There is controversy over the specific and non-specific components in the efficacy evaluation of acupuncture therapy.The placebo effect,as a key non-specific factor,needs to be clarified in terms of its mechanism and clinical value.This article reviewed the research progress in the placebo effect of acupuncture from three aspects:cognitive process,influencing factors,and mechanism.It focused on the regulatory effects of patient expectations,doctor-patient interaction,and individual differences on the effect,summarized key mechanisms such as endogenous opioid system,dopamine reward pathway,and neural projection of rostral anterior cingulate cortex to pontine nucleus,and pointed out the methodological limitations of current comfort acupuncture designs,in order to provide theoretical basis for the optimization of acupuncture clinical research models and the deepening of the effect mechanism.

OBJECTIVE: The study investigates the performance parameters of a nebulizer for pressurized intraperitoneal aerosol chemotherapy (PIPAC). METHODS: Laser diffraction spectroscopy was used to measure the median droplet diameter ( D ₅₀) and spray angle during the steady-state aerosol phase. RESULTS: The minimum droplet diameter of aerosol was achieved when using a nozzle of 0.2 mm diameter and 0.07 mm thickness. The nebulizer could not produce steady-state aerosol when the liquid flow rate was less than or equal to 0.3 mL/s. When the liquid flow rate was greater than or equal to 0.5 mL/s, as the working pressure increased, the median particle size gradually decreased and the spray angle gradually increased. When the pressure is greater than or equal to 200 psi（1 psi=6 894.76 Pa）, as the liquid flow rate increased, the spray angle gradually increased. At a flow rate of 0.7 mL/s and working pressure of 300 psi, the median droplet diameter of aerosol D ₅₀ was 16 μm with a spray angle up to 89.2°. CONCLUSION As a novel intraperitoneal drug delivery technology, PIPAC requires further research focusing on reducing droplet size, expanding drug distribution, improving tissue permeability, and increasing drug concentration.
Nebulizers and Vaporizers ; Aerosols ; Particle Size ; Pressure ; Drug Delivery Systems

There is controversy over the specific and non-specific components in the efficacy evaluation of acupuncture therapy.The placebo effect,as a key non-specific factor,needs to be clarified in terms of its mechanism and clinical value.This article reviewed the research progress in the placebo effect of acupuncture from three aspects:cognitive process,influencing factors,and mechanism.It focused on the regulatory effects of patient expectations,doctor-patient interaction,and individual differences on the effect,summarized key mechanisms such as endogenous opioid system,dopamine reward pathway,and neural projection of rostral anterior cingulate cortex to pontine nucleus,and pointed out the methodological limitations of current comfort acupuncture designs,in order to provide theoretical basis for the optimization of acupuncture clinical research models and the deepening of the effect mechanism.

Objective:To explore the efficacy and safety profile of sofosbuvir/velpatasvir/voxilaprevir ± ribavirin (SOF/VEL/VOX±RBV) for salvage treatment of chronic hepatitis C patients who have failed direct-acting antivirals (DAAs).Methods:Patients with chronic hepatitis C who failed DAAs±RBV treatment and were treated in five hospitals in Chongqing, Guangdong, Guizhou, and Guangxi from January 2022 to December 2023 were included in this retrospective study. One or more courses of DAAs±RBV therapy were evaluated for all patients who had been previously treated. Virological rebound occurrence was observed during the follow-up. SOF/VEL/VOX±RBV was used for one course of salvage treatment. Virological and biochemical indicators were analyzed before salvage therapy, post-treatment, and drug discontinuation at 12 weeks. Adverse drug events were recorded during treatment. Data between groups were compared using t-tests or non-parametric tests.Results:A total of 26 cases of chronic hepatitis C who had failed DAAs±RBV were included in this study, with an age of (52.9±9.6) years. Twenty-one cases (80.8%) were male, sixteen (61.5%) had a history of drug abuse, two (7.7%) had combined human immunodeficiency virus infection, and fourteen (53.8%) had combined cirrhosis. The previous DAA regimen of 21 cases (80.8%) included SOF/VEL. The baseline HCV RNA load of salvage treatment was (5.8±1.6) log 10 IU/ml, and 16 cases (61.5%) were genotype 3. All patients completed the 12-week SOF/VEL/VOX±RBV salvage treatment and achieved sustained virological response (SVR) at the end of treatment. All 22 cases were followed up for 12 weeks following treatment completion and attained SVR12, including patients with genotype 3 and cirrhosis. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) had normalized return rates of 94.1% and 93.8%, respectively, following therapy. ALT, AST, FIB-4 index, APRI, and aPMAP scores were significantly lower than those before treatment ( Z=-3.980, -3.875, -3.461, -3.582, P<0.05). The proportion of patients in the high-risk group of liver cancer dropped (52.6% before treatment and 33.3% after treatment), and more patients were reclassified to medium-and low-risk groups. Two cases (7.7%) experienced nausea and diarrhea, one case (3.8%) had a headache, and one case (3.8%) had fatigue, all of which were well managed during treatment. There were no serious adverse events, deaths, or interruptions of treatment due to adverse reactions. Conclusions:SOF/VEL/VOX is a safe and effective salvage treatment option for chronic hepatitis C patients who have failed DAAs therapy, and may be particularly beneficial to refractory populations infected with genotype 3 and combined with cirrhosis.

This study aims to obtain two whole-genome sequences of enzootic nasal tumor virus of goats(ENTV-2)from Anhui Province and analyzed the genetic diversity of ENTV-2 gene.Nasal secretion samples and blood samples of six goats with enzootic nasal adenocarcinoma(ENA)were collected from a goat farm in Anhui Province.The total RNA was extracted by the TRIzol method.The DNA interference was removed by the two-step reverse transcription.The ENTV-2 was detec-ted by PCR.Then,two positive samples were selected and five pairs of primers were used to ampli-fy the whole-genome sequences of ENTV-2.After sequencing and splicing,two sequences were up-loaded to the database for comparative analysis with the sequences in the NCBI database.Finally,the genetic evolution tree was constructed.ENTV-2 was detected in the nasal secretion samples,but not in the blood of the six ENA goats.The ENTV-2 genes were approximately 7 400 bp in length,named ENTV-2AH1(DDBJ accession no.:LC762616)and ENTV-2AH2(DDBJ accession no.:LC762617),respectively.Two sequences showed 99.2％and 99.1％homology with the Fujian strain(ENTV-2FJ)and Guangxi strain(ENTV-2-DA0),respectively.They were in the same evo-lutionary branch.In this study,two whole-genome sequences of ENTV-2 were obtained in Anhui for the first time,which can help to further study the genetic diversity of ENTV-2 in China.

Objective:To explore the efficacy and safety profile of sofosbuvir/velpatasvir/voxilaprevir ± ribavirin (SOF/VEL/VOX±RBV) for salvage treatment of chronic hepatitis C patients who have failed direct-acting antivirals (DAAs).Methods:Patients with chronic hepatitis C who failed DAAs±RBV treatment and were treated in five hospitals in Chongqing, Guangdong, Guizhou, and Guangxi from January 2022 to December 2023 were included in this retrospective study. One or more courses of DAAs±RBV therapy were evaluated for all patients who had been previously treated. Virological rebound occurrence was observed during the follow-up. SOF/VEL/VOX±RBV was used for one course of salvage treatment. Virological and biochemical indicators were analyzed before salvage therapy, post-treatment, and drug discontinuation at 12 weeks. Adverse drug events were recorded during treatment. Data between groups were compared using t-tests or non-parametric tests.Results:A total of 26 cases of chronic hepatitis C who had failed DAAs±RBV were included in this study, with an age of (52.9±9.6) years. Twenty-one cases (80.8%) were male, sixteen (61.5%) had a history of drug abuse, two (7.7%) had combined human immunodeficiency virus infection, and fourteen (53.8%) had combined cirrhosis. The previous DAA regimen of 21 cases (80.8%) included SOF/VEL. The baseline HCV RNA load of salvage treatment was (5.8±1.6) log 10 IU/ml, and 16 cases (61.5%) were genotype 3. All patients completed the 12-week SOF/VEL/VOX±RBV salvage treatment and achieved sustained virological response (SVR) at the end of treatment. All 22 cases were followed up for 12 weeks following treatment completion and attained SVR12, including patients with genotype 3 and cirrhosis. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) had normalized return rates of 94.1% and 93.8%, respectively, following therapy. ALT, AST, FIB-4 index, APRI, and aPMAP scores were significantly lower than those before treatment ( Z=-3.980, -3.875, -3.461, -3.582, P<0.05). The proportion of patients in the high-risk group of liver cancer dropped (52.6% before treatment and 33.3% after treatment), and more patients were reclassified to medium-and low-risk groups. Two cases (7.7%) experienced nausea and diarrhea, one case (3.8%) had a headache, and one case (3.8%) had fatigue, all of which were well managed during treatment. There were no serious adverse events, deaths, or interruptions of treatment due to adverse reactions. Conclusions:SOF/VEL/VOX is a safe and effective salvage treatment option for chronic hepatitis C patients who have failed DAAs therapy, and may be particularly beneficial to refractory populations infected with genotype 3 and combined with cirrhosis.

ObjectiveTo identify high-risk factors and high-risk process of nosocomial infection， and then take targeted prevention and control measures to improve nosocomial infection management. MethodsWe identified and determined the risk factors associated with nosocomial infection by using an expert brainstorming method， and then conducted risk assessment of the factors in the outcomes and process by using a semi-quantitative method. ResultsA total of 31 experts participated in the risk factor assessment. Risk assessment scores showed that nosocomial infection due to multi-drug resistant bacteria was the highest risk in the outcomes of nosocomial infection. Lack of isolation for airborne/droplet transmission， needle/sharp instrument injury， inadequate identification of infection risk and response measures in construction engineering， and insufficient implementation of infection control system were extremely high risk factors in the process of nosocomial infection. ConclusionPrevention and control should be strengthened on multi-drug resistant bacteria and catheter-related infections. The role of multidisciplinary team （MDT） in the prevention and control of nosocomial infection should be enhanced in medical practice. Risk assessment may facilitate the resource allocation and improve hand hygiene behavior.

Objective:To explore the effect of staged intervention based on the theory of planned behavior (TPB) on breastfeeding self-efficacy and exclusive breastfeeding among women with gestational diabetes mellitus (GDM) .Methods:From January to May 2019, continuous sampling was used to select 380 delivery women who were diagnosed with GDM in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University and met the inclusion and exclusion criteria as the research object. According to the random number table method, the delivery women were divided into the control group and the intervention group, 190 cases in each group. The delivery women in the control group received routine breastfeeding health education, while the delivery women in the intervention group implemented the TPB-based staged intervention on the basis of routine breastfeeding health education. The exclusive breastfeeding rate, knowledge and self-efficacy were compared between the two groups. As of four months postpartum, 169 delivery women were included in the intervention group and 157 delivery women in the control group.Results:The exclusive breastfeeding rate of delivery women in the intervention group at four months postpartum was 63.3% (107/169) , which was higher than that [47.1% (74/157) ] in the control group, with a statistically significant difference ( P<0.05) . The breastfeeding knowledge scores of the intervention group and the control group were (15.01±2.04) and (13.05±2.78) respectively, and the difference was statistically significant ( P<0.01) . The GDM breastfeeding knowledge scores were (8.86±1.85) and (4.80±2.76) , and the difference was statistically significant ( P<0.01) . There were significant differences in breastfeeding self-efficacy scores between the two groups at 38 to 40 weeks before delivery, three days, 42 days, and four months after delivery ( P<0.01) . There were significant differences in the exclusive breastfeeding rates between the two groups of GDM women at different time points ( P<0.05) . Conclusions:The staged intervention based on TPB can improve the effect of breastfeeding in GDM women, enhance maternal knowledge and self-efficacy, and increase the rate of exclusive breastfeeding.

Objective:To study the efficacy of three-dimensional (3D) CT reconstruction combined with 3D color printing compared with traditional imaging technology in treatment of complex hepatobiliary calculi treated with laparoscopy and choledochoscopy.Methods:A retrospective study was conducted on 128 patients with complex hepatobiliary calculi who underwent hepatobiliary surgery at the Qingdao Chengyang People’s Hospital, Qingdao Municipal Hospital Affiliated to Qingdao University and Qingdao University Affiliated Hospital from January 2019 to December 2019. A comparison was made between patients who underwent three-dimensional CT reconstruction combined with 3D color printing (the study group, n=62) and the traditional imaging technology group (the control group, n=66) on operation time, intraoperative blood loss, liver blood flow occlusion time, stone clearance rate, postoperative complication rate, and recurrence of calculi after operation. Results:The study group was significantly better than the control group in operation time, intraoperative blood loss, porta hepatis occlusion time, hospital stay and treatment cost (all P<0.05). The stone clearance rate of the study group was 96.8% (60/62), which was significantly higher than that of the control group (86.4%, 57/66) ( P<0.05). The incidence of postoperative complications in the study group was 3.2% (2/62), which was significantly lower than that in the control group (18.2%, 12/66) ( P<0.05). There was no significant difference in the stone recurrence rate between the two groups (all P>0.05). Conclusion:Three-dimensional CT reconstruction combined with 3D color printing contributed significantly to the surgical treatment of complex intrahepatic bile duct stones as these imaging technologies significantly improved surgical accuracy, improved stone clearance and reduced postoperative complication rates, and reduced surgical treatment costs.

Objective:To investigate the CT features of lung injury induced by paraquat poisoning and its relationship with prognosis, and to provide reference for the judgment of the condition and prognosis of paraquat poisoning.Methods:146 cases of paraquat poisoning patients were treated in the Third People's Hospital of Xuzhou City from January 2013 to April 2016. The cases were divided into mild group, moderate-severe group and fulminant group according to the concentration of paraquat in urine. The clinical data and CT imaging findings were analyzed and reconstructed in three-dimensional reconstruction. The extent of the lesion was observed and the relationship between CT and prognosis was explored.Results:Paraquat lung injury has many manifestations on CT images, and it's performance can be intersecting at the same time. Early lesions lighter cases, late CT imaging lesions can be completely absorbed or residual fibrosis, the prognosis was good; the early lesion was pulmonary consolidation, pleural effusion cases, the late CT image was usually pleural thickening and bronchiectasis, the prognosis was relatively good; early lesions were large patches of ground glass opacity cases, finally, pulmonary fibrosis was common, the mortality rate of 56.57%. There were significant differences in the extent of lung injury between different groups ( P<0.001) , and the difference in mortality was statistically significant when the lung injury was different ( P<0.001) . Multivariate stepwise Logistic regression analysis showed that ground-glass opacity ( OR value=2.013) , interstitial lung fibrosis ( OR=3.779) and mediastinal emphysema ( OR=33.118) were risk factors for death of lung injury caused by paraquat poisoning ( P<0.05) . Conclusion:There were many manifestations on CT images of paraquat lung injury, and the manifestations of paraquat lung injury can be intersecting at the same time. The pulmonary manifestations and outcomes of different paraquat types were different. The CT manifestations of lung injury in paraquat poisoning were mainly exudative changes at early stage, and can be gradually absorbed or evolved into interstitial changes at later stage. The cumulative damage range can be used as a reference for evaluating the prognosis. Ground-glass opacity, interstitial pulmonary fibrosis and mediastinal emphysema are the risk factors for death of lung injury caused by paraquat poisoning.