Ethnopharmacology Relevance Yokukansan (YKS), a traditional Japanese formula, relieves agitation, anxiety, and sleep disturbance and has demonstrated potential in alleviating behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). However, the evidence regarding its efficacy and safety remains limited. Aim of the Study The paper assessed the effect of YKS on managing BPSD and cognition in AD compared to placebo. Materials and Methods This was a single-center, randomized, double-blinded, placebo-controlled trial performed between July 2023 and May 2024. A total of 100 subjects with AD and BPSD were registered. The YKS group received 2.5g of YKS thrice daily for 4 weeks; the placebo group received identical granules. Evaluations were conducted at baseline and at weeks 2, 4, and 8. The primary outcome was the change in Neuropsychiatric Inventory (NPI) scores from baseline to week 4. Secondary outcomes included the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Alzheimer’s Disease Cooperative Study-Activities of Daily Living (ADCS-ADL), Hamilton Depression Rating Scale (HAMD-17), and Liver Qi Stagnation and Spleen Qi Deficiency (LQSSQD). Results Of the 100 participants, 89 completed the trial. The mean reduction in NPI scores was more significant in the YKS group than in the Placebo group at week 4 (P < 0.05). YKS showed trends of improvement in ADCS-ADL and MMSE scores, but no significant cognitive or mood changes were observed at week 4. Conclusion It was more effective than a placebo in reducing BPSD in AD patients, suggesting potential as an adjunct therapy. Larger studies are needed to confirm these results. Chinese Clinical Trial Registry ChiCTR2300069404

Neuropsychiatric symptoms (NPS) may signal dementia risk or early pathology, yet clinical evidence regarding the association between pre-diagnostic NPS and outcomes remains limited. This preliminary study explored NPS features and their potential associations with dementia progression. The study was conducted on 201 dementia patients from Shanghai Mental Health Center (ICD-10 diagnosed). NPS history was extracted from medical records. Statistical analyses included chi-square tests (demographics/subtypes), ANOVA (preclinical intervals), and logistic regression (AD vs. non-AD factors). 69.2

Rhabdomyolysis is a syndrome characterized by necrosis and the disruption of striated muscle fibers. It is secondary to etiologies, such as trauma, ischemia, or toxin exposure. Rhabdomyolysis releases intracellular muscle constituents into systemic circulation, frequently leading to acute kidney injury. Clinical manifestations, including muscle weakness, myalgia, and dark urine, in young adults with nontraumatic etiologies are frequently underrecognized. Early diagnosis and prompt intervention are critical for mitigating complications. We report a case of a 27-year-old male who was admitted to Shanghai Municipal Hospital of Traditional Chinese Medicine in September 2024, presenting with exertional rhabdomyolysis complicated by acute kidney injury. Serum myoglobin (>12,000 ng/mL) and creatine kinase (210,000 U/L) were strikingly elevated. Therapeutic intervention consisted of vigorous fluid resuscitation, urinary alkalinization, electrolyte correction, and combined intermittent renal replacement therapy and hemoperfusion. The patient recovered uneventfully and was discharged in stable condition. It highlights the vulnerability of young individuals to rhabdomyolysis and underscores the seriousness of the condition. The adjunctive use of intermittent renal replacement therapy combined with hemoperfusion was observed to reduce circulating creatinine and myoglobin levels, which may serve as a reference for future therapeutic decision-making.

Background Alzheimer's disease (AD) is an irreversible age-related neurodegenerative condition characterized by the deposition of amyloid-β (Aβ) peptides and neurofibrillary tangles. Di Huang Yi Zhi (DHYZ) formula, a traditional Chinese herbal compound comprising several prescriptions, demonstrates properties that improve cognitive abilities in clinical. Nonetheless, its molecular mechanisms on treating AD through improving neuron cells mitochondria function have not been deeply investigated. Objective This study administered DHYZ to APP/PS1 mice to explore its potential therapeutic mechanisms in AD treatment. Methods APP/PS1 transgenic mice were given DHYZ (L, M, H), donepezil, or distilled water for a consecutive 12-week period. The Morris water maze test was used to assess memory capacity, transmission electron microscopy was used to observe mitochondrial and synaptic structures, immunohistochemistry and western blot detected proteins involved in the mitochondrial autophagy pathway, ELISA measured serum Aβ content, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assessed neuronal cell apoptosis. Results DHYZ demonstrates a notable therapeutic impact on mice with AD, effectively improving cognitive and memory impairments. DHYZ decreases Aβ accumulation in the hippocampus by reducing BACE1 activity and enhancing Aβ clearance through the blood-brain barrier. Additionally, DHYZ significantly suppresses neuronal apoptosis, enhances synaptic structure, and increases synapse numbers, processes strongly linked to the activation of mitochondrial PINK1-Parkin autophagy. Conclusions DHYZ enhances cognitive function in APP/PS1 mice by stimulating neuronal mitochondrial autophagy through the PINK1-Parkin pathway.

Background:Amnestic mild cognitive impairment (aMCI), a prodromal stage of Alzheimer's disease (AD), carries a high risk of progression to dementia. However, few clinical trials have focused on interventions to delay this progression. Hekun Decoction, an herbal-based oral medicine, has shown potential in improving memory loss during early menopause. Here we performed a randomized controlled trial to evaluate the efficacy and safety of Hekun Decoction in women with aMCI. Methods:This prospective, randomized, three-arm, double-blind clinical trial enrolled women aged 40-60 years with aMCI during early menopause. Participants were randomized to Hekun Decoction, Femoston, or placebo for 24 weeks. The primary outcome was the change in the Montreal Cognitive Assessment (MoCA) score at 0 and 24 weeks. The secondary outcomes included the Menopause Rating Scale (MRS), Modified Kupperman Index (KI), and Insomnia Severity Index (ISI), along with adverse events. Results:Between October 2021 and February 2024, a total of 292 patients were randomized to Hekun Decoction (n = 98), Femoston (n = 98), and placebo (n = 96). After 24 weeks, both Hekun Decoction (MD = 3.18, 95% CI [2.44-3.92]) and Femoston (MD = 3.67, 95% CI [2.93-4.42]) were more effective than placebo in improving MoCA scores. Meanwhile, better outcomes were observed in the Hekun Decoction group and Femoston group compared with the placebo group for MRS (MD = -5.87, 95% CI [-7.02, -4.71], and MD = -6.01, 95% CI [-7.02, -5.01]), KI (MD = -6.74, 95% CI [-8.16, -5.33], and MD = -6.93, 95% CI [-8.27, -5.59]), and ISI (MD = -6.53, 95% CI [-7.66, -5.39], and MD = -6.51, 95% CI [-7.58, -5.43]). As for the adverse events, no cases of abdominal distension, pain, breast pain, or abnormal uterine bleeding were observed in the Hekun Decoction group. Conclusion:In women with aMCI during early menopause, Hekun Decoction demonstrated non-inferior efficacy to Femoston in improving cognitive function over 24 weeks, with a favorable safety profile. Notably, women in the Hekun Decoction group showed fewer adverse events compared with Femoston. However, further trials with longer follow-up periods are needed to confirm the efficacy of Hekun Decoction in women with aMCI. Clinical trial registration:http://chictr.org.cn, ChiCTR2000036772.

Background: The development of Alzheimer's disease (AD) can be divided into subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia. Early recognition of pre-AD stages may slow the progression of dementia. Objective: This study aimed to explore functional connectivity (FC) changes of the brain prefrontal cortex (PFC) in AD continuum using functional near-infrared spectroscopy (fNIRS), and to analyze its correlation with cognitive function. Methods: All participants underwent 48-channel fNIRS at resting-state. Based on Brodmann partitioning, the PFC was divided into eight subregions. The NIRSIT Analysis Tool (v3.7.5) was used to analyze mean Delta HbO2 and FC. Spearman correlation analysis was used to examine associations between FC and cognitive function. Results: Compared with HC group, the mean Delta HbO2 and FC were different between multiple subregions in the AD continuum. Both mean Delta HbO2 in the left dorsolateral PFC and average FC decreased sequentially from SCD to MCI to AD groups. Additionally, seven pairs of subregions differed in FC among the three groups: the differences between the MCI and SCD groups were in heterotopic connectivity; the differences between the AD and SCD groups were in left intrahemispheric and homotopic connectivity; whereas the MCI and AD groups differed only in homotopic connectivity. Spearman correlation results showed that FCs were positively correlated with cognitive function. Conclusions: These results suggest that the left dorsolateral PFC may be the key cortical impairment in AD. Furthermore, there are different resting-state prefrontal network patterns in AD continuum, and the degree of cognitive impairment is positively correlated with reduced FC strength.

睡眠、饮食和运动是国际公认健康生活的三大要素.吃得过多会感到胃撑,吃得过少会有饥饿感;运动过少会脂肪堆积,运动过量会肌肉拉伤;关于睡眠的问题更是层出不穷,不同年龄、不同境况的人面临着不同程度的睡眠障碍,从而引发一系列的连锁反应.

近日,我在门诊遇到一位15岁的小女孩来看记忆减退.年仅15岁的她感觉自己最近记忆力下降,对于很多事情都记不太清,会忘记自己的东西放在何处,不记得昨天吃了什么,她诉说着自己的担忧与害怕,加之前段时间宣武医院发表《19岁男孩确诊为最年轻的阿尔兹海默病患者》的相关报道,引起了她的担心及恐慌.无独有偶,不少年轻人纷纷表示自己也存在忘事、记忆力下降的情况.

西医治疗非痴呆型血管性认知障碍(VCIND)的有效药物主要有以下三类:以尼莫地平、丁苯酞为代表的脑循环改善剂,以奥拉西坦、甲磺酸二氢麦角碱为代表的脑代谢改善剂,以多奈哌齐为代表的胆碱酯酶抑制剂.中医认为VCIND可归属于呆证、健忘范畴,疾病的发生与痰、瘀、毒、虚相关,以活血、化痰、解毒、补肾填髓为基本治则.针灸、针药联合、中西药联合治疗临床应用广泛,其他疗法如认知康复训练、重复经颅电刺激、中文朗读等也逐渐在临床中推广应用.参考文献44篇.

视神经脊髓炎(neuromyelitis optica,NMO)是一组免疫介导的主要累及视神经和脊髓的原发性中枢神经系统炎性脱髓鞘病变,可在血清中检测到特异性免疫标志物水通道蛋白-4(AQP-4)抗体,MRI检查可见特征性脊髓长节段炎性脱髓鞘病灶.临床上有一组尚不能满足NMO诊断标准的局限形式的脱髓鞘疾病,可伴或不伴有AQP-4抗体阳性,后将NMO及上述疾病统一命名为视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorder,NMOSD)[1].根据文献报道,在NMOSD中,痛性痉挛的发生率在14％～43％[2-5].痛性痉挛能够极大影响患者的生活质量,目前治疗手段主要为药物对症治疗,例如卡马西平、加巴喷汀、普瑞巴林、巴氯芬等[1].2018年8月3日上海中医药大学附属龙华医院脑病科收治1例以乏力、痛性痉挛为主要表现,且对药物治疗反应不佳的NMOSD患者,经王庆其教授中药治疗取得了满意疗效,现报道如下.

BACKGROUND:Epilepsy is a chronic encephalopathy caused by abnormal discharge of neurons in the brain, resulting in brain dysfunction. Cognitive impairment is one of the most common complications of epilepsy. The current treatment of epilepsy in the control of symptoms at the same time cause a lot of side effects, especially the aggravation of cognitive impairment. Many literatures have stated that the efficacy and safety of integrated traditional Chinese and western medicine in the treatment of epilepsy with cognitive impairment is superior to that of western medicine alone. In this systematic review, we intend to evaluate the clinical efficacy and safety of removing stasis and resolving phlegm in the treatment of epilepsy with cognitive impairment.METHODS:We will search The Cochrane Library, EMbase, Pubmed, Web of Science, Chinese Journal Full-Text Database (CNKI), Wanfang Database, and VIP database. Simultaneously we will retrieval relevant meeting minutes, eligible research reference lists, symposium abstracts, and gray literatures. We will not apply any restrictions to the language and publication date. All randomized controlled trials about the efficacy and safety of removing blood stasis and phlegm in the treatment of epilepsy with cognitive impairment will be included. Two authors will independently carry out. Any objections will be worked out by a third author through consultation. We will use the Revman 5.3 and Stata 13.0 software for data synthesis, sensitivity analysis, meta regression, subgroup analysis, and risk of bias assessment. The grading of recommendations assessment, development, and evaluation standard will be used to evaluate the quality of evidence.RESULTS:This systematic review will synthesize the data from the present eligible high quality randomized controlled trials to assess whether the treatment of removing blood stasis and phlegm is effective and safety for epilepsy with cognitive impairment from various evaluation aspects including clinical efficacy of epilepsy, EEG improvement rate, MOCA score, QOLIE-31 cognitive function score, traditional Chinese medicine symptom score, incidence of adverse reactions, frequency of seizures of epilepsy, and duration of seizure of epilepsy.CONCLUSION:The systematic review will provide evidence to assess the efficacy and safety of removing blood stasis and phlegm in the treatment of patients with epilepsy with cognitive impairment.PROSPERO REGISTRATION NUMBER:CRD42021224893.

目的:观察3D教学模式在中医脑病科临床教学管理中的效果.方法:将60名规培基地医生随机分为试验组及对照组,每组各30名,试验组采用3D教学法,对照组采用传统教学法.实习结束后,分别通过理论考试、模拟病例、辩论的方法,从临床思辨、知识掌握、发散性思维方面对教学成效进行评估,同时发放满意度问卷,了解学生对此新型教学模式的接受程度.结果:在教学满意度调查中,试验组较对照组在带教内容、带教方法、带教效果及总体评价的满意度均较高,差异具有统计学意义(P<0.01).在教学成效评价中,试验组较对照组在知识掌握、临床思辨、发散性思维方面也有更优的表现(P<0.01).结论:在脑病科临床带教过程中,3D教学模式能够提高教学质量,提高学生积极性,加强师生间的沟通和交流.

血管性痴呆的临床表现多样,病因复杂,临床治疗难度较大.中医药是治疗血管性痴呆的重要手段之一,近年来越来越多的研究表明,淫羊藿及其提取物可用于血管性痴呆的治疗.淫羊藿苷能促进脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、血管内皮生长因子(vascular endothelial growth factor,VEGF)的分泌,降低转化生长因子-β1(transforming growth factor-β1,TGF-β1)的合成,从而促进损伤神经元的修复和新血管的形成,对保护神经功能发挥积极作用.淫羊藿可通过促进乙酰胆碱、单胺类神经递质的分泌,以发挥改善学习、记忆、认知功能的作用.淫羊藿提取物具有良好的抗氧化作用,有助于降低神经组织的自由基损伤,还能调节炎症因子的分泌,抑制神经炎性反应,对神经功能发挥保护作用.淫羊藿苷可调节 β-淀粉样蛋白(β-amyloid protein,Aβ)通路的多个环节,降低Aβ沉积引起的脑损伤.此外,淫羊藿苷可通过调节核因子红系2相关因子1(nuclear factor erythroid-2 related factor 1,NFE2L1)途径诱导的滑膜蛋白表达,抑制内质网应激诱导的神经细胞凋亡.淫羊藿苷还可以通过增强细胞周期蛋白DI(cyclin DI)和神经生长因子的表达,抑制抑癌基因(PTEN)的分泌,以促进脑缺血后神经组织的修复和再生.

目的 观察地黄益智方对卒中后认知障碍非痴呆(PSCIND)肾精亏虚证患者的临床疗效.方法 选取2019年7月—2021年1月就诊于上海中医药大学附属龙华医院记忆障碍专病门诊、神经内科普通门诊以及住院的PSCIND肾精亏虚证患者,共116例,按照随机数字表法分为试验组和对照组,各58例.其中试验组服用地黄益智方,对照组服用吡拉西坦片,共治疗6个月.观察2组患者治疗前、治疗3个月后、治疗6个月后简易精神状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分、照顾者负担量表(ZBI)评分和日常生活能力评定量表(ADL)评分以及中医证候积分量表评分的变化情况.结果 治疗期间试验组脱落5例、对照组脱落4例,最终试验组53例、对照组54例完成本研究.与治疗前比较,治疗6个月后2组患者均有MMSE、MoCA评分的升高(P<0.05),评分升高与时间有关(P<0.01).治疗3个月后试验组患者ZBI评分即有降低(P<0.01),治疗6个月后仍仅有试验组患者的ZBI评分下降(P<0.01),ZBI评分的下降与时间及分组和时间交互作用有关(P<0.01).在MoCA亚项统计中,治疗6个月后,命名(P<0.05)、注意力与计算力(P<0.01)、语言和抽象(P<0.01)方面评分的升高与时间有关,延迟回忆评分的升高与分组和时间的交互作用相关(P<0.01).与治疗前比较,治疗6个月后试验组患者ADL评分下降(P<0.01),ADL评分的下降与时间(P<0.01)及分组和时间交互作用(P<0.05)相关.与治疗前比较,治疗3个月后试验组患者的中医证候积分即有降低(P<0.01),治疗6个月后2组患者的中医证候积分均有降低(P<0.01),中医证候积分的下降与时间及分组和时间交互作用相关(P<0.01).2组患者治疗前后各项安全性指标均正常.结论 "补肾填精"理论指导下的地黄益智方可以改善PSCIND患者认知功能,提高患者生活质量,减轻照料者负担,较对照组有一定的优势.

炎热是夏季的一大特征,冷亦如此.夏季自然界气温高,人们有各种各样降温的方式,如吹风扇、空调,洗冷水澡,吃冷饮等,但由此极易引发健康问题.临床上,夏季有些患者来看头痛,询问病史,并未有明显的诱因,追问之下,发现有食冷饮(包括冰淇淋、冰镇汽水、冰镇啤酒)等的习惯,患者并未在意;而且觉得即使生冷刺激,也应该刺激到肠胃,与头痛关系不大.事实却并非如此.

问:归脾丸的组成、功效是什么? 答:归脾丸由人参、白术、黄芪、茯神、生姜、远志、酸枣仁、龙眼肉、当归、木香、大枣、甘草组成.其功效为益气健脾,养血安神.中药方剂配伍有君臣佐使,指中药处方中的各味药的不同作用.归脾丸中君药是黄芪和龙眼肉,起到补脾益气养血的作用.臣药有人参、白术,甘温补气,与黄芪相配,加强补脾益气之功;当归滋养营血,与龙眼肉配伍加强补心养血功效.佐药有茯神、枣仁、远志,有宁心安神的作用;木香理气醒脾.生姜、大枣调和脾胃.炙甘草调和诸药.

目的 探讨癫痫患者功能性肠病(FBD)与焦虑、抑郁状态的关系及中医证型分布规律.方法 将306例癫痫患者根据FBD的患病情况分为伴FBD组(172例)、不伴FBD组(134例),收集病例资料,分析比较两组一般情况(性别、年龄、病程、脑电图、认知功能)、焦虑状态自评量表(SAS)评分、抑郁状态自评量表(SDS)评分及中医证候分布情况,采用logistic回归分析癫痫FBD的影响因素.结果 ①伴FBD组年龄大于不伴FBD组,病程长于不伴FBD组,脑电图异常率高于不伴FBD组(P＜0.001,P＜0.05).②伴FBD组SAS、SDS评分高于不伴FBD组(P＜0.001),SAS、SDS评分异常率高于不伴FBD组(P＜0.001).③logistic回归分析结果显示,癫痫患者的病程、年龄、SAS评分为癫痫伴发FBD的影响因素(P＜0.05),其中SAS评分异常的癫痫患者伴发FBD的可能性是SAS评分正常者的6.104倍[OR=6.104,95％CI(3.416～ 10.906),P＜0.001].④伴FBD组患者心脾两虚证最多见(27.91％),不伴FBD组患者瘀阻脑络证最多见(41.79％);痰、虚、瘀三大中医证型分布显示,伴FBD组患者虚证最多见(44.19％),不伴FBD组患者痰证最多见(52.24％).结论 与不伴FBD比较,伴FBD的癫痫患者焦虑、抑郁情绪更加严重,癫痫病程、患者年龄、焦虑状态均为癫痫患者发生FBD的影响因素;癫痫伴FBD患者以虚证多见,其中占比最高的为心脾两虚证.

阿尔茨海默病(AD)是与年龄有关的神经退行性疾病,起病隐匿,呈进行性智能衰退,多伴有人格改变,且病程缠绵,严重影响患者的生活质量.氧化应激是细胞或机体由于活性氧类(ROS)导致的氧化损伤,与AD的发生密切相关.ROS包括氧离子、过氧化物和含氧自由基等,ROS可导致线粒体功能受损、胱天蛋白酶3活化,调控ROS/细胞凋亡信号调节激酶1/c-Jun氨基端激酶/p38信号转导,激发细胞凋亡;ROS还可抑制抗氧化酶的活性,导致脂质、蛋白质和DNA氧化,促使突触损伤及神经元丢失,参与AD发病.因此,抗氧化应激损伤可成为防治AD的重要途径.

目的 探讨乙型肝炎病毒(hepatitis B virus,HBV)基因型与S蛋白变异的关联,为分析病毒基因型在疾病预后转归中的作用提供理论基础.方法 选择上海中医药大学附属曙光医院东院2019年1月至2019年10月门诊或住院的HBeAg阴性慢性乙型肝炎患者99例,其中,B基因型50例,C基因型49例.基因测序法用于S蛋白基因序列分析,分类变量间差异分析采用χ2检验与连续校准.非正态分布数据采用非参数秩和检验.结果 HBeAg阴性慢性乙型肝炎组C基因型的S蛋白变异率高于B基因型为87.76％(43/49)比66.00％(33/50),(χ2=6.567,P=0.010),且变异差异位点似乎为随机分布,主要亲水区(major hydrophilic region,MHR)与MHR外的变异率,C基因型均高于B基因型为38.78％(19/49)比18.00％(9/50),(χ2=5.266,P=0.022);85.71％(42/49)比56.00％(28/50),(χ2=10.550,P=0.001).两基因型MHR的"a"决定簇[32.65％(16/49)比12.00％(6/50),(χ2=6.107,P=0.013)]以及MHR外的细胞毒T淋巴细胞+辅助性T淋巴细胞(CTL+Th)免疫表位[69.39％(34/49)比40.00％(20/50),(χ2=8.620,P=0.003)]与非免疫表位[53.06％(24/49)比30.00％(15/50),(χ2=5.424,P=0.020)]差异均有统计学意义.结论 HBeAg阴性慢性乙型肝炎患者C基因型较B基因型更容易产生HBV S蛋白变异.

痴呆是我们既熟悉又陌生的疾病,我们熟悉其症状,以至于经常有人因为忘了做某事或者丢三落四而被调侃为"痴呆",但是我们是否真的很了解痴呆?对于专业人士而言,其发生机制和病因仍在探索中;对于老百姓而言,如何鉴别以及早期诊治是关键. 随着社会老龄化以及人们对健康关注程度的加深,如今大众对于痴呆也越来越重视.经常有老年人甚至是中年人因为近来记忆减退或者是头颅CT/磁共振(MRI)提示脑萎缩而担心会不会痴呆,于是乎,经常在门诊发现初诊患者已经自行服用相关药物.殊不知,早期诊治的顺序是先诊后治,也就是先诊断,再治疗.本末倒置并不意味着防治到位,更可能导致"不是痴呆当痴呆治疗"而妨碍诊断,延误病情.