Objective To observe the clinical efficacy of withdrawal therapy based on regulating nutritive qi and defensive qi(shortened to Tiaohe Yingwei method)in treating sedative-hypnotic dependent insomnia of disharmony between nutritive qi and defensive qi type.Methods Ninety patients with sedative-hypnotic dependent insomnia of disharmony between nutritive qi and defensive qi type were randomly divided into the treatment group and the control group,with 45 patients in each group.The control group was given oral use of Estazolam by 25%of weekly dose-reduction,while the treatment group was treated with Chinese medicinal decoction of Tiaohe Yingwei Zhumian Prescription based on Tiaohe Yingwei method together with Estazolam.The treatment course for the two groups lasted for 4 weeks.The changes of Pittsburgh Sleep Quality Index(PSQI)scores,total TCM syndrome scores,and Drug-withdrawal Syndrome Scale(DWSS)scores in the two groups were observed before and after treatment.After treatment,the efficacy for improving sleep efficiency value(IUSEV)and clinical safety in the two groups were evaluated.Results(1)During the trial,2 cases fell off in the treatment group,and 43 cases included in the statistics;3 cases fell off in the control group,and 42 cases included in the statistics.(2)After 4 weeks of treatment,the total effective rate for improving IUSEV of the treatment group was 88.37%(38/43),and that of the control group was 61.90%(26/42).The intergroup comparison by non-parametric rank-sum test showed that the efficacy for improving IUSEV in the treatment group was significantly superior to that in the control group(P＜0.05).(3)After treatment,obvious reduction was shown in the overall PSQI scores and the scores of the items of sleep quality,time for falling asleep,sleep time,sleep efficiency,sleep disorder and daytime dysfunction in the two groups when compared with those before treatment(P＜0.05).The intergroup comparison showed that except for the items of sleep disorder and daytime dysfunction,the treatment group had stronger effect on decreasing the scores of the remaining items and the overall PSQI scores than the control group(P＜0.05).(4)After treatment,the total scores of TCM syndromes of both groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of the total scores of TCM syndrome in the treatment group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the total DWSS scores of the two groups were significantly decreased compared with those before treatment(P＜0.05),and the effect on lowering the scores in the treatment group was significantly superior to that in the control group(P＜0.05).(6)During the course of treatment,no significant adverse reactions occurred in the two groups,or no abnormal changes were found in the safety indexes such as routine test of blood,urine and stool,liver and kidney function,and electrocardiogram of the patients.Conclusion Withdrawal therapy based on Tiaohe Yingwei method exerts certain effect for the treatment of sedative-hypnotic dependent insomnia of disharmony between nutritive qi and defensive qi type.The therapy is effective on improving the quality of sleep and reducing the incidence of drug-withdrawal syndrome,and has a high safety.

Objective To investigate the occurrence of adverse events of lurasidone in the U.S.Food and Drug Administration Adverse Event Reporting System(FAERS)database by using Open Vigil FDA2.1,to enrich the experience and provide the basis for the clinical use of the drug in China.Methods Using Open Vigil FDA2.1,adverse event data were extracted from the FAERS database for a total of 51 quarters from the 4th quarter of 2010 to the 3rd quarter of 2023,and the ratio of reporting ratio(ROR)method and the proportional reporting ratio(PRR)method were used for data mining and analysis.Results A total of 32 728 adverse event reports with lurasidone as the first suspected drug was obtained,with a larger proportion of females(54.26％)and occurring mostly in adults(18 to 59 years).After the screening,326 preferred term(PT)signals were obtained,involving 20 system-organ classifications(injury,poisoning and procedural complications,general disorders and administration site conditions,psychiatric disorders,etc.).Among them,PTs with the higher frequency of occurrence included off label use,feeling abnormal,crying,anxiety,depression,insomnia,etc.PTs with stronger signal strength included activation syndrome,mania,tongue movement disturbance,hypoprolactinaemia,akathisia,etc.Multiple new suspected adverse drug reactions were unearthed,including hypoprolactinaemia,emotional poverty,stiff tongue,etc.Conclusion Lurasidone has a favorable safety profile,and women need to closely monitor prolactin levels when taking this medication.The drug is relatively safe for use in pregnant,puerperal and perinatal women and patients with poor metabolic function.Hypoprolactinaemia and restless leg syndrome are new rare suspected adverse events with lurasidone.

Objective: To investigate the clinical features and short-term prognosis of patients with SARS-CoV-2 infection associated acute encephalopathy (AE). Methods: Retrospective cohort study. The clinical data, radiological features and short-term follow-up of 22 cases diagnosed with SARS-CoV-2 infection associated AE in the Department of Neurology, Beijing Children's Hospital from December 2022 to January 2023 were retrospectively analyzed. The patients were divided into cytokine storm group, excitotoxic brain damage group and unclassified encephalopathy group according to the the clinicopathological features and the imaging features. The clinical characteristics of each group were analyzed descriptively. Patients were divided into good prognosis group (≤2 scores) and poor prognosis group (>2 scores) based on the modified Rankin scale (mRS) score of the last follow-up. Fisher exact test or Mann-Whitney U test was used to compare the two groups. Results: A total of 22 cases (12 females, 10 males) were included. The age of onset was 3.3 (1.7, 8.6) years. There were 11 cases (50%) with abnormal medical history, and 4 cases with abnormal family history. All the enrolled patients had fever as the initial clinical symptom, and 21 cases (95%) developed neurological symptoms within 24 hours after fever. The onset of neurological symptoms included convulsions (17 cases) and disturbance of consciousness (5 cases). There were 22 cases of encephalopathy, 20 cases of convulsions, 14 cases of speech disorders, 8 cases of involuntary movements and 3 cases of ataxia during the course of the disease. Clinical classification included 3 cases in the cytokine storm group, all with acute necrotizing encephalopathy (ANE); 9 cases in the excitotoxicity group, 8 cases with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and 1 case with hemiconvulsion-hemiplegia syndrome; and 10 cases of unclassified encephalopathy. Laboratory studies revealed elevated glutathione transaminase in 9 cases, elevated glutamic alanine transaminase in 4 cases, elevated blood glucose in 3 cases, and elevated D-dimer in 3 cases. Serum ferritin was elevated in 3 of 5 cases, serum and cerebrospinal fluid (CSF) neurofilament light chain protein was elevated in 5 of 9 cases, serum cytokines were elevated in 7 of 18 cases, and CSF cytokines were elevated in 7 of 8 cases. Cranial imaging abnormalities were noted in 18 cases, including bilateral symmetric lesions in 3 ANE cases and "bright tree appearance" in 8 AESD cases. All 22 cases received symptomatic treatment and immunotherapy (intravenous immunoglobulin or glucocorticosteroids), and 1 ANE patient received tocilizumab. The follow-up time was 50 (43, 53) d, and 10 patients had a good prognosis and 12 patients had a poor prognosis. No statistically significant differences were found between the two groups in terms of epidemiology, clinical manifestations, biochemical indices, and duration of illness to initiate immunotherapy (all P>0.05). Conclusions: SARS-CoV-2 infection is also a major cause of AE. AESD and ANE are the common AE syndromes. Therefore, it is crucial to identify AE patients with fever, convulsions, and impaired consciousness, and apply aggressive therapy as early as possible.
Child ; Female ; Male ; Humans ; Retrospective Studies ; Cytokine Release Syndrome ; COVID-19/complications* ; SARS-CoV-2 ; Brain Diseases/etiology* ; Prognosis ; Seizures ; Cytokines

OBJECTIVE To explore the efficacy of Sour Jujube Seed Decoction combined with Huanglian Wendan Decoction on adult chronic insomnia and its effect on hypnotic withdrawal.METHODS 187 patients with chronic insomnia were included for anal-ysis,including 102 in the traditional Chinese medicine(TCM)group and 85 in the western medicine group.The TCM group was trea-ted with Sour Jujube Seed Decoction combined with Huanglian Wendan Decoction,while the western medicine group was treated with benzodiazepine under the consideration of doctor.The intervention period was 1 month,with assessments using the Pittsburgh Sleep Quality Index(PSQI)conducted before and after the intervention.Follow-up evaluations were performed at 3 months and 6 months re-spectively after the intervention.RESULTS There was no significant difference between the two groups at baseline.After the inter-vention,the PSQI scores of patients in both groups were significantly improved(P<0.01).Among them,the TCM group was better than the western medicine group in the improvement of sleep quality and sleeping pills,total PSQI score reduction(P<0.01).The re-sults of linear regression analysis showed that after controlling for confounding factors,the regression coefficients of the TCM group in two different models were1.821 and 1.922 respectively,and the former was statistically significant(P<0.05).By screening patients who took hypnotics at baseline in the TCM group and comparing them with those in the western medicine group,the influencing factors of hypnotic withdrawal were analyzed.During the 3-month follow-up,25 out of 39 patients in the TCM group and 17 out of 80 patients in the western medicine group had hypnotic withdrawal(χ2= 19.25,P<0.001);during the 6-month follow-up,23 of the 39 patients in the TCM group and 18 of the 79 patients in the western medicine group had hypnotic withdrawal(χ2= 13.53,P<0.001),the with-drawal rate of patients in the TCM group was significantly higher than that in the western medicine group.Further regression analysis showed that after adjusting for confounding factors,the results showed that the western medicine group had a significantly higher rate of not withdrawal than the TCM group at 3 months(OR=5.50,95%CI:2.30～13.72)and 6 months(OR=6.43,95%CI:2.54～17.77),and the results were statistically different(P<0.05).CONCLUSION Sour Jujube Seed Decoction combined with Huangli-an Wendan Decoction is effective in treating adult chronic insomnia and assisting in hypnotic withdrawal.

Type 2 diabetes is a hypermetabolic disease characterized with disorders of glucose/lipid metabolism, absolute or relative lack of insulin, and can induce skeletal muscle atrophy. Hyperglycemia, hyperlipidemia, insulin resistance, and abnormal release of inflammatory factors can lead to abnormal signal transduction in skeletal muscle, thus make protein synthesis and degradation imbalance and eventually causing muscle atrophy. Under normal conditions, insulin-like growth factor 1 (IGF-1)/insulin can activate phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT). AKT not only increases protein synthesis through mammalian target protein of rapamycin (mTOR), but also phosphorylates forkhead box O (FoxO) transcription factor and then inhibits the transcription of several ubiquitin ligases (such as MAFbx/atrogin-1 and MuRF1), or autophagy related genes. The weakened IGF-1/PI3K/AKT pathway in type 2 diabetes is an important factor leading to skeletal muscle atrophy. Studies have shown that the commonly used anti-type 2 diabetic drugs have different effects in regulating the synthesis and degradation of skeletal muscle protein. Studies reported that drugs with effect of anti-diabetic muscle atrophy include thiazolidinediones, glucagon-like peptide analogs, glucose-sodium cotransporter 2 inhibitors, etc.; drugs that are still in controversial or even promote skeletal muscle atrophy include metformin, and some sulfonylurea or non-sulfonylurea insulin secretagogues. This article overviewed and analyzed the currently commonly used drugs for type 2 diabetes and summarized the related mechanisms, with the aim to provide references for the rational applications of drugs for type 2 diabetes.

【Objective】To investigate the expression of FosB in invasive breast cancer and its correlation to the ultrasound findings and clinical significance.【Methods】Immunohistochemical and ultrasound examination were performed for 155 cases with invasive breast cancer，36 cases with paracancerous tissue and 30 cases with normal breast tissue. To investigate the correlations between the different expression of FosB with histological grade ，lymph nodes，and ultrasound findings.【Results】①The expression of FosB in paracancerous tissue and normal breast tissue was higher than that in invasive breast cancer（P＜0.01）. ②Based on immunohistochemical staining，high positive expression rate of FosB was associated with low histological grade，ER positive and PR positive（P＜0.05）. There was no correlation between FosB and age，tumor diameter，lymph nodes，Her2 and clinical stages（P＞0.05）③The expression of FosB was higher in microcalcification positive and lymph nodes bigger tissues（P＜0.05）. There was no correlation between FosB and tumor size， regular shape，boundary，posterior attenuation ratio and blood flow（P＞0.05）.【Conclusion】The expression of FosB in invasive breast cancer was lower than that in paracancerous tissue and normal breast tissue. The different expression of FosB was correlated with histological grade，ER positive and PR positive. To study the expression of FosB in invasive breast cancer may be helpful for differential diagnosis and targeted treatment. The different expression of FosB was correlated with microcalcification，lymph nodes，and combined FosB with ultrasound findings may contribute to prognostic evaluation of breast cancer.

【Objective】ToinvestigatetheexpressionandclinicalsignificanceofJunDinmolecularsubtypesofinva⁃ sivebreastcarcinoma，benignandmalignantbreastlesions.【Methods】Immunohistochemicalexaminationwasperformed for160patientswithinvasivebreastcarcinoma，191patientswithbreastintraductalproliferativelesionsand20patients withnormalbreasttissue.【Results】①ComparisonwithothersubtypesshowedthattheexpressionofJunDwassignificantly increasedinTBNCsubtype（P＜0.05）anddifferencesbetweenothersubtypeswerenotstatisticallysignificant（P＞0.05） . ②TheexpressionofJunDininvasivebreastcarcinomawaslowerthanthatinbreastintraductalproliferativelesionsand normalbreasttissuse（P <0.01） .③Basedonimmunohistochemicalstaining，highpositiveexpressionrateofJunDwas associatedwithlowhistologicalgrade（P <0.01）.ThereisnocorrelationbetweenJunDandtumordiameter，age，lymph nodes，ER，PRandhistologicalgrade（P >0.05） .【Conclusions】TheexpressionofJunDwassignificantlyincreasedin TBNCsubtype.TostudytheexpressionofJunDinTBNCsubtypeofinvasivebreastcarcinomamayprovideanevaluation intargetedtreatment.ThedifferentexpressionofJunDinbenignandmalignantbreastlesionsmaybehelpfulfortheir differentialdiagnosis.

Objective To study the temporal distribution regular pattern of under 5 mortality rate(U5MR)from 1 998 to 201 4 in Zhejiang Province,and to predict the under 5 mortality rate in 201 5.Methods A time series ARIMA (p,d,q) forecasting model for U5MR was conducted using IBM SPSS Statistics 20.0 statistical analysis software.Results The UMAR showed downward trend.The ARIMA(2,1 ,2)model of U5MR from 1 998 to 201 4 in Zhejiang Province is yt =-0.696 +0.636yt -1 +0.024yt -2 +0.340yt -3 +αt -0.003αt -1 +0.997αt -2 ,and the model fitting was good.Each of the actual mortality was consistent with the trend of model prediction,and was within the 95% confidence interval.The predicted value of U5MR was 4.08‰ (95% CI:1 .52‰ -6.64‰)in 201 5.Conclusion Time series analysis is an effective way to analyze the temporal distribution regular pattern of U5MR,which could be used for short -term prediction.

Objective To discuss the effect of mind-body relaxing therapy on the eye pressure and physiological status of patients with glaucoma after surgery.Methods 86 patients with glaucoma were randomly divided into the research group and the control group, each with 43 cases. The control group received conventional medication treatment,while the research group received mind-body relaxing therapy in addition.SCL-90 was used to test two groups' physiological status,and their eye pressure was also measured and compared.Results The total score,average score,positive item quantity,body,press,depression,anxiety,opposition,horror,crankiness and lunacy score of SCL-90 of the research group were respectively (128.98 ±37.08),(1.59 ±0.41),(23.93 ±17.12),(1.35 ±0.81),(1.79 ±0.68),(2.25 ±0.91),(2.23 ±0.92),( 1.68 ± 0.82),(2.32 ± 0.92),( 1.88 ± 0.90),( 1.96 ± 0.92 ),all of which were lower than those of the control group [ ( 154.35 ± 37.82),( 1.88 ± 0.42 ),( 35.92 ± 17.56 ),( 1.90 ± 0.88 ),( 2.25 ± 0.71 ),( 2.88 ±0.95 ),(2.96 ± 0.96),( 2.26 ± 0.88 ),(2.98 ± 0.98 ),( 2.59 ± 0.93 ),(2.66 ± 0.95 ) ],and the differences were statistically significant ( u =3.14,3.24,3.21,3.01,3.07,3.14,3.60,3.16,3.22,3.60,3.47,respectively;P ＜0.01 ).The eye pressure of the research group was (18.10± 2.56)mm Hg,obviously lower than that of the control group which was ( 22.20 ± 2.68 ) mm Hg,and the difference was statistically significant ( u =7.25,P ＜ 0.01 ).Conclusions The mind-body relaxing therapy can evidently eliminate patients 'psychological barrier to recover their eye pressure and increase their confidence in the treatment,so as to promote their recovery and maintain their health to the maximum extend.

Objective To establish a community-based management model for heart failure patients under the professional guidance of upper first-class hospital staff.Methods Two hundreds heart failure (New York Heart Function Ⅱ-Ⅳ) patients aged from 35 to 85 in two communities of Chengdu city were divided into two groups by cluster randomization:the management group and the control group.The community hospital doctors were trained for the evaluation and management of heart failure according standardized guidelines by upper first-class hospital doctors,and responsible for the management of patients in the management group.Meanwhile,the management group patients also received self-care education.Patients in control group were treated by community doctors without special training.Data including the community hospital doctors' knowledge rate of heart failure,positive diagnosis rate,and the rate for standardized medication for heart failure; the patients' knowledge rate of heart failure,the rate of drug compliance,the rate of standardized drug taken for heart failure,the rate of self-care in daily-life,the quality of life,the iucidence of cardiovascular events,hospitalization time and cost were compared between the two groups.Results The community hospital doctors' knowledge rate of heart failure,the related knowledge for prevention and treatment on the causes of heart failure,the positive diagnosis rate,and the rate for standardized medication for heart failure [β receptor blocker 77.3％ (17/22); angiotensinconverting enzyme inhibitors 63.6％ (14/22)] were significantly higher than doctors in the control group (all P ＜ 0.05).There were 96 in the management group and 97 in the control group.Data were similar between the two groups at baseline.After (18.5 ± 0.5)months,the patient's knowledge rate of heart failure [100％ (96/96) vs.71.1％ (69/97)],the rate of drug compliance [78.1％ (75/96) vs.13.4％ (13/97)],the rate of standardized drug taken for heart failure[β receptor blocker:75.0％ (72/96) vs.8.2％(8/97) ; angiotensin-converting enzyme inhibitors:60.4％ (58/96) vs.10.3％ (10/97)],and the rate of self-care in daily-life [salt and food restriction:88.5％ (85/96) vs.29.9％ (23/97) ; blood pressure monitoring:83.3％ (80/96) vs.56.7％ (55/97) ; weight monitoring:78.1％ (75/96) vs.13.4％ (13/97)] were all significantly higher in the management group than in control group.For patients with New York Heart Function Ⅲ-Ⅳ,the score of the LiHFe questionnaire (43.7 ± 9.2 vs.49.5 ± 11.3),the incidence of cardiovascular events [63.3％ (19/30) vs.90.3％ (28/31)],the days of hospitalization [(8.2 ± 3.2) days vs.(13.9 ± 10.9) days],and the cost for hospitalization [(2873.3 ± 401.6) Yuan vs.(4525.8 ±6417.8) Yuan] were all significantly lower in the management group(n =30) than in the control group(n =31) (all P ＜ 0.05).Conclusions The community-based management model for heart failure patients in the community level is effective to improve the management and outcome in this cohort.