OBJECTIVE: To compare the clinical efficacy of acupuncture with yin-yang regulation method versus local acupuncture in treating chronic low back pain (CLBP) in elderly patients with lumbar disc herniation (LDH), and to evaluate the changes in the multifidus muscle before and after treatment using musculoskeletal ultrasound. METHODS: A total of 128 elderly patients with CLBP due to LDH were randomly assigned to an observation group (64 cases, 2 cases dropped out) and a control group (64 cases, 2 cases dropped out). The control group received local acupuncture at bilateral L₃-L₅ Jiaji points (EX-B2), Shenshu (BL23), Dachangshu (BL25), Weizhong (BL40), Yaoyangguan (GV3), and ashi points. The observation group received acupuncture with yin-yang regulation method, which included an abdominal protocol with Baihui (GV20), Zhongwan (CV12), Qihai (CV6), Guanyuan (CV4), bilateral Tianshu (ST25), and Dahe (KI12), etc., and a lumbar protocol with Baihui (GV20), Dazhui (GV14), Jizhong (GV6), Yaoyangguan (GV3), and ashi points, etc., alternated bilaterally. Both groups were treated once every other day, three times per week, for a total of 12 sessions. The visual analogue scale (VAS) score, Oswestry disability index (ODI) score, and the indexs of musculoskeletal ultrasound multifidus muscle (resting and functional thickness and Young's modulus values) were observed before and after treatment, and the clinical efficacy was evaluated in the two groups. RESULTS: After 1 and 4 weeks of treatment, both groups showed lower VAS scores compared to baseline (P<0.05), the VAS scores in the observation group were lower than those in the control group (P<0.001). ODI scores in both groups were decreased after 1 and 4 weeks of treatment compared to baseline (P<0.05), with a further reduction at 4 weeks of treatment compared to 1 week of treatment (P<0.05); the observation group showed lower ODI score than the control group after 1 week of treatment (P<0.001). After treatment, both groups demonstrated increased resting and functional multifidus muscle thickness bilaterally compared to baseline (P<0.01), with an increased right-side thickness change rate (P<0.01), though no significant difference was observed between groups (P>0.05). Compared to baseline, after treatment, the observation group exhibited decreased Young's modulus values for bilateral resting and functional multifidus muscle (P<0.01), while the control group showed reductions only in bilateral resting and right-side functional Young's modulus values (P<0.01). After treatment, the bilateral functional Young's modulus values in the observation group were lower than that in the control group (P<0.05), and the bilateral resting and functional changes in Young's modulus values were greater in the observation group than those in the control group (P<0.01). The overall effective rate was 93.5% (58/62) in the observation group, which was higher than 79.0% (49/62) in the control group (P<0.05). CONCLUSION Acupuncture with yin-yang regulation method effectively alleviates pain, improves functional disability, increases multifidus muscle thickness, and reduces Young's modulus values in elderly patients with CLBP due to LDH, which has superior therapeutic effect compared to local acupuncture.
Humans ; Low Back Pain/physiopathology* ; Male ; Acupuncture Therapy ; Female ; Aged ; Intervertebral Disc Displacement/physiopathology* ; Middle Aged ; Yin-Yang ; Lumbar Vertebrae ; Acupuncture Points ; Treatment Outcome

Rheumatoid arthritis(RA)is an autoimmune disease characterized by chronic,aggressive joint inflammation,which seriously harms mental and physical health of patients.Efficacy of clinical drugs for RA is limited,so it is a hot issue to seek new therapeutic targets and drugs.Zinc finger protein A20,a cytoplasmic ubiquitin modifier,is closely related to negative regulation of nuclear factor-kappaB(NF-κB),an inflammatory signaling pathway,and has anti-inflammatory and anti-apoptotic effects.A20 is involved in pathogenesis of RA and can improve inflammatory response and bone destruction of RA.Treatment of RA by traditional Chinese medicine has unique advantages of multi-target and multi-pathway,and studies have found that traditional Chinese medicine has a regulatory effect on A20.This paper expounds mechanism of A20 in RA and research progress of traditional Chinese medicine intervention in A20,in order to provide references for treatment and drug development of RA.

Rheumatoid arthritis(RA)is an autoimmune disease characterized by chronic,aggressive joint inflammation,which seriously harms mental and physical health of patients.Efficacy of clinical drugs for RA is limited,so it is a hot issue to seek new therapeutic targets and drugs.Zinc finger protein A20,a cytoplasmic ubiquitin modifier,is closely related to negative regulation of nuclear factor-kappaB(NF-κB),an inflammatory signaling pathway,and has anti-inflammatory and anti-apoptotic effects.A20 is involved in pathogenesis of RA and can improve inflammatory response and bone destruction of RA.Treatment of RA by traditional Chinese medicine has unique advantages of multi-target and multi-pathway,and studies have found that traditional Chinese medicine has a regulatory effect on A20.This paper expounds mechanism of A20 in RA and research progress of traditional Chinese medicine intervention in A20,in order to provide references for treatment and drug development of RA.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To provide references for the health management of thyroid nodules in naval flying personnel by analyzing the ultrasound characteristics of naval flying personnel with thyroid nodules.Methods:A total of 306 naval flying personnel, who were diagnosed as thyroid nodules in yearly health examination in the Third Sanatorium of Air Force Healthcare Center for Special Services Hangzhou from January of 2019 to December of 2021, were selected as the research subjects. They were divided into 3 groups by age (20-29 years, 30-39 years, ≥40 years), 2 groups by flying hours (<3 000 h, ≥3 000 h) and 3 groups by aircraft types (helicopter, transporter, fighter). The characteristics of thyroid nodule ultrasound images were retrospectively analyzed and the size, quantity and classification which defined in Chinese-thyroid imaging reporting and data system (C-TIRADS) of thyroid nodule were compared among the groups of different ages, flying hours, and aircraft types.Results:Among 306 naval flying personnel with thyroid noedules, 280 cases (91.50%) were small nodules (diameter <1 cm), 26 cases (8.50%) were large nodules (diameter ≥1 cm). One hundred and fifty-one cases (49.35%) were single nodules and 155 cases (50.65%) were multiple nodules. There were 135 cases (44.12%) with C-TIRADS grade 2 thyroid nodules, 158 cases (51.63%) with C-TIRADS grade 3 nodules, and 13 cases (4.25%) with C-TIRADS grade 4 nodules. There were significant differences in the size, number, classification of composition ratio of thyroid nodules among different age groups ( χ2=8.86, 5.94, 46.20, P=0.013, 0.051,<0.001). There were significant differences in the size and classification of composition ratio of thyroid nodules between different flying hours groups ( χ2=16.91, 24.35, both P<0.001). The proportion of C-TIRADS grade 4 nodules in the flying hours ≥3 000 h group was higher than that in the <3 000 h group, with a significant difference ( χ2=4.77, P=0.029).There were no significant differences in the size, number, classification of composition ratio of thyroid nodules among different aircraft types groups (all P>0.05). Conclusions:Age and flying hours have effects on size and classification of composition ratio of thyroid nodules in flying personnel, and age also has the effect on quantity. A scientific and systematic follow-up mechanism would be helpful to assess the risk of thyroid cancer and give early warning for the timely intervention.

Objective To explore the value of serum stearoyl sphingosine(C18∶1-Cer)and 1-stearoyl-sn-glycero-3-phospho-choline(LPC 18∶0)levels in pregnant women's serum samples during pregnancy in predicting gestational diabetes mellitus(GDM).Methods The clinical data and laboratory indicators of 126 pregnant women were retrospectively analyzed.The sub-jects were divided into GDM group(n=66)and control group(n=60)according to the GDM diagnosis results.Mass spec-trometry was used to detect the serum C18∶1-Cer and LPC18∶0 levels of the subjects in early and mid pregnancy.Logistic re-gression analysis was used to screen out the risk factors for GDM.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of C18∶1-Cer,LPC18∶0 and their combination for GDM.Results Compared with the control group,the serum C18∶1-Cer and LPC18∶0 levels of the subjects in the GDM group were significantly increased in early(18.92±2.77ng/ml vs 23.47±4.18ng/ml,41.32±17.55ng/ml vs 88.08±16.02ng/ml)and mid pregnancy(23.14±4.10ng/ml vs 18.76±4.05ng/ml,84.60±14.53ng/ml vs 40.50±17.79ng/ml),and the differences were statistically significant(t=7.127,15.637;-5.984,2.174,all P＜0.05)C18∶1-Cer was positively correlated with fasting plasma glucose(FPG),fasting plasma insulin(FPI),homeostasis model assessment of insulin resistance(HOMA-IR),glycated hemoglobin(HbA1c)and triglyceride(TG)(r=0.458,0.209,0.317,0.223,0.219,all P<0.05).LPC18.0 was positively correlated with FPG,FPI,HOMA-IR,HbA1c,total cholesterol(TC)and TG(r= 0.715,0.426,0.580,0.465,0.232,0.372,all P<0.05).Logistic regression analysis results showed that C18∶1-Cer[OR(95%CI):1.522(1.136～2.039),P<0.05]and LPC18:0[OR(95%CI):1.198(1.102～1.302),P<0.001]were independent risk factors for GDM.ROC curve analysis results showed that the area under the curve(AUC)of serum C18∶1-Cer,LPC18∶0 and the combination of the two indicators were 0.819,0.971 and 0.986,respectively.The predictive performance of the combination of the two indicators was better than that of the single detection.Conclusion Serum C18∶1-Cer and LPC18∶0 in early pregnancy were closely related to the occurrence of GDM.C18∶1-Cer combined with LPC 18∶0 has a certain predictive value for the early diagnosis of GDM.

Objective:To provide references for the health management of thyroid nodules in naval flying personnel by analyzing the ultrasound characteristics of naval flying personnel with thyroid nodules.Methods:A total of 306 naval flying personnel, who were diagnosed as thyroid nodules in yearly health examination in the Third Sanatorium of Air Force Healthcare Center for Special Services Hangzhou from January of 2019 to December of 2021, were selected as the research subjects. They were divided into 3 groups by age (20-29 years, 30-39 years, ≥40 years), 2 groups by flying hours (<3 000 h, ≥3 000 h) and 3 groups by aircraft types (helicopter, transporter, fighter). The characteristics of thyroid nodule ultrasound images were retrospectively analyzed and the size, quantity and classification which defined in Chinese-thyroid imaging reporting and data system (C-TIRADS) of thyroid nodule were compared among the groups of different ages, flying hours, and aircraft types.Results:Among 306 naval flying personnel with thyroid noedules, 280 cases (91.50%) were small nodules (diameter <1 cm), 26 cases (8.50%) were large nodules (diameter ≥1 cm). One hundred and fifty-one cases (49.35%) were single nodules and 155 cases (50.65%) were multiple nodules. There were 135 cases (44.12%) with C-TIRADS grade 2 thyroid nodules, 158 cases (51.63%) with C-TIRADS grade 3 nodules, and 13 cases (4.25%) with C-TIRADS grade 4 nodules. There were significant differences in the size, number, classification of composition ratio of thyroid nodules among different age groups ( χ2=8.86, 5.94, 46.20, P=0.013, 0.051,<0.001). There were significant differences in the size and classification of composition ratio of thyroid nodules between different flying hours groups ( χ2=16.91, 24.35, both P<0.001). The proportion of C-TIRADS grade 4 nodules in the flying hours ≥3 000 h group was higher than that in the <3 000 h group, with a significant difference ( χ2=4.77, P=0.029).There were no significant differences in the size, number, classification of composition ratio of thyroid nodules among different aircraft types groups (all P>0.05). Conclusions:Age and flying hours have effects on size and classification of composition ratio of thyroid nodules in flying personnel, and age also has the effect on quantity. A scientific and systematic follow-up mechanism would be helpful to assess the risk of thyroid cancer and give early warning for the timely intervention.

Objective:To explore the clinical significance of N6-methyladenine (m6A) in systemic lupus erythematosus (SLE) by comparing the changes in plasma levels of m6A modification related proteins [methyltransferase 3 (METTL3), methyltransferase 14 (METTL14), Wilms tumor 1 associated protein (WTAP), AlkB homologous protein 5 (ALKBH5), and fat mass and obesity-associated protein (FTO)] and m6A between patients with systemic lupus erythematosus (SLE) and healthy controls.Methods:A total of 64 SLE patients admitted to the Seventh Affiliated Hospital of Sun Yat-Sen University from May 2020 to June 2022 and 24 healthy volunteers during the same period were selected to compare and analyze the plasma levels of METTL3, METTL14, WTAP, ALKBH5, FTO and m6A between the two groups. The correlation between METTL3, WTAP, FTO levels and clinical indicators was analyzed.Results:The plasma METTL3 level of SLE patients was significantly higher than that of control group ( P<0.05), and the plasma WTAP and FTO levels were significantly lower than those of control group (all P<0.05). In SLE patients, plasma METTL3 level was negatively correlated with hemoglobin level ( r=-0.344, P<0.05), plasma FTO level was positively correlated with plasma IgM level ( r=0.337, P<0.05), and plasma IgA level was negatively correlated with SLE patients ( r=-0.286, P<0.05). The incidence of renal involvement and positive rate of plasma anti-histone antibody were higher in SLE patients with high METTL3 level (all P<0.05). The positive rates of plasma anti-dsDNA antibody, anti-SM antibody and AuaA antibody were higher in SLE patients with low FTO level (all P<0.05). Conclusions:The plasma METTL3 level in SLE patients are significantly increased, while the plasma WTAP and FTO levels are significantly reduced, which are related to various clinical indicators and may be related to the onset of SLE.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Background: Ferroptosis, which is caused by an iron-dependent accumulation of lipid hydroperoxides, is a type of cell death linked to diabetic kidney disease (DKD). Previous research has shown that fatty acid binding protein 4 (FABP4) is involved in the regulation of ferroptosis in diabetic retinopathy. The present study was constructed to explore the role of FABP4 in the regulation of ferroptosis in DKD. Methods: We first detected the expression of FABP4 and proteins related to ferroptosis in renal biopsies of patients with DKD. Then, we used a FABP4 inhibitor and small interfering RNA to investigate the role of FABP4 in ferroptosis induced by high glucose in human renal proximal tubular epithelial (HG-HK2) cells. Results: In kidney biopsies of DKD patients, the expression of FABP4 was elevated, whereas carnitine palmitoyltransferase-1A (CP-T1A), glutathione peroxidase 4, ferritin heavy chain, and ferritin light chain showed reduced expression. In HG-HK2 cells, the induction of ferroptosis was accompanied by an increase in FABP4. Inhibition of FABP4 in HG-HK2 cells changed the redox state, sup-pressing the production of reactive oxygen species, ferrous iron (Fe2+), and malondialdehyde, increasing superoxide dismutase, and reversing ferroptosis-associated mitochondrial damage. The inhibition of FABP4 also increased the expression of CPT1A, reversed lipid deposition, and restored impaired fatty acid β-oxidation. In addition, the inhibition of CPT1A could induce ferroptosis in HK2 cells. Conclusion Our results suggest that FABP4 mediates ferroptosis in HG-HK2 cells by inhibiting fatty acid β-oxidation.