OBJECTIVE: To investigate the effect of moxibustion on central insulin resistance related proteins of the rats suffering from diabetic cognitive decline, and analyze the underlying mechanism of moxibustion for cognition improvement. METHODS: Using the intraperitoneal injection of STZ combined with a high-fat diet, the rat model of diabetic cognitive decline were prepared. Twenty successfully-modeled rats were assigned randomly into a model group and a moxibustion group, 10 rats in each one. Besides, a blank group was set up with 10 rats collected. In the moxibustion group, suspending moxibustion was applied to "Baihui" (GV20), "Shenting" (GV24) and "Dazhui" (GV14) at the same time, 20 min in each intervention, once a day, and 6 interventions were delivered weekly and the duration of treatment was consecutive 4 weeks. The random blood glucose was measured using glucometer, and the learning-memory ability was detected by water maze test. HE staining was used to observe the morphology of neurons in the hippocampal tissue, real-time PCR assay was to detect mRNA expression of insulin receptor substrate 1 (IRS1), phosphatidylinositol 3-kinase (PI3K) and protein kinase B (AKT) in the hippocampal tissue. The Western blot method was employed to detect the protein expression of IRS1, PI3K, AKT, phosphorylated IRS1 (p-IRS1), phosphorylated PI3K (p-PI3K) and phosphorylated AKT (p-AKT) in the hippocampal tissue, and the ratio of p-IRS1/IRS1, p-PI3K/PI3K and p-AKT/AKT was calculated separately. The immunofluorescence intensity of p-IRS1, p-PI3K, and p-AKT was measured using immunofluorescence. RESULTS: Compared with the blank group, the rats of the model group exhibited higher random blood glucose (P<0.001), longer escape latency (P<0.001), severe pathological damage in the hippocampus, lower mRNA expression of IRS1, PI3K, and AKT (P<0.001), reduced ratio of p-IRS1/IRS1, p-PI3K/PI3K and p-AKT/AKT (P<0.001), and declined immunofluorescence intensity of p-IRS1, p-PI3K, and p-AKT in the hippocampal tissue (P<0.001). In comparison with the model group, for the rats of the moxibustion group, the random blood glucose decreased (P<0.05), the escape latency was shortened (P<0.01), the hippocampal pathological damage was attenuated, the mRNA expression of IRS1, PI3K and AKT increased (P<0.01), the ratio of p-IRS1/IRS1, p-PI3K/PI3K and p-AKT/AKT was elevated (P<0.01, P<0.05), and the immunofluorescence intensity of p-IRS1, p-PI3K, and p-AKT in the hippocampal tissue was strengthened (P<0.01, P<0.05). CONCLUSION In diabetic rats experiencing cognitive decline, moxibustion can enhance the learning-memory ability, which may be attributed to modulating the protein expression of IRS1, PI3K, and AKT, and their phosphorylation, activating insulin signal transduction, and reducing central insulin resistance.
Animals ; Moxibustion ; Insulin Resistance ; Rats ; Male ; Insulin Receptor Substrate Proteins/genetics* ; Rats, Sprague-Dawley ; Humans ; Proto-Oncogene Proteins c-akt/genetics* ; Cognitive Dysfunction/genetics* ; Diabetes Mellitus, Experimental/therapy* ; Hippocampus/metabolism* ; Acupuncture Points ; Phosphatidylinositol 3-Kinases/genetics*

OBJECTIVE: To observe the effects of moxibustion at different temperatures on cognitive function and blood glucose levels in patients with cognitive impairment associated with type 2 diabetes mellitus (T2DM). METHODS: A total of 66 T2DM patients with cognitive impairment were randomly assigned to a high-temperature group (22 cases, 1 case dropped out, 1 case was eliminated), a medium-temperature group (22 cases, 2 cases were eliminated), and a low-temperature group (22 cases, 2 cases were eliminated). All groups received moxibustion at Baihui (GV20), Dazhui (GV14), and Shenting (GV24) based on their existing glycemic control treatment. Moxibustion temperatures were maintained at 44-46 ℃ (high-temperature group), 41-43 ℃ (medium-temperature group), and 38-40 ℃ (low-temperature group), respectively, for 20 min per session, every other day, 3 times a week for 3 months. The Montreal cognitive assessment (MoCA) score, mini-mental state examination (MMSE) score, short-term memory (STM) accuracy and average reaction time, Rey-Osterrieth complex figure (ROCF) score, fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were assessed before and after treatment. Clinical efficacy was evaluated after treatment. RESULTS: After treatment, MMSE scores in all three groups were higher than those before treatment (P<0.05). In the high-temperature group, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, naming, language, and abstraction were higher than those before treatment (P<0.05); the scores of ROCF copy, immediate recall, and delayed recall were higher than those before treatment (P<0.05); the HbA1c level was lower than that before treatment (P<0.05). In the medium-temperature group, the total MoCA score and the scores of memory and delayed recall, attention, and language were higher than those before treatment (P<0.05). STM accuracy was higher than before treatment (P<0.05), and STM average reaction time was shorter than before treatment (P<0.05) in both the high-temperature and medium-temperature groups. After treatment, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, and language in the high-temperature group were higher than those in the medium- and low-temperature groups (P<0.05); MMSE score, STM accuracy, and ROCF immediate recall and delayed recall scores were higher than those in the medium- and low-temperature groups (P<0.05); STM average reaction time was shorter than that in the medium- and low-temperature groups (P<0.05); HbA1c level was lower than that in the low-temperature group (P<0.05). The total MoCA score, attention score, and MMSE score in the medium-temperature group were higher than those in the low-temperature group (P<0.05), and STM average reaction time was shorter than that in the low-temperature group (P<0.05). There were no statistically significant differences in FPG within or between the three groups before and after treatment (P>0.05). The total effective rates were 75.0% (15/20) in the high-temperature group, 50.0% (10/20) in the medium-temperature group, and 15.0% (3/20) in the low-temperature group; the total effective rate in the high-temperature group was significantly higher than that in the low-temperature group (P<0.05). CONCLUSION Moxibustion at different temperatures has a dose-effect relationship in treating cognitive impairment in T2DM patients. A temperature range of 44-46 ℃ is more effective in improving cognitive function and stabilizing average blood glucose levels over 2-3 months.
Humans ; Diabetes Mellitus, Type 2/therapy* ; Male ; Female ; Moxibustion ; Middle Aged ; Aged ; Cognitive Dysfunction/psychology* ; Cognition ; Temperature ; Blood Glucose/metabolism* ; Adult ; Acupuncture Points

OBJECTIVE: To investigate the effects of Huayu Tongluo (transforming stasis and unblocking collaterals) moxibustion on cognitive function and insulin resistance in patients with type 2 diabetes mellitus (T2DM) and cognitive decline. METHODS: Ninety patients with T2DM and cognitive decline were randomly divided into a moxibustion group (n=45, 3 cases dropped out, 2 cases were eliminated) and a waiting moxibustion group (n=45, 2 cases dropped out). Both groups received routine hypoglycemic treatment for 12 weeks. The moxibustion group additionally received Huayu Tongluo moxibustion at Baihui (GV20), Shenting (GV24), and Dazhui (GV14). Pressing moxibustion was applied to Baihui (GV20) for 20 min, while suspended moxibustion was applied to Shenting (GV24) and Dazhui (GV14) for 20 min each. Treatments of moxibustion were administered every other day (three times per week) for 12 weeks. All patients were followed up for 12 weeks, during which their original hypoglycemic medication regimen was maintained. Before treatment, after 12 weeks of treatment, and at the 12-week follow-up, the scores of Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), Addenbrooke's cognitive examination Ⅲ (ACE-Ⅲ), symbol digit modalities test (SDMT), and Athens insomnia scale (AIS) and the insulin resistance index (HOMA-IR) were observed in the two groups. RESULTS: Compared with before treatment, the MoCA scores, MMSE scores, ACE-Ⅲ subscale scores (attention, memory, language fluency, language, visuospatial ability) and total scores, and SDMT scores were increased (P<0.01), while the AIS scores were decreased (P<0.05) in the moxibustion group after treatment and at follow-up. Compared with before treatment, the MMSE score, ACE-Ⅲ subscale scores (memory, attention) and total score after treatment, as well as the ACE-Ⅲ subscale scores (language, memory, attention) and total score, and SDMT score at follow-up were increased (P<0.05, P<0.01) in the waiting moxibustion group. Compared with before treatment, HOMA-IR was decreased in both groups after treatment and at follow-up (P<0.01). At follow-up, ACE-Ⅲ subscale scores (attention, memory), and the total score in the moxibustion group were lower than those after treatment (P<0.05, P<0.01), and the ACE-Ⅲ language subscale score, total ACE-Ⅲ score, and SDMT score in the waiting moxibustion group were higher than those after treatment (P<0.01, P<0.05). After treatment and at follow-up, compared with the waiting moxibustion group, the moxibustion group had higher MoCA scores, MMSE scores, SDMT scores, ACE-Ⅲ subscale scores (attention, memory, language fluency) and total scores (P<0.05, P<0.01), and lower HOMA-IR (P<0.05). CONCLUSION Huayu Tongluo moxibustion can effectively improve cognitive function in patients with T2DM and cognitive decline. This improvement may be associated with the reduction in insulin resistance.
Humans ; Insulin Resistance ; Diabetes Mellitus, Type 2/complications* ; Male ; Female ; Moxibustion ; Middle Aged ; Aged ; Cognition ; Acupuncture Points ; Adult ; Cognitive Dysfunction/therapy*

Objective To explore the content and the psychometric properties of assessment tools used for evaluating functioning and adaptive behavior in school-age children with intellectual and developmental disabilities within educational settings. Methods The most used assessment tools included Vineland Adaptive Behavior Scales(VABS),Supports Intensity Scale for Children(SIS-C),Strengths and Difficulties Questionnaire(SDQ)and Repetitive Behavior Scale-Revised(RBS-R),for assessing functioning and adaptive behavior children with intellectual and developmental disabili-ties.Employing the framework and methods of the International Classification of Functioning,Disability,and Health(ICF),this research encoded and categorized the assessment dimensions and items of the four tools,and explored their psychometric properties. Results VABS's assessment content was solely focused on activities and participation,including speaking(d330),con-versation(d350),toileting(d530),eating(d550),drinking(d560),basic interpersonal interactions(d710),com-plex interpersonal interactions(d720),changing and maintaining body positions(d410-d429),carrying,moving and handing objects(d430-d449),and walking and moving(d450-d469).SIS-C assessed activities and participa-tion,and environmental factors,including washing oneself(d510),caring for body parts(d520),community life(d910),using transportation(d470),school education(d820),basic learning(d130-d159),looking after one's health(d570),basic interpersonal interactions(d710),and products and technology for education(e130).SDQ fo-cused on body functions,and activities and participation,including emotional functions(b152),global psychoso-cial functions(b122),attention functions(b140),and basic interpersonal interactions(d710).RBS-R focused on body functions,and activities and participation,including involuntary movement reaction functions(b755),invol-untary movement functions(b765),looking after one's health(d570),energy and drive functions(b130),under-taking a single task(d210),carrying out daily routine(d230),attention functions(b140),and handling stress and other psychological demands(d240).VABS was characterized by good specificity and excellent sensitivity.SIS-C demonstrated very good internal consistency,reliability and validity.SDQ was good in internal consistency,with excellent credibility and validity.RBS-R showed good internal consistency,reliability and validity. Conclusion SDQ and RBS-R cover both body functions,and activities and participation,SIS-C covers activity and par-ticipation,and environmental factors,while VABS solely assesses activities and participation.In terms of body functions,the assessment items primarily focus on mental functions(b130-b189)and movement functions(b750-b799).For activities and participation,the tools assess content across eight domains of functioning.Regarding en-vironmental factors,the assessment content mainly includes products and technology for education(e130),as well as design,construction and building products and technology of buildings for public use(e150).VABS,SIS-C,SDQ,and RBS-R are all norm-referenced measures,with moderate to excellent internal consistency,and good to excellent reliability and validity.

ObjectiveTo explore the policy framework, theoretical system and principles of educational placement for children with special needs based on the International Classification of Functioning, Disability and Health (ICF) for the multi-faceted educational placement services and methods for these children. MethodsBased on ICF theory and methods, public policy research techniques, and educational policy analysis, this study systematically investigated the policy architecture and theoretical underpinnings for the educational placement of children with special needs, focusing on an inclusive education-oriented system of multiple placements. ResultsThe study analyzed educational policies, emphasizing the rights to education under the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and UNESCO's guidelines on ensuring inclusivity and equity in education which encourage the provision of individualized educational support services and reasonable accommodations to enable the effective participation of students with disablities in education. China, the European Union (EU) and the United States (US) have enacted laws and policies promoting inclusive education, integrating children with disablities into the general education system, and providing them with the same educational opportunities as other children. The development of special education focuses on tailored educational services for those children who need additional support and resources. Policies underscore the need to evaluate the specific needs of children with disablities and provide individualized educational plan based on these needs. ConclusionBased on core content from the CRPD, UNESCO's guidelines, and relevant policies from China, the EU, and the US regarding the education and educational placement services for children with special needs, the theoretical framework and principles of educational placement for children with special needs based on ICF are discussed, proposing contents and methods for constructing a multi-faceted educational placement service system for children with special needs.

Objective: To learn the levels of thyroid hormone indicators among interventional and diagnostic radiologists, so as to provide insights into occupational health monitoring of radiologists. Methods: Demographic information, body mass index (BMI), thyroid hormone indicators and cumulative individual doses over 5 years among interventional and diagnostic radiologists were collected through the personal dosimetry monitoring database of Ningbo Center for Disease Control and Prevention and the Occupational Health Examination Center of a tertiary hospital in Ningbo City. The thyroid hormone indicators of different job types and cumulative individual doses over 5 years were analyzed, and factors affecting the thyroid hormone indicators were identified using a multivariable ordinal logistic regression model. Results: There were 159 interventional and 159 diagnostic radiologists included, and the proportions of abnormal thyroid hormone indicators were 9.43% and 12.26%, respectively, with no statistically significant difference (P>0.05). The levels of triiodothyronine and free triiodothyronine in interventional radiologists were lower than those in diagnostic radiologists [(1.54±0.41) vs. (1.68±0.34) nmol/L, (5.13±1.07) vs. (5.55±0.87) pmol/L; both P<0.05]. The levels of triiodothyronine and free triiodothyronine were significantly different among radiologists with cumulative individual doses over 5 years of <1.5 mSv, 1.5-<3.0 mSv and ≥3.0 mSv [(1.69±0.31), (1.69±0.40) vs. (1.52±0.41) nmol/L, (5.60±0.83), (5.32±0.94) vs. (5.14±1.09) pmol/L; both P<0.05]. Multivariable ordinal logistic regression analysis identified BMI (<18.5 kg/m2, OR=0.111, 95%CI: 0.028-0.436) and cumulative individual doses over 5 years (<1.5 mSv, OR=6.259, 95%CI: 2.368-16.547) as the factors affecting triiodothyronine, and job types (diagnostic radiologists, OR=3.171, 95%CI: 1.529-6.574), BMI (18.5-<24.0 kg/m2, OR=0.393, 95%CI: 0.184-0.842), and gender (men, OR=3.449, 95%CI: 1.294-9.190) as the factors affecting free triiodothyronine. Conclusion Occupational exposure has a certain impact on the thyroid hormone indicators among interventional and diagnostic radiologists, and the main influencing factors include BMI, radiation dose, job type and gender.

Objective: To evaluate the health risk of drinking water in Ningbo City, Zhejiang Province from 2021 to 2022, so as to provide insights into ensuring the safety of drinking water. Methods: The monitoring data of drinking water from 2021 to 2022 in Ningbo City were collected from the Chinese Disease Prevention and Control Information System. The routine indicators and disinfectant indicators (radioactivity indicators were excluded) of drinking water were evaluated according to the reference limits issued by Standards for Drinking Water Quality (GB 5749-2006), and the qualification rates were calculated. The indicators with detection rate higher than 50% were selected, and assessed the carcinogenic and non-carcinogenic risks via drinking water using the risk assessment model recommended by the United States Environmental Protection Agency. Results: A total of 1 678 samples were monitored in Ningbo City from 2021 to 2022. Sodium hypochlorite was the main disinfectant among 1 558 samples from centralized water supply (1 079 samples, 64.30%), and none of the 120 samples from decentralized water supply underwent disinfection treatment. The qualification rate of 88.38%, and the pollutants with a detection rate higher than 50% were nitrate, fluoride, trichloromethane and aluminum. The median carcinogenic risk value of trichloromethane was 2.964×10-6 (interquartile range, 3.909×10-6), and the median hazard quotient values of nitrate, fluoride, trichloromethane and aluminum were 1.631×10-2 (interquartile range, 1.361×10-2), 3.955×10-2 (3.164×10-2), 2.231×10-2 (2.942×10-2) and 2.136×10-4 (6.573×10-4), respectively. Conclusion The carcinogenic and non-carcinogenic risks through drinking water for 17 pollutants in drinking water of Ningbo City from 2021 to 2022 were at low levels.

Objective To synthesize evidence from systematic reviews on the positive impacts of music interventions on the func-tioning,health and development of children and adolescents with intellectual and developmental disabilities(IDD). Methods Literature was searched across databases including PubMed,EBSCO,PsycINFO,Embase,Web of Science and CNKI,focusing on high-quality systematic reviews published from January,2014 to March,2024.These reviews examined the functioning,health and developmental benefits of music interventions(including therapy and edu-cation)for children and adolescents with IDD. Results Eight English systematic reviews were included,involving 5 308 children and adolescents with IDD,from Chi-na,France,Spain,Canada,the United States and the United Kingdom;mainly from journals in the fields of mu-sic therapy,children and adolescents psychiatry,educational psychology,intellectual disability,autism spectrum disorder(ASD)and health psychology,mainly published between 2018 and 2023.The music therapy interven-tions mainly included music education interventions,improvisation music therapy(creation and performance),in-teractive music therapy(music and movement),mixed music therapy(including singing,dancing and drama),au-ditory-motor mapping training,family music therapy and melody-based communication therapy;involving basic music theory learning,music gesture and language training,music appreciation,improvisation,music ensemble,music cooperative games,etc;ten to 90 minutes a time,one to five times a week,for one to 32 weeks.In terms of cognitive development,music education interventions were beneficial for improving attention in children and ad-olescents with IDD.In terms of psycholinguistic skills,music therapy could significantly improve the articulation and language abilities of children and adolescents with ASD,especially phonological memory,word and sentence comprehension;and language and communication skills of children and adolescents with IDD,and enhance oral expression abilities.Music could also help improve behavioral disorders,including improving physical coordina-tion,reducing repetitive behaviors and controlling hyperactive behaviors.In terms of music education perfor-mance,music therapy could improve amiliarity with song rhythm and melody,phoneme discrimination,master-ing songs and lyrics,and enhance music rhythm perception of children and adolescents with IDD.In addition,music therapy also promoted social and emotional development,improved prosocial behavior and social skills,helped reduce anxiety,enhance emotional control,improve social skills and self-esteem,increase positive emo-tions,and strengthen communication and cooperation with peers and teachers. Conclusion Music intervention has a positive impact on the function,health and development of children and adoles-cents with IDD,which is reflected in cognitive development,psycholinguistic skills,motor skills,music educa-tion performance,and children and adolescents'social and emotional development.

Objective:To investigate the values of two-dimensional and three-dimensional echocardiographic parameters in predicting pulmonary vascular resistance (PVR) in chronic pulmonary thromboembolic pulmonary hypertension (CTEPH).Methods:A total of 141 patients diagnosed with CTEPH in China-Japan Friendship Hospital from November 2015 to December 2022 were included. Two-dimensional echocardiographic indicators reflecting PVR were constructed according to the calculation formula of PVR: echocardiographic estimated systolic pulmonary artery pressure (sPAP Echo)/left ventricular end-diastolic diameter (LVIDd), echocardiographic estimated mean pulmonary artery pressure (mPAP Echo)/LVIDd. sPAP Echo/left ventricular end-diastolic volume (LVEDV), sPAP Echo/left ventricular cardiac output (LVCO) were measured by three-dimensional echocardiography. The correlations between two-dimensional and three-dimensional echocardiographic ratios and invasive PVR were then analyzed using the Spearman correlation method. Using receiver operating characteristic curve analysis, cut-off values for the ratios were generated to identify patients with PVR>1 000 dyn·s -1·cm -5. Pre- and postoperative hemodynamics and echocardiographic data were analyzed, as well as the correlation between the reduction rate of the echocardiographic index and PVR in 54 patients who underwent pulmonary endarterectomy (PEA). Results:sPAP Echo/LVIDd, sPAP Echo/LVEDV and sPAP Echo/LVCO were moderately correlated with PVR( rs=0.62, 0.52, 0.63, both P<0.001). The ratio of sPAP Echo to LVEDV, when greater than or equal to 1.41, had a sensitivity of 0.800 and a specificity of 0.930 for determining PVR >1 000 dyn·s -1·cm -5 (AUC=0.860, P<0.001). Similarly, the ratio of sPAP Echo to LVIDd, when greater than or equal to 2.14, had a sensitivity of 0.647 and a specificity of 0.861 for determining PVR >1000 dyn·s -1·cm -5 (AUC=0.830, P<0.001). The sPAP Echo/LVIDd and mPAP Echo/LVIDd significantly decreased after PEA (both P<0.001). The sPAP Echo/LVIDd and mPAP Echo/LVIDd reduction rate (ΔsPAP Echo/LVIDd and ΔmPAP Echo/LVIDd) were significantly correlated with PVR reduction rate (ΔPVR), respectively ( rs=0.61, 0.63, both P<0.05). Conclusions:Two-dimensional ratio sPAP Echo/LVIDd and three-dimensional ratio sPAP Echo/LVEDV can be used to noninvasively estimate PVR in CTEPH patients. The conventional ratio sPAP Echo/LVIDd is convenient and reproducibly suitable for monitoring the improvement of PVR before and after treatment, and its ratio of 2.14 can predict the significant increase of PVR in CTEPH patients (>1 000 dyn·s -1·cm -5).

Objective:To explore the efficacy of central combined peripheral dual-target magnetic stimulation on Parkinson disease (PD) patients with freezing of gait (FOG).Methods:A total of 39 patients with FOG diagnosed at the Parkinson disease clinic of the Affiliated Hospital of Nantong University were included in the study from July 2022 to September 2023.They were randomly divided into observation group ( n=20) and control group ( n=19) by the random number table method. The patients in control group were treated with repetitive transcranial magnetic stimulation (rTMS), while the patients in observation group were treated with additional repetitive peripheral magnetic stimulation(rPMS) on the affected tibialis anterior muscle on the basis of the control group. Other clinical medical treatments were the same for both groups of patients.The timed up and go test (TUGT), 10 meter walk test (10MWT), and motor evoked potentials (MEP) were used to evaluate the efficacy before and after 2 weeks of treatment.The SPSS 25.0 software was used for statistical analysis. Independent sample t-test was used for comparison between the two groups, and paired sample t-test was used for comparison before and after treatment within group. Results:Before treatment, there were no statistically significant difference in TUGT time, 10MWT speed and MEP amplitude between the two groups( t=0.659, 0.514, 0.345, all P>0.05).After treatment, the TUGT time((7.87±1.74) s vs (9.31±1.57)s)and MEP amplitude((41.59±14.81)mV vs (58.26±19.26) mV)of the observation group were lower than those of the control group( t=2.723, 3.039, P=0.010, 0.004), while the 10MWT speed of the observation group was higher than that of the control group ((1.21±0.20) m/s vs (1.01±0.17)m/s, t=3.173, P=0.003).After treatment, the TUGT time and MEP amplitude of patients in the observation group and control group were all lower than before treatment (observation group: t=13.512, 7.126, both P<0.001; control group: t=6.535, 3.094, both P<0.05). The 10MWT speeds of patients in the observation group and control group after treatment were both higher than before treatment ( t=25.665, 6.750, both P<0.001). Conclusion:The combination of central and peripheral dual-target magnetic stimulation may improve the FOG of PD patients, and it is worthy of clinical promotion.