This paper summarizes Professor WANG Yaoxian's experience in treating diabetic kidney disease （DKD） from the perspective of spleen and stomach based on the "internal heat leading to concretions" theory. It is considered that internal heat leading to concretions constitutes the core pathogenesis of DKD， with the spleen and stomach serving as the source of internal heat； therefore， treatment should be based on regulating the spleen and stomach. In the early stage of DKD， dysfunction of the spleen and stomach leads to the initial generation of internal heat. Common syndrome patterns include gastrointestinal heat accumulation and constrained heat in the liver and stomach， for which modified Gegen Qinlian Decoction （葛根芩连汤） can be used to clear heat bind while modified Dachaihu Decoction （大柴胡汤） is used to clear stomach and soothe liver， respectively. In the middle stage of DKD， weakness of the spleen and stomach results in the initial formation of concretions and conglomerations. Common patterns include spleen deficiency with prevalence of dampness and deficiency of both the spleen and kidney. Treatment emphasizes strengthening the spleen and resolving dampness， raising yang and boosting the stomach with modified Shengyang Yiwei Decoction （升阳益胃汤）， or supplementing spleen and boosting kidney， dissipating bind and dispe-ring concretions with modified Shenqi Dihuang Decoction （参芪地黄汤）， respectively. In the late stage of DKD， it is characterized by spleen and stomach depletion， and rampant accumulation of turbidity and toxin， and the common syndrome patterns are damp-turbidity obstruction in the middle jiao （焦） and spleen-kidney yang deficiency. Treatment aims to remove turbidity and harmonize the stomach， or to warm the kidney and strengthen the spleen while elimina-ting turbidity， using modified Dahuang Gancao Decoction（大黄甘草汤） and Jupi Zhuru Decoction （橘皮竹茹汤） or modified Baoyuan Decoction （保元汤） and Lizhong Decoction （理中汤）， respectively. In clinical practice， appropriate formulas and medications are flexibly selected according to specific syndromes.

The paper introduces Professor FAN Gangqi's clinical experience in treatment of migraine. Regarding the syndrome/pattern differentiation of TCM, a four-approach framework is established, identifying the nature of illness, analyzing the syndrome/pattern and pathogenesis, determining the stage of illness, and identifying body constitution. In treatment, the principle of treatment is determined in line with syndrome/pattern differentiation, so as to ensure the therapeutic effect by means of "four dimensions". The acupuncture regimens are formulated in terms of the illness stages, "strong needling stimulation in acute stage for analgesia, and needle retaining in chronic stage for long-term effect". "Focusing on neuovascular pathway" is the effective approach to treatment of migraine with acupuncture and moxiubstion. The clinical holistic model by combining acupuncture with medication is advocated because that "the single acupuncture is weak in therapeutic effect, but with medication combined, the effect is enhanced". The different acupuncture techniques are provided comprehensively in treatment of migraine such as horizontal and row-like needling, collateral needling at Taiyang (EX-HN5), acupuncture at Sankong (Yuyao [EX-HN4], Sibai [ST2] and Jiachengjiang [Extra]), acupoint injection at Tianyou (TE16) and Renying (ST9), and acupoint embedding therapy at Fengchi (GB20).
Humans ; Migraine Disorders/diagnosis* ; Acupuncture Therapy ; Moxibustion ; Acupuncture Points ; Female ; Male ; Adult

Objective To explore the change trend and related mechanism of resting metabolic rate induced by corticosterone in mice,and observe the intervention effects of Zhibai Dihuang Pill and Jinkui Shenqi pill.Methods Sixty-four mice were randomly divided into short-term and long-term groups,and each group was randomly divided into four groups.Mice in CORT group,ZBDH group and JKSQ group were given sterile drinking water containing corticosterone,and mice in Ctrl group were given sterile drinking water containing 1%anhydrous ethanol.Mice in ZBDH group and JKSQ group were given Chinese medicine by gavage.RMR of mice in each group was dynamically monitored during modeling and Chinese medicine intervention.The morphology of mitochondria in liver and muscle were observed by transmission electron microscope.The TR expression level in liver and muscle tissues of each group was observed by immunofluorescence,and MDA and ATP levels were detected in liver and muscle tissues of each group.levels of ACTH,TSH,INS,T3,T4,FT3,FT4,8-OHdG,FGF-21,GDF-15,L-lactic acid and pyruvic acid in serum were also detected.Results Compared with Ctrl group,the mitochondrial morphology of liver and muscle tissues in CORT group was damaged,and the expression of TR was decreased.In short-term(Day 8),RMR,ATP in liver,serum T4,ACTH and INS levels were significantly increased in the CORT group,while serum FGF-21,TSH levels and MDA in liver were significantly decreased.In long term(Day 56),RMR,serum 8-OhdG,INS,and ATP in liver and muscle were significantly decreased in the CORT group,serum FGF-21,GDF-15,T3,T4,FT3,FT4,MDA in liver and muscle were significantly increased.Compared with CORT group,in short term,RMR,serum L(+)-lactate in ZBDH group were significantly decreased,while serum 8-OHdG and the expression of TRα in muscle were significantly increased.In JKSQ group,the mitochondrial morphology of muscle tissue was improved,the expression of TRα and serum FGF-21 were significantly increased,while serum L(+)-lactic acid,FT4 and ATP in liver were significantly decreased.In long term,serum FGF-21 was significantly lower in ZBDH group,and in JKSQ group,RMR,ATP in liver tissue and TRα expression in muscle were significantly increased,while the levels of FGF-21,GDF-15,T3,FT4 in serum and MDA in muscle tissue were significantly decreased.Conclusion CORT induced RMR to increase first and then decrease with the intervention time.In the short term,Zhibai Dihuang Pill significantly decreased RMR in mice,while in the long term,Jinkui Shenqi Pill significantly increased RMR.The mechanism may be related to mitochondrial injury,thyroxine secretion and thyroxine receptor expression.

The biological activity of chitinase in degrading chitin has garnered extensive attention,particularly for its potential applications in biological control.This study utilized four spore-form-ing Bacillus strains isolated from Dermacentor nuttalli ticks collected in the Hulunbuir region.Traditional bacterial culture methods were employed for isolation and identification,followed by 16S rRNA sequencing and phylogenetic analysis of the purified cultures.chitin-hydrolyzing strains were screened using colloidal chitin plates,and specific chitinase genes were detected via PCR.Fer-mentation was conducted at 37.0 ℃ for 4 d,and the supernatants were subjected to enzyme activity analysis using the DNS method.Four Gram-positive Bacillus strains were successfully isolated from tick tissue samples,they were identified as B.proteolyticus,B.paramycoides,B.thuringien-sis,and B.cereus,and renamed IMH/B-1,IMH/P-1,IMH/T-1,and IMH/C-1,respectively.PCR a-nalysis detected chitinase genes in B.proteolyticus and B.thuringiensis,while B.cereus and B.pa-ramycoides lacked these genes.However,three strains B.proteolyticus,B.thuringiensis,and B.ce-reus demonstrated significant(P＜0.01)chitin degradation activity on colloidal chitin.Enzyme ac-tivity assays revealed that chitinase activity ranged from 1.292 to 2.032 U/mL,with B.proteolytic-us exhibiting the highest activity 2.032 U/mL,followed by B.cereus 1.496 U/mL and B.thuring-iensis 1.324 U/mL.This study provides a foundation for further research and application of chiti-nase-producing Bacillus strains.

Objective:To investigate the clinical efficacy of vitamin D as an adjunct to low-dose aspirin on patients with early-onset severe preeclampsia.Methods:A retrospective analysis was conducted on the clinical data of 102 patients with early-onset severe preeclampsia admitted to Zhoushan Women and Children's Hospital from January 2020 to January 2024. Fifty patients admitted for treatment from January 2020 to January 2022 were included in the control group and received low-dose aspirin treatment. Fifty-two patients admitted between February 2022 and January 2024 were included in the observation group and received vitamin D as an adjunct to low-dose aspirin treatment. Both groups were treated for 7 days. Blood pressure, homocysteine, serum 25-hydroxyvitamin D 3, renal function indicators (glomerular filtration rate, 24-hour urine protein quantification), coagulation function indicators (prothrombin time, thrombin time, D-dimer, activated partial thromboplastin time), and pregnancy outcomes were compared between the two groups. Results:After treatment, systolic blood pressure, diastolic blood pressure, homocysteine, 24-hour urine protein quantification, and D-dimer in the observation group were (134.33 ± 6.28) mmHg (1 mmHg = 0.133 kPa), (88.57 ± 5.76) mmHg, (10.65 ± 3.15) μmol/L, (0.59 ± 0.31) g/24 hours, and (0.51 ± 0.32) mg/L, respectively. These values were significantly lower than those in the control group [(142.28 ± 6.04) mmHg, (93.85 ± 5.38) mmHg, (13.15 ± 2.89) μmol/L, (1.28 ± 0.47) g/24 hours, and (0.73 ± 0.49) mg/L, t = 4.17, -10.37, 4.17, 8.79, 2.69, all P < 0.05]. In the observation group, serum 25-hydroxyvitamin D 3 level and glomerular filtration rate were (27.94 ± 6.43) μg/L and (98.65 ± 14.72) mL·min?1·1.73 m?2, respectively. These values were significantly higher than those in the control group [(15.24 ± 5.92) μg/L, (90.19 ± 12.07) mL·min?1·1.73 m?2 ( t = -10.37, -3.18, both P < 0.05). Additionally, in the observation group, prothrombin time, thrombin time, and activated partial thromboplastin time were (12.19 ± 0.53) seconds, (12.19 ± 0.53) seconds, and (0.51 ± 0.32) seconds, respectively. These times were significantly shorter than those in the control group [(13.22 ± 1.15) seconds, (16.94 ± 2.07) seconds, and (34.21 ± 3.93) seconds ( t = 5.85, 4.27, 3.81, all P < 0.05). There was no statistically significant difference in incidence of pregnancy outcomes between the two groups ( P > 0.05). Conclusions:Vitamin D as an adjunct to low-dose aspirin for the treatment of early-onset severe preeclampsia significantly reduces blood pressure, enhances blood circulation, promotes metabolism, improves coagulation function, and aids in the recovery of renal function in patients.

OBJECTIVE:To assess the efficacy and safety of transcranial magnetic stimulation in the treatment of refractory depression and to compare the differences in efficacy between various transcranial magnetic stimulation treatment protocols in refractory depression,thereby providing a theoretical basis for the clinical selection of transcranial magnetic stimulation treatment protocols.METHODS:A comprehensive search was conducted across multiple databases,including PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data,CBM and VIP.The search terms were"transcranial magnetic stimulation,treatment-resistant depression,randomized controlled trial"in Chinese,and"depressive disorder,treatment-resistant,transcranial magnetic stimulation,randomized controlled trial"in English.The objective was to identify randomized controlled trials on the treatment of patients with refractory depression published from the establishment of the databases to September 2024.The quality of the included studies was evaluated using the Cochrane risk of bias assessment tool,version 5.1.0,and the Physiotherapy Evidence Database scale.Meta-analysis of the outcome indicators was conducted using the Review Manager 5.4 and Stata 18.0 software.RESULTS:(1)Following a comprehensive review,20 randomized controlled trials were included in the analysis.All of the trials were assessed to be of high or very high quality according to the Physiotherapy Evidence Database scale.(2)Meta-analysis results showed that,compared with the sham stimulation group,high-frequency repetitive transcranial magnetic stimulation could significantly reduce the scores of Hamilton Depression Rating Scale[mean difference(MD)=-3.89,95％confidence interval(CI):-6.14 to-1.65,P＜0.05)or the Montgomery Depression Rating Scale(MD=-3.97,95％CI:-6.57 to-1.36,P＜0.05).(3)The probability ranking results of the network Meta-analysis showed that,in terms of the Hamilton Depression Rating Scale score,the probability ranking results were as follows:high-frequency repetitive transcranial magnetic stimulation(69.9％)＞intermittent theta burst stimulation(62.8％)＞bilateral theta pulse stimulation(57.5％)＞low-frequency repetitive transcranial magnetic stimulation(54.9％)＞bilateral sequential transcranial magnetic stimulation(49.0％)＞transcranial pulsed electromagnetic field(37.0％)＞sham stimulation(18.9％).And in terms of the Montgomery Depression Rating Scale score,the probability ranking results were as follows:high-frequency repetitive transcranial magnetic stimulation(93.3％)＞bilateral theta pulse stimulation(50.3％)＞sham stimulation(45.9％)＞low-frequency repetitive transcranial magnetic stimulation(32.1％)＞bilateral sequential transcranial magnetic stimulation(28.4％).CONCLUSION:Transcranial magnetic stimulations can improve the depressive symptoms of patients with treatment-resistant depression.Among them,the high-frequency repetitive transcranial magnetic stimulation mode has the best effect on improving the depressive symptoms of patients with treatment-resistant depression,followed by the intermittent θ burst stimulation mode.

The role of osteoblast(OB)autophagy in regulating bone metabolism is a research hotspot in the field of biomedicine.OB autophagy can regulate osteoporosis(OP)induced by aging,oxidative stress,estrogen deficiency,and glucocorticoids(GCs)by mediating factors such as run and cysteine rich domain containing Beclin-1 interacting protein(RUBCN),silent information regulator of transcription 1(SIRT1),and osteoprotegerin(OPG).OB autophagy can also regulate OP by activating notch receptor(Notch)and forkhead box protein O subfamily(FoxO),up-regulating the expression of osteogenic transcription factors(such as Runx2 and Osterix),and mediating the amp-activated protein kinase(AMPK),mammalian target of rapamycin complex(mTOR),Wnt,and c-Jun n terminal kinase(JNK)pathways to act on OB and osteoclast(OC)differentiation.Exercise is an important means of improving OP,and its molecular mechanism is closely related to the up-regulation of phosphatidylinositol 3 kinase(PI3K),adenosine monophosphate(AMP),tumor necrosis factor-alpha(TNF-α),and SIRT1 expression.These in turn activate key factors or pathways(including AMPK,mTOR,Wnt,PI3K/protein kinase B(Akt)/mTOR,and nuclear transcription factor-KB(NF-κB)),regulate the expression of downstream target genes(β-catenin,mTOR,FoxO3a and B cell lymphoma-2(Bcl-2))to up-regulate the expression of autophagy factors(Beclin-1,autophagy related genes(ATG),and microtubule-associated protein 1 light chain 3(LC3)),and promote OB autophagy to restore the dynamic balance in the body,thereby regulating bone formation and bone resorption and improving OP.The relationships among exercise,OB autophagy and OP,however,remain unclear and there is currently a lack of systematic reviews.Here we review and analyze the mechanism of OB autophagy in relation to exercise-induced improvements in OP,and provide a new theoretical basis and research ideas for the prevention and treatment of OP.

Based on WANG Xugao's"thirty liver-regulating methods,"this paper summarized the clinical thinking of treating diabetic kidney disease from the liver.The liver is closely associated with the pathogenesis of diabetic kidney disease,including internal heat,essence depletion,latent wind,and the accumulation and dissipation of a conglomeration of kidney collateral zhengjia.WANG Xugao's"thirty liver-regulating methods"comprehensively reveals the physiological and pathological changes of the liver,as well as clinical approaches for liver treatment.Liver qi stagnation can lead to the generation of internal heat,liver stagnation and deficiency can cause essence depletion and collateral obstruction,and disharmony of the liver wood can cause internal wind disturbance,which all contribute to the progression of diabetic kidney disease at different stages.Treatment generally follows the essence of"thirty liver-regulating methods."In the early stage,treatment should focus on treating liver heat by soothing the liver qi,clearing the liver fire,and removing damp-heat to resolve stagnation and heat.In the middle stage,treatment should focus on treating liver deficiency by nourishing the liver yin to clear heat,replenishing the essence and blood to tonify deficiency,and promoting blood circulation to remove stasis,thereby strengthening the foundation and nurturing the primal essence.In the later stage,treatment should focus on treating liver wind to prevent complications and improve the patient's quality of life.Throughout the entire process,liver collaterals are treated using pungent herbs to invigorate qi and open the liver channels,relieving blood stasis and promoting circulation.In conjunction with the above methods,flexible selection of effective formulas and drug pairs should be used,each addressing specific treatment goals.

OBJECTIVE:To assess the efficacy and safety of transcranial magnetic stimulation in the treatment of refractory depression and to compare the differences in efficacy between various transcranial magnetic stimulation treatment protocols in refractory depression,thereby providing a theoretical basis for the clinical selection of transcranial magnetic stimulation treatment protocols.METHODS:A comprehensive search was conducted across multiple databases,including PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data,CBM and VIP.The search terms were"transcranial magnetic stimulation,treatment-resistant depression,randomized controlled trial"in Chinese,and"depressive disorder,treatment-resistant,transcranial magnetic stimulation,randomized controlled trial"in English.The objective was to identify randomized controlled trials on the treatment of patients with refractory depression published from the establishment of the databases to September 2024.The quality of the included studies was evaluated using the Cochrane risk of bias assessment tool,version 5.1.0,and the Physiotherapy Evidence Database scale.Meta-analysis of the outcome indicators was conducted using the Review Manager 5.4 and Stata 18.0 software.RESULTS:(1)Following a comprehensive review,20 randomized controlled trials were included in the analysis.All of the trials were assessed to be of high or very high quality according to the Physiotherapy Evidence Database scale.(2)Meta-analysis results showed that,compared with the sham stimulation group,high-frequency repetitive transcranial magnetic stimulation could significantly reduce the scores of Hamilton Depression Rating Scale[mean difference(MD)=-3.89,95％confidence interval(CI):-6.14 to-1.65,P＜0.05)or the Montgomery Depression Rating Scale(MD=-3.97,95％CI:-6.57 to-1.36,P＜0.05).(3)The probability ranking results of the network Meta-analysis showed that,in terms of the Hamilton Depression Rating Scale score,the probability ranking results were as follows:high-frequency repetitive transcranial magnetic stimulation(69.9％)＞intermittent theta burst stimulation(62.8％)＞bilateral theta pulse stimulation(57.5％)＞low-frequency repetitive transcranial magnetic stimulation(54.9％)＞bilateral sequential transcranial magnetic stimulation(49.0％)＞transcranial pulsed electromagnetic field(37.0％)＞sham stimulation(18.9％).And in terms of the Montgomery Depression Rating Scale score,the probability ranking results were as follows:high-frequency repetitive transcranial magnetic stimulation(93.3％)＞bilateral theta pulse stimulation(50.3％)＞sham stimulation(45.9％)＞low-frequency repetitive transcranial magnetic stimulation(32.1％)＞bilateral sequential transcranial magnetic stimulation(28.4％).CONCLUSION:Transcranial magnetic stimulations can improve the depressive symptoms of patients with treatment-resistant depression.Among them,the high-frequency repetitive transcranial magnetic stimulation mode has the best effect on improving the depressive symptoms of patients with treatment-resistant depression,followed by the intermittent θ burst stimulation mode.

The role of osteoblast(OB)autophagy in regulating bone metabolism is a research hotspot in the field of biomedicine.OB autophagy can regulate osteoporosis(OP)induced by aging,oxidative stress,estrogen deficiency,and glucocorticoids(GCs)by mediating factors such as run and cysteine rich domain containing Beclin-1 interacting protein(RUBCN),silent information regulator of transcription 1(SIRT1),and osteoprotegerin(OPG).OB autophagy can also regulate OP by activating notch receptor(Notch)and forkhead box protein O subfamily(FoxO),up-regulating the expression of osteogenic transcription factors(such as Runx2 and Osterix),and mediating the amp-activated protein kinase(AMPK),mammalian target of rapamycin complex(mTOR),Wnt,and c-Jun n terminal kinase(JNK)pathways to act on OB and osteoclast(OC)differentiation.Exercise is an important means of improving OP,and its molecular mechanism is closely related to the up-regulation of phosphatidylinositol 3 kinase(PI3K),adenosine monophosphate(AMP),tumor necrosis factor-alpha(TNF-α),and SIRT1 expression.These in turn activate key factors or pathways(including AMPK,mTOR,Wnt,PI3K/protein kinase B(Akt)/mTOR,and nuclear transcription factor-KB(NF-κB)),regulate the expression of downstream target genes(β-catenin,mTOR,FoxO3a and B cell lymphoma-2(Bcl-2))to up-regulate the expression of autophagy factors(Beclin-1,autophagy related genes(ATG),and microtubule-associated protein 1 light chain 3(LC3)),and promote OB autophagy to restore the dynamic balance in the body,thereby regulating bone formation and bone resorption and improving OP.The relationships among exercise,OB autophagy and OP,however,remain unclear and there is currently a lack of systematic reviews.Here we review and analyze the mechanism of OB autophagy in relation to exercise-induced improvements in OP,and provide a new theoretical basis and research ideas for the prevention and treatment of OP.