Research progress of pharmacologic therapy in obstructive sleep apnea / 中国临床药理学与治疗学

Obstructive sleep apnea (OSA) is a common sleep disordered breathing disorder. As a major global public health problem, untreated OSA can lead to a variety of adverse health outcomes, including various cardiovascular and cerebrovascular diseases, metabolic disorders, and psychiatric disorders such as anxiety and depression. Traditional OSA therapies such as positive airway pressure (PAP), weight loss, oral appliance, upper airway surgery, and postural therapy focus on the anatomical factors of OSA. However, the pathogenesis of OSA is heterogeneous, and non-anatomical factors also play an important role in most patients. Although there is no drug with exact efficacy for the treatment of OSA, with the deepening understanding of the pathophysiological mechanism of OSA, more and more clinical studies are devoted to the study of drug treatment of OSA and its complications, and a series of results have been achieved. The following is a review of the relevant studies on drug treatment of OSA in recent years, hoping to provide literature support and theoretical basis for future research on drug treatment of OSA.

A New Approach to Network Pharmacological Analysis Based on Key Pathophysiological Processes / 中国实验方剂学杂志

In recent years， the field of network pharmacology （NP） has developed rapidly， but the flawed and routine workflow has seriously affected the scientificity and reliability of NP analysis results. For complex diseases caused by environmental and genetic factors， symptomatic treatment or drugs targeting a single pathophysiological process cannot prevent or delay the progression of the disease， so the drug development fails or withdraws from the market. Therefore， there is an urgent need to develop new ideas for NP analysis that combines multiple pathophysiological processes. The key pathophysiological process is an important and complete set of pathological changes in the process of the occurrence， development， and outcome of the disease， which represents the current comprehensive and profound understanding of the nature of the disease. In order to improve the quality of NP research and promote the healthy development of the NP field， this paper proposes a new idea of NP analysis based on key pathophysiological processes. Based on the long-term clinical practice of traditional Chinese medicine and the key pathophysiological process of the disease， the method comprehensively analyzes the pharmacological mechanism and active ingredients of traditional Chinese medicine compound from the perspective of key pathophysiological process， which increases the scientifically， reliability， and repeatability of the analysis results. This paper takes Alzheimer's disease （AD） as an example to illustrate the necessity， feasibility， main workflow， advantages， and disadvantages of this method， and it is expected to screen disease-modifying drugs that prevent or reverse the course of the disease and promote the clinical transformation of research results.

Risk and Prevention of Thromboembolism in Inflammatory Bowel Disease / 胃肠病学

The incidence rate of inflammatory bowel disease(IBD)in China is in a rapid rise period in recent years,and the course of the disease is repeated and prolonged.The risk of IBD combined with thromboembolism is significantly increased,and it is one of the important reasons for poor prognosis in IBD patients.However,the pathological and physiological mechanisms of thromboembolism have not been fully understood and have not received sufficient attention from clinical physicians.This article aims to provide a systematic review of the risks and mechanisms of thromboembolism in IBD,and to summarize the progress in its prevention and treatment strategies,in order to be helpful for the prevention and treatment of thromboembolism in IBD patients.

Progress on diagnosis and treatment of trauma induced coagulopathy in children / 中国小儿急救医学

Trauma is a major cause of death in children.Hypoperfusion, tissue cell injury, inappropriate thrombin generation, fibrinogen depletion and dysregulated fibrinolysis are the main pathophysiological mechanisms of trauma induced coagulopathy.The conventional coagulation tests and thromboelastography are helpful for the diagnosis of trauma induced coagulopathy, and thromboelastography can guide clinical transfusion therapy. "Optimized end-organ perfusion" and "adequate oxygen delivery" are resuscitation goals.Active and correct pre-hospital treatment, damage control resuscitation, justified transfusions and antifibrinolytic therapy are helpful to improve the prognosis of children with trauma induced coagulopathy.

Individualized treatment for pediatric postural orthostatic tachycardia syndrome / 中国小儿急救医学

Postural orthostatic tachycardia syndrome (POTS) is a common condition that results in syncope among children and adolescents.It primarily manifests as a range of chronic orthostatic intolerance symptoms, accompanied by an abnormal increase in heart rate upon standing, significantly impacting the learning and quality of life in young individuals.POTS demonstrates diversity and heterogeneity in clinical symptoms, underlying pathophysiological mechanisms, and associated complications.Consequently, relying on experience to treatment often fails to achieve desired clinical outcomes.Delving deeper into potential clinical biomarkers capable of predicting POTS treatment efficacy and implementing individualized treatment approaches are crucial for enhancing patient prognosis and quality of life.This review provided a comprehensive exploration of the latest research findings on biomarkers for predicting POTS clinical outcomes, aiming to offer perspectives and approaches for the clinical treatment of pediatric POTS.

Neutrophil elastase:From mechanisms to therapeutic potential / 药物分析学报

Neutrophil elastase(NE),a major protease in the primary granules of neutrophils,is involved in microbicidal activity.NE is an important factor promoting inflammation,has bactericidal effects,and shortens the inflammatory process.NE also regulates tumor growth by promoting metastasis and tumor microenvironment remodeling.However,NE plays a role in killing tumors under certain conditions and promotes other diseases such as pulmonary ventilation dysfunction.Additionally,it plays a complex role in various physiological processes and mediates several diseases.Sivelestat,a specific NE inhibitor,has strong potential for clinical application,particularly in the treatment of coronavirus disease 2019(COVID-19).This review discusses the pathophysiological processes associated with NE and the potential clinical applications of sivelestat.

Research progress of ocular surface pathophysiological changes in dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

@#The incidence of dry eye is increasing year by year, and it has become one of the most common ophthalmic diseases. The main symptoms of dry eye disease are dry, foreign body sensation, burning in eyes, itchy and viscous secretion. These discomforts affect the daily life, efficiency of work and study, mental health and physical function of patients with dry eye. Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles. Meanwhile, there are changes in the tissue structure and ocular surface microenvironment of the eyes of patients with dry eye. In view of the fact that dry eye is an important public health problem, which seriously affects people's visual quality and life quality, studying the pathophysiology of dry eye is of great significance for efficient diagnosis, more targeted treatment and reduction of adverse events. This paper reviewed the research progress in the pathophysiology of dry eye in recent years.

Research Progress of Disease Developmental Process and Disease Dynamic Molecular Network Construction of "Myocardial Infarction-heart Failure" / 中国实验方剂学杂志

With the development of omics technology， the construction of disease networks has been widely used in the study of complex diseases. It has been widely used to construct disease networks using systems biology technology to study complex diseases. The mechanism exploration model of disease molecular network which uses the method of constructing disease networks， simulates the occurrence of diseases， explores the core development mechanism of complex diseases， and then predicts biomarkers and exploits the mechanism of drug action provided many new thoughts for the prevention and treatment of complex diseases. Nowadays， the research on the mechanism of myocardial infarction caused by myocardial ischemia and heart failure after myocardial infarction is still very important. However， the research of the molecular network of myocardial infarction and heart failure diseases is usually limited to a few targets and pathways， so it is not able to comprehensively and systematically explain the disease process. Furthermore， authors outlined the typical biological process of "myocardial infarction-heart failure" and related targets from the pathophysiological level， and summarized the existing methods of constructing dynamic networks for heart diseases and other diseases. Based on the dynamic molecular network construction methods of cardiac diseases and other diseases， this paper discusses the construction of the dynamic molecular network of myocardial infarction and heart failure， in order to understand the evolution of myocardial infarction and heart failure more accurately and explore the importance of the dynamic molecular network of the disease process for the study of disease mechanism.

Research Status and Prospects of Non-Traumatic Fat Embolism in Forensic Medicine / 法医学杂志

In the practice of forensic pathology, fat embolism is one of the common causes of death, which can be divided into two categories: traumatic and non-traumatic. Non-traumatic fat embolism refers to the blockage of small blood vessels by fat droplets in the circulatory blood flow caused by non-traumatic factors such as underlying diseases, stress, poisoning and lipid metabolism disorders. At present, it is believed that the production of non-traumatic fat embolism is related to the disturbance of lipid metabolism, C-reactive protein-related cascade reaction, the agglutination of chylomicron and very low-density lipoprotein. The forensic identification of the cause of death of non-traumatic fat embolism is mainly based on the case, systematic autopsy, HE staining and fat staining, but it is often missed or misdiagnosed by forensic examiners because of its unknown risk factors, hidden onset, the difficulty of HE staining observation and irregular implementation of fat staining. In view of the lack of attention to non-traumatic fat embolism in forensic identification, this paper reviews the concepts, pathophysiological mechanism, research progress, existing problems and countermeasures of non-traumatic fat embolism, providing reference for forensic scholars.

Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy

BACKGROUND The lepromatous pole is a stigmatising prototype for patients with leprosy. Generally, these patients have little or no symptoms of peripheral nerve involvement at the time of their diagnosis. However, signs of advanced peripheral neuropathy would be visible during the initial neurological evaluation and could worsen during and after multidrug therapy (MDT). Disabilities caused by peripheral nerve injuries greatly affect these patients' lives, and the pathophysiological mechanisms underlying nerve damage remain unclear. OBJECTIVES To evaluate the outcome of peripheral neuropathy in patients with lepromatous leprosy (LL) and persistent neuropathic symptoms years after completing MDT. METHODS We evaluated the medical records of 14 patients with LL who underwent nerve biopsies due to worsening neuropathy at least four years after MDT. FINDINGS Neuropathic pain developed in 64.3% of the patients, and a neurological examination showed that most patients had alterations in the medium- and large-caliber fibers at the beginning of treatment. Neurological symptoms and signs deteriorated despite complete MDT and prednisone or thalidomide use for years. Nerve conduction studies showed that sensory nerves were the most affected. MAIN CONCLUSIONS Patients with LL can develop progressive peripheral neuropathy, which continues to develop even when they are on long-term anti-inflammatory and immunosuppressive therapy.

Daño renal en pacientes con COVID-19 / Kidney damage in COVID-19 patients

Introducción: La COVID-19 es una enfermedad relativamente nueva, que puede causar afecciones en diferentes órganos. El daño renal se asocia a la mortalidad, por lo que debe ser identificado precozmente. Objetivo: Describir el daño renal en pacientes de COVID-19. Métodos: Se realizó una revisión bibliográfica de materiales publicados durante el periodo comprendido entre el 20 de abril al 25 de agosto de 2020. Se consultaron las bases de datos PubMed, SciELO, Ebsco y Clinical Key, así como el motor de búsqueda Google Académico. Los métodos utilizados fueron análisis-síntesis, inducción-deducción e histórico-lógico. Análisis e integración de la información: Para realizar un diagnóstico precoz que permita modificar el pronóstico y la historia natural de la mortalidad, se realizan numerosas investigaciones en los pacientes portadores de la COVID-19. En la literatura científica se reportan artículos sobre la importancia de la detección del daño renal. Se ha identificado que, tanto el daño renal previo, como el desarrollo de este durante la COVID-19, desempeñan un rol importante en el aumento de la tasa de letalidad. Conclusiones: La Afección renal crónica es una agravante en pacientes que padecen COVID-19. La descripción de los mecanismos causantes de la lesión renal es fundamental para establecer el pronóstico de estos pacientes, sin embargo, luego de la revisión, se comprobó que aún es escasa la literatura científica que aborde la relación del daño renal durante la COVID-19(AU)

Introduction: COVID-19 is a relatively new disease that affects various organs. Associated as it is to mortality, kidney damage should be identified as early as possible. Objective: Conduct a bibliographic review aimed at describing kidney damage in COVID-19 patients. Methods: A bibliographic review was conducted of materials about the topic published from 20 April to 25 August 2020. The search was carried out in the databases PubMed, SciELO, Ebsco and Clinical Key, as well as the search engine Google Scholar. Analytic-synthetic, inductive-deductive and historical-logical methods were used. Data analysis and integration: In order to obtain an early diagnosis allowing to modify the prognosis and natural evolution of mortality, a large number of studies are performed on patients carrying COVID-19. Papers are found in the scientific literature which refer to the importance of detecting kidney damage. It has been found that kidney damage, either developing before or during the course of the disease, plays an important role in the increase in lethality. Conclusions: Kidney damage is common in COVID-19 patients. Describing the mechanisms causing the kidney injury is a fundamental pillar to establish the prognosis for these patients. The description of kidney damage during COVID-19 is still scarce in the scientific literature(AU)

Disfunciones quimiosensoriales del olfato y el gusto provocadas por el SARS-CoV-2 / Chemosensory dysfunctions of taste and smell caused by SARS-CoV-2 / Disfunções quimiossensoriais de olfato e paladar causadas pelo SARS-CoV-2

RESUMEN Introducción: Múltiples reportes de la literatura científica avalan, que los trastornos del olfato y el gusto son cada vez más frecuentes desde el inicio de la COVID-19, ofreciendo diversos mecanismos fisiopatológicos para explicar estas alteraciones. Objetivo: Sistematizar las evidencias científicas disponibles, relacionadas con alteraciones del olfato y gusto producidas por SARS-CoV-2. Método: Se desarrolló una revisión bibliográfica basada en el análisis documental, la sistematización y contrastación de la información científica realizada sobre el tema. Las búsquedas se realizaron en bases de datos disponibles (SciELO, Medline, Scopus, Medscape), con el buscador Google Académico. Desarrollo: La información se estructuró en aspectos morfofuncionales de los sistemas del olfato y el gusto; estructura y replicación del SARS-CoV-2; interacción del virus con el sistema renina-angiotensina-aldosterona, su afinidad por el receptor enzima convertidora; mecanismos fisiopatológicos de estas disfunciones. Conclusiones: Aunque se describen las alteraciones del olfato y el gusto en pacientes con COVID-19, no están totalmente esclarecidos los mecanismos fisiopatogénicos relacionados con estas disfunciones quimiosensoriales. No obstante, su aparición en ausencia de otras enfermedades respiratorias, debe alertar al personal de salud sobre la posibilidad de infección por SARS-CoV-2.

ABSTRACT Introduction: Multiple scientific reports certified that disorders of taste and smell are more frequent since COVID-19 onset, reporting various pathophysiological mechanisms to explain these alterations. Objective: To methodize the available scientific evidence related to smell and taste disorders caused by SARS-CoV-2. Method: A bibliographic review, based on the documentary analyses, systematization and contrasting view of scientific information on the topic, was carried out. Search was conducted on available databases (SciELO, Medline, Scopus, Medscape), using the web search engine Academic Google. Development: Information gathered was performed based on taste and smell morphofunctional aspects; structure and replication of SARS-CoV-2; virus interaction with renin-angiotensin-aldosterone system and its affinity for the converting enzyme receptor; pathophysiological mechanisms of these dysfunctions. Conclusions: Although alterations of smell and taste are described in patients with COVID-19, the pathophysiological mechanisms associated with these chemosensory dysfunctions are not totally clarified. However, the onset of these symptoms in absence of other respiratory illnesses should alert health care personnel concerning to a possible SARS-CoV-2 infection.

RESUMO Introdução: Diversos relatos da literatura científica sustentam que os distúrbios do olfato e do paladar são cada vez mais frequentes desde o início da COVID-19, oferecendo vários mecanismos fisiopatológicos para explicar essas alterações. Objetivo: Sistematizar as evidências científicas disponíveis relacionadas às alterações de olfato e paladar produzidas pelo SARS-CoV-2. Método: Foi desenvolvida uma revisão bibliográfica a partir da análise documental, da sistematização e do contraste das informações científicas realizadas sobre o assunto. As buscas foram realizadas nas bases de dados disponíveis (SciELO, Medline, Scopus, Medscape), com a ferramenta de busca Google Scholar. Desenvolvimento: A informação foi estruturada em aspectos morfofuncionais dos sistemas olfativo e gustativo; estrutura e replicação de SARS-CoV-2; interação do vírus com o sistema renina-angiotensina-aldosterona, sua afinidade pelo receptor enzima conversora; mecanismos fisiopatológicos dessas disfunções. Conclusões: Embora as alterações do olfato e do paladar sejam descritas em pacientes com COVID-19, os mecanismos fisiopatogênicos relacionados a essas disfunções quimiossensoriais não estão totalmente esclarecidos. No entanto, seu aparecimento na ausência de outras doenças respiratórias deve alertar o pessoal de saúde para a possibilidade de infecção pelo SARS-CoV-2.

Research progress in drugs for treating sepsis / 药学学报

Sepsis is a refractory disease with high mortality in which the host's immune response to the infection is dysfunctional, resulting in life-threatening organ function damage. The pathogenesis of sepsis is complex, involving systemic inflammation, immunosuppressive and coagulation abnormalities, and endothelial barrier damage caused by the infecting pathogenic microorganisms and their toxins. The pathogenesis of sepsis is closely related to multiple systems disorder and multiple organ dysfunction and failure. In recent years, the incidence of sepsis has been increasing globally, with an annual increase of 9%. Since the development of sepsis does not depend on the infecting pathogenic microorganisms and the late inflammatory reaction can be life-threatening, clinical treatment of sepsis can be very difficult. However, the current antibiotic treatments for sepsis are not ideal. Most clinical treatments are not curative, so researchers seek new drug designs based on exploring molecular mechanisms of the pathophysiological process in sepsis patients. This paper reviews the recent development of drugs designed according to the sepsis pathophysiological process.

Current state of researches on mechanisms of acupuncture in improvement of hypoxia-ischemic diseases of the central nervous system / 针刺研究

Acupuncture is widely used in the treatment of ischemic diseases of the central nervous system in different clinical stages and has achieved a good clinical effect. The current research showed that acupuncture can improve cerebral blood flow perfusion via increasing blood flow volume, blood flow velocity, the levels of vasomotor substances and reduction of blood viscosity and erythrocyte aggregation index. In recent years, many studies focused on the pathophysiological mechanism of acupuncture in improving cerebral ischemia via triggering the cholinergic vasodilatation, up-regulation of expression of vascular-related proteins and genes，attenuation of inflammatory reaction, etc. Currently, the methods for evaluating the effect of acupuncture are mostly noninvasive functional magnetic resonance imaging in healthy subjects. Future studies should include united selection of acupoints and acupuncture needle manipulations, more reasonable combination of different acupoints, united outcome evaluative standards, better repeatability, employment of big data, etc.

Application of focused neuromonitoring in patients with severe brain injuries / 中国实用内科杂志

Focused neuromonitoring plays an important role in the management of severe brain injuries.Severe brain injuries have the pathophysiological complexity and diversity.The purpose of focused neuromonitoring is to detect abnormal links in the early stage;to screen etiology;to individualize patient care decisions;to monitor therapeutic response of some interventions and to avoidany potential adverse effects;to improve neurological outcome and quality of life in survivors.The first step in making good use of focused neuromonitoring is to allow clinicians to better understand the pathophysiology of complex disorders,and the second is to accurately obtain every parameter and correctly interpret them.Finally,multiple parameters of focused neuromonitoring were integrated and integrated with clinical indexes and pathophysiological changes.In the end,understanding the information transmitted by severe neurological patients and transforming the monitoring datas into scientific and rigorous treatment decisions.

Salt sensitivity and its implication in clinical practice

Hypertension (HTN) is a complex multi-factorial disease and is considered one of the foremost modifiable risk factors for stroke, heart failure, ischemic heart disease and renal dysfunction. Over the past century, salt and its linkage to HTN and cardiovascular (CV) mortality has been the subject of intense scientific scrutiny. There is now consensus that different individuals have different susceptibilities to blood pressure (BP)-raising effects of salt and this susceptiveness is called as salt sensitivity. Several renal and extra-renal mechanisms are believed to play a role. Blunted activity of the renin–angiotensin–aldosterone system (RAAS), adrenal Rac1-MR-Sgk1-NCC/ENaC pathway, renal SNS-GR-WNK4-NCC pathway, defect of membrane ion transportation, inflammation and abnormalities of Na+/Ca2+ exchange have all been implicated as pathophysiological basis for salt sensitive HTN. While salt restriction is definitely beneficial recent observation suggests that treatment with Azilsartan may improve salt sensitivity by selectively reducing renal proximal tubule Na+/H+ exchange. This encourages the future potential benefits of recognizing and therapeutically addressing the salt sensitive phenotype in humans.

Research progress of sepsis-induced acute kidney injury / 中华危重病急救医学

Acute kidney injury (AKI) is a common complication in patients with sepsis, with poor prognosis and high mortality. The pathogenesis of sepsis-induced acute kidney injury (SAKI) is closely related to renal hemodynamic abnormalities, inflammatory injury and adaptive mechanism. It is insufficient for previous criteria based on urine output and creatinine to the early diagnosis of SAKI. The emergence of new biomarkers may make up for deficiencies in early diagnosis. And significant progress has also been made in the treatment of SAKI. The aim of this article was to review the researches on pathophysiology, early diagnosis and treatment of SAKI and provides some help for clinical staff to understand SAKI.

The research status of pathogenesis of sepsis related thrombocytopenia / 天津医药

Sepsis is a lethal organ dysfunction caused by infection induced reaction maladjustment. Thrombocytopenia is not only a common complication of sepsis, but also closely related to the patient's prognosis. In the clinical treatment, it is important to identify the etiology and pathogenesis of thrombocytopenia associated with sepsis and choose appropriate methods to correct thrombocytopenia in time to improve the prognosis of patients. This article gives an introduction to the research status of the etiology, pathophysiological mechanism and molecular mechanism of sepsis-related thrombocytopenia.

Mechanism of neural plasticity of acupuncture on chronic migraine / 中国针灸

Chronic migraine is one of neurological disorders with high rate of disability, but sufficient attention has not been paid in this field. A large number of clinical studies have shown traditional Chinese acupuncture is a kind of effective treatment with less side effects. Through the analysis of literature regarding acupuncture and migraine published from 1981 to 2017 in CNKI and PubMed databases, the mechanism of neural plasticity of acupuncture on chronic migraine was explored. It was believed the progress of chronic migraine involved the changes of neural plasticity in neural structure and function, and the neural plasticity related with neural sensitization during the process of chronic migraine was discussed from three aspects of electrophysiology, molecular chemistry and radiography. Acupuncture could treat and prevent chronic migraine via the mechanism of neural plasticity, but there was no related literature, hindering the further spreading and development of acupuncture for chronic migraine.

Research progress in Takotsubo cardiomyopathy and its forensic application / 复旦学报（医学版）

Up to now,studies among the world have put forward various hypotheses about the pathophysiology and future research direction of Takotsubo cardiomyopathy (TTC).Large amounts of diagnosis and differential diagnosis have been done on TTC,and consensuses have been reached on it's definition,epidemiology,clinical manifestations and prognosis.In this review,we will summarize the recent progress in the study of TTC,and make a comprehensive analysis and perspective on it's clinical research and forensic value.