Abstract:Transcutaneous electrical acustimulation is a method based on electroacupuncture and transcutaneous electrical nerve stimulation, and it treats diseases by applying current stimulation with percutaneous electrodes to specific acupoints close to or overlapping with the nerves. It is non-invasive, portable, easy to operate and popularize, and may play a role by balancing autonomic nervous function, improving gastrointestinal motility, and regulating the secretion of gastrointestinal hormones and neurotransmitters. It is expected to become a promising treatment for gastrointestinal diseases, such as gastroesophageal reflux disease, functional dyspepsia, chronic constipation, irritable bowel syndrome, and inflammatory bowel disease. This article reviews the origin and mechanism of transcutaneous electrical acustimulation, as well as its application and progression in gastrointestinal diseases.

Abstract:Objective To investigate the correlation between Toll-like receptor 4 (TLR4) signal and the development and progression of ulcerative colitis (UC). Methods The colon biopsy samples (n＝63) were collected from UC patients and were divided into Matts’ histological grade 1-5. The TLR4 expression level was detected by immunohistochemistry. TLR4-immunoglobulin (Ig) fusion protein was prepared using FreeStyle 293 expression system. Peripheral blood mononuclear cells (PBMCs) from healthy individuals were cultured in vitro, 100 μg/mL lipopolysaccharide was added to induce inflammation, and 100 μg/mL TLR4-Ig was added to block TLR4. Then the secretion levels of 10 different inflammatory cytokines, including granulocyte-macrophage colony-stimulating factor, interferon γ, interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, and tumor necrosis factor α, were detected. The acute colitis mouse model was induced by dextran sulfate sodium (DSS), and was intervened with 20 mg/kg TLR4-Ig, 40 mg/kg TLR4-Ig or antibiotics＋40 mg/kg TLR4-Ig, respectively. Then the colon length of mice was measured and histopathological evaluation was performed. Results The expression level of TLR4 in colon tissues of UC patients was positively correlated with Matts’ histological grades (P＜0.001). TLR4-Ig fusion protein could bind TLR4 ligands with high affinity, blocking the activation of PBMCs and the secretion of inflammatory cytokines mediated by TLR4 signal. The blocking of TLR4 signal by TLR4-Ig fusion protein aggravated DSS-induced acute colitis in mice, and treatment with antibiotics alleviated the aggravation of the colitis caused by TLR4 signal blocking. Conclusion The communication between TLR4 signal and intestinal flora is an important protective mechanism at the early stage of UC. The absence of TLR4 signal is not conducive to relieving acute inflammation and repairing intestinal mucosa.

Abstract:Objective To investigate the effects of vagus nerve stimulation (VNS) on T helper cell 17 (Th17)- and regulatory T cell (Treg)-related proteins and inflammatory factors in lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS) rats. Methods Thirty SD rats were randomly divided into control group, LPS group and LPS＋ VNS group, with 10 rats in each group. The ARDS model was established by nasal instillation of 2 mg/kg LPS into SD rats in LPS group and LPS＋VNS group. In LPS＋VNS group, after LPS nasal instillation for 6 h, the left cervical vagus nerve was exposed and stimulated under 5 V, 5 Hz, 2 ms for 10 min. Tissues of lung and spleen were examined after 2 h. The indicators included lung pathological changes, lung wet to dry ratio, total protein content in bronchoalveolar lavage fluid (BALF), inflammatory factor levels in BALF, and expression of forkhead box protein P3 (Foxp3, a transcription protein of Treg) and retinoic acid-related orphan receptor γt (Rorγt, a transcription protein of Th17) in the lung and spleen. Results Compared with the control group, the alveolar wall of rats in LPS group was significantly thickened, inflammatory cells infiltrated into the alveolar space; the total protein content of BALF was significantly increased (P＜0.01); lung wet to dry ratio was significantly increased (P＜0.01); the expression of IL-1β, IL-6, IL-17 and IL-10 was significantly increased in BALF (all P＜0.01); and the expression of Foxp3 and Rorγt was up-regulated in the lung and spleen. Compared with LPS group, the pathological manifestations of rats were alleviated in LPS＋VNS group; the lung wet to dry ratio, the total protein content of BALF, and the levels of IL-6 and IL-17 in BALF were significantly decreased (all P＜0.05); the level of IL-10 in BALF was significantly increased (P＜0.01); and the expression of Foxp3 was up-regulated, while the expression of Rorγt was down-regulated in the lung and spleen. Conclusion VNS may regulate the expression of inflammatory factors by regulating Th17- and Treg- related proteins in the tissues of lung and spleen in rats, thereby alleviating the pathological changes of LPS-induced ARDS.

Abstract:Objective To establish and evaluate an animal model of chronic osteomyelitis of femur in SD rats. Methods Twenty-four male SD rats were used to construct the osteomyelitis model. The intercondylar groove of the femur was exposed in rats, and a small hole with diameter of 0.5 mm was drilled by electric drill into the intercondylar groove of femur through the femoral bone marrow cavity. Staphylococcus aureus suspension of 50 μL with concentration of 1×10⁶/mL was injected into the right femoral bone marrow cavity of rats, and then the hole was sealed with sterile bone wax. The behavior, wound healing, body temperature, healing of the incision, and gross infection of the lesion were observed after operation. At 2, 4 and 8 weeks after operation, the soft tissue around the femur of rats was taken for bacterial culture, and micro-CT findings of the molded femur were observed. Histopathological sections were analyzed by hematoxylin-eosin, Giemsa and Masson staining at 2 and 8 weeks after surgery. Results?The right lower limb of the osteomyelitis rats was suspended without weight bearing after operation, and the surgical incision completely healed about 10 d later. The animal returned to normal activity level on day 12, and 15 d after surgery the activity level decreased slightly. The body temperature of the rats began to rise after operation, and local redness and swelling occurred. After 2 weeks, the body temperature gradually decreased, but still higher than normal. The local swelling of right knee joint appeared in some rats. After 4 weeks, local swelling and body temperature increased in all the osteomyelitis rats. Staphylococcus aureus colonies were evenly distributed in the soft tissue culture around the femur of rats, and increased with time. Micro-CT results showed that 8 weeks after operation, inflammation reaction was obvious in medullary cavity of rats, with bone fragmentation involving all layers of bone cortex, also with dead bone formation and new bone formation. The histopathological analysis of the femur showed many inflammatory cells infiltrating into the bone marrow cavity with inflammation limited to the bone marrow cavity 2 weeks after operation, the collagen fibers in the cortical bone were arranged continuously, and a large number of Staphylococcus aureus were contained in the tissue. Eight weeks after operation, inflammation persisted, the collagen fibers in the cortical bone were broken and the cortical bone was destroyed, sinus channels were connected with the outside in cortical bone, and the number of Staphylococcus aureus in the tissue increased. Conclusion A model of chronic osteomyelitis of femur has been successfully established in SD rats, which can simulate the pathophysiological change of clinical osteomyelitis and has high replicability.

Abstract:Objective To assess the causal relationships between 91 inflammatory proteins and 5 cardiovascular diseases (including aortic dissection, aneurysm, coronary heart disease, non-rheumatic valve disease, and rheumatic valve disease) by Mendelian randomization (MR) and reverse MR. Methods MR and reverse MR analyses were used to assess bidirectional causality between 91 inflammatory proteins and 5 cardiovascular diseases based on Genome-Wide Association Studies (GWAS) data from European populations. MR analysis methods involved inverse variance weighted, weighted median, MR-Egger, simple mode and weighted mode approaches. Sensitivity analysis methods included Cochran’s Q test, MR-Egger intercept test, MR-PRESSO method, and leave-one-out approach. Results A total of 16 inflammatory proteins might be associated with the risk of cardiovascular diseases, including C-C motif chemokine ligand (CCL)20, CD5, CCL28, interleukin 20 receptor α (IL-20RA), latency-associated peptide transforming growth factor β1 (LAP-TGF-β1), thymic stromal lymphopoietin (TSLP), cystatin D (CST5), leukemia inhibitory factor (LIF), eukaryotic translation initiation factor 4E binding protein 1 (EIF4EBP1), CCL4, interleukin 22 receptor α1 (IL-22RA1), interleukin (IL)-10, IL-17C, monocyte chemoattractant protein (MCP)-2/CCL8, neurturin (NRTN), and MCP-3/CCL7. Furthermore, the progression of cardiovascular diseases might potentially lead to changes in the levels of 10 inflammatory proteins, including CCL11, IL-8, tumor necrosis factor β (TNF-β), fibroblast growth factor (FGF)-19, interleukin 10 receptor α (IL-10RA), FGF-21, interleukin 10 receptor β (IL-10RB), β-nerve growth factor (β-NGF), CD5, and MCP-1/CCL2. Conclusion The present study highlights the bidirectional causal relationship between an array of inflammatory proteins and the 5 cardiovascular diseases. Further research on the correlation between various inflammatory proteins and the above cardiovascular diseases has potential clinical value.

Abstract:Objective To compare the serum small molecule metabolites between heat acclimatization and heat non-acclimatization subjects, and reveal the characteristics of serum small molecule metabolites related to human heat acclimatization. Methods Seventy subjects involved in a cold-to-heat region transferring were enrolled in this study. According to the exposure to a high wet-heat natural environment or a comfortable air-condition artificial environment, the subjects were divided into heat acclimatization group (n＝40) and heat non-acclimatization group (n＝30). Early morning fasting blood samples from the subjects were collected 2 months after region transferring. After standard processing, liquid chromatography tandem mass spectrometry was used for metabolomic detection, and Progenesis QI software and ropls tool of R 1.6.2 software were employed to identify the differential small molecule metabolites of the 2 groups, and the pathway enrichment analysis of Kyoto Encyclopedia of Genes and Genomes (KEGG) was carried out for the differential small molecule metabolites. Results There were no significant differences in age or body mass index between the 2 groups (both P＞0.05). A total of 1 320 small molecule metabolites were detected by serum metabolomics. Orthogonal partial least squares-discriminant analysis showed that the samples of heat acclimatization group and heat non-acclimatization group had a good discrimination between groups and a good aggregation within groups. There were 89 small molecule metabolites with a concentration difference of more than 1.5 times (P＜0.05) between the 2 groups, with 57 being increased and 32 being decreased in the heat acclimatization group. KEGG pathway enrichment analysis showed that the differential small molecule metabolites were mainly enriched in 13 metabolic pathways, including amino acid metabolism and glycerophospholipid metabolism, involving tryptophan, glycine, serine, threonine, arginine, and proline. Conclusion Heat acclimatization training under heat exposure can change the omics characteristics of small molecule metabolites in human serum, mainly enhancing amino acid metabolism involved in heat tolerance.

Abstract:Objective To analyze the differences in plasma bile acid (BA) concentrations and BA profile in colorectal cancer patients with varying metastatic conditions, and to evaluate the clinical value of plasma BA ratio combined with tumor markers in diagnosing colorectal cancer liver metastasis (CRC-LM). Methods A total of 163 patients diagnosed with colorectal cancer between Apr. 2021 and Jan. 2022 were enrolled from Shuguang Hospital of Shanghai University of Traditional Chinese Medicine. They were categorized into 2 groups: non-metastatic group (CRC-NM group, n＝82) and CRC-LM group (n＝81). Clinical data and peripheral blood samples were collected from all the participants, the quality of life was evaluated using Karnofsky performance status (KPS) score, the levels of total bile acid (TBA) and tumor markers (carcinoembryonic antigen［CEA］ and carbohydrate antigen 125［CA125］) were examined, and the plasma concentrations of 15 BAs were detected using high-performance liquid chromatography/tandem mass spectrometry. The BA concentrations and BA profile were compared between the 2 groups. Additionally, receiver operating characteristic curve was generated to evaluate the efficacy of the BA ratio combined with tumor markers in diagnosing CRC-LM. Results No significant difference was found in age, gender, tumor location, degree of pathological differentiation, or KPS score between the 2 groups (all P＞0.05). Patients with CRC-LM had significantly higher concentrations of TBA, CEA and CA125 compared to those without metastasis (all P＜0.001). Additionally, the concentrations of glycocholic acid, deoxycholic acid, taurodeoxycholic acid, glycodeoxycholic acid, glycoursodeoxycholic acid, lithocholic acid and glycolithocholic acid in patients with CRC-LM were significantly higher compared to patients without metastasis (all P＜0.05). Furthermore, the plasma concentration of secondary bile acid (SBA) in CRC-LM patients was significantly higher than that in non-metastatic patients (P＜0.001), and the ratio of SBA to primary bile acid (PBA) was also significantly higher in CRC-LM patients (P＜0.001). Combination of SBA/PBA ratio with CEA and CA125 yielded a sensitivity of 71.60%, a specificity of 80.49%, and an area under curve of 0.820 (95% confidence interval 0.754 to 0.885, P＜0.001). Conclusion The plasma BA concentration is elevated in patients with CRC-LM, and the BA profile is notably different from that of patients without metastasis. The SBA/PBA ratio combined with CEA and CA125 demonstrates a great value for diagnosing CRC-LM.

Abstract:Objective To investigate the effectiveness of non-invasive brain stimulation in improving the executive functions of patients with Parkinson’s disease (PD). Methods The randomized controlled trials (RCTs) about transcranial magnetic stimulation (TMS), transcranial alternating current stimulation (tACS) or transcranial direct current stimulation (tDCS) in treating PD patients with outcome indicators including executive functions were retrieved from 5 databases (Web of Science, PubMed, EMBASE, CNKI, and Wanfang data). The literatures were screened according to the predetermined criteria and the data were extracted. The effectiveness of 3 non-invasive brain stimulation interventions on executive dysfunction of PD patients was compared using network meta-analysis (NMA). The results were summarized by standardized mean difference (SMD) and 95% Bayesian credibility interval (CrI), and the effectiveness of each intervention was ranked by surface under the cumulative ranking curve (SUCRA). Results A total of 20 RCTs (809 PD patients) were included. Compared with the control group, TMS significantly improved the executive functions of PD patients (SMD＝0.16, 95% CrI 0.01-0.32). The probability ranking results of the effectiveness of the interventions on the executive functions of PD patients were TMS＞tACS＞tDCS＞ control (SUCRA＝0.72, 0.61, 0.41, 0.25, respectively). TMS was the most likely intervention with the best performance. Conclusion TMS has a direct improvement effect on executive functions of PD patients. Limited by the number and quality of the included studies, the above conclusion need to be further verified by high-quality studies.

Abstract:Objective To evaluate the diagnostic value of ultrasonic artificial intelligence (AI) system in breast imaging-reporting and data system (BI-RADS) class 4 breast nodules with maximum diameter ≤2 cm. Methods A total of 210 breast nodules were analyzed in 204 patients with pathological results obtained by surgery at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. The maximum diameter of the breast nodules was ≤2 cm. With the pathological results as the gold standard, all nodules were examined by routine ultrasound (US) and AI aided diagnosis system. The values of routine US by a senior physocian, AI (threshold value 0.65) and AI (threshold value 0.70) in diagnosing benign and malignant in BI-RADS class 4 breast nodules with maximum diameter ≤2 cm were evaluated. Results The pathological results showed that 210 breast nodules included 94 benign nodules and 116 malignant nodules. The sensitivity, specificity and accuracy of routine US in diagnosing benign and malignant breast nodules were 92.24%, 75.53% and 84.76%, respectively; the sensitivity, specificity and accuracy of AI (threshold value 0.65) were 92.24%, 71.28% and 82.86%, respectively; and those of AI (threshold value 0.70) were 90.52%, 79.79% and 85.71%, respectively. The accuracy of diagnosing BI-RADS 4a nodules of AI (threshold value 0.70) was higher than those of routine US and AI (threshold value 0.65) (79.41% vs 77.94%, 75.00%). The senior physician had the highest diagnostic accuracy of 86.36% for nodules with maximum diameter ≤1 cm using routine US. The accuracies of the AI system with threshold value 0.65 and 0.70 were 81.82% and 84.09%, respectively. Conclusion Ultrasonic AI diagnosis system can assist to improve the diagnostic efficiency of BI-RADS class 4 breast nodules with maximum diameter ≤2 cm.

Abstract:Objective To investigate the relationship between circadian rhythm type and sleep quality among university students, and to clarify the mediating roles of trait anxiety and sleep beliefs and attitudes. Methods An online survey was conducted among university students at a medical school by convenience sampling method. The circadian rhythm types, trait anxiety levels, sleep beliefs and attitudes, and sleep quality were evaluated by the morning and evening questionnaire-5 (MEQ-5), trait anxiety inventory (T-AI), brief version of dysfunctional beliefs and attitudes about sleep scale-16 (DBAS-16), and Pittsburgh sleep quality index (PSQI), respectively. Pearson correlation analysis and mediation analysis were employed to examine the relationships between circadian rhythm types, trait anxiety levels, sleep beliefs and attitudes, and sleep quality. Results A total of 238 questionnaires were collected and 233 were valid, with an effective rate of 97.9%. Pearson correlation analysis revealed significant correlations between circadian rhythm type, trait anxiety level, sleep beliefs and attitudes, and sleep quality (all P＜0.01). The mediating effect was examined with circadian rhythm type as independent variable, sleep quality as dependent variable, and trait anxiety level and sleep beliefs and attitudes as mediating variables. The mediating effect of the trait anxiety level (MEQ-5→T-AI→PSQI) accounted for 30.48% of the total effect (r＝－0.128, 95% confidence interval［CI］ －0.211 to －0.066). The mediating effect of the sleep beliefs and attitudes (MEQ-5→DBAS-16→PSQI) accounted for 12.62% of the total effect (r＝－0.053, 95% CI －0.106 to －0.014). The chain mediating effects of the trait anxiety level and sleep beliefs and attitudes (MEQ-5→T-AI→DBAS-16→PSQI) accounted for 11.19% of the total effect (r＝－0.047, 95% CI －0.085 to －0.022). Conclusion The circadian rhythm type of university students can negatively predict their sleep quality, and the trait anxiety level and sleep beliefs and attitudes play mediating roles.

Abstract:Growth differentiation factor 15 (GDF15), a member of the transforming growth factor β (TGF-β) superfamily, is widely expressed in multiple tissues. Under normal physiological conditions, the expression of GDF15 is low in all tissues except for placenta and prostate. However, with aging and exercise or stress stimulation, the GDF15 level is significantly increased. GDF15 binds its reporter, glial cell line derived neurotrophic factor family receptor α-like (GFRAL), to induce the intracellular fatty acids β oxidation and lipolysis, subsequently alleviating the development of fatty liver and inhibiting obesity through decreased food intake. GDF15 is also considered as an inflammatory factor regulating aging and fibrosis related diseases. This article mainly summarizes the regulatory role of GDF15 in aging, metabolism and inflammation-related diseases, so as to provide insights for the treatment strategies targeting GDF15.

Abstract:Sepsis is a life-threatening multi-organ dysfunction syndrome caused by an imbalanced immune response to infection. Its condition is complex and variable, and it is one of the main causes of death in intensive care unit. Lung injury is the common organ injury in sepsis patients. Macrophages are an important component of innate and adaptive immunity that can dominate immune status through different polarization types. At the early stage of sepsis, macrophages often polarize to pro-inflammatory M1-like and lead to immune hyperactivity, while convert to anti-inflammatory M2-like at the late stage, resulting in immunosuppression. Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway plays an important role in the regulation of inflammatory signals, and the activation of the pathway occurs throughout the entire process of sepsis development and macrophage polarization. This review analyzes how the JAK/STAT pathway mediates the development of sepsis-associated lung injury by affecting macrophage polarization, and summarizes the potential therapeutic targets, with a view to provide new ideas for the treatment of sepsis.

Abstract:Ewing’s sarcoma is the second most common malignant primary bone tumor in children and adolescents, marked by its exceptional malignancy, abbreviated patient course, and rapid metastasis, posing a substantial threat to the health of children and adolescents. Tumor cells promote metabolic reprogramming of nutrients including sugars, amino acids, lipids, and more through a series of complex regulatory mechanisms, thus maintaining the high metabolic state of tumor and promoting tumor development. The products related to metabolic reprogramming exert a significant impact on various cellular constituents in the tumor microenvironment, inhibiting anti-tumor immune responses, and even inducing drug resistance events. A pivotal player in this context is the Ewing sarcoma breakpoint region 1 (EWSR1)-Friend leukemia virus integration 1 (FLI1) fusion protein, which assumes multifaceted roles with intricate regulatory mechanisms. Understanding the specific metabolic changes and regulatory pathways orchestrated by EWSR1-FLI1 in Ewing’s sarcoma cells holds the promise of shedding light on the disease’s etiology. Additionally, this knowledge offers a path to the discovery of novel diagnostic and therapeutic markers and strategies. This article summarizes and analyzes the recent research progress of EWSR1-FLI1 on metabolic reprogramming in Ewing’s sarcoma, providing new ideas for the early diagnosis and precise treatment of the disease.

Abstract:Tonsil is a part of the immune system and its abnormal immune function is closely related to autoimmune diseases. Tonsillectomy has been proven to have good clinical effects in the treatment of some autoimmune diseases, and it is expected to be a supplementary treatment in the comprehensive diagnosis and treatment of some autoimmune diseases. This article reviews the therapeutic effect and related mechanism of tonsillectomy in several autoimmune diseases such as IgA nephropathy, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection and palmoplantar pustulosis.

Abstract:Post-traumatic stress disorder (PTSD) and other psychiatry disorders are highly comorbid mental health problems, such as depression disorder, anxiety disorder, sleep disorder, and personality disorder. Comorbidity is associated with negative treatment and prognosis of both diseases, and is also an important factor in the reduction of combat personnel in modern war. Mental health of military officers and soldiers has drawn wide attention owing to the complexity and diversity of military tasks in recent years. As a common psychological trauma in the battlefield environment, PTSD needs to be fully concerned in the future war. This paper discusses the research progress of comorbidities of PTSD from the aspects of epidemiological characteristics, influencing factors, related mechanisms and treatment intervention strategies, so as to provide reference for the improvement of war capacity and the clinical diagnosis and treatment of PTSD.

Abstract:Objective To compare the anti-G constitution between the graduates of teenagers aviation school of air force (TASAF) and general high school, explore the results of anti-G constitution training project in TASAF, and provide an evidence for training program optimization. Methods A total of 160 senior students in TASAF and 191 general high school graduates who participated in the 2022 final-stage medical selection of PLA air force were randomly enrolled. The students in TASAF received special anti-G constitution training at the high school stage according to the established training program, and the physical exercise of general high school graduates was collected through questionnaires. The body dimensions, body weight, body composition, and muscle strength were collected and compared. WHO standard was used to categorize body fat percentage (BFP) into 3 grades: low (＜15%), normal (15%-20%), and high (＞20%), the interquartile method was used to categorize skeletal muscle mass index (SMI) into 3 grades: low (SMI≤lower quartile), moderate (lower quartile＜SMI＜upper quartile), and high (SMI≥upper quartile), and the classification statistics was done for the graduates of the TASAF and general high school. Correlation analysis was used to analyze BFP, SMI and anti-G strength of all study participants. Results The height, limb length, calm chest circumference, and body weight of the TASAF participants were significantly higher than those of the general high school students (all P＜0.05), and there was no significant difference in sitting height between them (P＞0.05). The SMI of the TASAF participants was significantly higher than that of the general high school students (P＜0.05), and there was no significant difference in BFP between them (P＞0.05). The mean/peak back muscle strength and lower limb muscle strength of the TASAF participants were significantly higher than those of the general high school students (all P＜0.05). There was difference in the distribution of SMI between the TASAF and general high school graduates, with a higher percentage of high SMI and a lower percentage of low SMI in the TASAF graduates (P＜0.01), while there was no significant difference in the distribution of BFP between the TASAF and general high school graduates (P＞0.05). SMI was significantly positively correlated with anti-G strength (peak back muscle strength, mean back muscle strength, peak lower limb muscle strength, mean lower limb muscle strength) (r＝0.32-0.39, all P＜0.05), while BFP was not significantly correlated with anti-G strength (r＝－0.06-0.01, all P＞0.05). Conclusion Anti-G constitution training project in the TASAF is effective in improving muscle strength related to anti-G constitution. However, there is still room for improvement in the control of BFP, and in the future anti-G training should take into account both muscle training and body fat control.

Abstract:Objective To observe the clinical effect of Jianpi Lishi Tongluo decoction combined with Yongquan moxibustion in the treatment of chronic lower limb venous edema (CLLVE) with damp pathogen and blood stasis syndrome. Methods Seventy CLLVE patients with damp pathogen and blood stasis syndrome were randomly divided into 2 groups, with 35 cases in each group. The control group received Yongquan moxibustion treatment, while the experimental group received Jianpi Lishi Tongluo decoction in addition to Yongquan moxibustion. Both groups were treated for 4 weeks. The total effective rate of the 2 groups was calculated, and the traditional Chinese medicine (TCM) symptom scores, symptoms and signs scores, limb circumferences, serum inflammatory factor levels and safety of the 2 groups were compared before and after treatment. Results A total of 34 patients were included in the experimental group, and the total effective rate was 91.17% (31/34). A total of 33 patients were included in the control group, and the total effective rate was 69.70% (23/33). The total effective rate of the experimental group was significantly higher than that of the control group (P＝0.026). After treatment, both groups showed decreased TCM syndrome scores, symptom and sign scores of the affected limb, circumferences of the affected limb 15 cm below the lower edge of patella and 2 cm above the upper edge of tibial medial condyle, and levels of inflammatory factors (interleukin-6 and tumor necrosis factor-α) (all P＜0.05). Moreover, the above indexes in the experimental group were significantly lower than those in the control group except for the circumference of the limb 2 cm above the upper edge of tibial medial condyle (all P＜0.05). During the treatment, no abnormalities were observed in the liver or kidney functions for either group, and there were no serious adverse reactions. Conclusion Jianpi Lishi Tongluo decoction combined with Yongquan moxibustion can significantly improve symptoms and signs of affected limbs in CLLVE patients with damp pathogen and blood stasis syndrome and reduce systemic inflammation response.

Abstract:Objective To analyze the safety and clinical effect of postemlateral endoscopic lumbar interbody fusion (PE-LIF) under local anesthesia in the treatment of lumbar spondylolisthesis. Methods The clinical data of 58 patients with lumbar spondylolisthesis treated with PE-LIF in our department from Jan. 2020 to Jan. 2022 were retrospectively analyzed. The operation time, intraoperative bleeding, hospital stay and complications were recorded. The clinical efficacy was evaluated by Oswestry dysfunction index (ODI) and visual analogue scale (VAS). Lumbar X-ray films were taken before operation, 1 month, 6 months and 1 year after operation, and the height of intervertebral space, lumbar lordosis angle and anterior lordosis angle of the surgical segment were measured. The accuracy of pedicle screw placement was evaluated by lumbar computed tomography (CT) according to the Gertzbein-Robbins pedicle screw position classification standard 1 month after operation. The fusion rate was evaluated by CT 6 months and 1 year after operation. Results The operation time of the 58 patients was 130-190 (160±30) min, the intraoperative bleeding volume was 52-120 (63±15) mL, and the hospital stay was 6-15 (9.3±3.5) d. All the patients were followed up for 13-26 (17.4±2.8) months. The VAS score of patients with low back pain was 7.28±0.93 before operation and 2.22±0.57 one year after operation, the VAS score of patients with lower limb pain was 7.82±1.40 before operation and 2.38±0.63 one year after operation, the ODI was (65.80±9.88)% before operation and (12.54±4.53)% one year after operation, the height of intervertebral space was (8.3±1.5) mm before operation and (10.8±1.6) mm one year after operation, the lumbar lordosis angle was 31.7°±7.3° before operation and 37.9°±4.4° one year after operation, and the anterior convex angle of the surgical segment was 13.1°±8.1° before operation and 16.1°±2.4° one year after operation, with significant differences in the above indexes (all P＜0.05). One month after surgery, the overall excellent and good rate of pedicle screw placement was 86.64% (201/232). One year after operation, all cases obtained bony fusion without serious complications such as nerve root injury, spinal infection, intraspinal hematoma, fusion cage displacement, or broken nails and rods. Conclusion PE-LIF under local anesthesia is safe and reliable in the treatment of lumbar spondylolisthesis.

Abstract:Objective To investigate the correlation between pain sensitivity and acute postoperative pain in patients undergoing laparoscopic gastrointestinal tumor surgery. Methods Fifty patients of either sex, aged≥18 years, with American Society of Anesthesiologists (ASA) gradeⅠ-Ⅱ, who were scheduled for laparoscopic gastrointestinal tumor surgery under general anesthesia were divided into high sensitivity group (pain sensitivity questionnaire ［PSQ］ score≥5.0, n＝19) and low sensitivity group (PSQ score＜5.0, n＝31). The general conditions, operation conditions, the number of analgesic pump compressions and the number of salvage analgesia within 24 h after surgery, and the complications such as nausea, vomiting, drowsiness, and abdominal distension of the 2 groups were recorded. Visual analogue scale (VAS) score was used to evaluate the pain degree of patients during peripheral venous catheterization and within 24 h after surgery. Results There were no significant differences in age, gender, ASA grade, body mass index, operation duration, recovery time, extubation time, number of analgesic pump compressions within 24 h after surgery, or postoperative complications between the 2 groups (all P＞0.05). Compared with the low sensitivity group, the VAS scores of the high sensitivity group were significantly higher during peripheral venous catheterization, immediately after waking, 1 h and 2 h after surgery (all P＜0.05). The preoperative PSQ score was positively correlated with the VAS score of peripheral venous catheterization (r＝0.693, P＜0.05), and was positively correlated with the VAS scores immediately after waking, 1 h and 2 h after surgery (r＝0.917, 0.901 and 0.841, all P＜0.05). The number of salvage analgesia in the high sensitivity group was significantly higher than that in the low sensitivity group (P＜0.05). The preoperative PSQ score was used as the test variable, and the occurrence of acute postoperative pain was used as the state variable to plot the receiver operating characteristic curve. The area under curve value was 0.909. The optimal cut-off value of PSQ score calculated by Jorden index was 4.85, suggesting that the PSQ score could predict the acute postoperative pain in patients undergoing laparoscopic gastrointestinal tumor surgery. Conclusion Pain sensitivity is associated with acute postoperative pain in patients undergoing laparoscopic gastrointestinal tumor surgery, and it may be a predictor of acute postoperative pain. Patients with PSQ≥4.85 are more likely to develop acute postoperative pain.

Abstract:Objective To explore the incidence and influencing factors of low birth weight in infants in high altitude areas. Methods A total of 340 live births delivered in the People’s Hospital of Anduo County, Xizang (with an average local altitude of 5 200 m) from Apr. 2022 to Apr. 2023 were enrolled, and the incidence of low birth weight was recorded. The effects of maternal general information, pregnancy and perinatal complications, and serum levels of 5 metal elements (calcium ［Ca］, iron ［Fe］, magnesium ［Mg］, zinc ［Zn］, and copper ［Cu］) in the third trimester of pregnancy on the incidence of low birth weight were analyzed. Results The incidence of low birth weight was 18.24% (62/340). The incidence of low birth weight in infants had no relation with maternal age, pregnancy times, parity, body mass index at the beginning of pregnancy, adverse pregnancy history, gestational diabetes mellitus or neonatal gender. The incidences of low birth weight in mathers with gestational hypertension, gestational intrahepatic cholestasis, gestational anemia, premature rupture of membranes, oligohydramnios, and preterm birth were significantly higher than that in mothers without the above symptoms (all P＜0.001). The maternal serum levels of Ca, Fe, Mg, Zn, and Cu in the third trimester of pregnancy of the low birth weight group were significantly lower than those in the non-low birth weight group (all P＜0.001). Multivariate logistic regression analysis showed that gestational hypertension, gestational intrahepatic cholestasis, premature rupture of membranes, premature birth, maternal serum Ca, Zn, and Cu levels were the influencing factors of the low birth weight (all P＜0.001). Conclusion The incidence of low birth weight in infants in high altitude areas is affected by gestational hypertension, gestational intrahepatic cholestasis, premature rupture of membranes, and premature delivery, and it is also related to the maternal serum levels of Ca, Zn and Cu in the third trimester of pregnancy.