Objective:To explore the clinical efficacy, safety and possible neuroimaging mechanism of deep transcranial magnetic stimulation (dTMS) and repetitive transcranial magnetic stimulation (rTMS) in the treatment of refractory migraine.Methods:Thirty patients with refractory migraine were selected from the Department of Neurology, Affiliated Hospital of North Sichuan Medical College from October 2022 to August 2023. The patients were randomly divided into dTMS group ( n=10), rTMS group ( n=10) and sham stimulation group ( n=10). The dTMS group was treated with H7 coil and the rTMS group with "8" coil, and the sham stimulation group was treated with sham stimulation rTMS with the frequency of 10 Hz. The stimulation site was the contralateral primary motor cortex (M1) of headache, which was treated for 2 weeks (3 600 pulses per time, 5 times per week, 10 times in total). Visual Analogue Scale (VAS) and Headache Impact Test-6 (HIT-6) evaluations were performed before treatment, on the first day after treatment, and 1, 3 and 6 months after treatment. The resting-state functional magnetic resonance images of the 3 groups of patients before and after treatment were collected and analyzed by MATLAB2018b, SPM12 and RESTPLUS softwares, and the brain regions with different regional homogeneity (ReHo) before and after treatment were obtained. The general clinical data and scale scoring data were analyzed and processed by SPSS 26.0 version software. Results:There were significant differences in VAS scores among the dTMS group (before treatment 6.70±0.68, the first day after treatment 5.60±0.70, 1 month after treatment 5.00±0.82, 3 months after treatment 3.50±0.85, 6 months after treatment 3.90±1.45), the rTMS group (before treatment 6.90±0.74, the first day after treatment 5.90±0.74, 1 month after treatment 5.30±0.82, 3 months after treatment 5.30±0.82, 6 months after treatment 6.80±0.63) and the sham stimulation group (before treatment 6.60±0.97, the first day after treatment 6.70±0.95, 1 month after treatment 6.90±1.10, 3 months after treatment 6.70±0.68, 6 months after treatment 7.10±0.88; F=16.054, P<0.001), VAS scores among different time points ( F=34.292, P<0.001), and the interaction between groups and time ( F=24.136, P<0.001). Compared with those before treatment, VAS scores in the dTMS group and the rTMS group decreased on the first day after treatment, 1 month and 3 months after treatment (all P<0.05); VAS scores decreased in the dTMS group 6 months after treatment ( P<0.05). Compared with the sham stimulation group, the VAS scores of the dTMS group were lower at the same time points after treatment (all P<0.05), and the VAS scores of the rTMS group were lower on the first day after treatment, 1 month and 3 months after treatment (all P<0.05). Compared with the rTMS group, VAS scores were lower at 3 and 6 months after dTMS treatment (both P<0.05). There were significant differences in HIT-6 scores among groups ( F=13.173, P<0.001), HIT-6 scores among different time points ( F=60.788, P<0.001), and interaction between groups and time ( F=35.576, P<0.001). Compared with those before treatment, the HIT-6 scores in the dTMS group decreased on the first day after treatment ( P<0.05); the HIT-6 scores in the dTMS group and the rTMS group decreased 1 month and 3 months after treatment (both P<0.05); the HIT-6 scores decreased in the dTMS group 6 months after treatment ( P<0.05). Compared with the sham stimulation group, the HIT-6 scores were lower in the dTMS group at the same time points after treatment (all P<0.05), and the HIT-6 scores were lower in the rTMS group at 1 and 3 months after treatment (both P<0.05). Compared with the rTMS group, HIT-6 scores were lower at 3 and 6 months after dTMS treatment (both P<0.05). Analysis of ReHo results: compared with those before treatment, the ReHo values of the right cerebellar angle area 1 increased in the dTMS group and the sham stimulation group, decreased in the rTMS group. The ReHo values of the right middle occipital gyrus, left dorsolateral superior frontal gyrus and right cerebellar area 8 increased in the dTMS group, but decreased in the rTMS group and the sham stimulation group. The ReHo values of the left precentral gyrus and left superior temporal gyrus decreased in the dTMS group, while those in the rTMS group and the sham stimulation group increased. There were no obvious adverse reactions in the 3 groups during the treatment and follow-up period. Conclusions:dTMS and rTMS may help to improve the headache degree and quality of life of patients with refractory migraine, and they are safe, which may be related to the changes of brain network in the right cerebellar angle area 1, right middle occipital gyrus, left dorsolateral superior frontal gyrus, left precentral gyrus, left superior temporal gyrus and right cerebellar area 8.

Objective Through visual analysis of literatures related to the treatment of chronic glomerulonephritis(CGN),the research hotspots and trends in this field were discussed.Methods Relevant literatures from CNKI,Wanfang Data Knowledge Service Platform,VIP,SinoMed,PubMed from 2010 to 2024 were retrieved,and analyzed using CiteSpace 6.2.R4 software.Results A total of 8887 articles in Chinese and 117 articles in English were included.The countries,institutions and authors who published most were China,the Affiliated Hospital for Liaoning University of Traditional Chinese Medicine and Wang Yiping.The research hotspots mainly focued on therapeutic drugs and clinical efficacy,and the research trend tended to be the treatment mechanism.Conclusion To further strengthen collaboration among different countries,institutions and authors,and to delve deeper into the mechanistic studies of CGN,will effectively promote the research progress in this field.

The theory of"spleen and stomach deficiency and excess transformation"originates from Huangdi Neijing,which is based on the five elements theory.It systematically elucidates the physiological interconnections and pathological transmission relationships among spleen,stomach,and the five zang and six fu viscera.This theory was continuously developed and refined by later physicians.It was first systematically summarized and deepened by LI Dongyuan in his work Piwei Lun,which elaborates on the pathological transmission relationships of other zang-fu viscera after spleen and stomach deficiency.From the perspective of LI Dongyuan's theory of"spleen and stomach deficiency and excess transformation",this paper discusses the pathological relationships between spleen-earth,lung-metal,and kidney-water,and proposes that spleen-earth deficiency is the pathological basis for the onset of allergic rhinitis.Based on the pathological evolution following spleen-earth deficiency,the traditional Chinese medicine syndromes of allergic rhinitis were categorized into three types:earth deficiency with metal weakness,earth dryness with metal desiccation,and water cold with metal excess and earth decline.The treatment of allergic rhinitis should prioritize the spleen-earth,employing acrid and dispersing herbs with light properties to elevate the spleen,sweet-warm and sour-astringent herbs to tonify the spleen,and diuretic and dampness-resolving herbs to activate the spleen,thereby restoring spleen-earth function.Simultaneously,treatment should regulate lung-metal and kidney-water according to different pathological evolutions,incorporating cold-cool or acrid-warm herbs as appropriate,combining cold and warm properties,and treating both the manifestation and root cause of the disease.

Objective Through visual analysis of literatures related to the treatment of chronic glomerulonephritis(CGN),the research hotspots and trends in this field were discussed.Methods Relevant literatures from CNKI,Wanfang Data Knowledge Service Platform,VIP,SinoMed,PubMed from 2010 to 2024 were retrieved,and analyzed using CiteSpace 6.2.R4 software.Results A total of 8887 articles in Chinese and 117 articles in English were included.The countries,institutions and authors who published most were China,the Affiliated Hospital for Liaoning University of Traditional Chinese Medicine and Wang Yiping.The research hotspots mainly focued on therapeutic drugs and clinical efficacy,and the research trend tended to be the treatment mechanism.Conclusion To further strengthen collaboration among different countries,institutions and authors,and to delve deeper into the mechanistic studies of CGN,will effectively promote the research progress in this field.

Objective:To explore the clinical efficacy, safety and possible neuroimaging mechanism of deep transcranial magnetic stimulation (dTMS) and repetitive transcranial magnetic stimulation (rTMS) in the treatment of refractory migraine.Methods:Thirty patients with refractory migraine were selected from the Department of Neurology, Affiliated Hospital of North Sichuan Medical College from October 2022 to August 2023. The patients were randomly divided into dTMS group ( n=10), rTMS group ( n=10) and sham stimulation group ( n=10). The dTMS group was treated with H7 coil and the rTMS group with "8" coil, and the sham stimulation group was treated with sham stimulation rTMS with the frequency of 10 Hz. The stimulation site was the contralateral primary motor cortex (M1) of headache, which was treated for 2 weeks (3 600 pulses per time, 5 times per week, 10 times in total). Visual Analogue Scale (VAS) and Headache Impact Test-6 (HIT-6) evaluations were performed before treatment, on the first day after treatment, and 1, 3 and 6 months after treatment. The resting-state functional magnetic resonance images of the 3 groups of patients before and after treatment were collected and analyzed by MATLAB2018b, SPM12 and RESTPLUS softwares, and the brain regions with different regional homogeneity (ReHo) before and after treatment were obtained. The general clinical data and scale scoring data were analyzed and processed by SPSS 26.0 version software. Results:There were significant differences in VAS scores among the dTMS group (before treatment 6.70±0.68, the first day after treatment 5.60±0.70, 1 month after treatment 5.00±0.82, 3 months after treatment 3.50±0.85, 6 months after treatment 3.90±1.45), the rTMS group (before treatment 6.90±0.74, the first day after treatment 5.90±0.74, 1 month after treatment 5.30±0.82, 3 months after treatment 5.30±0.82, 6 months after treatment 6.80±0.63) and the sham stimulation group (before treatment 6.60±0.97, the first day after treatment 6.70±0.95, 1 month after treatment 6.90±1.10, 3 months after treatment 6.70±0.68, 6 months after treatment 7.10±0.88; F=16.054, P<0.001), VAS scores among different time points ( F=34.292, P<0.001), and the interaction between groups and time ( F=24.136, P<0.001). Compared with those before treatment, VAS scores in the dTMS group and the rTMS group decreased on the first day after treatment, 1 month and 3 months after treatment (all P<0.05); VAS scores decreased in the dTMS group 6 months after treatment ( P<0.05). Compared with the sham stimulation group, the VAS scores of the dTMS group were lower at the same time points after treatment (all P<0.05), and the VAS scores of the rTMS group were lower on the first day after treatment, 1 month and 3 months after treatment (all P<0.05). Compared with the rTMS group, VAS scores were lower at 3 and 6 months after dTMS treatment (both P<0.05). There were significant differences in HIT-6 scores among groups ( F=13.173, P<0.001), HIT-6 scores among different time points ( F=60.788, P<0.001), and interaction between groups and time ( F=35.576, P<0.001). Compared with those before treatment, the HIT-6 scores in the dTMS group decreased on the first day after treatment ( P<0.05); the HIT-6 scores in the dTMS group and the rTMS group decreased 1 month and 3 months after treatment (both P<0.05); the HIT-6 scores decreased in the dTMS group 6 months after treatment ( P<0.05). Compared with the sham stimulation group, the HIT-6 scores were lower in the dTMS group at the same time points after treatment (all P<0.05), and the HIT-6 scores were lower in the rTMS group at 1 and 3 months after treatment (both P<0.05). Compared with the rTMS group, HIT-6 scores were lower at 3 and 6 months after dTMS treatment (both P<0.05). Analysis of ReHo results: compared with those before treatment, the ReHo values of the right cerebellar angle area 1 increased in the dTMS group and the sham stimulation group, decreased in the rTMS group. The ReHo values of the right middle occipital gyrus, left dorsolateral superior frontal gyrus and right cerebellar area 8 increased in the dTMS group, but decreased in the rTMS group and the sham stimulation group. The ReHo values of the left precentral gyrus and left superior temporal gyrus decreased in the dTMS group, while those in the rTMS group and the sham stimulation group increased. There were no obvious adverse reactions in the 3 groups during the treatment and follow-up period. Conclusions:dTMS and rTMS may help to improve the headache degree and quality of life of patients with refractory migraine, and they are safe, which may be related to the changes of brain network in the right cerebellar angle area 1, right middle occipital gyrus, left dorsolateral superior frontal gyrus, left precentral gyrus, left superior temporal gyrus and right cerebellar area 8.

The theory of"spleen and stomach deficiency and excess transformation"originates from Huangdi Neijing,which is based on the five elements theory.It systematically elucidates the physiological interconnections and pathological transmission relationships among spleen,stomach,and the five zang and six fu viscera.This theory was continuously developed and refined by later physicians.It was first systematically summarized and deepened by LI Dongyuan in his work Piwei Lun,which elaborates on the pathological transmission relationships of other zang-fu viscera after spleen and stomach deficiency.From the perspective of LI Dongyuan's theory of"spleen and stomach deficiency and excess transformation",this paper discusses the pathological relationships between spleen-earth,lung-metal,and kidney-water,and proposes that spleen-earth deficiency is the pathological basis for the onset of allergic rhinitis.Based on the pathological evolution following spleen-earth deficiency,the traditional Chinese medicine syndromes of allergic rhinitis were categorized into three types:earth deficiency with metal weakness,earth dryness with metal desiccation,and water cold with metal excess and earth decline.The treatment of allergic rhinitis should prioritize the spleen-earth,employing acrid and dispersing herbs with light properties to elevate the spleen,sweet-warm and sour-astringent herbs to tonify the spleen,and diuretic and dampness-resolving herbs to activate the spleen,thereby restoring spleen-earth function.Simultaneously,treatment should regulate lung-metal and kidney-water according to different pathological evolutions,incorporating cold-cool or acrid-warm herbs as appropriate,combining cold and warm properties,and treating both the manifestation and root cause of the disease.

OBJECTIVES: To investigate the inhibitory effect of Danshen Injection on endothelial-mesenchymal transition (EndMT) induced by peritoneal dialysis fluid in HMrSV5 cells and the role of the TGF‑β/Smad signaling pathway in mediating this effect. METHODS: HMrSV5 cells cultured in 40% peritoneal dialysis solution for 72 h to induce EndMT were treated with 0.05%, 0.1% and 0.5% Danshen Injection. CCK-8 assay was used to assess the changes in viability of the treated cells, and the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β), and vascular endothelial growth factor (VEGF) in the cell supernatant were detected using ELISA; Western blotting was performed to detect the protein expressions of E-cadherin, α-smooth muscle actin (α-SMA), p-Smad 2/3, and Smad 7 in the cells. RESULTS: Culture in 40% peritoneal dialysis fluid for 72 induced significant EndMT in HMrSV5 cells, which exhibited obviously lowered cell viability. Danshen Injection within the concentration range of 0.025%-1.5% did not significantly affect the viability of the cells. Exposure of HMrSV5 cells to peritoneal dialysis fluid for 72 h significantly increased the production of IL-6, TNF‑α, TGF‑β and VEGF, upregulated the protein expressions of α‑SMA and p-Smad 2/3, and lowered the expressions of E-cadherin and Smad7 proteins. Treatment of the exposed cells with Danshen injection significantly increased cell viability and cellular expressions of E-cadherin and Smad 7 proteins and reduced the production of IL-6, TNF-α, TGF-β and VEGF and the protein expressions of α‑SMA and p-Smad 2/3. CONCLUSIONS Danshen Injection can suppress peritoneal dialysis fluid-induced EndMT in HMrSV5 cells possibly by regulating the TGF-β/Smad signaling pathway.
Signal Transduction/drug effects* ; Drugs, Chinese Herbal/pharmacology* ; Transforming Growth Factor beta/metabolism* ; Humans ; Peritoneal Dialysis/adverse effects* ; Salvia miltiorrhiza ; Epithelial-Mesenchymal Transition/drug effects* ; Smad Proteins/metabolism* ; Vascular Endothelial Growth Factor A/metabolism* ; Cell Line ; Tumor Necrosis Factor-alpha/metabolism* ; Interleukin-6/metabolism* ; Cadherins/metabolism* ; Actins/metabolism* ; Dialysis Solutions ; Endothelial-Mesenchymal Transition

Objective:To investigate the application effect of situational simulation combined with the Debriefing-GAS method in the teaching of prenatal genetic counseling.Methods:A total of 30 medical students of the five- and eight-year programs in the classes of 2017 and 2018 who received genetic counseling training in The First Affiliated Hospital of Sun Yat-sen University from May 2021 to May 2022 were selected as research subjects, and situational simulation combined with the debriefing-GAS method was used for the teaching of prenatal genetic counseling. Assessment was performed by the teacher to evaluate the change in genetic counseling abilities during the teaching process, and a questionnaire survey was conducted to investigate the degree of satisfaction with teaching among the students. SPSS 26.0 software was used for data analysis; normally distributed continuous data were expressed as mean±standard deviation, non-normally distributed continuous data were expressed as M d(P 25,P75), and categorical data were expressed as frequency and rate; the paired samples t-test was used for comparison of assessment scores before and after teaching. Results:After teaching, there were significant increases in the assessment scores of genetic counseling [(74.5±18.6) points vs. (87.2±14.5) points, t=4.10, P<0.001] and comprehensive abilities such as clinical ability [(35.4±9.6) points vs. (41.1±6.9) points, t=3.72, P=0.001], doctor-patient communication [(17.5±4.6) points vs. (20.8±3.8) points, t=4.34, P<0.001], professional literacy [(11.0±2.5) points vs. (12.5±2.3) points, t=2.89, P=0.007], teamwork [(3.5±1.0) points vs. (4.2±0.8) points, t=3.67, P=0.001], and organizational effectiveness [(7.1±2.0) points vs. (8.3±1.7) points, t=2.94, P=0.006]. The questionnaire survey showed that the degree of satisfaction among students was rated above satisfaction for the reasonability of the implementation process and links of genetic counseling teaching [3.0 (3.0, 4.0) points], teaching quality [3.5 (3.0, 4.0) points], whether the teaching model could effectively increase the interest and initiative in learning [4.0 (3.0, 4.0) points], the improvement in theoretical knowledge [4.0 (3.0, 4.0) points], communication skills in genetic counseling [3.0 (3.0, 4.0) points], and the understanding of related techniques and application prospect [3.0 (3.0, 4.0) points]. However, two students (6.7%) thought that this teaching model could not efficiently reach teaching objectives, since the teaching process was slightly complicated. Conclusions:Situational simulation combined with the debriefing-GAS method has achieved a good effect in the teaching of prenatal genetic counseling and can help undergraduates to master the theoretical knowledge of prenatal genetic counseling and improve their comprehensive clinical abilities, with a relatively high degree of satisfaction, and therefore, it holds promise for clinical application.

Objective To investigate the inhibitory effect of Danshen Injection on endothelial-mesenchymal transition(EndMT)induced by peritoneal dialysis fluid in HMrSV5 cells and the role of the TGF-β/Smad signaling pathway in mediating this effect.Methods HMrSV5 cells cultured in 40％peritoneal dialysis solution for 72 h to induce EndMT were treated with 0.05％,0.1％and 0.5％Danshen Injection.CCK-8 assay was used to assess the changes in viability of the treated cells,and the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),transforming growth factor-β(TGF-β),and vascular endothelial growth factor(VEGF)in the cell supernatant were detected using ELISA;Western blotting was performed to detect the protein expressions of E-cadherin,α-smooth muscle actin(α-SMA),p-Smad 2/3,and Smad 7 in the cells.Results Culture in 40％peritoneal dialysis fluid for 72 induced significant EndMT in HMrSV5 cells,which exhibited obviously lowered cell viability.Danshen Injection within the concentration range of 0.025％-1.5％did not significantly affect the viability of the cells.Exposure of HMrSV5 cells to peritoneal dialysis fluid for 72 h significantly increased the production of IL-6,TNF-α,TGF-β and VEGF,upregulated the protein expressions of α-SMA and p-Smad 2/3,and lowered the expressions of E-cadherin and Smad7 proteins.Treatment of the exposed cells with Danshen injection significantly increased cell viability and cellular expressions of E-cadherin and Smad 7 proteins and reduced the production of IL-6,TNF-α,TGF-β and VEGF and the protein expressions of α-SMA and p-Smad 2/3.Conclusion Danshen Injection can suppress peritoneal dialysis fluid-induced EndMT in HMrSV5 cells possibly by regulating the TGF-β/Smad signaling pathway.

It is necessary to develop rapid and living guidelines in order to improve the evidence translation and guidance for clinical practice in emergency situations， and to enhance the participation of traditional Chinese medicine （TCM） in management of emergencies. This paper introduced the process of developing rapid and living guidelines of TCM and divided it into three stages， that is preparation， rapid development and dynamic updating， which highlights the features of rapid development， high quality， and dynamic updating and the integration with the predominance of TCM. By comparing with general guidelines on composition， personnel number， timing to formulate and communication patterns of the guideline working groups， as well as the content and number of clinical questions， this paper mainly gave suggestions on how to formulate a concise but authoritative team during the preparation stage， how to efficiently manage the guideline team and promote the development process from conflict of interest management， working and communication mode adjustment， and how to formulate and update the important and prioritized clinical questions， all of which may provide reference for the development of TCM rapid and living guidelines.