Purpose:To explore the pharmacological effects of Jianpi Zhidong Decoction (JPZDD) on Tourette Syndrome (TS) using proteomics and network pharmacology. Materials and Methods:Chemical components of JPZDD were identified via UPLC-MS/MS. Chronic restraint stress TS model was established by intraperitoneal injection of iminodipropionitrile (IDPN) for 1 week with restraint stress for 3 weeks. Sixty male SD rats were divided into control, model, Tiapride (Tia), and JPZDD groups. After the intervention of 28 days, behavioral tests, Nissl staining, Western blot, immunofluorescence, colorimetry, and ELISA were performed to evaluate the pharmacological effects of JPZDD. Proteomics and network pharmacology predicted targets, validated by Western blot. Results:JPZDD alleviated stereotypic behaviors, hippocampal pathology, and modulated glucose metabolites (GLU, pyruvate, lactate, ATP). It downregulated GLUT1, GLUT3, HK2, and LDHA levels while upregulating PDHA level. Besides, JPZDD balanced M1/M2 microglial phenotypes, reducing IL-1β and IL-6 and increasing IL-4 and IL-10. UPLC-MS/MS identified 44 active ingredients and 123 targets; proteomics revealed 28 differentially expressed proteins. GO/KEGG analysis implicated that the PI3K/AKT/mTOR pathway may be the molecular target. JPZDD inhibited PI3K, AKT, and mTOR phosphorylation. Conclusion:JPZDD (16 g·kg⁻¹·d⁻¹) alleviates motor tics, modulates microglial activation and glucose metabolism, and downregulates the PI3K/AKT/mTOR pathway, providing a mechanistic basis for its therapeutic role in TS.

Tic disorders are neurodevelopmental conditions that manifest in childhood or adolescence and can significantly impact the quality of life of affected children and their families to varying degrees. Integrated traditional Chinese and Western medicine treatment strategies have demonstrated more pronounced efficacy and better safety profiles. However, there is currently no standardized clinical expert consensus on this approach. To address this, the National Administration of Traditional Chinese Medicine initiated a project, and the China Association of Chinese Medicine assembled a team of authoritative domestic experts to develop this expert consensus, aiming to provide practical and feasible integrated treatment strategies for clinical practice. This consensus identified clinical issues through research, conducted literature reviews, and established evidence based on systematic evaluations. Expert surveys, two rounds of Delphi questionnaires, and expert consensus meetings were conducted to formulate a series of recommendations. We established a multidisciplinary consensus development panel. Based on systematic literature reviews, Delphi questionnaires, and consensus meetings, ten clinical issues were identified. Ultimately, a series of recommendations were developed, considering the balance of benefits and risks, the certainty of evidence, clinical feasibility, accessibility, and clinical acceptability. These recommendations comprehensively address key issues in the field of integrated traditional Chinese and Western medicine treatment, including indications for the use of Chinese or Western medicine alone or in combination, specific treatment protocols, methods for dose reduction and discontinuation, evaluation intervals, and the management of adverse reactions.

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ETHNOPHARMACOLOGICAL RELEVANCE:Several children with pneumonia (especially severe cases) have symptoms of cough and expectoration during the recovery stage after standard symptomatic treatment, which eventually results in chronic lung injury. Danggui yifei Decoction (DGYFD), a traditional Chinese formula, has shown clinical promise for the treatment of chronic lung injury during the recovery stage of pneumonia, however, its mechanism of action is yet to be deciphered.AIM OF THIS STUDY:To investigate the therapeutic mechanism of DGYFD for the treatment of chronic lung injury by integrating network pharmacology and transcriptomics.MATERIALS AND METHODS:BALB/c mice were used to establish the chronic lung injury mouse model by intratracheal instillation of lipopolysaccharide (LPS). Pathological analysis of lung tissue, lung injury histological score, lung index, protein levels in bronchoalveolar lavage fluid (BALF), immunohistochemical staining, blood rheology, inflammatory cytokines, and oxidative stress levels were used to evaluate the pharmacological effects of DGYFD. Chemical components of DGYFD were identified using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Integrated network pharmacology together with transcriptomics was used to predict potential biological targets. Western blot analysis was used to verify the results.RESULTS:In this study, we demonstrated that DGYFD could improve lung injury pathological changes, decreases lung index, down-regulate NO and IL-6 levels, and regulate blood rheology. In addition, DGYFD was able to reduce the protein levels in BALF, up-regulate the expression levels of occludin and ZO-1, improve the ultrastructure of lung tissues, and reverse the imbalance of AT I and AT II cells to repair the alveolar-capillary permeability barrier. Twenty-nine active ingredients of DGYFD and 389 potential targets were identified by UPLC-MS/MS and network pharmacology, and 64 differentially expressed genes (DEGs) were identified using transcriptomics. GO and KEGG analysis revealed that the MAPK pathway may be the molecular target. Further, we found that DGYFD inhibits phosphorylation levels of p38 MAPK and JNK in chronic lung injury mouse models.CONCLUSIONS:DGYFD could regulate the imbalance between the excessive release of inflammatory cytokines and oxidative stress, repair the alveolar-capillary permeability barrier and improve the pathological changes during chronic lung injury by regulating the MAPK signaling pathway.

Objectives: Mental health disorder is highly prevalent worldwide, and factors attributable to its development have not been fully understood. We aimed to explore the association of adverse childhood experiences (ACEs) with mental health disorder using data from the China Health and Retirement Longitudinal Study (CHARLS). Methods: CHARLS is an ongoing nationwide survey enrolling 17,708 residents aged >= 45 years in China. Total 20 ACE indicators were extracted. Unmeasured confounding and potential mediation were assessed, and effect -size estimates are expressed as odds ratio (OR) with 95 % confidence interval (CI). Results: Of 10,961 assessable participants with complete information, 3652 were reported to have mental health disorder. The risk for mental health disorder was increased by 20.7 % for participants with one to less than four events of ACEs (OR: 1.207, 95 % CI: 0.711 to 2.049), and this number reached 102.7 % for participants with four or more events (OR: 2.027, 95 % CI: 1.196 to 3.436) relative to those with no ACE. In subgroup analyses, between -group risk estimates differed significantly for residence, marital status, personal asset, life satisfaction, and living standard. The E -value of 2.35 for ACEs of 4 or more events indicated the low likelihood of unmeasured confounders. In mediation analyses, the proportion eliminated was 5.1 % for continuous ACEs and 6.1 % for categorical ACEs (both P < 0.001). Discussion: Our findings indicate that ACEs, especially with four or more events, can predict the significant risk of mental health disorder, underscoring the necessity of screening mental illness based on ACEs to reduce the resultant morbidity and mortality in China.

ObjectivesDepression is largely preventable, and strategies that can effectively suppress its development are imperative. We aimed to examine whether physical activity and sedentary behavior were associated with depression and explore the possible mediatory role of complete blood count in this association.MethodsIn this cross-sectional study, data were integrated from the National Health and Nutrition Examination Study (2007–2018). Depression was defined using the Patient Health Questionnaire-9. The risk for depression, expressed as odds ratio (OR) and 95% confidence interval (CI), was quantified by survey-weighted logistic regression analyses.ResultsA total of 31,204 respondents were analyzed. Significance was identified for all, except walking or bicycling per week, types of physical activity, and sedentary behavior. Per 1 standard deviation (SD) increment in metabolic equivalent of task (MET) of weekly vigorous recreational physical activity was associated with 31.3% decreased depression risk (adjusted OR: 0.687, 95% CI: 0.5663–0.840). Per 1 SD increment in sitting time can increase depression risk by 22.4% (adjusted OR: 1.224, 95% CI: 1.131–1.325). In subsidiary analyses, the association with depression was reinforced in respondents aged ≤65 years and those overweight or obese. Mediation analyses revealed significant effects for red blood cell (RBC) on total MET (19.4%) and moderate work-related physical activity (MWPA) (22.0%), and for red cell distribution wide (RCDW) on vigorous work-related physical activity (17.7%), moderate work-related physical activity (13.1%), total MET (11.2%), and sitting time (16.4%) (p < 0.01).ConclusionOur findings indicate that more physical activity and less sitting time were associated with a lower likelihood of having depression among US adults, and this association was probably mediated by RBC and RCDW.

从阴阳角度防治瘀热,认为瘀热属阳,阴虚阳盛体质是病理基础.瘀热病邪有火热伤阴动血的特点,且阴虚阳盛体质更容易发生瘀热.临床根据瘀热的阶段并结合其不同的症状,瘀和热均会有不同程度的变化.初期以火热为主,故清热为要;后期以阴血亏耗为主,故养阴为重.且凉血散血贯穿治疗的始终.同时指出,小儿瘀热形成除与饮食、情志、体质等因素有关外,尚与屡次感邪以致邪伏血络有密切联系.故预防应围绕其生活起居、饮食、情志进行,并注意驱邪务尽.附案例1则,以资验证.

《中医儿科学》是基础理论与临床实践之间的桥梁课,其教学重点既要注重培养学生扎实的理论基础知识,同时又要强化临床思维,培养学生临证能力,以适应今后临床工作的需要.案例教学法是培养学生中医临床思维能力的有效教学方法之一,元认知的纳入可促进案例教学法的实施,提高学习效果,弥补以往单纯讲授法教学对学生临床思维能力培养的不足,有利于实现以提升学生中医临床思维能力为导向的教学目标.

抽动障碍是一种神经精神疾病,以运动抽动和发声抽动为主要临床表现.除了抽动症状本身之外,抽动障碍患儿多存在不良的情绪状态或心理行为问题.基于"形神合一"理论,抽动障碍当属形神共病,神不宁、形不静为其临床特征,情志失调、神不御形为其发病关键,因此,治疗当形神兼顾,重在治神."鬼穴"为调神之要穴,兼有治形之功,故可将其用于治疗抽动障碍.于抽动障碍而言,针刺鬼穴既可以平衡阴阳、调畅情志以安神,又可调畅气血、舒筋息风以治形,发挥"形神共调"之效,令神安而形定,防治抽动症状.本文通过阐述"鬼穴"在抽动障碍中的作用机制和临床应用,有助于为抽动障碍的针刺穴位组方提供新的视角.

We read with enthusiasm the cohort study by James Peter Allinson and colleagues,1Allinson JP Chaturvedi N Wong A et al.Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study.Lancet. 2023; 401: 1183-1193Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar who estimated the risk and burden of premature adult mortality from respiratory disease attributable to lower respiratory tract infections (LRTIs) in the early childhoods of 5362 participants born in Great Britain in March, 1946. Cohort participants were contacted 25 times from birth until 2019. Although the study has addressed an important public health question, we are concerned about the assessment of exposure. Cigarette smoking remains the leading cause of premature deaths worldwide.2McCarthy M Smoking remains leading cause of premature death in US.BMJ. 2014; 348: g396Crossref Scopus (9) Google Scholar, 3Ordunez P Campbell NR Smoking tobacco, the major cause of death and disability in Cuba.Lancet Glob Health. 2020; 8: e752-e753Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar However, in this study, only smoking at age 20–25 years was evaluated as a confounding factor, which might not sufficiently cover the exposure period before premature deaths. As the authors stated,1Allinson JP Chaturvedi N Wong A et al.Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study.Lancet. 2023; 401: 1183-1193Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar smoking intensity at multiple age points was recorded among cohort participants, and we are curious to know the effect of lifelong smoking on premature deaths associated with early childhood LRTIs. Moreover, the potential confounding effect of passive smoking on early childhood LRTIs and premature deaths was not considered in the study.1Allinson JP Chaturvedi N Wong A et al.Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study.Lancet. 2023; 401: 1183-1193Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar According to a national UK database analysis, in the general population aged 20–64 years, passive smoking at work contributed to a fifth of all deaths from lung cancer, ischaemic heart disease, and stroke, and passive smoking at home accounted for 2700 deaths each year.4Jamrozik K Estimate of deaths attributable to passive smoking among UK adults: database analysis.BMJ. 2005; 330: 812Crossref PubMed Scopus (108) Google Scholar Establishing the effect of smoking—either as a confounder or a mediator—remains a challenging task, and we believe that the findings by Allinson and colleagues1Allinson JP Chaturvedi N Wong A et al.Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study.Lancet. 2023; 401: 1183-1193Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar could be reinforced and less susceptible to confounding after further exploration. We declare no competing interests. Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort studyIn this prospective, life-spanning, nationally representative cohort study, LRTI during early childhood was associated with almost a two times increased risk of premature adult death from respiratory disease, and accounted for one-fifth of these deaths. Full-Text PDF Open AccessLower respiratory tract infections in early childhood – Authors' replyWe thank Xiaoqian Zhang and colleagues, Jianning Guo and colleagues, and Seif Shaheen for their thoughtful correspondence regarding our Article.1 Full-Text PDF

Image thinking is one of the basic thinking modes in traditional Chinese medicine. By combing the concepts of image and image thinking, we aimed to deeply understand the relationship between the thinking mode of traditional Chinese medicine and image thinking. We recognize the ascarid appearance of Jueyin disease from the perspective of image thinking, and the essence of Jueyin disease is the mixture of cold and heat, and the internal movement of wind and Qi. In the process of occurrence and development of bronchial asthma, it is often manifested as the pattern and manifestations of Jueyin disease. Bronchial asthma is clinically characterized by relapsed attacks, diverse triggering factors, time rhythm, seasonality, reversability, etc. From the perspective of image thinking, bronchial asthma resembles Jueyin disease. This paper discusses the treatment of bronchial asthma with Wumei Pill from the aspects of its composition characteristics, clinical application and its mechanism of action. Combined with typical cases, the diagnosis and treatment ideas and medication experience of Wumei Pill in treating bronchial asthma are introduced.

注意缺陷多动障碍(ADHD)是起病于早期的儿童神经发育障碍,临床多从阳热亢盛角度进行论治,但对表现为神思涣散且易疲乏倦怠等阳热之象不甚的患儿效果不佳.基于临床实践,发现阳虚亦能引起ADHD发病,认为相火无根、君火上浮是此类患儿发病原因,虚阳浮越、神躁于外为其核心病机.提出以"温阳潜神法"进行治疗,以附子、肉桂等温阳补肾、引火归元治其本,以龙骨、牡蛎等敛阳宁心、潜镇安神治其标,适当配合滋阴清热之品,同时注重日常调护,为ADHD的中医药辨治拓展思路.

目的:对藤龙补中汤联合化疗治疗大肠癌的临床疗效进行系统评价.方法:检索CNKI、万方、VIP、中国生物医学文献服务系统临床随机对照试验文献,运用EndNote X9对检索文献进行归纳筛选,选用Cochrane协作网偏倚风险评价工具进行质量评价,用RevMan5.3对数据进行分析.结果:藤龙补中汤联合化疗治疗大肠癌的Karnofsky评分(MD=9.13,95％CI[7.97,10.29],P＜0.00001)、癌胚抗原水平(MD=-1.87,95％CI[-2.32,-1.41],P＜0.00001)、谷丙转氨酶(MD=-32.79,95％CI[-35.88,-29.71],P＜0.00001)、保肛率(OR=2.81,95％CI[1.23,6.40],P=0.01)均优于对照组;所有提及不良反应发生率的试验中,治疗组均低于对照组.结论:藤龙补中汤联合化疗治疗大肠癌疗效更好.

反复呼吸道感染是儿童常见肺系疾病,因其反复发作、病程迁延、缠绵难愈,严重影响患儿身心健康.本课题组创新性地提出从瘀热论治本病,并进行了相关临床试验和基础实验研究,疗效肯定.为提高中医药治疗儿童反复呼吸道感染临床疗效、进一步规范反复呼吸道感染瘀热内结证中医诊疗方案,助力临床推广,在儿科专家小组的指导下,遵循循证医学的基本原则,采用德尔菲法,经过3轮专家调查问卷,并结合临床评价,最终形成《儿童反复呼吸道感染瘀热内结证中医诊疗专家共识》.

目的 探讨健脾止动汤对慢性束缚应激抽动障碍大鼠大脑皮质区神经元及神经营养因子水平的影响.方法 将48只3周龄雄性SD大鼠随机分为空白组12只、造模组36只.空白组予生理盐水[1 mL/(kg·d)]腹腔注射7天;模型组予IDPN[250 mg/kg,1 mL/(kg·d)]腹腔注射7天,同时慢性束缚21天,造模成功后随机分为模型组、硫必利组、健脾止动汤组.空白组、模型组予生理盐水灌胃,硫必利组予盐酸硫必利混悬液灌胃(1 mL药液中约含2.1 mg原药),中药组予健脾止动汤溶液灌胃(1 mL药液中约含1.6 g生药),灌胃体积1 mL/100 g,每天灌胃1次,连续4周.末次用药后,对大鼠断头取脑,留取标本.尼氏染色法观察大鼠前额叶皮质区神经元尼氏小体改变,酶联免疫吸附法检测前额叶皮质中脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)和神经生长因子(nerve growth factor,NGF)的含量.结果 与空白组相比,模型组前额叶皮质中尼氏小体的数量显著减少,IGF-1含量显著降低;与模型组相比,硫必利组IGF-1含量显著升高,健脾止动汤组尼氏小体显著增多,BDNF、IGF-1、NGF含量显著升高.结论 健脾止动汤具有神经保护作用,可能与提高神经营养因子的表达有关.

目的 探讨刺络拔罐治疗小儿急性扁桃体炎的临床疗效.方法 选取2019年3月-2020年9月在北京中医药大学第三附属医院就诊的急性扁桃体炎患儿102例作为研究对象,采取前瞻性、平行开放对照的研究方法,随机分为对照组和观察组,每组51例.对照组仅给予对症治疗,观察组在对症治疗的基础上加用大椎穴刺络拔罐及双手少商穴刺络放血治疗,如果观察组治疗后2 d仍有发热,再次给予上述中医外治1次.观察热退时间、咽痛好转时间、咽部充血改善时间、扁桃体肿大好转时间、扁桃体脓点消失时间等,进行证候评分;总结2组治疗的有效率;并比较治疗前及治疗5 d白细胞计数(WBC)、中性粒细胞比率(N％)、C反应蛋白(CRP)数值;治疗后2周随访复发情况.结果 观察组总有效率为98.04％(分子/分母),高于对照组的90.20％(分子/分母),但差异没有统计学意义(P＞0.05).观察组热退时间、咽痛好转时间、咽部充血改善时间均较对照组缩短,差异均有统计学意义(P＜0.05).观察组扁桃体肿大好转时间及扁桃体脓点消失时间较对照组也有一定程度的缩短,但差异没有统计学意义(P＞0.05).治疗后,2组WBC、N％、CRP的水平较治疗前均有降低趋势(P＜0.05),其中观察组CRP水平明显低于对照组,差异具有统计学意义(P＜0.05).治疗后2周随访,观察组复发率明显低于对照组(P＜0.05).结论 刺络拔罐方法治疗小儿急性扁桃体炎较常规治法在改善临床症状、体征,缩短病程,减轻急性炎症反应及预防短期复发等方面具有一定疗效.

抽动障碍的发病与心肝关系密切,肝风内动,筋脉挛急而致抽动,为形病;心血不足,心失所养,而致情绪障碍等,为神病,治疗时应注重"形神同调".从心肝出发,以治肝调形、养心安神为治则,发病初期重在调形,以疏肝行气息风为主,佐以安神;发作程度重,合并共患病,应调形安神并重,治宜泻火平肝,重镇安神;抽动缓解期以健脾滋肾、养心安神为主,佐以息风,采用内外合治的方法,有助于提高抽动障碍的疗效,强化本病的防治及远期管理,也为其他儿童神经精神障碍性疾病的中医辨治提供新的思路.

Children are susceptible to pneumonia, which affects their growth and development. Immune disorders and unrepaired alveolar mucosal epithelium following pneumonia cause chronic lung injury. The mechanism of chronic lung injury is unknown and lacks animal models for reference. Therefore, we developed a chronic lung injury young mouse model to simulate the pathological process of children. 3-week-old mice were intratracheal instillation of lipopolysaccharide (LPS) every other day for six weeks. Consequently, the histopathology showed damaged integrity of lung tissue, fibrosis, and abnormally distributed alveolar epithelial cells. The total protein concentration in bronchoalveolar lavage fluid (BALF) was increased, alveolar epithelial type (AT) I cells were abnormal distribution, and AT II cells were reduced. The phosphorylation levels of IKBα and the expression levels of NF-κB p65 in lung tissue were up-regulated. In serum and BALF, the IL-6 was oversecretion, nitric oxide (NO) and superoxide dismutase (SOD) were perturbed secretion, oxidative stress imbalance. In addition, blood viscosity, plasma viscosity, and erythrocyte sedimentation rate (ESR) indexes in hemorheology were increased. In conclusion, it is feasible to construct the mouse model of chronic lung injury, and AT I and AT Ⅱ cells were imbalanced, which paves the way for further investigations on the pathogenesis of chronic lung injury and the efficacy of novel treatments.

茵陈蒿汤作为治疗湿热蕴结型黄疸的代表方,在治疗阻塞性黄疸、脂肪肝、肝硬化等疾病中有较好的疗效,临床亦将其广泛用于慢性乙型病毒性肝炎湿热内蕴证的治疗中,这与其抗炎、抗病毒、抗纤维化及利胆保肝的作用密切相关,此文通过查阅近10年的文献报道,总结有关茵陈蒿汤治疗慢性乙型病毒性肝炎湿热内蕴证的临床疗效与药理作用机制,以期为该方的临床应用与进一步研究提供参考.