OBJECTIVE: To construct and validate a predictive model for the therapeutic effect of acupuncture at Tongdu Yangxin prescription (acupoint prescription for promoting the circulation of the governor vessel and nourishing the heart) on insomnia, so as to develop an open-access interactive artificial intelligence (AI)-assisted decision-making platform. METHODS: Clinical data of 139 insomnia patients treated with Tongdu Yangxin acupuncture therapy were included. All the patients had received acupuncture at Baihui (GV20), Yintang (GV24⁺), bilateral Shenmen (HT7), and bilateral Sanyinjiao (SP6); and electric stimulation was attached to Baihui (GV20) and Yintang (GV24⁺), using a continuous wave and a frequency of 2 Hz. The treatment was delivered once every other day, 3 treatments a week, and for 2 consecutive weeks. Patients with Pittsburgh sleep quality index (PSQI) score reduction rate <50% were classified as the "no response group", and those with ≥50% were as the "response group". Outliers were addressed using the 1.5×IQR rule, and missing values were imputed via predictive mean matching. Key features were selected by intersecting the feature importance results from eXtreme Gradient Boosting (XGBoost) and random forest algorithms. After balancing class distribution using the Synthetic Minority Over-sampling Technique (SMOTE), 20% of the data was reserved as a validation set. The remained data underwent the stratified sampling iterations to generate 200 pairs of 3∶1 training-test sets, which was employed for training and internal validation of 8 machine learning algorithms. The optimal algorithm and data partitioning strategy were selected to construct the final model, followed by external validation. The best-performing model was deployed online via Streamlit to create an interactive AI platform. RESULTS: Key predictive features for model construction included insomnia duration, the total PSQI score, PSQI sleep efficiency subscore, the proportion of N1 and N2 sleep stages in total sleep duration, and the maximum pulse rate during sleep. The CatBoost-based model achieved an AUC of 0.92, the average precision of 0.77, and accuracy, average recall, and average F1-score of 0.75 on the test set. On the validation set, it attained an AUC of 0.84, with accuracy, average precision, average recall, and average F1-score all at 0.72, demonstrating robust predictive performance. An interactive AI platform was subsequently developed (https://tdyx-catboost.streamlit.app/). CONCLUSION This study successfully establishes and validates a CatBoost-based efficacy prediction model for Tongdu Yangxin acupuncture therapy in treatment of insomnia. The developed AI platform provides data-driven decision support for acupuncture-based insomnia management.
Humans ; Sleep Initiation and Maintenance Disorders/physiopathology* ; Acupuncture Therapy ; Male ; Acupuncture Points ; Female ; Middle Aged ; Adult ; Artificial Intelligence ; Aged ; Young Adult

Objective: To evaluate the effectiveness for the construction of "mosquito-free village" in Xuejia Village, Pujiang County, Zhejiang Province, so as to provide the guidance for the construction of "mosquito-free village" in other rural areas. Methods: Density of adult mosquitoes in Xuejia Village was investigated using light trap method and density of larval mosquitoes was investigated using larval straw method from April to November each year. Totally 30 households of villagers were randomly selected, and their awareness rates of mosquito control knowledge, mosquito control behavior forming rates and satisfaction rates were surveyed through questionnaires. Investment during construction (from August 2016 to December 2018) and maintenance period (from 2019 to 2023) of "mosquito-free village" were investigated through data review and interviews. Long-term effects of "mosquito-free village" construction in Xuejia Village were evaluated in terms of mosquito density from 2016 to 2023, effectiveness of health education for villagers, satisfaction and investment. Results: Compared with the year 2016, the densities of adult and larval mosquitoes in Xuejia Village were significantly decreased from 2017 to 2023. The average monthly density of adult mosquitoes in 2023 decreased by 98.34%, and the average monthly 100 household index of larval mosquitoes decreased by 98.45% compared to 2016. The average monthly density of adult mosquitoes from 2019 to 2023 was less than or equal to one mosquito per light trap in a night, and the average monthly 100 household index of larval mosquitoes was less than or equal to five places per 100 households. The awareness rate of mosquito control knowledge was 93.33%, the behavior forming rate was 86.67%, and the satisfaction rate was 90.00%. By December 2023, the total investment during construction and maintenance period was 450 thousand Yuan, with an average annual investment of 60.7 thousand Yuan and average annual investment of 206.61 Yuan per household. The average annual investment during maintenance period was 36.2 thousand Yuan, and the average annual investment per household was 109.70 Yuan. Conclusion The mosquito density, effectiveness of health education for villagers and satisfaction of "mosquito-free village" in Xuejia Village all meet the evaluation criteria of "mosquito-free village", and the investment is reasonable, making it suitable for promotion to other rural areas.

Objective:To introduce the therapeutic effect of forearm radial artery perforator propeller flap for repair of hand and wrist soft tissue defects.Methods:The clinical data of patients with soft tissue defects of hand and wrist who received the treatment with forearm radial artery perforator propeller flap in Northern Jiangsu People’s Hospital from January 2018 to September 2020 were collected. The radial artery of the forearm was projected on the skin surface as the axis, and the nearest perforator was selected as the rotation point according to the location of the soft tissue defect. The radial artery perforator propeller flap was designed based on the location, area and shape of soft tissue defect. The length of the large paddle of the flap is equal to the distance between the proximal side of the wound edge and the rotation point plus the length of the wound, and the length of the small paddle of the flap is equal to the distance between the proximal side of the wound edge and the rotation point. The donor site was closed directly or with full-thickness skin graft from the ipsilateral upper arm. The survival, appearance of the flap and skin graft, hand and wrist function and patients satisfactory rate were observed and recorded.Results:A total of 6 patients were included, including 4 males and 2 females; the mean age was 40.5 years (range, 25-65 years ). There were 1 case on the palm side of the hand, 1 case on the dorsal side of the hand, 3 cases on the volar side of the wrist, and 1 case on the dorsal side of the wrist. The area of soft tissue defect after debridement was 2 cm × 3 cm-7 cm × 10 cm. The forearm radial artery perforator propeller flap ranged from 3 cm × 4 cm to 8 cm × 11 cm. The donor site was closed directly in 3 cases, and with full-thickness skin graft in 3 cases. The flaps in all 6 patients survived completely with primary healing. The skin grafts for the donor site in 3 cases survived completely. The patients were followed up for 3 months to 1 year, with an average of 5 months. The function of the hand and wrist recovered well. The texture of the flap was similar to that of the surrounding tissue with good appearance, no swelling or slight swelling, no obvious color difference. The donor site healed well without scar hyperplasia. The patients were satisfied with the surgical results.Conclusion:Propeller flap pedicled with forearm radial artery perforator is a simple and effective method to repair soft tissue defects of wrist and hand with reliable recovery of appearance and function. The patients’ satisfactory rate is also high.

Objective:To introduce the therapeutic effect of forearm radial artery perforator propeller flap for repair of hand and wrist soft tissue defects.Methods:The clinical data of patients with soft tissue defects of hand and wrist who received the treatment with forearm radial artery perforator propeller flap in Northern Jiangsu People’s Hospital from January 2018 to September 2020 were collected. The radial artery of the forearm was projected on the skin surface as the axis, and the nearest perforator was selected as the rotation point according to the location of the soft tissue defect. The radial artery perforator propeller flap was designed based on the location, area and shape of soft tissue defect. The length of the large paddle of the flap is equal to the distance between the proximal side of the wound edge and the rotation point plus the length of the wound, and the length of the small paddle of the flap is equal to the distance between the proximal side of the wound edge and the rotation point. The donor site was closed directly or with full-thickness skin graft from the ipsilateral upper arm. The survival, appearance of the flap and skin graft, hand and wrist function and patients satisfactory rate were observed and recorded.Results:A total of 6 patients were included, including 4 males and 2 females; the mean age was 40.5 years (range, 25-65 years ). There were 1 case on the palm side of the hand, 1 case on the dorsal side of the hand, 3 cases on the volar side of the wrist, and 1 case on the dorsal side of the wrist. The area of soft tissue defect after debridement was 2 cm × 3 cm-7 cm × 10 cm. The forearm radial artery perforator propeller flap ranged from 3 cm × 4 cm to 8 cm × 11 cm. The donor site was closed directly in 3 cases, and with full-thickness skin graft in 3 cases. The flaps in all 6 patients survived completely with primary healing. The skin grafts for the donor site in 3 cases survived completely. The patients were followed up for 3 months to 1 year, with an average of 5 months. The function of the hand and wrist recovered well. The texture of the flap was similar to that of the surrounding tissue with good appearance, no swelling or slight swelling, no obvious color difference. The donor site healed well without scar hyperplasia. The patients were satisfied with the surgical results.Conclusion:Propeller flap pedicled with forearm radial artery perforator is a simple and effective method to repair soft tissue defects of wrist and hand with reliable recovery of appearance and function. The patients’ satisfactory rate is also high.

Objective:To analyze the clinical, imaging and pathological characteristics of pleomorphic xanthoastrocytoma (PXA), and to explore the effective treatment of PXA.Methods:A total of 25 patients with PXA admitted to our hospital from July 1, 2012 to December 1, 2019 were chosen in our study. Their clinical manifestations, imageology features, pathology features, treatments, and prognoses were retrospectively analyzed.Results:Headache ( n=12) and epilepsy ( n=8) were the most common first symptoms in 25 patients. The tumors in 8 patients were located in the parietal lobe, 6 were in the temporal lobe, and 6 were in the frontal lobe. Among the pathological results, the average positive rate of cell proliferation antigen Ki-67 and P53 in patients with WHO grading II was 6.4% and 21.2%, respectively; the average positive rate of Ki-67 and P53 in patients with WHO grading III was 22.2% and 48.3%, respectively. Synaptophysin protein was confirmed in 12 of the 15 patients. Twenty patients were followed up for 31 months after surgery; 19 survived; 9 had no tumor recurrence or residue, including 8 with WHO grading II and one with WHO grading III. Conclusion:Pathological result play an important role in PXA diagnosis; the prognosis of patients with WHO grading II is obviously better than that of patients with WHO grading III.

Objective:To investigate the clinical characteristics of R403C variant in DNM1L gene caused encephalopathy, lethal, due to defective mitochondrial peroxisomal fission 1 (EMPF1).Methods:The clinical data of three patients, who carried R403C variant in the DNM1L gene, diagnosed at Xiangya Hospital from February 2018 to February 2020 were retrospectively summarized. Literature reviewing was performed by taking "DNM1L" or "encephalopathy, lethal, due to defective mitochondrial peroxisomal fission 1" as keywords for searching in online Mendelian inheritance in man (OMIM), PubMed, China national knowledge infrastructure (CNKI), and Wanfang data knowledge service platform up to July 2020. And the clinical manifestation, laboratory examination, imaging, treatment, and prognosis were reviewed.Results:Case 1, a 7-year-old boy, developed seizures after a 9-day course of cough without fever. The seizures manifested as generalized tonic-clonic seizures (GTCS) and soon converted to focal status epilepticus (EPC) or focal myoclonus, which were resistant to multi-anti-epileptic drugs combined with sedative drugs. The boy died at the 2 nd week after seizure onset. Case 2, also a 7-year-old boy, developed seizures after a 10-day history of amygdalitis. The seizures manifested as focal to generalized tonic-clonic seizure and then converted to EPC or focal myoclonus. And all seizures showed poor responses to multi-anti-epileptic drugs combined with sedative drugs, ketogenic diet, and methylprednisolone treatment. The boy died after 1 month′s treatment. Case 3, a 3-year and 5-month old girl, had seizures onset after a 2-week course of viral pneumonia. The seizures onset manifested as focal clonic seizure and converted to EPC, shortly. She was resistant to multi-anti-epiletic drugs combined with sedative drugs and ketogenic treatment. The girl died 3 months afte seizure onset. All of their images showed multifocal T1 low, T2, fluid attenuated inversion recovery, and diffusion-weighted imaging high signal lesions among the brain, and diffuse brain atrophy in case 3. The blood metabolic and cerebrospinal-fluid immunological assays were normal. Genetic analysis suggested a de novo, heterozygous, NM_012062.4: c.1207C>T, p.R403C variant in the DNM1L gene. According to their clinical manifestations, all of them were diagnosed with EMPF1. Literature review included 11 patients carrying this variant in the world. Summarizing the 14 cases, 8 cases had an infectious history before seizure onset, 8 cases had mild or moderate development delay. All of 14 cases had seizures, and the forms mainly included EPC ( n=9), focal myoclonus ( n=6), GTCS ( n=5) and focal clonic seizures ( n=4). All of them were refractory, and no effective anti-epileptic drugs were recommended. Early-stage cranial magnetic resonance imaging results showed multiple intracranial focal lesions ( n=10), including thalamus ( n=7), hippocampus ( n=5), basal ganglia ( n=4), frontal lobe ( n=3), and temporal lobe ( n=2). As the disease progressed, the brain manifested as diffused progressive atrophy ( n=10). Five of the 14 cases died at reported age. Conclusions:R403C variant in the DNM1L gene can cause mitochondrial fission dysfunction. Patients carrying this variant may manifest as refractory status epilepticus with or without mild-infection indction, development regression and brain atrophy.

Objective To analyze the serum miRNA expression levels in non-obstructive azoospermia (NOA) patients and healthy sperm donors.Methods Serum miRNA levels in NOA patients and healthy sperm donors were analyzed by adopting the miRNA expression profiles chip.The data were processed and an alyzed by using the GenePix proV6.0 software to find out the differentially expressed miRNA,then the difference was verified by RQ-PCR,finally the bioinformatic software was utilized to predict the miRNA target gene.Results Compared to healthy sperm donors,71 cases of NOA had miRNAs expression difference,miRNA expression were increased in 47 cases and miRNAs expression was decreased in 24 cases.Moreover,Realtime PCR analysis verified the chip accuracy.The bioinformatic software target gene prediction showed that the potential target gene of these differential miRNA were involved in spermatogenesis.Conclusion The specific miRNA exists in serum miRNA of NOA,which helps to study the molecular mechanism of spermatogenesis.

OBJECTIVETo study the primary and secondary factors of the allergic history, the frequency of acupoint application and the time of acupoint application in the treatment of bronchial asthma and optimize its scheme.

METHODSEighty patients of bronchial asthma were selected as the subjects in the orthogonal trial. The herbal medicines were the empirical formula of acupoint application (prepared at the ratio as 2:2:1:1:1:1:1:1:1 of,, unprocessed,,,,,and) and used on bilateral Feishu (BL 13), Xinshu (BL 15), Geshu (BL 17) and Shenshu (BL 23). Firstly, two groups were divided according to allergic history (40 cases with allergic history and 40 cases without allergic history), and then four subgroups were divided on the basis of the two main groups, 10 cases in each one. Through studying three factors and two levels, i.e. allergic history (Factor A:A:with allergic history; A:without allergic history), the frequency of acupoint application (Factor B:B:4 times; B:10 times, in which, in the group of 4-time applications, the application was given once every 10 days; in the group of 10-time applications, the application was given once every 4 days); and the time of application (Factor C:C:4 h; C:8 h), the optimal scheme was screened on the basis of the attack frequency before and after treatment and the score of the asthma quality life questionnaire (AQLQ) before treatment and 6 months after treatment in the patients of each group.

RESULTS① The orthogonal trial indicated that the best optimal scheme was ABC, meaning the patients with allergic history were treated with acupoint application for 10 times, remained for 4 h. ②Factor B (frequency of acupoint application) and C (time of acpoint application) were the significant influential factors of AQLQ scores (both<0.05). ③The comparison of the attack frequency and AQLQ score before and after treatment in all of the patients showed that the different combinations of factor levels induced the different impacts on the asthma attack frequency and AQLQ scores. Except in the group No.1 and the group No.5, the improvements were all significant in the rest groups, indicating the significant differences (<0.05,<0.01).

CONCLUSIONSAcupoint application reduces apparently the attack frequency of asthma in the patients and improves the living quality. The primary and secondary relationship among the allergic history, the frequency of acupoint application and the time of acupoint application for the impacts on the therapeutic effects are:the frequency of acupoint application > the time of acupoint application > the allergic history. The best optimal scheme is ABC, meaning the patients with allergic history are treated with acupoint application for 10 times, remained for 4h.

Objective: The aim of the study is to validate whether the Recognition Of Stroke In the Emergency Room (ROSIER) scale can be used by general practitioners (GPs) in an emergency medical service (EMS) protocol to transfer stroke patients from primary care center to advanced hospital with acute stroke center. Methods: GPs prospectively performed the ROSIER scale and the Cincinnati Prehospital Stroke Scale (CPSS) on suspected stroke patients as a transfer protocol. All patients were immediately transferred to the Level-II hospital for further treatment. Results: 468 of the 512 suspected stroke patients met the inclusion criteria in this study. The ROSIER scale showed a diagnostic sensitivity of 83.13% (95% confidence intervals [CI] 79.74-86.52%) and specificity of 80.88% (95% CI 77.32- 84.44%). The CPSS showed a diagnostic sensitivity of 78.01% (95% CI 74.26-81.76%) and specificity of 70.59% (95% CI 66.46-74.72%). The Kappa statistic value of the ROSIER scale and the CPSS were 0.601 and 0.454, respectively. The area under the curve (AUC) of ROSIER scale was large than the CPSS (AUC 0.855 vs. 0.791). However, the difference was not significantly different. Conclusions: This study suggest that ROSIER and CPSS could be used in an EMS protocol to transfer stroke patients from a primary care center to an advanced hospital offering thrombolysis service
Stroke

Objective To observe the clinical efficacy of acupuncture at Xinming points (Extra) plus strong rein-forcing mani- pulation in treating optic atrophy.Methods Forty (56 eyes) optic atrophy patients were randomly allocated to a treatment group of 20 cases (29 eyes) and a control group of 20 cases (27 eyes). The control group received conventional medications, and the treatment group received acupuncture at Xinming points (Extra) plus strong reinforcing manipulation in addition. The visual acuity, the mean visual sensitivity (MS) of visual field and the P100 wave latency of P-VEP were recorded in the two groups before and after the treatment. The clinical therapeutic effects were compared between the two groups.Results The visual acuity, the MS of visual field and the P100 wave latency of P-VEP were significantly changed after treatment in both two groups (P<0.05). After the treatment, there were statistically significant differences in the visual acuity, the MS of visual field and the P100 wave latency of P-VEP between the two groups (P<0.05). The total efficacy rate was 75.0% in the treatment group versus 35.0% in the control group, and the difference was statistically significant (P<0.05).Conclusions Acupuncture at Xinming points (Extra) plus strong reinforcing manipulation is an effective method for optic atrophy.