Conventional dietary indices often fail to align with aging biology. To bridge this mechanistic gap, we propose the Nutrient-Signaling-Senescence (NSS) axis as an integrative framework. Based on this foundation, we develop the anti-aging dietary score (AADS). Preliminary validation using NHANES data demonstrates that a higher AADS is significantly associated with lower PhenoAge acceleration, performing comparably to established indices. This framework enables translating aging biology into population-based research.

This letter comments on the recent study by Javaid et al. regarding mortality trends at the nexus of pneumonia and Alzheimer's disease (AD). While acknowledging the study's important contributions to identifying public health disparities, we propose three key analytical refinements to build upon their findings. First, we advocate for stratifying the analysis by the underlying cause of death (UCD) to better distinguish the causal pathways between neurodegeneration and terminal infection. Second, we highlight the necessity of extending the analysis beyond 2020 to assess the full, long-term impact of the COVID-19 pandemic and vaccination on this vulnerable population. Third, we suggest employing a granular, intersectional analysis focusing on long-term care facilities (LTCFs) to identify specific "hotspots" of vulnerability by examining the interplay of race, geography, and place of death. These proposed directions are crucial for developing more precise, evidence-based public health strategies to protect older adults at the complex intersection of dementia and severe infection.

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: 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.

Background: Selenium (Se) has been reported to have an antagonistic effect on heavy metals in animals. Nevertheless, there is a lack of epidemiological research examining whether Se can mitigate the adverse effects of cadmium (Cd) and lead (Pb) on hand grip strength (HGS) in middle-aged and elderly individuals.Methods: This study used data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES). HGS measurements were conducted by trained examiners with a dynamometer. Concentrations of Se, Cd, and Pb in blood were determined via inductively coupled plasma mass spectrometry. We employed linear regression, restricted cubic splines, and quantile g-computation (qgcomp) to assess individual and combined associations between heavy metals and HGS. The study also explored the potential influence of Se on these associations.Results: In both individual metal and multi-metal models adjusted for confounders, general linear regression showed Se’s positive association with HGS, while Cd and Pb inversely related to it. At varying Se-Cd and Se-Pb concentrations, high Se relative to low Se can attenuate Cd and Pb’s HGS impact. An inverted U-shaped correlation exists between Se and both maximum and combined HGS, with Se’s benefit plateauing beyond approximately 200 μg/L. Stratified analysis by Se quartiles reveals Cd and Pb’s adverse HGS effects diminishing as Se levels increase. Qgcomp regression analysis detected Se alleviating HGS damage from combined Cd and Pb exposure. Subsequent subgroup analyses identified the sensitivity of women, the elderly, and those at risk of diabetes to HGS impairment caused by heavy metals, with moderate Se supplementation beneficial in mitigating this effect. In the population at risk for diabetes, the protective role of Se against heavy metal toxicity-induced HGS reduction is inhibited, suggesting that diabetic individuals should particularly avoid heavy metal-induced handgrip impairment.Conclusion: Blood Cd and Pb levels are negatively correlated with HGS. Se can mitigate this negative impact, but its effectiveness plateaus beyond 200 μg/L. Women, the elderly, and those at risk of diabetes are more vulnerable to HGS damage from heavy metals. While Se supplementation can help, its protective effect is limited in high diabetes risk groups.

目的 探讨基于智能手机的颅脑三维可视化技术在中医院校研究生神经系统疾病临床教学中的应用价值.方法 选择2020年6月—2021年6月在北京中医药大学东方医院脑病科进行临床学习的60名研究生,随机分为对照组和实验组,各30名.对照组研究生采用传统教学法进行培训,实验组在传统教学法基础上增加利用智能手机进行颅脑三维可视化的教学,2组教学课时相同.比较2组的入科及出科理论考核成绩、影像阅片能力考核成绩和教学评价满意度问卷调查结果.结果 2组的入科理论考核成绩差异无统计学意义(P＞0.05),实验组在出科理论考核成绩、影像阅片能力考核成绩、教学评价满意度问卷调查中,所有项目的得分均高于对照组,差异有统计学意义(P＜0.05).结论 在中医院校研究生神经系统疾病临床教学中,基于智能手机的颅脑三维可视化有助于提高学生学习的兴趣和积极性,培养学生空间想象力和系统思维能力,提高临床教学效果.

BackgroundHypertension has now developed into a major public health problem worldwide. Under the existing antihypertensive drug treatment paradigm, problems such as decreasing drug resistance and increasing drug side effects can occur for elderly patients. Acupuncture, a core technique in the non-pharmacological treatment of Chinese medicine, plays an important role in the treatment of elevated blood pressure.ObjectiveThis study aimed to systematically evaluate the effect of acupuncture alone or in combination with antihypertensive drugs on the efficiency of reducing blood pressure and controlling blood pressure in elderly patients with hypertension.MethodsArticles of randomized controlled trials of acupuncture for hypertension in the elderly published before November 2022 were searched in 7 databases. The methodological quality of the literature was evaluated using the Cochrane Risk of Bias Assessment Tool. The primary outcome was the efficiency rate of blood pressure reduction, and the secondary outcome was the change in blood pressure after treatment.ResultsThis study conducted a systematic review and meta-analysis of 12 randomized controlled trials with a total of 1,466 subjects. Among the primary outcome—efficiency rate, acupuncture-only treatment (RR = 1.11, 95% CI: 1.03–1.20, P < 0.01) and acupuncture combined with antihypertensive drug treatment (RR = 1.18, 95% CI: 1.06–1.31, P < 0.01) were significantly different compared with drugs-only treatment. Among the secondary outcomes, SBP (MD: −4.85, 95% CI: −10.39 to −0.69, P = 0.09) and DBP (MD: −1.45, 95% CI: −5.35 to 2.45, P = 0.47) show no significant difference between acupuncture-only treatment and drug-only treatment. Compared to drugs-only treatment, acupuncture plus drugs has more significant efficiency in lowering SBP (MD: −9.81, 95% CI: −13.56 to −6.06, P < 0.01) and DBP (MD: −7.04, 95% CI: −10.83 to −3.24, P < 0.01).ConclusionFor elderly patients with hypertension, acupuncture-only treatment has the same efficiency and antihypertensive effect compared to drug therapy and acupuncture plus drugs outperforms drugs-only treatment. If the patients receive therapy with less frequency per week and longer duration, there will be a more obvious antihypertensive effect. Due to the methodological defects in the included study and the limited sample size of this paper, more well-designed randomized controlled trials are needed for verification.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022376407, PROSPERO (CRD42022376407).

目的:观察手术结合活血化瘀法治疗慢性硬膜下血肿的临床疗效.方法:收集 2010年 1 月—2021 年 3 月在北京中医药大学东方医院脑病三科(神经外科)治疗的慢性硬膜下血肿病人 137 例,按照其治疗方式分为消瘀康胶囊手术组(38 例)、消瘀康胶囊保守组(18例)、非消瘀康胶囊手术组(40例)、非消瘀康胶囊保守组(41例).比较并分析 4组病人出入院时格拉斯哥昏迷量表(GCS)评分、Markwalder的慢性硬膜下血肿病人分级(MGS-GCS)评分、中医证候量表评分,并对 CT结果显示的血肿量进行评分.结果:消瘀康胶囊手术组 GCS评分较入院时升高,MGS-GCS评分较入院时降低,且与其他 3 组比较差异有统计学意义(P<0.05);血肿改善情况方面,消瘀康胶囊手术组血肿减少总有效率高于其他 3 组(P<0.05).消瘀康胶囊手术组出院时中医证候量表评分较其他 3组得分低,总有效率高(P<0.05).结论:具有活血化瘀作用的消瘀康胶囊可提高手术治疗慢性硬膜下血肿病人的临床疗效,并改善神经功能,提高生活能力.

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.

神经介入技术在治疗急性缺血性卒中方面的应用日渐广泛,这一技术同时也是对中医"治风先治血,血行风自灭"理论很好的诠释.通过分析中医对中风治法的认识发展情况,结合历代医家对"治风先治血,血行风自灭"理论的认识,对活血化瘀与血瘀的现代研究作相关总结,探讨该理论与介入技术的相关性,以进一步丰富中医治风理论的内涵.同时从中医理论出发,针对支架后血管内再狭窄等介入治疗的并发症,探讨中西医治疗新模式.

Background: Intractable epilepsy (IE) is still a major concern in neurology, and existing therapies do not adequately control symptoms. Chinese Herbal Medicine (CHM) has been widely used as an adjunct to antiepileptic drugs (AEDs) for IE. However, because of the contradictory findings reported in previous studies, it is uncertain if the present evidence is robust enough to warrant its usage. The purpose of this meta-analysis was to systematically evaluate the efficacy of the combination of CHM and AEDs for IE.Methods: From inception to September 2021, Medline, Ovid, Embase, Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database, and Wanfang Database were searched. Only randomized controlled trials (RCTs) that assessed the efficacy of the combination of CHM and AEDs for IE were included. We defined monthly seizure frequency as the primary outcome. The secondary outcomes included the abnormal rate of electroencephalogram (EEG), seizure duration, quality of life (QoL), and adverse events (AEs).Results: Twenty studies with 1,830 patients were enrolled. Most trials had poor methodological quality. The meta-analysis showed that the combination of CHM and AEDs was more efficient than AEDs alone in reducing monthly seizure frequency [MD = -1.26%, 95% CI (-1.62, -0.91); p < 0.00001], the abnormal rate of EEG [RR = 0.66%, 95% CI (0.53, 0.82); p = 0.0002], and improving the QoL [MD = 6.96%, 95% CI (3.44, 10.49); p = 0.0001]. There was no significant difference in seizure duration between groups. Moreover, the combination of CHM and AEDs significantly reduced the AEs [RR = 0.45%, 95% CI (0.32, 0.64); p < 0.00001].Conclusion: The combination of CHM and AEDs could improve seizure control by reducing monthly seizure frequency and abnormal rate of EEG with a decreased risk of adverse events in patients with IE. However, these findings must be interpreted carefully due to the high or uncertain risk of bias in the included trials. To provide stronger evidence for the use of CHM combined with AEDs in IE, high-quality RCTs will be urgently warranted in the future.

总结林谦教授运用气血理论整体局部辨证相结合治疗急性心肌梗死围手术期患者的经验.林谦教授认为气虚血瘀、郁而化热、瘀热互结是急性心肌梗死围手术期患者再发主要心血管不良事件、出现支架内再狭窄的主要病机.林谦教授传承廖家桢教授学术思想,着眼于整体与局部,提出"气血理论"整体辨证结合"创伤修复理论"局部论治,以整体益气活血、局部凉血生肌的治疗方法治疗急性心肌梗死围手术期患者,临床治疗中多有效验,可有效改善患者不适症状,减少主要心血管不良事件的发生,同时降低支架内再狭窄概率,提高急性心肌梗死围手术期患者生活质量.

Objective:To evaluate the effect of direct observation of procedural skills (DOPS) and outcome assessment supported by Questionnaire survey and WeChat in assessment of surgical internship by undergraduates of traditional Chinese medicine(TCM)program.Methods:Improved DOPS evaluation form was formulated. From June 2018 to December 2019, 180 students in the Department of Surgery of the Second Clinical Medical College, Beijing University of Chinese Medicine, were selected to conduct a DOPS assessment of surgical clinical skill in the early, middle and later stages. The results of each assessment were statistically analyzed and given real-time feedback by Questionnaire survey and WeChat. Students at early and later stages were asked to fill in the satisfaction questionnaire.Results:The scores of late DOPS assessment (5.44±0.13) were higher than those of early DOPS assessment (4.20±0.21) and middle DOPS assessment (4.44±0.13), ( P<0.01). For the satisfaction of DOPS assessment results, the scores from teachers were (7.33±1.51), (7.52±1.33), (8.52±0.53), and the students were (6.72±1.55), (7.22±1.40), (8.21±1.09) respectively in the early, middle and later stages. The score of later stage was higher than that of middle stage and that of middle stage was higher than that of early stage ( P<0.01). The results of the questionnaire survey among the students in early and later stage indicated that the contribution to improve teaching results was recognized with the highest score in the later stage [4.81±0.42], which was higher than that in the early stage [4.50±0.61] ( P<0.01). Conclusions:The application of the improved DOPS supported by a network Questionnaire and WeChat platform in the examination of surgical clinical skills has been recognized by teachers and students, which contributes to the improvement of surgical clinical operation skills of student.

目的:采用网络药理学的研究方法分析中药赤芍-牡丹皮配伍治疗脑出血(ICH)药效物质基础与探究其作用机制.方法:在TCMSP数据库收集中药赤芍、牡丹皮包含的活性成分,依据口服利用率和药物相似性等参数筛选;使用GeneCards、OMIM、DrugBank数据库收集ICH的作用靶点,获得药物与疾病的交集靶点后,运用Cytoscape软件绘制活性成分靶点疾病交互网络图.将获得交集靶点上传至在线STRING数据库进行分析,构建PPI网络图,获取关键靶点蛋白后进行GO功能富集分析和KEGG通路富集分析.结果:收集赤芍有效活性成分119个,牡丹皮55个,包括芍药苷(paeoniflorin)、黄芩素(baicalin)、β-谷甾醇(beta-sitosterol)等,相关药物靶点蛋白1190个,ICH疾病相关基因823个,赤芍-牡丹皮与ICH的72个共同靶点,主要作用于Akt1、IL-6、VEGFA、CASP3、EGF,涉及AGE-RAGE、TNF、IL-17、HIF1、PI3K-Akt等133条相关信号通路.结论:赤芍-牡丹皮配伍治疗ICH具有多途径、多靶点作用的特点,为今后进一步分子生物学验证提供了参考和依据.

目的 基于活血化瘀法治疗慢性硬膜下血肿,探讨消瘀康胶囊治疗慢性硬膜下血肿的临床疗效.方法 选取硬膜下血肿患者137例,随机分为观察组56例,对照组81例.对照组进行常规治疗,观察组在对照组的基础上加用消瘀康胶囊治疗(当归、苏木、木香、赤芍等).观察患者出入院时MGS-GCS评分、GCS评分、Barthel指数评分、ADL评分;记录服药前后CT结果显示的血肿量变化及拔除引流管时间;评价2组临床疗效.结果 至出院时,观察组GCS评分较治疗前升高、MGS-GCS评分较治疗前降低,且优于对照组(P＜0.05);观察组拔除引流管时间(3.49±1.30)d,优于对照组(4.38±1.51)d(P＜0.05);血肿改善情况比较,观察组良好率为44.64％,显著率为30.36％,明显优于对照组的12.50％和2.5.％,差异有统计学意义(P＜0.05);观察组总有效率为92.85％,优于对照组58.03％(P＜0.05).结论 基于活血化瘀法组方的消瘀康胶囊,可以改善慢性硬膜下血肿术后患者神经功能,促进血肿吸收,缩短引流管拔除时间,改善生活能力.

目的:基于网络药理学探讨通窍活血汤治疗颅脑损伤(TBI)的作用机制.方法:通过检索中药系统药理学数据库与分析平台(TCMSP)数据库筛选出通窍活血汤潜在活性成分及靶点,采用GeneCard与OMIM数据库获得颅脑损伤疾病靶点,得到通窍活血汤的中药与TBI的交集靶点,使用Cytoscape 3.7.2软件绘制活性成分靶点疾病交互网络图.采用String数据库构建靶点蛋白质-蛋白质相互作用(PPI)网络,并进行基因本体(GO)富集分析和京都基因和基因组百科全书(KEGG)信号通路富集分析.结果:筛选后收集得所有中药成分127个,收集疾病靶点1811个,疾病与药物交集靶点共62个.PPI网络提示核心靶点为ALB、IL6、CASP3、EGFR、VEGFA等;GO功能注释得到73条富集结果,包括DNA结合转录激活剂活性,RNA聚合酶Ⅱ特异性等,富集得到PI3K-AKT等75条核心的KEGG通路.结论:通窍活血汤治疗颅脑损伤具有多成分、多靶点、多通路的作用机制特点.

Xiaoyukang Jiaonang (XYK) is a Chinese patent medicine approved by the National Medical Product Administration which is used to treat intracranial hematoma in China. In this study, we observed the molecular mechanism of XYK in hypoxia-inducible factor 1α (HIF-1α), inflammation and angiogenesis of chronic subdural hematoma (CSDH). The CSDH model was made by using internal iliac vein blood of Wister rats, and rats were divided into sham group, CSDH group and XYK group. The rats in the XYK group were gavaged with Xiaoyukang Jiaonang (185 mg/kg) for 7 days, and rats in the CSDH group and sham group were gavaged with the same amount of physiological saline for 7 days. In the CSHD rat model, active inflammation and angiogenesis were observed around the hematoma. XYK promoted the ubiquitination and degradation of HIF-1α, and reduced the concentration of VEGF and the ratio of angiopoietin-1/angiopoietin-2. XYK reduced proinflammatory cytokines and increased anti-inflammatory cytokine. In tissue section, XYK reduced the size of the hematoma and membrane, and reduced vWF positive cells in membrane. Furthermore, the endothelial progenitor cells in blood decreased as well. Overall, XYK shows anti-inflammatory and antiangiogenesis effects which may relate to the degradation of HIF-1α.

重症肌无力(MG)是一种神经肌肉接头传递障碍的获得性自身免疫性疾病,通常隐袭起病.该病呈进展性或缓解与复发交替性发展,可因感染、劳累等因素诱发或导致病情加重.结合古文献MG相关症状的论述及现代研究,认为伏邪因素在MG发病过程中具有重要作用.因此在对MG的治疗方面,应在补虚的基础上,重视对伏邪的辨治.在急性发病期,应补虚与祛邪并重,随病情稳定,逐渐减少祛邪药物而增加补虚力度.补虚以补益脾肾为主,祛邪则根据毒、热、湿、痰、瘀的不同而给予不同的祛邪治法.