory, termed VAEGANTF (Variational Auto Encoder-Generative Adversarial Network-Transformer), was proposed. Subsequently, based on a multi-dimensional integrated dataset of “clinical features-syndrome elements-microorganisms”, all subjects were divided into training (70%) and testing (30%) sets for model construction and efficacy testing, respectively. Using pulmonary nodules as dependent variables, and combining candidate markers such as clinical features, lesion location, disease nature, and microbial genera, the independent variables were screened based on variable importance ranking after identifying and addressing multicollinearity. Missing values were then imputed, and data were standardized. Eight machine learning algorithms were then employed to construct pulmonary nodule risk prediction models: random forest, least absolute shrinkage and selection operator (LASSO) regression, support vector machine, multilayer perceptron, eXtreme Gradient Boosting (XGBoost), VAE-ViT (Vision Transformer), GAN-ViT, and VAEGANTF. K-fold cross-validation was used for model parameter tuning and optimization. The efficacy of the eight predictive models was evaluated using confusion matrices and receiver operating characteristic (ROC) curves, and the optimal model was selected. Finally, goodness-of-fit testing and decision curve analysis (DCA) were performed to evaluate the optimal model. Results There were no statistically significant differences between the two groups in demographic characteristics such as age and sex. The 213 subjects were randomly divided into training and testing sets (7 : 3), and prediction models were constructed using the eight machine learning algorithms. After excluding potential problems such as multicollinearity, a total of 301 clinical feature information, syndrome elements, and microbial genera markers were included for model construction. The area under the curve (AUC) values of the random forest, LASSO regression, support vector machine, multilayer perceptron, and VAE-ViT models did not reach 0.85, indicating poor efficacy. The AUC values of the XGBoost, GAN-ViT, and VAEGANTF models all reached above 0.85, with the VAEGANTF model exhibiting the highest AUC value (AUC=0.923). Goodness-of-fit testing indicated good calibration ability of the VAEGANTF model, and decision curve analysis showed a high degree of clinical benefit. The nomogram results showed that age, sex, heart, lung, Qixu, blood stasis, dampness, Porphyromonas genus, Granulicatella genus, Neisseria genus, Haemophilus genus, and Actinobacillus genus could be used as predictors. Conclusion The “disease-syndrome combination” risk prediction model for pulmonary nodules based on the VAEGANTF algorithm framework, which incorporates multi-dimensional data features of “clinical features-syndrome elements-microorganisms”, demonstrates better performance compared to other machine learning algorithms and has certain reference value for early non-invasive diagnosis of pulmonary nodules.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective:To investigate the clinical features and prognosis of male with anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody.Methods:The clinical data of 246 patients with DM and anti-MDA5 autoantibodies hospitalized by Jiangsu Myositis Cooperation Group from 2017 to 2020 were collected and retrospectively analyzed. Chi-square test was performed to compared between counting data groups; Quantitative data were expressed by M ( Q1, Q3), and rank sum test was used for comparison between groups; Single factor survival analysis was performed by Kaplan-Meier method and Log rank test; Cox regression analysis were used for multivariate survival analysis. Results:①The male group had a higher proportion of rash at the sun exposure area [67.1%(47/70) vs 52.8%(93/176), χ2=4.18, P=0.041] and V-sign [50.0%(35/70) vs 30.7%(54/176), χ2=8.09, P=0.004] than the female group. The male group had higher levels of creatine kinase [112(18, 981)U/L vs 57 (13.6, 1 433)U/L, Z=-3.50, P<0.001] and ferritin [1 500 (166, 32 716)ng/ml vs 569 (18, 14 839)ng/ml, Z=-5.85, P<0.001] than the female group. The proportion of ILD [40.0%(28/70) vs 59.7%(105/176), χ2=7.82, P=0.020] patients and the red blood cell sedimentation rate[31.0(4.0, 101.5)mm/1 h vs 43.4(5.0, 126.5)mm/1 h, Z=-2.22, P=0.026] in the male group was lower than that of the female group, but the proportion of rapidly progressive interstitial lung disease (PR-ILD) [47.1%(33/70) vs 31.3%(55/176), χ2=5.51, P=0.019] was higher than that of the female group. ②In male patients with positive anti-MDA5 antibodies,the death group had a shorter course of disease[1.0(1.0, 3.0) month vs 2.5(0.5,84) month, Z=-3.07, P=0.002], the incidence of arthritis [16.7%(4/24) vs 42.2%(19/45), χ2=4.60, P=0.032] were low than those in survival group,while aspartate aminotransferase (AST)[64(22.1, 565)U/L vs 51(14,601)U/L, Z=-2.42, P=0.016], lactate dehydrogenase (LDH) [485(24,1 464)U/L vs 352(170, 1 213)U/L, Z=-3.38, P=0.001], C-reactive protein (CRP) [11.6(2.9, 61.7) mg/L vs 4.95(0.6, 86.4) mg/L, Z=-1.96, P=0.050], and ferritin levels [2 000(681, 7 676) vs 1 125 (166, 32 716)ng/ml, Z=-3.18, P=0.001] were higher than those in the survival group, and RP-ILD [95.8%(23/24) vs 22.2%(10/45), χ2=33.99, P<0.001] occurred at a significantly higher rate. ③Cox regression analysis indicated that the course of disease LDH level, and RP-ILD were related factors for the prognosis of male anti-MDA5 antibodies [ HR (95% CI)=0.203(0.077, 0.534), P=0.001; HR (95% CI)=1.002(1.001, 1.004), P=0.003; HR (95% CI)=95.674 (10.872, 841.904), P<0.001]. Conclusion:The clinical manifestations of male anti-MDA5 antibody-positive patients are different from those of female. The incidence of ILD is low, but the proportion of PR-ILD is high. The course of disease, serum LDH level, and RP-ILD are prognostic factors of male anti-MDA5 antibody-positive patients.

Objective To explore the acupoint selection rules of acupuncture and moxibustion for the treatment of female menopausal obesity and to provide reference for clinical acupuncture treatment of female menopausal obesity based on data mining techniques.Methods Clinical literature on acupuncture treatment of female menopausal obesity was searched by computer in CNKI,Wanfang,VIP,SinoMed,and PubMed database,and the time limit of searching was from the establishment of database to the date of 1 August 2023,and the literature was screened and extracted according to the inclusion and exclusion criteria.The association rule analysis was performed using IBM SPSS Moderler 18.0 software,and cluster analysis was performed using IBM SPSS Statistics 27.0 software.Results A total of 50 literature meeting the requirements were screened out,and 83 groups of acupoint prescriptions were extracted.Descriptive analysis showed that the intervention measures of acupuncture and moxibustion in the treatment of female menopausal obesity were mainly acupoint catgut embedding,electroacupuncture and auricular acupuncture.The top 7 acupoints with the highest frequency were Sanyinjiao(SP6),Zusanli(ST36),Shenshu(BL23),Tianshu(ST25),Guanyuan(RN4),Zhongwan(RN12)and Qihai(RN6).Stomach meridian of foot yangming,conception vessel,bladder meridian of foot taiyang and spleen meridian of foot taiyin are the most commonly selected meridians.In terms of specific acupoints,the main acupoints are intersection points,front-mu points and back-shu points.The acupoints are mainly distributed in the chest and abdomen,lower limbs and waist and back.By using data mining technology,the core acupoint pair of acupuncture and moxibustion for menopausal obesity is'Zusanli-Sanyinjiao',and the core acupoint prescription is'Zusanli,Sanyinjiao,Zhongwan,Tianshu,Shenshu,Guanyuan,Qihai';cluster analysis found 7 types of clinical acupoint clustering.Conclusion Acupuncture and moxibustion for the treatment of female menopausal obesity focuses on tonifying the essence of the kidney and restoring the qi mechanism and characteristics of acupoint selection of spleen and stomach qi.

Objective:To investigate the efficacy and safety of combined catheter-directed thrombolysis and anticoagulation for acute pulmonary embolism combined with lower limb deep vein thrombosis.Methods:A retrospective analysis was conducted using a case-control study approach on the clinical data of 58 patients with acute pulmonary embolism who received treatment at the Inner Mongolia Autonomous Region People's Hospital from August 2021 to August 2023. These patients were categorized into two groups based on whether they had lower-limb deep vein thrombosis or not. The group with pulmonary embolism alone ( n = 14) underwent targeted catheter thrombolysis in combination with anticoagulation treatment using low molecular-weight heparin. The group with both pulmonary embolism and deep vein thrombosis in the lower limbs (combined group, n = 44) received inferior vena cava filter placement, along with targeted catheter thrombolysis and anticoagulation treatment with low-molecular weight heparin. The improvement in pulmonary circulation was observed before and after the surgical interventions in both groups. A comparison was made regarding the improvement in indicators including arterial oxygen pressure, fingertip oxygen saturation, the proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area, and respiratory rate, both before and after pulmonary artery catheterization and thrombolysis in both groups. Results:The surgery was successful for all patients. The symptom of shortness of breath was obviously relieved after surgery. After surgery, in the pulmonary embolism alone group, the respiratory rate was (22.75 ± 4.38) beats/min, the mean pulmonary artery pressure was (32.53 ± 3.63) mmHg (1 mmHg = 0.133 kPa), the arterial oxygen partial pressure was (81.46 ± 7.24) mmHg, and the fingertip oxygen saturation was (90.53 ± 4.57)%, respectively. In the combined group, the respiratory rate, mean pulmonary artery pressure, arterial oxygen partial pressure, and fingertip oxygen saturation were (23.35 ± 5.8) beats/min, (31.34 ± 4.53) mmHg, (82.34 ± 4.62) mmHg, and (92.57 ± 3.45)%, respectively. After surgery, the respiratory rate, pulmonary artery pressure, arterial oxygen partial pressure, and fingertip oxygen saturation in each group were significantly higher compared with the corresponding levels before surgery ( t = 6.33, 12.12, 17.32, 8.13, 6.86, 13.02, 15.52, 7.20, all P < 0.001). The proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area in the group with pulmonary embolism alone was (19.56 ± 7.53)%, while in the combined group, it was (20.63 ± 4.83)%. After surgery, the proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area in each group decreased compared with the corresponding value before surgery ( t = 19.36, 18.23, both P < 0.001). Conclusion:The surgical method combining catheter-directed thrombolysis with inferior vena cava filter placement is effective and safe for the treatment of acute pulmonary embolism combined with deep vein thrombosis in the lower limbs.

Although indigenous malaria has been eliminated in Wuhan since 2013,imported malaria remains a potential threat as an infectious source of local malaria transmission.The epidemiological and clinical characteristics of imported malaria are particularly important in areas where local malaria has been eliminated.This study was aimed at analyzing the epidemiological and clinical characteristics of imported malaria in Wuhan from 2012 to 2019,to provide a basis for further improving the preven-tion and control of imported malaria.Patients in Wuhan diagnosed with imported malaria from January 1,2012,to December 31,2019,were included in this study.A case-control study was con-ducted to analyze the features of patients with severe malaria.Uni-variate and multivariate logistic regression was used to identify risk factors for prolonged hospital length of stay(LOS).Among 229 imported malaria cases,212(92.6％)were in Chinese citizens,and most cases were in men(96.5％).The gender ratio is 28:1,and the age of cases is mainly concertrated between 18 and 50 years old(89.1％).More than 80％of patients were mi-grant workers,and most cases were infections from African countries(92.6％).Plasmodium falciparum(80.8％)was the dominant species.Fifty-three severe malaria cases were identified during the study period.Compared with uncomplicated cases,severe cases tended to occur in patients with no history of malaria(P=0.008),patients infected with Plasmodium falciparum(P=0.009),and patients who were initially misdiagnosed(P＜0.001).The median LOS was 6 days,and the species of infec-tion(Plasmodium falciparum),the use of antimalarial drugs(group B),antipyretic time(longer than 3 days),and the turn-around time of blood smear microscopy(longer than 3 days)were significantly associated with longer LOS(all P＜0.05).Al-though malaria has been eradicated in Wuhan for many years,imported cases continue to pose a threat.Efforts should be made to strengthen malaria knowledge education for outbound personnel.Additionally,medical institutions must enhance diagnosis and treatment capabilities for malaria,and adhere to standardized treatment processes,and the development of drug resistance and occurrence of severe malaria must be prevented.

Aim To investigate the intracellular up-take and target protein binding characteristics of two Bruton's tyrosine kinase inhibitors(BTKi)with differ-ent selectivities to provide further insights into the mechanisms of drug off-target-related bleeding risk.Methods Ibrutinib(non-selective BTKi)and za-nubrutinib(selective BTKi)were used as study drugs.After incubation of MEC-1 cells and human platelets with drugs,the cellular thermal shift assay(CETSA)was combined with Western blot to obtain the melting curve and isothermal curve to analyze the binding char-acteristics of the two drugs with the target protein BTK.After incubation of MEC-1 cells and human platelets with drugs,the concentrations of the two drugs were detected by liquid chromatography-tandem mass spectrometry(LC-MS/MS)to analyze the intracellular uptake of the two drugs.Results CETSA analysis confirmed that zanubrutinib was more selective for the target protein BTK compared to ibrutinib.LC-MS/MS analysis showed that both drugs were uptaken intracel-lularly by MEC-1 cells and platelets in a concentration-dependent manner.Conclusions While BTKi targe-ting BTK to B lymphocytes exerts therapeutic effects,off-target effects on platelets due to differences in their intracellular uptake,and target-binding characteristics may be one of the reasons for the differences in bleed-ing risk across selective BTKi.

AIM To explore the mechanism of Dabugan Decoction's action on a rat model of generalized anxiety disorder(GAD).METHODS The rat models established by 21 days exposure to chronic unpredictable mild stress(CUMS)were then randomly divided into the model group,the paroxetine group(1.8 mg/kg)and the high-dose,medium-dose and low-dose Dabugan Decoction groups(13.2,6.6 and 3.3 g/kg),in contrast to the other normal rats assigned into the blank group,for the following 28 days administration of the corresponding drugs by gavage.After the intervention,the rats had their anxiety intensity analyzed by behavioral tests;their hippocampal pathological changes and Nissl's body differences observed by HE staining and Nissl staining;their cerebral ROS activity detected by immunofluorescence;their hippocampal activities of SOD and CAT,and levels of MDA and GSH detected by kit;and their hippocampal mRNA and protein expressions of Nrf2,Keap1,HO-1,NQO1,BDNF,5-HT1A,caspase-3 and GSH detected by RT-qPCR and Western blot.RESULTS Compared with the model group,the Dabugan Decoction groups displayed improved anxiety responses;increased movement distance at the open arm end and total distance as well,more entries and duration at the open box,more time and entries at the open field center in elevated plus maze(P＜0.05,P＜0.01);increased number of hippocampal neurons,ameliorated cell body damage,increased Nissl bodies in cells,decreased hippocampal ROS activity and MDA level(P＜0.05,P＜0.01);increased activities of SOD and CAT,and GSH level(P＜0.05,P＜0.01);increased hippocampal mRNA and protein expressions of Nrf2,HO-1,NQO1,BDNF and 5-HT1A(P＜0.05,P＜0.01),and decreased mRNA and protein expressions of p62,Keap1 and caspase-3(P＜0.05,P＜0.01).CONCLUSION Dabugan Decoction can effectively improve the anxiety of GAD rats,and its mechanism may be related to the recovery of oxidative stress-induced injury in hippocampal neurons via ROS/Nrf2/HO-1 signaling pathway.