ObjectiveTo explore the potential mechanism underlying electroacupuncture therapy with the midnight-noon ebb-low method with hour-prescription for chronic obstructive pulmonary disease （COPD） with lung-qi deficiency syndrome from the perspective of brain and muscle basic helix-loop-helix ARNT-like 1 （BMAL1） as well as neutrophil extracellular traps （NETs）. MethodsThe experiment was conducted in two phases. For the therapeutic effectiveness observation， 24 rats were randomly allocated into control group 1， model group 1， midnight-noon electro-acupuncture group 1 and conventional electro-acupuncture group， with 6 rats per group. Rat models of COPD with lung-qi deficiency syndrome were established via cigarette smoke exposure combined with intratracheal instillation of lipopolysaccharide （LPS）. After successful modelling， rats in midnight-noon electro-acupuncture group 1 received electro-acupuncture at acupoints "Taiyuan （LU 9）"， "Feishu （BL 13）" and "Zusanli （ST 36）" during 05：00—07：00， 30 minutes per treatment once every other day for 14 consecutive days （7 sessions in total）. Rats in the conventional electro-acupuncture group received identical electroacupuncture manipulation at random daytime hours （08：00—18：00）. Pulmonary function parameters including forced expiratory volume in 0.3 second （FEV_0.3）， forced vital capacity （FVC） and FEV_0.3/FVC ratio were detected. Pulmonary histopathological changes were observed via hematoxylin-eosin （HE） staining. Plasma levels of pro-inflammatory factors interleukin-1β （IL-1β） and tumor necrosis factor-α （TNF-α）， as well as pulmonary reactive oxygen species （ROS） content， BMAL1 protein expression and the levels of neutrophil extracellular traps （NETs） biomarkers such as myeloperoxidase （MPO）， neutrophil elastase （NE）， and citrullinated histone H3 （CitH3） in lung tissue were determined. For the mechanistic verification phase， 36 rats were divided into control group 2， model group 2， midnight-noon electro-acupuncture group 2， overexpression empty group， overexpression BMAL1 group and overexpression with midnight-noon electro-acupuncture group， with 6 rats in each group. At the 5th week of model construction， rats in the overexpression BMAL1 group and overexpression with midnight-noon electro-acupuncture group received intratracheal instillation of 100 μl adenoviral suspension carrying overexpressed Bmal1 gene. Rats in the overexpression empty group were injected with an equal titer and equal volume of blank adenovirus without the Bmal1 coding sequence into the lung at the identical time point. Midnight-noon electro-acupuncture group 2 and overexpression with midnight-noon electro-acupuncture group were consistent with the aforementioned protocol. Finally， pulmonary levels of MPO， NE and CitH3 were measured in all groups. ResultsCompared with the control group 1， the model group 1 exhibited decreased FEV_0.3， FVC and FEV_0.3/FVC ratio， elevated plasma IL-1β， TNF-α and pulmonary ROS levels， downregulated lung BMAL1 protein expression， and increased contents of MPO， NE and CitH3 （all P＜0.05）； typical NETs-like structures with sparse granular substances attached to fibrous networks were observed under scanning electron microscopy； HE staining revealed damaged alveolar architecture accompanied by inflammatory cell infiltration. Compared with model group 1， both the midnight-noon electro-acupuncture group 1 and conventional electro-acupuncture group achieved obvious improvements in all above indicators， with superior therapeutic effects in midnight-noon electro-acupuncture group 1 （P＜0.05）. Consistently， midnight-noon electro-acupuncture group 1 showed more prominent alleviation of NETs-like structure formation and lung pathological injury compared to the conventional electro-acupuncture group. Mechanistic validation results demonstrated that compared with model group 2， the average optical density of MPO as well as the protein levels of MPO， NE and CitH3 were markedly reduced in midnight-noon electro-acupuncture group 2， overexpression BMAL1 group and overexpression with midnight-noon electro-acupuncture group （P＜0.05）； furthermore， these parameters were significantly lower in the overexpression with midnight-noon electro-acupuncture group than in midnight-noon electro-acupuncture group 2 （P＜0.05）. ConclusionElectro-acupuncture based on the midnight-noon ebb-low method with hour-prescription may alleviate pulmonary inflammation in COPD by upregulating the expression of clock protein BMAL1 and inhibiting excessive accumulation of NETs in lung tissue.

AIM:To investigate the role and mechanism of cell death-inducing DNA fragmentation factor al-pha(DFFA)-like effector B(Cideb)in promoting palmitic acid(PA)-induced lipid deposition in human hepatoblastoma HepG2 cells.METHODS:The HepG2 cells were divided into control group,model group,negative control silencing(siR-NC)group and Cideb silencing(siR-Cideb)group.The cells were treated with PA to establish a cellular model of lipid deposition.Specific siRNAs were used to silence the expression of Cideb,and the intracellular lipid content was mea-sured.Lipid deposition was observed by oil red O staining.RT-qPCR and Western blot were used to detect the expression levels of Cideb,sterol regulatory element-binding protein 1c(SREBP1c),acetyl-CoA carboxylase 1(ACC1),fatty acid synthase(FAS),stearoyl-CoA desaturase 1(SCD1)and AMP-activated protein kinase α(AMPKα)in the cells.The ef-fects of Cideb overexpression on HepG2 cells were observed by transfection with a Cideb eukaryotic expression plasmid.RESULTS:Compared with control group,the cells in PA model group presented lipid deposition,significantly increased triglyceride(TG)and total cholesterol(TC)content,elevated expression levels of Cideb,SREBP1c,ACC,FAS and SCD1,and decreased expression of AMPKα(P＜0.05).Compared with siR-NC group,the cells in siR-Cideb group pre-sented decreased lipid deposition,reduced intracellular TG and TC content,decreased SREBP1c,ACC,FAS and SCD1 expression levels,and increased AMPKα expression(P＜0.05).The overexpression of Cideb increased the lipid deposi-tion,TG and TC content,and the expression levels of SREBP1c,ACC,FAS and SCD1 in HepG2 cells,but decreased the expression of AMPKα(P＜0.05).CONCLUSION:Reduction of Cideb alleviates PA-induced lipid deposition in HepG2 cells by down-regulating the SREBP1c/ACC/FAS/SCD1 pathway and up-regulating the AMPKα pathway.

Objective To explore the effect of progressive intensity muscle training on joint function and inflammatory response after arthroscopic rotator cuff tear surgery.Methods Totally 226 patients with rotator cuff tear injuries and admitted to Shaoxing Traditional Chinese Medicine Hospital between April 2020 and April 2022 were selected,and randomly divided into a study group and a control group,each of 113,using a double-blind random number table.After the arthroscopic surgery,the study group received progressive intensity muscle strength training,while the control group was given routine functional training and rehabilitation.Before and 8 weeks after surgery,both groups were evaluated us-ing the Constant Murley shoulder joint function(CMSJF),Unilaterally Controlled Latin Assets(UCLA),and Fugl Meyer scale(FMA).Moreover,their Activities of Daily Living(ADL)score,se-rum inflammatory factors,and upper limb function score were compared.Results Before surgery,there was no significant difference between the two groups in the average CMSJF score,UCLA score,EMA score,ADL score and the range of motion(ROM)(P>0.05).However,8 weeks after the surgery,all the above values improve significantly,with significantly greater improvement in the study group than the control group(P<0.05).Moreover,before the surgery,there was no significant difference be-tween the two groups in the serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleu-kin-10(IL-10)and transformative growth factor-β(TGF-β)(P>0.05).However,8 weeks after the surgery,a significant increase was observed in the average IL-10 and TGF-β,with a significant de-crease in the average TNF-α and IL-6(P<0.05 for both).Conclusion After arthroscopic surgery for ro-tator cuff tear,progressive muscle strength training has a significant clinical effect on relieving pain,promoting muscle function and strength,and improving the function of the affected limb.

Objective:To investigate the longitudinal relationship between self-esteem and hope of adolescents and to explore gender differences.Methods:A total of 1 982 adolescents,aged 11 to 24,participated in a l-year lon-gitudinal study with 3 waves of assessments(T1,baseline time;T2,6 months later;T3,1 year later).The Self-Es-teem Scale(SES)and the Children's Hope Scale(CHS)were used to measure levels of self-esteem and hope.The data were analyzed using a cross-lagged panel model and multi-group structural equation modeling.Results:Across the three measurement waves,the self-esteem scores were positively correlated with the hope scores(r=0.40-0.67).Results from the cross-lagged analysis indicated a bidirectional predictive relationship between the self-es-teem scores and hope scores over the year(β=0.09-0.22).The results of multi-group analysis showed significant gender differences in the autoregressive path of self-esteem in the three measures(Waldx2=3.78-3.84).Conclu-sion:Adolescents' self-esteem and hope exhibit a bidirectional predictive relationship,with no significant gender differences in the cross-lagged paths.

Objective:To investigate the longitudinal relationship between self-esteem and hope of adolescents and to explore gender differences.Methods:A total of 1 982 adolescents,aged 11 to 24,participated in a l-year lon-gitudinal study with 3 waves of assessments(T1,baseline time;T2,6 months later;T3,1 year later).The Self-Es-teem Scale(SES)and the Children's Hope Scale(CHS)were used to measure levels of self-esteem and hope.The data were analyzed using a cross-lagged panel model and multi-group structural equation modeling.Results:Across the three measurement waves,the self-esteem scores were positively correlated with the hope scores(r=0.40-0.67).Results from the cross-lagged analysis indicated a bidirectional predictive relationship between the self-es-teem scores and hope scores over the year(β=0.09-0.22).The results of multi-group analysis showed significant gender differences in the autoregressive path of self-esteem in the three measures(Waldx2=3.78-3.84).Conclu-sion:Adolescents' self-esteem and hope exhibit a bidirectional predictive relationship,with no significant gender differences in the cross-lagged paths.

Objective:the subclavian approach without insufflation, the ability of assistants to master the technique of holding the endoscope plays a crucial role in the thoroughness and smoothness of the surgery. The author has summarized the "six-marker method", which adjusts the mirror holding technique based on surgical steps and surgical operation goals, so that assistants can quickly grasp the essentials of mirror holding and assist the chief surgeon in completing the surgery smoothly. This method has wide applicability and feasibility, which can achieve good coordination between the surgeon and the mirror holder, shorten the surgical time and break in period. It is worth promoting and applying in clinical practice.

Objective:To introduce an innovative concept teaching method called the core case analysis (CCA), to evaluate its application in teaching, and to provide a theoretical basis and practical reference for improving teaching effectiveness and cultivating practical talents.Methods:This paper elaborated the application strategies of CCA in teaching health service management courses. All the students of two undergraduate classes who studied "health service management" and enrolled in 2021 and 2020 at a medical university were selected as the research objects. The students were divided into experimental group and control group according to whether they received the CCA teaching method. A statistical analysis was performed on the scores of single-choice questions designed for concept definition and term explanation questions in the final exam. SPSS 23.0 software was used for t test. A questionnaire survey was conducted in the experimental group to comprehensively evaluate the effectiveness of teaching with the CCA method. Results:The score of the experimental group was significantly higher than that of the control group [(14.00±1.41) vs. (12.05±2.15), P=0.002]. The questionnaire showed that the teaching effectiveness of the CCA method and the students' acceptance of the method were relatively high. Conclusions:Compared with the traditional concept teaching method, the CCA method has advantages and is worthy of promotion and application in related teaching fields. Moreover, several key points of this method in teaching practice are put forward: emphasizing the combined use of multiple teaching methods, cultivating a professional teaching team, and optimizing the concept assessment and evaluation system.

Objective:the subclavian approach without insufflation, the ability of assistants to master the technique of holding the endoscope plays a crucial role in the thoroughness and smoothness of the surgery. The author has summarized the "six-marker method", which adjusts the mirror holding technique based on surgical steps and surgical operation goals, so that assistants can quickly grasp the essentials of mirror holding and assist the chief surgeon in completing the surgery smoothly. This method has wide applicability and feasibility, which can achieve good coordination between the surgeon and the mirror holder, shorten the surgical time and break in period. It is worth promoting and applying in clinical practice.

Objective To explore the effect of progressive intensity muscle training on joint function and inflammatory response after arthroscopic rotator cuff tear surgery.Methods Totally 226 patients with rotator cuff tear injuries and admitted to Shaoxing Traditional Chinese Medicine Hospital between April 2020 and April 2022 were selected,and randomly divided into a study group and a control group,each of 113,using a double-blind random number table.After the arthroscopic surgery,the study group received progressive intensity muscle strength training,while the control group was given routine functional training and rehabilitation.Before and 8 weeks after surgery,both groups were evaluated us-ing the Constant Murley shoulder joint function(CMSJF),Unilaterally Controlled Latin Assets(UCLA),and Fugl Meyer scale(FMA).Moreover,their Activities of Daily Living(ADL)score,se-rum inflammatory factors,and upper limb function score were compared.Results Before surgery,there was no significant difference between the two groups in the average CMSJF score,UCLA score,EMA score,ADL score and the range of motion(ROM)(P>0.05).However,8 weeks after the surgery,all the above values improve significantly,with significantly greater improvement in the study group than the control group(P<0.05).Moreover,before the surgery,there was no significant difference be-tween the two groups in the serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleu-kin-10(IL-10)and transformative growth factor-β(TGF-β)(P>0.05).However,8 weeks after the surgery,a significant increase was observed in the average IL-10 and TGF-β,with a significant de-crease in the average TNF-α and IL-6(P<0.05 for both).Conclusion After arthroscopic surgery for ro-tator cuff tear,progressive muscle strength training has a significant clinical effect on relieving pain,promoting muscle function and strength,and improving the function of the affected limb.

Objective:To introduce an innovative concept teaching method called the core case analysis (CCA), to evaluate its application in teaching, and to provide a theoretical basis and practical reference for improving teaching effectiveness and cultivating practical talents.Methods:This paper elaborated the application strategies of CCA in teaching health service management courses. All the students of two undergraduate classes who studied "health service management" and enrolled in 2021 and 2020 at a medical university were selected as the research objects. The students were divided into experimental group and control group according to whether they received the CCA teaching method. A statistical analysis was performed on the scores of single-choice questions designed for concept definition and term explanation questions in the final exam. SPSS 23.0 software was used for t test. A questionnaire survey was conducted in the experimental group to comprehensively evaluate the effectiveness of teaching with the CCA method. Results:The score of the experimental group was significantly higher than that of the control group [(14.00±1.41) vs. (12.05±2.15), P=0.002]. The questionnaire showed that the teaching effectiveness of the CCA method and the students' acceptance of the method were relatively high. Conclusions:Compared with the traditional concept teaching method, the CCA method has advantages and is worthy of promotion and application in related teaching fields. Moreover, several key points of this method in teaching practice are put forward: emphasizing the combined use of multiple teaching methods, cultivating a professional teaching team, and optimizing the concept assessment and evaluation system.