Objective To explore the clinical efficacy of acupuncture on post-stroke insomnia.Methods 148 outpatients and inpatients with post-stroke insomnia were recruited in the Shanghai municipal Hospital of Traditional Chinese Medicine from June 2016 to January 2018.They were randomly divided into two groups,acupuncture group(n=74)and control group(n=74).The acupuncture group was treated with GV20,GV24,GV29,HN22,HT7 and SP6 20 minutes each time,3 times per week for 4 weeks.The follow-up was after 4 weeks.The control group was treated with sham acupuncture on the same acupoints.The needles did not pierce the skin.The Insomnia Severity Index Scale(ISI),the Hospital Anxiety and Depression Scale(HADS)and the Stroke Special Quality of Life Scale(SS-QoL)were used to evaluate the patients before treatment,after 2 weeks of treatment,after 4 weeks of treatment and follow-up.The occurrence of adverse events of acupuncture was also recorded.Results ① ISI:after 2 weeks of treatment,4 weeks of treatment and follow-up,the score of treatment group was decreased compared with the control group,and the difference was statistically significant(P＜0.01).Compared with baseline,the ISI score of the treatment group was decreased after 4 weeks of treatment(P＜0.05).② HADS score:The difference between 4-week treatment and baseline score of the HADS-A,the difference between the treatment group and the control group was statistically significant(P＜0.01);the difference between 4-week treatment and baseline,and between follow-up and baseline score of the HADS-D,the difference between the treatment group and the control group was statistically significant(P＜0.01).③SS-QoL score:The difference between 2-week treatment and baseline,between 4-week treatment and baseline,and between follow-up and baseline score of the SS-QoL,the difference between the treatment group and the control group was statistically significant(P＜0.01).Conclusion Acupuncture is an effective and safe therapy in improving the severity of insomnia of patients with post-stroke insomnia.Compared with sham acupuncture,acupuncture can improve the anxiety and depression status and quality of life of patients.

Objective To observe the clinical efficacy of Tongdu Tiaoyang rolling needle pricking-cupping(RNP-C)therapy for cervical spondylosis of qi stagnation and blood stasis type.Methods A total of 90 patients with cervical spondylosis of qi stagnation and blood stasis type were randomly divided into the rolling needle pricking-cupping(RNP-C)group and the electroacupuncture(EA)group,with 45 cases in either group.Both groups were treated with electroacupuncture at Tianzhu(BL 10),Jingjiaji(EX-B2),Houxi(SI 3),Shenmai(BL 62),Xuanzhong(GB 39),Geshu(BL 17),Hegu(LI 4)and Ashi points with continuous wave and 2 Hz of frequency for once a day,7 times as a treatment course.On the basis of electroacupuncture treatment,the rolling needle pricking-cupping(RNP-C)group was treated with bloodletting by rolling needle on the neck Du Mai and three yang channels,from Fengfu(DU 16)to Taodao(DU 13),Yuzhen(BL 9)to Dazhu(BL 11),Fengchi(GB 20)to Jianjing(GB 21),and Yifeng(SJ 17)to Tianyou(SJ 16),followed by fire cupping,for once every other day,and 3 times in all.The visual analogue scale(VAS)scores and Japanese Orthopaedic Association Scores(JOA)were observed before and after treatment,and the efficacy was evaluated.Results Compared before treatment,the scores of VAS in either group were all significantly reduced after treatment(P＜0.01).The scores of VAS in the RNP-C group were significantly inferior to those in the EA group after treatment(P＜0.01).Compared before treatment,the scores of JOA in either group were all significantly promoted after treatment(P＜0.01).The differences of JOA scores between the RNP-C group and EA group after treatment were not significant(P＞0.05).The therapeutic effecacy of the RNP-C group is superior to that of the traditional EA group(P＜0.05).Conclusion Tongdu Tiaoyang rolling needle pricking-cupping(RNP-C)therapy combining with traditional electroacupuncture could improve the cervical pain symptoms of patients with cervical spondylosis of qi stagnation and blood stasis type in a short period of time,and the clinical efficacy is better than traditional electroacupuncture.

Objective To explore the clinical efficacy of acupuncture on post-stroke insomnia.Methods 148 outpatients and inpatients with post-stroke insomnia were recruited in the Shanghai municipal Hospital of Traditional Chinese Medicine from June 2016 to January 2018.They were randomly divided into two groups,acupuncture group(n=74)and control group(n=74).The acupuncture group was treated with GV20,GV24,GV29,HN22,HT7 and SP6 20 minutes each time,3 times per week for 4 weeks.The follow-up was after 4 weeks.The control group was treated with sham acupuncture on the same acupoints.The needles did not pierce the skin.The Insomnia Severity Index Scale(ISI),the Hospital Anxiety and Depression Scale(HADS)and the Stroke Special Quality of Life Scale(SS-QoL)were used to evaluate the patients before treatment,after 2 weeks of treatment,after 4 weeks of treatment and follow-up.The occurrence of adverse events of acupuncture was also recorded.Results ① ISI:after 2 weeks of treatment,4 weeks of treatment and follow-up,the score of treatment group was decreased compared with the control group,and the difference was statistically significant(P＜0.01).Compared with baseline,the ISI score of the treatment group was decreased after 4 weeks of treatment(P＜0.05).② HADS score:The difference between 4-week treatment and baseline score of the HADS-A,the difference between the treatment group and the control group was statistically significant(P＜0.01);the difference between 4-week treatment and baseline,and between follow-up and baseline score of the HADS-D,the difference between the treatment group and the control group was statistically significant(P＜0.01).③SS-QoL score:The difference between 2-week treatment and baseline,between 4-week treatment and baseline,and between follow-up and baseline score of the SS-QoL,the difference between the treatment group and the control group was statistically significant(P＜0.01).Conclusion Acupuncture is an effective and safe therapy in improving the severity of insomnia of patients with post-stroke insomnia.Compared with sham acupuncture,acupuncture can improve the anxiety and depression status and quality of life of patients.

Objective To observe the clinical efficacy of Tongdu Tiaoyang rolling needle pricking-cupping(RNP-C)therapy for cervical spondylosis of qi stagnation and blood stasis type.Methods A total of 90 patients with cervical spondylosis of qi stagnation and blood stasis type were randomly divided into the rolling needle pricking-cupping(RNP-C)group and the electroacupuncture(EA)group,with 45 cases in either group.Both groups were treated with electroacupuncture at Tianzhu(BL 10),Jingjiaji(EX-B2),Houxi(SI 3),Shenmai(BL 62),Xuanzhong(GB 39),Geshu(BL 17),Hegu(LI 4)and Ashi points with continuous wave and 2 Hz of frequency for once a day,7 times as a treatment course.On the basis of electroacupuncture treatment,the rolling needle pricking-cupping(RNP-C)group was treated with bloodletting by rolling needle on the neck Du Mai and three yang channels,from Fengfu(DU 16)to Taodao(DU 13),Yuzhen(BL 9)to Dazhu(BL 11),Fengchi(GB 20)to Jianjing(GB 21),and Yifeng(SJ 17)to Tianyou(SJ 16),followed by fire cupping,for once every other day,and 3 times in all.The visual analogue scale(VAS)scores and Japanese Orthopaedic Association Scores(JOA)were observed before and after treatment,and the efficacy was evaluated.Results Compared before treatment,the scores of VAS in either group were all significantly reduced after treatment(P＜0.01).The scores of VAS in the RNP-C group were significantly inferior to those in the EA group after treatment(P＜0.01).Compared before treatment,the scores of JOA in either group were all significantly promoted after treatment(P＜0.01).The differences of JOA scores between the RNP-C group and EA group after treatment were not significant(P＞0.05).The therapeutic effecacy of the RNP-C group is superior to that of the traditional EA group(P＜0.05).Conclusion Tongdu Tiaoyang rolling needle pricking-cupping(RNP-C)therapy combining with traditional electroacupuncture could improve the cervical pain symptoms of patients with cervical spondylosis of qi stagnation and blood stasis type in a short period of time,and the clinical efficacy is better than traditional electroacupuncture.

Objective:To compare the efficacy and safety of a new type of plastic biliary stent modified based on the pigtail nasobiliary duct and the common plastic biliary stent for hilar cholangiocarcinoma.Methods:Data of a total of 38 patients with obstructive jaundice caused by hilar cholangiocarcinoma who received endoscopic retrograde cholangiopancreatography (ERCP) palliative treatment at the Endoscopy Center, General Hospital of Northern Theater Command from June 2018 to December 2020 were collected, including 20 cases using the new type of plastic biliary stent (the new stent group), and 18 cases using the common plastic stent (the common stent group). Patients were followed up to May 30, 2021. The procedure time, hospital stay, postoperative biliary infection incidence, the bilirubin decrease, and the patency time of the stents in the two groups were compared.Results:The procedure time was 19.85±1.07 minutes in the new stent group and 22.00±3.38 minutes in the common stent group, respectively, showing no significant difference between them ( t=1.26, P=0.607). The lengths of hospital stay of the two groups were 11.45±2.39 days and 11.33±3.51 days, respectively, showing no significant difference between them ( t=-0.52, P=0.938). The median margins of total bilirubin reduction in the two groups were 122.85 μmol/L and 96.25 μmol/L, respectively, with significant difference ( Z=-2.03, P=0.042). The incidence of long-term cholangitis of the new stent group was significantly lower than that of the common stent group [10.0% (2/20) VS 44.4% (8/18), P=0.027]. The patency time of the new stent group was significantly longer than that of the common stent group (109.45±32.67 days VS 82.11±20.95 days) with significant difference ( t=2.23, P=0.032). Conclusion:In the palliative treatment of hilar bile duct obstruction, the new plastic bile duct stent modified based on pigtail type can reduce the incidence of long-term cholangitis and prolong the patency of bile duct stent compared with the common stent group.

This article reviewed the current knowledge on time-course manifestation of diabetic urethral dysfunction (DUD), and explored an early intervention target to prevent the contribution of DUD to the progression of diabetes-induced impairment of the lower urinary tract (LUT). In the literature search through PubMed, key words used included “diabetes mellitus,” “diabetic urethral dysfunction,” and “diabetic urethropathy.” Polyuria and hyperglycemia induced by diabetes mellitus (DM) can cause the time-dependent changes in functional and morphological manifestations of DUD. In the early stage, it promotes urethral dysfunction characterized by increased urethral pressure during micturition. However, the detrusor muscle of the bladder tries to compensate for inducing complete voiding by increasing the duration and amplitude of bladder contractions. As the disease progresses, it can induce an impairment of coordinated micturition due to dyssynergic activity of external urethra sphincter, leading to detrusor-sphincter dyssynergia. The impairment of relaxation mechanisms of urethral smooth muscles (USMs) may additionally be attributable to decreased responsiveness to nitric oxide, as well as increased USM responsiveness to α1-adrenergic receptor stimulation. In the late stage, diabetic neuropathy may play an important role in inducing LUT dysfunction, showing that the decompensation of the bladder and urethra, which can cause the decrease of voiding efficiency and the reduced thickness of the urothelium and the atrophy of striated muscle bundles, possibly leading to the vicious cycle of the LUT dysfunction. Further studies to increase our understandings of the functional and molecular mechanisms of DUD are warranted to explore potential targets for therapeutic intervention of DM-induced LUT dysfunction.
Ataxia ; Atrophy ; Diabetes Mellitus ; Diabetic Neuropathies ; Early Intervention (Education) ; Hyperglycemia ; Lower Urinary Tract Symptoms ; Muscle, Smooth ; Muscle, Striated ; Nitric Oxide ; Polyuria ; Relaxation ; Urethra ; Urinary Bladder ; Urinary Tract ; Urination ; Urothelium

Objective To identify risk factors for postdischarge venous thromboembolism(VTE) following lung resection.Methods Patients undergoing anatomic resection for lung cancer were identified in our institution from 2005-2015.Patient demographic and clinical characteristics were evaluated for any association with post-discharge VTE.Predictors of post-discharge VTE were identified using multivariable analysis.Results VTE occurred in 1.6％ (117) of the 7 154 patients identified.43.6％ (51) VTE events occurred following hospital discharge.Undergoing pneumonectomy was associated with a threefold increased risk for post-discharge VTE compared with lobectomy(2.03％ vs.0.64％,P ＜ 0.01),as was open resection compared to minimally invasive resection(0.86％ vs.0.53％,P＜0.01).Prolonged operative time(＞75％) was also associated with increased risk for post-discharge VTE compared to shorter operative time.Multivariable analysis identified older age,obesity,pneumonectomy,and prolonged operative time as independent predictors for post-discharge VTE.Conclusion The risk for VTE extends after hospital discharge,few patients are managed with post-discharge prophylaxis.Post-discharge prophylaxis should be considered for those at high risk for VTE,particularly for older patients,those who are obese,and following extended or lengthy resections.

Objective To investigate the prognostic factors of postoperative single metastasis in patients with esophageal cancer after treatment.Methods The clinical data of patients with single lesion metastasis from 2002 to 2016 were analyzed retrospectively.Demographic and clinicopathologic data were reviewed.Predictors of PRS after definitive therapy for isolated EC recurrence were determined by the multivariable Cox proportional hazards model.Results Of the 1 016 curative esophagectomies,383 patients(37.7％) experienced recurrences(median followup 53 months).114 (11.2％) received definitive treatment of isolated EC recurrence(63 were treated surgically with or without chemotherapy-radiotherapy[CTRT] and 51 received definitive CTRT alone).Median time to recurrence(TTR) was 18 months.The 1-year and 3-year PRSs were 78.9％ and 38.6％ (median survival 28 months).On multivariable analysis;TTR was the only significant independent predictor for survival after recurrence (HR =0.982,95 ％ CI:0.95-1.03,P =0.036).No pronounced difference was found in disease-free survival or in PRS between recurrent patients treated with operation with or without CTRT and patients who received definitive CTRT.Conclusion A select subgroup of patients with isolated EC recurrence can be treated with curative intent.TTR was the best predictor for PRS.