OBJECTIVE: To observe the effect of "Zhibian" (BL54)-toward-"Shuidao" (ST28) needling technique on the relative protein expression of the signaling pathway of nucleotide-binding oligomerization domain-containing protein 1 (NOD1)/ receptor-interacting protein 2 (RIP2)/nuclear factor kappa-B (NF-κB) and the expression of proinflammatory cytokines in the rats with primary dysmenorrhea (PD), so as to explore the underlying mechanism of this acupuncture technique for pain alleviation in PD. METHODS: Thirty female SD rats of SPF grade with normal estrous cycle were randomized into a blank group, a model group and an acupuncture group, 10 rats in each one. Using the intraperitoneal injection with estradiol benzoate combined with oxytocin, PD model was prepared in the model group and the acupuncture group. In the acupuncture group, during model preparation, the intervention with "Zhibian" (BL54)-toward-"Shuidao" (ST28) needling technique was delivered simultaneously, 20 min each time, once daily for consecutive 10 days. On day 11, within 30 min after the intraperitoneal injection with oxytocin, the writhing reaction (latency, frequency and score) was recorded; the morphology of uterine tissue was observed with HE staining, the contents of prostaglandin E₂ (PGE₂), prostaglandin F_2α (PGF_2α), interleukin (IL)-1β, IL-18, cyclooxygenase-2 (COX-2), and tumor necrosis factor-α(TNF-α) in the serum were detected using ELISA method; the relative protein expression of NOD1, RIP2, NF-κB p65, phosphorylation-NF-κB p65 (p-NF-κB p65) was detected in the uterine tissue using Western blot method; and the mRNA expression of NOD1, RIP2 and NF-κB p65 was detected with the quantitative real-time PCR employed. RESULTS: Compared with the blank group, in the model group, the writhing latency was prolonged (P<0.01), the writhing frequency and score increased (P<0.01) in the rats; the endometrial epithelial cells showed massive degeneration and necrosis, with severe endometrial edema and widespread shedding, combined with neutrophil infiltration; the serum PGE₂ content was dropped (P<0.01), while those of PGF_2α, IL-1β, IL-18, COX-2, and TNF-α elevated (P<0.01); the protein expression of NOD1, RIP2, NF-κB p65 and p-NF-κB p65, and the mRNA expression of NOD1, RIP2 and NF-κB p65 in uterine tissue increased (P<0.01). In comparison with the model group, in the acupuncture group, the writhing latency was prolonged (P<0.01), the writhing frequency and score were reduced (P<0.01) in the rats; there was less degeneration and necrosis of endometrial epithelial cells, with mild endometrial edema and very little neutrophil infiltration; the serum PGE₂ content increased (P<0.01), while those of PGF_2α, IL-1β, IL-18, COX-2, and TNF-α decreased (P<0.01); the protein expression of NOD1, RIP2, NF-κB p65 and p-NF-κB p65 and the mRNA expression of NOD1, RIP2 and NF-κB p65 in uterine tissue were dropped (P<0.05, P<0.01). CONCLUSION "Zhibian" (BL54)-toward-"Shuidao" (ST28) needling technique can alleviate the pain symptom of PD rats, and its action mechanism may be related to inhibiting the active expression of NOD1/RIP2/NF-κB signaling pathway in the uterine tissue, thereby reducing the inflammatory response.
Animals ; Female ; Rats, Sprague-Dawley ; Rats ; Signal Transduction ; Dysmenorrhea/metabolism* ; NF-kappa B/metabolism* ; Acupuncture Points ; Humans ; Acupuncture Analgesia ; Nod1 Signaling Adaptor Protein/metabolism* ; Receptor-Interacting Protein Serine-Threonine Kinase 2/metabolism* ; Acupuncture Therapy

The expert consensus on the clinical treatment of herpes zoster with fire needling was developed, and the commonly used fire needling treatment scheme verified by clinical research was selected to form a standardized diagnosis and treatment scheme for acute herpes zoster and postherpetic neuralgia (PHN), so as to answer the core problems in clinical application. The consensus focuses on patients with herpes zoster, and forms recommendations for 9 key clinical issues, covering simple fire needling and TCM comprehensive therapy based on fire needling, including fire needling combined with cupping, fire needling combined with Chinese herb, fire needling combined with cupping and Chinese herb, fire needling combined with filiform needling, fire needling combined with moxibustion, and provides specific recommendations and operational guidelines for various therapies.
Humans ; Herpes Zoster/therapy* ; Acupuncture Therapy/instrumentation* ; Consensus ; Clinical Protocols

BACKGROUND: Renal osteodystrophy (ROD) is a skeletal pathology associated with chronic kidney disease-mineral and bone disorder (CKD-MBD) that is characterized by aberrant bone mineralization and remodeling. ROD increases the risk of fracture and mortality in CKD patients. The underlying mechanisms of ROD remain elusive, partially due to the absence of an appropriate animal model. To address this gap, we established a stable mouse model of ROD using an optimized adenine-enriched diet and conducted exploratory analyses through ribonucleic acid sequencing (RNA-seq). METHODS: Eight-week-old male C57BL/6J mice were randomly allocated into three groups: control group ( n = 5), adenine and high-phosphate (HP) diet group ( n = 20), and the optimized adenine-containing diet group ( n = 20) for 12 weeks. We assessed the skeletal characteristics of model mice through blood biochemistry, microcomputed tomography (micro-CT), and bone histomorphometry. RNA-seq was utilized to profile gene expression changes of ROD. We elucidated the functions of differentially expressed genes (DEGs) using gene ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and gene set enrichment analysis (GSEA). DEGs were validated via quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: By the fifth week, adenine followed by an HP diet induced rapid weight loss and high mortality rates in the mouse group, precluding further model development. Mice with optimized adenine diet-induced ROD displayed significant abnormalities in serum creatinine and blood urea nitrogen levels, accompanied by pronounced hyperparathyroidism and hyperphosphatemia. The femur bone mineral density (BMD) of the model mice was lower than that of control mice, with substantial bone loss and cortical porosity. ROD mice exhibited substantial bone turnover with an increase in osteoblast and osteoclast markers. Transcriptomic profiling revealed 1907 genes with upregulated expression and 723 genes with downregulated expression in the femurs of ROD mice relative to those of control mice. Pathway analyses indicated significant enrichment of upregulated genes in the sphingolipid metabolism pathway. The significant upregulation of alkaline ceramidase 1 ( Acer1 ), alkaline ceramidase 2 ( Acer2 ), prosaposin-like 1 ( Psapl1 ), adenosine A1 receptor ( Adora1 ), and sphingosine-1-phosphate receptor 5 ( S1pr5 ) were successfully validated in mouse femurs by qRT-PCR. CONCLUSIONS Optimized adenine diet mouse model may be a valuable proxy for studying ROD. RNA-seq analysis revealed that the sphingolipid metabolism pathway is likely a key player in ROD pathogenesis, thereby providing new avenues for therapeutic intervention.
Animals ; Mice ; Chronic Kidney Disease-Mineral and Bone Disorder/genetics* ; Male ; Disease Models, Animal ; Mice, Inbred C57BL ; Sphingolipids/metabolism* ; Transcriptome/genetics* ; Signal Transduction/genetics* ; X-Ray Microtomography ; Adenine

Adenosine, a critical molecule regulating cellular function both inside and outside cells, is controlled by two human adenosine deaminases: ADA1 and ADA2. While ADA1 primarily resides in the cytoplasm, ADA2 can be transported to lysosomes within cells or secreted outside the cell. Patients with ADA2 deficiency (DADA2) often suffer from systemic vasculitis due to elevated levels of TNF-α in their blood. Monocytes from DADA2 patients exhibit excessive TNF-α secretion and differentiate into pro-inflammatory M1-type macrophages. Our findings demonstrate that ADA2 localizes to endolysosomes within macrophages, and its intracellular concentration decreases in cells secreting TNF-α. This suggests that ADA2 may function as a lysosomal adenosine deaminase, regulating TNF-α expression by the cells. Interestingly, pneumonia patients exhibit higher ADA2 concentrations in their bronchoalveolar lavage (BAL), correlating with elevated pro-inflammatory cytokine levels. Conversely, cord blood has low ADA2 levels, creating a more immunosuppressive environment. Additionally, secreted ADA2 can bind to apoptotic cells, activating immune cells by reducing extracellular adenosine levels. These findings imply that ADA2 release from monocytes during inflammation, triggered by growth factors, may be crucial for cell activation. Targeting intracellular and extracellular ADA2 activities could pave the way for novel therapies in inflammatory and autoimmune disorders.
Humans ; Adenosine Deaminase/deficiency* ; Monocytes/cytology* ; Cell Differentiation ; Intercellular Signaling Peptides and Proteins/metabolism* ; Tumor Necrosis Factor-alpha/metabolism* ; Biomarkers/metabolism* ; Macrophages/metabolism* ; Pneumonia/metabolism*

Objective:To explore the correlation between serum nidogen-2 (NID-2) and thoracic aortic calcification in patients with chronic kidney disease (CKD), and construct a risk prediction model based on NID-2 to evaluate its value in predicting the risk of the severe thoracic aortic calcification and cardiovascular and cerebrovascular events in CKD patients.Methods:It was a prospective cohort study. Patients with CKD at stage 3 to 5D in the Zhongda Hospital Affiliated to Southeast University from January 2022 to January 2023 were enrolled. Syngo.via software was used to evaluate the volume of thoracic aortic calcification, and enzyme-linked immunosorbent assay was employed to determine the level of serum NID-2. According to the volume of thoracic aortic calcification, the patients were divided into three groups: no calcification group, mild calcification group and severe calcification group. The top 25% of the patients were defined as no or mild calcification group, and the latter 75% were defined as severe calcification group. The follow-up period was one year. During the follow-up period, cardiovascular and cerebrovascular events, as well as all-cause death among the enrolled patients were recorded. Logistic regression analysis was used to screen the influencing factors of thoracic aortic calcification. Based on the results of logistic regression analysis, a nomogram prediction model was constructed. The receiver operating characteristic curve (ROC curve), calibration curve, and decision curve were employed to evaluate the discrimination, calibration and clinical practicality of the nomogram model.Results:A total of 132 patients were included, with 91 males (68.94%) and age of (56.51±16.37) years. There were 60 CKD 3-5 stage patients (non-dialysis, 45.45%) and 72 CKD 5D patients (dialysis, 54.55%). Serum ND-2 levels differed significantly among healthy individuals, dialysis patients and non-dialysis patients ( H=70.651, P<0.001). There was no statistically significant difference in serum NID-2 level between the no or mild calcification group and the severe calcification group in dialysis patients ( Z=350.00, P=0.426). The serum NID-2 level in the severe calcification group was significantly higher than that in the no or mild calcification group in non-dialysis patients ( Z=242.00, P=0.019). In non-dialysis patients, there was a statistically significant correlation between serum NID-2 level and volume of thoracic aortic calcification ( r=0.40, P<0.001). In dialysis patients, there was no statistically significant correlation between serum NID-2 level and volume of each segment of thoracic aortic calcification (all P>0.05). The univariate logistic regression analysis showed that, age, hemoglobin, serum albumin, estimated glomerular filtration rate, NID-2, hypertension, type 2 diabetes mellitus and cerebral infarction were correlated factors of thoracic aortic calcification in non-dialysis patients (all P<0.05). Multivariate logistic regression analysis showed that age ( OR=1.22, 95% CI 1.08-1.50, P=0.010) was an independent correlated factor of thoracic aortic calcification in non-dialysis patients. The above related variables of univariate logistic regression analysis were incorporated into a nomogram to construct a predictive model for severe vascular calcification in non-dialysis patients, yielding an AUC of 0.94 (95% CI 0.89-0.99) in ROC curve, with a sensitivity of 83% and a specificity of 95%. A nomogram model based on above variables for predicting cardiovascular and cerebrovascular events in non-dialysis patients demonstrated an AUC of 0.95 (95% CI 0.90-1.00) in ROC curve, with a sensitivity of 95% and a specificity of 87%. Conclusions:In non-dialysis patients, serum NID-2 level in the severe calcification group is significantly higher than that in the no or mild calcification group. The serum NID-2 is a related factor of thoracic aortic calcification and cardiovascular and cerebrovascular events in non-dialysis patients. The nomogram prediction model constructed by combining NID-2 with age, hemoglobin, serum albumin, estimated glomerular filtration rate, hypertension, type 2 diabetes mellitus and cerebral infarction has a high predictive value for the risk of thoracic aortic calcification as well as cardiovascular and cerebrovascular events in non-dialysis patients.

Objective:To observe the pregnancy outcomes of patients with unexplained recurrent spontaneous abortion (URSA) after interventional treatment or expectant treatment.Methods:This prospective study followed up 398 patients with recurrent spontaneous abortion from March 2017 to September 2022 in seven hospitals. Among them, 267 patients were diagnosed with URSA, including 124 patients who were initially diagnosed in the interventional treatment hospital and 143 patients who were initially diagnosed in the expectant treatment hospital. All URSA patients were followed up for 33 months. Ongoing pregnancy rates were observed as main outcome indicators.Results:A total of 127 patients became pregnant, and 107 of them had sustained pregnancies, the ongoing pregnancy rate was 84.25% (107/127). The ongoing pregnancy rate was 86.11% (31/36) in the interventional treatment group and 83.52% (76/91) in the expectant treatment group, with no significant difference ( P>0.05). During the follow-up, the ongoing pregnancy rates in the interventional treatment hospital and the expectant treatment hospital were 75.71% (53/70) and 94.74% (54/57), respectively, with a significant difference ( P<0.05). The ongoing pregnancy rate after interventional treatment in the interventional treatment hospital was 82.76% (24/29), which was similar to the 94.00% (47/50) after expectant treatment in the expectant treatment hospital ( P>0.05). Conclusion:The ongoing pregnancy rate of interventional treatment for URSA patients has not been significantly improved, suggesting that it may not be necessary to carry out this treatment.

Objective:To explore the focus points and emotional tendencies of cancer patients regarding medical services from their free-form comments, and to analyze the elements of perceived medical service value by patients.Methods:A tertiary general hospital in Shanghai invited patients to evaluate inpatient services through the assessment module of a patient satisfaction management platform, which included open-ended questions in the patient satisfaction survey. This study extracted free-form comment texts from cancer patients regarding medical services collected from September 2022 to August 2023 from this platform, forming a corpus of patient opinions. A hybrid method combining manual coding and natural language processing techniques was used to conduct sentiment analysis and topic modeling on the free-form comment texts. Descriptive analysis was performed on the comment themes and emotions, and logistic regression analysis was used to explore the relationship between patient negative comments and patient satisfaction and loyalty.Results:A total of 10 446 comment texts provided by cancer patients were included. The most frequently targeted objects in the comments were nurses (2 223 cases), followed by doctors (1 125 cases) and nursing assistants (162 cases). The results of sentiment analysis showed that 7 058 patients made positive comments, 1 958 patients made negative comments, 1 114 patients made neutral comments, and 316 patients made mixed comments. The results of topic analysis showed that the five most frequently mentioned themes by cancer patients were humanistic care (1 327 times), information provision, communication, and education (589 times), diet (582 times), effectiveness of diagnosis and treatment (506 times), and medical staff responsibility (489 times). Logistic regression analysis showed that negative evaluations of humanistic care ( OR=0.306, P<0.001), professional technical level ( OR=0.425, P=0.010), information provision, communication, and education ( OR=0.475, P<0.001), and response to needs ( OR=0.412, P=0.026) were significantly associated with decreased patient satisfaction. Negative evaluations of humanistic care ( OR=0.407, P<0.001), professional technical level ( OR=0.466, P=0.009), and information provision, communication, and education ( OR=0.557, P<0.001) were significantly associated with decreased patient loyalty. Conclusions:Hospital managers should value the role of patient free-form comment texts in improving medical services and make full use of natural language processing techniques for information mining. In addition, the results of this study show that patient comments mainly involve the interpersonal and functional aspects of service, especially the interpersonal interactions, which are often the " critical moments" for patients to critically evaluate hospital services during their service experience.

Eye-tracking technology monitors eye movement trajectories to reveal the cognitive mechanisms underlying visual behavior.With advantages like objectivity and real-time capability,it is increasingly applied in nursing.However,research and application in China are still in the early stages.This article reviews the development,measurement metrics,methods,and impact of eye-tracking in nursing,analyzes current challenges,and suggests solutions to aid its development in the field of nursing in China.

Objective To construct a critical care humanistic nursing curriculum under the perspective"great ideological and political education",and evaluate its effects in the training of intensive care unit(ICU)standardized training nurses.Methods A research team was established and organized by department of nursing of Zhongshan Hospital,Fudan University,which consisting of 6 critical care nursing managers and specialists,including 1 chief nurse,3 head nurses,1 master's graduate,and 1 doctoral graduate.The team was responsible for literature review,questionnaire design,expert recruitment,survey distribution and collection,data integration,and analysis.A preliminary questionnaire was developed through literature reviews on critical care humanistic nursing,brainstorming sessions,and clinical surveys.A two-round Delphi method was conducted to finalize the humanistic nursing training curriculum.Ideological and political elements,such as political identity,patriotism,moral cultivation,legal awareness,scientific spirit and professional quality were integrated into the program.From July 2023 to June 2024,newly enrolled ICU standardized training nurses at Zhongshan Hospital,Fudan University participated in the training.Training outcomes were assessed via theoretical examinations and pre-and post-training evaluations of humanistic competency.Results A total of 10 experts participated in the consultation,resulting in a training course consisting of two primaryl indicators and 11 secondary indicators.A total of 60 nurses participated in the training,achieving an average post-training theoretical score of 84.92±7.73.Significant improvements were observed across all dimensions of humanistic competency post-training compared to pre-training(humanistic care practice competency:33.95±4.50 vs.30.82±4.10,communication skills:20.27±2.68 vs.18.98±2.98,self-management:10.07±1.91 vs.9.20±2.02,ethical and legal competence:10.38±1.61 vs.9.68±2.02,psychological adaptability:14.20±2.31 vs.13.03±2.19,and total humanistic practice competency score:88.87±7.65 vs.81.71±8.55),with all differences statistically significant(all P<0.05).Conclusion The critical care humanistic nursing curriculum under the perspective of"great ideological and political education"can effectively improve the humanistic quality of nurses and enhance their ICU practical skills,so as to provide reference for the training of nurses in intensive care.

Objective To evaluate the methodological quality and literature report quality of randomized controlled trials(RCTs)on acupuncture treatment for diminished ovarian reserve published both domestically and internationally;To provide reference for future related clinical research.Methods RCTs on acupuncture treatment for diminished ovarian reserve were retrieved from Cochrane Library,PubMed,Embase,Web of Science,CBM,CNKI,Wanfang Data and VIP from the establishment of the databases to 16th,March 2024.Literature was screened according to the inclusion criteria,and basic research features were extracted from literature.Cochrane Collaborative Network randomized controlled trial bias risk assessment tool RoB2 was used for methodological quality evaluation,and CONSORT statement and STRICTA checklist were used for literature report quality evaluation.Results Totally 19 RCTs were included.The evaluation results of RoB2 showed that 18 RCTs(94.74%)had a certain risk of bias,and 1 RCT(5.26%)had a high risk of bias.In the evaluation of the CONSORT statement,there were a total of 24 items with a research report rate of less than 50%,accounting for 64.86%of all items,and 14 items with a report rate of less than 10%,accounting for 37.84%of all items;in the evaluation of the STRICTA list,there were a total of 3 items with a research report rate of less than 50%,accounting for 17.65%of all items,and 2 items with a report rate of less than 10%,accounting for 11.76%of all items.Conclusion Currently,the overall number of RCTs for acupuncture treatment of diminished ovarian reserve is relatively small,the methodological quality of the study is generally low,and the risk of bias is high.The literature reporting rate of the CONSORT statement items is low.Researchers should further strengthen clinical trial design and methodological training,improve the level of clinical research,and strictly follow the CONSORT statement and STRICTA checklist for standardized reporting.