With intensified aging， Alzheimer's disease has become a serious problem in China's health field. In the field of traditional Chinese medicine （TCM）， Alzheimer's disease mainly describes cognitive deficits such as dementia and amnesia. After the inheritance and summary by medical experts of successive generations， the theory of "toxin damaging brain collaterals" has become a mature pathogenesis hypothesis of this disease. Blood stasis， as one of the main viral pathogens， is also closely related to the theory of Alzheimer's disease in modern pharmacology. Chuanxiong Rhizoma is used frequently in clinical prescriptions for Alzheimer's disease. As the main component of Chuanxiong Rhizoma， tetramethylpyrazine has a series of pharmacological effects on the cardiovascular system such as vasodilation， anti-platelet aggregation， anti-atherosclerosis， and anti-myocardial ischemia， which reflects the effects of Chuanxiong Rhizoma in activating blood circulation and removing blood stasis. However， few studies have focused on the effect of tetramethylpyrazine on the pathogenesis of Alzheimer's disease. From the perspective of TCM theory and modern pharmacology， this article discussed the effects of tetramethylpyrazine on the pathology and pathogenesis of Alzheimer's disease from the aspects of cardiovascular function， oxidative stress， inflammatory response， mitochondrial function， and cholinergic system and made prospects for the future application of tetramethylpyrazine to prevent and treat Alzheimer's disease.

Objective:To identify and analyze the genuine medicinal plant Gentiana scabra Bge. from 9 regions in Liaoning Province using DNA barcode technology based on the base sequence of internal transcribed spacer. Methods:DNA was extracted from the medicinal parts of 26 Gentiana scabra Bge. samples by using DNA kit extraction method. The ITS sequence was amplified through polymerase chain reaction (PCR), and then two-way sequencing was carried out. Other sources and outgroup sequences of the medicinal plant Gentiana scabra Bge. were downloaded from Genbank. After the sequencing results were spliced by using SeqMan 7.1.0 software, MEGA 7.0 software was used to analyze and compare the data, and calculate the genetic distance of K2P (Kimura 2-parameter). The phylogenetic tree was established by Neighbor-Joining (NJ) method for analysis. Results:According to the results of NJ cluster tree, all Gentiana scabra Bge. samples from different sources were clustered into one large branch, and Gentiana scabra Franch. and Gentiana triflora Pall. were clustered into one branch respectively, with obvious differences; Gentiana scabra and Gentiana manshurica Kitag. were clustered into one branch, and the genetic relationship was relatively close. In combination with the variation site and genetic distance, the base sequences of Gentiana scabra and Gentianamanshurica were very similar, and the interspecific differences were very small. Except for the intraspecific variation of only one sample collected in Liaoning Province, the base sequences of the other samples were the same, and there was no difference between " Gentiana scabra Bge. in Qingyuan" and Gentiana scabra Bge. samples from other regions in Liaoning Province. Conclusion:The DNA barcode technology of ITS sequence can be used to differentiate and identify medicinal plant Gentiana scabra Bge. and its original plants from different sources with a high success rate.

Objective:To use rbcL sequences to identify the rhizomes of the Liaoning collection of Atractylodes chinensis (DC.) Koidz.; To provide a basis for ensuring the feasibility of cultivation of the native herb in Liaoning Province. Methods:A total of 30 rhizomes of Atractylodes chinensis (DC.) Koidz. were collected from 10 regions cultivated in Liaoning Province, and the total DNA was extracted. DNA barcodes were screened by PCR, and the rbcL sequences of the samples were amplified and sequenced, and the amplification and sequencing success rates were calculated. Sequence alignment was performed using MEGA 7.0 software; a systematic clustering tree was constructed using the neighbour-joining method. Results:The success rates of DNA extraction from the rhizomes of Atractylodes chinensis (DC.) Koidz. were all 93.3%, and the success rates of PCR amplification and sequencing were all 100%. Among the 30 samples of Atractylodes chinensis (DC.) Koidz. in Liaoning Province, two samples had intraspecific variation, and the rest of the base sequences of Atractylodes chinensis (DC.) Koidz. were identical. Atractylodes chinensis (DC.) Koidz. was closer to the herbs of the genus Cangzhu, a relative species of Asteraceae, and was genetically more distant from the rest of Asteraceae. The NJ tree could distinguish Atractylodes chinensis (DC.) Koidz. and its relatives. Conclusion:The quality of Atractylodes chinensis (DC.) Koidz. cultivars in Liaoning Province is basically similar, and the rbcL sequence can be used as a valid sequence fragment for the identification of Atractylodes chinensis (DC.) Koidz. DNA barcode.

Objective To explore the effect of sling exercise with Tuina therapy on kinesiophobia in old patients with lumbar disc herniation,and analyze the mechanism based on brain-bone axis. Methods A total of 56 old patients with chronic lumbar disc herniation and kinesiophobia were selected from the Reha-bilitation Hospital of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from September,2022 to December,2023;and randomly divided into control group(n=28)and experimental group(n=28).The control group accepted conventional exercise therapy,while the experimental group accepted sling exercise with Tuina therapy,for four weeks.They were assessed with simplified Chinese version of Tampa Scale of Kinesiophobia(TSK),Japanese Orthopaedic Association score(JOA)and Visual Analogue Scale for pain(VAS)before and after treatment,while the bone mineral density(BMD)was tested,the levels of osteoprote-gerin(OPG),norepinephrine(NE)and corticosteroids(Cor)in serum were measured,and the median frequency(MF)of weak-link erector spinae was detected with surface electromyography. Results Two cases dropped off in the control group,and one in the experimental group.The scores of all the assessment improved in both groups after treatment(|t|>14.168,P<0.001),as well as the serum levels of OPG,NE and Cor(|t|>2.103,P<0.05),BMD(|t|>2.726,P<0.05),and MF of erector spinae(|t|>14.736,P<0.001);all of them were better in the experimental group than in the control group(|t|>2.154,P<0.05). Conclusion Sling exercise with Tuina therapy can improve the pain and kinesiophobia of lumbar disc herniation in the old adults,which may promote the recovery of physical and mental function through regulating the levels of hor-mones and neurotransmitters related to the brain-bone axis.

Objective The best evidence of respiratory muscle training for patients with mechanical ventilation in ICU after machine withdrawal was extracted and summarized to provide evidence-based evidence for respiratory muscle training for patients with mechanical ventilation after machine withdrawal.Methods We searched relevant guideline networks and association websites,as well as PubMed,Web of Science,Embase,CINAHL,CNKI,VIP,Wanfang and other databases to collect relevant guidelines,clinical decisions,evidence summaries,expert consensuses,systematic reviews and randomized controlled studies,and the search time limit is from the establishment of the databases to July 30,2023.There were 2 researchers who independently evaluated the literature quality and extracted data.Results A total of 13 articles were included,including 2 guidelines,2 clinical decisions,5 systematic reviews and 4 expert consensuses.There were 24 pieces of evidence being summarized in 7 categories,including training team,training evaluation,training methods,training frequency,training safety,training effect evaluation and health education.Conclusion This study summarizes the best evidence for respiratory muscle training in patients with mechanical ventilation after withdrawal,which can provide references for medical staffs to conduct respiratory muscle training for patients after withdrawal.It is recommended that medical staff should consider the clinical situation when applying the evidence,and selectively apply the best evidence.

A 3-year-old male patient was diagnosed with neurofibromatosis type 1(NF1) for two years. The patient has multiple neurofibromas in retroperitoneum, lumbococcygeal paravertebral, lumbosacral spinal canal, and foramina. Due to retroperitoneal mass compression, the child suffered from urological complications such as hydronephrosis, ureterdilation, neurogenic bladder, etc., which seriously affected the urination function and resulted in multiple surgical treatments. Currently, the patient has been treated with mitogen activates extracelluar signal-regulated kinases(MEK) inhibitor selumetinib targeted therapy, and has voluntarily urinated, and his general state is better than before medication. The diagnosis and treatment of this case reflects the importance of multidisciplinary collaboration in the diagnosis and treatment of rare diseases.

Objective:To explore the clinical value of cardiac MR (CMR) compression sensing (CS) ultrafast cine sequence in evaluating left and right ventricular systolic function by comparing with traditional segmented acquisition cine sequence (Seg).Methods:Twenty-seven patients with various heart disease were prospectively included. Seg, breath holding CS (bhCS) and free breathing CS (fbCS) covering the left and right ventricles using multi slices in short axis were performed in random order. Friedman test was used to evaluate the overall image quality (grade 1-5 score), blood pool myocardial signal ratio (BMC) and edge sharpness under different methods. Biventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and left ventricular myocardial mass (Mass) were measured for all three methods. The agreements of the functional measurements between bhCS and Seg (gold standard), and between fbCS and Seg were analyzed by Bland-Altman, and the correlation test was performed.Results:Twenty-four patients with diagnostic images(overall image quality score≥2) for all three methods were included in further analysis. The total imaging time of Seg, bhCS and fbCS decreased successively[375.0 (332.0, 405.6) vs. 50.0 (47.8, 53.7) vs. 20.0 (17.8, 23.7) s, χ 2=48.00, P<0.001]. The overall image quality of fbCS was slightly lower than that of Seg ( Z=-2.67, P=0.023), and there was no difference between Seg and bhCS ( Z=-1.44, P=0.447), bhCS and fbCS ( Z=1.23, P=0.660). There were no differences in edge sharpness (χ 2=1.08, P=0.582) and BMC (χ 2=0.58, P=0.747) for three methods. Bland-Altman polts showed good agreement for biventricular functional measurements between bhCS and Seg, and between fbCS and Seg. All functional measurements of bhCS and fbCS were highly correlated with that of seg ( r>0.96, P<0.001). Conclusions:Compared with traditional sequences, CS ultrafast cine sequences can save scanning time and provide similar image quality. No matter whether breath holding or not, the cardiac functional results of CS sequence and traditional cine sequence have good agreement and high correlation.

Background::Gestational weight gain (GWG) is associated with the risk of gestational diabetes mellitus (GDM). However, the effect of weight gain in different trimesters on the risk of GDM is unclear. This study aimed to evaluate the effect of GWG on GDM during different trimesters.Methods::A birth cohort study was conducted from 2017 to 2020 in Shenzhen, China. In total, 51,205 participants were included comprising two models (early pregnancy model and middle pregnancy model). Gestational weight (kg) was measured at each prenatal clinical visit using a standardized weight scale. Logistic regression analysis was used to assess the risk of GDM. Interaction analysis and mediation effect analysis were performed in the middle pregnancy model.Results::In the early pregnancy model, the risk of GDM was 0.858 times lower (95% confidence interval [CI]: 0.786, 0.937) with insufficient GWG (iGWG) and 1.201 times higher (95% CI: 1.097, 1.316) with excessive GWG after adjustment. In the middle pregnancy model, the risk of GDM associated with iGWG increased 1.595 times (95% CI: 1.418, 1.794) after adjustment; for excessive GWG, no significant difference was found ( P = 0.223). Interaction analysis showed no interaction between GWG in early pregnancy (GWG-E) and GWG in middle pregnancy (GWG-M) ( F = 1.268; P = 0.280). The mediation effect analysis indicated that GWG-M plays a partial mediating role, with an effect proportion of 14.9%. Conclusions::eGWG-E and iGWG-M are associated with an increased risk of GDM. Strict control of weight gain in early pregnancy is needed, and sufficient nutrition should be provided in middle pregnancy.

Chronic cough can occur in children of all ages, and the incidence rate and consultation rate increase each year.Clarifying the cause of chronic cough is the key to treatment.At present, there are no convenient, operable and unified standards for etiological analysis of chronic cough in the world.Therefore, the etiological analysis of chronic cough has always been a hot topic in clinical research.With the development of diagnosis and treatment technology, the role of pulmonary function and exhaled nitric oxide in the diagnosis of chronic cough has attracted attention.This article reviews the application value of pulmonary function combined with exhaled nitric oxide in etiology analysis of chronic cough in children, to provide reference for etiology analysis of chronic cough in children.

Bronchial asthma in children is a common chronic inflammation of the lower airway.It is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness.Acute asthma attack in different degrees is often accompanied by multiple system damage, including respiratory system, circulatory system, blood system and so on.At present, the literature reports about acute attack of asthma accompanied by thrombophilia, thrombosis, pulmonary embolism and other life-threatening complications gradually appear, and show an upward trend.This paper summarizes the literature of acute asthma attack with thrombophilia at home and abroad, and reviews the pathogenesis, monitoring indicators and treatment, so as to diagnose and treat early, prevent serious complications and reduce mortality.