Acupotomy therapy demonstrates the definite clinical efficacy on knee osteoarthritis (KOA). After reviewing systematically the mechanism studies on acupotomy for KOA over the past 5 years, It is revealed that acupotomy synergistically intervenes in the pathological progression of KOA through multi-target approaches, such as regulating cartilage homeostasis, restoring skeletal muscle function, alleviating synovial inflammatory responses, remodeling subchondral bone, and neuromodulation. But the current research still limits to single-tissue phenotypic observation, and is insufficiency in the in-depth exploration of multi-tissue synergistic interactions and molecular upstream-downstream regulatory mechanisms. Future studies should focus on the inheritance and innovation of acupotomy theory, and integrating multi-omics analytical technologies, artificial intelligence, and novel biochemical detection methods. The mechanism research targets on the interaction mechanisms among tissues, direct effects of acupotomy, immune-inflammatory regulatory mechanisms, and analgesic mechanisms, so as to comprehensively elucidate the therapeutic mechanism of acupotomy for KOA.
Humans ; Acupuncture Therapy ; Osteoarthritis, Knee/genetics* ; Animals

OBJECTIVE: To study incident and clinical characteristics of the coronary microcirculation dysfunction (CMD) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and to explore the predictive value of CMD for in-hospital acute heart failure event. METHODS: One hundred and forty five patients with AMI who had received PCI and completed MCE during hospitalization in Peking University People' s Hospital from November 2015 to July 2021 were enrolled in our study. The patients were divided into CMD group and normal group according to the coronary microcirculation status detected by MCE. Clinical data and MCE data of the two groups were collected and analyzed. The acute heart failure event during hospitalization was described. A multivariate Logistic regression model was built to analyze the risk of acute heart failure in patients with CMD. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of CMD in predicting acute heart failure event. RESULTS: CMD detected by MCE occurred in 87 patients (60%). Compared with normal group, patients with CMD had higher troponin I (TnI) peak level [52.8 (8.1, 84.0) μg/L vs. 18.9 (5.7, 56.1) μg/L, P=0.005], poorer Killip grade on admission (P=0.030), different culprit vessel (P < 0.001) and more patients had thrombolysis in myocardial infarction (TIMI) flow pre-PCI less than grade 3 in culprit vessel (65.1% vs. 43.1%, P=0.025). Meanwhile, patients with CMD had poorer left ventricular ejection fraction (LVEF) [52% (43%, 58%) vs. 61% (54%, 66%)], poorer global longitudinal strain (GLS) [-11.2% (-8.7%, -14.0%) vs.-13.9% (-10.8%, -17.0%)] and worse wall motion score index (WMSI) (1.58±0.36 vs. 1.25± 0.24) (P all < 0.001). Acute left heart failure happened in 13.8% of the CMD patients, which were significant higher than that in the patients with normal coronary microcirculation perfusion (1.7%, P=0.013). After correcting for the culprit vessel, the TIMI flow pre-PCI in the culprit vessel and the peak TnI value, the risk of acute left heart failure in the patients with CMD was still high (OR=9.120, 95%CI: 1.152-72.192, P=0.036). The area under ROC curve (AUC) was 0.677 (95%CI: 0.551-0.804, P=0.035). CONCLUSION The incidence of CMD detected by MCE in patients with AMI post-PCI was 60%. Patients with CMD have a higher risk of acute left heart failure during hospitalization.
Humans ; Heart Failure/physiopathology* ; Microcirculation ; Percutaneous Coronary Intervention/adverse effects* ; Myocardial Infarction/complications* ; Male ; Female ; Hospitalization ; Middle Aged ; Aged ; Echocardiography ; Coronary Circulation ; Predictive Value of Tests ; Troponin I/blood*

Objective: To screen and identify the key active molecules, signaling pathways, and therapeutic targets of Shuxuening (SXN) injection for treating liver cirrhosis (LC) and to evaluate its therapeutic potential using a mouse model. Methods: Target genes of SXN and LC were retrieved from public databases, and enrichment analysis was performed. A protein–protein interaction (PPI) network was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING), and hub genes were identified using Molecular Complex Detection (MCODE). LC was induced in rats and mice via intraperitoneal injections of diethylnitrosamine and carbon tetrachloride (CCl4) for 12 weeks. Starting at week 7, SXN was administered intraperitoneally to the mice in the treatment group. Serum and liver tissues of the mice were collected for the detection of indicators, pathological staining, and expression analysis of hub targets using quantitative real-time polymerase chain reaction (qRT-PCR). Results: We identified 368 overlapping genes (OLGs) between SXN and LC targets. These OLGs were subsequently used to build a PPI network and to screen for hub genes. Enrichment analysis showed that these genes were associated with cancer-related pathways, including phosphoinositide-3-kinase/Akt and mitogen-activated protein kinase signaling and various cellular processes, such as responses to chemicals and metabolic regulation. In vivo experiments demonstrated that SXN treatment significantly improved liver function and pathology in CCl4-induced LC mice by reducing inflammation and collagen deposition. Furthermore, qRT-PCR demonstrated that SXN regulated the expression of MAPK8, AR and CASP3 in the livers of LC mice. Conclusion This study highlighted the therapeutic effects of SXN in alleviating LC using both bioinformatics and experimental methods. The observed effect was associated with modulation of hub gene expression, particularly MAPK8, and CASP3.

Objective:To explore the role of clinical pharmacists participating in the management of prophylactic antibiotics during the perioperative period of thoracic surgery, and to evaluate the effects after participating in the practice.Methods:The use of antimicrobials during the perioperative period of thoracic surgery in Wenjiang Hospital of Sichuan Provincial People's Hospital in August 2019 (pre-practice) was retrospectively analyzed. The existing problems were summarized, and the possible causes of the existing problems were analyzed. The improvement measures were jointly developed by clinical pharmacists and physicians. Clinical pharmacists continued to manage the use of antimicrobials by means of medication order reviews, ward rounds for pharmacy service, and medication training. The use of prophylactic antibiotics during the perioperative period of thoracic surgery was compared between August 2019 (pre-practice group) and December 2019 (post-practice group) and the practical effect was evaluated.Results:Clinical pharmacists reviewed perioperative patients' medication orders once a day, ward rounds for pharmacy service twice a week, and medication training once a month. Twenty-two patients were enrolled before practice, and 26 patients were enrolled after practice. There were no significant differences in age, sex, body weight, operative time, type of surgical incision, and preventive use of antibiotics between the two groups (all P > 0.05). In the post-practice group, the appropriate time for preoperative administration was 100.0%, which was significantly higher than 88.2% in the pre-practice group. The reasonable rate of preoperative preventive drug selection was 100.0%, which was significantly higher than 44.4% in the pre-practice group ( χ2 = 17.50, P < 0.001). In the post-practice group, the duration of preventive medication was (1.82 ± 0.59) days, which was significantly shorter than (7.54 ± 3.25) days in the pre-practice group ( t = 11.97, P < 0.001). In the post-practice group, the cost of antibacterial drugs was 316.00(237.00,454.25) yuan, which was significantly lower than 1 136.00(391.81 , 2 184.65) yuan in the pre-practice group ( Z = -2.78, P < 0.05). The defined daily dose of antibiotics among inpatients was 2.67(2.00,3.42), which was significantly lower than 8.88(3.92 , 19.18) in the pre-practice group ( Z = -3.26, P < 0.05). There were no significant differences in the incidence of postoperative pulmonary infection and total length of hospital stay between the two groups (both P > 0.05). Conclusion:Clinical pharmacists participating in the management practice of perioperative prophylactic antibiotics in thoracic surgery can effectively promote the rational application of perioperative antibiotics, markedly improve the reasonable rate of prophylactic drug delivery, shorten the course of prophylactic drugs, reduce the cost of antibiotics, decrease the defined daily dose of antibiotics, without increasing the risk of postoperative pulmonary infection and the total length of hospital stay.

Objective: This study aimed to evaluate the role of preoperative two-dimensional (2D) shear wave elastography (SWE) in assessing the stages of liver fibrosis in patients with suspected biliary atresia (BA) and compared its diagnostic performance with those of serum fibrosis biomarkers. Materials and Methods: This study was approved by the ethical committee, and written informed parental consent was obtained. Two hundred and sixteen patients were prospectively enrolled between January 2012 and October 2018. The 2D SWE measurements of 69 patients have been previously reported. 2D SWE measurements, serum fibrosis biomarkers, including fibrotic markers and biochemical test results, and liver histology parameters were obtained. 2D SWE values, serum biomarkers including, aspartate aminotransferase to platelet ratio index (APRi), and other serum fibrotic markers were correlated with the stages of liver fibrosis by METAVIR. Receiver operating characteristic (ROC) curves and area under the ROC (AUROC) curve analyses were used. Results: The correlation coefficient of 2D SWE value in correlation with the stages of liver fibrosis was 0.789 (p < 0.001). The cut-off values of 2D SWE were calculated as 9.1 kPa for F1, 11.6 kPa for F2, 13.0 kPa for F3, and 15.7 kPa for F4. The AUROCs of 2D SWE in the determination of the stages of liver fibrosis ranged from 0.869 to 0.941. The sensitivity and negative predictive value of 2D SWE in the diagnosis of ≥ F3 was 93.4% and 96.0%, respectively. The diagnostic performance of 2D SWE was superior to that of APRi and other serum fibrotic markers in predicting severe fibrosis and cirrhosis (all p < 0.005) and other serum biomarkers. Multivariate analysis showed that the 2D SWE value was the only statistically significant parameter for predicting liver fibrosis. Conclusion 2D SWE is a more effective non-invasive tool for predicting the stage of liver fibrosis in patients with suspected BA, compared with serum fibrosis biomarkers.

Objective: This study aimed to evaluate the role of preoperative two-dimensional (2D) shear wave elastography (SWE) in assessing the stages of liver fibrosis in patients with suspected biliary atresia (BA) and compared its diagnostic performance with those of serum fibrosis biomarkers. Materials and Methods: This study was approved by the ethical committee, and written informed parental consent was obtained. Two hundred and sixteen patients were prospectively enrolled between January 2012 and October 2018. The 2D SWE measurements of 69 patients have been previously reported. 2D SWE measurements, serum fibrosis biomarkers, including fibrotic markers and biochemical test results, and liver histology parameters were obtained. 2D SWE values, serum biomarkers including, aspartate aminotransferase to platelet ratio index (APRi), and other serum fibrotic markers were correlated with the stages of liver fibrosis by METAVIR. Receiver operating characteristic (ROC) curves and area under the ROC (AUROC) curve analyses were used. Results: The correlation coefficient of 2D SWE value in correlation with the stages of liver fibrosis was 0.789 (p < 0.001). The cut-off values of 2D SWE were calculated as 9.1 kPa for F1, 11.6 kPa for F2, 13.0 kPa for F3, and 15.7 kPa for F4. The AUROCs of 2D SWE in the determination of the stages of liver fibrosis ranged from 0.869 to 0.941. The sensitivity and negative predictive value of 2D SWE in the diagnosis of ≥ F3 was 93.4% and 96.0%, respectively. The diagnostic performance of 2D SWE was superior to that of APRi and other serum fibrotic markers in predicting severe fibrosis and cirrhosis (all p < 0.005) and other serum biomarkers. Multivariate analysis showed that the 2D SWE value was the only statistically significant parameter for predicting liver fibrosis. Conclusion 2D SWE is a more effective non-invasive tool for predicting the stage of liver fibrosis in patients with suspected BA, compared with serum fibrosis biomarkers.

Objective:To survey the influencing factors for depression based on path model analysis in late pregnant women, and to explore the interrelationships for depression.Methods:This cross-sectional study was conducted from January 2018 to March 2019.Antenatal women who came for a routine check-up at the antenatal clinic were invited to participate in the study.Collecting general information of pregnant women(including biological, psychological, social and other factors). The Hospital Anxiety and Depression Scale (HADS) was used to evaluate the incidence of depression during pregnancy.The differences between depression group and non-depression group were compared by SPSS 24.0, and the path analysis model was conducted by AMOS 21.0 to explore the influencing factors and interrelations of depression during pregnancy.Results:A total of 1 059 pregnant women completed questionnaire.The incidence of depression depression in third trimester women was 11.1%(118/1 059). The path model fitting well with the sample data(GFI=0.912, AGFI=0.901, RFI=0.920, CFI=0.931, RMSEA=0.033). Anxiety, psychological preparation for the current pregnancy, and level of education had both direct and indirect effects on depression in third trimester women(the total effects of the three factors were 0.381, -0.140 and -0.156, respectively). Sleep quality and family member with whom the pregnant women living during pregnancy had only direct effects (the effects were 0.136 and 0.107, respectively). Residence, monthly income of family and social support had only an indirect influence on depression(the effects were 0.175, 0.103, and 0.102, respectively).Conclusion:Path model analysis suggests that the residence, monthly income of family, family member with whom the pregnant women living during pregnancy and educational level are not easy to change. It is suggested the incidence of depression is reduced by intervening the pregnancy anxiety, social support, sleep quality and the psychological preparation for pregnancy.

Objective:To investigate the effect of cluster protection measures on postoperative infection in elderly lumbar disc herniation patients undergoing minimally invasive surgery by using intervertebral foramen mirror surgery.Methods:A total of 98 elderly lumbar disc herniation patients treated with the surgery in our hospital were enrolled from January 2018 to December 2019.They were randomized into the intervention group(n=49)receiving cluster protection measures and the routine group(n=49)receiving conventional protection measures.The incidences of infection and related indexes after surgery were compared between the two groups.Results:A total infection rate was higher in the routine group [16.33%(8/49)]than in the intervention group [4.08%(2/49)]( χ2=4.009, P=0.045). The operation time, out-of-bed activity time, hospitalization days and surgical blood loss were less in the intervention group than in the routine group[(30.4±1.1) min vs.(101.9±51.1) min, (1.6±0.7) d vs.(3.7±1.2) d, (4.3±0.6) d vs.(13.2±3.8) d, (54.8±7.3) ml vs.(142.7±69.6) ml, t=9.759, 10.193, 15.789 and 8.780, all P=0.000]. Conclusions:Compared with the routine prevention measures, the cluster prevention measures can ensure the perioperative safety, shorten the operation time and reduce surgical blood loss, out-of-bed activity time and hospitalization days.Therefore, after careful perioperative treatment and protection, the cluster prevention measures can relieve pain, restore function, reduce the incidences of postoperative infection and complications, and achieve satisfactory nursing results.

Objective:Explore the main measures and operation mechanism to improve the scientific and technological innovation capacity of district and county hospitals by taking advantage of medical consortium, to achieve the goal of targeted poverty alleviation.Methods:Combine the practical exploration and empirical study on the main measures and operating mechanism to improve the scientific and technological innovation capacity of district and county hospitals, pre-and post comparison were conducted to analyze the effectiveness.Results:During the construction of medical consortium, a district-level general hospital has seen obvious increase in the comparison of many achievement indicators of scientific and technological innovation, with the growth rate ranging from 66.67% to 700%.Conclusions:Based on medical consortium, the operation mechanism that takes discipline construction as the starting point and key discipline establishment as the target, Scientific and technological innovation incubation platform, incentive mechanism and regular summary and evaluation can encourage district and county hospitals to improve scientific and technological innovation ability.

Objective: To analyze and compare the changes of cardiac structure and function in patients with borderline pulmonary hypertension. Methods: Echocardiographic data of 617 outpatients from February to October 2018 in Peking University People′s Hospital were retrospectively analyzed. According to the estimated mean pulmonary artery pressure (mPAP), the patients were divided into normal group (mPAP<19 mmHg), borderline group (19 mmHg≤mPAP<25 mmHg) and elevated group (mPAP≥25 mmHg). Results: ①Compared with normal group，the patients were older in borderline group and elevated group[(39.2±10.1)years old vs (46.5±13.5)years old vs (51.8±14.2)years old，all P<0.001] and the proportions of male were relatively lower (69.9% vs 58.9% vs 54.4%，all P<0.01). The incidences of smoking，drinking and cardiovascular complications increased significantly. ②Compared with normal group，the left atrium[(30.2±8.2)ml/m² vs (34.5±9.7)ml/m²，P<0.001]，left ventricle[(57.4±11.6)ml/m² vs (60.6±12.5)ml/m²，P<0.01]and right atrium[(19.5±5.9)ml/m² vs (22.6±7.0)ml/m²，P<0.001] were enlarged in borderline group.Left ventricular global long-axis strain (GLS_LV) increased[(-20.1±2.5)% vs (-21.1±3.1)%，P<0.001]，but the long-axis strain in the middle segment of right ventricular free wall (GLS_RVFWmid) decreased[(-31.4±6.6)%对(-27.2±8.8)%，P<0.001] in borderline group.Meanwhile，left ventricular diastolic function was impaired. ③Age，sex，right atrial volume，right ventricular area，RV-S′，GLS_LV，GLS_RVFWmid and mitral valve E/e′ were independent risk factors for mPAP elevation. Conclusions Early changes of cardiac structure and function exist in the patients with borderline pulmonary hypertension. Echocardiography is critical for the early diagnosis and follow-up monitoring of pulmonary hypertension.