OBJECTIVE: To investigate the effects of Huayu Tongluo (transforming stasis and unblocking collaterals) moxibustion on cognitive function and insulin resistance in patients with type 2 diabetes mellitus (T2DM) and cognitive decline. METHODS: Ninety patients with T2DM and cognitive decline were randomly divided into a moxibustion group (n=45, 3 cases dropped out, 2 cases were eliminated) and a waiting moxibustion group (n=45, 2 cases dropped out). Both groups received routine hypoglycemic treatment for 12 weeks. The moxibustion group additionally received Huayu Tongluo moxibustion at Baihui (GV20), Shenting (GV24), and Dazhui (GV14). Pressing moxibustion was applied to Baihui (GV20) for 20 min, while suspended moxibustion was applied to Shenting (GV24) and Dazhui (GV14) for 20 min each. Treatments of moxibustion were administered every other day (three times per week) for 12 weeks. All patients were followed up for 12 weeks, during which their original hypoglycemic medication regimen was maintained. Before treatment, after 12 weeks of treatment, and at the 12-week follow-up, the scores of Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), Addenbrooke's cognitive examination Ⅲ (ACE-Ⅲ), symbol digit modalities test (SDMT), and Athens insomnia scale (AIS) and the insulin resistance index (HOMA-IR) were observed in the two groups. RESULTS: Compared with before treatment, the MoCA scores, MMSE scores, ACE-Ⅲ subscale scores (attention, memory, language fluency, language, visuospatial ability) and total scores, and SDMT scores were increased (P<0.01), while the AIS scores were decreased (P<0.05) in the moxibustion group after treatment and at follow-up. Compared with before treatment, the MMSE score, ACE-Ⅲ subscale scores (memory, attention) and total score after treatment, as well as the ACE-Ⅲ subscale scores (language, memory, attention) and total score, and SDMT score at follow-up were increased (P<0.05, P<0.01) in the waiting moxibustion group. Compared with before treatment, HOMA-IR was decreased in both groups after treatment and at follow-up (P<0.01). At follow-up, ACE-Ⅲ subscale scores (attention, memory), and the total score in the moxibustion group were lower than those after treatment (P<0.05, P<0.01), and the ACE-Ⅲ language subscale score, total ACE-Ⅲ score, and SDMT score in the waiting moxibustion group were higher than those after treatment (P<0.01, P<0.05). After treatment and at follow-up, compared with the waiting moxibustion group, the moxibustion group had higher MoCA scores, MMSE scores, SDMT scores, ACE-Ⅲ subscale scores (attention, memory, language fluency) and total scores (P<0.05, P<0.01), and lower HOMA-IR (P<0.05). CONCLUSION Huayu Tongluo moxibustion can effectively improve cognitive function in patients with T2DM and cognitive decline. This improvement may be associated with the reduction in insulin resistance.
Humans ; Insulin Resistance ; Diabetes Mellitus, Type 2/complications* ; Male ; Female ; Moxibustion ; Middle Aged ; Aged ; Cognition ; Acupuncture Points ; Adult ; Cognitive Dysfunction/therapy*

Objective To investigate the effect of esketamine on postoperative anxiety and cognitive function in gynecological malignant tumor patients with preoperative anxiety and cognitive decline.Methods Eighty-nine patients were selected for resection of gynecological malignant tumors,aged 18-64 years,BMI 18-28 kg/m2,ASA physical status Ⅱ or Ⅲ,the hospital anxiety and depression scale(HADS)anxiety subscale score&ge;8 points and montreal cognitive rating scale(MoCA)＜26 points 1 day before surgery.The patients were divided into two groups using the random number table method:the esket-amine group(group S,n = 45)and the normal saline group(group C,n = 44).In group S,esketamine 0.2 mg/kg was injected intravenously during anesthesia induction,0.25 mg·kg-1·h-1 was injected by pump during anesthesia maintenance,and esketamine 100 mg was used in the postoperative analgesic pump.Group C was given the same volume of normal saline during anesthesia induction,maintenance and PCIA analgesia,and other medications were the same as those in group S.HADS and MoCA were used to evaluate patients'anxiety and cognitive function 1 day before surgery and the 1 day and 3 days after surgery.The con-centration of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),S100 calcium-binding protein(S100β),and brain-derived neurotrophic factor(BDNF)were detected 1 day before surgery and 3 days af-ter surgery.The intraoperative dosage of remifentanil,ephedrine use rate,Ramsay sedation score 10 minutes after admission to PACU,extubation time,the number of total and effective compressions of PCIA within 48 hours after surgery,postoperative remedial analgesia,and the occurrence of adverse reactions,such as hy-pertension,hypotension,nausea and vomiting,chill,dizziness,and fever within 48 hours after surgerywere recorded.Results Compared with group C,the incidence of anxiety were significantly reduced and MoCA cognitive score were increased 1 day and 3 days after surgery,the concentrations of TNF-α,IL-6,and S100β were significantly reduced,the concentration of BDNF was significantly increased,the dosage of remifentanil was significantly reduced,the sedation score of Ramsay was significantly increased,the number of total compressions and effective compressions of PCIA within 48 hours after surgery was significantly re-duced,and postoperative fever was significantly reduced in group S(P＜0.05).There were no statistically significant differences in ephedrine use rate,extubation time,postoperative remedial analgesia rate,the in-cidence of other adverse reactions,such as hypertension,hypotension,nausea and vomiting,chills and diz-ziness within 48 hours after surgery between the two groups.Conclusion Esketamine can decrease the con-centrations of inflammatory factors and reduce nerve damage,help relieve anxiety and cognitive function of patients with gynecological malignant tumors.

Objective:To explore the correlation between the family cohesion and adaptability of naval officers and sailors and their negative emotions.Methods:A total of 610 naval officers and sailors from four units of a naval troop were selected by cluster and convenience samplings. The Chinese version of Family Adaptability and Cohesion Evaluation Scale（FACES-CV），the Patient Health Questionnaire 9-Item（PHQ-9），and the Generalized Anxiety Disorder 7-Item（GAD-7）Scale were used for measurement. Variance tests and correlation analyses were conducted.Results:The anxiety of naval officers and sailors was negatively correlated with their family cohesion and adaptability（ r=-0.235， r=-0.200，both P<0.01）；and their depression was negatively correlated with their family cohesion and adaptability（ r=-0.294， r=-0.257，both P<0.01）. Conclusions:The negative emotions of naval officers and sailors are negatively correlated with their family cohesion and adaptability. Stronger family cohesion and adaptability are conducive to reducing negative emotions.

Objective:To investigate the severity of anxiety and depression of officers and soldiers stationed on islands and reefs and the related influencing factors，so as to provide a theoretical basis for the subsequent psychological screening and mental health maintenance of these officers and soldiers.Methods:Self-Rating Anxiety Scale（SAS），Self-Rating Depression Scale（SDS），Neuroticism-Extraversion-Openness Five-Factor Inventory（NEO-FFI），Interpersonal Relationship Comprehensive Diagnostic Scale（IRCDS），Connor-Davidson Resilience Scale（CD-RISC）were used to evaluate the emotional status and its related factors of the officers and soldiers stationed on islands and reefs.Results:Among all the research objects，34.14% of them showed anxiety，and 65.51% showed depression. The scale ratings of the officers and soldiers stationed on islands and reefs were significantly different from Chinese norm（ P<0.01）. According to the ratings of IRCDS，16.11% of the officers and soldiers had serious problems in interpersonal relationship，and they also had varying degrees of distress in conversation，making friends，manners，and heterosexual interactions. Anxiety and depression were significantly and positively correlated with neuroticism in personality traits（ P<0. 01），while they were significantly and negatively correlated with other personality traits（ P<0.01）；they were significantly and positively correlated with all factors of IRCDS（ P<0.01），while they were significantly and negatively correlated with all factors of CD-RISC（ P<0.01）. Through multiple linear regression analysis，the neuroticism of NEO-FFI，the conversation and manners of IRCDS，and the strength of CD-RISC have impacts on anxiety；the strength and optimism of CD-RISC，the neuroticism of NEO-FFI，and the conversation of IRCDS had impacts on depression. Conclusion:Officers and soldiers stationed on islands and reefs have obvious anxiety and depression，and the factors of personality traits，interpersonal relationship，and resilience can affect the emotions of anxiety and depression to varying degrees.

Objective To investigate the influencing factors for low-level viremia (LLV) and their dynamic changes in chronic hepatitis B (CHB) patients treated with nucleos(t)ide analogues (NAs) for the first time. Methods A retrospective analysis was performed for 78 CHB patients who attended Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University, from November 2020 to March 2022 and received antiviral therapy with NAs for at least 12 months, and according to HBV DNA level during treatment, they were divided into sustained virologic response (SVR) group with 58 patients and LLV group with 20 patients. The independent samples t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. The multivariate Logistic regression analysis was used to investigate the independent influencing factors for LLV and establish a predictive model, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of this model. The Kaplan-Meier method was used to analyze cumulative HBV DNA negative conversion rate, and the Log-rank test was used for comparison. The analysis of variance with repeated measures was used to analyze the differences in HBV DNA and HBsAg between the two groups or within each group at weeks 0, 12, 24, 36, and 48. Results Compare with the SVR group, the LLV group had significantly higher HBeAg positive rate (90.0% vs 48.3%, χ 2 =10.701, P =0.001), log(HBV DNA) value (7.26±1.46 vs 5.65±1.70, t =-4.178, P < 0.001), and log(HBsAg) value (4.53±0.86 vs 3.44±0.93, t =-4.813, P < 0.001) and significantly lower age [29 (26-34) vs 33 (30-43), Z =-2.751, P =0.009], alanine aminotransferase (ALT) [67.0 (54.0-122.0)U/L vs 111.0 (47.0-406.0)U/L, Z =-2.203, P =0.028], aspartate aminotransferase [43.5 (32.8-62.8) U/L vs 77.5 (35.0-213.0)U/L, Z =-2.466, P =0.014], and liver stiffness measurement [7.7 (6.3-8.5)kPa vs 8.9 (7.2-11.4)kPa, Z =-2.022, P =0.043]. The multivariate logistic regression analysis showed that baseline HBV DNA (odds ratio [ OR ]=2.365, 95% confidence interval [ CI ]: 1.220-4.587, P =0.011), HBsAg ( OR =4.229, 95% CI : 1.098-16.287, P =0.036), and ALT ( OR =0.965, 95% CI : 0.937-0.994, P =0.018) were independent influencing factors for LLV in CHB patients, and the predictive model of Logit(MLLV)=-8.668+1.441×lgHBsAg+0.598×lgHBV DNA-0.016×ALT was established based on these factors, which had a larger area under the ROC curve than HBV DNA, HBsAg, and ALT (0.931 vs 0.774/0.856/0.666), with a sensitivity of 85.00% and a specificity of 93.10% at the optimal cut-off value of 0.44. The CHB patients with baseline HBV DNA > 7.29 lgIU/mL or HBsAg > 4.38 lgIU/mL had a significantly lower DNA negative conversion rate than those with DNA ≤7.29 lgIU/mL or HBsAg ≤4.38 lgIU/mL ( χ 2 =22.52 and 26.35, both P < 0.001). In the CHB patients, the highest reduction rates of HBV DNA and HBsAg were observed at weeks 12 and 24, respectively, and the LLV group had significantly higher levels of HBV DNA and HBsAg than the SVR group at weeks 0, 12, 24, 36, and 48 (HBV DNA: t =-4.084, -4.526, -5.688, -7.123, and -6.266, all P < 0.001; HBsAg: t =-4.652, -4.691, -4.952, -4.804, and -4.407, all P < 0.001). Conclusion For the CHB patients treated with NAs for the first time, those with high HBV DNA load, high HBsAg quantification, and low ALT level at baseline are more likely to develop LLV, and dynamic monitoring of these indices is of great significance to observe the onset of LLV.

Aristolochic acids (AAs) have long been considered as a potent carcinogen due to its nephrotoxicity. Aristolochic acid I (AAI) reacts with DNA to form covalent aristolactam (AL)-DNA adducts, leading to subsequent A to T transversion mutation, commonly referred as AA mutational signature. Previous research inferred that AAs were widely implicated in liver cancer throughout Asia. In this study, we explored whether AAs exposure was the main cause of liver cancer in the context of HBV infection in mainland China. Totally 1256 liver cancer samples were randomly retrieved from 3 medical centers and a refined bioanalytical method was used to detect AAI-DNA adducts. 5.10% of these samples could be identified as AAI positive exposure. Whole genome sequencing suggested 8.41% of 107 liver cancer patients exhibited the dominant AA mutational signature, indicating a relatively low overall AAI exposure rate. In animal models, long-term administration of AAI barely increased liver tumorigenesis in adult mice, opposite from its tumor-inducing role when subjected to infant mice. Furthermore, AAI induced dose-dependent accumulation of AA-DNA adduct in target organs in adult mice, with the most detected in kidney instead of liver. Taken together, our data indicate that AA exposure was not the major threat of liver cancer in adulthood.

Objective:To explore the correlation between the family cohesion and adaptability of naval officers and sailors and their negative emotions.Methods:A total of 610 naval officers and sailors from four units of a naval troop were selected by cluster and convenience samplings. The Chinese version of Family Adaptability and Cohesion Evaluation Scale（FACES-CV），the Patient Health Questionnaire 9-Item（PHQ-9），and the Generalized Anxiety Disorder 7-Item（GAD-7）Scale were used for measurement. Variance tests and correlation analyses were conducted.Results:The anxiety of naval officers and sailors was negatively correlated with their family cohesion and adaptability（ r=-0.235， r=-0.200，both P<0.01）；and their depression was negatively correlated with their family cohesion and adaptability（ r=-0.294， r=-0.257，both P<0.01）. Conclusions:The negative emotions of naval officers and sailors are negatively correlated with their family cohesion and adaptability. Stronger family cohesion and adaptability are conducive to reducing negative emotions.

Objective:To investigate the severity of anxiety and depression of officers and soldiers stationed on islands and reefs and the related influencing factors，so as to provide a theoretical basis for the subsequent psychological screening and mental health maintenance of these officers and soldiers.Methods:Self-Rating Anxiety Scale（SAS），Self-Rating Depression Scale（SDS），Neuroticism-Extraversion-Openness Five-Factor Inventory（NEO-FFI），Interpersonal Relationship Comprehensive Diagnostic Scale（IRCDS），Connor-Davidson Resilience Scale（CD-RISC）were used to evaluate the emotional status and its related factors of the officers and soldiers stationed on islands and reefs.Results:Among all the research objects，34.14% of them showed anxiety，and 65.51% showed depression. The scale ratings of the officers and soldiers stationed on islands and reefs were significantly different from Chinese norm（ P<0.01）. According to the ratings of IRCDS，16.11% of the officers and soldiers had serious problems in interpersonal relationship，and they also had varying degrees of distress in conversation，making friends，manners，and heterosexual interactions. Anxiety and depression were significantly and positively correlated with neuroticism in personality traits（ P<0. 01），while they were significantly and negatively correlated with other personality traits（ P<0.01）；they were significantly and positively correlated with all factors of IRCDS（ P<0.01），while they were significantly and negatively correlated with all factors of CD-RISC（ P<0.01）. Through multiple linear regression analysis，the neuroticism of NEO-FFI，the conversation and manners of IRCDS，and the strength of CD-RISC have impacts on anxiety；the strength and optimism of CD-RISC，the neuroticism of NEO-FFI，and the conversation of IRCDS had impacts on depression. Conclusion:Officers and soldiers stationed on islands and reefs have obvious anxiety and depression，and the factors of personality traits，interpersonal relationship，and resilience can affect the emotions of anxiety and depression to varying degrees.

Objective:To investigate the factors affecting the prognosis of sudden sensorineural hearing loss (SSNHL), so as to guide the comprehensive treatment combined with hyperbaric oxygen (HBO) on SSNHL.Methods:A retrospective analysis was conducted on 112 patients (115 ears) with SSNHL who were admitted to the Department of Hyperbaric Medicine of Beijing Chao-yang Hospital from June 2018 to September 2021. They were divided into effective group (cured + markedly effective + effective) and ineffective group. The factors, i. e., head magnetic resonance angiography (MRA) and neck vascular ultrasound, were compared between the two groups, and then binary logistic regression analysis was performed.Results:There were 45 cases (46 ears) in the effective group, 67 cases (69 ears) in the ineffective group, and the effective rate was 40.0%. After two courses of HBO treatment, ultrasound-assisted examination was performed. Internal carotid artery plaques were found in 53 cases and vertebral artery plaques were found in 12 cases. Head MRI showed white matter lesions (WMLs) in 53 cases and MRA showed intracranial vascular stenosis in 26 cases. Types of hearing loss curves: 12 cases (12 ears) were hearing loss in low tone frequencies, 16 cases (16 ears) were hearing loss in high tone frequencies; 44 cases (45 ears) were hearing loss in all tone frequencies; and 40 cases (42 ears) were total deafness. Hearing loss degree: 22 cases (22 ears) were mild, 29 cases (30 ears) were moderate, 17 cases (17 ears) were severe, and 44 cases (46 ears) were extremely severe. The time from onset to first treatment, the type of hearing loss, and the degree of hearing loss between the two groups were significantly different ( P<0.01). Logistic regression analysis showed that the type of hearing loss and the time from onset to first treatment were correlated with the prognosis of SSNHL ( P<0.01). Conclusion:The prognosis of SSNHL with early HBO intervention was better, while the prognosis of SSNHL patients with intracranial vascular stenosis was poor. The SSNHL patients with abnormal head MRA results need more attention.

Objective:To investigate the factors affecting the prognosis of sudden sensorineural hearing loss (SSNHL), so as to guide the comprehensive treatment combined with hyperbaric oxygen (HBO) on SSNHL.Methods:A retrospective analysis was conducted on 112 patients (115 ears) with SSNHL who were admitted to the Department of Hyperbaric Medicine of Beijing Chao-yang Hospital from June 2018 to September 2021. They were divided into effective group (cured + markedly effective + effective) and ineffective group. The factors, i. e., head magnetic resonance angiography (MRA) and neck vascular ultrasound, were compared between the two groups, and then binary logistic regression analysis was performed.Results:There were 45 cases (46 ears) in the effective group, 67 cases (69 ears) in the ineffective group, and the effective rate was 40.0%. After two courses of HBO treatment, ultrasound-assisted examination was performed. Internal carotid artery plaques were found in 53 cases and vertebral artery plaques were found in 12 cases. Head MRI showed white matter lesions (WMLs) in 53 cases and MRA showed intracranial vascular stenosis in 26 cases. Types of hearing loss curves: 12 cases (12 ears) were hearing loss in low tone frequencies, 16 cases (16 ears) were hearing loss in high tone frequencies; 44 cases (45 ears) were hearing loss in all tone frequencies; and 40 cases (42 ears) were total deafness. Hearing loss degree: 22 cases (22 ears) were mild, 29 cases (30 ears) were moderate, 17 cases (17 ears) were severe, and 44 cases (46 ears) were extremely severe. The time from onset to first treatment, the type of hearing loss, and the degree of hearing loss between the two groups were significantly different ( P<0.01). Logistic regression analysis showed that the type of hearing loss and the time from onset to first treatment were correlated with the prognosis of SSNHL ( P<0.01). Conclusion:The prognosis of SSNHL with early HBO intervention was better, while the prognosis of SSNHL patients with intracranial vascular stenosis was poor. The SSNHL patients with abnormal head MRA results need more attention.