Chinese herb couple against diabetes: integrating network pharmacology and mechanism study.

Cassia twig is a dry twig of Cinnamomum cassia Presl, a Lauraceae plant. Astragalus L is one of the largest genuses of flowering plants in the Leguminosae family. Roots of A. membranaceus Bge. var. mongholicus (Bge.) Hsiao, A. membranaceus (Fisch.) Bge. Chinese herb couple refers to the matching of two herbs in pairs, mostly with synergistic effects or toxicity reduction. This Chinese herb couple (Cassia twig-Astragalus) come from the classic famous book "Zhang Xichun's book on Chinese herb couple", which is widely used to treat diabetes. Moreover, both Cassia twig and Astragalus belong to the homology of medicine and food. However, its mechanism is still unclear. The study identified the effective components of Cassia twig-Astragalus by UPLC-Q-TOF-MS/MS and investigated the mechanism of Cassia twig-Astragalus in treating diabetes by virtue of network pharmacology, molecular docking and experimental verification. Firstly, based on UPLC-Q-TOF-MS/MS and network pharmacology, a total of 10 active ingredients of Astragalus and 6 active ingredients of Cassia twig were screened, and a total of 13 key targets were obtained. There were 64 targets at the intersection of Cassia twig-Astragalus with diabetes, mainly including IL-17, TNF, NF-κß, AGE-RAGE signaling pathway, etc. It mainly involves the response of cells to insulin stimulation, the response to insulin and the positive regulation of cell adhesion. Secondly, molecular docking results showed that quercetin has good binding activities with AKT1 and TNF. Calycosin has good binding activities with AKT1, TNF and CAV1. Formononetin has good binding activities with TNF and IL-6. Isorhamnetin has good binding activities with AKT1, TNF and IL-6. Finally, the animal experiments showed that Cassia twig-Astragalus could improve the body weight, blood glucose and glucose tolerance in diabetic rats. After the intervention with Cassia twig-Astragalus, the inflammatory factors (IL-10, TNF-α, IL-6) were significantly improved in diabetic rats, which also effectively reduced TG and TC.Communicated by Ramaswamy H. Sarma.

Bronchoscopic interventions for bronchopleural fistulas.

Bronchopleural fistula is a potentially fatal disease most often caused after pneumonectomy. Concomitant problems such as pulmonary infection and respiratory failure are typically the main contributors to patient mortality because of the improper contact between the bronchial and pleural cavity. Therefore, bronchopleural fistulas need immediate treatment, which requires the accurate location and timely closure of the fistula. Currently, bronchoscopic interventions, because of their flexibility and versatility, are reliable alternative therapies in patients for whom surgical intervention is unsuitable. Possible interventions include bronchoscopic placement of blocking agents, atrial septal defect (ASD)/ventricular septal defect (VSD) occluders, airway stents, endobronchial valves (EBVs) and endobronchial Watanabe spigots (EWSs). Recent developments in mesenchymal stem cells (MSCs) transplantation technology and three-dimensional (3D) printed stents have also contributed to the treatment of bronchopleural fistula, but more research is needed to investigate the long-term benefits. This review focuses on the effectiveness of various bronchoscopic measures for the treatment of bronchopleural fistula and the directions for future development.

Facilitation of sensory transmission to motoneurons during cortical or sensory-evoked primary afferent depolarization (PAD) in humans.

Sensory and corticospinal tract (CST) pathways activate spinal GABAergic interneurons that have axoaxonic connections onto proprioceptive (Ia) afferents that cause long-lasting depolarizations (termed primary afferent depolarization, PAD). In rodents, sensory-evoked PAD is produced by GABAA receptors at nodes of Ranvier in Ia afferents, rather than at presynaptic terminals, and facilitates spike propagation to motoneurons by preventing branch-point failures, rather than causing presynaptic inhibition. We examined in 40 human participants whether putative activation of Ia-PAD by sensory or CST pathways can also facilitate Ia afferent activation of motoneurons via the H-reflex. H-reflexes in several leg muscles were facilitated by prior conditioning from low-threshold proprioceptive, cutaneous or CST pathways, with a similar long-lasting time course (∼200 ms) to phasic PAD measured in rodent Ia afferents. Long trains of cutaneous or proprioceptive afferent conditioning produced longer-lasting facilitation of the H-reflex for up to 2 min, consistent with tonic PAD in rodent Ia afferents mediated by nodal α5-GABAA receptors for similar stimulation trains. Facilitation of H-reflexes by this conditioning was likely not mediated by direct facilitation of the motoneurons because isolated stimulation of sensory or CST pathways did not alone facilitate the tonic firing rate of motor units. Furthermore, cutaneous conditioning increased the firing probability of single motor units (motoneurons) during the H-reflex without increasing their firing rate at this time, indicating that the underlying excitatory postsynaptic potential was more probable, but not larger. These results are consistent with sensory and CST pathways activating nodal GABAA receptors that reduce intermittent failure of action potentials propagating into Ia afferent branches. KEY POINTS: Controlled execution of posture and movement requires continually adjusted feedback from peripheral sensory pathways, especially those that carry proprioceptive information about body position, movement and effort. It was previously thought that the flow of proprioceptive feedback from Ia afferents was only reduced by GABAergic neurons in the spinal cord that sent axoaxonic projections to the terminal endings of sensory axons (termed GABAaxo neurons). Based on new findings in rodents, we provide complementary evidence in humans to suggest that sensory and corticospinal pathways known to activate GABAaxo neurons that project to dorsal parts of the Ia afferent also increase the flow of proprioceptive feedback to motoneurons in the spinal cord. These findings support a new role for spinal GABAaxo neurons in facilitating afferent feedback to the spinal cord during voluntary or reflexive movements.

Diagnostic value and safety of medical thoracoscopy under local anesthesia for unexplained diffuse interstitial lung disease: A retrospective study.

OBJECTIVE: We aimed to explore the safety and diagnostic value of medical thoracoscopic lung biopsy in patients with unexplained diffuse interstitial lung disease (ILD) in a single center pilot study. METHOD: We retrospectively analyzed clinical and pathological diagnostic data from 52 patients with diffuse ILD undergoing medical thoracoscopic lung biopsy. RESULTS: Forty-four cases of diffuse ILD were confirmed pathologically, giving a diagnostic rate of 84.6%. Among these 44 patients, 11 patients were diagnosed with cancer, including eight patients with lung adenocarcinoma, three patients with metastases; two from a gastrointestinal malignancy, and one from a granulosa cell tumor of the ovary. There were 17 cases of idiopathic interstitial pneumonia, including nine cases of usual interstitial pneumonia (UIP), four cases of non-specific interstitial pneumonia (NSIP), three cases of cryptogenic organizing pneumonia (COP), and one case of acute interstitial pneumonia (AIP). There were 12 cases of rare interstitial pneumonias, which included six cases of pulmonary alveolar proteinosis, one case each of pulmonary Langerhans cell histiocytosis (LCH) and pulmonary lymphangiomyomatosis, two cases of nodular sarcoidosis, and two cases of chronic eosinophilic pneumonia. We recorded various complications, including bleeding, infection, and pneumothorax. A total of 28 patients (53.8%) experienced at least one of the above complications, but there were no deaths associated with biopsy. CONCLUSIONS: Medical thoracoscopic lung biopsy appears a safe and effective method for diagnosing diffuse ILD of unknown cause but further prospective studies, with larger numbers, including comparison with other established techniques are required.

Spectrum-effect relationship between HPLC fingerprint and antioxidant of "San-Bai Decoction" extracts.

"San-Bai Decoction" (SBD) has been a traditional Chinese medicine compound preparation for replenishing Qi and promoting blood circulation, whitening skin, and removing blemishes since ancient times. However, its chemical composition and antioxidant activity are not clear thus far, which limits the in-depth study on its pharmacodynamic material basis and efficacy. The objective of this study was to establish the fingerprint profile of SBD, assess its antioxidant activity by measuring 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging ability, and find the spectrum-effect relationship of SBD by Grey Relation Analysis (GRA) and Partial Least Squares Regression (PLS). In this study, the fingerprint of SBD was established by high performance liquid chromatography (HPLC), and 20 common peaks were found, among which 6 peaks were designated. The similarities between the fingerprints of 12 batches of SBD and the reference fingerprint (R) were all greater than 0.900. Meanwhile, the antioxidant activities of all batches were concentration-dependent in their linear regression equation. The result of GRA showed that the correlation order of 20 common peaks for DPPH radical scavenging was X13 > X7 > X3 > X6 > X10 > X11 > X4 > X12 > X2 > X18 > X9 > X5 > X19 > X1 > X20 > X16 > X17 > X15 > X8 > X14. At the same time, PLS study demonstrated that the contribution of six identified characteristic peaks to DPPH radical scavenging ability was X1 = X7 > X6 > X19 > X20 > X16. In this study, the spectrum-effect relationship of SBD between its HPLC fingerprint and the antioxidant activity can be used to screen the pharmacodynamic substance basis of its antioxidant action and lay the foundation for establishing quality standards and product development.

Comparison of Tigecycline or Cefoperazone/Sulbactam therapy for bloodstream infection due to Carbapenem-resistant Acinetobacter baumannii.

Background: We retrospectively analyzed the effect of tigecycline and cefoperazone/sulbactam therapies on the prognosis of patients with carbapenem-resistant Acinetobacter baumannii bloodstream infection (CRAB-BSI). Methods: CRAB-BSI patients receiving tigecycline therapy or cefoperazone/sulbactam therapy between January 2012 and December 2017 was enrolled, and strict exclusion criteria were followed. The 28-day mortality of patients was analyzed. The impact of cefoperazone/sulbactam therapy on prognosis was evaluated using Cox multivariate regression analysis. The 28-day mortality of patients receiving cefoperazone/sulbactam monotherapy and cefoperazone/sulbactam-based combination therapy was also compared. Results: Three hundred forty eight patients with CRAB-BSI were enrolled in the study. Two hundred ten patients were included after applying the exclusion criteria. Of these, 135 patients received tigecycline therapy and 75 patients received cefoperazone/sulbactam therapy. The 28-day mortality of patients in the latter group was, significantly lower than that of the tigecycline group [29.3% vs. 51.9%; P = 0.001]. Cox multivariate regression analysis revealed that cefoperazone/sulbactam therapy exerted a protective effect on the prognosis of patients [hazard ratio 0.566, 95% confidence interval (0.342-0.940); P = 0.028]. Kaplan-Meier survival curve analysis indicated that the 28-day mortality of patients receiving cefoperazone/sulbactam therapy was lower than that of patients receiving cefoperazone/sulbactam monotherapy, but the difference was not significant (22.2% vs. 40%; P = 0.074). However, the mortality of patients receiving cefoperazone/sulbactam with imipenem/cilastatin was significantly lower than that of patients receiving cefoperazone/sulbactam monotherapy (P = 0.048). Conclusions: Patients treated with cefoperazone/sulbactam therapy had a better clinical outcome. The mortality of patients receiving cefoperazone/sulbactam with imipenem/cilastatin seems to be the lowest.

[Effects of Long-term Fertilization Regimes on As Accumulation in Upland Red Earth and the Crops Growing on It].

To investigate the effects of different long-term fertilization treatments on arsenic (As) accumulation in upland red earth and the crops growing on it, different fertilization treatments, including no fertilization (CK), fertilization with chemical fertilizers containing nitrogen, phosphorus and potassium (NPK), fertilization with swine manure (M), and fertilization with chemical fertilizers plus manure (NPKM), in a long-term fertilization site located in Qiyang County, Hunan Province, were selected.. The results showed that after 26 years of fertilization, both the total and available As concentrations in the soils were significantly improved in the fertilized soils (i.e., NPK, M, and NPKM) when compared to the CK soil. Meanwhile, NPK treatment had the highest As concentration (44.68 mg·kg-1), which was higher than the national standard value (40 mg·kg-1) in acidic soils. Fertilization practices had the biggest impacts on the non-specifically-absorbed As, followed by the residual As, and the well-crystallized hydrous oxides of Fe and Al absorbed As, but minor impacts on the amorphous and poorly-crystalline hydrous oxides of Fe and Al-absorbed As, and the specifically absorbed As. Furthermore, NPKM treatment significantly decreased the concentrations of As(Ⅲ) and As(Ⅴ) in the soils, when compared to the other treatments. Also, M treatment could cause the accumulation of As in the grains and straws in corn. In contrast, M treatment could not cause the accumulation of As in the grains and straws in wheat. Furthermore, correlative synchrotron-radiation-based FTIR and micro X-ray fluorescence spectromicroscopic analysis showed that As had a similar distribution pattern with clay -OH and C-OH.

[A proposal for the works of traditional Chinese medicine drafted by Mr. Yue Meizhong].

In 1951, The Interim Regulations on Practitioners of Traditional Chinese Medicine was issued by the Ministry of Health to restrict the practitioners' practice of traditional Chinese medicine (TCM) and to transform TCM, resulting in TCM facing the risk of interrupting its inheritance and development. In 1953, Yue Meizhong, a famous TCM physician, drafted a proposal about TCM development. After discussing and revising with Li Zhensan, the Director of North China Institute of TCM Experiment, the proposal was submitted to the Central Committee of Chinese Communist Party and Government Administration Council as a reference. The proposal made a retrospect of the long history of TCM development, elaborated the characteristic and significance of TCM, proposed the detailed suggestions about the establishment of TCM administration institutions at various levels, set up of TCM Academy and Colleges etc., which represented the voice of TCM professionals, and reflected the objective principle of TCM development.