OBJECTIVE:To clarify the clinical characteristics of type 2 diabetes in adolescents and young adults (T2DMY) patients, and their treatment strategies involving Traditional Chinese Medicine (TCM) and Western Medicine. METHODS:This study was conducted at Dongfang Hospital of Beijing University of TCM. Clinical data of outpatients and inpatients from 2011 to 2023 were retrieved from the electronic medical record database with type 2 diabetes mellitus (T2DM) as the first diagnosis. RESULTS:A total of 405 outpatients and 570 inpatients with T2DMY were included in the analysis. Compared with middle aged and elderly T2DM patients (T2DME), T2DMY patients have a higher proportion of diabetes family history and higher body mass index, poorer control of blood glucose, blood lipid, liver and kidney function, and a higher incidence of non-alcoholic fatty liver disease and gout. In terms of anti-diabetes treatment, T2DMY patients are more likely to receive metformin and insulin drugs. In terms of TCM diagnosis and treatment, compared with T2DME patients, T2DMY patients are more frequently diagnosed with the syndrome of phlegm damp trapped spleen, and more herbs such as Fuling (Poria) and Chenpi (Pericarpium Citri Reticulatae) are more frequently used to invigorate the spleen and dispel dampness. CONCLUSION:Compared with T2DME patients, T2DMY patients have worse metabolism. In the treatment of TCM, more attention can be paid to the function of the spleen, and the herbal medicine can be used to enhance the function of the spleen and dispell dampness when it is compatible with Qitonifying drugs.

Shenmai Injection (SMI), a traditional Chinese medicine with nourishing properties, has been explored for its therapeutic effects in ischemic stroke (IS). This study aimed to evaluate the protective effects of SMI in patients with IS who received intravenous thrombolysis and to elucidate its potential molecular mechanisms through laboratory investigations. Patients with IS were randomized to receive either SMI or a placebo for 10 days within 12 h post-intravenous thrombolysis. Clinical efficacy and safety were assessed. An IS cell model was induced using H2O2, followed by treatment with SMI to explore its therapeutic effects and underlying mechanisms. The modified Rankin Scale (mRS) score at 30 days was significantly lower in the SMI group (n = 35) compared to the placebo group (n = 35), indicating improved functional outcomes. No significant difference was observed in NIHSS scores between the groups. Adverse events and biochemical indices showed no significant differences, confirming the safety of SMI. In the H2O2-induced cell model, SMI enhanced cell viability, reduced apoptosis, and decreased the levels of malondialdehyde (MDA) and reactive oxygen species (ROS). It also improved ATP content and mitochondrial membrane potential. Mechanistic studies revealed that these protective effects were partially mediated through the AMPKα1. SMI significantly improves short-term outcomes in IS patients treated with rt-PA thrombolysis. Its protective effects are likely mediated through the AMPKα1, highlighting its potential as an adjunctive therapy for IS.

BackgroundIschemic stroke is a serious and sudden cerebrovascular condition that significantly affects individual’s health and imposes a substantial economic burden on medical management. Despite its widespread use in China, there is still a lack of reliable evidence regarding the efficacy of Shenmai injection (SMI) in acute ischemic stroke (AIS). We aimed to comprehensively assess the effectiveness and safety of SMI in treating AIS through a systematic review and meta-analysis.MethodsRandomized controlled studies (RCTs) investigating the efficacy of SMI in treating AIS were searched for in eight databases from the inception of each database till January 2024. We utilized the ROB 2.0 to assess the risk of bias. A meta-analysis was conducted using Review Manager 5.4, while sensitivity analyses and publication bias assessments were conducted using Stata 16.1.ResultsA total of 17 studies involving 1,603 AIS patients were included in our meta-analysis. Our results showed that SMI plus conventional treatments (CTs) was more effective than CTs alone in improving the total effective rate (RR 1.22, 95% CI: 1.14 to 1.30, p < 0.00001), the Barthel index (BI) (MD 12.18, 95% CI: 10.30 to 14.06, p < 0.00001), and reducing the National Institute of Health Stroke Scale Score (NIHSS) score (MD -3.05, 95% CI: 3.85 to −2.24, p < 0.00001) and Modified Rankin Scale (mRS) (MD -0.68, 95% CI: 0.86 to-0.49, p < 0.00001). In addition, SMI combination therapy was better than CTs alone in decreasing the levels of IL-6, IL-18, and hs-CRP. SMI therapy also enhanced the cerebral hemorheology of patients by reducing levels of fibrinogen and plasma viscosity. However, there was no significant difference in the incidence of adverse events, including elevated transaminase, rash, nausea, bleeding, urticaria, headache, vomiting, chest tightness, and facial flushes. Moreover, no serious adverse effects or life-threatening events were reported.ConclusionOur study shows that combining SMI with CTs effectively enhances the neurological function of patients with acute cerebral infarction. However, our findings should be interpreted considering the significant heterogeneity and suboptimal quality of the analyzed trials.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024504675, Identifier PROSPERO, CRD42024504675

Abstract Introduction Epilepsy is a common neurological disease affecting at least 50 million people globally. Cognitive impairment is a recognised comorbidity in patients with epilepsy (PWE) and is associated with low quality of life. A large number of studies have investigated the relevant risk factors of cognitive impairment in PWE, while these results were not consistent. The main aim of our study is to review the risk factors that increase the likelihood of cognitive impairment in PWE. Methods and analysis We will search the literature that reported risk factors for cognitive impairment in PWE in the following online databases from inception to October 2022: China National Knowledge Infrastructure, Wan Fang database, VIP, the Chinese clinical trial registry, China Biology Medicine disc, PubMed, the Cochrane Central Register of Controlled Trials, Embase, and Web of science. Two independent authors will screen the eligible literature according to the inclusion and exclusion criteria. Data extraction will also be conducted by two independent authors, and discrepancies will be solved by a third author. We will use the software Revman 5.4 and Stata 15.1 to perform data synthesis, sensitivity analysis, and meta-regression. If data are sufficient, we will also perform the subgroup analysis. The quality of evidence will be evaluated by the Grading of Recommendations Assessment, Development and Evaluation(GRADE). Discussion Our study can assist clinicians in better understanding and managing this disease through reviewing the risk factors of cognitive impairment in PWE. We also expect this study can provide reliable evidence for this unanswered research question and promote the development of the prevention and treatment of cognitive impairment in PWE. Registration number CRD 42022365184.

BACKGROUND:Older adults in China are at a high risk of cardiovascular diseases (CVD), and impaired lower extremity function (LEF) is commonly observed in this demographic. This study aimed at assessing the association between LEF and CVD, thus providing valuable insights for clinical practice and public health policies.METHODS:A sample of 4,636 individuals was included from the China Health and Retirement Longitudinal Study (CHARLS) dataset. Logistic regression and cox proportional hazard regression model was utilized to study the association between LEF and CVD incidence. Cross-lagged panel models were utilized to investigate the potential causal association between LEF and CVD over time.RESULTS:Poor LEF was significantly associated with a higher risk of CVD in the total population [OR (95 % CI): 1.62 (1.27-2.05), P < 0.001]. Individuals with poor LEF demonstrated an increased risk of developing CVD [HR (95 % CI): 1.11 (1.02-1.23), P < 0.05], particularly stroke, compared to those with good LEF. And those with poor LEF had higher risks for heart disease [1.21 (1.00-1.45), P < 0.05] and stroke [1.98 (1.47-2.67), P < 0.001].CONCLUSION:The results suggest the potential usefulness of the Short Physical Performance Battery (SPPB) for classifying stroke risk in older Chinese adults, which also suggested that preventing and/or improving LEF may be beneficial for reducing stroke incidence and promoting healthy aging for older adults.

Background: Atherosclerosis is a chronic inflammatory disease that leads to ischemic cerebrovascular and cardiovascular diseases. Curcumin, known for its anti-inflammatory properties, may influence the development of atherosclerosis. This study aims to elucidate the effects of curcumin and its mechanisms on atherosclerosis progression. Methods: The proliferative ability, the angiogenesis capacity, and cell migration rate were assessed using cell counting kit-8 (CCK-8), 5-ethynyl-29-deoxyuridine (EdU), tube formation assays, and wound healing, respectively. Furthermore, the protein expression levels of proliferating cell nuclear antigen (PCNA), glycogen synthase kinase 3 beta (GSK3 beta), p-GSK3 beta, beta-catenin, and c-myc were determined utilizing western blot analysis. Results: Oxidized low-density lipoprotein (ox-LDL) significantly triggered cell damage by inhibiting cell proliferation, reducing the migration rate, and angiogenesis capacity in human umbilical vein endothelial cells (HUVECs) (p < 0.05). Curcumin treatment significantly alleviated ox-LDL-induced HUVECs injury (p < 0.05), as evidenced by elevating the proliferative ability (p < 0.05), cell migration (p < 0.05), and angiogenesis (p < 0.05). Moreover, the Wnt/beta-catenin pathway was substantially boosted following ox-LDL treatment (p < 0.05), which was suppressed by curcumin (p < 0.05). Additionally, SKL2001 significantly increased the levels of beta-catenin and c-myc (p < 0.05). The inhibitory effects of curcumin treatment on the Wnt/beta-catenin signaling pathway were reduced by SKL2001 (p < 0.05). Furthermore, the promoting effects of curcumin on ox-LDL-induced cell damage were hampered following SKL2001 treatment in HUVECs (p < 0.05). Conclusion: Curcumin elevated cell proliferation, migration, and angiogenesis of HUVECs to inhibit the development of atherosclerosis through inactivating the Wnt/beta-catenin pathway.

Objective Acute ischemic stroke (AIS) is a significant health burden in China, affecting a sizable portion of the population. Conventional pharmacological treatments frequently fall short of desirable outcomes. Therefore, exploring alternative therapies is crucial. Remote ischemic postconditioning (RIPostC) is a noninvasive and cost-effective adjunctive therapy. This study aimed to investigate the efficacy and safety of RIPostC as an adjunctive therapy for AIS to inform clinical practice. Methods A comprehensive search was conducted across the PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, Weipu (VIP), and China Biology Medicine disc (CBM) databases up to October 2023. All included studies underwent bias risk assessment using the Cochrane risk-of-bias assessment tool. The primary outcome measure was the National Institute of Health Stroke Scale (NIHSS), with secondary outcomes including the Barthel index (BI), D-dimer, C-reactive protein (CRP), fibrinogen (FIB), brain-derived neurotrophic factor (BDNF), modified Rankin scale (mRS), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels. The data were analyzed using fixed-effects and random-effects models in Review Manager, with mean differences (MDs) and 95% confidence intervals (CIs) calculated for each outcome. The grading of recommendations, assessment, development, and evaluations (GRADE) approach was used to evaluate the level of evidence for each outcome measure. Results This meta-analysis included 38 studies, encompassing 4334 patients. Compared with the control group, the RIPostC group had significantly lower NIHSS scores, serum CRP, D-dimer, IL-6, TNF-α, and FIB levels, and increased BDNF levels. Moreover, it improved the patient’s BI and mRS scores. According to the GRADE approach, the quality of evidence for mRS was deemed “moderate,” while the NIHSS, BI, and CRP were rated as “low” quality. IL-6, TNF-α, FIB, D-dimer, and BDNF received “very low” quality ratings. Conclusion The findings suggest that RIPostC activates endogenous protective mechanisms, providing benefits to patients with AIS.

BACKGROUND:Ketamine, as an anesthetic, has been considered for terminating status epilepticus (SE); however, due to the urgency and severity of the condition, there are currently no randomized controlled trials internationally assessing the efficacy of ketamine for treating super-refractory status epilepticus. Similarly, there appears to be a lack of systematic reviews addressing this topic in the literature. Therefore, this systematic review aims to explore the effectiveness and safety of ketamine for terminating super-refractory status epilepticus. METHODS:We conducted a systematic search on PubMed, EMBASE, and Web of Science databases. Manuscripts unrelated to the research on super-refractory status epilepticus were excluded, as were manuscripts published in non-English languages. The quality assessment and risk of bias were evaluated using the MINORS criteria. Data extraction was limited to qualitative synthesis due to the unsuitability of the data for meta-analysis. RESULTS:Out of 782 studies retrieved from electronic databases, 11 met the inclusion criteria. Among them, 10 studies were retrospective, and 1 study was prospective. Patient data for inclusion were sourced from the case registries of the researchers' respective hospitals. Across all included studies, the administration of ketamine significantly reduced the duration of status epilepticus and demonstrated higher safety compared to patients not receiving ketamine treatment for super-refractory status epilepticus. Additionally, early administration of ketamine correlated with improved treatment outcomes. The risk of bias across all studies was deemed low. CONCLUSION:This systematic review suggests that ketamine may be a feasible treatment option for super-refractory status epilepticus. However, given the critical nature of super-refractory status epilepticus, clinicians should prioritize its termination over evaluating the efficacy of specific medications, ensuring patient safety remains paramount. If feasible in real-world medical settings, future research should focus on designing randomized controlled trials to observe the specific efficacy and mechanisms of ketamine. Careful validation is necessary before considering ketamine as a first-line treatment for super-refractory status epilepticus.

OBJECTIVE:To explore the neuroprotective effects and mechanism of Tanreqing Injection (TRQ) on treating ischemic stroke based on network pharmacology and in vivo experimental validation. METHODS:The chemical compounds of TRQ were retrieved based on published data, with targets retrieved from PubChem, Therapeutic Target Database and DrugBank. Network visualization and analysis were performed using Cytoscape, with protein-protein interaction networks derived from the STRING database. Enrichment analysis was performed using Kyoto Encyclopedia of Genes Genomes pathway and Gene Ontology analysis. In in vivo experiments, the middle cerebral artery occlusion (MCAO) model was used. Infarct volume was determined by 2,3,5-triphenyltetrazolium hydrochloride staining and protein expressions were analyzed by Western blot. Molecular docking was performed to predict ligand-receptor interactions. RESULTS:We screened 81 chemical compounds in TRQ and retrieved their therapeutic targets. Of the targets, 116 were therapeutic targets for stroke. The enrichment analysis showed that the apelin signaling pathway was a key pathway for ischemic stroke. Furthermore, in in vivo experiment we found that administering with intraperitoneal injection of 2.5 mL/kg TRQ every 6 h could significantly reduce the infarct volume of MCAO rats (P<0.05). In addition, protein levels of the apelin receptor (APJ)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) pathway were increased by TRQ (P<0.05). In addition, 41 chemical compounds in TRQ could bind to APJ. CONCLUSIONS:The neuroprotective effect of TRQ may be related to the APJ/PI3K/AKT signaling pathway. However, further studies are needed to confirm the findings.

ObjectiveThis study aimed to evaluate the efficacy of combining diterpene ginkgolide meglumine injection (DGMI) with edaravone for the treatment of acute ischemic stroke. This is particularly relevant because Western drugs, excluding intravenous thrombolysis, have shown limited success.MethodsA comprehensive search was conducted using multiple databases, including PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure WanFang, VIP, and Chinese Biomedical Database (CBM) until June 2023. The data were analyzed using fixed-effects and random-effects models in Review Manager. The mean difference with 95% confidence interval was calculated for each outcome.ResultsEighteen studies involving 1,636 participants were included in the analysis. The DGMI group showed significant reductions in the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, and C-reactive protein (CRP) level, compared to the control group. Furthermore, the DGMI group showed a significant improvement in superoxide dismutase (SOD) levels and a reduction in malondialdehyde (MDA) levels. The combination of DGMI and edaravone was more effective in reducing neuron-specific enolase (NSE) levels following brain tissue injury than edaravone alone. Additionally, DGMI complemented edaravone in reducing rheological parameters associated with ischemic stroke, including hematocrit, plasma viscosity, platelet adhesion rate, and erythrocyte deformation index.ConclusionThe combination of DGMI and edaravone significantly improved the therapeutic efficacy in patients with acute ischemic stroke. However, more extensive and high-quality clinical trials are required to validate these underlying mechanisms.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=260215, identifier: PROSPERO (CRD42021260215)

目的 分析急性缺血性脑卒中患者出现卒中后失眠的危险因素,以期为早期预防及治疗卒中后失眠提供一定的临床依据.方法 回顾性分析 2015 年 1 月—2018 年 9 月住院的 127 例急性缺血性脑卒中患者的临床资料.参考发病 2 周内病情稳定、排除谵妄等情况进行汉密尔顿抑郁量表(HAMD)及北京版蒙特利尔认知评估(MoCA)量表测评,根据有无失眠,分为卒中后失眠组与卒中后无失眠组,通过统计学分析探讨急性缺血性脑卒中患者出现卒中后失眠的危险因素.结果 与卒中后无失眠组比较,卒中后失眠组美国国立卫生研究院卒中量表(NIHSS)评分较高、HAMD评分较高(P = 0.032,P＜0.001);2组间病灶位置有差异.结论 NIHSS评分高、HAMD评分高及病灶位置不同是急性缺血性脑卒中患者出现失眠的危险因素.临床工作中在对卒中患者积极治疗的同时,应重视睡眠问题,早期干预与治疗,可能会降低卒中复发风险、改善中风后的功能结局.

Background: Given that little is known about the effect of lower extremity function (LEF) on cardiovascular disease (CVD) risk among older adults, the association between LEF and CVD in the older Chinese population was investigated by cross-sectional and longitudinal analysis using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS).Methods: The sample comprised 4636 participants aged at least 60 years from the CHARLS 2011. LEF was defined according to the short physical performance battery (SPPB) scores lower than 8. CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. A total of 4636 participants were recruited from the CHARLS 2011 and were followed up in 2018. Cox proportional hazards regression models were conducted to examine the effect of LEF on CVD.Findings: The prevalence of CVD in total populations, good LEF, normal LEF, and poor LEF individuals were 19.07% (884/4636), 16.97% (504/2970), 20.72% (167/806), 24.77% (213/860), respectively. Poor LEF [OR (95% CI): 1.62 (1.27−2.05), P<0.001] was associated with CVD in total populations. During the 8 years of follow-up, 1354 cases (29.54%) with incident CVD were identified. In the longitudinal analysis, individuals with poor LEF [HR (95% CI): 1.11 (1.02−1.23), P<0.05] were more likely to have incident CVD than good LEF peers, especially stroke. In CVD components, compared to good LEF, individuals with poor LEF had higher risks of heart disease [1.21 (1.00 −1.45), P<0.05] and stroke [1.98 (1.47 −2.67), P<0.001], and they had higher risks of newly onset stroke [1.69 (1.20 −2.40), P<0.001] but not newly onset heart disease.Interpretation: Poor lower extremity function, assessed using the short physical performance battery, was associated with higher stroke risk among older Chinese adults.Funding: This work was supported by the program of China Scholarships Council (No.202006550005).Declaration of Interest: The authors declare no competing interests.Ethical Approval: All participants provided informed consent, and the protocol was approved by the Ethical Review Committee of Peking University (approval number: IRB00001052 −11,015). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was conducted following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Purpose: To quantitatively explore the associations of economy, climate, and nutrition as spatial heterogeneity drivers on stroke morbidity and mortality at the regional level in China.Materials and methods: Economic and nutrient consumption data for each province were obtained from the 2019 Statistical Yearbook data. Climate data came from reference and basic weather stations for 2019, calculated to be annual climate data by the inverse distance weighting (IDW) method. The Geodetector method was used to explore global spatial heterogeneity in associations of climate, economic, and nutrient factors with stroke morbidity and mortality. Further we used geographically weighted regression (GWR) to measure their local spatial heterogeneity quantitatively.Results: The results showed that annual sunshine time (AST) and consumption of pork, poultry, and dried and fresh melons and fruits (DFMF) were spatial heterogeneity drivers associated with stroke morbidity. And for mortality, annual average temperature (AAT), annual relative humidity (ARH), annual atmospheric pressure (AAP), annual precipitation (APP), gross domestic product (GDP) per capita (PPP), capita disposable income of households (CDIH), and consumption of vegetable and edible mushroom (VEM), pork, beef, lamb, poultry, and aquatic products (AP) were spatial heterogeneity drivers with it.Conclusion: The age-standardized rates for morbidity and age-standardized rates for mortality of stroke at the province level in China showed significant spatial heterogeneity and aggregation. Targeted interventions for stroke prevention and control should consider regional differences in economic, climate, and nutrient factors. The results of this study support the necessity for regional adaptive nutrient strategies to alleviate the increasing stroke burden.

目的 探讨柴贝止痫汤对海人酸致痫大鼠氧化应激反应及核因子E2相关因子2(Nrf2)/Kelch样ECH相关蛋白1(Keap1)信号通路的影响.方法 雄性Wistar大鼠30只,随机取10只作为假手术组,余20只采用海人酸侧脑室注射方法建立慢性复发性癫痫模型.将造模成功的大鼠随机分为癫痫组及柴贝止痫汤组各8只,柴贝止痫汤组大鼠给予柴贝止痫汤8.48 g/kg灌胃,假手术组和癫痫组大鼠给予生理盐水灌胃,均1次/d,连续8周.采用Morris水迷宫行为学实验评估大鼠空间学习及记忆能力,试剂盒检测血清丙二醛(MDA)含量和超氧化物歧化酶(SOD)、过氧化氢酶(CAT)活性,HE染色观察海马组织病理形态,Western blot法检测海马组织中Nrf2及Keap1蛋白表达情况.结果 与假手术组比较,癫痫组大鼠定位航行实验逃避潜伏期明显延长(P＜0.05);空间探索实验中总路程明显延长(P＜0.05),平台区域路程及平台象限停留时间均明显缩短(P均＜0.05),穿越平台次数明显减少(P＜0.05);血清MDA含量明显升高(P＜0.05),血清SOD及CAT活性均明显降低(P均＜0.05);HE染色显示大鼠脑组织结构重度异常,海马CA1、CA3及DG区可见大量神经元变性,固缩深染,神经元纤维缠结;海马组织中Keap1蛋白表达量明显增加(P＜0.05),Nrf2蛋白表达量明显降低(P＜0.05).与癫痫组比较,柴贝止痫汤组大鼠逃避潜伏期和总路程均明显缩短(P均＜0.05),平台区域路程及平台象限停留时间均明显延长(P均＜0.05),穿越平台次数明显增加(P＜0.05);血清MDA含量明显降低(P＜0.05),SOD及CAT活性均明显增高(P均＜0.05);HE染色显示大鼠脑组织结构轻度异常,可见少量神经元变性,固缩深染,个别神经元纤维缠结现象;海马组织中Keap1蛋白表达量明显降低(P＜0.05),Nrf2蛋白表达量明显增加(P＜0.05).结论 柴贝止痫汤可改善海人酸致痫大鼠空间学习及记忆能力,保护神经元细胞,作用机制可能与激活Nrf2/Keap1信号通路,抑制氧化应激反应有关.

目的:系统评价柴贝止痫汤联合抗癫痫药物(AEDs)治疗癫痫的临床疗效.方法:计算机检索建库以来中国知网、万方数据库、维普数据库、中国临床试验注册中心、中国生物医学文献数据库、PubMed、the Cochrane Library、EMbase、MedLine以及Web of Science.检索以柴贝止痫汤联合西药治疗癫痫的随机对照试验,按照纳入标准及排除标准筛选文献、提取有效资料,评价所有纳入研究的方法学质量,采用RevMan 5.4.1以及Stata 12软件进行Meta分析.结果:共纳入7篇文献,涉及病人555例,其中试验组275例,对照组280例.Meta分析结果显示,试验组临床有效率[RR=1.49,95％CI(1.29,1.72),P<0.00001]、中医证候改善率[RR=4.94,95％CI(2.80,8.71),P<0.00001]高于对照组,差异均有统计学意义;试验组中医症状积分低于对照组,差异有统计学意义[SMD=-1.55,95％CI(-1.96,-1.13),P<0.00001],脑电图改善程度优于对照组,差异有统计学意义[RR=1.72,95％CI(1.17,2.53),P=0.006].安全性分析显示,试验组8例出现不良反应,对照组5例出现不良反应,两组不良反应发生率比较差异无统计学意义.结论:现有证据表明,柴贝止痫汤联合抗癫痫药物在临床有效率、中医证候改善率、中医症状积分方面均优于单独应用AEDs.

癫痫归属于中医学的"痫病",其病机为神机受累,元神失控.玄府为气机出入升降、脑髓神机运转之道路门户.与癫痫发病机制相关的微观结构和"玄府"具有一定的相似性.玄府的开阖性与癫痫呈现发作性密切相关,其开阖状态也关乎脑髓中气血津液的灌渗、神机状态,导致癫痫的发病形式多样、迁延难愈.玄府开阖失常可概括癫痫的病机.因此,防治癫痫当以调控玄府开阖为治则,其中又以调节气机升降最为关键,气机畅则痰郁消,以恢复神机正常运转.基于玄府学说论治癫痫对癫痫的临床治疗具有重要的指导价值.

Aims Given that little is known about the effect of lower extremity function (LEF) on cardiovascular disease (CVD) subsequent risk among older adults, the association between LEF and CVD in the older Chinese population was investigated by cross-sectional and longitudinal analysis using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS). Methods The sample comprised 4636 participants aged at least 60 years from the CHARLS 2011. LEF was defined according to the short physical performance battery (SPPB) scores lower than 8. CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. A total of 4636 participants were recruited from the CHARLS 2011 and were followed up in 2018. Results The prevalence of CVD in total populations, good LEF, normal LEF, and poor LEF individuals were 19.07%, 16.97%, 20.72%, 24.77%, respectively. Poor LEF was associated with CVD in total populations. In the longitudinal analysis, individuals with poor LEF were more likely to have incident CVD than good LEF peers, especially stroke. In CVD components, compared to good LEF, individuals with poor LEF had higher risks of heart disease and stroke, and they had higher risks of newly onset stroke but not newly onset heart disease. Conclusion The results suggest the potential usefulness of the short physical performance battery for classifying stroke risk in older Chinese adults, which also suggested that preventing and/or improving lower extremity function may be beneficial for reducing stroke incidence and promoting healthy aging for older adults.

通过归纳大脑不同部位异常放电产生的癫痫证候学特点,结合中医五神脏功能异常所产生的证候特征,比较二者之间的异同,探讨其中的关联.结果发现,额叶癫痫证候特点与肝及所藏肝魂功能失常表现高度相似;颞叶癫痫证候表现与心、肝、脾及其所藏神、魂、意功能失常表现相符;枕叶癫痫证候特点与肝、肾及所藏魂、志功能失常表现相似;顶叶癫痫证候特点与肺、心及所藏魄、神功能失常表现有一定关联;岛叶癫痫证候特点与脾及所藏意失常表现相符.

Background: Poststroke epilepsy (PSE) is a common complication of strokes that seriously affects the recovery and quality of life of patients, and effective treatments are needed. Chinese herbal medicine (CHM) adjunctive therapy is a viable treatment option, but current evidence is insufficient to support its efficacy and safety. This study aimed to evaluate the efficacy and tolerability of CHM adjunctive therapy in the treatment of PSE.Methods: A systematic search of eight databases was conducted to identify PSE-related randomized clinical trials from the inception of each database through October 2023. The methodological quality assessment was conducted by RoB 2.0, meta-analysis was conducted by RevMan 5.3 and Stata 15.1, and evidence quality was evaluated by GRADE.Results: Twenty-three RCTs involving 1,901 PSE patients were identified. We found that orally administered CHM plus conventional Western medicine (CWM) was superior to CWM monotherapy in increasing the 75% responder rate (RR 1.46, 95% CI: 1.31 to 1.62, p < 0.00001), decreasing the seizure duration (MD -1.01, 95% CI: −1.30 to −0.72, p < 0.00001), improving total responder rate (RR 1.29, 95% CI: 1.20 to 1.37, p < 0.00001), reducing epileptiform discharges (EDs) (MD -2.02.46, 95% CI: −2.64 to −1.40, p < 0.00001), and decreasing the number of leads involved in epileptiform discharge (MD -3.92, 95% CI: −5.15 to −2.68, p < 0.00001). Furthermore, intravenously administered CHM plus CWM was superior regarding 75% responder rate (RR 1.39, 95% CI: 1.24 to 1.56, p < 0.00001), total responder rate (RR 1.29, 95% CI: 1.20 to 1.39, p < 0.00001), EDs (MD -3.92, 95% CI: −5.15 to −2.68, p < 0.00001), and the number of leads involved in epileptiform discharge (MD -1.82, 95% CI: −2.62 to −1.02, p < 0.00001). However, regarding the 50%–75% responder rate, there was no statistically significant difference between the two groups for either oral (RR 1.00, 95% CI: 0.77 to 1.29, p = 0.98) or injectable CHM (RR 0.95, 95% CI: 0.67 to 1.33, p = 0.75). Both orally administered CHM plus CWM (RR 0.56, 95% CI: 0.35 to 0.90, p = 0.02) and intravenously administered CHM plus CWM (RR 0.64, 95% CI: 0.45 to 0.90, p = 0.010) caused fewer AEs than CWM. Furthermore, the levels of evidence ranged from low to high due to publication bias and heterogeneity.Conclusion: CHM adjuvant therapy may be an effective and safe therapy for PSE. However, due to the poor quality of clinical data, more well-designed RCTs are needed to confirm these findings.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=364356, identifier PROSPERO (CRD42022364356)

目的 通过数据挖掘方法分析2020 年版《中华人民共和国药典》(一部)所收录治疗中风中成药的用药情况及处方配伍规律,以期为临床组方用药提供思路与参考.方法 筛选整理《中华人民共和国药典》所收载治疗中风的中成药,运用古今医案云平台系统(V 2.3.5)对其进行频数统计、关联规则分析与聚类分析.结果 2020 年版《中华人民共和国药典》(一部)共纳入51 个治疗中风的中成药,涉及236 味中药,使用频数≥11 的高频药物 16 味,前3 位是川芎、丹参、红花,用药四气以温、平、寒为主;五味以甘、辛、苦为主;归经涉及十二经,以肝、脾、心为多.得到核心药对 16 条,出现频次最多的药对为川芎-丹参,置信度最高的药对为全蝎-地龙,并聚类得到4 类药物组合.结论 2020 年版《中华人民共和国药典》中成药治疗中风病多用活血化瘀、息风止痉、芳香开窍、补虚类药物,治疗以调理脏腑气血阴阳为核心,重用活血化瘀之品,根据病机、病程、症状等,兼顾祛风通络、开窍、补虚之品,以平为期.