BACKGROUND:Acupuncture is an effective method for lumbar pain in lumbar disc herniation,but its mechanism has not yet been clarified.Factors related to the JAK2/STAT3 signaling pathway regulate the body's inflammatory response and are involved in the process of neuropathic pain. OBJECTIVE:To study the mechanism of acupuncture on lumbar disc herniation in a rat model based on the JAK2/STAT3 signaling pathway. METHODS:Forty Sprague-Dawley rats were randomly divided into four groups:sham operation group,model group,acupuncture group,and acupuncture+agonist group,with 10 rats in each group.Animal models of L5 lumbar disc herniation was constructed through autologous disc cell transplantation in the model group,acupuncture group,and acupuncture+agonist group.Rats in the acupuncture group and the acupuncture+agonist group received acupuncture treatment(Yanglingquan,Shenshu,Huantiao,and Dachangshu acupoints)at 3 days after modeling,and acupuncture treatment was given once a day,20 minutes each,for 15 consecutive days.Rats in the acupuncture+agonist group were injected intrathecally with coumermycin A1,a JAK2 agonist,into the L4/L5 intervertebral space,once a day,20 minutes each,prior to the acupuncture at 6,12,and 18 days after modeling.Paw withdrawal mechanical threshold was detected before and 3,6,9,12,15,and 18 days after modeling.At 18 days after modeling,serum inflammatory factor levels were detected,hematoxylin-eosin staining was performed to observe the morphology of L5-L6 tissues,RT-PCR was performed to detect the expression of JAK2 and STAT3 mRNAs in L5-L6 tissues,and western blot was performed to detect the expression of JAK2,p-JAK2 and p-STAT3 proteins in L5-L6 tissues. RESULTS AND CONCLUSION:The paw withdrawal mechanical thresholds of rats in the model group at different time points after modeling were lower than those in the sham operation group(P<0.05),the paw withdrawal mechanical thresholds of rats in the acupuncture group were higher than those in the model group at 9,12,15,and 18 days after modeling(P<0.05),and the paw withdrawal mechanical thresholds of rats in the acupuncture+agonist group were lower than those in the acupuncture group at 9,12,15,and 18 days after modeling(P<0.05).The levels of interleukin 6,tumor necrosis factor α,neurotransmitter substance P,and brain neuropeptide Y were elevated in the model group compared with the sham operation group(P<0.05);the levels of all four inflammatory factors were reduced in the acupuncture group compared with the model group(P<0.05);and the levels of all four inflammatory factors were elevated in the acupuncture+agonist group compared with the acupuncture group(P<0.05).Hematoxylin-eosin staining showed that lumbar degeneration was obvious in the model group but reduced in the acupuncture group and the acupuncture+agonist group.Moreover,the reduction was more obvious in the acupuncture group compared with the acupuncture+agonist group.The JAK2 and STAT3 mRNA expression as well as the p-JAK2 and p-STAT3 protein expression were elevated in the model group compared with the sham operation group(P<0.05),were decreased in the acupuncture group compared with the model group(P<0.05),and were increased in the acupuncture+agonist group compared with the acupuncture group(P<0.05).To conclude,acupuncture can alleviate inflammation to exert analgesic effects in the rat model of lumbar disc herniation,and its mechanism of action may be related to the inhibition of the JAK2/STAT3 signaling pathway.

Objective:To explore the application value of Jiedu Jiangtang Futan Decoction combined with acupuncture and moxibustion in the treatment of acute cerebral infarction patients with diabetes(qi deficiency and blood stasis type).Methods:All pa-tients with acute cerebral infarction complicated with diabetes(type of qi deficiency and blood stasis)were treated in Hongdu Tradi-tional Chinese Medicine Hospital from October 2020 to September 2022 and randomly divided into two groups,with 69 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with Jiedu Jiangtang Futan Decoction and acupuncture and moxibustion,and the efficacy was compared after two weeks of treatment.Results:Compared with before treatment,the serum levels of superoxide dismutase(SOD),vascular endothelial growth factor(VEGF)and brain-derived neurotrophic factor(BDNF)were increased in the two groups after treatment.The levels of serum matrix metalloproteinase-9(MMP-9),IL-6,fasting blood glucose(FBG),2-hour postprandial glucose(2 h PG)and glycated hemoglobin(HbA1c)were decreased.The Barthel index(BI)was increased,and the modified Rankin score(mRS)and National Institutes of Health Stroke Scale(NIHSS)were decreased(P<0.05).Compared with the control group,the levels of SOD,VEGF,BDNF and other indicators in the observation group were higher after treatment.The levels of MMP-9,IL-6,FBG,2 h PG and HbA1c were lower.BI was higher,mRS and NIHSS were lower,the difference were statistically significant(P<0.05).The total effective rate in the observation group was 94.20%(65/69),higher than 84.06%(58/69)in the control group(P<0.05).Conclusion:For patients with acute cerebral infarction complicated with diabetes(type of qi deficiency and blood stasis),the combination of Jiedu Jiangtang Futan Decoction and acupuncture and moxi-bustion treatment is helpful to promote blood supply to the brain,correct the imbalance of oxidative stress,regulate blood sugar level and improve clinical efficacy.

Objective To explore the application value of Kaiqiao Xingshen acupuncture combined with Buyang Huanwu decoction in the treatment of patients with cerebral hemorrhage in the recovery period(Qi defi-ciency and blood stasis syndrome),and to observe its impact on inflammatory indicators and neurokines.Method A total of 166 patients with cerebral hemorrhage in the recovery period(Qi deficiency and blood stasis syndrome)treated in Hongdu Traditional Chinese Medicine Hospital from September 2021 to October 2023,were randomly divided into control group(83 cases treated with conventional western medicine),and observation group(83 cases treated with a combination of Kaiqiao Xingshen acupuncture and Buyang Huanwu decoction).The therapeutic effect in the two groups was compared after 8 weeks of treatment.Results After treatment,the serum levels of matrix metalloproteinase-9(MMP-9),endothelin-1(ET-1),interleukin-2(IL-2),homocysteine(Hcy),and Bcl-2-associated X protein(bax)decreased in both groups,while brain-derived neurotrophic factor(BDNF)increased,and the improvement was more significant in the observation group,showing statistical significance(P<0.05);the average cerebral vascular flow and flow velocity in the observation group increased,while peripheral vascular resistance decreased,and the improvement in the observation group was more significant(P<0.05);the total symptom score of traditional Chinese medicine in the observation group decreased,while the Fuel Meyer functional score(FMA score)increased,and the improvement in the observation group was more significant(P<0.05);The total effective rate of the observation group was 93.98%(78/83),which was higher than that of the control group(80.72%,67/83)(P<0.05).Conclusion For patients with cerebral hemorrhage in the recovery period(Qi deficiency and blood stasis syndrome),Kaiqiao Xingshen acupuncture and Buyang Huanwu decoction help alleviate inflammatory reactions,promote the recovery of the blood-brain barrier,improve cerebral blood flow,promote neurological function recovery,and enhance clinical efficacy.

Objective To evaluate the analgesic effect and diaphragmatic paralysis of different concentrations of ropivacaine on brachial plexus superior trunk block(STB)in shoulder arthroscopic surgery under general anesthesia.Methods Fifty-seven patients with right rotator cuff injury who underwent shoulder arthroscopic surgery in Lihuili Hospital Affiliated to Ningbo University were selected.According to the random number table method,the patients were divided into three Groups:group L(0.25％ropivacaine,19 cases),group M(0.375％ropivacaine,18 cases)and group H(0.5％ropivacaine,20 cases).The duration of nerve block,diaphragmatic paralysis,handgrip strength and visual analogue scale(VAS)score were compared among three groups.Results There were no significant differences in hemodynamics,postoperative extubation time,dosage of propofol and remifentanil among three groups(P＞0.05).The duration of nerve block in group L was significantly shorter than that in group M and group H(P＜0.001).At 12 hours after operation,the VAS score of group L was significantly higher than that of group M and group H(P＜0.01).At 30 minutes after operation,the resting state and forced breathing diaphragm mobility in group L and group M were significantly better than those in group H(P＜0.05),and the incidence of partial diaphragm paralysis in group L and group M was significantly lower than that in group H(P＜0.05).At 30 minutes after operation,the handgrip strength of group H was significantly lower than that of group L and group M(P＜0.05).Conclusion 10ml 0.375％ropivacaine not only has a good analgesic effect,but also reduces the probability of partial diaphragm paralysis and muscle weakness,which is a safe and comfortable administration regimen.

Objective:To explore the application value of Jiedu Jiangtang Futan Decoction combined with acupuncture and moxibustion in the treatment of acute cerebral infarction patients with diabetes(qi deficiency and blood stasis type).Methods:All pa-tients with acute cerebral infarction complicated with diabetes(type of qi deficiency and blood stasis)were treated in Hongdu Tradi-tional Chinese Medicine Hospital from October 2020 to September 2022 and randomly divided into two groups,with 69 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with Jiedu Jiangtang Futan Decoction and acupuncture and moxibustion,and the efficacy was compared after two weeks of treatment.Results:Compared with before treatment,the serum levels of superoxide dismutase(SOD),vascular endothelial growth factor(VEGF)and brain-derived neurotrophic factor(BDNF)were increased in the two groups after treatment.The levels of serum matrix metalloproteinase-9(MMP-9),IL-6,fasting blood glucose(FBG),2-hour postprandial glucose(2 h PG)and glycated hemoglobin(HbA1c)were decreased.The Barthel index(BI)was increased,and the modified Rankin score(mRS)and National Institutes of Health Stroke Scale(NIHSS)were decreased(P<0.05).Compared with the control group,the levels of SOD,VEGF,BDNF and other indicators in the observation group were higher after treatment.The levels of MMP-9,IL-6,FBG,2 h PG and HbA1c were lower.BI was higher,mRS and NIHSS were lower,the difference were statistically significant(P<0.05).The total effective rate in the observation group was 94.20%(65/69),higher than 84.06%(58/69)in the control group(P<0.05).Conclusion:For patients with acute cerebral infarction complicated with diabetes(type of qi deficiency and blood stasis),the combination of Jiedu Jiangtang Futan Decoction and acupuncture and moxi-bustion treatment is helpful to promote blood supply to the brain,correct the imbalance of oxidative stress,regulate blood sugar level and improve clinical efficacy.

Objective To evaluate the analgesic effect and diaphragmatic paralysis of different concentrations of ropivacaine on brachial plexus superior trunk block(STB)in shoulder arthroscopic surgery under general anesthesia.Methods Fifty-seven patients with right rotator cuff injury who underwent shoulder arthroscopic surgery in Lihuili Hospital Affiliated to Ningbo University were selected.According to the random number table method,the patients were divided into three Groups:group L(0.25％ropivacaine,19 cases),group M(0.375％ropivacaine,18 cases)and group H(0.5％ropivacaine,20 cases).The duration of nerve block,diaphragmatic paralysis,handgrip strength and visual analogue scale(VAS)score were compared among three groups.Results There were no significant differences in hemodynamics,postoperative extubation time,dosage of propofol and remifentanil among three groups(P＞0.05).The duration of nerve block in group L was significantly shorter than that in group M and group H(P＜0.001).At 12 hours after operation,the VAS score of group L was significantly higher than that of group M and group H(P＜0.01).At 30 minutes after operation,the resting state and forced breathing diaphragm mobility in group L and group M were significantly better than those in group H(P＜0.05),and the incidence of partial diaphragm paralysis in group L and group M was significantly lower than that in group H(P＜0.05).At 30 minutes after operation,the handgrip strength of group H was significantly lower than that of group L and group M(P＜0.05).Conclusion 10ml 0.375％ropivacaine not only has a good analgesic effect,but also reduces the probability of partial diaphragm paralysis and muscle weakness,which is a safe and comfortable administration regimen.

Objective To explore the application value of Kaiqiao Xingshen acupuncture combined with Buyang Huanwu decoction in the treatment of patients with cerebral hemorrhage in the recovery period(Qi defi-ciency and blood stasis syndrome),and to observe its impact on inflammatory indicators and neurokines.Method A total of 166 patients with cerebral hemorrhage in the recovery period(Qi deficiency and blood stasis syndrome)treated in Hongdu Traditional Chinese Medicine Hospital from September 2021 to October 2023,were randomly divided into control group(83 cases treated with conventional western medicine),and observation group(83 cases treated with a combination of Kaiqiao Xingshen acupuncture and Buyang Huanwu decoction).The therapeutic effect in the two groups was compared after 8 weeks of treatment.Results After treatment,the serum levels of matrix metalloproteinase-9(MMP-9),endothelin-1(ET-1),interleukin-2(IL-2),homocysteine(Hcy),and Bcl-2-associated X protein(bax)decreased in both groups,while brain-derived neurotrophic factor(BDNF)increased,and the improvement was more significant in the observation group,showing statistical significance(P<0.05);the average cerebral vascular flow and flow velocity in the observation group increased,while peripheral vascular resistance decreased,and the improvement in the observation group was more significant(P<0.05);the total symptom score of traditional Chinese medicine in the observation group decreased,while the Fuel Meyer functional score(FMA score)increased,and the improvement in the observation group was more significant(P<0.05);The total effective rate of the observation group was 93.98%(78/83),which was higher than that of the control group(80.72%,67/83)(P<0.05).Conclusion For patients with cerebral hemorrhage in the recovery period(Qi deficiency and blood stasis syndrome),Kaiqiao Xingshen acupuncture and Buyang Huanwu decoction help alleviate inflammatory reactions,promote the recovery of the blood-brain barrier,improve cerebral blood flow,promote neurological function recovery,and enhance clinical efficacy.

Objective To compare the effect of quadratus lumborum block at supra-arcuate ligament(SA-QLB)and erector spinae plane block(ESPB)on postoperative analgesia and recovery quality in the pa-tients undergoing thoracoscopic surgery.Methods Sixty patients undergoing elective thoracoscopic surgery,aged 18-70 years old,ASA grade Ⅰ-Ⅱ,served as the study subjects and were randomly divided into the two groups by the random number table method:SA-QLB group(group Q,n=30)and ESPB(group E,n=30).Before induction of general anesthesia,the group Q conducted SA-QLB in the operation side under the ultra-sound guide and the group E conducted ESPB,the both were given 30 mL of 0.25％ropivacaine.All patients in both groups were given the patient-controlled intravenous analgesia(PCIA)after surgery.The dosage of remifentanil during surgery,recovery time,Visual Analogue Scale(VAS)score at rest and cough at 1,6,12,24,48 h after surgery,first pressing time of patient-controlled analgesia,times of effective pressing,dosage of sufentanil and number of cases of rescue analgesia at 24 h after surgery,forced vital capacity(FVC)and forced expiratory volume first second(FEV1)at 1 h before surgery and 24 h after surgery,scores of quality recovery at postoperative 24 h(QoR-15)and Barthel score,hospitalization duration after operation and the occurrence of adverse reactions were recorded.Results Compared with the group E,the intraoperative remifentanil dos-age in the group Q was decreased(P＜0.05);the VAS scores in rest and cough at postoperative 6,12,24 h were decreased(P＜0.05);the first pressing time of postoperative analgesia pump in the group Q was pro-longed,number of effective pressures of analgesia pump,dosage of sufentanil and cases number of remedy an-algesia were decreased(P＜0.05);FEV1 and FVC at postoperative 24 h in the group Q were significantly in-creased(P＜0.05);the scores of QoR-15 and Barthel at postoperative 24 h were increased(P＜0.05).The in-cidence rates of postoperative nausea and vomiting in the group Q were lower than those in the group E(P＜0.05),and no serious adverse events occurred in the two groups.Conclusion Compared with ESPB,SA-QLB could provide more perfect postoperative analgesia effect,which is conducive to postoperative early pulmonary function recovery,and the postoperative recovery quality is higher.

Objective:Compared with long-term renal replacement therapy,kidney transplantation is the ideal treatment for end-stage renal disease(ESRD),significantly extending patient life and improving quality of life.Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens,but their medication adherence is generally poor compared with other organ transplant recipients.Medication adherence is closely related to medication literacy and psychological status,yet related studies are limited.This study aims to investigate the current status of medication adherence,inner strength,and medication literacy in kidney transplant patients,analyze the relationships among these 3 factors,and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence. Methods:A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province.The inner strength,medication literacy,and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale(ISS),the Chinese version of the Medication Literacy Assessment in Spanish and English(MedLitRxSE),and the Chinese version of the Morisky Medication Adherence Scale-8(C-MMAS-8),respectively.Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence.Correlation analysis was conducted to explore the relationships among medication literacy,medication adherence,and inner strength.Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression,and the mediating effect of inner strength was explored. Results:Among the 421 questionnaires collected,408 were valid,with an effective rate of 96.91％.The scores of C-MMAS-8,MedLitRxSE,and ISS were 6.64±1.16,100.63±14.67,and 8.47±4.03,respectively.Among the 408 patients,only 86(21.08％)patients had a high level of medication adherence,whereas 230(56.37％)patients had a medium level of medication adherence,and 92(22.55％)patients had poor medication adherence.Univariate analysis indicated that the kidney transplant patients'age,marital status,education levels,years since their kidney transplant operation,number of hospitalizations after the kidney transplant,and adverse drug reactions showed significant differences in medication adherence(all P＜0.05).Correlation analysis showed that inner strength positively correlated with both medication literacy(r=0.183,P＜0.001)and medication adherence(r=0.201,P＜0.00l).Additionally,there was a positive correlation between medication adherence and medication literacy(r=0.236,P＜0.00l).Inner strength accounted for 13.22％of the total effect in the mediating role between medication literacy and medication adherence. Conclusion:The level of medication adherence among kidney transplant patients needs improvement,and targeted intervention measures are essential.Inner strength mediates the relationship between medication literacy and medication adherence in these patients.Healthcare professionals should focus on enhancing medication literacy and supporting patients'inner strength to improve medication adherence.

Objective To investigate the analgesic effect and safety of transincisional quadratus lumborum block(TQLB)technique for laparoscopic nephrectomy.Methods Sixty patients scheduled for laparoscopic nephrectomy at the Affiliated Lihuili Hospital of Ningbo University from December 2023 to March 2024,the patients were randomly divided into TQLB group(T group)and control group(C group)using a random number table method,with 30 cases in each group.C group received general anesthesia with tracheal intubation,while T group received general anesthesia with tracheal intubation combined with TQLB.Two groups of patients were routinely given sufentanil controlled intravenous analgesia pump after surgery.Record the wound healing status of two groups of patients,postoperative 24h sufentanil consumption,resting and exercise time numerical rating scale(NRS)scores at 6h,12h,and 24h postoperatively,range of sensory blockade at 2h postoperatively,number of salvage analgesia cases at 24h postoperatively,analgesic satisfaction score,and incidence of postoperative complications.Results Compared with group C,patients in group T had a reduced consumption of sufentanil 24h after surgery(P＜0.001);The resting and exercise NRS scores decreased at 6h,12h,and 24h after surgery(P＜0.05);The number of postoperative 24h rescue analgesia cases and the satisfaction score of analgesia were both lower than C group(P＜0.05);The incidence of postoperative nausea and vomiting in group T was lower(P＜0.05);Both groups of patients did not experience serious complications.Conclusion TQLB appears to offer effective postoperative analgesia during the early stages of laparoscopic nephrectomy,while also reducing the occurrence of complications.This suggests that it could serve as a safe and efficient alternative for analgesic management in such surgical procedures.