ObjectiveTo observe the clinical efficacy of acupuncture combined with bloodletting and cupping in the treatment of chronic spontaneous urticaria（CSU） and to explore its potential mechanisms of action. MethodsSeventy CSU patients were randomly divided into loratadine group and acupuncture + bloodletting group， with 35 patients in each group. The loratadine group received oral loratadine tablets， 10 mg once daily in the evening. The acupuncture + bloodletting group received acupuncture at Zhongwan （CV 12）， Guanyuan （CV 4）， Tianshu （ST 25）， Zusanli （ST 36）， Sanyinjiao （SP 6）， Xuehai （SP 10）， Quchi （LI 11）， Hegu （LI 4）， Taichong （LR 3）， Baihui （GV 20）， and Shenting （GV 24）， once daily，along with bloodletting and cupping at Dazhui （GV 14） and Geshu （BL 17）， every other day. Both groups were treated for 4 weeks. The 7-day urticaria activity score（UAS7） was assessed before and after the treatment， and levels of serum immunoglobulin E （IgE）， interleukin-4 （IL-4）， interleukin-5 （IL-5）， eosinophil cationic protein （ECP）， plasma tissue factor （TF）， activated factor Ⅶ （FⅦa）， prothrombin fragment 1+2 （F1+2）， D-dimer （D-D） and complement component 5a （C5a） were detected. ResultsA total of 65 patients were included in the final analysis， 32 in the loratadine group and 33 in the acupuncture + bloodletting group. Before treatment， there was no significant difference in UAS7 score， serum IgE， IL-4， IL-5， ECP levels， or plasma TF， FⅦa， F1+2， D-D， C5a levels between groups （P＞ 0.05）. After treatment， both groups showed significant reductions in UAS7 score， serum IgE， IL-4， IL-5， and plasma TF， FⅦa， F1+2， D-D， and C5a levels compared to those before treatment （P＜0.01）. However， after treatment， there was no significant difference in UAS7 score and serum ECP， IgE， IL-4， IL-5 levels between groups （P＞0.05）. The acupuncture + bloodletting group showed lower plasma TF， FⅦa， F1+2， D-D and C5a levels compared to the loratadine group （P＜0.05 or P＜0.01）. ConclusionAcupuncture combined with bloodletting and cupping can effectively improve the skin symptoms of CSU patients and reduce the levels of inflammatory factors. The potential mechanism of action may involve the regulation of the coagulation-complement-mast cell activation axis， thereby inhibiting mast cell degranulation.

BACKGROUND:Pravastatin is a clinically effective drug for the treatment of hypercholesterolemia and is now found to play a beneficial role in the treatment of CNS injury;however,the mechanism remains unknown. OBJECTIVE:To ascertain the possible mechanism of action and whether pravastatin medication can expedite functional recovery following sciatic nerve crush injury. METHODS:Male Sprague-Dawley rats were randomly assigned into:pravastatin(sciatic nerve crush injury+pravastatin gavage),negative control(sciatic nerve crush injury+saline gavage),and sham operation(sciatic nerve exposure but no injury+saline gavage).While the other two groups received comparable amounts of saline gavage,the pravastatin group received postoperative pravastatin(5 mg/kg)by gavage for 1 week.The general conditions of the rats in each group were observed after operation.Sciatic function index was evaluated at the end of the 2nd,4th,6th,and 8th week after operation,and the wet mass ratio of the gastrocnemius muscle was measured at the end of the 8th week after operation.The levels of inflammatory cytokines in serum were measured using ELISA.Histomorphometrics was used to measure the number of myelinated nerve fibers,fiber diameter,axon diameter,and myelin sheath thickness.RT-qPCR assay was used to measure the relative mRNA expression of nerve growth factor and brain-derived neurotrophic factor,and western blot was used to measure the protein expression of growth-associated protein 43. RESULTS AND CONCLUSION:Compared with the negative control group,the sciatic function index in the pravastatin group recovered faster(P<0.05)and was closer to the level of the sham operation group,the expression of tumor necrosis factor α and interleukin 6 in serum was lower(P<0.05)and close to that of the sham operation group,and the relative mRNA expression of nerve growth factor and brain-derived neurotrophic factor in the sciatic nerve increased(P<0.05 or P<0.01),the relative protein expression of growth-associated protein 43 in the sciatic nerve was also significantly increased(P<0.05),the number of myelinated nerve fibers was increased more,and the values of fiber diameter,axon diameter,and myelin sheath thickness were larger(P<0.01)and closer to those of the sham operation group.To conclude,treatment with pravastatin accelerates functional recovery from sciatic nerve crush injury by a possible mechanism of inhibiting the expression of tumor necrosis factor α and interleukin 6 and promoting the secretion of neurotrophic factors nerve growth factor and brain-derived neurotrophic factor.

Lumbar disc (LD) herniation and aging are prevalent conditions that can result in substantial morbidity. This study aimed to clarify the mechanisms connecting the LD aging and herniation, particularly focusing on cellular senescence and molecular alterations in the nucleus pulposus (NP). We performed a detailed analysis of NP samples from a diverse cohort, including individuals of varying ages and those with diagnosed LD herniation. Our methodology combined histological assessments with single-nucleus RNA sequencing to identify phenotypic and molecular changes related to NP aging and herniation. We discovered that cellular senescence and a decrease in nucleus pulposus progenitor cells (NPPCs) are central to both processes. Additionally, we found an age-related increase in NFAT1 expression that promotes NPPC senescence and contributes to both aging and herniation of LD. This research offers fresh insights into LD aging and its associated pathologies, potentially guiding the development of new therapeutic strategies to target the root causes of LD herniation and aging.
Intervertebral Disc Displacement/metabolism* ; Humans ; Aging/pathology* ; Nucleus Pulposus/pathology* ; Male ; Female ; Transcriptome ; Middle Aged ; Lumbar Vertebrae/pathology* ; Adult ; Cellular Senescence ; Stem Cells/pathology* ; Aged ; Intervertebral Disc Degeneration/metabolism*

Objective To analyze the prevalence,disease burden,and trends of diabetes in China from 1999 to 2019,providing reference for diabetes prevention and control as well as health resource allocation to alleviate the disease burden.Methods Data on the disease burden of diabetes in China from 1999 to 2019 were collected from the Global Burden of Disease(GBD)2019 database.Indicators such as incidence rate,prevalence rate,mortality rate,disability-adjusted life years(DALYs),years of life lost due to premature mortality(YLLs)and years lived with disability(YLDs)were used to analyze the diabetes burden in China by gender,age and year.The estimated annual percentage change(EAPC)was used to measure the temporal trend of standardized rates over a specified period,and the rank sum test was used to assess the gender differences in disease burden.Results In 2019,3.78×106 cases of diabetes and 1.73×105 deaths were reported in China.Compared with 1999,the standardized rates of incidence and prevalence increased by 5.80%and 17.12%,respectively,while the standardized mortality rate decreased by 2.82%.Compared with 1999,the standardized rates of DALYs and YLDs increased by 2.86%and 16.06%,respectively,while the standardized YLL rate decreased by 14.39%.The EAPC for diabetes incidence,prevalence,YLDs,and DALYs in the 20-40 age group all exceed 0,indicating an annually upward trend in disease burden of diabetes.Additionally,the disease burden in males was significantly higher than that in females(P＜0.05),and the gap is continuously widening.Conclusions The disease burden of diabetes in China is severe,particularly in term of life loss due to disability.The population with diabetes onset is becoming increasingly younger.Males constitute a high-risk population for diabetes-related morbidity and mortality.Diabetes prevention and control efforts should continue to enhance behavioral interventions,appropriately tilt health resource allocation towards high-risk population,and focus on improving the rehabilitation capabilities and promoting rehabilitation technology at grass-roots unit.

Objective To investigate the effect of transcutaneous electrical acupoint stimulation(TEAS)on emergence agitation(EA)in children undergoing selective posterior rhizotomy(SPR).Methods Forty-two children with cerebral palsy undergoing SPR were selected,20 males and 22 females,aged 6-12 years,BMI 13-24 kg/m2,ASA physical status Ⅰ or Ⅱ,randomly divided into two groups:TEAS group(group T)and control group(group C),21 children in each group.Children in group T re-ceived TEAS at the bilateral acupoints of Neiguan and Hegu from 30 minutes before anesthesia induction to the end of surgery.In group C,electrodes were placed on the same acupoints without electrical stimulation.All children in both groups received total intravenous anesthesia.HR and MAP were recorded at the time of entry,extubation,5,15,30 minutes after extubation.The consumption of remifentanil and propofol during the procedure were recorded.The time of operation and extubation were recorded.The Wong-Baker faces pain scale-revised(FPS-R)and the pediatric anesthesia emergence delirium(PAED)were recorded at 15 minutes after extubation,and the incidence of EA was assessed by PAED.While,the occurrence of post-operative nausea and vomiting(PONV)was recorded.Results Compared with that at the time of entry,HR at the time of extubation,5,15 minutes after extubation and MAP at the time of extubation,5,15,30 minutes after extubation in group C were significantly increased(P＜0.05),HR and MAP at the time of extubation,5,15 minutes after extubationin group T were significantly increased(P＜0.05).Compared with group C,HR was significantly slower and MAP was significantly lower in group T at the time of extuba-tion,5,15,30 minutes after extubation(P＜0.05).Compared with group C,the consumption of remifen-tanil during operation was reduced,the time of extubation was significantly shortened,the FPS-R and PAED were significantly decreased,and the incidence of EA were significantly reduced(P＜0.05).There were no significant differences in the time of operation,the consumption of propofol during operation and the inci-dence of PONV.Conclusion TEAS is beneficial to prevent the occurrence of EA in pediatric patients un-dergoing SPR,stabilize hemodynamics,reduce the dosage of opioids during surgery,reduce the postopera-tive pain,andaccelerate the time of anesthesia resuscitation.

Objective To compare the clinical efficacy of abdominal ultrasound-guided endoscopic retrograde appendicitis therapy(ERAT)with laparoscopic appendectomy(LA)for acute uncomplicated appendicitis using propensity score matching.Methods The clinical data of 441 patients with acute uncomplicated appendicitis admitted to the Third People's Hospital of Yunnan Province from March 2020 to April 2023 were collected.The cases were classified based on the differences in surgical method and divided into the ERAT group(n = 30)and LA group(n = 411).The clinical efficacy of patients was compared between the two groups after reducing confounding bias by propensity score matching(PSM).Results After PSM,a total of 30 pairs of patients in the two groups were successfully matched,and the baseline data of the two groups met the requirements for comparability.At 24 hours after the operation,the ERAT group exhibited lower white blood cells,neutrophil counts,and C-reactive protein levels compared to the LA group,and these differences were statistically significant(P<0.05).There was no significant difference in the operation time and total effective rate between the ERAT group and the LA group(P>0.05).However,the ERAT group had lower intraoperative blood loss and shorter pain relief time compared to the LA group,and these differences were statistically significant(P<0.05).Conclusion Abdominal ultrasound-guided endoscopic retrograde appendicitis treatment is an effective,safe,and feasible technique with good prospects for the treatment of acute uncomplicated appendicitis.

Objective:To explore the strategies and technical points for breast reconstruction using free lower abdominal skin flap transplantation through lateral chest incision.Methods:The data of patients who underwent unilateral breast reconstruction with free lower abdominal flap transplantation using lateral thoracic incision in Hunan Cancer Hospital from October 2022 to March 2023 were retrospectively analyzed. Lateral thoracic incision was used in the recipient area. Firstly suitable radical mastectomy was performed for patients with early onset of breast cancer or recurrence after breast-conserving surgery, and prosthetic dilator removal or breast capsule release was performed for patients with dilator removed or capsular contracture after breast cancer prosthesis reconstruction. After that, the free lower abdominal skin flap breast reconstruction was completed under the same incision. During the operation, blood vessel preparation in the recipient area, skin flap preparation in the donor area, blood vessel anastomosis and breast shaping were completed successively according to the actual situation of the patient. Postoperative observation of complications, follow-up evaluation of reconstructed breast appearance and donor site healing were carred out.Results:A total of 15 female patients were included, aged range from 24 to 57 years old, with an average of 42.3 years old. There were 9 cases of early breast cancer, 2 cases of breast cancer recurrence after breast conserving surgery, 2 cases of breast cancer with dilator removed after breast reconstruction, and 2 cases of capsule contracture after breast cancer prosthesis reconstruction. The length of the lateral chest incision was 7.5-11.2 cm, with an average of 8.7 cm. Six cases were performed with 3/4 of the lower abdominal skin flaps, using a unilateral inferior abdominal vascular pedicle. The volume of the flaps ranged from 19.0 cm × 10.0 cm × 4.5 cm to 23.0 cm × 13.0 cm × 6.0 cm. The weight ranged from 280 to 510 g, with an average of 370 g. Nine cases were performed by cutting the entire lower abdominal skin flap and using bilateral inferior abdominal vascular pedicle. The volume of the skin flaps ranged from 27.0 cm × 11.0 cm × 5.0 cm to 30.0 cm × 14.0 cm × 6.5 cm. The weight ranged from 420 to 730 g, with an average of 530 g. Nine cases were selected as the main trunk of the thoracic and dorsal blood vessels, 4 cases were selected as the anterior serratus branch of the thoracic and dorsal blood vessels, and 2 cases were selected as the main trunk of the thoracic and dorsal blood vessels combined with the anterior serratus branch. One flap experienced venous crisis and the surgery failed, while the remaining 14 flaps survived smoothly. Follow-up period was 6-17 months, with an average of 10.4 months. The reconstructed breast had a satisfactory appearance and texture, without skin flap contraction or deformation. The skin flap donor area and breast recipient area only had linear scars, and there was no significant impact on abdominal wall and shoulder joint function. There was no tumor recurrence or metastasis during follow-up.Conclusion:When the side chest incision is used to perform the related operations of breast cancer radical resection, the free lower abdominal skin flap can be transplanted into the same incision for breast reconstruction. The effect is satisfactory, and the damage of the affected area is further reduced.

Objective:To explore the clinical value and therapeutic effects of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction using an oblique pedicled rectus abdominis myocutaneous flap(ORAMF).Methods:The data of patients admitted to Hunan Cancer Hospital from May to September 2023 who underwent breast cancer resection followed by immediate breast reconstruction with ORAMF were analyzed retrospectively. Surgical methods: firstly, axillary anterior sentinel lymph node biopsy and subcutaneous glandular excision for breast cancer were performed through a lateral chest incision using an endoscopic technique. Subsequently, a unilateral ORAMF was prepared by removing the epidermis and creating subcutaneous tunnels on the surface of the rectus abdominis myocutaneous flap under direct visualization. The subcutaneous tunnel of the flap was then extended to the deep surface of the breast with the assistance of an endoscope, allowing for the transfer of the ORAMF to reconstruct the breast. Post surgery, the flap survival was monitored, and after discharge, patients received enhanced anti-scar treatment and functional rehabilitation exercises. Follow-up assessments included the evaluation of the reconstructed breast shape, incision scarring in both the donor and recipient areas, abdominal wall function, tumor recurrence and metastasis.Results:A total of 8 female patients with unilateral breast cancer were included in this study, aged between 27 and 52 years, with a mean age of 41.7 years old. The body mass index of the patients ranged from 19.1 to 22.5 kg/m 2. All patients had early-stage breast cancer. During the operation the average mass of the resected breast was 245 g(ranging from 220 to 285 g). The length of the lateral thoracotomy incision varied from 6.9 to 9.5 cm, with a mean length of 7.7 cm. In 3 cases, the ipsilateral ORAMF was used for breast reconstruction, while in 5 cases, the contralateral ORAMF was utilized. The dimensions of the flap were as follows: length (20.4±0.7) cm, width (10.8±1.5) cm, thickness (5.4±0.9) cm, with the volume of the flap cutting ranging from 19.7 cm×9.2 cm×4.4 cm to 21.2 cm×11.8 cm×5.9 cm. All of the flaps exhibited good blood supply and survived successfully without the need for additional anastomotic vessels. The patients were followed up for a period of 8 to 10 months post-operation, with an average follow-up of 8.7 months. The reconstructed breasts maintained a good shape and texture, showing no contracture or deformation of the flap, and were generally symmetrical with the healthy breast. The incisions in both the flap donor area and the recipient area had healed well, leaving only linear scars, and the function of the abdominal wall was not significantly compromised. No recurrence or metastasis was observed during the follow-up period. Conclusion:The endoscopic technique helps to preserve the integrity of the breast skin tissue to the greatest extent possible, reducing scarring and assisting in the creation of subcutaneous tunnels to facilitate the transposition of the ORAMF for breast reconstruction. For carefully selected patients with moderately small breasts and ample subcutaneous tissue in the lower abdomen, the preparation of a unilateral ORAMF for breast reconstruction can yield superior results. This approach minimizes additional damage to the donor area, enhancing the safety of the surgery while significantly reducing the complexity of the operation.

BACKGROUND:Some patients with cervical spondylosis have not been fully corrected sagittal position balance after cervical surgery,and this continuous sagittal position imbalance may be an important reason for the poor long-term clinical outcome of patients. OBJECTIVE:To analyze the correlation between the cervical sagittal position balance parameters and their changes and the clinical efficacy of patients in the unbalanced state after anterior cervical decompression and fusion and to explore the necessity of surgical correction of sagittal balance in order to improve the clinical effect in the later stage. METHODS:A retrospective analysis was performed on 125 patients with cervical spondylosis who underwent anterior cervical decompression and fusion in the Department of Spinal Surgery of Affiliated Hospital of Southwest Medical University from July 2019 to July 2022.Follow-up patients had good postoperative recovery(neck disability index score less than 10%one week after surgery)and had complete follow-up data.According to the axial vertical distance(C2-7 SVA)in sagittal position one week after surgery,patients were divided into type I imbalance group(C2-7 SVA loss≤5 mm,n=27),type Ⅱ imbalance group(C2-7 SVA loss>5 mm,and≤10 mm,n=19),and type Ⅲ imbalance group(C2-7 SVA loss>10 mm,n=12),and non-unbalanced group(C2-7 SVA in the normal range,n=67).The changes of visual analog scale score and neck disability index were compared among groups postoperatively and the last follow-up,as well as the changes of imaging sagittal balance parameters C2-7 cobb angle,C2-7 SVA value,neck inclination angle,T1 inclination angle,and thoracic entrance angle.The correlation between the late clinical effect and postoperative cervical sagittal disequilibrium was explored. RESULTS AND CONCLUSION:(1)There was no statistical difference in general data among the four groups(P>0.05).All patients underwent successful surgery without serious complications and postoperative wound infection.The follow-up time was more than 1 year.(2)There was no significant difference in preoperative symptom score and clinical efficacy one week after surgery(P>0.05).At the last follow-up,pain visual analog scale score,neck disability index and C2-7 SVA were lower than those before surgery but higher than those one week after surgery(P<0.05).C2-7 cobb angle was increased compared with those before operation(P<0.05).T1 inclination angle was decreased compared with those before operation(P<0.05).(3)Pearson correlation test showed that the change of neck disability index was positively correlated with the change of C2-7 SVA(P<0.05).(4)It is indicated that anterior cervical decompression and fusion is effective in the treatment of cervical spondylosis,and can effectively relieve the symptoms of patients.Patients with more severe cervical sagittal disequilibrium after surgery had worse curative effect in the later period.Continuous sagittal disequilibrium in patients with cervical spondylosis after surgery is an important cause of poor curative effect in the later stage.Clinicians should pay more attention to the correction of cervical sagittal balance before and during surgery,formulate surgical strategies and plans according to sagittal balance parameters before surgery,and correct C2-7 SVA intraoperatively to the normal range.