Severity distribution and treatment of chronic obstructive pulmonary disease in China: baseline results of an observational study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) receives low awareness and is undertreated in China. Understanding the burden and treatment of COPD across the nation is important for improving quality of care for this disease. This study aims to reveal the current situation of COPD severity distribution and management across China. METHODS: Baseline data from REALizing and Improving Management of Stable COPD in China, a multicentre, prospective, longitudinal, observational study, were analysed. Patients diagnosed with COPD as per Global Initiative for Chronic Obstructive Lung Disease 2016 (GOLD 2016) criteria were enrolled from 50 randomly selected hospitals (tertiary, 25; secondary, 25) across six geographical regions. Data were collected in routine clinical settings. RESULTS: Between 15 December 2017 and 6 August 2020, 5013 patients were enrolled and 4978 included in the full analysis set. Of these, 2459 (49.4%) reported ≥ 1 exacerbation within 12 months prior to study enrolment, with a mean annual rate of 0.9/patient, including 0.2/patient and 0.5/patient leading to emergency room visits and hospitalisation, respectively. Spirometry graded 458 (10.1%), 1886 (41.7%), 1558 (34.5%), and 616 (13.6%) were GOLD stage I-IV, and 536 (11.4%), 1034 (22.0%), 563 (12.0%), and 2566 (54.6%) were classified as GOLD 2016 Group A-D, respectively, without evident regional variations. Inhaled corticosteroids plus long-acting beta2-agonist (ICS/LABA, 1316 [26.4%]), ICS/LABA plus long-acting muscarinic antagonist (ICS/LABA + LAMA, 871 [17.5%]), and LAMA (754 [15.1%]) were prescribed at high rates across all groups and regions. Medications not recommended by GOLD were commonly prescribed (TCM, 578 [11.6%]; others, 951 [19.1%]), and 681 (13.7%) were not given ICS or long-acting bronchodilators. CONCLUSIONS: Disease burden among Chinese COPD outpatients is high. Improved guideline adherence for COPD treatment is needed. Trial registration ClinicalTrials.gov identifier, NCT03131362.

Extractive removal of micro and trace nitrofen, 2, 4-dichlorophenol and p-nitrotrophenol from water/soil by humic acid ester ether.

The amphiphilic humic acid ester ether (HAEE), as a kind of solid-phase extractant with characteristics of easy separation and hydrophilic-hydrophobic amphiphilic property, was prepared and used to extract micro or trace nitrofen, 2,4-dichlorophenol and p-nitrotrophenol (NIPs) from water and soil. Degradation of NIPs and extractant regeneration were carried out by simple photocatalysis. The adsorption equilibrium of the mono- or three mixed NIPs by HAEE in aqueous could be quickly reached within 20 min. The adsorption process was fit to quasi-second-order kinetics model and Friendlich thermodynamics model. The possible adsorption interaction was discussed. Results suggested that the adsorption of NIPs onto HAEE predominated by hydrogen bonding, hydrophobic interaction and π-π interaction. The extraction capacity of mixed NIPs (80 µg/L each component) by HAEE was up to 0.38 mg/g and tended to be multi-layer adsorption, in which p-nitrotrophenol had higher adsorption competitiveness because of lower resistance to HAEE. When HAEE-NIPs were degraded by photo-catalyst Fe0/F-TiO2 for 8 h, not only the adsorbed NIPs could be totally degraded and mineralized, but also the HAEE could be effectively regenerated. When the NIPs were continuously extracted from 40-year aging soil for three times (regenerative twice) by combined extractant (48 mL H2O + 2 mL n-hexane + 0.1 g HAEE), the total extraction efficiency of NIPs could reach to 84.66%. This research could supplement the theory and technique for harmless treatment of NIPs contaminated water and soil.

Gingival health benefits of essential-oil and cetylpyridinium chloride mouthrinses: a 6-month randomized clinical study.

PURPOSE: This randomized, single center, examiner-blind, controlled, parallel-group, 6-month clinical study compared the antiplaque/antigingivitis potential of an essential oil (EO) versus a 0.07% cetylpyridinium chloride (CPC)-containing mouthrinse. A 5% hydroalcohol solution was included as a control group. METHODS: 354 healthy volunteers (18-71 years of age) were enrolled in this clinical trial; 338 subjects completed the study. At baseline, 1-, 3-, and 6-month visits, subjects received an oral examination, gingivitis (MGI), gingival bleeding (BI) and plaque assessments (PI). Following randomization, subjects received a prophylaxis and began brushing twice daily with the provided fluoride toothpaste and rinsing twice daily with 20 mL of the assigned mouthrinse for 30 seconds. RESULTS: All rinses were well tolerated by the subjects, with the exception of extrinsic tooth stain complaints in 13 subjects in the CPC group between the 3- and 6-month exams. Statistically significant reductions in gingivitis, bleeding and plaque were observed for both EO and CPC at all post-baseline time-points when compared to the negative control. At 6 months MGI and PI were reduced by 42.6% and 42.0% for EO and by 17.1% and 13.9% respectively, for CPC vs. control. When compared to CPC, EO was statistically significantly superior at all post-baseline time-points. EO showed increasing reductions in MGI of 10.5%, 20.3% and 30.7% as well as reductions in PI of 12.7%, 23.7% and 32.6% at 1, 3 and 6 months, respectively. When analyzing the number of healthy sites (MGI scores of 0 or 1), the beneficial effect of the EO-containing mouthrinse is 45.8% greater than using a CPC-containing mouthrinse and 59.8% greater than placebo.

Effect of Electroacupuncture at ST36 on Gastric-Related Neurons in Spinal Dorsal Horn and Nucleus Tractus Solitarius.

The aim of this study was to observe the effect of electroacupuncture (EA) at the ST36 acupoint on the firing rate of gastric-related neurons in the spinal dorsal horn (SDH) and nucleus tractus solitarius (NTS). There were different effects of gastric distention in SDH and NTS in 46 male Sprague-Dawley rats. In 10 excitatory neurons in SDH, most of the neurons were inhibited by homolateral EA. The firing rates decreased significantly (P < 0.05) in 10 excitatory gastric-related neurons in NTS; the firing rates of 6 neurons were further excited by homolateral EA, with a significant increase of the firing rates (P < 0.05); all inhibitory gastric-related neurons in NTS were excited by EA. The inhibition rate of homolateral EA was significantly increased in comparison with contralateral EA in gastric-related neurons of SDH (P < 0.05). There was no significant difference between homolateral and contralateral EA in gastric-related neurons of NTS. EA at ST36 changes the firing rate of gastric-related neurons in SDH and NTS. However, there are some differences in responsive mode in these neurons. The existence of these differences could be one of the physiological foundations of diversity and complexity in EA effects.

Preliminary Research of Relationship between Acute Peritonitis and Celiac Primo Vessels.

Previous studies demonstrated that primo vessels (PVs) were distributed in different parts of the body in mammals, and PVs were also involved in some processes of pathology such as cancer. Whether PVs are intrinsic structures in mammals or not is still ignored. In this study, a peritonitis model rat was induced by i.p. administration of E. coli in rats. PVs were observed in all infected rats, but it appeared less in untreated rats, taking 10.53% (4/38). In addition, we examined cell types in celiac PVs by fluorescent staining with 4',6-diamidino-2-phenylindole (DAPI) and Alexa Fluor 488 phalloidin, as well as immunofluorescent staining with CD11b and intercellular adhesion molecule-1(ICAM-1), and found the following. (1) The rod-shaped nuclei aligned longitudinally along PVs. (2) DAPI-, phalloidin-, CD11b-, and ICAM-1-positive labeling coexisted in PVs, suggesting that fibroblasts and leucocytes might be two kinds of cell types in PVs for both infected and control rats. (3) The difference was that numerous cells in PVs of the infected rats contained DAPI-labeled multilobal nucleus and were expressed with CD11b- and ICAM-1-positive labeling on the cytoplasm and membrane, showing the typical characteristics of neutrophil. (4) The cells in PVs from the untreated rats are those of loose connective tissue. Therefore, it is reasonably considered that PVs from infected rats might be the pathological products which might be involved in inflammation.

"Intensity-response" effects of electroacupuncture on gastric motility and its underlying peripheral neural mechanism.

The aim of this study was to explore the "intensity-response" relationship between EAS and the effect of gastric motility of rats and its underlying peripheral neural mechanism by employing ASIC3 knockout (ASIC3-/-), TRPV1 knockout (TRPV1-/-), and C57BL/6 mice. For adult male Sprague-Dawley (n = 18) rats, the intensities of EAS were 0.5, 1, 3, 5, 7, and 9 mA, respectively. For mice (n = 8 in each group), only 1 mA was used, by which C fiber of the mice can be activated. Gastric antrum motility was measured by intrapyloric balloon. Gastric motility was facilitated by EAS at ST36 and inhibited by EAS at CV12. The half maximal facilitation intensity of EAS at ST36 was 2.1-2.3 mA, and the half maximal inhibitory intensity of EAS at CV12 was 2.8 mA. In comparison with C57BL/6 mice, the facilitatory effect of ST36 and inhibitive effect of CV12 in ASIC3-/- mice decreased, but the difference was not statistically significant (P > 0.05). However, these effects in TRPV1-/- mice decreased significantly (P < 0.001). The results indicated that there existed an "intensity-response" relationship between EAS and the effect of gastric motility. TRPV1 receptor was involved in the regulation of gastric motility of EAS.

Transcutaneous auricular vagus nerve stimulation as a complementary therapy for pediatric epilepsy: a pilot trial.

OBJECTIVE: We investigated the safety and efficacy of transcutaneous auricular vagus nerve stimulation (ta-VNS) for the treatment of pediatric epilepsy. METHODS: Fourteen pediatric patients with intractable epilepsy were treated by ta-VNS of the bilateral auricular concha using an ear vagus nerve stimulator. The baseline seizure frequency was compared with that after 8weeks, from week 9 to 16 and from week 17 to the end of week 24, according to the seizure diaries of the patients. RESULTS: One patient dropped out after 8weeks of treatment due to lack of efficacy, while the remaining 13 patients completed the 24-week study without any change in medication regimen. The mean reduction in seizure frequency relative to baseline was 31.83% after week 8, 54.13% from week 9 to 16 and 54.21% from week 17 to the end of week 24. The responder rate was 28.57% after 8weeks, 53.85% from week 9 to 16 and 53.85% from week 17 to the end of week 24. No severe adverse events were reported during treatment. CONCLUSION: Transcutaneous auricular VNS may be a complementary treatment option for reducing seizure frequency in pediatric patients with intractable epilepsy and should be further studied.

Intravenous laser blood irradiation, interstitial laser acupuncture, and electroacupuncture in an animal experimental setting: preliminary results from heart rate variability and electrocorticographic recordings.

This is the first study to investigate intravenous (i.v.) laser blood irradiation, interstitial (i.st.) laser acupuncture, and electroacupuncture (EA) in combination with heart rate variability (HRV) and electrocorticogram. We investigated 10 male anesthetized Sprague-Dawley rats under the three conditions mentioned previously in Beijing, China, and data analysis was performed in Graz, Europe. For i.v. laser stimulation in the femoral vein and i.st. laser acupuncture at Neiguan (PC6), we used a European system (Modulas needle, Schwa-Medico, Germany; 658 nm, 50 mW, continuous wave mode), and for EA at Neiguan, a Chinese system (Hanshi-100A; Nanjing Jisheng Medical Technology Company, China; 15 Hz, 1 mA). HR, HRV, and electrocorticogram were recorded using a biophysical amplifier AVB-10 (Nihon-Kohden, Japan). HR changed significantly during i.st. laser acupuncture stimulation of Neiguan in anesthetized rats. Total HRV increased insignificantly during i.v. and i.st. laser stimulation. The LF/HF ratio showed significant changes only during i.v. laser blood irradiation. Integrated cortical EEG (electrocorticogram) decreased insignificantly during EA and i.v. laser blood irradiation. Further studies concerning dosage-dependent alterations are in progress.

Antiplaque and antigingivitis efficacy of an alcohol-free essential-oil containing mouthrinse: a 2-week clinical trial.

PURPOSE: This randomized, examiner blind, parallel group, controlled clinical study evaluated the antiplaque and antigingivitis potential of an alcohol-free essential oils containing mouthrinse (Listerine Zero) compared to a 5% hydroalcohol mouthrinse (negative control), using a 2-week experimental gingivitis model. METHODS: 92 subjects, male and female, ranging in age from 18-68 years, in good general health, were assigned to one of the two treatment groups: Alcohol-free essential oils containing mouthrinse (LZ) or 5% hydroalcohol negative control (C) rinse. The mean Turesky Modification of the Quigley-Hein Plaque Index (PI) and the mean Modified Gingival Index (MGI) at 2 weeks were the primary efficacy endpoints. Following baseline examinations, subjects received a complete dental prophylaxis and began supervised rinsing with their assigned mouthrinse twice daily for 2 weeks, as their sole oral hygiene measure. RESULTS: 90 subjects completed the trial. At 2 weeks, LZ was more effective (P<0.001) than C in reducing plaque (23.9%) and gingivitis (10.4%).

Are Primo Vessels (PVs) on the Surface of Gastrointestine Involved in Regulation of Gastric Motility Induced by Stimulating Acupoints ST36 or CV12?

Previous studies showed primo vessels (PVs), which were referred to as Bonhan ducts (BHDs) and a part of circulatory system by Kim, located in different places of the body. The BHDs system was once considered as the anatomical basis of classical acupuncture meridian but not clearly identified by other investigators. In the present study, we tried to address the relationship between PVs and meridians through detecting the modulation of gastric motility by stimulating the PVs on the surface of stomach or intestine, as well as acupoints Zusanli (ST36) and Zhongwan (CV12). The results showed electric stimulation of the PVs had no effect on the gastric motility. While stimulating CV12 inhibited gastric motility significantly in PVs-intact and PVs-cut rats, there is no significant difference between the inhibition rate of the PVS-intact and the PVS-cut rats. Stimulating at ST36 increased gastric motility significantly in both the PVs-intact and the PVs-cut rats, yet there was no significant difference between the facilitation rate of the both groups. Taken together, the PVs on the surface of stomach or intestine did not mediate the regulation of gastric motility induced by stimulating at the acupoints ST36 or CV12.

Auricular acupuncture and vagal regulation.

Auricular acupuncture has been utilized in the treatment of diseases for thousands of years. Dr. Paul Nogier firstly originated the concept of an inverted fetus map on the external ear. In the present study, the relationship between the auricular acupuncture and the vagal regulation has been reviewed. It has been shown that auricular acupuncture plays a role in vagal activity of autonomic functions of cardiovascular, respiratory, and gastrointestinal systems. Mechanism studies suggested that afferent projections from especially the auricular branch of the vagus nerve (ABVN) to the nucleus of the solitary tract (NTS) form the anatomical basis for the vagal regulation of auricular acupuncture. Therefore, we proposed the "auriculovagal afferent pathway" (AVAP): both the autonomic and the central nervous system could be modified by auricular vagal stimulation via projections from the ABVN to the NTS. Auricular acupuncture is also proposed to prevent neurodegenerative diseases via vagal regulation. There is a controversy on the specificity and the efficacy of auricular acupoints for treating diseases. More clinical RCT trials on auricular acupuncture and experimental studies on the mechanism of auricular acupuncture should be further investigated.

[Effects of electroacupuncture and regional thermal stimulation at "Zusanli" (ST 36) on pain thresholds of TRPV 1 knock-out mice].

OBJECTIVE: To observe the effect of electroacupuncture (EA) and moxibustion-like thermal stimulation with different temperatures at "Zusanli" (ST 36) on pain reactions in transient receptor potential vanilloid type 1 knock-out (TRPV 1 -/-) mice so as to study its mechanisms underlying analgesia. METHODS: Ten C 57 BL/6 mice and 10 TRPV 1 -/- mice were respectively divided into control and TRPV 1 -/- groups. EA (0.3 mA, 1.0 mA, 3.0 mA) or thermal water-bath (38 degrees C, 43 degrees C, 46 degrees C) stimulation was applied to the right ST 36 for 20 min and 10 min, respectively. Mechanical and thermal pain thresholds of the bilateral paws were detected before and immediately after stimulation, and 5 min after EA stimulation at 0.3 mA, 3.0 mA and thermal water-bath stimulation at 38 degrees C, 46 degrees C, separately. RESULTS: (1) The thermal threshold was significantly higher in TRPV 1 -/- mice than in C 57 BL/6 mice (P < 0.001). (2) In C 57 BL/6 mice, both homolateral and contralateral mechanical and thermal pain thresholds were significantly increased following 1.0 mA, 3.0 mA EA, and 43 degrees C and 46 degrees C thermal stimulation of the right Zusanli (ST 36) (P < 0.05, P < 0.01, P < 0.001); while only homolateral mechanical and thermal pain thresholds were increased after 0.3 mA EA and 38 degrees C thermal stimulation of ST36 (P < 0.05, P < 0.01). In TRPV 1 -/- mice group, both homolateral and contralateral mechanical and thermal pain thresholds were significantly increased by 3.0 mA EA stimulation of ST 36 (P < 0.05, P < 0.01). Bilateral mechanical thresholds and homolateral thermal threshold were significantly increased by 1.0 mA EA stimulation of ST 36 (P < 0.05, P < 0.01), while only homolateral mechanical and thermal pain thresholds were increased by 0.3 mA EA, and 43 degrees C and 46 degrees C thermal stimulation (P < 0.05, P < 0.01). Additionally, only the homolateral mechanical threshold was increased by 38 degrees C thermal stimulation (P < 0.05). (3) The mechanical and thermal pain thresholds of the bilateral limbs were increased to some extent in TRPV 1 -/- mice compared with those of C 57 BL/6 mice following EA and thermal stimulation of the right ST 36. (4) Five minutes after 0.3 mA, 3.0 mA EA and 38 degrees C, 46 degrees C thermal water-bath stimulation, both mechanical and thermal pain thresholds recovered to their baseline levels in both TRPV 1 -/- and C 57 BL/6 mice. CONCLUSION: Both EA and thermal stimulation of the right ST 36 can raise mechanical and thermal pain thresholds in TRPV 1 -/- and C 57 BL/6 mice, but needing a stronger stimulation in TRPV 1 -/- mice, suggesting an involvement of TRPV 1 receptors in analgesia.

[Effects of transcutaneous electrostimulation of auricular concha at different stimulating frequencies and duration on acute seizures in epilepsy rats].

OBJECTIVE: To observe the inhibitory effect of auricular concha transcutaneous electrostimulation (ACTES) of different frequencies and duration on acute seizures in epilepsy rats so as to select a better stimulating parameter for relieving epilepsy. METHODS: According to the stimulation duration of ACTES, 44 Sprague-Dawley rats were randomized into: 30 s, 5 min, 10 min, and 30 min groups. Epilepsy model was duplicated by intraperitoneal injection of PTZ (pentylenetetrazol, 50 mg/kg). Cerebral field potentials delivered from the fixed 4 recording electrodes array (A-P: -3 -6, L: 4 - 6, H: 1. 5) and reference electrode (a fixed screw) touching the cerebral dura surface were recorded using a data acquisition system (Cerebus 5.0 system). Transcutaneous electrostimulation (1 mA, duration 500 micro(s)) of frequency 2 Hz, 20 Hz and 100 Hz was applied to auricular concha by using an electric stimulator. The anti-epileptic effects of ACTES were evaluated by using the duration and rate of seizure suppression. RESULTS: (1) The anti-epileptic effect of 20 Hz -ACTES was markedly longer than those of 2 Hz and 100 Hz in the duration of seizure suppression (P < 0.05). (2) After 2 Hz-ACTES, the anti-epileptic effects (duration and inhibitory rate) in 30 s-stimulation group were markedly longer than those of the 5 min-, 10 min- and 30 min-stimulation groups (P < 0.01, P < 0.05). (3) After 100 Hz-ACTES, the anti-epileptic effects (duration and rate of seizure suppression) in the 30 min-stimulation group were markedly longer than those in the 30 s-, 5 min- and 10 min-stimulation group (P < 0.01, P < 0.05). CONCLUSION: ACTES at 20 Hz can effectively lessen epileptic seizures, and under fixed stimulating frequencies of 2 Hz and 100 Hz, the anti-epileptic effects of 30 s ACTES and 30 min-ACTES are obviously better in epilepsy rats.

[Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on cortical spreading depression (CSD) and contents of plasma calcitonin gene-related peptide (CGRP) and substance P (SP) in migraine rats. METHODS: Thirty male SD rats were equally randomized into control, model and EA groups. Migraine model was established by topical application of KCI (3 mol/L) immersed in a piece of filter paper to the cerebral cortex (parietal lobe, 6 mm posterior to the Bregma and 5 mm to the sagital fissure) after exposure of the skull (in reference to Michael' method). KCI stimulation evoked CSD potentials (3 mm rostral to the Bregma, and 2 mm to the sagital fissure) were recorded by using a glass microelectrode. For rats of control group, filter paper containing 0.9% NaCl was applied to the same parietal cortex area. EA (1 mA, 2 Hz/100 Hz) was applied to bilateral "Yanglingquan" (GB 34) and "Taichong" (LR 3) for 30 min. The contents of plasma CGRP and SP were assayed by radioimmunoassay. RESULTS: CSD was induced 3-5 min after application of KCI to the parietal lobe. The average amplitude of model group was (-25.13 +/- 1.23) mV, and that of EA group was (-19.19 +/- 1.53) mV, displaying a significant reduction of CSD amplitude after EA (P < 0.01). Comparison among 3 groups showed that both plasma CGRP and SP contents in model group were significantly higher than those of control group (P < 0.001, P < 0.01), while compared with model group, plasma CGRP and SP levels in EA group decreased considerably (P < 0.05, P < 0.001), suggesting an inhibitory effect of EA on pain-producing substance. CONCLUSION: EA of GB 34 and LR 3 can effectively suppress KCI provoked cortical spreading depression and plasma CGRP and SP levels in the rat, which may contribute to its effect in relieving migraine in clinic.