INTRODUCTION:Cognitive decline and dementia are key features of brain aging that substantially affect individuals' health and quality of life. Existing treatments for dementia mainly focus on individuals with mild-to-moderate cognitive impairment. Ginseng, known for its anti-aging properties, has shown potential benefits for cognitive function. This study aimed to systematically review clinical evidence from randomized controlled trials (RCTs) regarding the potential of ginseng to prevent or slow cognitive decline and to explore the most effective dosing strategies. METHODS:A comprehensive search was performed across 10 databases, including PubMed, Embase, Cochrane Library, Web of Science, Scopus, Ovid, CNKI, Wanfang Data, VIP database, and Chinese Biomedical Literature Database (CBM), covering studies from their inception to October 15, 2024. Two independent reviewers screened the studies for eligibility and assessed their quality. Data extraction and meta-analysis were conducted using Review Manager 5.4 and Stata 15.1, while Trial Sequential Analysis (TSA) was conducted using TSA 0.9.5.10 beta. The analysis focused on older adults diagnosed with mild cognitive impairment (MCI), Alzheimer's disease (AD), or other types of dementia. RESULTS:Nine studies involving 617 patients were included. The results revealed that (1) compared with the control group, the ginseng group exhibited higher scores on the Mini-Mental State Examination (MMSE) (MD = 0.38, 95%CI (0.03, 0.74), P = 0.03) and lower scores on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) (MD = -2.21, 95%CI (-3.97, -0.44), P = 0.014), indicating improved cognitive function. (2) Subgroup analysis of MMSE outcomes indicated that a ginseng dose of 4.5g/d provided cognitive benefits. (3) TSA results confirmed the reliability of these meta-analysis results. DISCUSSION:Ginseng may provide modest cognitive benefits for older adults with MCI, AD, or dementia. The observed effects are biologically plausible given ginseng's antioxidant and neuroprotective properties; however, the improvements did not reach the threshold for clinical significance. The limited number of included studies and moderate heterogeneity underscore the need for larger, high-quality RCTs to confirm these results and determine the most effective dosing strategies. CONCLUSIONS:Current evidence indicates that ginseng can improve cognitive function in older adults with MCI, AD or dementia. However, the extent of improvement is modest and not statistically significant, and its clinical relevance remains uncertain. Nevertheless, ginseng could still be considered as a potential therapy for age-related cognitive decline.

BACKGROUND:Cognitive impairment is a significant health concern among older adults, highlighting the need for non-pharmacological interventions, such as mind-body exercises. However, a comprehensive synthesis of the effects of various traditional Chinese exercises (TCEs) on cognitive function in older adults is lacking. METHODS:A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted. Six databases were searched from inception to 2 May 2024 for studies examining the effects of TCEs on cognitive outcomes in adults aged 60 years and older. Studies were included if they were RCTs involving TCEs and reported outcome measures for global cognition, or individual cognitive domains. RESULTS:Twenty-eight RCTs with a total of 2297 participants were included. Meta-analysis revealed that TCEs led to significant improvements in global cognition: Montreal Cognitive Assessment [mean differences (MD) = 1.67; 95% confidence interval (CI): (1.20, 2.14)], Mini-Mental State Examination [MD = 0.76; 95% CI: (0.04, 1.48)]; executive function: Trail Making Test (B-A) [MD = -7.96; 95% CI: (-15.34, -0.59)], Category Fluency for Animals [MD = 2.96, 95% CI (2.08, 3.85)]; working memory: Digit Span-Backwards [MD = 0.48; 95% CI: (0.07, 0.90)]; processing speed: Digit Symbol Coding [MD = 4.16; 95% CI: (1.82, 6.50)]; memory function: Memory Quotient [MD = 13.13; 95% CI: (4.06, 22.20)], Auditory Verbal Learning Test: immediate recall [MD = 1.13; 95% CI: (0.07, 2.20)], short-term delayed recognition [MD = 0.80; 95% CI: (0.28, 1.32)] and long-term delayed recognition [MD = 1.38; 95% CI: (0.68, 2.09)]. CONCLUSIONS:TCEs are effective in improving cognitive function in older adults, particularly in domains such as global cognition, executive function, working memory, processing speed and memory function. However, given the methodological limitations and heterogeneity of the included studies, these findings require confirmation in further large-scale, high-quality RCTs.

Introduction Clinical reasoning is an essential competency for all physicians, and fostering this skill in medical students is a primary objective of medical education. Currently, clinical reasoning is predominantly cultivated through experiences in clinical settings; however, this approach presents certain limitations. The emergence of innovative medical simulation teaching methods has led to the increasing utilisation of standardised patient (SP) simulations in medical education. However, the specific contribution of the SP teaching method to the development of clinical reasoning skills in medical students remains unclear. Therefore, we propose a systematic review to summarise the impact of the SP teaching method on the clinical reasoning competence of medical students.Methods and analysis This systematic review protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines for reporting results. A comprehensive literature search will be conducted across five major online databases: PubMed, Embase, Web of Science, Education Research Complete and the Cochrane Library. The screening process comprises an initial review of titles and abstracts to identify relevant studies efficiently, followed by a full-text assessment of the selected articles. Two reviewers will independently conduct study selection, data extraction and risk of bias assessment. Data extraction will be performed using a standardised form. The primary outcome is clinical reasoning competence, and secondary outcomes are communication skills and student satisfaction. The risk of bias in included studies will be evaluated using the Cochrane Risk of Bias tool 2. Depending on the literature search results and the characteristics of the selected studies, a meta-analysis will be conducted where feasible. Otherwise, a narrative synthesis will be performed.Ethics and dissemination This study presents a protocol for a systematic review and does not involve human subjects. The findings will be disseminated through publication as a manuscript submitted to a peer-reviewed journal.PROSPERO registration number CRD420251163882.

ABSTRACT Background Sarcopenia, a condition characterized by a substantial reduction in muscle mass and decreased muscle function, is a common degenerative condition in older adults. Regular Baduanjin exercise (BE) is deemed an effective intervention for improving muscle function in older adults. It is a traditional Chinese practice of qigong that combines gentle exercise, breathing techniques and meditation, in the elderly population. However, randomized controlled trials on the efficacy of BE in preventing and treating sarcopenia among older adults remain limited. The aim of our study was to assess the efficacy of a systematic BE regimen based on the short physical performance battery (SPPB) in managing sarcopenia. By establishing a clear link between BE and improvements in muscle function, this study reveals valuable insights into nonpharmacological strategies for the prevention and treatment of sarcopenia. Methods This is a 24‐week randomized controlled trial involving 90 participants aged 60–77 years who were diagnosed with primary sarcopenia. The participants were randomly assigned by SAS software to either BE or a resistance training (RT) group. Both groups undertook their respective training under professional supervision from July 2022 to August 2023 in Chengdu, China. The intervention consisted of 60‐minute sessions, three times a week for 24 weeks. Participants were evaluated at baseline, Week 12 (midintervention) and Week 24 (postintervention) using the primary outcome measure, SPPB, along with secondary indicators, including limb muscle mass, two‐handed grip strength and other indicators, which were analysed using a generalized estimating equation (GEE) model. Results Generalized estimating equations were used to assess 24‐week postintervention effects. Among the entire group, which consisted of 13 males and 77 females, significant differences (p < 0.05) were noted between the BE and RT in several measures: SPPB scores (B = 1.94 [95% CI, 1.20–2.68]), balance (B = 0.76 [95% CI, 0.31–1.22]), lower limb strength (B = 0.75 [95% CI, 0.25 to 1.24]), gait speed (B = 0.41 [95% CI, 0.01–0.81]), skeletal muscle index (SMI) (B = 0.37 [95% CI, 0.25–0.50]), left leg muscle mass (B = 0.38 [95% CI, 0.23–0.52]), right leg muscle mass (B = 0.34 [95% CI, 0.17–0.51]) and right hand grip strength (B = 1.56 [95% CI, 1.13–1.99]). No significant differences were found in the muscle mass of the left arm, right arm or left handgrip strength or in the results of the 6‐m walk test. Conclusions Regular BE markedly improved muscle function and increased muscle mass in older adults with sarcopenia, indicating a safe and effective exercise for sarcopenia management. BE, which was tailored using the short physical performance battery assessment, offers a valuable approach to help prevent and treat sarcopenia in older adults. Future research should investigate the long‐term effects of varying BE intensities and frequencies in individuals with sarcopenia. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2100051871).

BACKGROUND:Cognitive impairment is a growing public health concern, particularly in aging populations. While trends in CI prevalence in China were studied up to 2018, no previous research has explored how the COVID-19 pandemic has affected these trends. OBJECTIVES:This study aims to extend the analysis to 2022, examining the impact of the pandemic on cognitive impairment prevalence. PARTICIPANTS:The Chinese Longitudinal Healthy Longevity Survey (CLHLS) data across multiple waves (2002 to 2022) was used (n=64,872). MEASUREMENTS:Cognitive impairment was assessed using a Chinese version of the Mini-Mental State Examination (MMSE). The rural/urban-sex-single age-specific prevalence of cognitive impairment across different waves were estimated using the DemoRates R package. Cognitive impairment trends before and after the onset of the COVID-19 pandemic were compared to identify any significant changes. RESULTS:In 2018 and previous waves, an average of 16,191 participants per wave were surveyed (four waves), with a cognitive impairment prevalence of 4.3%. In 2022, post-COVID-19, the survey included 14,022 participants and showed a significant increase in CI prevalence to 6.8%. The observed trends were independent of gender, age group, and residential environment (P-trend < 0.001). However, a significant decrease in mean calf circumference, increase in proportion of overweight participants, and increases in daily fruit and vegetable intake and regular physical activity were notable after the pandemic. CONCLUSION:The study suggests that the COVID-19 pandemic may have contributed to the observed increase in cognitive impairment prevalence in China, underscoring the importance of further research into the long-term cognitive effects of global health crises. These findings highlight the need to strengthen healthcare systems to support cognitive health in an aging population, while considering both pandemic-related and ongoing factors in the management of cognitive impairment.

Cardiovascular implantable electronic devices (CIEDs) are essential in the management of chronic heart failure, which remains a major cause of morbidity and mortality despite guideline-directed medical therapy. By targeting mechanisms beyond pharmacological control, CIEDs improve outcomes through resynchronization, arrhythmia prevention, and contractility modulation. Cardiac resynchronization therapy enhances ventricular synchrony, with conduction system pacing emerging as a physiological alternative to biventricular pacing. Implantable cardioverter-defibrillators remain central to the prevention of sudden cardiac death, while sub-cutaneous implantable cardioverter-defibrillators extend options for patients with limited venous access or an elevated infection risk. Cardiac contractility modulation represents an innovative approach for moderate ventricular dysfunction, augmenting contractility without inducing arrhythmias. Collectively, these therapies complement medical treatment and highlight the importance of individualized, patient-centered strategies to improve survival, functional capacity, and quality of life in patients with heart failure, underscoring the expanding clinical relevance of CIEDs.

INTRODUCTION With the expansion of the ageing population,cognitive decline has become an increas-ingly pressing challenge.1 As life expectancy increases,its socioeconomic burden is also increasing,highlighting the urgent need for effective interventions.Numerous studies suggest that specific dietary patterns and nutritional interventions may help mitigate cognitive decline associated with ageing.

Ethnic pharmacological relevance: Pulmonary fibrosis (PF) is a fibrotic interstitial lung disease caused by continuous damage and excessive repair of alveolar epithelial cells, the pathogenesis of which is not fully understood. At present, the incidence of PF has increased significantly around the world. The therapeutic arsenals against PF are relatively limited, with often poor efficacy and many adverse effects. As a conventional and effective therapeutic strategy, traditional Chinese medicine (TCM) has been widely applied in treating lung fibrosis for thousands of years in China. Due to the multi-ingredient, multi-target characteristics, Chinese medicines possess promising clinical benefits for PF treatment.Aim of this review: This review aims to systematically analyze the clinical efficacy of Chinese medicine on PF, and further summarize the relevant mechanisms of Chinese medicine treating PF in preclinical studies, in order to provide a comprehensive insight into the beneficial effects of Chinese medicines on PF.Methods: Eight major Chinese and English databases were searched from database inception up to October 2022, and all randomized clinical trials (RCTs) investigating the effects of Chinese medicine intervention on effectiveness and safety in the treatment of PF patients were included. Subsequently, preclinical studies related to the treatment of PF in Chinese medicine, including Chinese medicine compounds, Chinese herbal materials and extracts, and Chinese herbal formulas (CHFs) were searched through PubMed and Web of science to summarize the related mechanisms of Chinese medicine against PF.Results: A total of 56 studies with 4019 patients were included by searching the relevant databases. Total clinical efficacy, pulmonary function, blood gas analysis, lung high resolution CT (HRCT), 6 min walk test (6-MWT), St George's Respiratory Questionnaire (SGRQ) scores, clinical symptom scores, TCM syndrome scores and other outcome indicators related to PF were analyzed. Besides, numerous preclinical studies have shown that many Chinese medicine compounds, Chinese herbal materials and extracts, and CHFs play a preventive and therapeutic role in PF by reducing oxidative stress, ameliorating inflammation, inhibiting epithelial-mesenchymal transition and myofibroblasts activation, and regulating autophagy and apoptosis.Conclusion: Chinese medicines show potential as supplements or substitutes for treating PF. And studies on Chinese medicines will provide a new approach to better management of PF.

Context: Diabetes mellitus (DM) is one of the fastest-growing diseases worldwide; however, its pathogenesis remains unclear. Complications seriously affect the quality of life of patients in the later stages of diabetes, ultimately leading to suffering. Natural small molecules are an important source of antidiabetic agents. Objective: Astragaloside IV (AS-IV) is an active ingredient of Astragalus mongholicus (Fisch.) Bunge. We reviewed the efficacy and mechanism of action of AS-IV in animal and cellular models of diabetes and the mechanism of action of AS-IV on diabetic complications in animal and cellular models. We also summarized the safety of AS-IV and provided ideas and rationales for its future clinical application. Methods: Articles on the intervention in DM and its complications using AS-IV, such as those published in SCIENCE, PubMed, Springer, ACS, SCOPUS, and CNKI from the establishment of the database to February 2022, were reviewed. The following points were systematically summarized: dose/concentration, route of administration, potential mechanisms, and efficacy of AS-IV in animal models of DM and its complications. Results: AS-IV has shown therapeutic effects in animal models of DM, such as alleviating gestational diabetes, delaying diabetic nephropathy, preventing myocardial cell apoptosis, and inhibiting vascular endothelial dysfunction; however, the potential effects of AS-IV on DM should be investigated. Conclusion: AS-IV is a potential drug for the treatment of diabetes and its complications, including diabetic vascular disease, cardiomyopathy, retinopathy, peripheral neuropathy, and nephropathy. In addition, preclinical toxicity studies indicate that it appears to be safe, but the safe human dose limit is yet to be determined, and formal assessments of adverse drug reactions among humans need to be further investigated. However, additional formulations or structural modifications are required to improve the pharmacokinetic parameters and facilitate the clinical use of AS-IV.

With the development of the mobile internet and the intensification of the differentiated behaviour of communication audiences, there are many challenges and difficulties in content dissemination to younger generations about promoting Traditional Chinese Medicine (TCM) and improving health-related behaviour. Current literature lacks information on the association between knowledge, attitude, practice, and campus culture construction. This article investigates the relationship between traditiona Chinese medicine (TCM) campus culture construction and health-related knowledge, attitudes, and practices (KAP) among primary campus students in China. It employed structural equation modelling (SEM) to analyze the data. For this study, the data was collected through an online questionnaire from a group of students. Exploratory factor analysis (EFA) and Confirmatory FactorAnalysis (CFA) was conducted on data for validation and reliability. The study contributes to the existing literature by providing empirical evidence on the influence of TCM campus culture construction on health-related KAP among primary campus students.

Formononetin (FMNT) is a secondary metabolite of flavonoids abundant in legumes and graminaceous plants such as Astragalus mongholicus Bunge [Fabaceae; Astragali radix] and Avena sativa L. [Poaceae]. Astragalus is traditionally used in Asia countries such as China, Korea and Mongolia to treat inflammatory diseases, immune disorders and cancers. In recent years, inflammation and oxidative stress have been found to be associated with many diseases. A large number of pharmacological studies have shown that FMNT, an important bioactive metabolite of Astragalus, has a profoundly anti-inflammatory and antioxidant potential. This review focuses on providing comprehensive and up-to-date findings on the efficacy of the molecular targets and mechanisms involve of FMNT and its derivatives against inflammation and oxidative stress in both in vitro and in vivo. Relevant literature on FMNT against inflammation and oxidative stress between 2013 and 2023 were analyzed. FMNT has antioxidant and anti-inflammatory potential and shows mild or no toxicity in various diseases. Moreover, in the medical field, FMNT has shown potential in the prevention and treatment of cancers, neurological diseases, fibrotic diseases, allergic diseases, metabolic diseases, cardiovascular diseases, gastrointestinal diseases and autoimmune diseases. Thus, it is expected to be utilized in more products in the medical, food and cosmetic industries in the future.

MicroRNA (miRNA) plays a regulatory role in periodontitis. This study aimed to explore whether miR-29a could affect lipopolysaccharides (LPSs)-induced injury in human gingival fibroblasts (HGFs) through the competitive endogenous RNAs (ceRNA) mechanism. Periodontal ligament (PDL) tissues and HGFs were derived from patients with periodontitis and healthy volunteers. Periodontitis cell model was established by treating HGFs with LPS. Expression levels of circ_0036490, miR-29a, and DKK1 were evaluated by the reverse transcription quantitative real-time PCR (RT-qPCR) method. Western blotting assay was performed to assess protein expression levels of pyroptosis-related proteins and Wnt signalling related proteins. Cell viability was evaluated by cell counting kit-8 (CCK-8) assay. Concentration of lactate dehydrogenase (LDH), interleukin (IL)-1β, and IL-18 were determined by Enzyme-linked immunosorbent assay (ELISA). Pyroptosis rate were determined by flow cytometry assay to evaluate pyroptosis. The interaction between miR-29a and circ_0036490 or DKK1 was verified by dual-luciferase reporter and RNA pull-down assays. MiR-29a expression was lower in PDL tissues of patients with periodontitis than that in healthy group; likewise, miR-29a was also downregulated in LPS-treated HGFs. Overexpression of miR-29a increased cell viability and decreased pyroptosis of HGFs induced by LPS while inhibition of miR-29a exerted the opposite role. MiR-29a binds to circ_0036490 and elevation of circ_0036490 contributed to dysfuntion of LPS-treated HGFs and reversed the protection function of elevated miR-29a. In addition, miR-29a targets DKK1. Overexpression of DKK1 abrogated the effects of overexpressed miR-29a on cell vaibility, pyroptosis, and protein levels of Wnt signalling pathway of LPS-treated HGFs. Circ_0036490 and DKK1 competitively bind miR-29a to promote LPS-induced HGF injury in vitro. Wnt pathway inactivated by LPS was activated by miR-29a. Thence, miR-29a may be a promising target for periodontitis.

20世纪以来,随着大量先秦两汉简帛文献的出土及释读,为中医药理论起源及疾病发生、发展等问题提供了新的探索方向.本文通过总结分析现有已出版的秦汉简帛医学文献中有关"心"的内容,发现秦汉时期医家对"心疾"的认识,无论是在疾病的名称、发病的原因还是疾病的防治等方面与以前的认知相比,均有了极大的提高,尤其发现秦汉时期医家在治疗方面大量应用"养生法",为我们现今防治疾病提供了新的思路及方法,值得借鉴.

BackgroundThe practical training course of internal medicine of traditional Chinese medicine (PTC-IMTCM) is primarily based on traditional case teaching, which can be stressful for teachers. The use of virtual standardized patient (VSP) applications could be an alternative; however, there is limited evidence regarding their feasibility and effectiveness. ObjectiveThis study aimed to build a VSP-TCM application according to the characteristics of PTC-IMTCM and the needs of students and to compare its efficacy with that of traditional teaching in improving TCM clinical competence among students. MethodsA prequestionnaire investigation was conducted before the course, and a VSP-TCM system was developed based on the results of the questionnaire. A randomized controlled trial was then conducted between February 26, 2020, and August 20, 2021. A total of 84 medical students were included and were divided into 2 groups: an observation group, trained with VSP-TCM (n=42, 50%), and a control group, trained with traditional academic training (n=42, 50%). Formative and summative assessments were conducted to evaluate teaching effectiveness. After completing the course, the students were administered a questionnaire to self-assess their satisfaction with the course. A questionnaire was also administered to 15 teachers to uncover their perspectives on VSP-TCM. ResultsAll participants completed the study. In the formative assessment, the VSP-TCM group performed better in medical interviewing ability (mean 7.19, SD 0.63, vs mean 6.83, SD 0.81; P=.04), clinical judgment (mean 6.48, SD 0.98, vs mean 5.86, SD 1.04; P=.006), and comprehensive ability (mean 6.71, SD 0.59, vs mean 6.40, SD 0.58; P=.02) than the control group. Similarly, in the summative evaluation, the VSP-TCM group performed better in the online systematic knowledge test (OSKT; mean 86.62, SD 2.71, vs mean 85.38, SD 2.62; P=.046), application of TCM technology (mean 87.86, SD 3.04, vs mean 86.19, SD 3.08; P=.02), TCM syndrome differentiation and therapeutic regimen (mean 90.93, SD 2.42, vs mean 89.60, SD 2.86; P=.03), and communication skills (mean 90.67, SD 4.52, vs mean 88.24, SD 4.56; P=.02) than the control group. There was no significant difference in medical writing between both groups (mean 75.07, SD 3.61, vs mean 75.71, SD 2.86; P=.37). The postcourse feedback questionnaire indicated that VSP-TCM can better enhance students’ TCM thinking ability (n=39, 93%, vs n=37, 88%; P=.002), medical history collection (n=38, 90%, vs n=30, 72; P=.001), syndrome differentiation and treatment and critical thinking (n=38, 90%, vs n=37, 88%; P=.046), comprehensive clinical application ability (n=40, 95%, vs n=36, 86%; P=.009), interpersonal communication skills (n=36, 86%, vs n=28, 67%; P=.01), and autonomous learning ability (n=37, 88%, vs n=28, 67%; P=.01) than traditional academic training. Similarly, the teachers held a positive perspective on VSP-TCM. ConclusionsVSP-TCM enhances students’ TCM clinical competence and dialectical thinking and improves their ability to work autonomously. Moreover, the VSP-TCM system is feasible, practical, and cost-effective and thus merits further promotion in TCM education.

Background and aimsBoth casts and braces can be used for post-operational immobilization of ankle fractures. This meta-analysis aimed to assess the complications and functional effects of the two types of immobilization.Material and methodsPubMed, Embase, Cochrane, and CNKI was searched for randomized controlled trials (published between Jan 1, 1950, and March 2022). Relative risk (RR) or standard mean difference (SMD) with a 95% confidence interval (CI) was used to present the outcomes. The pooled data were assessed by using the fixed-effects model or random-effects model.ResultsA total of 5 randomized controlled studies involving 930 subjects were included according to our inclusion criteria. On the ankle score at 6w,12w and 52w, there was no statistically significant difference between the two groups. In terms of 6w, the brace group showed better ankle dorsiflexion (MD = 6.78, 95% CI 0.56–13.00, p = 0.03) and plantar flexion (MD = 6.58, 95% CI 1.60–11.55, p = 0.01) than the cast group. The wound complications (RR = 3.49, 95% CI 1.32 to 9.24, p = 0.01) and total complications (RR = 3.54, 95% CI 1.92 to 6.50, p < 0.0001) in the brace group were three times more than that in the cast group. There was no statistically significant difference between the two groups in the non-wound complications. There was no statistically significant difference between the two groups in the time of going back to work, swelling of the ankle, and atrophy of the calf muscle.ConclusionThe short-term and long-term functional outcomes after postoperative treatment of adult ankle fractures with braces are similar to those with casts. The usage of braces may cause three times more wound complications than that of casts.

ETHNOPHARMACOLOGICAL RELEVANCE:Yuanzhi Powder (YZP) is a classical Chinese medicine prescription, which is suitable for the treatment of dementia by "dispelling phlegm and opening orifice". The therapeutic efficacy of YZP on Alzheimer's disease (AD) has been previously reported in our work. However, it remains unclear whether the neuroprotective effect of YZP is linked to β-amyloid(Aβ) clearance through cerebral lymphatic drainage. AIM OF THE STUDY:The aim was to determine the protective efficacy of YZP against AD and investigate the potential mechanism for eliminating excessive Aβ deposition. MATERIALS AND METHODS:APP/PS1 mice were divided into four groups of 8 mice each: APP/PS1 group, DONE group, L-YZP group, and H-YZP group. Additionally, 8 wild-type littermates were assigned to the control group (WT group). After 8 weeks of consecutive intragastric administration, behavioral tests, including the open field test, novel object recognition test and Morris Water Maze test, were employed to assess the cognitive abilities of all groups of mice. Nissl staining, immunohistochemistry, and western blotting were utilized to evaluate clearance of excessive Aβ deposition and pathological changes. Furthermore, immunofluorescence was applied to visualize the drainage of the cerebral lymphatic system after fluorescent tracer injection in the cisterna magna. RESULTS:The administration of YZP significantly attenuated cognitive deficits, cleared excessive Aβ deposition, and improved pathological damage in APP/PS1 mice. Furthermore, YZP effectively enhanced glymphatic system drainage by restoring AQP4 polarization and inhibiting reactive astrogliosis. Additionally, YZP facilitated the drainage of meningeal lymphatic vessels (MLVs) by augmenting their diameter and coverage. Lastly, YZP promoted the elimination of Aβ from the brain to deep cervical lymph nodes. CONCLUSIONS:The administration of YZP may ameliorate the cognitive deficits and pathological damage in APP/PS1 mice by effectively clearing excessive Aβ deposition. The underlying mechanisms potentially involve Aβ clearance through the cerebral lymphatic system, which includes the glymphatic system and MLVs.

To assess the clinical value of mechanical thrombectomy (MT) combined with intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) by comparing it with the MT alone. In this study, we conducted a comprehensive meta-analysis of both observational and randomized controlled studies (RCTs) to investigate various outcomes. Our search for relevant studies was conducted between January 2011 and June 2022 in four major databases: PubMed, Embase, WOS, and Cochrane Library. We collected data on several outcomes, including functional independence (FI; defined as modified Rankin Scale score of 0 to 2), excellent outcomes (mRS 0–1), successful recanalization (SR), symptomatic intracerebral hemorrhage (sICH), any intracerebral hemorrhage (aICH), and mortality at three months or discharge. The primary efficacy outcome and safety outcome were FI and sICH, respectively, whereas excellent outcomes and SR were considered secondary efficacy outcomes. Additionally, mortality and aICH were analyzed as secondary safety outcomes. We employed the Mantel–Haenszel fixed-effects model for RCTs when I2 < 50%, otherwise the random-effects model was utilized. For observational studies and subgroup analyses, we used the random-effects model to minimize potential bias. A total of 55 eligible studies (nine RCTs and 46 observational studies) were included. For RCTs, the MT + IVT group was superior in FI (OR: 1.27, 95% CI: 1.11–1.46), excellent outcomes (OR: 1.21, 95% CI: 1.03–1.43), SR (OR: 1.23, 95% CI: 1.05–1.45), mortality (OR: 0.72, 95% CI: 0.54–0.97) in crude analyses. In adjusted analyses, the MT + IVT group reduced the risk of mortality (OR: 0.65, 95% CI: 0.49–0.88). However, the difference in FI between the MT + IVT group and the MT alone group was not significant (OR: 1.17, 95% CI: 0.99–1.38, Fig. 3a). For observational studies, the results of FI (OR: 1.34, 95% CI: 1.16–1.33), excellent outcomes (OR: 1.30, 95% CI: 1.09–1.54), SR (OR: 1.23, 95% CI: 1.05–1.44), mortality (OR: 0.70, 95% CI: 0.64–0.77) in the MT + IVT group were better. Additionally, the MT + IVT group increased the risk of hemorrhagic transformation (HT) including sICH (OR: 1.16, 95% CI: 1.11–1.21) and aICH (OR: 1.24, 95% CI: 1.05–1.46) in crude analyses. In adjusted analyses, significant better outcomes were seen in the MT + IVT group on FI (OR: 1.36, 95% CI: 1.21–1.52), excellent outcomes (OR: 1.49, 95% CI: 1.26–1.75), and mortality (OR: 0.73, 95% CI: 0.56–0.94). The MT + IVT therapy did improve the prognosis for AIS patients and did not increase the risk of HT compared with MT alone therapy.

ObjectiveThis study aimed to evaluate the effectiveness of total contact casts (TCCs) versus removable offloading interventions among patients with diabetic foot ulcers (DFUs).MethodsA comprehensive search was done in databases Embase, Cochrane Library, and, PubMed. The references of retrieved articles were reviewed, up until February 2023. Controlled trials comparing the effects of TCCs with removable offloading interventions (removable walking casts and footwear) in patients with DFUs were eligible for review.ResultsTwelve studies were included in the meta-analysis, involving 591 patients with DFUs. Among them, 269 patients were in the intervention group (TCC), and 322 in the control group (removable walking casts/footwear). The analysis revealed that the TCC group had higher healing rates (Risk Ratio(RR)=1.22; 95% confidence interval(CI):1.11 to 1.34, p<0.001), shorter healing time (Standard Mean Difference(SMD)=-0.57; 95%CI: -1.01 to -0.13, P=0.010), and elevated occurrence of device-related complications (RR=1.70; 95%CI:1.01 to 2.88, P=0.047), compared with the control group. Subgroup analysis illustrated patients using TCCs had higher healing rates than those using removable walking casts (RR=1.20; 95%CI:1.08 to 1.34, p=0.001) and footwear (RR=1.25; 95%CI:1.04 to 1.51, p=0.019), but they required comparable time for ulcer healing compared with those using removable walking casts (SMD=-0.60; 95%CI: -1.22 to 0.02, P=0.058) or footwear group (SMD=-0.52; 95%CI: -1.17 to 0.12, P=0.110). Although patients using TCCs had significantly higher incidence of device-related complications than those using footwear (RR=4.81; 95%CI:1.30 to 17.74, p=0.018), they had similar one compared with those using the removable walking casts (RR=1.27; 95%CI:0.70 to 2.29, p=0.438).ConclusionThe use of TCCs in patients with DFUs resulted in improved rates of ulcer healing and shorter healing time compared to removable walking casts and footwear. However, it is important to note that TCCs were found to be associated with increased prevalence of complications.

Review question / Objective: Is shenqi bufei decoction Efficacy and safe on stable chronic obstructive pulmonary disease patients Rationale: Chronic obstructive pulmonary disease is defined as persistent respiratory symptoms and airflow restriction due to airway and / or alveolar abnormalities.In the past decades, COPD has become a serious global public health problem.Chronic obstructive pulmonary disease causes about 300000 deaths worldwide INPLASY 1 International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY PROTOCOLEfficacy of shenqi bufei decoction on stable chronic obstructive pulmonary disease patients: A protocol for systematic review and meta-analysis