Covalent linkage with acetylcholinesterase (AChE) to form ligand-target adduct (L-T) is primarily responsible for pesticide poisoning, notably those carbamates (CARs) and organophosphorus (OPs), which frequently occurs in clinic. Because covalent modification resists proteolysis, L-T measurement can be accomplished by monitoring modified peptide(s) that further act as a quantitatively bidirectional indicator for both ligand and target. Covalent modification locates at hydroxyl group of Ser225 residue. Modified peptide relative response (AM) and the response ratio (RM/U) between modified and unmodified peptides were specifically concerned. When providing adequate AChE, RM/U was correlated linearly with ligand concentration, and similarly, linear relationships occurred between RM/U and AChE content when the given ligand was sufficient. Agreement emerged for the sigmoid trajectories between AM against carbamate concentration and colorimetric Ellman assay. AM against ligand concentration curve uniquely enabled inhibition measurement of the mixed pesticides. Structural annotation of modified peptide facilitated the unknown toxin(s) identity annotation. Together, the measurement of modified peptide that reflects L-T identity and concentration, enabled the qualitative and quantitative analysis of either ligand or target, as well as toxicological performance evaluation of individual ligands and even ligand mixtures.

AimObesity in children have become major public health issues worldwide. The study aimed to determine the prevalence of overweight and obesity among children in Longgang District, Shenzhen, China, in the context of COVID-19 and analyze associated risk factors.MethodsA cross-sectional study was conducted through online survey from May to July 2021. World Health Organization child growth standards and the health industry standards of the People’s Republic of China were used as the diagnostic criteria for overweight and obesity. The prevalences of overweight and obesity were calculated, and risk factors of obesity were analyzed using binary logistic regression.ResultsThe parents or guardians of 124,593 children were administered, and 108,581 subjects were included. The prevalences of overweight and obesity among kindergarten children in Longgang District, Shenzhen, were 8.3 and 7.9%, respectively. The risk factors for childhood obesity included congenital, family, and lifestyle factors.ConclusionIn 2021, the obesity prevalence of kindergarten children in Longgang District was close to some high-income countries and higher than Shenzhen before the outbreaks of COVID-19. This finding may be associated with social, family, and personal factors. Exploration of evidence-based, effective means of modifying children’s health habits, and social support is urgently needed.

Idiopathic pulmonary fibrosis (IPF) is characterized by fibrotic matrix deposition and irreversible aberrant tissue remodeling. Their mechanisms of action are associated with the activation of macrophages and a disturbed immune environment. We aim to determine how these activated macrophages influenced the pathogenesis of pulmonary fibrosis. We found the fibrotic areas of IPF patients contained more serum and glucocorticoid-induced kinase 1 (SGK1)-positive and M2-type macrophages. Similarly, bleomycin (BLM)+LPS significantly triggered high expression of SGK1 in the IPF mice, accompanied by destroyed lung structure and function, increased fibrosis markers and disturbed immune microenvironment. Mechanistically, SGK1 markedly promoted the reprogramming of M2-type macrophages in fibrotic lungs by triggering glycogen synthase kinase 3beta (GSK3β)-tat-interacting protein 60 (TIP60)- histone-3 lysine-27 acetylation (H3K27ac) signalings, which further released chemokine (C-C motif) ligand 9 (CCL9) to attract Th17 cells and delivered TGF-β to fibroblasts for synergistically destroying immune microenvironment, which was largely reversed by macrophage depletion in mice. We took macrophages as the entry point to deeply analyze IPF pathogenesis and further provided insights for the development of novel drugs represented by SGK1.

Helicobacter pylori（Hp） is a class I carcinogen, and eradication of Hp can be used as a primary preventive measure for gastric cancer. Hp infection has been clearly defined as an infectious and contagious disease. Hp infection has the basic characteristics of bacterial pathogenicity. From the perspective of traditional Chinese medicine（TCM）, it is caused by external pathogens, but it also has the pathological basis of internal injuries. The normal gastric mucosa have regular arrangement of collecting venules（RAC） rules. Inflammatory microenvironment of gastric mucosa caused by Hp adhesion inflammation can cause RAC signs to become irregular, disordered, fused, or even disappear. Based on the Sanjiao theory, the location of Hp infection was clearly in the mid-focal gastric mucosa. The process of adhesion induced inflammation can directly lead to the deterioration of the ‘permeability network effect’ of the Sanjiao. The pathological process can be visually reflected by the changes of gastric mucosal RAC signs under the microscope. The summed up TCM syndromes by previous studies on the correlation between Hp infection and TCM syndrome types are mainly dampness, heat, stagnation of qi and deficiency. The combination of these syndromes is the ‘swelling’ ‘fullness’ and ‘distension’ of Sanjiao diseases. YE Tian-shi put forward the method of separating upper and lower elimination aiming at pathogenic pathogens invading Sanjiao. According to the difference between the up and down trends, it is also specifically divided into aromatic xinsan method, open drainage method and bitter drainage method. Aiming at the inflammatory microenvironment caused by Hp infection, these methods can play a comprehensive role in treating both symptoms and root causes. Based on the theory of Sanjiao theory, the treatment principle of the method of separating upper and lower elimination is adopted to provide a relatively systematic new idea for the treatment of Hp infection of TCM.

Viral infectious diseases (VIDs) impose a heavy burden on global public health. Traditional Chinese medicine (TCM) has previously and is currently contributing to the prevention and treatment of infectious diseases. Omics and information technology enable the precise identification of virus characteristics, virus‒host interactions and TCM mechanisms. In this study, we constructed the YiNet platform to better integrate the novel techniques and historical experience of TCM in infectious diseases. YiNet comprises three modules: knowledge base, database and toolkit. The YiNet knowledge base involves 43 VIDs, thereby systematically integrating the knowledge regarding viruses, host symptoms and TCM and Western medicine (commonly used chemical drugs, 6,899 herbs and 2,481 formulas). The YiNet database module includes multiple databases, comprising 57,340 genome sequences of 45,791 viral strains and 5,726 multi-omics datasets such as RNA-seq, ChIP-seq and ATAC-seq from different tissues and cell models. It also integrates 1,105 real-world TCM clinical cases. We adopted visual analysis tool to investigate pathogen–host–herb relationships. To explore pharmacological mechanisms for the core herbs, we added formula data mining and network pharmacology analysis pipelines and visualisation tools. YiNet can facilitate the mechanistic study of TCM and drug development for VIDs. The YiNet platform is publicly available at http://yinet.gene.ac/ .

循证医学的理念和方法已引入中医药领域研究20余年,着眼于将循证医学的理念和方法整合到中医疫病研究中,顺应时代发展的需要,产出高质量临床研究证据,探索中医与西医的有机协同,实现最佳的疫病诊疗效果,提出"一个目标、两头强化、三点突破、四项侧重"的循证中医疫病学建设思路,认为具有重要的现实意义和实用价值,以期能为构建中医疫病学的循证研究方向提供参考.

名老中医传承是进一步推动中医药创新发展的关键所在,但目前名老中医研究存在重"术"轻"道"的问题,缺乏全面挖掘和传承的方法学体系及研究范式,缺乏对名老中医防治重大、难治疾病的群体研究.认为名老中医传承工作的重点应聚焦在名老中医的"道""术"研究上.通过应用扎根理论、病例系列研究、队列研究,以及数据挖掘等定性、定量混合研究方法,创新性构建了名老中医道术传承范式.提出了不同名老中医诊治重大、难治疾病的道术异同对比研究策略,为未来基于名老中医群体开展重大、难治疾病诊疗方案提供参考意见.并利用表述性状态传递(REST)互联网架构提供网络化开放式的稳定服务,搭建医疗、科研、传承、推广一体化的服务平台作为推广范式,进一步推广名老中医道术研究成果,惠及基层医生、科研人员和广大群众.

Background The impact of COVID-19 has most likely increased the prevalence of stunting. The study aimed to determine the prevalence of stunting among kindergarten children in the context of coronavirus disease 2019 (COVID-19) in Longgang District, Shenzhen, China, and its risk factors. Methods A cross-sectional study was conducted to identify children from 11 sub districts of 481 kindergartens in the Longgang District of Shenzhen City from May to July 2021. In the context of COVID-19, an online survey was conducted to gather demographic information, height, birth information, and lifestyle. The prevalence of stunting was calculated, and the risk factors were analyzed using binary logistic regression with three stepwise models. Results A total of 118,404 subjects were included from May to July 2021, with a response and questionnaire effective rates of 85.75% and 95.03%, respectively. The prevalence of stunting and severe stunting were 3.3% and 0.8%, respectively. Model 3 showed that risk factors for stunting were male sex [odds ratio (OR) = 1.07], low birth weight (OR = 2.02), insufficient sleep time (OR = 1.08), less food intake than their peers (OR = 1.66), slower eating than their peers (OR = 1.16), accompanied by grandparents alone or non-lineal relatives (reference: parents accompanying) (OR = 1.23, 1.51), and children induced to eat (OR = 1.17). Protective factors included only-child status (OR = 0.66), reported high activity (OR = 0.37, 0.26, 0.23), parents with high education levels (father: OR = 0.87, 0.69; mother: OR = 0.69, 0.58), high monthly income per capita of the family (OR = 0.88, 0.74, 0.68), and allowing children to make food choices (OR = 0.82). Conclusion The stunting rate of children in kindergartens in Longgang District is 3.3%, close to the level of developed countries but higher than the average level of developed cities in China. The relatively high stunting rate in children under 3 years old in 2021 may be associated with the influence of COVID-19. Appropriate policies should be formulated for individuals and families with children to help children establish good living habits and reduce stunting.

中医药防治疫病历史悠久,积累了丰富的经验,形成了独特的辨证论治体系.疫病常用的辨证体系包括卫气营血辨证、三焦辨证、六经辨证、表里辨证,各体系能够从不同角度对于疫病病机进行辨证.在疫病的诊疗中,要注重辨证与辨病相结合,在辨证思维的指导下,辨别疫病的病性、病所、病期、病势、病理,则可确定相应的治则治法,从而确定方剂、配伍选药.文章对疫病的辨证与辨病进行了梳理和总结,有利于提高疫病的临床辨治水平.

肺系疫病是指以肺系为主要传染途径而导致的疫病,其发生发展是包括了病原微生物、气候、地理、环境等在内的多种生物、物理因素与机体脏腑、气、津、血等相互作用所产生综合反应的结果.不同人群因个人体质不同、接触病原微生物的风险大小不同,存在着不同的患病机率,四季气候的变化、不同的地理、自然环境同样可影响病原微生物的生长繁殖和传播,从而对传染病的发生发展产生不同的影响.文章基于中医学"三因制宜"原则,综合考虑不同人群、不同季节、不同地域的特点,因人、因地、因时制宜制定相应的中药处方策略,为肺系疫病的中医药预防提供参考.

ObjectiveTo explore the structural and functional characteristics of microbiota in oropharynx of sub-healthy children with gastrointestinal heat retention syndrome (GHRS) differentiated by traditional Chinese medicine, and screen the biometric operational taxonomic units (OTUs) to assist the clinical diagnosis.MethodsWe recruited children according to the "GHRS diagnostic scale", collected their oropharyngeal swabs, and sequenced the 16S rDNA V4 region. We described the bacterial structure with alpha-indexes, beta-distances, and relative abundances; moreover, we screened the differential genera/OTUs with Wilcoxon rank-sum test, MetagenomeSeq analysis, and linear discriminant analysis effect size (LEfSe) analysis, in which biometric OTUs were selected to construct the receiver operating characteristic curve to verify the diagnostic value. The bacterial function was predicted with Kyoto Encyclopedia of Genes and Genomes pathways according to 16S rDNA gene by using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States.ResultsThe study population was composed of 10 children with GHRS and 10 healthy control children. GHRS children were more likely to overeat (gluttony, P = .033). Alpha-indexes, such as Sobs, abundance-based coverage estimator, Bootstrap, and Qstat, were significantly higher in the GHRS group, while beta-distances did not exhibit any significant intergroup differences. There were 9 differently distributed non-predominant genera between the groups in Wilcoxon rank-sum test, as well as 13 non-predominant genera in MetagenomeSeq analysis and 3 non-predominant OTUs in LEfSe analysis. OTU44 and OTU196 were used to construct the receiver operating characteristic curve, and the area under curve was 0.92. Predicted functions showed that pathways related to oxidative phosphorylation and carbon metabolism were enriched in healthy control samples, while the pathway related to renin secretion was remarkably enriched in GHRS samples.ConclusionUnique oropharyngeal microbial structure and function were identified in GHRS children. OTU44 and OTU196 were specific OTUs, which could be used as biomarkers of GHRS to assist clinical diagnosis.

通过部位划分的三焦,在结构上将心肺、脾胃、肝肾分别归属于上、中、下三焦,在功能上又把三焦功能与脏腑等同,虽然三焦结构和功能范围更加全面,但实际临床意义却越来越小.通过追本溯源,笔者发现《黄帝内经》不存在将三焦按部位划分之意,只有"六腑之三焦"的概念.三焦是一个具有明确结构的组织器官,其结构基础为"肉分之间"非实质之处,结合现代医学,可以将此结构进一步深入探讨,即三焦器官是一个间质组织,基本功能是气化,发挥的是通道作用.三焦气化功能发挥"通透性网状效应",由于病理产物聚积,导致三焦气化通道出现不畅或闭塞,进而会造成五脏六腑功能表达不全甚至闭塞.笔者认为,三焦器官是急性传染性疾病发生发展过程中病机传变规律重要的参与者,与慢性内伤疾病"一脏累及多脏"的病机传变思维模式不同.三焦疾病在临床上是常见病,有特定的生理、病理特点以及治疗原则,还原《黄帝内经》"三焦器官"概念,具有非常重要的临床价值.

Traditional Chinese medicine has widely been used internationally in the treatment of coronavirus disease 2019 (COVID-19) since January 2020. There has been great interest in initiating clinical studies testing different Chinese medicine therapies for COVID-19, but the majority of registered studies have yet to move forward due to a lack of COVID-19 patients in mainland China. The aim of this article was to systematically review the current clinical research evidence on Chinese medicine for treating COVID-19 from international and domestic bibliographic databases to reflect on the advances in this field.

通过对《肘后备急方》与盐相关记载的梳理,整理、归纳并分析葛、陶《肘后方》中盐相关条文.《肘后备急方》中盐应为食盐;所涉及疾病种类范围广泛;所载盐的用法包括内服合外用,内服法包括合它药煮取,水、温酒等为溶剂送服,盐汤、熬或烧后口服,单行,食疗,合药为丸,口含等法;外用法,含煮后渍患处或渍它药、洗法、外敷法、熨法、枕、掩耳、伺鼻、隔盐灸等法,且已出现忌盐调护的记载.《肘后备急方》中盐的用法多样,功效丰富,值得探讨.但,《肘后备急方》盐的应用存在扬弃两面,需辨证、客观对待.

中医医案是记录医家之经验心得、诊疗过程、指导后学继承和发展中医的特殊载体.它承载了大量的医学与人文信息,对中医学的发展起承前启后的作用,是一种被广泛接受、记录和传播中医文化的文体.随着大数据信息时代的到来,中医医案报告数量随之增多,但没有报告规范的指导,撰写和发表的医案报告质量难免良莠不齐,不能很好地指导或应用于临床实践和研究.通过对国内中医医案报告及规范的梳理并对国际相关报告规范的研究,本文讨论和分析了中医医案报告规范制定的必要性、存在问题并提出对策建议,促进中医医案报告撰写标准化工作的推进.

INTRODUCTION The contribution made by e-cigarettes to smoking cessation continues to be controversial. Reports suggest that teenagers are becoming increasingly addicted to e-cigarettes and that e-cigarette use in adolescents is associated with subsequent cigarette smoking. METHODS Systematic searches of eleven databases were conducted (January 2015 to June 2020). Systematic reviews, randomized controlled trials (RCTs) and cohort studies comparing e-cigarettes with placebo e-cigarettes, nicotine replacement therapy (NRT) or no e-cigarette use were included. The two primary outcomes were smoking cessation among smokers and smoking initiation among non-smoking teenagers. The secondary outcome was adverse events. Data were synthesized using risk ratio (RR) or adjusted odds ratio (AOR) with 95% confidence interval (CI). RESULTS Six systematic reviews, 5 RCTs and 24 cohort studies were identified. For smoking cessation, findings from 4 systematic reviews indicated that e-cigarettes contributed to cessation while one found the opposite. Meta-analysis of 5 RCTs suggested that e-cigarettes were superior to NRT or placebo for smoking cessation (RR=1.55; 95% CI: 1.00-2.40; I-2=57.6%; low certainty; 5 trials, n=4025). Evidence from 9 cohort studies showed that e-cigarette use was not associated with cessation (AOR=1.16; 95% CI: 0.88-1.54; I-2=69.0%; n=22220). Subgroup analysis suggested that intensive e-cigarette use may be associated with cessation. In terms of smoking initiation, adolescents who ever used e-cigarettes had a greater risk for smoking initiation than non-users (AOR=2.91; 95% CI: 2.61-3.23; I-2=61.0%; 15 trials, n=68943), the findings were consistent with one included systematic review. No serious adverse events were reported in the included studies. CONCLUSIONS Low certainty evidence suggests that e-cigarettes appear to be potentially effective for smoking cessation. The use of e-cigarettes in adolescents may be associated with smoking initiation. No serious adverse events were reported.

六经辨证、卫气营血辨证以及三焦辨证,不同的辨证体系都是对人体的生理病理进行一种“模型化”的讨论,是一种完整探究人体的理论模型.《温热论》中“辨营卫气血虽与伤寒同”这句话深刻揭示了不同辨证体系虽然理论模型不同,但生理病理基础相同,这是交叉融合的根本所在.同时,不同的分类方法决定了不同的辨证体系在同一病位上一定会有交叉和重叠, “邪中少阳”与“邪留三焦”便是如此.叶天士在《温热论》中将这一问题抛出,笔者试着以“少阳与三焦”这一层面为例,客观谈论不同辨证体系的交叉与融合.

探讨名老中医经验传承研究中访谈法问题的设计与实施过程.认为需结合研究目的,选择恰当的方法,访谈前要了解研究对象基本情况,而开场问题是建立访谈互信的基础.在设计主体问题时要紧扣研究目的,灵活运用开放型、封闭型、清晰型、具体型和抽象型问题,并针对不同研究对象设计不同的访谈问题,适当进行追问,解决实际需求.访谈结尾建议设置开放型问题,提前进行预访谈以及通过专家共识方法完善访谈清单.掌握访谈方法,将有效提高访谈效率和质量,使访谈获得具有足够广度和深度的研究资料,促进名医传承工作的高效开展.

脾胃湿热证是中医脾胃病最常见的证型之一,叶天士在《温热论》中完整地提出"分消上下"法治疗气分湿热证.虽然叶天士将湿热的病位定位于三焦,但其重心仍在中焦脾胃.根据脾胃湿热证偏于上焦、中焦和偏于下焦不同的症状体现,以及"湿重于热""热重于湿"病理性质的差异,进一步将"分消上下"法分为"芳香辛散""开泄"和"苦泄"三法,为后世指导临床治疗脾胃湿热证提供了法门.

目的:通过梳理中医古籍,对疫病的中医病名进行探究,以发挥中医防治疫病的优势作用.方法:检索中医古籍,构建中医疫病病名数据库,对病名进行分类和总结,探究疫病命名规律.结果:共检索中医古籍文献1 156本,检索出有疫病记载的条目31 786个,涉及病名2 207个.以发病特点命名的689个,以临床特征命名的548个,以发病原因命名的325个,以病症性质命名的171个,以病机特点命名的49个,以病变部位命名的100个,以时令主气命名的108个,以发病季节命名的60个,以人群命名的102个,以种属类别命名的51个,以五运六气命名的19个.结论:根据传染和流行程度是最多的命名方式,能够体现疫病的发病特点;根据临床特征命名是最直观的方式,能够很好地区分疫病;根据病证性质可分为寒性和热性,其中热性的命名较多;涉及病变部位最多的是呼吸系统和消化系统,这与病邪多从口鼻而入有关;五运六气是疫病最早命名方法,目前应用较少,更多是推算邪气的性质和特征.疫病命名方式不是独立的,经常是多种方式相结合命名.对疫病中医病名进行梳理和研究,有利于更好地认识疫病,对于其临床防治具有重要意义.