OBJECTIVE: To observe the effect of electroacupuncture combined with enhanced recovery after surgery (ERAS) protocol on promoting intestinal function in patients after gastric cancer surgery. METHODS: Forty-four patients who underwent radical gastrectomy for gastric cancer were randomly divided into an experimental group (22 cases, 3 cases were excluded) and a control group (22 cases, 4 cases were excluded). Both groups received treatment under ERAS protocol, the experimental group was given electroacupuncture at bilateral Neiguan (PC6), Hegu (LI4), Zusanli (ST36) and Quchi (LI11), disperse-dense wave was selected, with frequency of 2 Hz/100 Hz. The control group received placebo electroacupuncture intervention, with the same acupoints as the experimental group, electrode pads were placed on the acupoints without electrical stimulation. Each session lasted 30 min, starting from 1 h after surgery, once every 24 h, until the patient resumed anal flatus. The intestinal sound rate of both groups was observed 24 h before surgery and 24, 48 h after surgery. The bowel sound recovery time (BSRT), time to first anal flatus, time to first defecation, and tolerance to oral enteral nutrition suspension were compared between the two groups. The levels of serum C-reactive protein (CRP), interleukin (IL)-2, IL-4, IL-6, IL-10, IL-12, IL-17, tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were measured 24 h before surgery and 24 h after surgery in both groups. RESULTS: The intestinal sound rate 24 h after surgery was decreased compared with that 24 h before surgery in the two groups (P<0.05), the intestinal sound rate 24, 48 h after surgery in the experimental group was higher than that in the control group (P<0.05). The BSRT in the experimental group was earlier than that in the control group (P<0.05) .The levels of serum CRP, IL-6, IL-10 24 h after surgery in the experimental group were higher than those 24 h before surgery (P<0.05), while the levels of serum CRP, IL-4, IL-6, IL-10, IFN-γ in the control group were higher than those 24 h before surgery (P<0.05); the levels of serum CRP、IL-4、IFN-γ 24 h after surgery in the experimental group were lower than those in the control group (P<0.05) .The tolerance rate of oral enteral nutrition suspension in the experimental group was 84.2% (16/19), which was higher than 50.0% (9/18) in the control group (P<0.05). CONCLUSION Electroacupuncture combined with ERAS protocol can improve the intestinal motility, shorten the BSRT, enhance the tolerance of oral intake, and reduce inflammatory response in patients after gastric cancer surgery.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Acupuncture Points ; C-Reactive Protein/metabolism* ; Electroacupuncture ; Gastrectomy ; Interleukin-10 ; Interleukin-6 ; Intestines/physiopathology* ; Stomach Neoplasms/therapy*

BACKGROUND:Bone grafting is one of the important steps in the treatment of thoracolumbar burst fractures.Because the fracture involves the spinal canal or is accompanied by spinal cord nerve damage,severe fracture bleeding and other factors,minimally invasive bone grafting for thoracolumbar burst fractures is restricted.At present,the minimally invasive treatment of thoracolumbar burst fractures is limited to percutaneous screw fixation under the tunnel.Minimally invasive percutaneous bone grafting of injured vertebrae is rarely reported,and percutaneous precise bone grafting under the endplate has not yet been reported. OBJECTIVE:To investigate the clinical effect of subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fractures. METHODS:From June 2017 to December 2021,90 patients with A3+B2 type asymptomatic thoracolumbar burst fracture were randomly divided into 3 groups according to admission time.In group A,33 patients received the bone graft funnel accurately placed through the pedicle channel by percutaneous puncture under C-arm fluoroscopy,bone graft support reduction under the fracture endplate,percutaneous pedicle screw fixation.In group B,30 patients received multifissure intermuscular approach through pedicle bone graft support reduction combined with pedicle screw fixation.In group C,27 patients received percutaneous pedicle screw short-segment fixation under postural reduction.All patients were followed up for at least 18 months after surgery.The clinical data of the three groups,including preoperative,postoperative and last follow-up Cobb angle,anterior edge height ratio and visual analog scale pain score,were compared and analyzed. RESULTS AND CONCLUSION:(1)There were no significant differences in age,sex,injury segment and causative factors among the three groups(P>0.05).(2)All patients at follow-up had no neurological impairment,no obvious lumbar posterior deformity or intractable low back pain.(3)The operation time of group C was less than that of group A and group B(P<0.05).Intraoperative blood loss was less in group A and group C than in group B(P<0.05).(4)There were no significant differences in the anterior edge height ratio and Cobb angle among the three groups(P>0.05).Postoperative data in groups A and B were better than that in group C.At last follow-up,group A and group B outperformed group C(P<0.05).The height and Cobb angle of the vertebral body lost in the three groups were smaller in groups A and B than those in group C(P<0.05).(5)Visual analog scale pain score was better in groups A and C than that in group B after surgery(P<0.05).There was no significant difference in visual analog scale pain score among the three groups at last follow-up(P>0.05).(6)In group C,there was one case of loose internal fixation and displacement in 1 month after surgery,and the vertebral height was lost again with back pain,and after strict bed rest for 6 weeks,the vertebral height loss was not aggravated,the pain was relieved,and the internal fixation was removed after 1 year,and the height loss at the last follow-up was not aggravated.There were no cases of failure of internal fixation in groups A and B.(7)It is indicated that subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fracture has the advantages of less trauma,less bleeding and light postoperative pain symptoms,and the effect of injury vertebral reduction and height maintenance is the same as the reduction through pedicle bone grafting support and short segment fixation with pedicle screws through the multifidus space approach.

Objective: To investigate the molecular mechanism and identify potential drugs for subthreshold depression (SD), and elucidate the detalied mechanism of Danzhi Xiaoyao powder (DZXY) in SD. Methods: Using RNA-sequencing, we identified differentially expressed genes (DEGs) in leukocytes of SD compared to healthy controls, deciphered their functions and pathways, and identified the hub genes of SD. We also assessed changes in leukocyte transcription factor activity in patients with SD using the TELiS platform. The Connectivity Map database was retrieved to screen candidate drugs for SD. Based on network pharmacology, we elucidated the “multi-component, multi-target, and multi-pathway” mechanism of DZXY in the treatment of SD. Results: We identified 1080 DEGs (padj <0.05 and |log2 (fold change)| ≥ 1 & protein coding) in the leukocytes of patients with SD. These DEGs, including hub genes, were primarily involved in immune and inflammatory response-related processes. Transcription factor activity analysis revealed similarities between the leukocyte transcriptome profile in SD and the conserved transcriptional response to adversities in immune cells. Connectivity Map analysis identified 28 potential drugs for SD treatment, particularly SB-202190 and TWS-119. Constructing the “Direct Compounds-Direct Targets-Pathways” network for DZXY and SD revealed the curative mechanisms of DZXY in SD, primarily including inflammatory response, lipid metabolism, immune response, and other processes. Conclusion These results provide new insights into the characteristics and functional changes of leukocytes in SD, partially illustrate the pathogenesis of SD, and suggest potential drugs for SD. The curative mechanisms of DZXY in SD are also partially elucidated.

Objective To assess the elderly health-related rehabilitation services(HRRS)needs from a community and population perspective and construct a community-based elderly HRRS framework. Methods The limitation of the elderly HRRS was analyzed,a community-based elderly rehabilitation service framework based on the International Classification of Functioning,Disability,and Health(ICF)was guided,and the imple-mentation path was proposed. Results This paper analyzed the evaluation,provision and models of existing community rehabilitation services both do-mestically and internationally.It combined the background and practical requirements of China's new era to eluci-date the connotation of HRRS for the elderly in the community.It proposed constructing a community-based el-derly HRRS framework guided by ICF.The paper also offered implementation strategies for promoting communi-ty-based elderly HRRS,focusing on enhancing leadership and policy,financing,human resources,service provi-sion,technology,and digital intelligence empowerment.It provided reference and insights for advancing the na-tional strategy of population aging and implementing the Healthy China strategy. Conclusion It is suggested to continue to accelerate the development of rehabilitation capacity,and increase the supply of HRRS,to meet the diverse needs of the masses of HRRS.

Objective To analyze the clinical and imaging features of hemichorea associated with non-ketotic hyperglycemia(HC-NH)and to explore the perfusion of cerebral blood flow in the patients.Methods A retrospective study was conducted on 23 HC-NH patients diagnosed in Henan Provincial People's Hospital from January 2018 to December 2023.The clinical manifesta-tions,imaging features and prognosis were collected and analyzed,and the correlation with cere-bral blood flow hypoperfusion was investigated.Results The symptoms were all lateral involun-tary movements,of which 4 cases presented only single upper limb(1 case was left upper limb,the other 3 cases were right upper limb),and 19 cases had both upper and lower limbs involved(10 cases were left limb,and 9 cases were right limb).After the onset of the symptoms,the blood glucose level was 19.72±4.72 mmol/L,glycated hemoglobin level was(13.60±3.68)％,but all of patients were negative to urine ketone bodies.Hyperdense lesions in the contralateral basal ganglia region on CT images were observed in 6 cases.Strip or patchy hyperintensity was seen on T1-weighted MR images.All patients had ipsilateral stenosis of the vessels and regional hypoperfu-sion of cerebral blood flow as shown by MR perfusion-weighted imaging.All symptoms were re-lieved after actively controlling blood glucose,improving blood circulation,and symptomatic man-agement.Conclusion HC-NH is quite rare in clinical practice,and its occurrence may be related to cerebral blood flow hypoperfusion triggered by basal nucleus degeneration.

Objective To investigate the efficacy and safety of Xihuang capsules as an adjuvant treatment for metastatic colorectal cancer and their impact on immune function. Methods A retrospective analysis was conducted on clinical data from 112 patients diagnosed with metastatic colorectal cancer. The patients were categorized into two groups: a control group (n=56) that did not take Xihuang capsules and an observation group (n=56) that did. The efficacy, improvement of quality of life, toxic and side effects and immune function of the two groups were analyzed and compared. Results After treatment, the disease control rate (DCR) and the rate of improvement in quality of life were significantly higher in the observation group compared to the control group. Additionally, levels of carcinoembryonic antigen (CEA) and the incidence of adverse reactions, including bone marrow suppression and liver and kidney function damage, were significantly lower in the observation group. Furthermore, the percentages of CD4⁺ and CD8⁺ T cells, the CD8⁺/CD4⁺ T cells ratio, as well as serum levels of high mobility group box-1 (HMGB1) and interleukin 2 (IL-2) in observation group were significantly elevated compared to pre-treatment levels. Subgroup analysis revealed that patients with a Karnofsky Performance Status (KPS) score ≤80, a high CD8⁺/CD4⁺ T cells ratio, and elevated HMGB1 levels experienced a significantly higher objective response rate (ORR) in the observation group. Conversely, patients with stage IVB disease, who had KPS score ≤80, a low CD8⁺/CD4⁺ T cells ratio and high CEA and IL-2 levels demonstrated a more pronounced DCR in the observation group. Conclusion Xihuang capsules exhibit promising clinical efficacy as an adjuvant treatment for advanced colorectal cancer. They not only enhance patients' quality of life and reduce the toxic and adverse effects of chemotherapy, but also improve immune function. These benefits are particularly significant in patients with a high tumor burden, indicating that Xihuang capsules are worthy of clinical application.
Humans ; Colorectal Neoplasms/immunology* ; Male ; Female ; Middle Aged ; Drugs, Chinese Herbal/adverse effects* ; Capsules ; Aged ; Carcinoembryonic Antigen/blood* ; Retrospective Studies ; Quality of Life ; Adult ; Neoplasm Metastasis ; Interleukin-2/blood* ; HMGB1 Protein/blood* ; Chemotherapy, Adjuvant

Objective:To investigate the effects of insulin glargine administration by jet injection versus conventional insulin pen on glucose profile using professional mode flash glucose monitoring(FGM) system in type 2 diabetic patients with poor glucose control.Methods:In this randomized, controlled, crossover study, 40 patients with T2DM who treated with insulin glargine were enrolled. The patients were randomly divided into group A(jet injector-conventional pen, n=20) and group B(conventional pen-jet injector, n=20). Each patient wore FreeStyle Libre sensor from day 4 to day 17. The specialist nurse instructed patients how to master the injection techniques. Professional FGM system was applied to assess glucose profile. Results:The fasting blood glucose(FBG) of the enrolled patients was(9.37±1.84) mmol/L. In contrast to conventional insulin pen, treatment with the jet injector significantly decreased the 24h MBG [(9.06±2.13 vs 9.98±2.67) mmol/L, P=0.001], MaxBG [(16.69±3.01 vs 17.95±3.48) mmol/L, P=0.001], AUC>10 mmol/L [95.93(21.12, 129.02) vs 142.66( 27.88, 198.46), P=0.002], TAR(31.10±21.89 vs 39.49±25.93, P=0.003), MAGE and SDBG. It was observed that patients using jet injector had significant increased TIR(65.94±20.47 vs 58.32±25.00, P=0.001). There were no difference in the risk of hypoglycaemia between two groups. Conclusion:Insulin jet injector was more effective than the insulin pen on glycaemic control and glucose fluctuation without increasing the risk of hypoglycemia in type 2 diabetic patients with uncontrolled glycemia.

Objective:To investigate the clinical and imaging characteristics of central pontine myelinolysis (CPM) without hyponatremia and explore its pathogenesis.Methods:A retrospective analysis was performed. Six CPM patients without hyponatremia, admitted to Department of Neurology, He'nan Provincial People's Hospital from March 2021 to March 2023 were chosen. Demographic information, causes, medical history, clinical presentations, and MRI features at onset, and 1 and 3 months after onset were analyzed. The prognoses were evaluated by modified Rankin Scale (mRS) scores 3 months after onset: mRS scores≤2 was classified as good prognosis, and mRS scores>2 as poor prognosis.Results:In these 6 CPM patients without hyponatremia, 4 were males and 2 females; 4 patients had dizziness, 3 headache, 4 limb weakness, 2 cognitive decline, and 2 slow reaction. Four CPM patients had a history of hypertension, 5 had a history of diabetes, and 1 had a history of alcoholic cirrhosis. Hormone therapy, nutritional support and symptomatic treatment were given; 5 patients had obvious improvement, and 1 had poor prognosis 3 months after onset. MRI showed asymmetrical abnormal signal in the basal pons and bilateral brachium pontis, with T1WI hypointensity, T2WI hyperintensity, T2-FLAIR hyperintensity, DWI hyperintensity and clear boundary, and without obvious mass effect or enhancement. DWI sequence enjoyed good diagnostic sensitivity in early stage of CPM: high signal changes could occur within 24 h of clinical symptoms, and isointensity 3 months after onset.Conclusion:Causes of CPM without hyponatremia are mostly hypokalemia, diabetes, malnutrition, and chronic alcoholism; its characteristic MRI manifestations are "pig nose sign", "bat wing sign" and "trident sign".

Objective:To investigate the effectiveness of probe-based near-infrared autofluorescence imaging (NIRAF) of the parathyroid gland.Methods:A total of 71 patients with thyroid cancer eligible for admission from May 4, 2023 to May 26, 2023 were selected, including 42 patients with thyroid cancer enrolled in the Department of Thyroid (hernia), Department of General Surgery, PLA General Hospital, including 29 females and 13 males, with a median age of 41 years, ranging from 21 to 76 years. A total of 29 patients with thyroid cancer were enrolled in the Department of Thyroid Surgery of Guangzhou First People’s Hospital, including 22 females and 7 males. The median age was 42.5 years, ranging from 24 to 72 years. The follow-up period was 1 month.Results:Among them, 196 suspicious parathyroid tissues were identified by the naked eye, and 207 suspicious parathyroid tissues were identified by probe NIRAF technology. Naked eye identification sensitivity, specificity and accuracy were 84.86%, 56% and 81.89%. The sensitivity, specificity and accuracy of parathyroid tissue identification by probe NIRAF were 92.66%, 80.00% and 90.53%, which were better than that of naked eye identification, and had a good coincidence rate with the results of immunocolloidal gold test or intraoperative freezing pathology (Kappa=0.61, P<0.001) . Conclusion:The probe-based NIRAF technique has a good ability to identify parathyroid tissue.

Objective:To investigate the relationship between serum glial cell line-derived neurotrophic factor (GDNF) levels and neuroimaging changes and cognitive impairment in patients with cerebral small vascular disease (CSVD).Methods:135 patients with CSVD recruited from the Department of Neurology of the First Affiliated Hospital of Xinxiang Medical University from September 2021 to July 2022 were assessed by cranial multimodal magnetic resonance imaging and Montreal cognitive function assessment (MoCA), and the basic data were analyzed at the same time.The serum GDNF concentration of all patients was detected by enzyme-linked immunosorbent assay (ELISA). According to the median GDNF concentration, the patients were divided into low GDNF group and high GDNF group. The baseline data, MoCA score and imaging markers of the two groups were compared by Mann-Whitney U test, chi-square test, logistic regression, Kruskal-Wallis H test and Jonckheere-Terpstra trend test, and the correlation between serum GDNF level and imaging markers and cognitive function of patients with CSVD was analyzed. Results:The median serum GDNF concentration of all CSVD patients was 16.66 pg/mL. Multivariate logistic regression analysis showed that low serum GDNF level was a risk factor for white matter hyperintensity and total image load in patients with CSVD. Serum GDNF level was a protective factor of cognitive impairment in patients with CSVD in multiple logistic regression analysis. The area under the curve of ROC curve analysis of cognitive impairment after CSVD predicted by serum GDNF level was 0.735, the sensitivity was 66.4%, and the specificity was 71.4%. The level of serum GDNF was positively related with visual space and executive function, attention and computational power, delayed recall and orientation( r=0.267, 0.187, 0.219, 0.215, all P<0.05). Conclusion:The serum GDNF level is related to white matter hyperintensities, total imaging load and cognitive impairment in patients with CSVD. Serum GDNF level may play a predictive role in CSVD and cognitive impairment.