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In this study, post-heat treatments were applied to Ti–6Al–4V (TC4) alloy fabricated by selective laser melting (SLM) to investigate the effects of annealing temperature (750–950 °C in 50 °C intervals) on the alloy's microstructure, residual stress and mechanical properties. The initial microstructure of as-SLMed TC4 alloy was dominated by needle-like α′ martensite with a high density of dislocations and minor β phase, resulting in high strength (1190 MPa) but limited ductility (2.2% elongation). Annealing led to the transformation of α′ martensite into α phase, with the β phase content remaining relatively stable. Increasing the annealing temperature caused the acicular martensite to evolve into bundles of coarse α laths, forming a basket-weave microstructure. Annealing at 750 °C for 2 h reduced the yield strength to 1040 MPa and improved elongation to 8.3%. Interestingly, both the strength and ductility decreased with further increases in annealing temperature. This unusual phenomenon was rarely mentioned in current literature and was considered to be associated with the abnormal variations in the Schmid factor of (0001) [11-20] slip system and the reduction of mobile dislocations within the coarsened α martensite. Additionally, annealing combined with air cooling effectively alleviated residual tensile stresses in the SLM-formed TC4 alloy.

Summary: Lung parenchyma destruction represents a severe condition commonly found in chronic obstructive pulmonary disease (COPD), a leading cause of morbidity and mortality worldwide. Promoting lung regeneration is crucial for achieving clinical improvement. However, no therapeutic drugs are approved to improve the regeneration capacity due to incomplete understanding of the underlying pathogenic mechanisms. Here, we identify a positive feedback loop formed between adipose triglyceride lipase (ATGL)-mediated lipolysis and overexpression of CD36 specific to lung epithelial cells, contributing to disease progression. Genetic deletion of CD36 in lung epithelial cells and pharmacological inhibition of either ATGL or CD36 effectively reduce COPD pathogenesis and promote lung regeneration in mice. Mechanistically, disruption of the ATGL-CD36 loop rescues Z-DNA binding protein 1 (ZBP1)-induced cell necroptosis and restores WNT/β-catenin signaling. Thus, we uncover a crosstalk between lipolysis and lung epithelial cells, suggesting the regenerative potential for therapeutic intervention by targeting the ATGL-CD36-ZBP1 axis in COPD.

Objective: The objectives of this study were to define the superiority of icariin and its derivatives' anti-inflammatory activities and to create a reference framework for evaluating preclinical evidence. This method combines machine learning and meta-analysis to identify underlying biological pathways. Methods: Data came from PubMed, Embase, Web of Science, and the Cochrane Library. SYRCLE was used to evaluate the risk of bias in a subset of research. Meta-analysis and detailed subgroup analyses, categorized by species, genders, disease type, dosage, and treatment duration, were performed using R and STATA 15.0 software to derive nuanced insights. Employing R software (version 4.2.3) and the tidymodels package, the analysis focused on constructing a model and selecting features, with TNF-α as the dependent variable. This approach aims to identify significant predictors of drug efficacy. An in-depth literature facilitated the synthesis of anti-inflammatory mechanisms attributed to icariin and its constituent compounds. Results: Following a meticulous search and selection process, 19 studies, involving 370 and 260 animals were included in the meta-analysis and machine-learning assessment, respectively. The findings revealed that icariin and its derivatives markedly reduced inflammation markers, including TNF-α and IL-1β. Additionally, machine-learning outcomes, with TNF-α as the target variable, indicated enhanced anti-inflammatory effects of icariin across respiratory, urological, neurological, and digestive disease types. These effects were more pronounced at doses exceeding 27.52 mg/kg/day and treatment durations beyond 31.22 days. Conclusion: Strong anti-inflammatory effects are exhibited by icariiin and its derivatives, which are especially beneficial in the management of digestive, neurological, pulmonary, and urinary conditions. Effective for periods longer than 31.22 days and at dosages more than 27.52 mg/kg/day. Subsequent research will involve more targeted animal experiments and safety assessments to obtain more comprehensive preclinical evidence.

Objective: To deepen the imaging-pathological mechanism of primary central nervous system lymphoma (PCNSL) and provide a theoretical basis for clinical diagnosis and treatment, the functional magnetic resonance imaging (fMRI) characteristics of PCNSL were analyzed, and the relationship between the fMRI characteristics and vasculogenic mimicry (VM) and reticular fiber in PCNSL was discussed. Methods: Ninety-six patients with PCNSL treated in our hospital were divided into three groups according to the pathological examination results, including strong positive group of VM (n = 40), weak positive group of VM (n = 56), strong positive group of reticular fiber (n = 45) and weak positive group of reticular fiber (n = 51). The levels of augmentation index and apparent diffusion coefficient (ADC) were compared among the groups. receiver operator characteristic (ROC) curve analysis was used to analyze the clinical value of ADC value in differential diagnosis of PCNSL. Results: The levels of augmentation index in the strong positive group of VM were significantly higher than that in the weak positive group of VM, and the ADC value in the strong positive group of VM was significantly lower than that in the weak positive group of VM (P

In present work, tensile behaviors of cold-rolled 304L stainless steel were investigated at both room temperature (RT) and liquid nitrogen temperature (LNT). After cold-rolling with a thickness reduction of ∼92%, the 304L stainless steel exhibits an ultrahigh yield strength of 1787 MPa at the expense of ductility (1.06% of uniform elongation) at RT. At LNT, the yield strength (upper yield point of σyu = 2308.4 MPa and lower yield point of σyl = 1894.2 MPa) and uniform elongation (23%) increase greatly. Detailed microstructural investigation reveals that the cold-rolled 304L stainless steel comprises mainly of deformation induced martensite and high density of dislocations (9.06 ×1014 m−2), leading to a lack of dislocation storage capacity and thus brittle fracture at RT. While interrupt tests at LNT reveal a first increase and then decline in dislocation density with tensile strain, accompanied with phase transformation from austenite to martensite. The delamination events also occur, characterized by the multiple separated laminated ligaments observed at fracture surface. Therefore, the high dense dislocations and transformation-induced plasticity (TRIP) effect as well as delamination toughening mechanism contributes to the excellent combination of strength and ductility at LNT. Our work provides experimental and microstructural insights into the deformation mechanisms of the ∼92%-cold-rolled 304L stainless steel during tensile deformation at RT and LNT.

A high-strength-ductility 304L stainless steel with heterogeneous lamella structure (HLS) was fabricated by cold rolling and subsequent partial recrystallization. The HLS was composed of lamellar recrystallized grains (mean grain size of ∼4.1 μm) embedded in a hard matrix of ultra-fine grains (mean grain size of ∼0.65 μm) and dislocation-cell structure. It exhibited a superior cryogenic impact property compared with coarse-grained, fine-grained and cold-rolled 304L stainless steels. This was mainly attributed to the suppression of crack propagation by lamellar recrystallized grains, dislocation-cell structure and TRIP effect. In addition, the extra fracture energy was also caused by the delamination in ultra-fine grains. This work will give an important theoretical guidance for the cryogenic applications of the HLS 304L stainless steel.

Glycogen synthase kinase 3β (GSK3β) has been associated with sensing many different stimuli to trigger the NLRP3 inflammasome, which plays a crucial role in promoting the inflammatory response in diseases, including chronic obstructive pulmonary disease (COPD). Bufei Yishen formula (BYF), a traditional Chinese herbal medicine, has beneficial effects on COPD. Effective-component compatibility of BYF (ECC-BYF), optimized from BYF, is equally effective as BYF in inhibiting COPD inflammation. However, the exact mechanism by which ECC-BYF regulates the activation of NLRP3 inflammasome to inhibit COPD inflammation remains unclear. Hence, we investigated the mechanisms underlying the alleviation of COPD inflammation by ECC-BYF through the inhibition of GSK3β-mediated NLRP3 inflammasome activation by experimental rat model of COPD and lipopolysaccharide/adenosine triphosphate (LPS/ATP) induced macrophages. The data showed that ECC-BYF significantly improved the lung function, attenuated histopathological damage, and alleviated inflammatory cell infiltration and alveolar destruction. Further, it significantly inhibited inflammatory cytokine production and downregulated the phosphorylation of GSK3β by inhibiting the activation of NLRP3 inflammasome in the rat model of COPD. Moreover, ECC-BYF suppressed the activation of the NLRP3 inflammasome by increasing the phosphorylation at serine 9 and decreasing the phosphorylation at tyrosine 216 of GSK3β, followed by the inhibition of IL-1β secretion in macrophages. Together, ECC-BYF effectively ameliorates COPD by suppressing inflammation, which is dependent on the regulation of GSK3β-mediated NLRP3 inflammasome activation.

Ag nanoparticles (AgNPs) are toxic and can accumulate in the human body or the environment, resulting in biotoxic effects. Ti3C2Tx, a new class of graphene-like 2D nanomaterials, is used in numerous applications due to its special physicochemical properties. There is great concern about the potential damage that this material may cause to the environment and human health. In this study, the interaction mechanisms of Ti3C2Tx, AgNPs and Ti3C2Tx/AgNPs materials with human serum albumin (HSA) were characterized using multispectral analysis and zeta potential measurements, respectively. The results showed that the effects of the three materials on the conformational changes of HSA were AgNPs > Ti3C2Tx/AgNPs > Ti3C2Tx in order. Hydrogen bonding and electrostatic interaction forces played an important role in the binding process of Ti3C2Tx and its complexes with HSA. Ag nanoparticles have a comparatively high level of biotoxicity and have a more significant effect on the conformational changes of proteins. Ti3C2Tx itself has biocompatibility and a large specific surface area. The biotoxicity of Ti3C2Tx/AgNPs complex is lower than that of AgNPs, indicating that the addition of Ti3C2Tx can reduce the biotoxicity of Ag nanoparticles, and Ti3C2Tx may be used as a carrier substance for Ag nanoparticles, which can reduce the toxicity of AgNPs while giving it unique properties similar to those of Ti3C2Tx, thus improve the biosafety of Ag nanoparticles in the application process.

Heterogeneous laminates are developed to address the trade-off between strength and ductility, but interface cracking is a major concern. In this work, a heterostructured copper-brass laminate with 20 layers was successfully prepared by diffusion welding + cold rolling + annealing (DRA) technique. The obtained copper-brass laminate was composed of brass layers with fine grains and copper layers with coarse grains. During diffusion welding, a transition layer was found between copper and brass layers, with composition, grain size and hardness gradient. With the help of the gradient transition layer (GTL), the bonding strength of the welding interface is so high that cannot be torn apart during peeling test. The GTL plays important role in coordinating plastic deformation and relaxing stress concentration. An excellent combination of strength and ductility was realized in the copper-brass laminates, which can be attributed to the unique GTL and high density of heterogeneous interfaces. Moreover, the GTL with hardness gradient can prevent micro-cracks from initiating at interfaces, and avoid macro-crack propagating along the welding interface or coarse/fine grained heterogeneous interface.

Community-acquired pneumonia (CAP) is one of the most common infectious diseases, and its morbidity and mortality increase with age. Resistance and mutations development make the use of anti-infective therapy challenging. Chinese patent medicines (CPMs) are often used to treat CAP in China and well tolerable. However, currently there are no evidence-based guideline for the treatment of CAP with CPMs, and the misuse of CPMs is common. Therefore, we established a guideline panel to develop this guideline. We identified six clinical questions through two rounds of survey, and we then systematically searched relevant evidence and performed meta-analyses, evidence summaries and GRADE decision tables to draft recommendations, which were then voted on by a consensus panel using the Delphi method. Finally, we developed ten recommendations based on evidence synthesis and expert consensus. For the treatment of severe CAP in adults, we recommend Tanreqing injection, Reduning injection, Xuebijing injection, Shenfu injection, and Shenmai injection respectively. For the treatment of non-severe CAP in adults, we recommend Tanreqing injection, Reduning injection, Lianhua Qingwen capsule/granule, Qingfei Xiaoyan Pill and Shufeng Jiedu capsule respectively. CPMs have great potential to help in the fight against CAP worldwide, but more high-quality studies are still needed to strengthen the evidence.

In this work, heterostructured duplex stainless steel consisting of fine-grained austenite and bimodal-grained ferrite was prepared by heavy cold rolling and 2-min annealing at 1050 °C. The tailored steel achieved an excellent combination of high strength with a yield stress of ∼710 MPa and high ductility with a tensile elongation of ∼43%. The results revealed that the plastic incompatibilities between the constituent phases arising from the microstructural heterogeneity contributed to the significant partitioning of plastic strain, and the respectable strength–ductility synergy was attributed to hetero-deformation induced strengthening and strain hardening.

Inverted Oil-immersed Current Transformer (CT) is an important electrical equipment in the power system, which plays the role of current conversion and voltage isolation, also plays an indispensable role in the stable operation of the power system. Studies have shown that hydrogen is the earliest and easiest produced gas in the discharge and overheating faults of CTs, and hydrogen is also considered an early signal of equipment failure. In order to study the distribution and diffusion of hydrogen under typical defects of CTs, this paper established a 110 kV CT electric-thermal-flow multi-physics coupling three-dimensional simulation model. Using the method of finite element analysis, the internal temperature field of the CT and the distribution and diffusion of hydrogen are obtained. At the same time, an CT test platform is established to verify the accuracy and validity of the simulation results.

Background: Baojin Chenfei formula (BCF), a Chinese herbal formula, has significant effects on improving the clinical symptoms of patients with silicosis. However, its active compounds and the underlying mechanisms have not yet fully been elucidated. Purpose: This study aimed to explore the underlying mechanisms of BCF in treating silicosis. Methods: The rat model of silicosis was developed via a single intratracheal instillation of SiO2 suspension to examine the therapeutic impacts of BCF on silicosis. Subsequently, the active compounds, targets, and mechanisms of BCF were analyzed based on serum pharmacochemistry and network analysis. Finally, the underlying mechanisms of representative compounds of BCF were validated in vitro experiments. Results: BCF significantly alleviated SiO2-induced silicosis in rats, evidenced by improved lung function, decreased pathological injury, and reduced inflammatory response and fibrosis. 19 active compounds were identified from the rat serum samples after BCF gavage. Subsequently, 299 targets for these 19 compounds in BCF and 257 genes related to silicosis were collected. 26 overlapping targets, including AKT1, TNF, IL6, MAPK3, EGFR, and others, were obtained from the intersection of the 299 BCF-related targets and 257 silicosis-associated genes. These overlapping targets mainly corresponded to glycyrrhetic acid and paeoniflorin and were mainly associated with positive regulation of smooth muscle cell proliferation, positive regulation of MAP kinase activity, and inflammatory response. In vitro experiments also demonstrated that the representative compounds of BCF (glycyrrhetic acid and paeoniflorin) could suppress inflammatory response by the MAPK pathway, and also inhibited fibroblast activation by the EGFR-PI3K-AKT pathway. Conclusion: Active compounds of BCF, such as glycyrrhetic acid and paeoniflorin, could suppress inflammatory response by the MAPK pathway and suppress fibroblast activation by the EGFR-PI3K-AKT pathway. These might be the mechanisms of BCF in treating silicosis.

In this paper,a high strength Al-4.82Mg-0.75Sc-0.49Mn-0.28Zr (Al–Mg-Sc-Mn) alloy was prepared by selective laser melting (SLM). The effects of laser power on microstructures, relative density, and mechanical properties of SLM-fabricated Al–Mg-Sc-Mn alloy were studied. The results shown that the bimodal structure with an ultra-equiaxed grain and columnar crystal is formed in Slammed-fabricated Al–Mg-Sc-Mn alloy. The columnar crystal is surrounded by ultra-fine equiaxed crystal, and the columnar crystal shows (001) preferred orientation, the ultra-fine equiaxed structure shows no anisotropy in SLM-fabricated alloy. With increase of laser power, the molten pool size increases during SLM process, and the samples relative density and hardness decrease as laser power increase. The relative density of SLM-fabricated Al–Mg-Sc-Mn alloy is 99.74% under the process parameters of laser power 310W and scanning speed 1200 mm/s, and the hardness of alloy is as high as 107.73 ± 1.27 HV. The tensile strength of SLM-fabricated Al–Mg-Sc-Mn alloy samples are all higher than 400 MPa, and elongations are more than 19%. The fracture morphology of SLM-fabricated Al–Mg-Sc-Mn alloy is a typical ductile fracture feature, which shows a high comprehensive mechanical property. Supersaturated solid solution is formed in Al–Mg-Sc-Mn alloy because of rapid cooling during SLM process, resulting in grain refinement and improvement of mechanical properties. Fine-grain strengthening and second phase strengthening are the main reasons for the improvement of mechanical properties of SLM-fabricated Al–Mg-Sc-Mn alloy.

In this work, the formation mechanism of surface nano-grains was explored for a 316L stainless steel processed by a rotationally accelerated shot peening (RASP). The microstructural evolution below the processed surface was observed to reveal the refining behavior during the continuous impact deformation. The results showed that deformation ultrafine-twins were easily generated by one high-speed impact with the strain rate of ∼102–103 s−1. As it was impacted by the second ball, ultrafine-twin-twin intersections were appeared in the coupled domain, which was attributed to the accumulated strain induced by twice impacts, activating the bidirectional twinning. Twin–twin intersection can effectively divide the coarse-grains into smaller structures. When the impact number further increased, the average thickness of deformation twins decreased, and resulted in segmentation of original structures. Eventually, nano-grains were formed by nano-twin-twin intersections in the topmost surface. The average grain size of nano-grains is ∼30 nm. The current work clearly exhibited the surface microstructural evolution and revealed that twin-twin intersection was the dominated nanocrystallization mechanism for RASP-processed 316L stainless steel.

Al matrix composites reinforced with ceramic particles show excellent wear resistance and have great potential to replace convectional materials in many fields. In this paper, a high proportion (∼ 60%) of large ZrO2 particles reinforced Al matrix composites were manufactured by a high pressure infiltration method. The tribological behavior of the Al/ZrO2 composite and non-reinforced Al were investigated and compared using a GCr15 ball-on-disc apparatus under dry sliding wear condition. The microstructure, elements distribution and wear track morphology were analyzed to understand their tribological behavior and wear mechanisms. The wear rate of Al is 2.0 × 10−3 mm3 N−1 m−1, while the wear rate of Al/ZrO2 composite is only 0.15 × 10−3 mm3 N−1 m−1. The experimental results showed that Al is a combined wear mechanism of adhesive wear and abrasive wear. It also proved that the high proportion of large ceramic particle reinforced composite is stable under low load wear condition. The ceramic particles were firmly embedded in the Al matrix, and no ejection or removal of the particles was observed. The results showed that the wear mechanism of this composite is mainly three body abrasion in the stable wear stage.

A high-strength 316L stainless steel with heterostructure (HS) was used to explore its corrosion properties in 3.5wt.% NaCl solution at 25 °C. Compared with a conventional coarse-grained (CG) sample, the HS sample with the characteristic of that the recrystallized grains (RGs) were surrounded by ultrafine/nano-structures (UFS/NSs) exhibited an enhanced pitting resistance. This was ascribed to interrupted propagation of the stable corrosion pits in RGs by the surrounded UFS/NSs. The results in current work may provide a new strategy to improve corrosion properties by heterostructural designing.

The microstructures and morphologies of directionally solidified Ti–47Al alloys with different growth rates ranging from 1 to 200 μm/s were investigated using the Bridgman directionally solidified method. The results showed that numerous columnar grains were formed along the growth direction with the onset of directional solidification. With a variation in the growth rate, the solid/liquid interface changed from a flat to cellular and to dendritic interface. The flat-to-cellular interface transition rate of the Ti–47Al alloy varied from 1 to 3 μm/s. When the growth rate was higher than 10 μm/s, the solid/liquid interface showed typical dendritic growth. During the directional solidification process, the main phase of the directionally solidified Ti–47Al alloy was the α phase, which can be attributed to the solute segregation, supercooling of the components, and contamination of the alloy melt by the Y2O3 ceramic shell. After reaching the steady growth state during the directional solidification process, the solidification path of the alloy was: L→α→α+γ→(α2+γ) + γ. With an increase in the growth rate, the primary dendrite spacing (λ) and lamellar spacing (λs) of the alloy decreased gradually.

Ambient particulate matter

Summary: Interfacial solar steam generation is emerging as a promising technique for efficient desalination. Although increasing efforts have been made, challenges exist for achieving a balance among a plethora of performance indicators—for example, rapid evaporation, durability, low-cost deployment, and salt rejection. Here, we demonstrate that carbonized manure can convert 98% of sunlight into heat, and the strong capillarity of porous carbon fibers networks pumps sufficient water to evaporation interfaces. Salt diffusion within microchannels enables quick salt drainage to the bulk seawater to prevent salt accumulation. With these advantages, this biomass-derived evaporator is demonstrated to feature a high evaporation rate of 2.81 kg m−2 h−1 under 1 sun with broad robustness to acidity and alkalinity. These advantages, together with facial deployment, offer an approach for converting farm waste to energy with high efficiency and easy implementation, which is particularly well suited for developing regions.

Nanoscale zero-valent iron (nZVI), although being increasingly used in anaerobic systems for strengthening the removal of various refractory pollutants, is limited by various inherent drawbacks, such as easy precipitation, passivation, poor mass and electron transfer. To address the above issues, biochar stabilized sulfide-modified nZVI (S-nZVI@BC) was added into an up-flow anaerobic sludge blanket (UASB) to investigate the enhancement of anaerobic biodegradation of nitrobenzene (NB) and its impacts on microbial community structure. The results demonstrated that both NB reduction and aniline formation could be substantially facilitated in S-nZVI@BC coupled system compared to other anaerobic ones coupled with nZVI or S-nZVI. The dosage of S-nZVI@BC resulted in the formation of densely packed aggregates, evidently increased the extracellular polymeric substances content, promoted the volatile fatty acids transformation and stimulated the methane yield. Furthermore, species related to fermentation (Bacteroides and Longilinea), methanogenesis (Methanosarcina and Methanomethylovorans), electroactivity (Pelobacter, Thiobacillus and Phaselicystis) as well as reduction (Desulfovibrio) were considerably enriched in S-nZVI@BC coupled system. The activities of electron transport, total adenosine triphosphate, nitroreductase and NAD(P)H, which were closely related to microbial activity and NB transformation, were increased noticeably in S-nZVI@BC coupled anaerobic system. This study demonstrated the promising potential for long-term operation and full-scale application of S-nZVI@BC coupled system for the treatment of NB containing wastewater. Keywords: Sulfide-modified nanoscale zero-valent iron (S-nZVI), Biochar, Anaerobic system, Microbial community, Nitrobenzene

Development of efficient catalysts for peroxymonosulfate (PMS) activation and further understanding its mechanism on organic pollutants degradation is of significant importance for advanced oxidation processes (AOPs). Herein, hollow (Co, Mn) 3 O 4 catalysts were synthesized by calcination of Co, Mn containing metal-organic frameworks (MOFs) and further used to evaluate the effectiveness of organic pollutants (Bisphenol A (BPA), atrazine (ATZ), and diethyl phthalate (DEP)) degradation by PMS activation. The PMS utilization efficiency in (Co, Mn) 3 O 4 /PMS system (36.4%) was estimated to be 28.0% and 43.8% higher than that of Co 3 O 4 /PMS and Mn 5 O 8 /PMS system, respectively. Notably, the metal leaching in (Co, Mn) 3 O 4 /PMS system was significantly suppressed. The utilization efficiency also reveals an inverse proportionality relationship with BPA mineralization but decreases with increasing initial pH value. A synergy between oxides of Co and Mn was perceived to enhance PMS utilization efficiency and BPA degradation. The results indicate enhanced catalytic performance with (Co, Mn) 3 O 4 compared to Co 3 O 4 derived from Co-MOF and other reported catalysts, with 99% of BPA degradation within 4 min. The oxidation mechanism was then proposed based on the electron paramagnetic resonance (EPR) and XPS results. Our findings might have contributed to designing heterogeneous catalysts for efficient PMS utilization in AOPs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To evaluate the efficacy and safety of the comprehensive interventions based on three Traditional Chinese medicine (TCM) patterns therapy in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and AECOPD risk window., Methods: A prospective, multi-center, single-blinded, double-dummy and randomized controlled clinical trial is being conducted to test the therapeutic effects of a sequential two stage treatment. A total of 364 patients were enrolled into this study with 182 in each treatment group (TCM and conventional). Patients received medication (or control) according to their assigned group. TCM treatment according to syndrome differentiation for AECOPD were administered twice daily to patients with AECOPD over 7-21days, followed by TCM for AECOPD risk window (RW) over 28days. All patients were followed up for 6 months. Exacerbations were used as the primary outcome measures. Forced expiratory volume in the first second (FEV 1 ) and the modified medical research council dyspnea (MMRC) scale, quality of life and mortality rate were used as secondary outcome measures., Results: Of 364 randomized patients, 353 were included in the intention-to-treat analysis and 290 in the per-protocol analysis. In the TCM group, 16 patients (10.4%) reached the primary end point; 24 (17.7%) in the conventional group (RR 0.59, 95% CI 0.33-1.06; p=0.074). Among patients with a re-exacerbation, the median time to event was 107.5days (interquartile range [IQR], 39.5-129.0) in the TCM and 50days (IQR, 31-130.5) in the conventional group (P=0.011). After exacerbation therapy and a further 180-days follow-up, patients in the TCM group had significant improvements in dyspnea, as measured by MMRC (P=0.003), Patients in the TCM group also had improvements in health-related quality of life (P=0.002), as measured COPD Assessment Test (CAT). There was no difference between groups in death, and recovery of lung function. There were no differences between the TCM and conventional treatment group in adverse events., Conclusions: In patients presenting to the respiratory department with acute exacerbations of COPD, TCM treatments with syndrome differentiation will have beneficial effects with regard to re-exacerbation, relieving symptoms, improving quality of life for COPD patients., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: This study was intended to evaluate the efficacy and safety of Traditional Chinese Medicine (TCM) on stable chronic obstructive pulmonary disease (COPD)., Method: A systematic review was conducted of clinical trials that compared TCM plus conventional medicine treatment versus conventional medicine treatment alone. Randomized controlled trials (RCTs) of clinical therapeutic studies on COPD by TCM were included. Searches were applied to the following electronic databases: The PubMed、 the Cochrane Library、CNKI、CBM and VIP. No blinding and language restriction was used. All trials included were analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.2 software was used for data analysis., Result: 37 randomized clinical trials enrolling 3212 patients were included. Follow-up duration ranged from 4 weeks to 1.5 years. Compared to conventional medicine treatment alone, TCM plus conventional medicine treatment showed improvement in forced expiratory volume in one second (FEV1) (MD 0.12 L; 95% CI 0.08 to 0.16), and less exacerbation (OR -0.86; 95% CI -1.13 to -0.60). TCM treatment also led to a statistically improvement in SGRQ score compared to placebo (MD -4.36; 95% CI -7.12 to -1.59). There was statistically significant difference in six-minute walk distance (MD 36.66 meters, 95% CI 24.57 to 48.74) found with TCM compared to placebo., Conclusion: Among patients with stable COPD, TCM plus conventional medical treatment therapy might be associated with reduction risk of exacerbation, improvement of lung function, better quality of life and higher exercise capacity. The results were limited by the methodological flaws of the studies. High quality studies are needed to provide clear evidence for the future use of TCM., (Copyright © 2015 Elsevier Ltd. All rights reserved.)