As a patented characteristic medicine of Yi ethnic minority， Pingxuan capsules have the effects of nourishing the liver and kidney， pacifying the liver， and subduing Yang. With the main indications of dizziness， headache， palpitations， tinnitus， insomnia， dreaminess， waist and knee soreness caused by liver-kidney deficiency and liver Yang upward disturbance， Pingxuan capsules are widely used in the treatment of posterior circulation ischemic vertigo， vestibular migraine， benign paroxysmal positional vertigo. However， the current knowledge is limited regarding the efficacy， syndrome differentiation， and safety of this medicine. On the basis of summarizing the experience of clinicians and the existing evidence， this study invites clinical experts of traditional Chinese and Western medicine， pharmaceutical experts， and methodological experts from relevant fields across China to conduct evidence-based evaluation of Pingxuan capsules. The evaluation follows the Specifications for the Development of Clinical Expert Consensus on Chinese Patent Medicines issued by the Standardization Office of the China Association of Chinese Medicine， and reaches 5 recommendations and 16 consensus suggestions. The consensus clarifies the clinical applications， efficacy， dose， course of treatment， combination of medicines， precautions， and contraindications of Pingxuan capsules in the treatment of vertigo and explains the safety of clinical application. This consensus is applicable to clinicians （traditional Chinese medicine， Western medicine， and integrated traditional Chinese and Western medicine） and pharmacists in tertiary hospitals， secondary hospitals， and community-level medical and health institutions across China， providing a reference for the rational use of Pingxuan capsules in the treatment of vertigo. It is hoped that the promotion of this consensus can facilitate the rational use of drugs in clinical practice， reduce the risk of drug use， and give full play to the advantages of Pingxuan capsules in the treatment of vertigo diseases. This consensus has been reviewed and published by the China Association of Chinese Medicine， with the number GS/CACM330-2023.

Background The impact of cold spells on population health can be categorized into an independent main effect of extreme low temperatures and an added effect of prolonged low temperatures. However, studies on the added effects of cold spells on hospitalizations remain limited. Objective To investigate the added effects of cold spells on hospitalizations of residents in Hengyang City, Hunan Province, and to provide a scientific basis for establishing a cold spell early warning system. Methods Daily meteorological data, air pollutant data, and hospitalization data from six tertiary hospitals of four districts in Hengyang City from 2017 to 2023 were collected. A generalized linear model (GLM) combined with a distributed lag nonlinear model (DLNM) was used to assess the added effects of cold spells on non-accidental hospitalizations, as well as hospitalizations for circulatory system diseases and respiratory system diseases, after controlling the main effect of temperature. The modifying effects of cold spell characteristics (intensity and duration) and individual characteristics (gender and age) were also analyzed. Results Compared with non-cold spell periods, the relative risks (RRs) of total non-accidental hospitalizations and hospitalizations across disease categories, genders, and age groups were elevated during cold spells of varying intensities and durations. However, the total effects of cold spells exhibited a "U-shape" nonlinear relationship with intensity and decreased with prolonged duration. During high-intensity cold spells (daily average temperature < P₅ and lasting ≥ 2 d), the RR (95%CI) for non-accidental hospitalizations was 1.71 (1.21, 2.42); the RRs (95%CIs) for males and females were 1.99 (1.38, 2.84) and 1.47 (1.00, 2.16), respectively; for individuals < 65 years and ≥ 65 years, the RRs (95%CIs) were 1.59 (1.12, 2.26) and 1.93 (1.27, 2.92), respectively; and for circulatory and respiratory system diseases, the RRs (95%CIs) were 1.84 (1.22, 2.79) and 1.07 (0.71, 1.60), respectively. No statistically significant differences were observed between the above subgroups. The single-day lagged effects of cold spells displayed a two-peaked pattern. The single-day lag RR for total non-accidental hospitalizations peaked at lag 1 d after cold spell exposure, declined thereafter, and began to rise again after lag 5 d, reaching a second peak at lag 12–13 d before gradually decreasing. The lagged effects remained statistically significant during lag 8–18 d. The lag patterns of cold spell associations across disease categories, genders, and age groups were largely consistent with those of total hospitalizations. Conclusion Cold spells have a significant impact on non-accidental hospitalizations of residents in Hengyang City, with notable lagged effects. The findings provide important theoretical support for establishing a more targeted cold spell early warning system.

BackgroundModified electroconvulsive therapy （MECT） is a common front-line strategy widely used in psychiatric practice， and the optimal first stimulus dosage in MECT is usually estimated clinically based on the factors influencing the patient's initial seizure threshold （IST）. However， previous studies on the influencing factors of IST have mostly suffered from limitations such as small sample sizes and single-dimensional research perspectives. ObjectiveTo explore the factors influencing IST in MECT for patients with mental disorders， so as to provide references for stimulus dosing strategies in MECT for the patients. MethodsA retrospective study was used to include 1 446 inpatients fulfilling the diagnostic criteria for any specific mental disorder listed in the ICD-10 and receiving MECT at Shandong Daizhuang Hospital from January 1， 2021 to August 1， 2023. Their general and clinical data were collected， including IST， psychiatric diagnostic categories， gender， ethnicity， age， body weight， body mass index （BMI）， course of disease， family history of psychiatric disorders， first episode status， use of antiepileptic drugs the day before treatment， use of benzodiazepines the day before treatment， and previous MECT treatment history. Pearson correlation analysis was utilized to test the correlation of IST with age， height， body weight， BMI， and course of disease， and stepwise multivariate linear regression analysis was performed to identify the factors affecting IST. ResultsIST yielded statistical difference among patients in terms of gender， first episode status， use of antiepileptic drugs the day before treatment， and use of benzodiazepines the day before treatment （t=2.256， -3.059， -2.136， -3.006， P<0.05 or 0.01）. IST in patients of different ages and psychiatric diagnostic categories also demonstrated statistical difference （F=913.120， 6.212， P<0.01）. Within young population， IST varied significantly based on the psychiatric diagnostic categories （F=2.986， P<0.05）. Correlation analysis indicated that IST was positively correlated with age， body weight， BMI and course of disease （r=0.886， 0.055， 0.184， 0.456， P<0.05 or 0.01）， and negatively correlated with height （r=-0.183， P<0.01）. Stepwise multivariate linear regression analysis revealed that age， gender， and body weight were influencing factors of IST （β=0.888， -0.049， -0.035， P<0.01）. ConclusionsAge， gender and body weight may be factors influencing IST in MECT for patients with mental disorders. ［Funded by Key R&D Plan Projects of Jining City in 2024 (number, 2024YXNS202）］

Objective To observe the efficacy and safety of repetitive transcranial magnetic stimulation(rTMS)on refractory tinnitus and the differences of resting-state functional magnetic resonance imaging(rs-fMRI)imaging between before and after treatment,and to explore the possible central mechanism of rTMS regulation of tinnitus.Methods Thirty-seven patients with refractory tinnitus admitted in Affiliated Hospital of North Sichuan Medical College from September 2022 to February 2023 were selected and were divided into experimental group(n=20)and control group(n=1 7).The experimental group was given true rTMS treatment,and the control group was given sham stimulation with the same parameters.Tinnitus handicap inventory(THI)score,tinnitus loudness visual analogue scale(VAS)score and rs-fMRI scan were performed before and after treatment.Regional homogeneity(ReHo)was calculated after scanning,and the different brain regions were selected as the area of interest(ROI)and the whole brain functional connection(FC)was performed.Results There were no significant differences in age,gender,education level,tinnitus side,course of disease,hearing level,self-rating depression scale,self-rating anxiety scale the experimental group and control group.There were no significant differences in THI and VAS scores between the two groups before treatment;the THI and VAS scores in the experimental group decreased after 2 weeks of rTMS treatment(P＜0.001),while there was no significant difference in the two scores in the control group before and after treatment.Only 3 patients in the experimental group experienced left facial muscle tremor or transient mild scalp pain during treatment,without other serious side effects.The ReHo of the left cerebellar area 9 increased in the experimental group after rTMS(P＜0.005);the ReHo values in the right inferior temporal gyrus,left posterior central gyrus and left anterior central gyrus increased in the control group after intervention(P＜0.005).The FCs between the right inferior temporal gyrus and the left orbital inferior frontal gyrus,the left anterior cingulate gyrus increased in the experimental group(P＜0.005),and FC between the right inferior temporal gyrus and the left superior marginal gyrus decreased(P＜0.005).The FCs between the right cuneus and the left fusiform gyrus,right superior occipital gyrus decreased in the experimental group after rTMS(P＜0.005).The FC between the right cuneus and the left fusiform gyrus increased in the control group after intervention(P＜0.005),while other FCs remained unchanged.Conclusions rTMS has a certain therapeutic effect on refractory tinnitus with higher safety;regulation of auditory brain network and related non-auditory brain network may be one of the central mechanisms of rTMS treating refractory tinnitus.

BackgroundMajor depressive disorder is one of the most disabling mental diseases. Currently， medication in combination with physiotherapy and psychotherapy remains the most commonly used treatment modality for the disease， whereas only a few randomized controlled studies have been conducted on physiotherapy， and even fewer studies have focused on medication combined with physiotherapy. ObjectiveTo explore the efficacy and safety profile of repetitive transcranial magnetic stimulation （rTMS） versus modified electroconvulsive therapy （MECT） in combination with antidepressants in the treatment of major depressive disorder， so as to provide an optimized treatment plan for patients with major depressive disorder. MethodsPatients with major depressive disorder （n=335） hospitalized in Shandong Daizhuang Hospital from January 1， 2019 to April 30， 2023 were included， all of whom met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10）. Depending on their disease condition， patients were subjected to either MECT in combination with drugs （n=141） or rTMS in combination with drugs （n=194） after admission. Depressive symptoms were assessed using Hamilton Depression Scale-24 item （HAMD-24） at the baseline and the end of the 1^st， 2^nd， 3^rd and 4^th week of treatment， and the adverse reactions were documented in patient's medical records. ResultsAnalysis of variance on HAMD-24 revealed a significant effect of time （F=3.081， P=0.042）， but no effect of group （F=1.023， P=0.313）， and the interaction effect between the time and the groups was not statistically significant （F=1.642， P=0.191）. No statistical difference was reported between two groups in response rate and full remission rate （P>0.05）. Throughout the course of treatment， 58 cases （41.13%） of recent memory impairment and 74 cases （52.48%） of headache or neck muscle pain occurred in MECT combined with drugs group， and 27 cases （13.92%） in rTMS combined with drugs group experienced headache or head skin discomfort. ConclusionAntidepressants in combination with rTMS or MECT show equivalent efficacy in the treatment of major depressive disorder， while rTMS combined with antidepressants demonstrates a superior safety profile compared to MECT.

Objective:To develop a risk prediction model for identifying bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH) in very premature infants.Methods:This was a retrospective cohort study. The clinical data of 626 very premature infants whose gestational age <32 weeks and who suffered from BPD were collected from October 1 st, 2015 to December 31 st, 2021 of the Seventh Medical Center of the People′s Liberation Army General Hospital as a modeling set. The clinical data of 229 very premature infants with BPD of Hunan Children′s Hospital from January 1 st, 2020 to December 31 st, 2021 were collected as a validation set for external verification. The very premature infants with BPD were divided into PH group and non PH group based on the echocardiogram after 36 weeks′ corrected age in the modeling set and validation set, respectively. Univariate analysis was used to compare the basic clinical characteristics between groups, and collinearity exclusion was carried out between variables. The risk factors of BPD associated PH were further screened out by multivariate Logistic regression, and the risk assessment model was established based on these variables. The receiver operating characteristic (ROC) area under curve (AUC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model′s discrimination and calibration power, respectively. And the calibration curve was used to evaluate the accuracy of the model and draw the nomogram. The bootstrap repeated sampling method was used for internal verification. Finally, decision curve analysis (DCA) to evaluate the clinical practicability of the model was used. Results:A total of 626 very premature infants with BPD were included for modeling set, including 85 very premature infants in the PH group and 541 very premature infants in the non PH group. A total of 229 very premature infants with BPD were included for validation set, including 24 very premature infants in the PH group and 205 very premature infants in the non PH group. Univariate analysis of the modeling set found that 22 variables, such as artificial conception, fetal distress, gestational age, birth weight, small for gestational age, 1 minute Apgar score ≤7, antenatal corticosteroids, placental abruption, oligohydramnios, multiple pulmonary surfactant, neonatal respiratory distress syndrome (NRDS)>stage Ⅱ, early pulmonary hypertension, moderate-severe BPD, and hemodynamically significant patent ductus arteriosus (hsPDA) all had statistically significant influence between the PH group and the non PH group (all P<0.05). Antenatal corticosteroids, fetal distress, NRDS >stage Ⅱ, hsPDA, pneumonia and days of invasive mechanical ventilation were identified as predictive variables and finally included to establish the Logistic regression model. The AUC of this model was 0.86 (95% CI 0.82-0.90), the cut-off value was 0.17, the sensitivity was 0.77, and the specificity was 0.84. Hosmer-Lemeshow goodness-of-fit test showed that P>0.05. The AUC for external validation was 0.88, and the Hosmer-Lemeshow goodness-of-fit test suggested P>0.05. Conclusions:A high sensitivity and specificity risk prediction model of PBD associated PH in very premature infants was established. This predictive model is useful for early clinical identification of infants at high risk of BPD associated PH.

Objective:To investigate the effects of Longmu Anshen prescription on microglia(MG)polarization in the medial prefrontal cortex(mPFC)and anxiety behavior of chronic restraint stress(CRS)mice.Methods:Forty-eight healthy male KM mice were randomly divided into normal group,paroxetine hydrochloride group and Longmu Anshen prescription high,middle and low dose groups.From the 15th day,after 30 minutes of CRS every day,the normal group and the model were given distilled water by gavage,the paroxetine hydrochloride group was given paroxetine hydrochloride(2.6 mg/kg)by gavage,and the traditional Chinese medicine group was given Longmu Anshen prescription at high,medium and low doses(4.16,2.08,1.04 g/kg)by gavage for 21 days.The changes of anxiety behavior in mice were evaluated by light-dark boxes experiment and elevated plus maze;ELISA was used to detect IL-1β,IL-6,TNF-α and IL-10 levels;protein expression of inducible nitric oxide synthase(iNOS)and arginase-1(Arg-1)in mice mPFC tissue were detected by Western blot;mRNA expression of ionized calcium binding adaptor molecule-1(Iba-1),iNOS and Arg-1 in mice mPFC tissue were detected by RT-PCR;the protein expression of Iba-1 in mice hippocampal tissue was detected by immuno-histochemistry(IHC).Results:Compared with normal group,the residence time in the light boxes,the number of times of shuttle between the light-dark boxes,the percentage of times of entering the open arm(OE%)and the percentage of time spent in the open arm(OT%)of mice in model group were significantly reduced(P<0.01);moreover,in the mPFC tissue of the model group mice,the protein and mRNA expressions of Iba-1 and iNOS were significantly increased(P<0.01),and the levels of IL-1β,IL-6 and TNF-α were significantly increased(P<0.01),while the protein and mRNA expressions of Arg-1 were significantly decreased(P<0.01),and the level of IL-10 was significantly decreased(P<0.01).Compared with model group,the residence time in the light boxes,the number of shuttles between the light-dark boxes,the OE%and OT%of mice in the paroxetine hydrochloride group and the high and medium dose groups of Longmu Anshen prescription were significantly increased(P<0.01);the expression levels of Iba-1 and iNOS protein and mRNA in mPFC tissue were significantly decreased(P<0.05,P<0.01),and the levels of IL-1β,IL-6 and TNF-α were significantly decreased(P<0.01),while the expression levels of Arg-1 protein and mRNA were significantly increased(P<0.01).IL-10 level was significantly increased(P<0.01).Conclusion:Longmu Anshen prescription can inhibit the activation of MG in mPFC tissues of CRS mice and may reduce nerve inflammation and increase the level of anti-inflammatory cytokines by regulating the polarization phenotype of M1/M2,thereby ameliorate CRS-induced anxiety behavior.

In November 2023, the seventh National Nucleic Acid Vaccine Conference was held to deeply discuss the immune mechanism, safety risks, advantages, and disadvantages of nucleic acid vaccines, and review the safety and effectiveness of COVID-19 vaccines developed by nucleic acid vaccine technology. Some prospectives were formed in the meeting that in the post-pandemic era, nucleic acid vaccine technology will play a role in the following areas: dealing with pathogens that are difficult to be prevented by traditional vaccines, promoting the upgrading of traditional live attenuated vaccines, contributing to the development of multivalent and combined vaccines, and rapid response to emerging and re-emerging infectious diseases. These views point out the direction for the future development of nucleic acid vaccine technology.

Objective:To investigate the effect of biological maternal sounds on blood gas analysis index, mechanical ventilation time, oxygen therapy time and hospital stay in mechanically ventilated children with severe pneumonia.Methods:This study was a randomized controlled trial. From June 2020 to November 2020, 128 mechanically ventilated children with severe pneumonia in Hunan Children′s Hospital were selected by convenient sampling method and divided into four groups with 32 cases in each group by random number table method. Group A was given routine nursing care, group B was given mother sounds, group C was given mother cardiotone, group D was given biological maternal sounds. Data of blood gas analysis index, mechanical ventilation duration, oxygen therapy duration, hospital stays were collected for comparative analysis.Results:Finally, group A, B, C, and D included 28, 30, 28 and 28 cases, respectively. There was no statistically significant difference in PaO 2 among the four groups on the 1st to 2nd day after intervention ( P>0.05), but PaO 2 on the 3rd to 7th day after intervention were (75.57 ± 12.88), (77.71 ± 15.81), (78.21 ± 14.51), (78.64 ± 17.71), (79.04 ± 11.57) mmHg (1 mmHg=0.133 kPa), (81.71 ± 17.89), (82.93 ± 18.36), (82.68 ± 15.47), (83.25 ± 14.24), (83.77 ± 13.90) mmHg, (80.89 ± 18.78) (82.11 ± 13.34), (82.96 ± 14.20), (83.43 ± 14.37), (83.68 ± 12.64) mmHg, (84.54 ± 18.77), (86.29 ± 10.94), (86.96 ± 10.53), (87.46 ± 12.64), (89.08 ± 12.21) mmHg, with statistically significant differences ( F values were 41.17 - 332.68, all P<0.01). Further pairwise comparison revealed that PaO 2 in group B and group C were higher than those in group A on the 3rd to 7th day after intervention, while those in group D were higher on the 3rd to 7th day after intervention than those in group A, B, and C, with statistically significant differences( t values were 3.35- 4.75, all P<0.01). There was no statistically significant difference in PaCO 2 among the four groups on the 1st to 4th day after intervention ( P>0.05), but PaCO 2 on the 5th to 7th day after intervention was (47.31 ± 2.89), (46.18 ± 2.06), (41.94 ± 2.09) mmHg, (44.73 ± 1.76), (41.38 ± 1.30), (38.33 ± 1.16) mmHg, (44.81 ± 1.24), (41.23 ± 1.89), (38.73 ± 2.55) mmHg, (40.83 ± 1.78), (37.87 ± 1.43), (34.78 ± 2.05) mmHg, with statistically significant differences ( F=29.48, 36.12, 34.52, all P<0.05). Further pairwise comparison revealed that PaCO 2 in group B and group C were lower than those in group A on the 5th to 7th day after intervention, while PaCO 2 in group D were lower than those in groups A, B, and C, with statistically significant differences ( t values were 3.37-4.85, all P<0.01). During the analysis of PaO 2 and PaCO 2 in the four groups at different time points, the interaction effects were not statistically significant ( P>0.05). There was no significant difference in invasive mechanical ventilation duration, non-invasive mechanical ventilation duration and hospital stay among the four groups after intervention ( P>0.05). The oxygen therapy time of the four groups were (8.61 ± 6.40), (6.17 ± 4.80), (6.23 ± 2.75), and (3.75 ± 2.10) days, with statistically significant differences ( F=17.27, P<0.01). Further pairwise comparison revealed that the oxygen therapy time in group B and group C was shorter than that in group A, while group D was significantly shorter than that in groups A, B, and C, with statistically significant differences ( t values were 4.02-4.74, all P<0.01). Conclusions:Biological maternal sounds is superior to maternal sound and mother cardiotone in improve the blood gas analysis index, shorten the oxygen treatment time, which is worthy of clinical promotion in neonatal unaccompanied ward.

Objective:To summarize the situation of dead newborns and their parents after parents gave up treatment, and analyze the reasons and emotional needs of parents who gave up treatment, so as to provide reference for reducing neonatal mortality and negative emotions of parents.Methods:A retrospective study was conducted to collect the data of neonates and mothers who died after giving up treatment reported in Hunan Children′s Hospital from January 2019 to December 2021. The general information, perinatal risk factors, and the incidence of in-hospital diseases were analyzed. Then, semi-structured interviews were conducted with parents of newborns who died after giving up treatment from February to December 2021. Understand why parents give up treatment and their emotional needs.Results:A total of 172 newborns died after giving up were included in the analysis, including 103 males (59.88%) and 74 premature infants (43.02%); Umbilical cord, placenta and amniotic fluid abnormalities were 21 cases (12.21%), 39 cases (22.67%) and 25 cases (14.53%), respectively. Birth asphyxia was 31 cases (18.02%), including severe asphyxia in 18 cases (10.46%); There were 21 (12.21%), 35 (20.35%) and 30 (17.44%) cases of maternal infection in the third trimester, hypertension in pregnancy and diabetes in pregnancy, respectively. The top three causes of death were septicemia (18.02%), congenital malformation (16.86%) and severe pneumonia (10.47%). The main reason why parents give up treatment was that the child′s disease was critical and irreversible, and parents had strong emotional needs for hospice care in their hearts.Conclusions:There are many high risk factors of perinatal death of newborns after giving up treatment. Sepsis is the primary cause of death, and strengthening perinatal health care is fundamental. Parents have a strong demand for hospice care, so it is of practical significance to implement family-centered hospice care model for such special newborns.