Research progress on effects of air pollution on pollinosis and its mechanisms / 环境与职业医学

Pollinosis is one of the common allergic diseases, and its morbidity continues to increase. Studies have demonstrated that air pollution is a key environmental factor that leads to the increased prevalence of pollinosis. Air pollutants and pollen allergens exert synergistic effects in stimulating allergic responses in susceptible individuals. In this article, we analyzed the relationship between air pollution and pollinosis based on the latest studies, and elaborated potential mechanisms on how air pollution increases the incidence of pollinosis and aggravates allergic reactions. Air pollutants can increase both pollen production and the levels of allergenic proteins, and enhance allergenicity of pollen allergens through structural alterations or chemical modifications. The potential mechanisms of air pollutants exacerbating pollen allergies are as follows: Air pollutants may disrupt the barrier function of the respiratory epithelium and facilitate the penetration of pollen allergens into deeper tissues. Additionally, they may accelerate the process of the release of pollen allergy-related cytokines, promoting T helper 2 (Th2) cell differentiation and exacerbating inflammatory responses in the airways. Given the limitations of existing research, future prospective studies are needed to explore the effects of mixed pollutants and different types of pollutants on pollen, and the response mechanisms of allergy-related cells and cytokines to different pollutant categories. The findings would provide a comprehensive understanding of the impacts of air pollution on pollen allergies and scientific evidence for effective protection of the heath of pollinosis patients.

Potential profile analysis and influencing factors of nurses′ spiritual health in elderly care institutions / 中国实用护理杂志

Objective:To investigate the spiritual health status of nurses in elderly care institutions, analyze the potential categories of spiritual health of nurses in elderly care institutions and explore the influencing factors of different categories.Methods:This study was a cross-sectional survey. From April to July 2022, 352 nurses from 15 elder care institutions in Shandong province were selected to conduct a questionnaire survey on demographic characteristics and spiritual health. Potential profile analysis was used to identify different spiritual health categories, and one-way ANOVA and ordered logistic regression were used to test the differences in population characteristics.Results:There were group heterogeneity in the spiritual health of nurses in elderly care institutions, which were divided into "high level stable type" (34.66%), "medium level type" (44.89%) and "low self transcendence type" (20.45%). Ordered logistic regression showed that age ( OR = 1.054, OR 95% CI: 1.031-1.078, P<0.01), self-assessment health ( OR = 3.034, OR 95% CI: 1.478-6.221, P<0.01), and spiritual learning and training experience ( OR = 2.221, OR 95% CI: 1.370-3.600, P<0.01) were protective factors of spiritual health. Single parent families ( OR = 0.018, OR 95% CI: 0.002-0.197, P<0.01) and working 12 to 16 hours a day ( OR = 0.029, 95% CI: 0.009-0.091, P<0.01), working more than 16 hours a day ( OR = 0.046, 95% CI: 0.018-0.119, P<0.01) were risk factors for spiritual health. Conclusions:There are three potential categories of nurses′ spiritual health in the elderly care institutions, and different categories of nurses have different characteristics. Institutional managers should carry out targeted interventions according to different characteristics to improve their spiritual health.

Meta-integration of behavioral barriers to help-seeking in elderly abuse victims / 中国实用护理杂志

Objective:To systematically integrate qualitative studies of impediments to help-seeking behavior in victims of elder abuse.Methods:A computer search of PubMed, the Cochrane Library, Web of Science, PsyINFO, Scopus, China Biology Medicine disc, China Knowledge Network, Vipshop, and Wanfang was conducted to collect qualitative studies on help-seeking in abused older adults, with search time from establishment of the database to February 2022. The literature was evaluated using the Australian JBI Centre for Evidence-Based Health Care quality assessment criteria, and the results were integrated using the Meta integration method.Results:A total of 9 papers were included, 32 results were extracted and grouped into 9 categories, and 3 integrated results were synthesized including the role of personal factors, the influence of cultural values, and the lack of effective support networks.Conclusions:Seeking help after elder abuse is a complex process influenced by a variety of personal, social and cultural factors. Awareness of seeking help after abuse should be raised, attention should be paid to the physical and mental health of the elderly, and professional assistance and counseling services should be provided.

Reflection on the Changes in the Scope of Ethical Review / 中国医学伦理学

At the end of February 2023, the new Notice on the Issuance of Ethical Review Measures for Life Science and Medical Research Involving Humans was issued by the National Health Commission, the Ministry of Education, the Ministry of Science and Technology, and the State Administration of Traditional Chinese Medicine. It adheres to the basic principles and institutional framework of the Ethical Review Measures for Biomedical Research Involving Humans , and combines with the actual situation of domestic ethical work to optimize and improve the details and procedures of the review. Based on the Ethical Review Measures for Biomedical Research Involving Humans, the Ethical Review Measures for Life Science and Medical Research Involving Humans have expanded the scope of application of ethical review. Different experts in the field have discussed in detail the changes in the scope of review, and proposed review procedures that may need to be corresponding adjustments based on the changes for the readers’ reference.

Difference analysis of imported malaria characteristics in Pudong New Area of Shanghai before and after COVID-19 / 上海预防医学

ObjectiveTo describe the differences in imported malaria cases before and after the COVID-19 pandemic in Pudong New Area， Shanghai， to explore the possible impact of isolation measures during the pandemic on malaria， and to provide a basis for formulation of malaria control strategies during the prevention and control of major infectious diseases in the future. MethodsInformation on malaria cases reported in Pudong New Area from 2017 to 2022 was collected and divided into two groups： cases before the COVID-19 pandemic （2017‒2019） and cases after the COVID-19 pandemic （2020‒2022）. Analysis was conducted on information such as gender， age， parasite species， country of infection， place of onset， time of onset， time of first diagnosis， time of confirmed diagnosis， hospitalization， and duration of treatment for both groups. ResultsThe pre-COVID group consisted of 21 cases， and post-COVID group consisted of 28 cases， with male and falciparum malaria predominating in both groups. There were statistically significant differences between the two groups in terms of Shanghai residency status， use of preventive measures， and adherence to standardized treatment （P<0.05）. The time interval from symptom onset to first diagnosis was longer in the pre-COVID group than that in the post-COVID group （Z=-2.617， P<0.05 ）. The interval from the first diagnosis to the confirmed diagnosis and duration of treatment were shorter in the pre-COVID group than that in the post-COVID group （Z=-3.381， P<0.05； Z=-4.148， P<0.05）. There was no significant difference in gender， age， malaria classification， source of infection， onset area， length of hospital stay， complications， severe cases， and interval between onset and diagnosis between the two groups （P>0.05）. ConclusionAfter the outbreak of COVID-19， the medical priority plan prolongs the treatment time of malaria patients， increasing the risk of severe illness and death.

Effect of local unstable atherosclerotic plaque on plaque formation in the carotid artery and abdominal aorta of rabbits / 南方医科大学学报

OBJECTIVE@#To analyze the effect of local unstable atherosclerotic plaque on plaque formation in the carotid and aortic arteries of rabbits.@*METHODS@#Thirty New Zealand white rabbits were randomly divided into atherosclerosis model group, highfat diet feeding group, and normal chow feeding group (blank control group). In the model group, carotid artery balloon injury was induced after 4 weeks of high-fat diet feeding. Eight weeks later, all the rabbits were euthanized for histopathological examination of the carotid artery and abdominal aorta, and the mean intimal thickness and plaque to lumen area ratio were measured using image analysis software. Venous blood samples were collected from the rabbits for blood lipid analysis.@*RESULT@#At the ends of 4, 8 and 12 weeks, the rabbits in the model group and high-fat feeding group, but not those in the blank control group, all showed significant weight gain compared with their body weight at 0 week (P < 0.05). The mean intimal thickness was significantly greater in atherosclerosis model group than in the other two groups (P < 0.05). In atherosclerosis model group, the mean intimal thickness and plaque to lumen area ratio in the injured carotid artery were significantly greater than those in the contralateral carotid artery and abdominal aorta (P < 0.05). At the end of the 12 weeks, the levels of triglyceride (TG), total cholesterol (TC), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C) and highsensitivity C-reactive protein (CRP) were all significantly higher in the model group and high-fat feeding group than in the blank control group (P < 0.05); the levels of TG, TC, LDL-C, or HDL-C did not differ significantly between the model group and high-fat feeding group (P>0.05), but the level of CRP was significantly higher in arteriosclerosis model group (P < 0.05).@*CONCLUSION@#Local unstable atherosclerotic plaque can increase the level of CRP and promote the formation of atherosclerotic plaques in the carotid artery and abdominal aorta in rabbits.

Meta-analysis of Simotang Oral Liquid in treatment of functional dyspepsia in adults / 中国中药杂志

This study was conducted to evaluate the efficacy and safety of Simotang Oral Liquid in the treatment of functional dyspepsia in adults. "Simotang Oral Liquid" "Simotang" "Si Mo Tang" "Si Mo Tang Oral Liquid" were used for retrieval of the relevant papers from CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, Springer Link, and Web of Science from database inception to June 2021. Randomized controlled trial(RCT) of Simotang Oral Liquid in the treatment of functional dyspepsia in adults was screened out for Meta-analysis which was conducted in RevMan 5.3. A total of 16 RCTs were included. Meta-analysis showed that compared with the control group, Simotang Oral Liquid increased the total response rate and lowered the traditional Chinese medicine syndrome scores, serum cholecystokinin(CCK), serum nitric oxide(NO), and incidence of adverse reactions. However, the serum substance P(SP) had no statistical difference between the two groups. Simotang Oral Liquid is effective and safe in the treatment of functional dyspepsia in adults. However, this study has evidence and limitations, so the conclusions need to be further verified by large sample and multicenter clinical studies.

Imaging classification and analysis of the diagnosis and treatment of infected pancreatic necrosis:a report of 126 cases / 中华外科杂志

Objective: To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN) and the prognosis of different treatment methods in the imaging classification of IPN proposed. Methods: The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively. There were 70 males(55.6%) and 56 females(44.4%), with age(M(IQR)) of 44(17)years (range: 12 to 87 years). There were 67 cases(53.2%) of severe acute pancreatitis and 59 cases (46.8%) of moderately severe acute pancreatitis. All cases were based on the diagnostic criteria of IPN. All cases were divided into Type Ⅰ(central IPN)(n=21), Type Ⅱ(peripheral IPN)(n=23), Type Ⅲ(mixed IPN)(n=74) and Type Ⅳ(isolated IPN)(n=8) according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(n=109) and Step-jump group(n=17). The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,t-test,χ2 test or Fisher exact test,respectively. Results: There was no significant difference in mortality, complication rate and complication grade in each type of IPN(all P>0.05). Compared with other types of patients, the length of stay (69(40)days vs. 19(19)days) and hospitalization expenses(323 000(419 000)yuan vs. 60 000(78 000)yuan) were significantly increased in Type Ⅳ IPN(Z=-4.041, -3.972; both P<0.01). The incidence of postoperative residual infection of Type Ⅳ IPN was significantly higher than that of other types (χ2=16.350,P<0.01). There was no significant difference in the mortality of patients with different types of IPN between different treatment groups. The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days vs. 33(35)days, Z=-2.052, P=0.040;59 000(80 000)yuan vs. 122 000(109 000)yuan,Z=-2.317,P=0.020). Among the patients in Type Ⅳ IPN, the hospitalization expenses of Step-up group was significantly higher than that of Step-jump group(330 000(578 000)yuan vs. 141 000 yuan,Z=-2.000,P=0.046). The incidence of postoperative residual infection of Step-up group(17.4%(19/109)) was significantly lower than that of Step-jump group(10/17)(χ2=11.980, P=0.001). Conclusions: Type Ⅳ IPN is more serious than the other three types. It causes longer length of stay and more hospitalization expenses. The step-up approach is safe and effective in the treatment of IPN. However, for infected lesions which are deep in place,difficult to reach by conventional drainage methods, or mainly exhibit "dry necrosis", choosing the step-jump approach is a more positive choice.

Analysis of clinical efficacy and risk factors of relapse in young patients with cervical instability treated by manipulation / 中国骨伤

OBJECTIVE@#To determine the clinical efficacy of different manipulation in the treatment of cervical instability in young people, and to analyze the risk factors of relapse of cervical instability in young people.@*METHODS@#From March 2021 to June 2022, the clinical data of 120 young patients with cervical instability were retrospectively analyzed. According to the different treatment methods, they were divided into rotation group (60 cases, 3 cases of loss) and tendon group (60 cases, 5 cases of loss). There were 25 males and 32 females in rotation-traction manipulation group;age ranged from 22 to 44 years old with a median of 28 years old;course of disease ranged from 0.17 to 120 months with amedian of 22 months. There were 22 males and 33 females in tendon-regulating manipulation group;age ranged from 21 to 42 years old with a median of 27 years old;course of disease ranged from 0.23 to 180 months with a median of 24 months. Both groups were treated for 2 weeks, once every other day for 7 times, and were followed up for 1 year. The clinical efficacy of the two groups was evaluated, and the visual analogue scale (VAS), neck disability index (NDI) were observed before and after treatment. One year after the course of treatment, patients with effective treatment were followed up to make statistics on recurrence. Patients with recurrence were included in the recurrence group, while those without recurrence were included in the non-recurrence group. Factors that may affect symptom recurrence were analyzed, and univariate and multivariate Logistic regression analysis were performed.@*RESULTS@#The 13 patients who failed the treatment (4 cases in the rotation-traction manipulation group and 9 cases in the tendon-regulating manipulation group) were not followed up. All the 99 patients who were effective in treatment were followed up ranged from 303 to 406 days with a median of 359 days. No complications occurred in all patients. There were significant differences in VAS and NDI between the two groups after treatment and before treatment (P<0.05), and there were significant differences in VAS and NDI between the two groups after treatment (P<0.05). Ninety-nine patients achieved follow-up, 56 (56.57%) relapsed and 43 (43.43%) did not. Univariate correlation analysis showed that NDI index, the time spent at the desk every day, the time spent using electronic products every day and angular displacement of anterior flexion before treatment in the relapse group were significantly higher than those in the non-relapse group (P<0.05). Logistic regression analysis showed that the time spent at the desk every day [OR=2.447, 95%CI(1.255, 4.771)], the time spent using electronic products every day [OR=1.892, 95%CI(1.066, 3.358)] and the angular displacement of anterior flexion of the cervical before treatment [OR=1.246, 95%CI(1.045, 1.485) ]were the risk factors for relapse.@*CONCLUSION@#Both rotation-traction manipulation and tendon-regulating manipulation can effectively treat cervical instability in young people, and rotation-traction manipulation has more advantages than tendon-regulating manipulation in improving cervical pain and cervical dysfunction in patients. The time spent at the desk every day, the time spent using electronic products every day, and the increase of cervical flexion angle displacement will increase the risk of relapse in patients.

Evolution and progress of surgical intervention strategies for acute pancreatitis / 中华外科杂志

Acute pancreatitis is one of the common surgical acute abdominal diseases. Since people first recognized acute pancreatitis in the middle of the nineteenth century, a diversified minimally invasive treatment model with standardization has been formed today. According to the main line of surgical intervention of acute pancreatitis treatment,this period can be roughly divided into five stages:exploration stage, conservative treatment stage, pancreatectomy stage, debridement and drainage of the pancreatic necrotic tissue stage, and minimally invasive treatment as the first choice led by the multidisciplinary team mode stage. Throughout history, the evolution and progress of surgical intervention strategies for acute pancreatitis cannot be separated from the progress of science and technology, the update of treatment concepts and the further understanding of the pathogenesis. This article will summarize the surgical characteristics of acute pancreatitis treatment at each stage to explain the development of surgical treatment of acute pancreatitis,to help investigate the development of surgical treatment of acute pancreatitis in the future.

Comparison of Zhuyao and Douchi Ligustri Lucidi Fructus Based on Quality Investigation of Commercial Samples / 中国实验方剂学杂志

ObjectiveTo investigate the quality of Ligustri Lucidi Fructus in the market， and the moisture， extract， determination of Zhuyao and Douchi Ligustri Lucidi Fructus were compared to increase the utilization rate of Ligustri Lucidi Fructus. MethodThe properties， moisture， total ash， alcohol-soluble extract content and thin layer chromatography （TLC） identification were determined by the methods of Ligustri Lucidi Fructus included in the 2020 edition of Chinese Pharmacopoeia， and high performance liquid chromatography （HPLC） fingerprint and determination of specnuezhenide and salidroside were established with the mobile phase of 0.2% phosphoric acid aqueous solution （A）-acetonitrile （B） （0-70 min， 92%-65%A） for gradient elution， and the detection wavelength of 220 nm at 0-14 min and 225 nm at 14-70 min. The two different characters of Ligustri Lucidi Fructus were comprehensively compared by the above indicators. ResultExcept for one batch which did not meet the requirements due to the quality of harvesting， the other 12 batches of samples all met the requirements of the 2020 edition of Chinese Pharmacopoeia， but there were two different characters. Comparing the two different characters of Ligustri Lucidi Fructus， it is found that the moisture， total ash， extract， salidroside and specnuezhenide contents of Zhuyao samples were 2.22%-5.19%， 3.91%-4.49%， 32.56%-40.95%， 0.073%-0.170% and 1.45%-4.14%， and these values of Douchi samples were 3.57%-5.61%， 3.65%-4.44%， 41.31%-46.70%， 0.041%-0.067% and 3.01%-4.20%， respectively. ConclusionThe contents of extract and specnuezhenide of Douchi Ligustri Lucidi Fructus are mostly higher than those of Zhuyao Ligustri Lucidi Fructus， while the content of salidroside is lower than that of Zhuyao samples， and there are no significant differences in moisture， TLC identification and total ash content. Based on the above research， if the main purpose is to extract salidroside， it is recommended to choose Zhuyao Ligustri Lucidi Fructus. If the main purpose is to use Ligustri Lucidi Fructus as medicine， it is recommended to choose Douchi Ligustri Lucidi Fructus.

Discussion on Pharmacopoeia Standard and Drug Site of Amomi Fructus Based on Quality Investigation of Commercial Samples / 中国实验方剂学杂志

ObjectiveTo investigate the quality of Amomi Fructus in the market， and to compare the difference between the seed mass and shell， so as to provide a basis for standardizing the usage of Amomi Fructus. MethodThe properties， thin layer identification， moisture， the content of bornyl acetate were determined by the methods in the 2020 edition of Chinese Pharmacopoeia， and the ash and extract content were determined according to the collection method of the 2020 edition of Chinese Pharmacopoeia. ResultAmong the 17 batches of samples， except the content of bornyl acetate in 2 batches of Amomum longiligulare， 2 batches of A. longiligulare and A. villosum mixture was lower than the standard， the quality of other samples all met the standard of the 2020 edition of Chinese Pharmacopoeia， but there were two specifications with shell and without shell. The husk rate， volatile oil， extract and bornyl acetate contents of the seed mass and shell were tested. It was found that the content of volatile oil in three kinds of Amomi Fructus seed mass was 1.8-5.3 times that of the corresponding shell， and the content of bornyl acetate in the seed mass was 8.8-62.1 times that of the corresponding shell， but there was little difference in the extract content. ConclusionBased on the above research， it is considered that the content of bornyl acetate in A. longiligulare contained in the 2020 edition of Chinese Pharmacopoeia remains to be discussed. It is tentatively determined that the total ash content of Amomi Fructus should not be more than 10.0%， and the extract content should not be less than 15.0%. At the same time， it is suggested that when Amomi Fructus is used as medicine， the dosage of Amomi Fructus should be calculated according to the removal rate of 20%-30% of shell， and it should be crushed regardless of whether it is used in shell or not.

A proposed mechanism by which Qishen Yiqi dropping pill improves cardiac energy metabolism in rats with heart failure based on metabolomics and network pharmacology / 药学学报

"Omics" and bioinformatics have brought new ideas to the study of traditional Chinese medicine. This study used metabonomics and network pharmacology to investigate the pharmacodynamic basis and regulation of Qishen Yiqi dropping pill (QDP) improving cardiac energy metabolism in rats with heart failure (HF). 1H NMR metabonomics analysis showed that eight metabolites, including carnitine, glutamine, creatine, proline, homocitrulline, lactic acid, taurine and alanine appeared significant callback after QDP treatment for HF. The results indicate that QDP regulates the metabolism of carbohydrate, lipid, ATP and protein. The animal experiment was conducted in accordance with the regulations of the Ethics Committee for Experimental Animal Management and Animal Welfare of Institute of Materia Medica, Chinese Academy of Medical Sciences. A "drug-component-target-disease" network was established using network pharmacology, and the "component-target" sub-network related to the above energy metabolism processes was extracted by combining metabonomics results. Results revealed 79 chemical compounds and 47 potential targets of QDP involved in the regulation of energy metabolism, and identified key chemical components including ursolic acid, notoginsenoside G, ginsenoside-Rh1, and core targets such as INS, PPARG, and AKT1. The results also demonstrated the complex multi-target and multi-component relationship between QDP and HF from the perspective of energy metabolism. The molecular docking technique verified a strong interaction between some targets and chemical compounds, with affinities less than -5 kcal·mol-1. The results of this study provide useful information for the clinical application, development, and utilization of QDP.

Effect of indoor and outdoor environmental factors on allergic and infectious diseases in children / 上海预防医学

Objective To investigate the prevalence of allergic and infectious diseases in children， and to assess the influence of indoor and outdoor environmental factors on these two common diseases in children. Methods A questionnaire was used to investigate the prevalence of allergic and infectious diseases in 140 children of 7 years old in Laizhou Bay， Shandong Province. Logistic regression was used to analyze the associations between indoor and outdoor environmental factors and children’s allergic and infectious diseases， respectively. Results The prevalence of previous eczema and other allergic diseases for the past year in children was 37.9% and 15.0%， respectively， and the prevalence of infectious diseases for the past year was 35.7%. As for allergic diseases， eye irritation due to outdoor air （ OR =2.977； 95% CI ： 1.407‒6.296） and nose irritation due to outdoor air （ OR =5.147； 95% CI ： 1.272‒20.827） were the risk factors for previous eczema in children. Indoor musty taste increased the risks of urticaria （ OR =4.306； 95% CI ： 1.062‒17.454） and previous eczema （ OR =3.853； 95% CI ： 1.080‒13.743）. The use of cockroach killers indoors increased the risk of rhinitis （ OR =6.102； 95% CI ：1.297‒28.697）. As for infectious diseases， having outdoor pollution sources increased the risk of gastrointestinal infection （ OR =4.937； 95% CI ： 1.050‒23.216）， and the use of mosquito coils and clothing mothproofing agents increased the risks of respiratory （ OR =6.333； 95% CI ： 1.397‒28.714） and gastrointestinal infections （ OR =3.218； 95% CI ： 1.074‒9.644）， respectively. However， we did not find associations between indoor passive smoking and allergic or infectious diseases. Conclusion Except outdoor passive smoking， all the other indoor and outdoor environmental factors increase the risks of children’s allergies and infectious diseases.

Effect of indoor and outdoor environmental factors on allergic and infectious diseases in children / 上海预防医学

Objective To investigate the prevalence of allergic and infectious diseases in children， and to assess the influence of indoor and outdoor environmental factors on these two common diseases in children. Methods A questionnaire was used to investigate the prevalence of allergic and infectious diseases in 140 children of 7 years old in Laizhou Bay， Shandong Province. Logistic regression was used to analyze the associations between indoor and outdoor environmental factors and children’s allergic and infectious diseases， respectively. Results The prevalence of previous eczema and other allergic diseases for the past year in children was 37.9% and 15.0%， respectively， and the prevalence of infectious diseases for the past year was 35.7%. As for allergic diseases， eye irritation due to outdoor air （ OR =2.977； 95% CI ： 1.407‒6.296） and nose irritation due to outdoor air （ OR =5.147； 95% CI ： 1.272‒20.827） were the risk factors for previous eczema in children. Indoor musty taste increased the risks of urticaria （ OR =4.306； 95% CI ： 1.062‒17.454） and previous eczema （ OR =3.853； 95% CI ： 1.080‒13.743）. The use of cockroach killers indoors increased the risk of rhinitis （ OR =6.102； 95% CI ：1.297‒28.697）. As for infectious diseases， having outdoor pollution sources increased the risk of gastrointestinal infection （ OR =4.937； 95% CI ： 1.050‒23.216）， and the use of mosquito coils and clothing mothproofing agents increased the risks of respiratory （ OR =6.333； 95% CI ： 1.397‒28.714） and gastrointestinal infections （ OR =3.218； 95% CI ： 1.074‒9.644）， respectively. However， we did not find associations between indoor passive smoking and allergic or infectious diseases. Conclusion Except outdoor passive smoking， all the other indoor and outdoor environmental factors increase the risks of children’s allergies and infectious diseases.

Molecular Mechanism of Shengxiantang in Treating Myasthenia Gravis： Based on Network Pharmacology and Molecular Docking / 中国实验方剂学杂志

ObjectiveTo predict the pharmacodynamic basis and core target of Shengxiantang in the treatment of myasthenia gravis （MG） by network pharmacology and molecular docking and to further verify the molecular mechanism through animal experiment. MethodThe active components and potential targets of Shengxiantang were retrieved from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）， and the disease-related targets from GeneCards and other databases. Then the common targets of the decoction and the disease were screened out， followed by the construction of protein-protein interaction （PPI） network， and Gene Ontology （GO） term enrichment and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment of the common targets based on STRING database and Cytoscape 3.8.2. Afterward， Cytoscape 3.8.2 was employed to construct the disease-active component-target network. AutoDock and PyMOL were used for molecular docking of key components and hub genes. Finally， we used the Rα97-116 peptide to induce experimental autoimmune myasthenia gravis （EAMG） in rats and then verified the core target yielded in the docking with the model rats. ResultA total of 655 disease-related targets， 118 active components of the decoction， 21 common targets of the disease and the decoction， and 3 hub genes were screened out. The common targets were mainly involved in the GO terms of regulation of active oxygen metabolism， positive regulation of protein transport， and positive regulation of protein localization， and the KEGG pathways of toll-like receptor signaling pathway， phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， hypoxia inducible factor-1 （HIF-1） signaling pathway， and T cell receptor signaling pathway. The results of molecular docking showed that quercetin and Akt1 had the lowest and stable binding energy and interacted with each other through the amino acid residue LYS-30. Western blot demonstrated that Shengxiantang significantly inhibited the expression of p-Akt protein in the spleen of EAMG rats. ConclusionThe pharmacological mechanism of Shengxiantang in the treatment of MG may be that the main chemical components regulate the expression of the core protein Akt， and then may participate in and affect PI3K/Akt signaling pathways， laying a theoretical and experimental basis for further research.

Expert consensus on clinical application of GBE50 Dispersible Tablets for ischemic cardiovascular and cerebrovascular diseases / 中国中药杂志

Ginkgo biloba Extract( GBE50) Dispersible Tablets is a new standardized prescription,which is widely used in the treatment of ischemic cardiovascular and cerebrovascular diseases. However,there are still many problems in its clinical application.Rational and safe use of GBE50 Dispersible Tablets is pivotal to the medication safety and clinical prognosis of patients. This consensus has been jointly formulated by clinical experts of traditional Chinese medicine and western medicine in cardiovascular and cerebrovascular diseases and followed the Manual for the Clinical Experts Consensus of Chinese Patent Medicine published by the China Association of Chinese Medicine. The present study identified clinical problems based on clinical investigation,searched the research papers according to PICO clinical problems,carried out evidence evaluation,classification,and recommendation by GRADE system,and reached the expert consensus with nominal group technique. The consensus combines evidence with expert experience. Sufficient evidence of clinical problems corresponds to " recommendations",while insufficient evidence to " suggestions". Safety issues of GBE50 Dispersible Tablets,such as indications,usage and dosage,and medication for special populations,are defined to improve clinical efficacy,promote rational medication,and reduce drug risks. This consensus needs to be revised based on emerging clinical issues and evidencebased updates in practical applications in the future.

Clinical symptoms and imaging findings of cervical instability in young adult / 中国骨伤

OBJECTIVE@#To explore clinical symptoms and X-ray imaging features of cervical instability in young adult represented by postgraduates with a master's degree in medicine.@*METHODS@#Totally 91 postgraduates with a master's degree in medicine were investigated from September to December 2021, including 45 males and 46 females;aged from 22 to 30 years old with an average of (25.30±2.18) years old. The cervical spondylosis-related discomfort symptoms of the subjects were collected and examined by the examiner for neck and shoulder tenderness point examination and cervical vertebra positive and lateral and functional X-ray radiography. According to the results of X-ray examination, the subjects were divided into stable cervical group and unstable cervical group.@*RESULTS@#Among 91 subjects, there were 50 patients with cervical instability, accounting for 54.90% of total number of subjects. The cervical curvature was abnormal in 78 patients, accounting for 85.70% of total number of subjects. Among 50 patients with cervical instability, 50 patients were diagnosed as cervical instability on the basis of angular displaxement(AD)≥ 11 °, including 13 cases of C3,4 instability, 30 cases of C4,5 instability and 7 cases of C5,6 instability;and 5 cases were diagnosed as cervical instability based on horizontal displacement(HD)≥ 3.5 mm, including 1 case of C3,4 instability and 4 cases of C4,5 instability. Compared with stable cervical group, the number of discomfort symptoms of neck pain, headache and shoulder pain in instability group was significantly higher than that of in stable cervical group(P<0.05);and the number of tenderness in spinous process space of C4,5 and C5,6, 2 cm adjacent to the spinous process of C2-C5 and the superior angle of the scapula (the stop point of levator scapulae) in the instability group was significantly higher than that in the stable cervical group (P<0.05);and the cervical curvature in the instability group was significantly lower than that in stable cervical group(P<0.05).@*CONCLUSION@#The incidence of cervical instability in young adult represented by postgraduates with a master's degree in medicine is high, they are mainly diagnosed as cervical instability on the basis of vertebral angular displacement ≥ 11°, and the instability segments are concentrated on C3,4, C4,5 and C5,6 segments, the occurrence of cervical instability is often accompanied by abnormalities of cervical curvature. Most of clinical manifestations are head, neck and shoulder pain, especially neck pain in unstable segment.

Effect of laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration on pain stress and inflammatory factors in elderly patients with cholecystolithiasis and choledocholithiasis / 国际外科学杂志

Objective:To investigate the effect of laparoscopic cholecystectomy (LC) combined with common bile duct exploration (LCBDE) on pain stress and inflammatory factors in elderly patients with gallbladder stones and common bile duct stones.Methods:Eighty elderly patients with cholecystolithiasis and choledocholithiasis in Huadong Hospital Affiliated to Fudan University from January 2020 to January 2021 were selected. According to the surgical method, they were divided into observation group of 40 cases and control group of 40 cases. Patients in the observation group were treated with LC combined with LCBDE, and patients in the control group were treated with traditional open surgery. The perioperative indicators and complications, changes in pain stress and inflammatory factors before and 3 days after operation, and the quality of life before operation, 1 month after operation and 6 months after operation were compared between the two groups. Normally distributed measurement data were represented by mean±standard deviation ( Mean± SD), and t test was used to compare between groups. The chi-square test was used to compare the count data between groups. Results:The operation time, time to get out of bed, postoperative exhaust time, intraoperative blood loss, and postoperative complications in the observation group were (98.39±7.23) min, (1.56±0.37) d, (1.29±0.28) d, (38.94±5.64) mL, 5%, the control group were (107.53±9.98) min, (2.53±0.52) d, (2.16±0.34) d, (65.87±7.96) mL, 25%, the observation group were excellent in all indicators compared with the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum 5-hydroxytryptamine, substance P and norepinephrine in the two groups were higher than before operation ( P<0.05); after operation 3rd day, serum 5-hydroxytryptamine, substance P and norepinephrine the observation group were (0.70±0.12) pg/mL, (175.42±17.87) ng/mL and (378.52±26.57) ng/mL, the control group were (1.02±0.18) pg/mL, (248.98±18.98) ng/mL, and (460.92±35.42) ng/mL. The indexes of the observation group were smaller than those of the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the two groups were higher than before operation ( P<0.05); after operation 3rd day, Serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the observation group were (108.76±10.86) pg/mL, (14.23±3.18) mg/L and (17.84±3.98) pg/mL, respectively, on the 3rd day after operation. The control group were (156.95±16.67) pg/mL, (26.52±4.59) mg/L and (28.53±5.67) pg/mL, the observation group indexes were all smaller than control group, the differences between the two groups were statistically significant ( P<0.05). The quality of life scores of the two groups at 1 month and 6 months after the operation were higher than before operation ( P<0.05); The quality of life scores of patients in the observation group at 1 month and 6 months after surgery were higher than control group ( P<0.05). Conclusion:LC combined with LCBDE treatment has little effect on pain stress and inflammatory factors in elderly patients with cholecystolithiasis and choledocholithiasis, and has fewer postoperative complications, and can improve the quality of life of patients.

Effect of Sishenwan， Baitouweng Tang， and Lianlitang on Ulcerative Colitis in Rats / 中国实验方剂学杂志

Objective:To explore the mechanism of Sishenwan， Baitouweng Tang， and Lianlitang in the treatment of ulcerative colitis （UC）， and compare their efficacies on UC in rats. Method:Ninety SD rats of SPF grade were randomly divided into blank group （distilled water， 2 mL·d^-1） and experimental group. The rats in the experimental groups were administered with 2，4，6-trinitrobenzene sulfonic acid （TNBS） by clysis to induce the UC model. Subsequently， the model rats were divided into a model group （distilled water， 2 mL·d^-1）， positive group ［sulfasalazine （SASP）， 0.4 g·kg^-1·d^-1］， Sishenwan group （1.76 g·kg^-1·d^-1）， a Baitouweng Tang group （1.40 g·kg^-1·d^-1）， and Lianlitang group （2.13 g·kg^-1·d^-1） according to the random number table. The rats in each group were dosed at 2 mL·d^-1 for 14 days. The pathological score for colonic mucosa was detected. Cytokines were detected by the cytokine chip. The enzyme-linked immunosorbent assay （ELISA） was used to detect the free triiodothyronine （FT₃）， glucagon-like peptide-1 （GLP-1）， and corticosterone （CORT） in plasma， and neurotensin （NT）， substance P （SP）， vasoactive intestinal peptide （VIP）， and somatostatin （SST） in colon tissues. Result:Compared with the normal group， the model group showed increased colon mass-length ratio and pathological score for colonic mucosa （<italic>P</italic><0.01）， infiltration of massive lymphocytes， disordered or absent intestinal villi， elevated levels of cytokine-induced neutrophil chemoattractant-1/2<italic>α</italic>/<italic>β</italic>/3 （CINC-1/2<italic>α</italic>/<italic>β</italic>/3）， interleukin-1<italic>α</italic> （IL-1<italic>α</italic>）， interferon-inducible protein-10 （IP-10） and other factors in colon tissues （<italic>P</italic><0.05）， dwindled CORT and GLP-1 levels in plasma （<italic>P</italic><0.05）， and increased SP content in colon tissues （<italic>P</italic><0.05）. Compared with the results in the model group， the mucosal injury in the colon of rats in each drug group was relieved. The levels of IL-1<italic>α</italic>， IP-10， lipopolysaccharide-inducible CXC chemokine （LIX）， and L-selectin of rats in the Lianlitang group and Sishenwan group were reduced （<italic>P</italic><0.05）， and the CINC-3 and IL-17 levels were diminished in the Baitouweng Tang group （<italic>P</italic><0.05）. The levels of CINC-1/3， IL-1<italic>α</italic>， and IP-10 were reduced in the SASP group （<italic>P</italic><0.05）. The plasma FT₃ was up-regulated in the Lianlitang group， and the plasma GLP-1 levels were elevated in the three Chinese medicine groups （<italic>P</italic><0.05）. The VIP content in colon tissues of the Sishenwan group and Baitouweng Tang group was down-regulated （<italic>P</italic><0.05）， and the SST content in colon tissues of the SASP group was significantly up-regulated （<italic>P</italic><0.01）. Conclusion:The intervention of Lianlitang and Sishenwan on UC was significant， and the underlying mechanism of action might be related to inflammation inhibition and immune balance by regulating the cytokine network. The efficacy of Lianlitang was predominant， followed by Sishenwan and Baitouweng Tang.