Introduction:Cerebral small vessel disease (CSVD) is increasingly recognized as an important determinant of outcome after acute ischemic stroke (AIS). However, the contribution of global CSVD burden, individual imaging markers, and systemic clinical phenotypes to early neurological recovery remains incompletely understood. Methods:We conducted a retrospective cohort study of consecutive AIS patients admitted to Dongzhimen Hospital, Beijing University of Chinese Medicine between January and December 2024. CSVD markers were assessed using MRI according to STRIVE criteria, and a total CSVD burden score (0-4) was calculated. Systemic clinical phenotypes were defined based on standardized admission assessments. The primary outcome was unfavorable neurological status at discharge (NIHSS >8). Multivariable logistic regression with collinearity diagnostics was performed. Distributions of NIHSS scores across CSVD features were visualized using violin plots. Results:A total of 474 patients were included (median age 67 years; 71% male), of whom 31 (6.5%) had unfavorable outcomes. Higher total CSVD burden (adjusted OR 1.57, 95% CI 1.13-2.17), hyperhomocysteinemia (adjusted OR 2.76, 95% CI 1.21-6.31), and a Traditional Chinese Medicine (TCM)-defined Phlegm-Heat Fu-Excess phenotype (adjusted OR 5.28, 95% CI 1.85-15.04) were independently associated with unfavorable outcomes. Among individual CSVD markers, lacunar infarction showed the strongest association. White matter hyperintensities, cerebral atrophy, and basal ganglia enlarged perivascular spaces were associated with higher discharge NIHSS scores in exploratory analyses. Given the limited number of outcome events, the stability of the regression model may be limited, and these findings should be interpreted with caution. Discussion:Global CSVD burden and selected systemic clinical phenotypes are associated with poor short-term neurological outcomes after AIS. These findings should be considered exploratory and hypothesis-generating, and may provide supplementary information for early risk stratification. Further validation in larger, prospective multicenter studies is required.

BackgroundPost-stroke thalamic pain (PSTP) represents one of the most challenging types of refractory central neuropathic pain. The application of herbal medicine alongside Western medicine (WM) has been proposed as a potential therapeutic option for managing PSTP. Nevertheless, its comprehensive effectiveness and safety have yet to be conclusively established.ObjectiveThis study aimed to systematically evaluate the efficacy and safety of herbal medicine combined with WM for the management of PSTP.MethodsEight electronic databases were searched from inception to August 2025 to retrieve randomized controlled trials (RCTs) evaluating combined herbal medicine and WM against WM monotherapy in the management of PSTP. Outcomes included pain intensity measures (VAS, PPI, PRI), anxiety and depression scales (HAMA, SAS, HAMD and SDS), overall treatment effectiveness and adverse events. Sensitivity and subgroup analyses were performed to explore potential sources of heterogeneity. The GRADE framework was used to appraise the strength of evidence for specific results. Trial sequential analysis was carried out with TSA software.ResultsThe systematic review encompassed 16 trials, incorporating 1,122 participants. The pooled analysis showed that herbal medicine combined with WM was associated with a higher total effective rate than WM alone (RR = 1.38, 95% CI: 1.28–1.49, p < 0.00001). Compared with WM alone, herbal medicine combined with WM significantly reduced VAS score (MD = −1.50, 95% CI: −1.84 – -1.16, p < 0.00001), PPI score (MD = −1.39, 95% CI: −1.55 – -1.22, p < 0.00001), and PRI score (MD = −2.46, 95% CI: −3.24 – -1.69, p < 0.00001). Combination therapy also effectively reduced anxiety (HAMA: MD = −3.10, 95% CI: −3.53 – -2.67, p < 0.00001; SAS: MD = −6.97, 95% CI: −7.49 – -6.46, p < 0.00001) and depression (HAMD: MD = −2.26, 95% CI: −2.72 – -1.80, p < 0.00001; SDS: MD = −7.15, 95% CI: −7.66 – -6.65, p < 0.00001). Regarding safety, herbal medicine combined with WM was not associated with an increased incidence of adverse events compared with WM alone (RR = 0.95, 95% CI: 0.55–1.64, p = 0.86). The certainty of evidence assessed using GRADE ranged from moderate to very low, and TSA provided additional statistical support for the potential benefit of the combined therapy.ConclusionEvidence from this systematic review indicates that adjunctive herbal medicine combined with WM may have potential benefits in reducing pain, anxiety, and depression, and improving clinical response in patients with PSTP. However, these findings should be interpreted with caution due to methodological limitations and the exclusive inclusion of studies from China. Further rigorous, multicenter, and multinational trials are needed to confirm these findings.Systematic review registrationThe systematic review was registered in PROSPERO (registration number: CRD42024494796).

Neurological disorders are the leading cause of global health loss and disability. However, the success rate of drug development in the nervous system is very low, mainly because of the blood-brain barrier (BBB). In addition, gastrointestinal irritation, low stability, rapid metabolism, imprecise targeting, and organ toxicity of drugs are also important constraints in the development and application of neurological drugs. Emerging technologies, such as nano-delivery technology, offer a number of strategies to address these challenges drugs face entering the central nervous system. This review systematically introduces the various challenges of existing drug development in neurological disorders and summarizes BBB regulation strategies, drug delivery strategies, and modes of administration. It's summarized that the challenges of BBB can be addressed with the help of strategies including physical stimulation and modification of nanocarriers, and drug delivery in the nervous system can be achieved with the help of passive and active nanocarriers and self-assembly. Moreover, drug delivery strategies in major neurological disorders are discussed in detail. Finally, the limitations of some drug delivery strategies are summarized and the future development direction is prospected, which can provide new ideas and technologies for the optimization of drug delivery for neurological disorders.

Objective To explore the inhibitory effects of mulberry leaf flavonoid extract (MFE) on high glucose-induced diabetic encephalopathy (DE) in a cell model, and to investigate the underlying mechanisms combined with network pharmacology prediction and experimental validation. Methods A DE cell model was established by chronic high glucose stimulation of HT22 mouse hippocampal neuronal cells. Following intervention with MFE, cell viability, advanced glycation end products (AGEs) content, and ferroptosis-related indices were detected. Network pharmacology was used to screen potential signaling pathways and key targets of MFE, while Western blotting validated the expression of proteins related to the screened pathways and targets. Results Network pharmacology screening identified Akt1, ALB, TNF, IL-1B, and IL-6 as the top-ranked targets. Molecular docking confirmed stable binding between major MFE components and these potential targets. MFE treatment markedly upregulated ferritin heavy chain (FTH) and ferroportin (FPN) levels while decreasing transferrin receptor (TFRC) levels, attenuating iron overload in DE cells. It also suppressed AGEs accumulation, which activated the downstream PI3K/Akt/Nrf2/SLC7A11/GPX4 ferroptosis regulatory pathway to mitigate oxidative stress and inhibit ferroptosis. Additionally, MFE activated Akt, leading to p38 MAPK deactivation, reduced Bax/Bcl-2 ratio, and decreased Caspase-3 levels, blocking the apoptosis pathway. It alleviated inflammatory injury by suppressing the p38 MAPK/NF-κB pathway, thereby reducing TNF-α, IL-1β, and IL-6 protein levels. Conclusion MFE inhibits ferroptosis by upregulating the PI3K/Akt/Nrf2/GPX4 signaling pathway. This study provides valuable insights into the therapeutic application of MFE for DE.

BACKGROUND AND PURPOSE:Siguan points, comprising bilateral Hegu (LI4) and Taichong (LR3), have shown good therapeutic potential in migraine management. We aimed to systematically evaluate the clinical efficacy and neurovascular regulatory mechanisms of Siguan points-based acupuncture treatment (SPBAT) for migraine. METHODS:A comprehensive literature search was conducted across 15 databases through January 1st, 2025. Randomized controlled trials (RCTs) comparing SPBAT with conventional pharmacotherapy or sham acupuncture were included. Primary outcomes encompassed the clinical effective rate and the headache intensity measured by the visual analogue scale (VAS). Secondary outcomes included attack frequency, migraine days, doses of analgesics, adverse events (AEs), and other relevant measures. Dichotomous variables were reported as risk ratios (RR) or risk differences (RD), and continuous variables as mean differences (MD) or standardized mean differences (SMD); all estimates were presented with 95 % confidence intervals (CIs). Trial sequential analysis (TSA) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were employed to assess evidence reliability and certainty. The neurovascular regulatory mechanisms of Siguan points for migraine were systematically reviewed. RESULTS:Analysis of 19 RCTs (1312 participants) demonstrated significant improvements with SPBAT in clinical effective rate (RR 1.22 [1.14, 1.31]), VAS for headache intensity (MD -1.11 [-1.50, -0.73]), attack frequency (SMD -0.81 [-1.49, -0.14]), and other outcomes. TSA confirmed the robustness of primary outcome findings. GRADE assessment indicated moderate to low evidence certainty across outcomes. No significant differences in AEs were observed between groups (RD -0.04 [-0.11, 0.04]). Mechanistic investigations revealed that Siguan points exerted therapeutic effects through integrated modulation of central pain processing networks and peripheral neurovascular pathways. CONCLUSION:SPBAT demonstrates significant efficacy in reducing migraine severity, duration, and frequency while maintaining a safety profile comparable to standard treatments. Its neurovascular regulatory effects and clinical benefits position SPBAT as a viable alternative for migraine management, though further high-quality research is warranted to strengthen the evidence base.

Background:Elevated blood pressure (BP) in acute ischemic stroke (AIS) significantly impacts clinical outcomes, yet optimal BP management remains contentious due to patient heterogeneity. Traditional Chinese medicine (TCM) constitution theory categorizes individuals into distinct physiological patterns, offering a novel framework to address this variability. This study integrates TCM constitutional theory into modern AIS care to propose a personalized BP management ‌hypothesis. Methods:A systematic review and meta-analysis were conducted across nine databases, including PubMed, Web of Science, Scopus, the Cochrane Library, ScienceDirect, the Chinese National Knowledge Infrastructure, Wanfang Data, VIP Database, and China Biology Medicine, covering publications up to January 2025. We analyzed TCM constitution distributions in AIS, hypertension, hypotension, AIS with hypertension, ischemic stroke (IS) with hypertension, and ischemic cerebrovascular disease with hypoperfusion, correlating constitutional types with clinical outcomes. We employed the Agency for Healthcare Research and Quality (AHRQ) checklist to evaluate the methodological quality of cross-sectional studies and utilized the Newcastle-Ottawa Scale (NOS) for quality assessment of cohort and case-control studies. Subgroup and sensitivity analyses were performed, and publication bias was assessed. A constitution-guided framework for BP management was developed through evidence synthesis. Results:Fifty-four studies were included in the study, with the majority being of moderate-to-high quality. The findings demonstrated that Phlegm-dampness, Qi-deficiency, Yin-deficiency, and Blood-stasis constitutions predominated in AIS patients with hypertension. Subgroup and sensitivity analyses confirmed the robustness of the results. Most analyses demonstrated no evidence of publication bias. Although several analyses indicated potential publication bias, the primary conclusions withstood the trim-and-fill adjustment and remained robust. A TCM constitution-based BP management hypothesis was proposed: patients with Phlegm-dampness or Blood-stasis constitutions may benefit from intensive BP control, whereas Qi-deficiency and Yin-deficiency types may require conservative strategies to mitigate hypoperfusion risks. Conclusion:This integration of TCM constitutional theory into AIS BP management provides a potential framework for advancing precision care to improve clinical outcomes in AIS patients. Further validation in multicenter cohorts and mechanistic exploration is warranted to enhance clinical applicability (Registration information: https://www.crd.york.ac.uk/PROSPERO2/view/CRD420250655689).

AIM:To survey the physician's attention to the workload of combining clinical practice with Traditional Chinese Medicine (TCM) data collection. BACKGROUND:With the development of artificial intelligence technology in the medical field, the task of collecting diverse clinical data in TCM has increased. Based on the TCM's diagnostic and treatment principles, the collection of research data accompanying clinical practice is inevitable, which may have an impact on TCM clinical practice. METHOD:A previous research was conducted to collect diverse instant TCM diagnostic and treatment data, and physicians and research designers proposed many suggestions focusing on the workload of combining clinical practice with TCM data collection. In this study, A 54-item questionnaire was developed based on the suggestions. Forty-eight participants with data-collection experience participated in a questionnaire survey, and they needed to grade each item, which reflected their attention to the workload of combining clinical practice with TCM data collection. RESULTS:The survey received 40 valid questionnaires, with 49 items scoring 4 or above. Three items in the content dimension (Q9, Q10, Q11) and two items in the spatial dimension (Q31, Q48) are scored lower. Additionally, 25 supplementary suggestions were collected during the study. CONCLUSION:The workload of combining clinical practice with TCM data collection needs to be considered. The items in this survey could be regarded as a basis for developing a tool to consider the relationship between clinical practice and data collection.

Background:Post-stroke thalamic pain (PS-TP), a common form of central pain, is characterized by hyperalgesia and abnormal sensations in the contralateral affected area. Acupuncture treatment has shown increasing promise in treating PS-TP in recent years. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of acupuncture treatment for PS-TP. Methods:According to the established search strategy, randomized controlled trials (RCTs) of acupuncture therapy for PS-TP were retrieved from eight Chinese and English databases as well as two clinical trial registration platforms, up to February 2024. Outcome measures included the total efficacy rate, visual analogue scale (VAS), present pain intensity score (PPI), pain rating index (PRI), β-endorphin (β-EP), substance P (SP) and adverse reactions. Sensitivity analysis and subgroup analysis were conducted to identify the sources of heterogeneity. We evaluated the evidence quality of outcomes via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) rating system and performed trial sequential analyses using TSA software. Results:The final inclusion comprised 12 articles, which involved 953 patients. Meta-analysis results indicated that acupuncture treatment for PS-TP was more effective than conventional medical treatment in reducing VAS scores [MD = -1.11, 95% CI (-1.33, -0.88), p = 0.002], PPI scores [MD = -0.65, 95% CI (-1.13, -0.16), p = 0.009], and PRI scores [MD = -1.02, 95% CI (-1.41, -0.63), p < 0.00001]. Additionally, acupuncture treatment for PS-TP was superior to the conventional medical treatment in increasing plasma β-EP levels [MD = 8.83, 95% CI (5.42, 12.25), p < 0.00001], and reducing SP levels [MD = -4.75, 95% CI (-7.11, -2.40), p < 0.0001]. Regarding the total efficacy rate, acupuncture treatment was superior to the conventional medical treatment in treating PS-TP [RR = 1.24, 95% CI (1.17, 1.31), p < 0.00001]. The incidence of adverse events was lower in acupuncture treatment than in conventional medical treatment [RR = 0.43, 95% CI (0.14, 1.32), p = 0.03]. The GRADE assessment indicated that the quality of evidence for all outcome measures ranged from moderate to very low. Trial sequential analysis (TSA) results provided compelling evidence for the efficacy of acupuncture in treating PS-TP. Conclusion:Acupuncture treatment emerges as a potentially efficacious and safe treatment option for PS-TP. In the future, more large-sample, high-quality RCTs are needed to provide primarily high-level evidence in evidence-based medicine regarding the safety and sustained effects of acupuncture treatment for PS-TP. Systematic review registration:https://www.crd.york.ac.uk/PROSPERO/view/CRD42024498698, identifier CRD42024498698.

Background:Dupilumab is generally considered safe and effective for treating bullous pemphigoid (BP). We report the first case of recurrent hypoperfusion-induced cerebral infarction temporally associated with dupilumab administration in an elderly patient. Case Presentation:A 96-year-old male with BP, type 2 diabetes, and a history of stroke developed acute hypotension, depressed consciousness, and reduced oral intake within 24-72 hours after three separate dupilumab injections. Initial neuroimaging revealed watershed infarcts. Proactive volume expansion during one administration successfully averted new infarction, whereas lack of prophylactic hydration on another occasion precipitated a transient ischemic attack (TIA). Observations & Analysis:A significant temporal association was documented. The Naranjo Adverse Drug Reaction Probability Scale score was 8, indicating a probable association. The patient's advanced age, compromised cerebrovascular reserve, and mandatory discontinuation of antithrombotics created a hypervulnerable substrate. The hypotensive mechanism is hypothesized to involve IL-4/IL-13 pathway blockade, potentially disrupting endothelial function and vascular tone regulation. Conclusion & Clinical Implications:This case report describes a potential, albeit rare, serious adverse effect associated with dupilumab in an elderly individual at high risk. Based on this single experience, we suggest at least 72 hours of post-injection blood pressure monitoring for high-risk patients. Management could include administering prophylactic fluid replacement based on the patient's actual condition and critically reassessing concomitant antihypertensive regimens. This finding highlights the need for heightened clinical vigilance and suggests that the drug's safety profile in advanced-age patients may warrant further investigation.

Introduction Cupping mark color is believed to be related to the mechanism and efficacy of cupping therapy, but exploration of the factors influencing its depth has so far been limited. Methods We recruited 100 patients with fibromyalgia and 100 healthy volunteers (aged 18u201375 years) from Dongfang Hospital Beijing University of Chinese Medicine (Beijing, China), and nearby communities. A survey was conducted to collect demographic data and the Traditional Chinese Medicine (TCM) constitution of participants. Cupping was then performed at six acupoints (bilateral Feishu [BL 13], Xinshu [BL 15], and Ganshu [BL 18]) for 10 min, and the resulting color of each cupping mark was rated according to a cupping color rating chart. Statistical multiple linear regression analysis was carried out using SPSS 22.0 to determine the correlation between cupping mark color and possible influencing factors including health status, TCM constitution type, sex, age, and body mass index (BMI). Results A total of 33 males (16.5%) and 167 females (83.5%), with an average age of 42.08 years, completed the survey. Forty-four participants (22%) were classified as yang-deficiency constitution, 38 (19%) as balanced constitution, and 26 (13%) as phlegm-dampness constitution. The average score of cupping mark color was 4.38. Sex (u03B2 = u22121.025, P = 0.001) and health status (u03B2 = u22120.678, P = 0.003) were significant factors influencing cupping mark color: female participants had lighter marks than males, and fibromyalgia patients had lighter marks than healthy volunteers. TCM constitution type, age, and BMI were not associated with cupping mark color. Conclusions This cross-sectional study of 200 participants did not reveal any correlation between TCM constitution type and cupping mark color. However, given the limited sample size, future studies with larger cohorts are warranted.

ObjectiveThis study aims to investigate the pathogenesis of hyperglycemia and its associated vasculopathy using multiomics analyses in diabetes and impaired glucose tolerance, and validate the mechanism using the cell experiments.MethodsIn this study, we conducted a comprehensive analysis of the metagenomic sequencing data of diabetes to explore the key genera related to its occurrence. Subsequently, participants diagnosed with impaired glucose tolerance (IGT), and healthy subjects, were recruited for fecal and blood sample collection. The dysbiosis of the gut microbiota (GM) and its associated metabolites were analyzed using 16S rDNA sequencing and liquid chromatograph mass spectrometry, respectively. The regulation of gene and protein expression was evaluated through mRNA sequencing and data-independent acquisition technology, respectively. The specific mechanism by which GM dysbiosis affects hyperglycemia and its related vasculopathy was investigated using real-time qPCR, Western blotting, and enzyme-linked immunosorbent assay techniques in HepG2 cells and neutrophils.ResultsBased on the published data, the key alterable genera in the GM associated with diabetes were identified as Blautia, Lactobacillus, Bacteroides, Prevotella, Faecalibacterium, Bifidobacterium, Ruminococcus, Clostridium, and Lachnoclostridium. The related metabolic pathways were identified as cholate degradation and L-histidine biosynthesis. Noteworthy, Blautia and Faecalibacterium displayed similar alterations in patients with IGT compared to those observed in patients with diabetes, and the GM metabolites, tauroursodeoxycholic acid (TUDCA) and carnosine (CARN, a downstream metabolite of histidine and alanine) were both found to be decreased, which in turn regulated the expression of proteins in plasma and mRNAs in neutrophils. Subsequent experiments focused on insulin-like growth factor-binding protein 3 and interleukin-6 due to their impact on blood glucose regulation and associated vascular inflammation. Both proteins were found to be suppressed by TUDCA and CARN in HepG2 cells and neutrophils.ConclusionDysbiosis of the GM occurred throughout the entire progression from IGT to diabetes, characterized by an increase in Blautia and a decrease in Faecalibacterium, leading to reduced levels of TUDCA and CARN, which alleviated their inhibition on the expression of insulin-like growth factor-binding protein 3 and interleukin-6, contributing to the development of hyperglycemia and associated vasculopathy.

BACKGROUND:Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare disease that is characterized by autoinflammatory lesions on both bones and skin. The diverse manifestations and limited understanding of its etiology have hindered the diagnosis and treatment of this condition. SAPHO syndrome is also classified as a primary inflammatory osteitis. The onset of osteoarticular involvement in this disease is typically gradual, and the identification of associated biomarkers may be crucial for accurate diagnosis, effective treatment, and a better understanding of its underlying mechanisms. METHODS:We enrolled a total of 6 SAPHO patients and 3 healthy volunteers for this study. The miRNA expression profile in circulating exosomes was analyzed using next-generation sequencing. A total of 45 miRNAs were found to be differentially expressed in SAPHO patients. Linear discriminant analysis effect size analysis and Wilcoxon rank-sum test were employed to identify biomarkers based on these differentially expressed miRNAs. Among them, we selected 4 miRNAs as biomarkers for SAPHO syndrome, resulting in an area under the receiver operating characteristic curve of 1. RESULTS:The differentially expressed miRNAs indicated enrichment in immune system and endocrine system-related KEGG pathways, as well as infectious diseases and cancers. Furthermore, the most significantly enriched molecular functions in GO analysis were protein binding and catalytic activity. CONCLUSION:The exosomal miRNA profile in SAPHO syndrome exhibited significant changes, suggesting its potential as a candidate biomarker for diagnostic assistance, although further investigation is warranted to elucidate their role in the pathology.

Ethnopharmacological relevance: Kai-Xin-San (KXS) is a classic herbal formula for the treatment and prevention of AD (Alzheimer 's disease) with definite curative effect, but its mechanism, which involves multiple components, pathways, and targets, is not yet fully understood. Aim of the study: To verify the effect of KXS on gut microbiota and explore its anti-AD mechanism related with gut microbiota. Materials and methods: AD rat model was established and evaluated by intraperitoneal injection of D-gal and bilateral hippocampal CA1 injections of Af3 25-35 . The pharmacodynamics of KXS in vivo includes general behavior, Morris water maze test, ELISA, Nissl & HE staining and immunofluorescence. Systematic analysis of gut microbiota was conducted using 16S rRNA gene sequencing technology. The potential role of gut microbiota in the anti-AD effect of KXS was validated with fecal microbiota transplantation (FMT) experiments. Results: KXS could significantly improve cognitive impairment, reduce neuronal damage and attenuate neuroinflammation and colonic inflammation in vivo in AD model rats. Nine differential intestinal bacteria associated with AD were screened, in which four bacteria ( Lactobacillus murinus , Ligilactobacillus , Alloprevotella , Prevotellaceae _ NK3B31_group ) were very significant. Conclusion: KXS can maintain the ecological balance of intestinal microbiota and exert its anti-AD effect by regulating the composition and proportion of gut microbiota in AD rats through the microbiota-gut-brain axis.

Shaoyao Decoction (SYD) is a widely recognized herbal formula utilized in traditional Chinese medicine for the treatment of diarrhea. Although it has demonstrated significant effectiveness in clinical practice for treating ulcerative colitis, the precise mechanisms by which it operates remain largely elusive. The active ingredients of SYD were obtained by ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS), which were used to explore the potential pharmacological mechanism based on TCMSP (Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform) and PANTHER (Protein Analysis Through Evolutionary Relationships) classification system. In a mouse model of dextran sulfate sodium (DSS)-induced colitis, mRNA sequencing, 16S rDNA sequencing and targeted metabolomics techniques were used to elucidate the mechanisms of SYD, and immunohistochemistry, immunofluorescence, enzyme linked immunosorbent assay, real time quantitative polymerase chain reaction and western blot were used to test the key targets. In addition, QGP-1 and H9 cells were performed to validate the discoveries from the animal experiments. In the mouse model of DSS-induced colitis, SYD effectively alleviated symptoms such as bloody stool, tissue damage, inflammation, intestinal flora dysbiosis and abnormal gene expression. Analyses of both differential expressed genes in colonic tissue and predicted 16S rDNA genes, as well as the analyses of targeted genes from TCMSP based on the active ingredients in UPLC-MS/MS of SYD, uncovered the enrichment of pathways involved in the biosynthesis and degredation of 5-hydroxytryptamine (5-HT). Interestingly, SYD suppressed the relative abundance of key genes in 5-HT synthesis, Tph1(Tryptophan hydroxylase 1) and Ddc (Dopa decarboxylase), in faeces from DSS-induced mice, leading to a reduction in the concentration of fecal 5-HT. Moreover, SYD augmented the production of butyric acid. Subsequently, increasing butyric acid influenced the metabolism of 5-HT in the organism through G protein-coupled receptor 43 by impeding its synthesis, facilitating its transport and degredation. These findings were additionally corroborated in a model utilizing enterochromaffin cell (QGP-1 cells). Furthermore, reduced levels of 5-HT hindered the activation of T lymphocytes (H9 cells) via the PKC (Protein kinase C) and NF-κB (Nuclear factor kappa-B) signaling pathways, by means of HTR1A (5-HT receptor 1A) and HTR3 (5-HT receptor 3). Additionally, diminished secretion of 5-HT resulted in reduced secretion of associated cytokines, thereby alleviating inflammation in the colon. Through modulation of T lymphocyte activation mediated by 5-HT metabolism in the local colon via the intestinal flora and its metabolite, SYD effectively mitigated colonic inflammation in DSS-induced mice.

背景:量化脑梗死偏瘫患者步态特征能够作为其后期康复治疗的重要参考依据,而RSSCAN步态系统能够实时定量地采集受试者行走时的步态参数.目的:探究脑梗死偏瘫患者的步态特征及健、患侧足之间的步态差异.方法:纳入北京中医药大学东直门医院与北京中医医院怀柔医院收治的脑梗死偏瘫患者134例,其中男102例,女32例,年龄(60±9)岁.通过RSSCAN步态系统采集受试者步行时的步态参数,选取中间段测试中两对步态周期连续的清晰足印,并将受试者双侧足底手动分成十分区(第1趾区、第2-5趾区、第1跖骨区、第2跖骨区、第3跖骨区、第4跖骨区、第5跖骨区、中足区、足跟内侧区、足跟外侧区),获取偏瘫患者步态时-空参数及生物力学相关参数进行分析.结果与结论:①步态时-空参数:健侧足支撑时间大于患足(P＜0.01),患侧足摆动时间、步长均大于健足(P＜0.05);Pearson或Spearman秩相关分析表明,健侧足与患侧足的支撑时间、步态周期、步长、步宽、步幅具有显著正相关关系(P＜0.01);②生物力学相关参数:与患侧足相比,健侧足在第1趾区、第2-5趾区、第1跖骨区的最大压力、最大压强、足冲量增大(P＜0.05),足跟外侧区的最大压力增大(P＜0.05),足跟内侧区、足跟外侧区的足冲量增加(P＜0.01),第2-5趾区、中足区的足底接触面积增加(P＜0.05);Pearson或Spearman秩相关分析表明,健侧足与患侧足在足底十分区的最大压力、最大压强和足冲量值均具有显著正相关关系(P＜0.01),在第2-5趾区、第1跖骨区、第2跖骨区、第3跖骨区、第4跖骨区、中足区、足跟内侧区、足跟外侧区的足底接触面积具有显著正相关关系(P≤0.01);③脑梗死偏瘫患者步态特征主要体现在:从时间参数上看,健足承担主要代偿作用;从空间参数方面上看,为维持步行的稳定性,与患侧足对比,健侧足表现更为保守;生物力学方面:为弥补患侧足向前推力的不足,健侧足前足区受力增加,这种不对称受力的代偿模式可能不利于步行能力的恢复.

多发性硬化病位在脑髓、督脉,主要病机为脾肾亏虚、湿浊/湿热蕴结.香药多性温,味辛、苦,具有健脾、温肾、化湿、通络、开窍等功效,现代研究证实其具有调节机体免疫功能的作用.根据香药的药性、功效,结合多发性硬化急性期和缓解期的虚实病机,分别从健脾温肾、芳香化湿、芳香通络、芳香开窍等方面探讨香药防治多发性硬化之理法.并附验案1则.

Vertebrobasilar dolichoectasia (VBD), a rare posterior circulation vascular variant disease, is an important risk factor for many acute cerebrovascular diseases. An insufficient understanding of VBD often leads to misdiagnose. Two cases of VBD that were initially diagnosed as posterior circulation watershed infarction are reported here. Absence of common causes of stroke including hypoperfusion, blood system diseases, carotid and aortic dissection, and eosinophil elevation, the symptoms of the 2 patients met the diagnostic criteria of VBD. Both patients displayed symptoms that were in line with the Traditional Chinese Medicine (TCM) syndrome pattern of "deficiency and blood stasis". Accordingly, they were comprehensively treated with Supplementingand activating blood circulation method. The clinical manifestations of the 2 patients were remarkably improved and no recurrence of watershed infarction was found in a 1-year follow-up. A detailed medical history and laboratory examination are capable of improving diagnostic accuracy of VBD. TCM treatment based on syndrome identification might be a promising candidate for VBD management.

目的 了解脑卒中后语言和非语言认知功能相关研究的趋势.方法 检索建库至2022年8月Web of Science核心合集脑卒中后语言与非语言认知主题相关的文献,对年度、作者、期刊、机构/国家发文量分布情况进行文献计量分析.采用VOSviewer软件对作者合作关系、作者共被引、期刊共被引、国家/机构合作关系及动态演变和关键词热点、趋势进行可视化分析.结果 共纳入1630篇.2004年检索到第1篇,之后发文量总体呈逐年增加的趋势,2019年之后有所下降.高产、高被引、高中心度的作者为Matthew A.Lambon Ralph和Elizabeth Jefferies.高产、高被引的期刊是Neuropsychologia.高产、高中心度的国家/机构分别为英国曼彻斯特大学、美国约翰斯霍普金斯大学,中国跻身高产前5名,但中心度不足.关键词动态演变显示研究最开始从基于神经影像的损伤机制研究,到关注记忆障碍、注意力、抑郁等功能障碍在语言损伤和康复中的作用,随后广泛开展如非侵入性脑刺激、电子远程康复设备等疗效及机制探索,机制的研究从关注额、颞叶转为关注脑网络.结论 近年来脑卒中后语言与非语言认知相关研究取得了一定成果,尤其是基于神经影像的共性损伤机制研究,以及协同治疗的干预疗效研究等.未来不同区域之间、不同作者团队之间的学术合作有待加强,亟待开展从非语言认知角度完善认知心理模型,探索新的治疗技术,以提高脑卒中后失语临床疗效.

ImportancePrimary insomnia (PI) has a high global incidence, and effective treatments with fewer side effects are needed. Acupuncture, a treatment used in traditional Chinese medicine, has become increasingly established as a treatment method for PI and is recognized by many physicians and patients. Some evidence has suggested that acupuncture was associated with improvements in objective sleep parameters and might induce changes in some brain regions. Individual studies with limited sample size and low detection thresholds may lead to false positives, and no systematic review of the effects of acupuncture has been conducted in PI.ObjectiveThe aim of this systematic review and coordinate-based meta-analysis was to summarize the literature on fMRI evaluation of patients with PI treated with acupuncture.DesignWe performed a methodical and comprehensive search of multiple publication databases (from inception to December 2022): Web of Science, PubMed, ScienceDirect, Embase, Wan Fang, China National Knowledge Infrastructure, and Chinese Scientific Journal Database. Bias and quality of studies were evaluated by three researchers. Furthermore, a seed-based D-mapping meta-analysis with permutation of subject images (SDM-PSI) was applied to investigate the central mechanisms behind acupuncture treatment at PI. The International Prospective Registry of Systematic Reviews received the protocol for this study. (PROSPERO: CRD42023400086).ResultsThe analysis included 305 patients with PI and 116 healthy controls from 11 studies. SDM-PSI analysis showed that patients with PI exhibited increased amplitudes of regional homogeneity and low-frequency fluctuations in the left superior frontal gyrus (1352 voxels, p = 0.0028), right angular gyrus (14 voxels, p = 0.0457), and cerebellum (12 voxels, p = 0.0446). Acupuncture improved the function of right superior frontal gyrus (1, 404 voxels, p = 0.0123), left inferior frontal gyrus (1068 voxels, p = 0.0088), left inferior temporal gyrus (903 voxels, p = 0.0074), left supramarginal gyrus (888 voxels, p = 0.0113), left precuneus (457 voxels, p = 0.0247), right precuneus (302 voxels, p = 0.0191), left supplementary motor area (82 voxels, p = 0.0354), and right parahippocampal gyrus (28 voxels, p = 0.0379). The brain regions affected by non-acupoint acupuncture were all located in the frontal lobe. The Cochrane risk-of bias tool and MINORS5 were used for quality assessment and the included articles had high performance bias and attrition bias.ConclusionThis coordinate-based meta-analysis found that acupuncture in patients with PI had significant effects on the default mode network, particularly on the frontal lobe and precuneus, and that non-acupoint acupuncture may provide some benefit to frontal brain region function.Systematic review registrationPROSPERO: CRD42023400086.

Ethnopharmacological relevance: Tibetan Patent Medicines (TPMs) have unique advantages in the treatment of ischemic stroke (IS) with the features of multi-component, multi-channel, and multi-target. In China, five TPMs mainly consisting of precious medicinal materials such as gold, pearls, and agate are widely utilized to treat IS and have achieved good results according to the current clinical practice. Aim of the study: To systematically evaluate the efficacy and safety of the five TPMs orally in treating IS and provide a reference for future clinical application and research. Materials and methods: We searched the following 24 databases up to December 11, 2022: China National Knowledge Infrastructure (CNKI), Wanfang database, China Science and Technology Journal Database, Chinese Biomedical Database (CBM), PubMed, Embase, Web of Science, MEDLINE, Scopus, the Cochrane Library, ScienceDirect, etc. Comprehensive searches for randomized controlled trials (RCTs) of the five TPMs for IS were conducted. Outcome measures included clinical effective rate, neurological impairment score, activities of daily living (ADL), hematologic indices, and adverse events (AEs). The meta-regression, subgroup analyses, and sensitivity analyses were conducted to explore the sources of heterogeneity. We assessed the evidence grade of outcomes via the GRADE system. TSA software was used for trial sequential analyses of the clinical effective rate, neurological impairment score, and ADL. Results: 17 RCTs (1603 patients) met our criteria. Compared with the control groups, the five TPMs showed greater improvement in clinical effective rate (RR = 1.23, 95% CI 1.17 to 1.29, P < 0.00001), neurological impairment score (SMD = -1.71, 95% CI -2.31 to -1.10, P < 0.00001), ADL (SMD = 1.97, 95% CI 1.26 to 2.68, P < 0.00001), hematocrit (MD = -1.56, 95% CI -2.83 to -0.29, P = 0.02), and hypersensitive-c-reactive-protein (MD = -2.96, 95% CI -3.30 to -2.61, P < 0.00001). AEs were reported in four RCTs and there was no statistical difference between groups (RD = -0.00, 95% CI -0.04 to 0.03, P = 0.82). The quality of evidence of the outcomes was rated as low to very low according to the GRADE system. The results of TSA provided firm evidence for the significant effect of the five TPMs on clinical effective rate, neurological impairment score, and ADL. Conclusions: This review showed that the five TPMs were beneficial in improving clinical effective rate, neurological impairment scores, and ADL. However, no definite conclusions for hematologic indices and AEs were drawn due to insufficient studies. Further high-quality clinical trials are required to confirm these findings.