OBJECTIVE: To elucidate the rules of temporal and spatial variations in distal skin potential at Hegu (LI4) under different stimulation modes by extracting nonlinear characteristic parameters from array multichannel data and adopting multivariate statistical analysis. METHODS: Seven healthy subjects were selected and the surface potential at the left Quchi (LI11) was collected using 14×9 array multichannel electrodes. Using Hegu (LI4) on the left as the stimulation point, four stimulation modes were applied, i.e. being quiescent, point pressing, moxibustion, and manual needling manipulation. Electrical signals were collected for 30 s in each mode, with a 5-min interval between operations, and a sampling frequency of 16 384 Hz. The data was denoised using ensemble empirical mode decomposition (EEMD), and sample entropy (SaEn) features were extracted. Statistical analysis was conducted on these data using factor analysis and multivariate analysis of variance. RESULTS: The SaEn values of most electrode channels were higher under point pressing, moxibustion and manual needling manipulation compared with those under quiescent condition. Under manual needling manipulation, the SaEn value of the electrode channel reached the peak in the first time interval (1-5 s) and it was declining thereafter. Factor analysis showed that the specificity of activation channels was concentrated at the left Quchi (LI11) (loading capacity ≥0.90). Analysis of variance indicated that the significant differences were presented in average sample entropy (SaEn()) values of activation channels among different stimulation modes at Hegu (LI4) (P<0.001), but there was no statistically significant interaction effect between groups and time intervals (P>0.05). CONCLUSION Through nonlinear characteristic parameter extraction and multivariate statistical analysis, we have uncovered the complex temporal and spatial dynamical rules of distal skin potential at Hegu (LI4) under various stimulation modes and successfully identified the specific activation characteristics at Quchi (LI11).
Humans ; Moxibustion ; Acupuncture Points ; Male ; Adult ; Female ; Young Adult ; Acupuncture Therapy/instrumentation*

ObjectiveTo explore the effects and mechanisms of Naotai Formula （脑泰方） against white matter lesions associated with cerebrovascular disease via Wnt/β-catenin pathway. MethodsTen WKY rats were used as sham surgery group， and 30 spontaneously hypertensive rats （SHRs） were randomly divided into model group， low-and high-dose Naotai Formula group， with 10 rats in each group. In addition to the sham surgery group， rats in each group were modelled by dorsum subcutaneous injection of D-galactose for 56 days， by performing bilateral common carotid artery stenosis on the 29th day of modelling with low perfusion for 28 days to construct the rat models of cerebral small-vessel disease with composite risk factors. The rats in the low- and high-dose Naotai Formula groups were given 9 and 27 g/（kg·d） of Naotai Formula by gavage on the day after surgery， and 10 ml/（kg·d） of pure water by gavage in the sham surgery group and the model group， with all rats in each group gavaged for 4 weeks. Blood pressure of rats was monitored weekly before and after medication administration； water maze experiments were performed for 6 consecutive days from the 50th day of modelling； and changes in cerebral blood flow were detected by laser scattering preoperatively， postoperatively， and after medication administration. The samples were taken on the next day after the last gavage， and the extent of myelin damage in the rat corpus callosum was observed by Lucas fast blue （LFB） and transmission electron microscopy， and the levels of interleukin 1β （IL-1β）， tumour necrosis factor α （TNF-α）， interleukin 10 （IL-10）， and tumour necrosis factor β （TNF-β） were detected by ELISA， and the levels of expression of myelin basic protein （MBP） and ionized calcium binding adaptor molecule 1 （IBA1）， neuroglial antigen 2 （NG2）， cell proliferation marker Ki67 antigen （MBP）， and cell proliferation marker Ki67 antigen （Ki67A）/NG2， 2'，3'- cyclic-nucleotide 3'-phosphodiesterase （CNPase） expression were measured by immunofluorescence. MBP in the corpus callosum， wingless MMTV integration site family member 3a （Wnt3a）， phosphorylated glycogen synthase kinase 3β （p-GSK-3β）， glycogen synthase kinase 3β （GSK-3β）， phosphorylated β-catenin （p-β-catenin）， β-catenin expression were detected by western blotting， and GSK-3β， β-catenin mRNA expression in the corpus callosum were detected by RT-qPCR. ResultsCompared with the sham surgery group， rats in the model group had elevated systolic blood pressure at all time points， decreased the number of traversing platforms and the percentage of time spent in the target quadrant in the water maze experiments， significantly prolonged the evasion latency on days 4 and 5， and decreased cerebral blood flow in the postoperative period and after medication administration （P＜0.05 or P＜0.01）； significant myelin sheath damage in the corpus callosum was seen by LFB staining and transmission electron microscopy； the callus had significantly higher levels of TNF-α and IL-1β content increased， TNF-β content decreased， MBP fluorescence intensity and protein expression decreased， the number of IBA1-positive cells increased， Wnt3a and p-GSK-3β/GSK-3β values increased， p-β-catenin/β-catenin values decreased， GSK-3β mRNA expression decreased， and β-catenin mRNA expression increased （P＜0.05 or P＜0.01）. Compared with the model group， the myelin sheath damage of corpus callosum in rats in the high-dose Naotai Formula groups was significantly improved， and all of the above indexes were significantly improved （P＜0.05 or P＜0.01）. Compared with the low-dose Naotai Formula group， myelin damage in the corpus callosum of the high-dose Naotai Formula group was improved， systolic blood pressure reduced， cerebral blood flow and MBP fluorescence intensity and protein expression in the corpus callosum， the number of positive cells for NG2 and CNPase， the values of p-β-catenin/β-catenin and GSK-3β mRNA expression increased， and the expression of Wnt3a， p-GSK-3β/ GSK-3β values and β-catenin mRNA expression decreased （P＜0.05 or P＜0.01）. ConclusionsHigh-dose Naotai Formula can significantly improve white matter lesions in cerebral small vessel disease， and the mechanism may be related to the inhibition of the Wnt/β-catenin signalling pathway， reducing the inflammatory microenvironment in the brain， and promoting the differentiation of oligodendrocyte precursor cells into oligodendrocytes.

OBJECTIVE To explore the mechanism of limonin treating in hepatic fibrosis through network pharmacology, and validate its mechanism by molecular docking and animal experiments. METHODS Firstly, the targets of limonin and hepatic fibrosis were screened from the SwissTargetPrediction, GeneCards and DisGeNet database, etc. Meanwhile, the common targets of limonin and hepatic fibrosis were obtained from the bioinformatics website. The protein protein interaction network of common target was constructed by using STRING database and Cytoscape software, and the CytoNCA plug-in was used to screen core targets. And then the enrichment analysis of GO and KEGG on the common target was performed by Metascape database. Thereby, the possible mechanism of limonin against hepatic fibrosis were predicted. Finally, the AutoDock Vina was used for molecular docking verification, and the prediction results of network pharmacology were verified by animal experiments. RESULTS The prediction results indicated that limonin might acted on 86 targets including AKT1, VEGFA and HIF1A, and participated in biological processes including hormone response, protein phosphorylation, angiogenesis, and PI3K-Akt pathway, HIF-1 pathway, VEGF pathway and other signaling pathways related to hepatic fibrosis. The results of protein protein interaction network topology analysis showed that the 11 core targets including AKT1, VEGFA, HIF1A and PIK3CA, etc. Molecular docking results showed that limonin had strong affinity and relatively stable binding conformation with the core targets. In the animal experiments, compared with the model group, hyaluronidase(HA) and laminin(LN) in rat serume in high-dose group of limonin(LH) and low-dose group of limonin(LL)(except for LN in LL group) were declined(P<0.01 or P<0.05), and the degree of inflammation and hepatic fibrosis were relieved to different degrees in liver tissue of the LH group and LL group; Western blotting and qPCR detection showed that protein and mRNA expression levels of AKT, HIF-1α and VEGF(except for VEGF in LL group) was down-regulated in the LH group and LL group(P<0.01 or P<0.05). CONCLUSION Limonin may acts on AKT1, VEGFA, HIF1A and other core targets to treat hepatic fibrosis angiogenesis, which may be related to the inhibition of AKT/HIF-1α/VEGF signaling pathway.

Objective To explore the selection strategy of diagnostic and therapeutic regimens and assess the efficacy for postoperative infection following internal fixation of patellar fractures. Methods A retrospective analysis was conducted on the clinical data of 12 patients with postoperative infection after internal fixation of patellar fractures. Results A total of 6 patients underwent complete removal of the internal fixation devices during debridement and were subsequently fixed with knee braces, while the other 6 had their original internal fixation devices removed and replaced with Kirschner wire fixation. Three patients developed septic arthritis and underwent knee arthroscopic lavage treatment. All 12 patients underwent bacterial culture and metagenomic next-generation sequencing (mNGS) testing, and the key pathogenic bacteria were successfully identified by mNGS. All wounds achieved primary healing within 2 weeks after closure. At the final follow-up, all patients exhibited good fracture healing, with Böstman patellar fracture function scores ranging from 24 to 29 (mean score of 26.58), and the outcomes were evaluated as excellent in 7 cases and good in 5, resulting in an excellent and good rate of 100.0%. Conclusion For patients with early and delayed postoperative infections following internal fixation of patellar fractures, removal of the internal fixation devices can help reduce the risk of infection recurrence. For patients with concurrent septic arthritis, early diagnosis and timely implementation of arthroscopic joint debridement and irrigation and drainage are crucial.

Objective:To investigate the effect of preoperative old muscular calf vein thrombosis on the safety and efficacy of total knee arthroplasty (TKA).Methods:A total of 411 patients with end-stage knee osteoarthritis who underwent primary TKA in the First Affiliated Hospital of Nanjing Medical University from September 2021 to March 2023 were retrospectively analyzed. There were 89 males and 322 females, aged 68.05±5.91 years (range, 50-82 years). The body mass index was 26.8±3.7 kg/m 2 (range, 17.4-39.8 kg/m 2). The group was divided into a preoperative thrombosis group (47 cases) and a preoperative none-thrombosis group (364 cases) according to whether or not there was a combination of old muscular calf vein thrombosis before TKA. The clinical characteristics (location and size) and lower limb swelling were observed, and the American Knee Society (AKS) score, visual analogue scale (VAS) and Villalta score were recorded to compare the differences between the two groups. Results:All patients successfully completed the operation and were followed up for 7.4±1.1 months (range, 6-9 months). Postoperative deep venous thrombosis (DVT) occurred in 96% (45/47) of the patients in the preoperative thrombus group, which was greater than the 38.5% (140/364) in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=55.184, P<0.001). 29% (13/45) of the patients who developed DVT postoperatively in the preoperative thrombus group had DVT located in the main vein, which was greater than the 9% (12/140) in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=12.028, P<0.001). 51% (23/45) of patients with DVT after operation had thrombosis ≥6 mm, which was higher than 34% (47/140) of patients in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=4.454, P=0.035). The rate of thigh swelling on postoperative day 3 was 8.42%±3.50% in the group with preoperative thrombus and 7.80%±4.12% in the preoperative none-thrombus group, and the differences were not statistically significant ( t=-0.995, P=0.320). The rate of calf swelling on postoperative day 3 was 8.14%±3.40% in the preoperative thrombus group, which was greater than the 5.51%±3.45% in the preoperative none-thrombus group, and the difference was statistically significant ( t=-4.923, P<0.001). Postoperative AKS scores were elevated in both groups and were greater than preoperative scores at 3 and 6 months postoperatively, with statistically significant differences ( P<0.05). There was no significant difference in AKS score between the two groups before operation ( P>0.05), and the AKS scores in the preoperative thrombus group were smaller than those in the preoperative none-thrombus group at 3 and 6 months postoperatively, with a statistically significant difference ( P<0.05). Postoperative VAS scores were reduced in both groups and were smaller than preoperative scores at 3 and 6 months postoperatively, with statistically significant differences ( P<0.05). There was no significant difference in preoperative VAS scores between the two groups ( P<0.05), and the VAS scores in the preoperative thrombus group were greater than those in the preoperative none-thrombus group at 3 and 6 months postoperatively, with a statistically significant difference ( P<0.05). The Villalta score of patients with DVT after operation in the preoperative thrombus group was 4.47±2.47 at the last follow-up, which was greater than that of the preoperative none-thrombus group, which was 2.90±1.92, and the difference was statistically significant ( t=-4.395, P<0.001). Conclusion:Preoperative combined old muscular calf vein thrombosis increases the incidence of postoperative DVT and the dangerousness of DVT is higher.

Objective The aim of this study was to establish an acute gastric mucosal injury(AGMI)rat model induced by hydrochloric acid(HCl)at different concentration gradients and to investigate the effects of intravenous injection of evans blue(EB)at various concentrations and dosages on survival rate and superficial extravasation.Methods(1)Wistar rats were randomly assigned to five weight-based groups:150～180 g,180～200 g,200～250 g,300～400 g,400～500 g.Each group was further subdivided into eight subgroups based on HCl concentration,specifically:0.40,0.45,0.50,0.55,0.60,0.65,0.70 mol/L HCl,along with a control group treated with saline.This result ed in a total of 40 subgroups,with three rats per subgroup,summing up to 120 animals in total.The survival rate of rats 24 hours post-modeling was assessed,and the interaction between body weight and HCl concentration on rat survival was analyzed.Following the establishment of five graded HCl concentrations,gastric mucosal pathological changes were observed microscopically using hematoxylin-eosin staining(HE)staining.(2)From these result,the highest suitable concentration of HCl was selected to prepare the AGMI model.Subsequently,rats were randomly allocated into different groups based on the concentration and dose of EB,specifically:EB 1(0.5％,0.4 mL),EB 2(1％,0.1 mL/100 g),EB 3(1％,0.2 mL/100 g),EB 4(2％,0.1 mL/100 g),EB 5(2％,0.2 mL/100 g),and EB 6(5％,0.1 mL).Each group consisted of five rats,totaling 30 animals.The survival rate and extent of dermal exudation were evaluated 24 hours post-injection of EB.Results(1)Post-modeling symptoms in AGMI rats intensified with increasing concentrations of HCl,with the 24-hour survival rate in all weight groups being 0％for both 0.65 mol/L and 0.70 mol/L HCl.Kaplan-Meier survival curves indicated significant differences in survival rates among rats in different HCl concentration groups(P＜0.001).Furthermore,a significant interaction effect between HCl concentration and body weight on rat survival time was observed(P＜0.001).The five gradient HCl concentrations established were from 0.40、0.45、0.50、0.55、0.60 mol/L.Histological observations revealed that the degree of inflammatory cell infiltration in the gastric mucosa of AGMI rats escalated with increasing HCl concentrations.(2)AGMI rats prepared with 0.60 mol/L HCl and injected with 5％EB(0.1 mL)had a 24 h survival rate of only 40％.Kaplan-Meier survival curves showed no significant differences in survival rates among AGMI rats under different concentrations and dosages of EB(P＞0.05).Analysis of superficial extravasation revealed that skin and eye color were lighter in EB 1 group rats,with fewer extravasation points,while rats in EB 4 and EB 5 groups exhibited more apparent skin color changes and extravasation.One-way ANOVA further confirmed that the number of superficial EB extravasation points in the EB 3,EB 4,and EB 5 groups was significantly higher than that in EB 1 group(P＜0.05,P＜0.01).Conclusions HCl modeling successfully achieved a setting of multiple precise concentration gradients.Gastric lavage with HCl concentrations ranging from 0.40 mol/L to 0.60 mol/L in rats with a fasting body weight of 180～200 g was used to successfully prepare an AGMI model.Intravenous injection of 2％EB(0.2 mL/100 g)can facilitate the study and analysis of the distribution characteristics of superficial EB extravasation points in AGMI rats over time and as the condition progresses.

Objective:To investigate the effect of preoperative patellar tilt angle on postoperative outcome of total knee arthroplasty (TKA).Methods:A total of 277 patients with knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to September 2022 were retrospectively analyzed. There were 72 males and 205 females, aged 69.16±6.77 years (range, 52-87 years), body mass index 27.01±3.81 kg/m 2 (range 18.14-39.01 kg/m 2). The patients were divided into three groups according to the preoperative tilt angle of the patella: tilt angle<5° for mild tilt group, 5°≤tilt angle<10° for moderate tilt group, and tilt angle≥10° for severe tilt group. There were 103 cases in the mild group, 137 cases in the moderate group, and 37 cases in the severe group. The preoperative and postoperative visual analogue scale (VAS), Hospital for Special Surgery (HSS) score and Feller's score of patella were compared. Results:All patients were followed up for 15.73±3.06 months (range, 12-22 months). The patellar tilt angle was 6.86°±3.55° preoperatively and 3.63°±2.61° postoperatively ( t=19.086, P<0.001). The patellar tilt angle of mild group, moderate group and severe group decreased after operation, and the difference was statistically significant compared with that before operation ( P<0.05). The anterior knee VAS of the three groups decreased after operation, and the differences were statistically significant compared with those before operation. The anterior knee VAS at 3, 6, and 12 months after operation were lower than those before operation. The differences between groups at 6 and 12 months postoperatively were statistically significant ( P<0.05), with anterior knee VAS scores of 2.59±0.55 and 2.03±0.55 in the severe group being greater than those of 2.15±0.38 and 1.57±0.50 in the mild group and 2.19±0.49 and 1.67± 0.61 in the moderate group. The HSS score of the three groups was increased after operation, and the difference was statistically significant compared with that before operation ( P<0.05), and the HSS scores at 3, 6 and 12 months after operation were higher than those before operation. There were significant differences at 6 and 12 months after operation ( P<0.05), the HSS scores of the severe group were 86.27±2.04 and 87.73±2.28, which were lower than those of the mild group 89.02±2.33 and 89.83±1.48, and the moderate group 88.77±2.83 and 89.52±1.95. Postoperative patellar Feller score increased in all three groups, and the difference was statistically significant compared with that before operation ( P<0.05), the patellar Feller score at 3, 6 and 12 months after operation was higher than that before operation. There were significant differences at 6 and 12 months after operation ( P<0.05), the patellar Feller scores in the severe group were 18.32±1.99 and 20.32±1.60, which were lower than those in the mild group 20.92±1.01 and 23.07±1.39 and the moderate group 20.91±1.95 and 22.69±1.59. Conclusion:In TKA patients without patella replacement, the increase of patellar tilt angle before operation can lead to anterior knee pain and reduced knee function.

Objective:To analyze the surveillance data of Kashin-Beck disease (KBD) in Shandong Province, master the changes of KBD, and provide scientific basis for formulating prevention and control strategies of KBD and adjustment of the prevention and control focus of KBD.Methods:According to the requirements of the "National KBD Monitoring Plan" and the "Shandong KBD Monitoring Plan", from 2016 to 2020, the disease monitoring was carried out in the villages of KBD areas in Shandong Province, including the number of clinical positive cases, the number of X-ray positive cases, and the number of metaphyseal positive cases. The detection rate was calculated, and the dynamic changes of the disease was analyzed macroscopically.Results:From 2016 to 2020, a total of 1 816 children aged 7 - 12 years were clinically examined in Shandong Province, and no child with KBD was found. A total of 1 224 children were examined by X-ray, among which 1 positive patient was found in 2016 and 2017, respectively, both of whom were metaphyseal changes, with a total detection rate of 0.16%. There were 367 adult patients with KBD in Shandong Province, including 304 patients with grade Ⅰ, 47 patients with grade Ⅱ and 16 patients with grade Ⅲ. All villages in the KBD areas in Shandong Province had reached the elimination standard, with the elimination rate of 100%.Conclusion:No clinical case of KBD is detected in children aged 7 - 12 years in Shandong Province from 2016 to 2020, which has reached the elimination standard and is in a continuous elimination state.

Objective:To analyze the effect of patellar tilt angle on postoperative outcomes after total knee arthroplasty (TKA) without patella resurfacing.Methods:A total of 143 patients with end-stage knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to October 2021 were retrospectively analyzed. There were 32 males and 111 females, aged 68.44±6.79 years (range, 52-86 years). Patients were divided into three groups according to the postoperative patellar tilt angle: tilt angle<5° was the mild tilt group (97 cases), 5°≤tilt angle<10° was the moderate tilt group (31 cases), and tilt angle≥10° was the severe tilt group (15 cases). All patients were followed up in the outpatient clinic at 3, 6 and 12 months after surgery, and knee visual analogue score (VAS), Hospital for Special Surgery (HSS) score and patella Feller score were observed and recorded to compare the postoperative knee pain and function of patients in different patella tilt groups.Results:All patients were followed up for 1.16±0.23 years (range, 1.0-2.0 years). There was no significant difference in baseline data between the groups. There were significant differences in the intra-group comparison of the VAS score before and after surgery among the three groups ( F=51.12, P<0.001; F=36.90, P<0.001; F=15.76, P<0.001). The VAS scores at 3, 6 and 12 months after operation were significantly lower than those before operation ( P<0.05). The knee VAS of the severe group was higher than that of the mild and moderate groups at 3, 6 and 12 months after surgery, and the difference was statistically significant ( P<0.05). There were statistically significant differences in knee HSS scores before and after surgery among the three groups ( F=81.12, P<0.001; F=36.05, P<0.001; F=32.93, P<0.001). The knee HSS scores at 3, 6 and 12 months after surgery were higher than those before surgery, and the difference was statistically significant ( P<0.05). The knee HSS scores of the severe tilt group at 3, 6 and 12 months after surgery were lower than those of the mild and moderate groups, and the difference was statistically significant ( P<0.05). There were statistically significant differences in the intra-group comparison of the patella Feller score before and after surgery among the three groups ( F=88.81, P<0.001; F=49.59, P<0.001; F=37.40, P<0.001). The patellar Feller score at 3, 6 and 12 months after surgery was higher than that before surgery, and the difference was statistically significant ( P<0.05). The patellar Feller score of the severe group at 3, 6 and 12 months after surgery was lower than that of the mild and moderate groups, and the difference was statistically significant ( P<0.05). Conclusion:Patellar tilt angle after TKA without patellar resurfacing will increase knee pain and limit joint function.

Objective To determine the radiation dose of sensitive organs under different protective methods in lung CT scanning environment, and to explore the best protective scheme of corresponding organs. Methods Annealed thermoluminescence dose elements were placed in the stomach, liver, colon, and thyroid gland of a simulated human body model. The dose effect experiment of protective methods included non-protective group, half lead apron group, and full lead apron group. The dose effect experiment of protective thickness included 0.50 mmpb full lead apron group and 0.35 mmpb full lead apron group. The same exposure conditions of lung CT scan were used in the above experiments. Results Compared with the non-protective group, the exposure dose of the stomach, liver, colon, and thyroid gland increased significantly in the half lead apron group (P < 0.05), and the exposure dose of the thyroid gland and colon decreased significantly in the full lead apron group (P < 0.05). There were no significant differences in the exposure dose of the liver, stomach, and colon in the simulated human body model between the 0.35 mmpb full lead apron group and the 0.50 mmpb full lead apron group. Conclusion For lung CT scan, the protective measure of lead apron may not reduce the exposure dose of subjects. The protective thickness of lead apron does not necessarily have a substantial influence on the exposure dose of human body.