Objective: To observe and compare the clinical effects of different electroacupuncture waveforms on primary dysmenorrhea. Methods: This was a prospective, randomized, three-group, parallel-controlled trial. Participants with primary dysmenorrhea were randomly divided into dense-sparse wave, continuous wave, and discontinuous wave groups in a 1:1:1 ratio. Two lateral Ciliao (BL 32) points were used. All three groups started treatment 3–5 days before menstruation, once a day for six sessions per course of treatment, one course of treatment per menstrual cycle, and three menstrual cycles. The primary outcome measure was the proportion with an average visual analog scale (VAS) score reduction of ≥50% from baseline for dysmenorrhea in the third menstrual cycle during treatment. The secondary outcome measures included changes in dysmenorrhea VAS scores, Cox Menstrual Symptom Scale scores and the proportion of patients taking analgesic drugs. Results: The proportion of cases where the average VAS score for dysmenorrhea decreased by ≥50% from baseline in the third menstrual cycle was not statistically significant (P > .05). Precisely 30 min after acupuncture and regarding immediate analgesia on the most severe day of dysmenorrhea, there was a statistically significant difference in the dense-sparse wave group compared with the other two groups during the third menstrual cycle (P < .05). Additionally, there was a statistically significant difference between the dense-sparse wave and discontinuous wave groups 24 h after acupuncture (P < .05). Conclusions Waveform electroacupuncture can alleviate primary dysmenorrhea and its related symptoms in patients. The three groups showed similar results in terms of short- and long-term analgesic efficacy and a reduction in the number of patients taking analgesic drugs. Regarding achieving immediate analgesia, the dense-sparse wave group was slightly better than the other two groups.

Objective To analyze the correlation between Ki-67 expression in tumor tissue and ultrasound features of patients with mass breast cancer.Methods A total of 90 patients(90 masses)with mass breast cancer admitted to Xinxiang Central Hospital from January 2020 to December 2022 were selected and divided into the Ki-67 high expression group(n=53)and Ki-67 low expression group(n=37)according to the expression of Ki-67 in tumor tissue.The qualitative and quantitative characteristics of contrast-enhanced ultrasound(CEUS),shear wave elastography(SWE)and color doppler flow imaging(CDFI)were compared between the two groups,and their correlation with Ki-67 expression in patients with mass breast cancer was analyzed by multivariate logistic regression.Results The proportion of CEUS perfusion defects patients in the Ki-67 high expression group was significantly higher than that in the Ki-67 low expression group(P＜0.05).There was no significant difference in CEUS margin,homogeneity,enhancement level,post-enhancement lesion range and direction between the two groups(P＞0.05).The maximum intensity,rise time,and half time in the Ki-67 high expression group were significantly higher than those in the Ki-67 low expression group(P＜0.05).There was no significant difference in arrival time,time to peak,and mean transit time between the two groups(P＞0.05).The proportion of hard ring signs in SWE of patients in the Ki-67 high expression group was significantly higher than that in the Ki-67 low expression group(P＜0.05),while there was no significant difference in the proportion of SWE black hole signs between the two groups(P＞0.05).The elastic modulus ratio between lesions to surrounding parenchyma of patients in Ki-67 high expression group was higher than that in the Ki-67 low expression group(P＜0.05).There was no significant difference in the maximum,average,and minimum elastic modulus between the two groups(P＞0.05).In the Ki-67 high expression group,the proportion of patient where tumor size under CDFI was 2-5 cm,and the proportion of patients with burrs on the lesion edge were higher than those in the Ki-67 low expression group(P＜0.05).There was no significant difference in the shape,location and calcification of the lesions under CDFI between the two groups(P＞0.05).Perfusion defect,hard ring sign and edge burr were associated with high Ki-67 expression in patients with mass breast cancer(P＜0.05).Conclusion Ultrasonographic features of mass breast cancer can predict Ki-67 expression.Perfusion defect,hard ring sign,and edge burr are related to Ki-67 positive expression.

Objective:To analyze the expression and prognosis of B-cell lymphoma 7 protein family member A (BCL7A) in hepatocellular carcinoma, as well as the effect and mechanism of BCL7A expression on the invasion and migration of hepatocellular carcinoma cells.Methods:The cancer tissues and adjacent tissues of 40 patients with hepatocellular carcinoma who underwent radical hepatobiliary resection in the Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University from November 2017 to March 2018 were prospectively collected for protein extraction, including 29 males and 11 females, aged (58.5±10.4) years. The information of 374 cases of hepatocellular carcinoma and 50 cases of adjacent tissues were downloaded from The Cancer Genome Atlas (TCGA) database, and the hepatocellular carcinoma cell lines Hep3B and SMMC-7721 were transfected with overexpressing BCL7A plasmid and empty vector plasmid (negative control), respectively. Western blotting and immunohistochemistry were used to detect the expression of BCL7A, and Western blotting was also used to detect the expression of proteins related to epithelial-mesenchymal transition (N-cadherin, E-cadherin, snail). Transwell and cell scratch assays were used to detect cell invasion and migration.Results:Compared with adjacent tissues, the mRNA expression of BCL7A in 50 patients with hepatocellular carcinoma in TCGA was significantly increased ( t=13.38, P<0.001). According to the median mRNA expression level of BCL7A, 374 patients were divided into BCL7A high expression group ( n=187) and low expression group ( n=187), and the cumulative survival rate of BCL7A high expression patients was lower than that of low expression group, and the difference was statistically significant ( χ2=6.95, P=0.009). Western blot was used to detect the relative expression of BCL7A protein in cancer tissues, and found it was higher compared to adjacent tissues. Compared with the negative control group, the number of cells invaded by the BCL7A overexpression group of hepatoma cells Hep3B and SMMC-7721 was more than the negative control group respectively, (153.7±1.3) vs (63.7±4.7) and (307.7±25.14) vs (72.3±12.5), and the differences were statistically significant ( t=7.97, 8.38, both P=0.001) .The results of the cell scratch assay were consistent with the results of the Transwell invasion assay. The expressions of N-cadherin and snail in the BCL7A overexpression group were higher than those in the negative control group, and the E-cadherin was lower, and the difference was statistically significant (all P<0.05). Conclusions:The expression of BCL7A in cancer tissues of patients with hepatocellular carcinoma is elevated and is associated with poor prognosis. BCL7A may promote hepatocellular carcinoma cell metastasis and invasion by promoting epithelial-mesenchymal transition.

Abstract The Children s Aid Society of New York has been providing free food to students at local vocational schools since 1853. It wasn t until 1975 that the school lunch program was permanently mandated by Congress. The National School Lunch Program in America has gone through a historic process from its inception and establishment to its development. The continued interest and oversight of the American people, public opinion guidance by progressive people like nutrition reformers, home economics and other are external factors in the continued development of this program. The timely enactment of the bill by the federal government and the high concern of senior leaders on this project is an important prerequisite for continued development. Integrating this program into the national agricultural development strategy and realizing the overall development philosophy is the key to the sustainability of this program. Paying attention to children s physical health is the core reason why American School Feeding Programs focus on children s diet quantity to children s nutritional quality. All of these factors contribute to the development of this project.

Objective: To investigate the effects of a ketogenic diet (KD) alone and in combination with resistance training (KD+RT) on body composition and glucolipid metabolism of obese and female college students, and to provide a theoretical basis for the application of KD+RT in obese patients. Methods: Totally 45 obese and female college students in Wuyi University were recruited and randomly divided into KD group ( n =23) and KD+RT group ( n =22) in September 2021. After received training for 4 weeks, the changes of body composition and glucose and lipid metabolism of obese and female college students were compared before and after intervention. Results: Both a 4 week KD and KD+RT led to decreases in weight, BMI, body fat mass, body fat percentage, waist to hip ratio, visceral fat area of obese female college students ( t =16.19, 16.21, 12.42, 7.99, 2.10, 6.37; 18.82, 18.02, 17.80, 10.72, 3.41, 7.59, P <0.01). The change of muscle mass was decreased in KD group( t=4.12, P <0.01), but there was no statistically significant difference in KD+RT group( P >0.05). Both a 4 week KD and KD+RT significantly reduced the levels of the fasting blood glucose, fasting insulin, glycosylated hemoglobin and triglyceride (TG) of obese female college students ( t =10.15, 8.94 , 6.94, 7.63; 9.23, 12.75, 9.85, 9.09, P <0.01), and increased the high density lipoprotein (HDL) level( t =-7.36, -5.22, P <0.01). However, only KD+RT group had a significant decrease in the level of LDL ( t =5.27, P <0.01), and there was no significant change in the level of TC both groups ( P >0.05). After the intervention, there was no statistically significant difference between the KD+RT group compared to the KD group ( P >0.05), except for a significant decrease in triacylglycerol ( t =2.51, P < 0.05 ). Conclusion Both a short term KD and KD+RT show beneficial changes in body composition and glucolipid metabolism in obese female college students. However, the KD+RT is superior to a KD in maintaining muscle mass and reducing the effects of lipid metabolism.

Objective To observe the effect of abdominal electrical stimulation combined with high-frequency chest wall oscillation on airway clearance ability in critical ill patients with tracheostomy. Methods From January to June, 2021, a total of 84 critical ill patients with tracheostomy in the department of Critical Care Medicine, Zhongda Hospital, Southeast University, were randomly divided into control group (n = 28),experimental group A (n = 28) and experimental group B (n = 28). All the groups received routine therapy and early activities; while high-frequency chest wall oscillation was added to experimental group A, and abdominal electrical stimulation combined with high-frequency chest wall oscillation were added to experimental group B, for two weeks. Their involuntary cough peak flow (ICPF), Clinical Pulmonary Infection Score (CPIS), diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and thickness of abdominal muscle (Tab) were measured before and after treatment. Results The improvement of CPIS, ICPF and Tab were better in the experimental group B than in the other two groups (P < 0.05). The improvement of DE and DTF were slightly better in experimental group B, however, there was no significant difference among groups (FDE = 0.514, FDTF = 1.582, P > 0.05). The thickness d-values of rectus abdominis, musculi obliquus internus abdominis and musculus transversus abdominis were positively correlated with the d-value of ICPF in the exprimental group B (r > 0.415, P < 0.05). ICPF was highly negatively correlated with CPIS before treatment for all the patients (r = -0.702, P < 0.001). No adverse events occurred during the intervention period. Conclusion Abdominal electrical stimulation combined with high-frequency chest wall oscillation could improve airway clearance ability in critical ill patients with tracheostomy.

Objective:To analyze the effect of transtracheal pressure (TTP) on the application of a speaking valve in critically ill patients after tracheostomy.Methods:A retrospective analysis was conducted of 50 patients wearing a speaking valve after tracheostomy. Patients who had been wearing a speaking valve for 30min or more were the tolerance group, while those with less than 30min were the intolerance group. Transtracheal pressure was monitored during resting breathing, forced expiration and speaking. Linear regression models were evaluated to isolate the factors best predicting tolerance. The changes in respiratory muscle contraction before and after wearing a speaking valvs were evaluated using ultrasound. The patients′ satisfaction with wearing a speaking valve was also recorded.Results:TTP during speaking significantly predicted tolerance. The baseline values of diaphragmatic thickening fraction and physical functioning also positively predicted tolerance. Acute physiology and chronic health (APACHE II) score was a significant negative predictor. After wearing the speaking valve, the average contraction of the rectus abdominis, external oblique, internal oblique and transverse abdominis muscles increased significantly. Both groups expressed high satisfaction with the speaking valves.Conclusions:Transtracheal pressure during speaking can help predict the tolerance for wearing a speaking valve among critically ill patients after a tracheostomy. Baseline diaphragmatic thickening fraction, physical functioning and APACHE II score can predict the duration of speaking valve tolerance.

Objective:Long-term proton pump inhibitor(PPI) therapy may increase the risk of small intestinal bacterial overgrowth(SIBO). Few studies on the effect of on-demand and continuous PPI therapy are available in elderly. To investigate the prevalence of SIBO and the effect of on-demand and continuous PPI therapy on SIBO in elderly.Methods:A total of 200 elderly outpatients admitted to Department of Gastroenterology at the Second Medical Center of PLA General Hospital were enrolled and divided into 3 groups: continuous PPI group, on-demand PPI group and control group. SIBO was diagnosed according to methane and hydrogen lactulose breath test (LBT).The prevalence of SIBO in the 3 groups was analyzed.Results:The prevalence of SIBO was 71.5% in 200 elderly. PPI therapy and diabetes mellitus (DM) were independent risk factors for SIBO. The prevalence of SIBO was 77.1% (108/140) in elderly who underwent long-term PPI therapy and 58.3% (35/60) in those without PPI therapy ( P<0.01).The prevalence of SIBO was significantly higher in continuous PPI therapy group than that in on-demand PPI group and control group(88.6% vs. 65.7% and 58.3%, all P<0.01).However, no significant difference was found in the prevalence of SIBO between on-demand PPI group and control group ( P>0.05). In elderly who underwent long-term PPI therapy, the prevalence of SIBO increased significantly if administration time was longer than 61 months. Conclusions:SIBO usually occurs in elderly patients who receive continuous PPI rather than on-demand use. If elderly require long-term PPI therapy, on demand administration is suggested as long as primary diseases are properly treated.

Objective:To investigate the effects of oxidized low density lipoprotein (Ox-LDL) on cell proliferation and mRNA expression of inflammatory factors in fibroblast-like synoviocytes (FLS) from patients with rheumatoid arthritis (RA).Methods:Tissue culture was used to isolate and 4-6 generation cultured RA-FLS cells were used for subsequent experiments. RA-FLS were stimulated for 24 hours with different con-centr-ations of human Ox-LDL, then the MTS cell proliferation and toxicity test kit were used to detect the prolifer-ation of RA-FLS. Real time-polymerase chain reaction (RT-PCR) was used to test the expression of inflamm- atory factors like interleukin (IL)-6, transforming growth factor (TGF)-β, IL-8, tumor necrosis factor (TNF)-α and receptors like CD36 and scavenger receptor binds phosphatidylsed neoxidized lipoprotein (SR-PSOX) inRA-FLS. T test and F test were used in this study. Results:Ox-LDL (10, 25, 50 μg/ml) could obviously promote the proliferation of RA-FLS, and theabsorbance values (490 nm) were (1.04±0.15), (1.05±0.14), and (1.00±0.10), respectively, all higher than the control group (0.81±0.04) and the difference was statistically significant ( F=4.737, P<0.01). In addition, 50 μg/ml and 100 μg/ml Ox-LDL also promoted the expression of IL-6 mRNA ( F=14.709, P<0.01) and inhi-bited the expression of TGF-β mRNA ( F=299.074, P<0.01), but there was no obvious effect on the expression of IL-8 and TNF-α. Ox-LDL stimulation could obviously promote the expression of SR-PSOX receptor on RA-FLS ( F=68.636, P<0.01) and inhibit the expression of CD36( F=18.085, P<0.01). After the transfection of siRNA, SR-PSOX mRNA level was significantly inhibited and the mRNA expression of IL-6 was significantly decreased after Ox-LDL stimulation of RA-FLS ( t=3.875, P<0.01), while TGF-β mRNA expres-sion was not significantly changed( t=-0.193, P>0.05). Conclusion:Ox-LDL may play a role in promoting the activation of RA-FLS proliferation and the expression of IL-6 mRNA by increasing the SR-PSOX receptor of RA-FLS, suggesting that Ox-LDL is involved in the synovial inflammation of RA.

Objective: To analyze the hematological characteristics of a patient with Hb Ottawa in conjunction with β-thalassemia. Methods: Peripheral blood samples from the proband and her parents were collected and subjected to red blood cell analysis and hemoglobin electrophoresis. Genotypes of α- and β-globin genes were also analyzed. Results: The proband and her mother were both heterozygotes for Hb Ottawa and β-thalassemia variant IVS II-654, and presented with typical β-thalassemia trait featuring hypochromic microcytic anemia. An abnormal hemoglobin band was detected upon electrophoresis. Conclusion Co-existence of Hb Ottawa and β-thalassemia may not aggravate the phenotype.