Objective:To evaluate the effect of electroacupuncture preconditioning on perioperative shivering and stress responses in elderly patients undergoing transurethral resection of the prostate.Methods:In this randomized controlled trial, 60 elderly patients, aged 65-85 yr, weighing 60-85 kg, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective transurethral resection of the prostate, were divided into electroacupuncture preconditioning group (group E) and control group (group C) using the random number table method, with 30 patients in each group. Combined spinal-epidural anesthesia was used in two groups. Bilateral Neiguan and Zusanli acupoints were stimulated for 30 min, with disperse-dense waves, frequency 2/100 Hz, current intensity 3 mA, starting from 30 min before anesthesia puncture. Group C received no treatment. The incidence of shivering, postoperative nausea and vomiting, use of vasoactive drugs and rescue analgesia were recorded in the two groups. Peripheral venous blood samples from the upper limbs were collected before electroacupuncture treatment (T 0) and at 2 h after operation (T 1) for determination of serum concentrations of interleukin-6 (IL-6), 5-serotonin (5-HT), norepinephrine (NE) and dopamine (DA) by enzyme-linked immunosorbent assay. Results:Compared with the baseline at T 0, serum concentrations of IL-6, 5-HT, NE and DA were significantly increased at T 1 in group C ( P<0.05). Compared with group C, the incidence of shivering, usage rate of vasoactive drugs and rate of rescue analgesia were significantly decreased, and the serum concentrations of IL-6, 5-HT, NE and DA were decreased at T 1 in group E ( P<0.05). Conclusions:Electroacupuncture preconditioning can decrease the occurrence of perioperative shivering and inhibit stress responses in elderly patients undergoing transurethral resection of the prostate.

Objective:To evaluate the effect of electroacupuncture preconditioning on perioperative shivering and stress responses in elderly patients undergoing transurethral resection of the prostate.Methods:In this randomized controlled trial, 60 elderly patients, aged 65-85 yr, weighing 60-85 kg, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective transurethral resection of the prostate, were divided into electroacupuncture preconditioning group (group E) and control group (group C) using the random number table method, with 30 patients in each group. Combined spinal-epidural anesthesia was used in two groups. Bilateral Neiguan and Zusanli acupoints were stimulated for 30 min, with disperse-dense waves, frequency 2/100 Hz, current intensity 3 mA, starting from 30 min before anesthesia puncture. Group C received no treatment. The incidence of shivering, postoperative nausea and vomiting, use of vasoactive drugs and rescue analgesia were recorded in the two groups. Peripheral venous blood samples from the upper limbs were collected before electroacupuncture treatment (T 0) and at 2 h after operation (T 1) for determination of serum concentrations of interleukin-6 (IL-6), 5-serotonin (5-HT), norepinephrine (NE) and dopamine (DA) by enzyme-linked immunosorbent assay. Results:Compared with the baseline at T 0, serum concentrations of IL-6, 5-HT, NE and DA were significantly increased at T 1 in group C ( P<0.05). Compared with group C, the incidence of shivering, usage rate of vasoactive drugs and rate of rescue analgesia were significantly decreased, and the serum concentrations of IL-6, 5-HT, NE and DA were decreased at T 1 in group E ( P<0.05). Conclusions:Electroacupuncture preconditioning can decrease the occurrence of perioperative shivering and inhibit stress responses in elderly patients undergoing transurethral resection of the prostate.

Endosomal TLRs (TLR3/7/8/9) are highly analogous innate immunity sensors for various viral or bacterial RNA/DNA molecular patterns. Among them, TLR7, in particular, has been suggested to be a target for various inflammatory disorders and autoimmune diseases including systemic lupus erythematosus (SLE); but few small-molecule inhibitors with elaborated mechanism have been reported in literature. Here, we reported a well-characterized human TLR7-specific small-molecule inhibitor, TH-407b, with promising potency and negligible cytotoxicity through a novel binding mechanism. Notably, TH-407b not only effectively inhibited TLR7-mediated pro-inflammatory signaling in a variety of cultured cell lines but also demonstrated potent inflammation suppressing activities in primary peripheral blood mononuclear cells (PBMCs) derived from SLE patients. Furthermore, TH-407b showed prominent efficacy in vivo, improved survival rate and ameliorated symptoms of SLE model mice. To obtain molecular insights into the TH-407b derivatives' inhibition mechanism, we performed the structural analysis of TLR7/TH-407b complex using cryogenic electron microscopy (cryo-EM) method. As an atomistic resolution cryo-EM structure of the TLR family, it not only of value to facilitate structure-based drug design, but also shed light to methodology development of small proteins using EM. Significantly, TH-407b has unveiled an inhibition strategy for TLR7 via stabilizing its resting/inactivated state. Such a resting state could be generally applicable to all TLRs, rendering a useful method for targeting this group of important immunological receptors.

"Toxicity Testing in the 21st Century—A Vision and Strategy"proposed by the National Research Council of US has brought innovative directives and objectives for toxicity evaluation and risk assessment,pushing forward the next generation of toxicity testing and risk assessment.In this initiative,the concept of adverse outcome pathways(AOPs)has emerged as a prominent methodology,capturing the attention of toxicologists and researchers due to its promising applications in recent years.The quantitative AOP(qAOP)is an extension of the adverse outcome pathway,which is built upon the foundational qualitative adverse outcome pathway model and leverages mathematical frame-works to depict dose-response and/or response-response relationships.This article reviews the princi-ples and advancement surrounding qAOP,introduceds two prevalent methodologies for constructing qAOP,Bayesian network models and regression models,and demonstrates diverse applications of qAOP.Actual cases are used to underscore the transformative role of qAOP in contemporary toxicology and risk assessment practices.

OBJECTIVE: To investigate the effect of electroacupuncture pretreatment on the quality of recovery in the patients undergoing laparoscopic gastrointestinal surgery. METHODS: Sixty patients for elective laparoscopic resection of gastrointestinal tumors under general anesthesia were randomly assigned to either an observation group or a control group, with 30 patients in each group. In the control group, the routine inhalation-intravenous combined general anesthesia was adopted. On the basis of the control group, in the observation group, 30 min before anesthesia induction, electroacupuncture was applied to bilateral Neiguan (PC 6) and Neimadian (Extra) for 30 min, using disperse-dense wave and at 2 Hz/100 Hz. The recovery time of spontaneous breathing, awakening time, extubation time, and the post-anesthesia care unit (PACU) stay time were compared between the two groups. Mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO₂) were recorded at multiple time points: before electroacupuncture (T0), before extubation (T1), immediately after extubation (T2), 5 minutes (T3) and 10 minutes (T4) after extubation, and upon discharge from PACU (T5). The visual analogue scale (VAS) score for pain and Ramsay sedation score at T3, T4 and T5 were observed; and the incidence of agitation, nausea and vomiting at T5 was evaluated in the two groups. At T0 and T5, the serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and cortisol were determined in the two groups. RESULTS: In the observation group, the recovery time of spontaneous breathing, awakening time, extubation time, and PACU stay time were shorter (P<0.001), MAP and HR at T2 were lower (P<0.01, P<0.05), the VAS scores for pain at T3, T4, and T5 dropped (P<0.001, P<0.01), and the Ramsay sedation score at T3 reduced (P<0.05) compared with those in the control group. The incidence of nausea and vomiting was lower in the observation group when compared with that in the control group (P<0.05). In comparison with the indexes at T0, the serum levels of TNF-α, IL-6, and cortisol increased at T5 in both groups (P<0.01); and these indexes at T5 in the observation group were lower than those in the control group (P<0.01, P<0.05). CONCLUSION Electroacupuncture pretreatment can enhance the quality of recovery in the patients undergoing laparoscopic gastrointestinal tumor surgery, shorten the time for spontaneous breathing recovery, awakening, extubation and PACU stay, and attenuate postoperative pain and stress response.
Humans ; Electroacupuncture ; Female ; Male ; Middle Aged ; Laparoscopy ; Adult ; Aged ; Anesthesia Recovery Period ; Interleukin-6/blood* ; Pain, Postoperative/therapy* ; Tumor Necrosis Factor-alpha/blood* ; Young Adult ; Gastrointestinal Neoplasms/therapy* ; Acupuncture Analgesia

Objective To determine the levels of arsenic in food in Chongqing city,and to assess the levels of dietary arsenic exposure and the associated potential health risks in residents of Chongqing city.Methods By using the monitoring data on arsenic levels in food in Chongqing between 2018 and 2023 in combination with the local dietary survey data for Chongqing from the 2018 China Nutrition and Health Survey Program,and adopting the 2-dimensional Monte Carlo simulation,we made an estimate of the dietary arsenic exposure levels of Chongqing residents.The margin of exposure(MOE)method was applied to assess both non-carcinogenic risks(skin damage)and carcinogenic risks(lung cancer and urinary system cancers)associated with dietary intake of arsenic.Results Out of 4900 food samples,the detection rate of arsenic was 36.40％,with the average levels ranging from the median bound(MB)of 0.020 7 to the upper bound(UB)of 0.023 4 mg/kg.The highest average levels were found in rice and its products,with an MB of 0.0981 and a UB of 0.098 5 mg/kg.The daily average exposure to inorganic arsenic for residents of different ages,sexes,and places of residence was highest in individuals aged 3 to 6,with an MB of 1.046 μg/(kg·d)and a UB of 1.116 μg/(kg·d),and lowest among individuals aged 60 and older.Arsenic exposure was higher in males than that in females and higher in people living in rural areas compared to those in urban areas.In terms of non-carcinogenic risks,the MOE values for inorganic arsenic were always higher than 1 in various populations.As for carcinogenic risks,the MOE values were all less than 100 in various populations.Rice and its products were the main source of dietary arsenic exposure in Chongqing,accounting for 69.97％to 74.37％of the total exposure.Conclusion The non-carcinogenic risk caused by dietary arsenic exposure in Chongqing is relatively low,but there may be a certain level of carcinogenic risk.Continued attentions should be given to dietary arsenic exposure levels in young children.

Objective:To evaluate the effect of electroacupuncture preconditioning on emergence agitation in the patients undergoing total laparoscopic hysterectomy.Methods:This was a randomized controlled trial. Ninety American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, aged 40-60 yr, with a body mass index of 50-70 kg, scheduled for elective total laparoscopic hysterectomy, were divided into control group (C group) and electroacupuncture preconditioning group (E group) using a random number table method, with 45 patients in each group. At 30 min before anesthesia induction, Zusanli and Neiguan acupoints were stimulated for 30 min with disperse-dense waves at a frequency of 2 Hz/100 Hz, an intensity of 3 mA, in group E. Group C did not receive electroacupuncture treatment. The occurrence of emergence agitation, usage of vasoactive drugs and rescue analgesia were recorded in two groups. Peripheral venous blood samples from the upper extremity were obtained before electroacupuncture stimulation (T 0) and at 2 h after operation (T 1) for determination of the plasma concentrations of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) by enzyme-linked immunosorbent assay. Results:The plasma CRP and TNF-α concentrations in group C and plasma IL-10 concentrations in group E were significantly higher at T 1 than at T 0 ( P<0.05). Compared with group C, the usage rate of vasoactive drugs, rate of rescue analgesia, and incidence of emergence agitation were significantly decreased, and the plasma concentrations of CRP and TNF-α were decreased and the plasma IL-10 concentrations were increased at T 1 in group E ( P<0.05). Conclusions:Electroacupuncture preconditioning can decrease the occurrence of emergence agitation in the patients undergoing total laparoscopic hysterectomy, which may be related to inhibiting inflammatory responses.

Objective:To evaluate the effect of electroacupuncture preconditioning on cellular immune function in the patients undergoing thyroid surgery.Methods:Sixty-six patients of either sex, aged 30-55 yr, with body mass index of 18.5-23.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification ⅠorⅡ, were selected and divided into electroacupuncture preconditioning group (group D) and control group (group C) by a random number table method, with 33 cases in each group. Patients in both groups received combined intravenous-inhalational anesthesia. Before anesthesia induction, both Hegu and Neiguan acupoints were stimulated for 30 min using a continuous wave at a frequency of 2/100 Hz, and the stimulation intensity was subjected to patient tolerance in group D. Group C received sham electroacupuncture for 30 min without stimulation. Venous blood samples were collected at 30 min before anesthesia induction (T 0) and 12, 24 and 48 h after anesthesia (T 1-3). The percentages of T lymphocyte subsets (CD3 +, CD4 +, CD8 +, CD4 + /CD8 + ) and natural killer cells and concentrations of interleukin-6 and tumor necrosis factor-alpha in the serum were measured by flow cytometry. Results:Compared with group C, the percentage of CD3 +, CD4 + and natural killer cells and ratio of CD4 + /CD8 + were significantly increased at T 1, 2, and the concentrations of interleukin-6 and tumor necrosis factor-alpha in the serum were decreased at T 1-3 in group D ( P<0.05). Conclusions:Electroacupuncture preconditioning can improve cellular immune function in the patients undergoing thyroid surgery.

Objective:To evaluate the effect of electroacupuncture preconditioning on the immune function of elderly patients after radical resection for gastric cancer.Methods:A total of 70 patients, aged 65 to 75 yr, with body mass index of 18-25 kg/m 2, scheduled for elective radical resection for gastric cancer, of American Society of Anesthesiology physical status Ⅱ or Ⅲ, were divided into 2 groups ( n=35 each) by a random number table method: electroacupuncture pretreatment group (group EP) and control group (group C). Combined intravenous-inhalational anesthesia was used in both groups.In group EP, electroacupuncture (continuous wave, frequency 2/100Hz, current 1 mA) of the internal anesthesia point and Zusanli acupoint was performed for 30 min before induction of anesthesia.In group C, electroacupuncture was not performed, and patient-controlled intravenous analgesia was used after operation.Before electroacupuncture and at 2, 12, 24 and 48 h after operation (T 0-4), the rating of safety and efficacy was assessed, and central venous blood samples were collected, and the percentages of CD3 + , CD4 + and CD8 + T cells were measured by flow cytometry, and the CD4 + /CD8 + ratio was calculated. Results:There was no significant difference in the rating of safety and efficacy between the two groups ( P>0.05). Compared with the baseline at T 0, the percentages of serum CD3 + and CD4 + T cells and CD4 + /CD8 + ratio at T 1-4 and percentage of CD8 + T cells at T 3 were significantly decreased in group C ( P<0.05). Compared with group C, the percentages of serum CD 3+ and CD4 + T cells and CD4 + /CD8 + ratio at T 1-4 and percentage of CD8 + T cells at T 3 were significantly increased in group EP ( P<0.05). Conclusion:Electroacupuncture of internal anesthesia points and Zusanli acupoint preconditioning can improve the immune function of elderly patients after radical resection for gastric cancer.

Objective: To investigate the feasibility and clinic outcome of the turbocharging technique in repairing large defect with free perforator flap. Methods: From January 2017 to December 2018, 6 patients with defect of over length or large size were repaired with free perforator flaps, anterolateral thigh(ALT) flap in 3 cases and deep inferior epigastric artery perforator(DIEP) flap in 3 cases in Department of Hand Surgery, Ningbo No.6 Hospital. There were 4 males and 2 females, aged from 29 to 54 years old, with an average age of 41 years old.It was found that the size of the flap beyond the perforasome, while multiple perforators in the flaps were not from the same pedicle. The turbocharging technique was applied in the operation. The distal perforator of the flap was anastomosed with the proximal pedicle branch. The flap size ranged from 20 cm×8 cm to 25 cm×12 cm. The donor sites were closed directly for 3 cases and skin grafting for 3 cases. Results: All the flaps survived successfully, no distal necrosis occurred. The patients were followed up for 3 to 12 months, with an average of 9 months. All flaps survived well with satisfactory appearance and pliable texture. The healing of skin graft was satisfactory in 3 cases in donor site. No graft skin contracture occurred. The donor sites closed directly in 3 cases had linear scar in donor site, no obvious contracture occurred. The flap sensation returned to S2-S3. Conclusions If the size of the flap is super long or large, beyond the perforasome, while multiple perforators in the flaps were not from the same pedicle, the application of turbocharging technique can avoid partial necrosis of the flap and improve the survival rate of the flap, which is an ideal alternative.