OBJECTIVE: To observe the clinical efficacy of acupuncture combined with bamboo-based medicinal moxibustion in the treatment of chronic insomnia complicated with mild depressive state. METHODS: A total of 60 patients with chronic insomnia complicated with mild depressive state were randomly divided into an observation group and a control group, 30 cases in each group. The control group was treated with acupuncture at bilateral Zhaohai (KI6), Shenmen (HT7), Sanyinjiao (SP6), Anmian (Extra) and Sishencong (EX-HN1), Baihui (GV20), etc. The observation group was treated with bamboo-based medicinal moxibustion based on the treatment in the control group, on the abdomen，Shenque (CV8), Guanyuan (CV4), Zhongwan (CV12) and bilateral Tianshu (ST25) were selected , on the back, the acupoints of governer vessel from Dazhui (GV14) to Yaoshu (GV2) were selected. Both groups were treated once every other day, 3 times a week for 4 weeks. The Pittsburgh sleep quality index (PSQI) score, Hamilton depression scale-17 (HAMD-17) score, insomnia severity index (ISI) score, fatigue assessment instrument (FAI) score before and after treatment and after 2 weeks of treatment completion (follow-up) were observed in the two groups, and the serum level of γ-aminobutyric acid (GABA) before and after treatment was detected in the two groups, and the clinical efficacy and safety were evaluated. RESULTS: After treatment and in the follow-up, the sub-item scores and total scores of PSQI in both groups were reduced compared with those before treatment (P<0.001); except for the score of daytime dysfunction in the follow-up, the scores of sleep quality, sleep duration, daytime dysfunction, and total scores of PSQI in the observation group were lower than those in the control group (P<0.05). After treatment and in the follow-up, the HAMD-17, ISI and FAI scores in both groups were reduced compared with those before treatment (P<0.001); the scores in the observation group were lower than those in the control group (P<0.05). After treatment，the serum levels of GABA in both groups were increased compared with those before treatment (P<0.05); the level in the observation group was higher than that in the control group (P<0.05). The total effective rate of treating chronic insomnia in the observation group was 96.7% (29/30), which was higher than 80.0% (24/30) in the control group (P<0.05); and the total effective rate of improving mild depressive state was 93.3% (28/30), which was higher than 66.7% (20/30) in the control group (P<0.001). During the treatment period, no serious adverse reactions occurred in both groups. CONCLUSION Acupuncture combined with bamboo-based medicinal moxibustion has definite efficacy in the treatment of chronic insomnia complicated with mild depressive state, and has synergistic efficacy in improving sleep quality, sleep duration, daytime dysfunction and depressive state, its action mechanism may be related to the increase of serum level of GABA.
Humans ; Moxibustion ; Sleep Initiation and Maintenance Disorders/therapy* ; Male ; Female ; Middle Aged ; Adult ; Depression/therapy* ; Acupuncture Therapy ; Combined Modality Therapy ; Treatment Outcome ; Aged ; Young Adult ; Acupuncture Points

Objective: To investigate the effect of integrin α5 on the expression of NOD-like receptor thermal protein domain associated protein 3 (NLRP3) in periodontal ligament fibroblasts (PDLFs) within an inflammatory microenvironment. Methods: This study was approved by the Ethics Committee of Laboratory animals. After rat PDLFs were treated with LPS (0.5, 5, and 50 µg/mL) for 24 h, the primary medium was discarded and replaced with serum-free culture medium. After 24 h, the supernatant was collected and mixed with DMEM medium containing 10% exosome-free serum at a volume ratio of 1:1 to obtain conditioned medium (CM). The groups were labeled as the 0.5-CM, 5-CM, and 50-CM groups. In addition, PDLFs cultured in DMEM medium containing 10% exosome-free serum were considered the 0-CM group. PDLFs were cultured with the above CM. In the inhibitor group, PDLFs were cultured in 0-CM containing different concentrations of integrin α5 inhibitor ATN-161 (0, 0.025, 0.25, 2.5, 25, and 250 μg/mL). The effect of CM and integrin α5 inhibitor ATN-161 on cell viability was assessed using the CCK-8 assay. According to the CCK-8 results, in further inhibitor intervention experiments, PDLFs were cultured in 0-CM, 5-CM (without/with 25 μg/mL ATN-161), and 0-CM containing 25 μg/mL ATN-161, which were labeled as the 0-CM, 5-CM, ATN-161+5-CM, and ATN-161 groups, respectively. The expression changes of integrin α5 and NLRP3 were detected using Western blot and qRT-PCR techniques. For in vivo experiments, 24 rats were randomly divided into four groups (n=6). The control group contained healthy rats that received no treatment. The rats in the other three groups were injected with 40 µL of 0-CM containing 25 μg/mL ATN-161 or 5-CM (without or with 25 μg/mL ATN-161) on the palatal side of the left maxillary first molar every three days; these groups were classified as the ATN-161, 5-CM, and ATN-161+5-CM groups, respectively. On the 30th day, the left maxillary tissue of rats was used for Micro-CT, HE staining, and immunohistochemical detection. Results : The CCK-8 assay showed that CM, 25 μg/mL ATN-161, and ATN-161 concentrations below 25 μg/mL had no significant effect on cell viability at 12 h and 24 h (P > 0.05). 50-CM and 25 μg/mL ATN-161 significantly inhibited cell viability at 48 h (P < 0.05). For in vitro experiments, compared to the 0-CM group, both the protein and mRNA levels of integrin α5 and NLRP3 were significantly increased in rat PDLFs in the 5-CM group (P < 0.05). Intervention with 25 μg/mL ATN-161 significantly attenuated the enhancement of 5-CM on the expression of integrin α5 and NLRP3 (P < 0.05). For in vivo experiments, compared to the control group, alveolar bone resorption and periodontal inflammatory cell infiltration were significantly increased in the 5-CM and ATN-161+5-CM groups, and the expression of integrin α5 and NLRP3 was significantly increased (P < 0.01). However, compared to the 5-CM group, the ATN-161+5-CM group had less alveolar bone resorption and fewer periodontal inflammatory cells. Further, the expression of integrin α5 and NLRP3 was significantly reduced (P < 0.01). Conclusion In vitro and in vivo experiments showed that integrin α5 mediated NLRP3 expression in PDLFs under an inflammatory microenvironment. ATN-161 inhibited the expression of integrin α5, thus significantly downregulating the expression of NLRP3, which plays a role in inhibiting inflammation.

To investigate the safety and feasibility of gasless total endoscopic resection of deep lobe parotid gland tumors via a postauricular hairline plus temporal approach. The approach was designed as: a 4 to 5 cm main incision was designed at the postauricular hairline, and a 0.5 cm auxiliary incision was designed in the temporal hairline. The operating cavity was established with the assistance of a special retractor. "Anterograde" dissection of the facial nerve was performed throughout the procedure, along with partial or total gland removal of the tumor. All 16 operations were successfully completed without conversion to open surgery. During the operation, the trunk and branches of the facial nerve were completely preserved, the tumor was completely removed, and the incision healed. Six patients had mild facial paralysis after operation, and recovered completely after 3 to 6 months. There was no salivary fistula, Frey syndrome, infection, or other complications. The postoperative incision was concealed and the aesthetic effect was good. The postauricular hairline plus temporal approach gasless total endoscopic parotidectomy is safe and feasible. This technique can achieve the complete dissection of the total trunk to the branches of the facial nerve, and has good access to the tumors located in any part of the parotid gland region. On the basis of radical resection of the tumor, it achieves minimally invasive and aesthetic improvement.

Objective To understand the factors that affect the pulmonary rehabilitation behavior of elderly patients with lung cancer during the post-operative transitional period,and provide reference bases for formulating the pulmonary rehabilitation plan of elderly patients with lung cancer during the transitional period and improving the compliance of pulmonary rehabilitation.Methods Based on the capability,opportunity,and motivation-behavior model(COM-B model),12 elderly lung cancer patients who underwent surgery at a tertiary A tumor hospital in Tianjin from March to July 2022 were selected for semi-structured interviews using descriptive research methods and purposive sampling method.The data were analyzed using directed content analysis.Results The ability factors(physical strength and postoperative discomfort symptoms of the elderly limit lung rehabilitation exercise,lack of pulmonary rehabilitation knowledge and awareness of the importance of exercise in lung rehabilitation knowledge),opportunity factors(lack of grassroots medical and health services,limiting lung rehabilitation exercise;family and friends are important resources for promoting lung rehabilitation exercise;medical support is a guarantee for promoting lung rehabilitation exercise),motivational factors(high self-efficacy in exercise is the foundation for lung rehabilitation exercise,perception of lung rehabilitation effects increases motivation for lung rehabilitation exercise)and 7 sub themes were extracted.Conclusion There are certain obstacles and promoting factors in the transitional lung rehabilitation process for elderly lung cancer patients after surgery.It is necessary to improve their postoperative discomfort symptoms,increase their knowledge of lung rehabilitation,enhance their awareness of lung rehabilitation,face the social support role of family,friends,and medical staff,improve the infrastructure and lung rehabilitation system,increase community lung rehabilitation support,provide multi-channel high-quality lung rehabilitation resources,and promote the development of smart medical services,constructing a transitional lung rehabilitation strategy for elderly patients with lung cancer.

Objective: To analyze the characteristics of school injury among students aged 3 to 18 years in Yantian District of Shenzhen City, Guangdong Province, so as to provide the reference for developing the strategies for prevention and control of school injury. Methods: Data of the students aged 3 to 18 years who were initially diagnosed as injury in sentinel hospitals and whose injuries occurred in nurseries, primary or middle schools in Yantian District in 2023, were collected from the Shenzhen Injury Surveillance System. The onset time, places, activities, characteristics and sites of injury were descriptively analyzed. Results: A total of 1 681 cases of school injuries among students aged 3 to 18 years were reported in Yantian District in 2023, including 1 182 boys and 499 girls, with a boy-to-girl ratio of 2.37∶1. There were 206 preschool children (12.25%), 856 primary school students (50.92%), 358 junior high school students (21.30%) and 261 high school students (15.53%). The peak months for school injuries were February to June, accounting for 49.97%; the peak time period was from 15: 00 to 18: 59, accounting for 44.68%. The main causes of injuries included falls (41.94%) and blunt injury (33.85%). The activities at the time of injury mainly included leisure activities (57.70%) and physical activities (21.83%). Contusion/abrasion was the main characteristics (49.20%). Mild injury was predominant, accounting for 74.60%, and there was no fatal case. The top three injury sites were the head and neck, upper limbs and lower limbs, accounting for 36.94%, 27.54%, and 24.33%, respectively. Boys had higher proportions of blunt injuries and contusion/abrasion (AR=4.8 and 4.0). The proportion of sports injuries, sprains/strains and lower limb injuries increased with grade (all P<0.05). Conclusions School injury among students predominantly occur in spring when having leisure or physical activities in Yantian District. The main causes of injuries are falls and blunt injury, with boys and primary school students being the high-risk groups.

Objective:To investigate the outcomes of periacetabular osteotomy (PAO) through modified Smith-Petersen or Bikini approach with an auxiliary posterolateral incision for developmental dysplasia of hip (DDH).Methods:85 patients (97 hips) who underwent PAO through modified Smith-Petersen or Bikini approach with auxiliary posterolateral incision for DDH in the 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army or the Second Xiangya Hospital of Central South University from January 2016 to January 2021 were retrospectively analyzed. There were 70 females and 15 males, with an average age of 28.6±8.4 years (12-49). According to the Hartofilakidis classification, all patients were classified as type Ⅰ. There were 77 hips classified as Grade 0 and 20 hips classified as Grade 1 according to the T?nnis classification. The X-ray evaluation including the lateral central edge angle (LCEA), t?nnis angle (TNS) and anterior central edge angle (ACEA), visual analogue score (VAS) and modified Harries hip score (mHHS) were recorded preoperatively and during each postoperative follow-up. The cumulative sum (CUSUM) method was used to fit the learning curves of operation time.Results:All patients were followed-up with an average of 52.7±18.9 months (21 to 84). The average operative time and intraoperative blood loss were 95.9±28.2 min (65 to 215) and 414.7±97.0 ml (250 to 900), respectively. The learning curve of operation time was 10 cases. The average LCEA 32.39° (30.29°, 34.92°), TNS 3.14° (1.56°, 5.67°) and ACEA 31.55° (29.07°, 33.88°) were all significantly improved compared to preoperative values ( Z=-30.764, P<0.001; Z=30.595, P<0.001; Z=-38.134, P<0.001). The average VAS was reduced from 5.18±0.88 points preoperatively to 1.27±0.93 points postoperatively with significant difference ( t=51.231, P<0.001). The average mHHS was increased from 73.12±9.17 to 92.02±4.05 postoperatively with significant difference ( t=-26.902, P<0.001). No patients received total hip arthroplasty during the follow-up period. Conclusion:Bernese PAO through modified Smith-Petersen or Bikini approach with a small auxiliary posterolateral incision was not only a safe and effective method for the treatment of DDH but also shortened the learning curve and reduced difficulty of the surgery.

Objective:To observe any effect of ultrashortwave (USW) therapy on inflammatory cytokines and the MAPK pathway of rats with a spinal cord injury.Methods:Seventy-nine Sprague-Dawley rats were randomly divided into a control group ( n=35), an intervention group ( n=35) and a sham group ( n=9). Allen′s method was used to establish a contusion model of SCI in the rats of the control and intervention groups, while the sham group′s spinal tissues were exposed but not stricken. Beginning twenty-four hours after SCI modeling, the intervention group was given 7min of USW therapy daily, five days a week till the day of sacrifice for sampling the target area of spinal cord for tests. Then, motion function was evaluated using Basso, Beattie and Bresnahan (BBB) scoring. One, three and seven days after the SCI modeling, immunofluorescence and western blotting were employed to observe any changes in inflammatory factors and the MAPK pathway in the lesioned area. Results:Fourteen days after the modeling the average BBB score of the intervention group was significantly higher than the control group′s average. Moreover, 7 days after the modeling the average content of the domains containing protein 3 (NLRP3), interleukin-6 (IL-6), IL-6 receptor and tumor necrosis factor-α (TNF-α) in the target area of the spinal cord of sham group showed significantly lower levels than in the other 2 groups. And the levels in the intervention group were significantly lower than in the control group. Seven days after the modeling the number of cells positive for zinc finger protein 36 (TTP) in the lesioned area of the intervention group was significantly greater than among the control group. At the same time the levels of MAPK-activated protein kinase 2 (MK2), phosphorylated-mitogen-activated protein kinase-activated version (p-MK2) and TTP in the control and intervention groups were significantly higher than in the sham group. And there were significant differences between the intervention group and control group in the levels of MK2, p-MK2 and TTP.Conclusion:Ultrashortwave therapy can inhibit inflammation by regulating the MAPK inflammatory pathway, promoting the recovery of motion functions, at least in rats.

Objective:To investigate the protective effect of external diaphragm pacing（EDP）combined with hyperbaric oxygen（HBO）therapy on preventing ventilator-induced diaphragm dysfunction（VIDD）and its related mechanism.Methods:A total of 100 adult male rats were randomly divided into five groups：blank control（BC）group，VIDD group，EDP group，HBO therapy group，and the combination of EDP and HBO therapy（EDP+HBO）group，with 20 rats per group. After tracheotomy，the BC group received no treatment，while the rats in the other four groups were given controlled mechanical ventilation to establish the VIDD rat model. And after successful modeling，the VIDD group did not receive further intervention，and the other three groups were treated accordingly. After 10 days of consecutive treatment，the changes in diaphragm weight（DW）and DW/body weight（BW），contraction force of diaphragm in vitro，and transection area of muscle fibers of each group were measured. Gene and protein expressions of diaphragm-related factors were detected. Results:Compared with the BC group，the DW，DW/BW，the transection area of muscle fibers，and the fiber structure and the contraction force of diaphragm in vitro of the VIDD group were decreased significantly. The expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1 in the VIDD group were significantly increased while the expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px were significantly decreased after treatment（ P < 0.05）. Compared with the VIDD group，the EDP+HBO group had higher DW and DW/BW［（0.35 ± 0.02）g vs.（0.63 ± 0.06）g，0.78 ± 0.08 vs. 1.34 ± 0.06，both P<0.05］，stronger contraction force of diaphragm in vitro［（1.15 ± 0.42）N/cm 2vs.（2.19 ± 0.10）N/cm 2， P < 0.05］，declining expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1，increased expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px，and much better diaphragmatic function，and all the differences were statistically significant（ P<0.05）. Conclusion:External diaphragm pacing combined with HBO therapy can significantly mitigate and decelerate VIDD by increasing the contraction force of the diaphragm，and reducing the oxidative stress，diaphragmatic atrophy and structural injury.

Objective:To investigate the protective effect of external diaphragm pacing（EDP）combined with hyperbaric oxygen（HBO）therapy on preventing ventilator-induced diaphragm dysfunction（VIDD）and its related mechanism.Methods:A total of 100 adult male rats were randomly divided into five groups：blank control（BC）group，VIDD group，EDP group，HBO therapy group，and the combination of EDP and HBO therapy（EDP+HBO）group，with 20 rats per group. After tracheotomy，the BC group received no treatment，while the rats in the other four groups were given controlled mechanical ventilation to establish the VIDD rat model. And after successful modeling，the VIDD group did not receive further intervention，and the other three groups were treated accordingly. After 10 days of consecutive treatment，the changes in diaphragm weight（DW）and DW/body weight（BW），contraction force of diaphragm in vitro，and transection area of muscle fibers of each group were measured. Gene and protein expressions of diaphragm-related factors were detected. Results:Compared with the BC group，the DW，DW/BW，the transection area of muscle fibers，and the fiber structure and the contraction force of diaphragm in vitro of the VIDD group were decreased significantly. The expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1 in the VIDD group were significantly increased while the expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px were significantly decreased after treatment（ P < 0.05）. Compared with the VIDD group，the EDP+HBO group had higher DW and DW/BW［（0.35 ± 0.02）g vs.（0.63 ± 0.06）g，0.78 ± 0.08 vs. 1.34 ± 0.06，both P<0.05］，stronger contraction force of diaphragm in vitro［（1.15 ± 0.42）N/cm 2vs.（2.19 ± 0.10）N/cm 2， P < 0.05］，declining expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1，increased expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px，and much better diaphragmatic function，and all the differences were statistically significant（ P<0.05）. Conclusion:External diaphragm pacing combined with HBO therapy can significantly mitigate and decelerate VIDD by increasing the contraction force of the diaphragm，and reducing the oxidative stress，diaphragmatic atrophy and structural injury.

Objective:To investigate the protective effect of external diaphragm pacing on the prevention of ventilator-induced diaphragm dysfunction (VIDD) in rabbits and its mechanism.Methods:Eighty-five New Zealand white rabbits were randomly (random number) divided into the blank control group (BC, n=5), spontaneous breathing group (SB, n=20), volume control ventilation group (VC, n=20), external diaphragm pacing group (EDP, n=20), external diaphragm pacing and volume control ventilation group (EDP+ VC, n=20). After successful modeling, the rabbits in each group were treated accordingly except for the BC group. Rabbitss in the BC group were not mechanically ventilated, and the diaphragm was removed immediately after anesthetizing. Whole diaphragms of 5 rabbits per time point per other group were also collected after anesthesia at post treatment hour (PTH) 6 and on post treatment day (PTD) 1, 3, and 7. Diaphragm weight/body weight and diaphragm isometric contractile force of each group were measured. The pathological changes of diaphragmatic tissues were observed by HE staining. The protein expressions of Cyt c, RyR1, caspase-3, and p-mTORC1 were measured by Western blot. Repeated measures analysis of variance was used for the comparison between multiple groups of variables at different time points, and LSD- t test was used for the further comparison between two groups at the same time point, a P<0.05 was considered statistically significant. Results:Compared with the BC group, the VC group showed diaphragmatic pathological changes conformed to VIDD: DW/BW was decreased obviously; HE staining revealed obvious changes in diaphragmatic tissue; Diaphragmatic contractility was also significantly decreased; The expression of Cyt c and caspase-3 were increased while the expression of RyR1 and p-mTORC1 were decreased gradually with the extension of treatment time ( P<0.05). Compared the EDP+VC group with the VC group, with the extension of treatment time, DW, DW/BW, pathological damages and diaphragmatic contractility were improved [PTD 1: (0.80±0.05)kg vs (0.56±0.04) kg, PTD 3: (1.06±0.05) kg vs (0.47±0.03) kg, PTD 7: (1.24±0.10) kg vs (0.39±0.07) kg, all P<0.05; PTD 1: (2.05±0.54) vs (1.86±0.72), PTD 3: (2.19±0.61) vs (1.74±0.40), PTD 7: (2.46±0.62) vs (1.53±0.85), all P<0.05; PTD 1: (2.39±0.42) N/cm 2vs (1.91±0.25) N/cm 2, PTD 3: (2.57±0.62) N/cm 2vs (1.72±0.50) N/cm 2, PTD 7: (2.77±0.55) N/cm 2vs (1.54±0.33) N/cm 2, all P<0.05]. The expression of Cyt c and caspase-3 were decreased while the expression of RyR1 and p-mTORC1 were increased gradually in the EDP+VC group ( P<0.05). Conclusions:External diaphragm pacer plays a protective role in ventilator-induced diaphragm dysfunction, which can inhibit mitochondrial damage, reduce oxidative damage, and mitigate diaphragmatic atrophy and injury.