A qualitative analysis by high-performance liquid chromatography coupled with time-of-flight mass spectrometry (HPLC-QTOF-MS/MS) was performed for the identification of main constituents in Gentiana veitchiorum. High-performance liquid chromatography (HPLC) was developed for the quantification of seven major components, including loganic acid (1), swertiamarin (2), gentiopicroside (3), sweroside (4), isoorientin (5), isoscoparin (6), and gentiournoside A (7). A total of 42 compounds, including 31 flavonoids, and 11 Iridoids, were identified based on their retention behaviors, and MS fragment information. Furthermore, regression equations for these seven chemical components were established, with good linear relationships (r2 > 0.9999), and the sample recovery rate was 97.02%-103.08%. This method was successfully applied for simultaneous determination of seven components in 7 batches of G. veitchiorum samples by HPLC-UV method. The method established in this study is simple and reliable, capable of qualitatively and quantitatively analyzing the main chemical components of G. veitchiorum, and is applicable to its quality evaluation.

Objective To analyze the basic conditions and pathological characteristics of the samples in the Human Brain Bank of Hebei Medical University,which were pathologically diagnosed as cerebral amyloid angiopathy,and to provide reference for the research of related diseases.Methods The basic data of gender,age,apolipoprotein E genotype,pathological classification of cerebral amyloid angiopathy,Alzheimer's disease-related pathological change score,comorbidities and other pathological information were analyzed.Results Up to October 2024,twenty samples were confirmed by pathological diagnosis,with a male to female ratio of 3:1 and an average age of(80.90±8.08)years.Involve three kinds of apolipoprotein E subtype,5 kinds of genotypes(ε2/ε3 xε2/ε4、ε3/ε3 xε3/ε4、ε4/ε4);There were 2 pathologic types,including 6 cases of type 1 and 14 cases of type 2.The pathological grade included 3 grades.The severity grade and subtype classification of cerebral amyloid vascular disease were correlated with the degree of pathological changes of Alzheimer's disease.Cerebral amyloid angiopathy samples could coexist with other degenerative diseases with high comorbidity.Conclusion The incidence of cerebral amyloid angiopathy is higher in the aged samples collected based on Brain Bank,which coexists with conditions such as Alzheimer's disease and microbleeds,etc.It provides more detailed pathological diagnosis basis for further scientific research sharing of samples.

ObjectiveMicrotube associated protein-2 （MAP-2）， alpha-tubulin （α-tubulin）， and synaptophysin （SYP） are important proteins in neuronal signal communication. This paper observed the effects of modified Zhigancao Tang on the expression of serum α-Synuclein （α-Syn） and its oligomers， MAP-2， α-tubulin， and SYP of patients with liver and kidney deficiency of Parkinson's disease （PD）， analyzed their correlation， and evaluated the therapeutic effect of modified Zhigancao Tang in patients with liver and kidney deficiency of PD based on α-Syn transmission pathway mediated by neuronal communication in vivo. MethodsA total of 60 patients with PD who met the inclusion criteria were randomly divided into a treatment group （30 cases） and a control group （30 cases）. Both groups were treated on the basis of PD medicine， and the treatment group was treated with modified Zhigancao Tang. Both groups were treated for 12 weeks. The changes in UPDRS score， TCM syndrome score， and expression of serum α-Syn and its oligomers， MAP-2， α-tubulin， and SYP were observed before and after 12 weeks of treatment in each group. The correlation between the above-mentioned serum biological indexes and the levels of serum α-Syn and its oligomers was analyzed. ResultsAfter treatment， the TCM syndrome score， UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ score of the treatment group were significantly decreased （P<0.05， P<0.01）. The UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ scores in the treatment group were significantly decreased compared with those in the control group after treatment （P<0.05）. After treatment， the total effective rate of the control group was 63.3% （19/30）， and that of the treatment group was 86.7% （26/30）. The clinical effect of the observation group was better than the control group （Z=-2.03， P<0.05）. The total effective rate of the observation group was better than that of the control group， and the difference was statistically significant （χ²=5.136， P<0.05）. After treatment， the oligomer level of serum α-Syn and MAP-2 level in the treatment group were significantly decreased （P<0.05， P<0.01）. The levels of serum α-Syn and its oligomers， as well as α-tubulin in the treatment group， were significantly decreased compared with those in the control group after treatment （P<0.05， P<0.01）. Serum α-Syn was correlated with serum MAP-2 and α-Syn oligomer in patients with PD （P<0.05， P<0.01） but not correlated with serum SYP . Serum α-Syn oligomers of patients with PD were correlated with serum MAP-2 and α-tubulin （P<0.05， P<0.01） but not correlated with serum SYP level. Serum SYP of patients with PD was correlated with serum MAP-2 （P<0.05）. ConclusionModified Zhigancao Tang has a therapeutic effect on patients with liver and kidney deficiency of PD by inhibiting the production of α-Syn oligomers and intervening α-Syn microtubule transport pathway in vivo.

Objective:To investigate the experiences of residents in completing case reports, the support needed in writing case reports, and the necessary conditions for future case report education.Methods:Using purposive sampling, one-on-one semi-structured in-depth interviews were conducted with residents who had published case reports. A thematic analysis was employed to analyze the data.Results:The study included 15 residents [3 males, 12 females; mean age: (27.20±2.57) years], with 8 undergoing standardized residency training and 7 receiving specialized physician training. The study identified three themes, including the challenges, strategies, and desired support during data collection prior to writing the case report, the writing process, and the submission and publication. The following specific needs were identified. Before writing, residents sought access to free and official research resources, guidance on the value of case publication, high-quality case resources, comprehensive supervision of data collection, access to interdepartmental collaboration, and funding support. During the writing period, they sought case report templates, experiences in writing case reports, guidance on article composition, and motivational support. After writing, they expected operational guidance of submission websites, recommendations for target journals, and templates for revision response letters.Conclusions:This study explored the challenges, strategies, and expected support in the continuous stages of before, during, and after writing case reports, thereby initially identifying the essential support conditions for case report instruction from the perspective of resident physicians.

Objective:To construct an indicator system for entrustable professional activities (EPAs) in the general practice enhancement stage of pediatric specialist physician training.Methods:A draft indicator system for EPAs in the general practice enhancement stage of pediatric physician training was developed through core EPAs working group discussion, literature review, nominal group discussion, and expert consultation. Subsequently, the indicator system was preliminarily implemented and revised.Results:The core EPAs working group consisted of nine specialist physician trainers. In the initial brainstorming stage, a "potential list" of 30 activities was established. After literature review and collation, the draft indicator system included eight EPAs. Through nominal group discussion, the connotation of the draft was enriched, and the importance of the EPAs was ranked and modified. Finally, through expert consultation, the EPAs for the general practice enhancement stage of pediatric specialist physician training were determined. These included basic operations for the treatment of critically ill children, identification and management of critical illnesses, referral of critically ill children, perioperative management, in-hospital consultation, medical and teaching management and system improvement, doctor-patient communication and dispute handling, and response to public health events. During the preliminary implementation stage, a total of nine specialist physicians who participated in the training were evaluated. Based on the problems found in the pre-evaluation, the indicators of EPAs were revised, and a corresponding curriculum training system was developed.Conclusions:Through multiple rounds of nominal group discussion and expert consultation, the indicator system for EPAs in the general practice enhancement stage of pediatric specialist physician training was formulated. The system was preliminarily implemented and revised, and a curriculum system was constructed.

Objective:To explore the mechanism of Hegu(LI4)point's effect on facial nerve from the perspective of modern medicine.Additionally,it seeks to investigate the specificity of LI4 effect on the face in comparison with other points,providing guidance for the clinical practice of acupuncture.Method:Twenty healthy subjects were enrolled in a crossover design(homozygous self before and after con-trol).The volunteers were randomly assigned to the LI4 group and the Quchi(LI11)group,with a two-week interval between the two groups was used as the washout period.The motor evoked potentials(MEPs)of the facial buccal muscles were compared before and after acupuncture in the LI4 and LI11 groups under various in-tensities of transcranial magnetic stimulation(TMS).The latency and amplitude of MEPs were measured at each intensity of TMS.At the end of the first trial,all volunteers entered the second trial after a two-week in-terval,with the grouping method of the second trial being the same as that of the first trial.The amplitude and latency of buccal muscle MEPs were recorded at eight time points(before needling,needling,leaving the needle in place for 3 minutes,electro-acupuncture,3 minutes after electro-acupuncture,switching off electro-acu-puncture,3 minutes after switching off electro-acupuncture and pulling out the needle)at a stimulation intensity.Result:The amplitude of buccal muscle MEPs increased significantly and the latency decreased significantly before and after the intervention in the LI4 and LI11 groups under TMS intensity of 1％to 25％.The differ-ence was statistically significant(P<0.001),and the rate of change in the amplitude of buccal muscle MEPs in the LI4 and the rate of change in the amplitude of buccal muscle MEPs in the LI4 group was significantly higher than that in the LI11 group(P<0.01).In test 2,the amplitude of buccal muscle MEPs in the LI4 group was lower than that in the LI11 group before acupuncture(P<0.01).The amplitude of buccal muscle MEPs was higher than that in the LI11group after electro-acupuncture,electro-acupuncture for 3 minutes,switching off electro-acupuncture,and switching off electro-acupuncture for 3 minutes(P<0.05).The latency of buccal muscle MEPs was lower than that of the LI4 group in the LI11group before,after,electro-acupunc-ture,electro-acupuncture,electro-acupuncture for 3 minutes,and switching off electro-acupuncture(P<0.05).There was no statistically significant difference between the two groups in other intervention phases(P>0.05).Conclusion:In the physiological state,needling both Hegu and Quchi increased buccal muscle excitability,and Hegu acupoints were more specific for increasing buccal muscle excitability compared with Quchi acu-points.

Objective To investigate the analgesic effect of combined spinal-epidural analgesia and its impact on stress levels in multiparous women during labor in a high-altitude region.Methods A total of 86 multiparous women were enrolled as study subjects.They were divided into observation group(43 cases)and control group(43 cases)based on whether they received labor analgesia.The obser-vation group received combined spinal-epidural analgesia during the first stage of labor.Pain levels[Visual Analogue Scale(VAS)],labor psychological experience[Chinese version of the Childbirth Self-Efficacy Inventory(CBSEI-C32)and Coping with Childbirth(CCB)],stress levels[serum cor-tisol(Cor),norepinephrine(NE)and adiponectin(APN)]as well as maternal and neonatal out-comes were compared between the two groups.Results The VAS scores during the first,second and third stages of labor were significantly lower in the observation group than those in the control group(P＜0.05).The CBSEI-C32 and CCB scores at 24 hours postpartum in the observation group were significantly higher than those in the control group(P＜0.05).The serum levels of Cor,NE and APN at 12 hours postpartum in the observation group were significantly lower than those in the control group(P＜0.05).The incidence of adverse maternal and neonatal outcomes in the observation group was 0％,which was significantly lower than 9.30％in the control group(P＜0.05).Con-clusion In high-altitude regions,combined spinal-epidural analgesia is effective in reducing labor pain,improving labor psychological experience,lowering stress levels,and reducing adverse maternal and neonatal outcomes in multiparous women.

Objective:To analyze the clinical characteristics，laboratory tests，endoscopic features，treatment，and follow-up of peptic ulcers caused by eosinophilic gastrointestinal disorders（EGIDs）in children，with the aim of improving the level of understanding，diagnosis and treatment of EGIDs in children with the onset of peptic ulcers.Methods:A retrospective analysis was conducted on children admitted to the Department of Gastroenterology，Capital Center for Children's Health，Capital Medical University from January 1st，2019 to October 31st，2023，who underwent complete endoscopic examination. The first examination showed the presence of peptic ulcers（gastric or duodenal ulcers）under the endoscope，and were ultimately diagnosed with peptic ulcers caused by EGIDs through examination and follow-up. The clinical characteristics，laboratory tests，endoscopic results，and treatment follow-up were analyzed.Results:Thirty-five children were EGIDs，22 males and 13 females.Twenty-two cases（62.9%）had abdominal pain as the main symptom.Laboratory tests：17 cases（48.6%）showed a decrease in hemoglobin，15 cases（42.9%）showed an increase in eosinophil count，20 cases（57.1%）tested gastro positive for food allergen specific IgE，and 17 cases（48.6%）showed thickening of the intestinal wall on gastrointestinal ultrasound. Endoscopic features：8 cases（22.9%）showed gastric antral ulcers，including 7 cases（20.0%）with multiple gastric antral ulcers，and 25 cases（71.4%）showed duodenal bulb ulcers.There were 15 cases（42.9%）showed huge ulcers，and 14 cases（40.0%）were located in the duodenal bulb. Comparison of clinical characteristics between children with EGIDs（EGIDs group）and those with peptic ulcers caused by Helicobacter pylori infection（Hp group）：the first clinical symptom in both groups was mainly abdominal pain，but the incidence rate in the EGIDs group was lower（62.9% vs 93.5%），and the weigth for length Z score in the EGIDs group was lower［0（-1.6，0.8）vs 1.1（0，1.9）］，with statistical significance（all P<0.05）. Comparison of laboratory tests：the EGIDs group showed a statistically significant difference in hemoglobin levels［120（101，124）g/L vs 130（100，138）g/L］，eosinophil count［0.28（0.13，0.71）× 10 9/L vs 0.16（0.08，0.22）×10 9/L］，a positive rate of food allergen specific IgE detection（57.1% vs 32.3%），and a positive rate of intestinal wall thickening detected by gastrointestinal ultrasound（48.6% vs 16.1%）compared with the Hp group（all P<0.05）. Comparison of endoscopic examinations：multiple ulcers in the gastric antrum were more common in the EGIDs group than in the Hp group（20.0% vs 0），and the difference was statistically significant（ P<0.05）. Conclusion:For children with peptic ulcers with onset of abdominal pain，with anemia or malnutrition，or multiple ulcers in the gastric antrum and huge ulcers in the duodenal bulb detected by endoscopy，it is recommended to perform multi site biopsies to help diagnose EGIDs early.

Objective:To analyze the practical experiences and challenges faced by nurses in community-based elderly care institutions in the management of insulin therapy for elderly patients with diabetes.Methods:This qualitative study employed purpose sampling to recruit nurses from two community-based elderly care institutions in Beijing from June to October 2023. Semi-structured interviews were conducted focusing on their experiences and challenges in insulin use for elderly patients with type 2 diabetes. All interviews were audio-recorded and transcribed into text. Framework analysis was used to analyze the interview data.Results:A total of 15 nurses participated in the interviews, all of whom were female with work experience ranging from 4 to 12 years. The analysis revealed three main themes and 2-3 subthemes under each theme. Theme 1 patients′ experiences with insulin injection: concerns about adverse reactions such as hypoglycemia, obesity, and injection pain; attention to insulin dosage, blood glucose levels, dietary management, and weight control. Theme 2 nurses′ practices and challenges in insulin management: communication and emotional support; trust-building between nurses and elderly patients; impact of insufficient human resources. Theme 3 nurses′ experiences with diabetes knowledge education and training: motivation for training; adaptation of training content, format and frequency to local conditions; implementation and significance of health education.Conclusions:The management of elderly people with diabetes in community-based elderly care institutions presents significant challenges. It is essential to provide personalized insulin management support, emotional support, and psychological counseling for elderly diabetic patients. Additionally, nurses require access to relevant diabetes knowledge education and training to enhance their ability of effective care.