ObjectiveTo explore the driving forces for oncology nurses’ participation in palliative care work， thereby providing a theoretical basis for the improvement of education and training， incentive mechanisms， and other aspects of the palliative care nursing staff. MethodsEmploying a qualitative research method， semi-structured interviews lasting 40-60 minutes were conducted with 14 nurses who had participated in palliative care work. The interview data were analyzed using the Colaizzi seven-step analysis method. ResultsInternal positive driving forces were job interest， empathy， and a sense of professional responsibility， while the negative was low psychological resilience. External positive driving forces included high work support， professional identity， mutual benefits for nurses and patients， and positive patient attitudes， whereas negative driving forces comprised busy routine clinical work， lack of a reward and incentive system， and bland or negative patient attitudes. ConclusionIt is essential to provide a flexible platform for the enhancement of nurses’ professional capabilities in palliative care， intensify the publicity of palliative care and death education； intervene and guide nurses’ negative emotions， improve and implement relevant incentive systems， and standardize the job recognition and scope of responsibilities of palliative care nurses.

OBJECTIVES: To evaluate the safety and efficacy of thiotepa (TT)-containing conditioning regimens for allogeneic hematopoietic stem cell transplantation (HSCT) in children with inborn errors of immunity (IEI). METHODS: Clinical data of 22 children with IEI who underwent HSCT were retrospectively reviewed. Survival after HSCT was estimated using the Kaplan-Meier method. RESULTS: Nine patients received a traditional conditioning regimen (fludarabine + busulfan + cyclophosphamide/etoposide) and underwent peripheral blood stem cell transplantation (PBSCT). Thirteen patients received a TT-containing modified conditioning regimen (TT + fludarabine + busulfan + cyclophosphamide), including seven PBSCT and six umbilical cord blood transplantation (UCBT) cases. Successful engraftment with complete donor chimerism was achieved in all patients. Acute graft-versus-host disease occurred in 12 patients (one with grade III and the remaining with grade I-II). Chronic graft-versus-host disease occurred in one patient. The incidence of EB viremia in UCBT patients was lower than that in PBSCT patients (P<0.05). Over a median follow-up of 36.0 months, one death occurred. The 3-year overall survival (OS) rate was 100% for the modified regimen and 88.9% ± 10.5% for the traditional regimen (P=0.229). When comparing transplantation types, the 3-year OS rates were 100% for UCBT and 93.8% ± 6.1% for PBSCT (P>0.05), and the 3-year event-free survival rates were 100% and 87.1% ± 8.6%, respectively (P>0.05). CONCLUSIONS TT-containing conditioning for allogeneic HSCT in children with IEI is safe and effective. Both UCBT and PBSCT may achieve high success rates.
Humans ; Retrospective Studies ; Transplantation Conditioning/methods* ; Thiotepa/therapeutic use* ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Male ; Female ; Child, Preschool ; Infant ; Child ; Transplantation, Homologous ; Graft vs Host Disease ; Adolescent

OBJECTIVE: To explore the effects of hydroxychloroquine (HCQ) on immune mediators dysregulation in severe infection after chemotherapy in acute myeloid leukemia (AML) and its molecular mechanism. METHODS: Bone marrow or peripheral blood samples of 36 AML patients with severe infection (AML-SI) and 29 AML patients without infection (AML-NI) after chemotherapy were collected from the First Affiliated Hospital of Gannan Medical University from August 2022 to June 2023. In addition, the peripheral blood of 21 healthy subjects from the same period in our hospital was selected as the control group. The mRNA expressions of CXCL12, CXCR4 and CXCR7 were detected by RT-qPCR technology, and the levels of IL-6, IL-8 and TNF-α were detected by ELISA. Leukemia-derived THP-1 cells were selected and constructed as AML disease model. At the same time, bone marrow mesenchymal stem cells (BM-MSCs) from AML-SI patients were co-cultured with THP-1 cells and divided into Mono group and Co-culture group. THP-1 cells were treated with different concentration gradients of HCQ. The cell proliferation activity was subsequently detected by CCK-8 method and apoptosis was detected by Annexin V/PI double staining flow cytometry. ELISA was used to detect the changes of IL-6, IL-8 and TNF-α levels in the supernatant of the cell co-culture system, RT-qPCR was used to detect the mRNA expression changes of the core members of the CXCL12-CXCR4/7 regulatory axis, and Western blot was used to detect the expressions of apoptosis regulatory molecules and related signaling pathway proteins. RESULTS: CXCL12, CXCR4, CXCR7, as well as IL-6, IL-8, and TNF-α were all abnormally increased in AML patients, and the increases were more significant in AML-SI patients (P <0.01). Furthermore, there were statistically significant differences between AML-NI patients and AML-SI patients (all P <0.05). HCQ could inhibit the proliferation and induce the apoptosis of THP-1 cells, but the low concentration of HCQ had no significant effect on the killing of THP-1 cells. When THP-1 cells were co-cultured with BM-MSCs of AML patients, the levels of IL-6, IL-8 and TNF-α in the supernatance of Co-culture group were significantly higher than those of Mono group (all P <0.01). After HCQ intervention, the levels of IL-6, IL-8 and TNF-α in cell culture supernatant of Mono group were significantly decreased compared with those before intervention (all P <0.01). Similarly, those of Co-culture group were also significantly decreased (all P <0.001). However, the expression of the core members of the CXCL12-CXCR4/7 regulatory axis was weakly affected by HCQ. HCQ could up-regulate the expression of pro-apoptotic protein Bax, down-regulate the expression of anti-apoptotic protein Bcl-2, as well as simultaneously promote the hydrolytic activation of Caspase-3 when inhibiting the activation level of TLR4/NF-κB pathway, then induce the programmed death of THP-1 cells after intervention. CONCLUSION The core members of CXCL12-CXCR4/7 axis and related cytokines may be important mediators of severe infectious immune disorders in AML patients. HCQ can inhibit cytokine levels to reverse immune mediators dysregulation and suppress malignant biological characteristics of leukemia cells. The mechanisms may be related to regulating the expression of Bcl-2 family proteins, hydrolytically activating Caspase-3 and inhibiting the activation of TLR4/NF-κB signaling pathway.
Humans ; Leukemia, Myeloid, Acute/immunology* ; Hydroxychloroquine/pharmacology* ; Receptors, CXCR4/metabolism* ; Apoptosis/drug effects* ; Tumor Necrosis Factor-alpha/metabolism* ; Chemokine CXCL12/metabolism* ; Interleukin-8/metabolism* ; Interleukin-6/metabolism* ; Receptors, CXCR/metabolism* ; Mesenchymal Stem Cells ; THP-1 Cells

OBJECTIVE: The present study evaluated the effects of deep acupuncture at Weizhong acupoint (BL40) on bladder function and brain activity in a rat model of overactive bladder (OAB), and investigated the possible mechanisms around the acupuncture area that initiate the effects of acupuncture. METHODS: Adult female Sprague-Dawley rats were randomly divided into six groups, comprising a control group, model group, group treated with deep acupuncture at BL40, group treated with shallow acupuncture at BL40, group treated with acupuncture at non-acupoint next to BL40, and group treated with acupuncture at Xuanzhong (GB39). Urodynamic evaluation was used to observe the urination, and functional magnetic resonance imaging was used to observe the brain activation. The mechanism of acupuncture at BL40 in regulating bladder function was explored by toluidine blue staining and enzyme-linked immunosorbent assay, and the mechanism was verified by stabilizing mast cells (MCs) or blocking tibial nerve. RESULTS: Deep acupuncture at BL40 significantly increased the intercontraction interval in OAB rats and enhanced the mean amplitude of low frequency fluctuation of primary motor cortex (M1), periaquaductal gray matter (PAG), and pontine micturition center (PMC). It also increased the zero-lag functional connectivity between M1 and PAG and between PAG and PMC. Shallow acupuncture at BL40 and acupuncture at non-acupoint or GB39 had no effect on these indexes. Further studies suggested that deep acupuncture at BL40 increased the number and degranulation rate of MCs as well as the contents of 5-hydroxytryptamine, substance P, and histamine in the tissues around BL40. Blocking the tibial nerve by lidocaine injection or inhibiting MC degranulation by sodium cromoglycate injection obstructed the effects of acupuncture on restoring urinary function and modulating brain activation in OAB rats. CONCLUSION Deep acupuncture at BL40 may be more effective for inhibiting OAB by promoting degranulation of MCs around the acupoint and stimulating tibial nerve, thereby regulating the activation of the brain area that controls the lower urinary tract. Please cite this article as: Liu X, Zhang CY, Du XY, Li SS, Wang YQ, Zheng Y, Deng HZ, Fang XQ, Li JY, Wang ZQ, Xu SF, Mi YQ. Acupuncture at Weizhong (BL40) attenuates acetic acid-induced overactive bladder in rats by regulating brain neural activity through the modulation of mast cells and tibial nerves. J Integr Med. 2025; 23(1): 46-55.
Animals ; Urinary Bladder, Overactive/physiopathology* ; Mast Cells/physiology* ; Rats, Sprague-Dawley ; Female ; Acupuncture Therapy ; Acupuncture Points ; Rats ; Brain/physiopathology* ; Tibial Nerve/physiopathology* ; Acetic Acid ; Urinary Bladder/physiopathology*

OBJECTIVE: Comorbid pain and depression are common but remain difficult to treat. Electroacupuncture (EA) can effectively improve symptoms of depression and relieve pain, but its neural mechanism remains unclear. Therefore, we used resting-state functional magnetic resonance imaging (rs-fMRI) to detect cerebral changes after initiating a mouse pain model via constriction of the infraorbital nerve (CION) and then treating these animals with EA. METHODS: Forty male C57BL/6J mice were divided into 4 groups: control, CION model, EA, and sham acupuncture (without needle insertion). EA was performed on the acupoints Baihui (GV20) and Zusanli (ST36) for 20 min, once a day for 10 consecutive days. The mechanical withdrawal threshold was tested 3 days after the surgery and every 3 days after the intervention. The depressive behavior was evaluated with the tail suspension test, open-field test, elevated plus maze (EPM), sucrose preference test, and marble burying test. The rs-fMRI was used to detect the cerebral changes of the functional connectivity (FC) in the mice following EA treatment. RESULTS: Compared with the CION group, the mechanical withdrawal threshold increased in the EA group at the end of the intervention (P < 0.05); the immobility time in tail suspension test decreased (P < 0.05); and the times of the open arm entry and the open arm time in the EPM increased (both P < 0.001). There was no difference in the sucrose preference or marble burying tests (both P > 0.05). The fMRI results showed that EA treatment downregulated the amplitude of low-frequency fluctuations and regional homogeneity values, while these indicators were elevated in brain regions including the amygdala, hippocampus and cerebral cortex in the CION model for comorbid pain and depression. Selecting the amygdala as the seed region, we found that the FC was higher in the CION group than in the control group. Meanwhile, EA treatment was able to decrease the FC between the amygdala and other brain regions including the caudate putamen, thalamus, and parts of the cerebral cortex. CONCLUSION EA can downregulate the abnormal activation of neurons in the amygdala and improve its FC with other brain regions, thus exerting analgesic and antidepressant effects. Please cite this article as: Yin X, Zeng XL, Lin JJ, Xu WQ, Cui KY, Guo XT, Li W, Xu SF. Brain functional changes following electroacupuncture in a mouse model of comorbid pain and depression: a resting-state functional magnetic resonance imaging study. J Integr Med. 2025; 23(2): 159-168.
Animals ; Electroacupuncture ; Male ; Magnetic Resonance Imaging ; Depression/diagnostic imaging* ; Mice, Inbred C57BL ; Brain/diagnostic imaging* ; Disease Models, Animal ; Mice ; Pain/diagnostic imaging* ; Acupuncture Points

Objective:To analyze the effects of enteral nutrition on interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),pulmonary surfactant protein A(SPA),and clinical pulmonary infection score(CPIS)in patients with hospital-acquired pneumonia(HAP)after stroke.Methods:A retrospective review was conducted of the clinical records of 90 patients with hospital-acquired pneumonia following stroke admitted to the Geriatric Medicine Department of Nanjing Brain Hospital between January 2022 and February 2023.Participants were divided into a control group and a study group based on the use of enteral nutrition,with 45 patients in each group.The control group received standard treatment(conventional stroke management combined with meropenem for infection control),while the study group received standard treatment supplemented with enteral nutrition.Within the study group,cases were classified as non-severe(n=33)and severe(n=12)based on disease severity.Peripheral blood levels of IL-6,TNF-α,and SPA,alongside the Clinical Pulmonary Infection Score(CPIS),were collected.Results:Before treatment,baseline data between the study group and control group showed no statistically significant differences,with no significant differences in IL-6,TNF-α,SPA,or CPIS scores between groups(P>0.05).Following enteral nutrition therapy,the study group exhibited significantly lower levels of IL-6,TNF-α,and SPA,as well as lower CPIS scores compared to the control group,with statistically significant differences(P<0.05).Before treatment,statistically significant differences existed between severe and non-severe cases within the study group for IL-6,TNF-α,SPA,and CPIS scores(P<0.05).After therapy,no statistically significant differences were observed between non-severe and severe patients in the study group for IL-6,TNF-α,SPA levels,or CPIS scores(P>0.05).Patients in the study group demonstrated shorter symptom resolution times,overall hospital stays,and recovery times for IL-6,TNF-α,and SPA levels compared to the control group,with all differences being statistically significant(P<0.05).Conclusion:Enteral nutrition significantly reduces peripheral blood levels of IL-6,TNF-α,and SPA in patients with post-stroke HAP,lowers CPIS scores,shortens symptom resolution time and overall hospital stay,and accelerates recovery of IL-6,TNF-α,and SPA levels.

Objective To evaluate the clinical efficacy of electroacupuncture at acupoints distributed on conception vessel(CV)and governor vessel(GV)in treating ischemic stroke(AIS)complicated with dysphagia and explore its potential mechanism.Methods A total of 120 patients diagnosed with AIS complicated with dysphagia at Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University from December 2020 to December 2023 were enrolled and randomly divided into an observation group and a control group,with 60 patients per group.The control group received conventional swallowing training,while the observation group received additional electroacupuncture at acupoints distributed on CV and GV.The treatment lasted for 4 weeks.After 1 month of treatment,clinical efficacy was assessed,and the changes in Standardized Swallowing Assessment(SSA)scores,National Institutes of Health Stroke Scale(NIHSS)scores,hyolaryngeal mobility(thyroid cartilage anterior/superior displacement,hyoid bone anterior/superior displacement),and KubotaWater Swallowing Test scores were observed.Cerebral microcirculation parameters and the Chinese version of the Eating/Drinking Quality of Life(EDQoL)questionnaire were also compared.Safety and adverse events were evaluated.Results(1)The total effective rate in the observation group was 95.00%(57/60),compared to 76.67%(46/60)in the control group,demonstrating statistically superior therapeutic efficacy in the observation group(P＜0.05).(2)After treatment,both groups showed significant improvements in SSA scores and NIHSS scores(P＜0.05),with the observation group exhibiting markedly better enhancement in both SSA and NIHSS scores compared to the control group,showing statistically significant differences(P＜0.05).(3)After intervention,significant improvements were observed in anterior displacement of thyroid cartilage,superior displacement of thyroid cartilage,anterior displacement of hyoid bone,and superior displacement of hyoid bone in both groups(P＜0.05).The observation group outperformed the control group in all these laryngeal kinematic parameters with statistically significant differences(P＜0.05).(4)Both groups demonstrated significant improvement in Kubota Water Swallowing Test scores after treatment(P＜0.05),with the observation group displaying statistically greater improvement than the control group(P＜0.05).(5)Cerebral arterial parameters including peak systolic velocity(Vs),mean velocity(Vm),and resistance index(RI)were significantly improved in both groups after treatment(P＜0.05).The observation group showed superior enhancement in these cerebrovascular hemodynamic indices compared to the control group(P＜0.05).(6)Significant improvements in EDQoL scores were observed in both groups after treatment(P＜0.05),with the observation group achieving statistically greater improvement than the control group(P＜0.05).(7)The total incidence of adverse reactions was 1.67%(1/60)in the observation group versus 11.67%(7/60)in the control group,indicating a statistically significant lower adverse event rate in the observation group(P＜0.05).Conclusion Electroacupuncture at acupoints distributed on CV and GV effectively alleviates dysphagia and neurological impairment,improves hyolaryngeal mobility and cerebral microcirculation,enhances quality of life,and reduces adverse events such as aspiration pneumonia in AIS patients complicated with dysphagia.

Objective To analyze the nucleic acid positive rate and genotype characteristics of the pa-tients with viral hepatitis C in Yongchuan District of Chongqing city during 2004-2022.Methods All the hepatitis C patients whose current address was in Yongchuan District of Chongqing City and audited for man-agement entering in the database of the Infectious disease surveillance System of China Disease Prevention and Control Information from 2004 to 2022 were selected as the study subjects.The questionnaire survey,nucleic acid and genotype detection were conducted.The nucleic acid positive rate and genotype characteristics were analyzed.Results Among 489 cases of viral hepatitis C,there were 286 cases of hepatitis C viral nucleic acid(HCV-RNA)positive(58.49％),the positive rate of males was 64.63％,which was high than 49.23％in fe-males,and the differences was statistically significant(P＜0.05).The HCV-RNA positive rate had statistical difference among different professions,cultural levels and medical insurance types(P＜0.05).But the HCV-RNA positive rates had no statistically difference among different ages,marital status,incomes and permanent residences(P＞0.05).A total of 285 cases of single infection subtype and 1 case of 1b and 6a mixed subtype were detected out.The single infection subtypes were mainly the 1b type(56.45％),3b type(12.89％)and 6a type(13.24％).Conclusion The positive rate of HCV-RNA among hepatitis C patients in Yongchuan Dis-trict during 2004-2022 was 58.49％,more than half of the previous cases are still the active infected persons requiring the antiviral treatment.The HCV genotype is mainly the 1b type,followed by 3a,3b and 6a types.It is necessary to further mobilize the treatment of previous patients with hepatitis C and improve the treatment rate and clinical cure rate.

Objective To clarify the high-touch surface in oral diagnosis and treatment procedures,provide basis and guidance for cleaning and disinfection.Methods The direct observation method was used to investigate the tou-ch time and frequency of environmental surfaces in 7 outpatient departments of a tertiary stomatology hospitals in Beijing.The average touch frequency,95％confidence interval and cumulative touch rate were calculated.Results In oral diagnosis and treatment procedures,the average touch frequency of the environmental surface was 26.75 times per procedure,with the highest in endodontics(46.25 times per procedure)and the lowest in the oral mucosal specialty(10.19 times per procedure).The high-touch surface consisted of the shadowless lamp handle,manipula-tion panel and handle on dental unit(doctor's side),computer keyboard and mouse,handle and line front end of three way syringe,as well as dental high speed handpiece and line front end,with average touch frequencies of 3.99,3.85,2.65,1.86,and 1.40 times per procedure.The high-touch surface in all stomatology specialties in-cluded the manipulation panel and handle on dental unit(doctor's side),75％of specialties included computer key-board and mouse,and the shadowless lamp handle has the highest touch frequency in 50％of specialties.The ave-rage touch frequency of the environmental surface was highest(113.50 times per procedure)during crown prepara-tion procedure,and the lowest(8.50 times per procedure)during the orthodontic consultations.Conclusion The high-touch surface of different dental specialties and different diagnosis and treatment procedures are different.Me-dical institutions should take corresponding cleaning,disinfection and management measures according to the actual situation of high-touch surface in stomatology departments,so as to effectively improve the quality of environmental cleaning and disinfection.