OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Post-traumatic stress disorder (PTSD) is a psychiatric disorder caused by traumatic past experiences, rooted in the neurocircuits of fear memory formation. Memory processes include encoding, storing, and recalling to forgetting, suggesting the potential to erase fear memories through timely interventions. Conventional strategies such as medications or electroconvulsive therapy often fail to provide permanent relief and come with significant side-effects. This review explores how fear memory may be erased, particularly focusing on the mnemonic phases of reconsolidation and extinction. Reconsolidation strengthens memory, while extinction weakens it. Interfering with memory reconsolidation could diminish the fear response. Alternatively, the extinction of acquired memory could reduce the fear memory response. This review summarizes experimental animal models of PTSD, examines the nature and epidemiology of reconsolidation to extinction, and discusses current behavioral therapy aimed at transforming fear memories to treat PTSD. In sum, understanding how fear memory updates holds significant promise for PTSD treatment.
Fear/psychology* ; Extinction, Psychological/physiology* ; Animals ; Stress Disorders, Post-Traumatic/psychology* ; Humans ; Memory Consolidation/physiology* ; Memory/physiology*

Objective To explore and construct the clinical questions and outcome indicators of the Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome;To provide a basis for the subsequent preparation of this guide to form recommendations.Methods First,by searching the databases of seven major Chinese and English journals,including CNKI,the preliminary list of clinical problems and outcome indicators in the Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome were sorted out,and then the clinical questions and outcome indicators that formed the recommendations of the guide were finally determined based on the modified Delphi method in the form of three rounds of online.The first two rounds were conducted in the form of online questionnaires filled out by experts,and the importance ratings of clinical issues and outcome indicators were imported into the SPSS 27.0 software for statistical analysis.The first and second rounds of clinical questions and outcome indicators were rated as the average score≥4,full score frequency≥30%,and the coefficient of variation≤25%,respectively;the inclusion criteria for entering the second round of evaluation were an average score of≥7 and an average score of≤25%.The third round would be further discussed and voted on by experts in an online consensus meeting,with a voting rate of≥80%as the standard to determine the final items to be included in the guidelines.Results A total of 109 questionnaires were distributed nationwide in the first round of inquiry,and 107 were collected;a total of 20 questionnaires were distributed for the second round of expert research,and 20 were collected.The positive coefficients of the first and second rounds of experts were 98.17%and 100%;the Cronbach coefficients of clinical questions were 0.937 and 0.943,respectively;the Cronbach coefficients of the outcome indicators were 0.970 and 0.940,respectively.In the third round,a total of 22 experts participated in the meeting and all voted,resulting in a positive coefficient of 100%and an authority coefficient of 0.88.13 clinical questions and 17 outcome indicators were finally included in Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome.Conclusion According to the results of the above three rounds of modified Delphi method,it indicates that the questionnaire survey in the process of formulating the guidelines is highly reliable,which can provide a reliable basis for the writing of this guide,and to provide a reference for the development of acupuncture guidelines in related fields.

Objective : To investigate the effects of heat shock protein 70 ku protein 1A(HSPA1A) on H9c2 inflammation and apoptotic injury in rat cardiomyocytes under hypoxia, and to analyze its mechanism. Methods: H9c2 cells were treated with normal oxygen(Nor) and hypoxia(Hyp), and the expression of HSPA1A was detected by RT-qPCR and Western blot. Normal H9c2 cells were divided into Nor group(normoxia culture), sh-HSPA1A+Nor group(cells transfected with HSPA1A shRNA, normoxia culture), Hyp group(hypoxia culture), sh-HSPA1A+Hyp group(cells transfected with HSPA1A SHRNA, hypoxia culture), the expression level of HSPA1A in H9c2 cells in each group was detected by RT-qPCR and Western blot, the morphology of H9c2 cells in each group was observed by inverted microscope, and the activity of H9c2 cells in each group was detected by CCK-8, the contents of inflammatory factors tumor necrosis factor-α(TNF-α), interleukin(IL)-6, IL-1β and the activities of myocardial injury markers lactate dehydrogenase(LDH), creatine kinase(CK) in the supernatant of H9c2 cells were detected by ELISA, apoptosis rate of H9c2 cells in each group was detected by Annexin V-FITC/PI double staining, the expression levels of TNF receptor-associated factor 2(TRAF2)/nuclear factor κB(NF-κB) pathway-related proteins in H9c2 cells of each group were detected by Western blot. Results: Compared with Nor group, the relative expression of HSPA1A mRNA and protein in H9c2 cells in Hyp group after hypoxia induction was significantly up-regulated(P<0.05). Compared with Nor group, the number of H9c2 cells in Hyp group significantly decreased, some cells were wrinkled and disordered, the cell activity significantly decreased(P<0.05), the contents of TNF-α, IL-6, IL-1β and the activities of LDH and CK in supernatant significantly increased(P<0.05), the cell apoptosis rate significantly increased(P<0.05), the relative expressions of TRAF2 protein and the phosphorylation level of p65 and inhibitor of nuclear factor κB alpha(IκBα) were significantly up-regulated(P<0.05); compared with Hyp group, the morphology of H9c2 cells in sh-HSPA1A+Hyp group was improved, the cell arrangement was more dense, the cell activity significantly increased(P<0.05), the contents of TNF-α, IL-6 and IL-1β in supernatant decreased, the activities of LDH and CK significantly decreased(P<0.05), the apoptosis rate significantly decreased(P<0.05), the relative expressions of TRAF2 protein and the phosphorylation level of p65 and IκBα were also significantly down-regulated(P<0.05). Conclusion The expression of HSPA1A in rat cardiomyocytes H9c2 is increased by hypoxia, and inhibition of HSPA1A expression can improve the hypoxia-induced inflammatory response of H9c2 cells and reduce apoptosis damage, which may be related to the regulation of TRAF2/NF-κB pathway.

Background:With the widespread use of vonoprazan-based dual therapy for Helicobacter pylori(Hp)eradication,a comparative analysis of its efficacy and safety against bismuth-containing quadruple therapy is warranted.Aims:To compare the efficacy and safety of vonoprazan and amoxicillin-based 14-day dual therapy and 10-day bismuth-containing quadruple therapy for eradication of Hp infection.Methods:This study is a single-center,prospective,randomized,controlled,open-label,non-inferiority trial.Patients with chronic gastritis,diagnosed with Hp infection and scheduled for eradication therapy at Yuancheng District People's Hospital between December 2023 and December 2025 are planned to enroll in this study and randomly assigned into two groups.Patients in the control group received bismuth-containing quadruple therapy(vonoprazan 20 mg+bismuth potassium citrate 220 mg+amoxicillin 1.0 g+furazolidone 0.1 g,all twice daily)for 10 days,and those in the treatment group received dual therapy(vonoprazan 20 mg twice daily+amoxicillin 1.0 g three times daily)for 14 days.Both groups were supplemented with compound lactobacillus capsule.Adverse events were recorded during the treatment period.Hp eradication was assessed by 13C-or 14C-urea breath test at least four weeks after the completion of therapy.Results:As of the interim analysis,a total of 160 patients have been enrolled in the study,with 80 in each group.The per-protocol(PP)Hp eradication rates were 93.6%(95%CI:85.6%-97.9%)for the treatment group and 94.7%(95%CI:86.8%-98.5%)for the control group,with an intergroup difference of-1.147%(95%CI:-8.5%-6.1%).While in intention-to-treat(ITT)analysis,the Hp eradication rates were 91.2%(95%CI:82.9%-96.4%)for the treatment group and 90.0%(95%CI:81.2%-95.6%)for the control group,with an intergroup difference of 1.25%(95%CI:-7.8%-10.4%).Non-inferiority was confirmed for both PP and ITT analyses(P=0.012,P=0.021).No significant difference in symptoms relieve was observed between the two groups(92.1%vs.91.0%,P=0.81).The incidence of adverse events was significantly lower in the treatment group(7.7%vs.18.4%,P=0.043).The symptoms were mild and required no intervention.Conclusions:The 14-day vonoprazan-amoxicillin dual therapy is non-inferior to 10-day bismuth-containing quadruple therapy in Hp eradication rate with fewer adverse events,making it a preferred option for family-based management and primary care settings for Hp eradication.

Background:With the widespread use of vonoprazan-based dual therapy for Helicobacter pylori(Hp)eradication,a comparative analysis of its efficacy and safety against bismuth-containing quadruple therapy is warranted.Aims:To compare the efficacy and safety of vonoprazan and amoxicillin-based 14-day dual therapy and 10-day bismuth-containing quadruple therapy for eradication of Hp infection.Methods:This study is a single-center,prospective,randomized,controlled,open-label,non-inferiority trial.Patients with chronic gastritis,diagnosed with Hp infection and scheduled for eradication therapy at Yuancheng District People's Hospital between December 2023 and December 2025 are planned to enroll in this study and randomly assigned into two groups.Patients in the control group received bismuth-containing quadruple therapy(vonoprazan 20 mg+bismuth potassium citrate 220 mg+amoxicillin 1.0 g+furazolidone 0.1 g,all twice daily)for 10 days,and those in the treatment group received dual therapy(vonoprazan 20 mg twice daily+amoxicillin 1.0 g three times daily)for 14 days.Both groups were supplemented with compound lactobacillus capsule.Adverse events were recorded during the treatment period.Hp eradication was assessed by 13C-or 14C-urea breath test at least four weeks after the completion of therapy.Results:As of the interim analysis,a total of 160 patients have been enrolled in the study,with 80 in each group.The per-protocol(PP)Hp eradication rates were 93.6%(95%CI:85.6%-97.9%)for the treatment group and 94.7%(95%CI:86.8%-98.5%)for the control group,with an intergroup difference of-1.147%(95%CI:-8.5%-6.1%).While in intention-to-treat(ITT)analysis,the Hp eradication rates were 91.2%(95%CI:82.9%-96.4%)for the treatment group and 90.0%(95%CI:81.2%-95.6%)for the control group,with an intergroup difference of 1.25%(95%CI:-7.8%-10.4%).Non-inferiority was confirmed for both PP and ITT analyses(P=0.012,P=0.021).No significant difference in symptoms relieve was observed between the two groups(92.1%vs.91.0%,P=0.81).The incidence of adverse events was significantly lower in the treatment group(7.7%vs.18.4%,P=0.043).The symptoms were mild and required no intervention.Conclusions:The 14-day vonoprazan-amoxicillin dual therapy is non-inferior to 10-day bismuth-containing quadruple therapy in Hp eradication rate with fewer adverse events,making it a preferred option for family-based management and primary care settings for Hp eradication.

Objective To explore and construct the clinical questions and outcome indicators of the Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome;To provide a basis for the subsequent preparation of this guide to form recommendations.Methods First,by searching the databases of seven major Chinese and English journals,including CNKI,the preliminary list of clinical problems and outcome indicators in the Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome were sorted out,and then the clinical questions and outcome indicators that formed the recommendations of the guide were finally determined based on the modified Delphi method in the form of three rounds of online.The first two rounds were conducted in the form of online questionnaires filled out by experts,and the importance ratings of clinical issues and outcome indicators were imported into the SPSS 27.0 software for statistical analysis.The first and second rounds of clinical questions and outcome indicators were rated as the average score≥4,full score frequency≥30%,and the coefficient of variation≤25%,respectively;the inclusion criteria for entering the second round of evaluation were an average score of≥7 and an average score of≤25%.The third round would be further discussed and voted on by experts in an online consensus meeting,with a voting rate of≥80%as the standard to determine the final items to be included in the guidelines.Results A total of 109 questionnaires were distributed nationwide in the first round of inquiry,and 107 were collected;a total of 20 questionnaires were distributed for the second round of expert research,and 20 were collected.The positive coefficients of the first and second rounds of experts were 98.17%and 100%;the Cronbach coefficients of clinical questions were 0.937 and 0.943,respectively;the Cronbach coefficients of the outcome indicators were 0.970 and 0.940,respectively.In the third round,a total of 22 experts participated in the meeting and all voted,resulting in a positive coefficient of 100%and an authority coefficient of 0.88.13 clinical questions and 17 outcome indicators were finally included in Clinical Practice Guideline of Acupuncture and Moxibustion Treatment for Irritable Bowel Syndrome.Conclusion According to the results of the above three rounds of modified Delphi method,it indicates that the questionnaire survey in the process of formulating the guidelines is highly reliable,which can provide a reliable basis for the writing of this guide,and to provide a reference for the development of acupuncture guidelines in related fields.

The purpose of this study was to investigate the damage mechanism of pathogenic E.coli on mouse brain microvascular endothelial cells(BMEC cells)and mouse alveolar macrophages(MH-S cells),as well as the lung and brain of healthy mice.In this study,BMEC cells and MH-S cells were infected with pathogenic E.coli strains,and cell morphological changes were observed.Plate counting method was used to detect the adhesion and invasion ability of the strains to cells and the number of bacteria in the lungs and brains of mice.RT-qPCR was used to detect the ex-pression of TNF-α,IL-1β and IL-6 genes in cells and mouse organs at different time periods.West-ern blot was used to detect the expression of p-NF-κB,p-JAK2 and p-STAT3 proteins related to inflammation in cells and mouse organs after infection.The results showed that the cell culture medium of the infection group was turbid,the cell vision became dark and blurred,some cells shrank and died,and more fragments were produced.The adhesion rate and invasion rate of BMEC cells at 3 h were significantly lower than those at 6 h(P＜0.050),and the adhesion rate and inva-sion rate of MH-S cells at 3 h were significantly higher than those at 6 h(P＜0.010).Infected mice had a large area of swelling and bleeding in the brain,and the lungs had different degrees of swell-ing and bleeding.The bacterial load in the brain and lung was the highest at 12 h.Compared with the control group,the mRNA expression levels of IL-1β,IL-6 and TNF-α in the infection group were significantly increased at 3 h and 6 h(P＜0.050),and the mRNA expression levels of inflam-matory factors in BMEC cells and MH-S cells were the highest at 6 and 3 h,respectively.The mR-NA expression of inflammatory factors in the brain and lung of infected mice showed a trend of in-creasing first and then decreasing with time,with the highest expression at 12 h after infection.The expression levels of p-NF-κB protein in BMEC cells,MH-S cells,lung and brain tissues of mice in the infection group were significantly higher than those in the control group(P＜0.001),and the expression levels of p-JAK2 protein and p-STAT3 protein were significantly lower than those in the control group(P＜0.050).The above results showed that pathogenic E.coli could adhere and invade BMEC cells and MH-S cells,colonize in lung and brain tissues of mice,promote the expres-sion of NF-κB protein in cells and tissues,inhibit the expression of JAK2 protein and STAT3 pro-tein,and then stimulate cells and tissues to produce inflammatory response.

Background::Pulmonary embolism (PE) is a severe and acute cardiovascular syndrome with high mortality among patients with autoimmune inflammatory rheumatic diseases (AIIRDs). Accurate prediction and timely intervention play a pivotal role in enhancing survival rates. However, there is a notable scarcity of practical early prediction and risk assessment systems of PE in patients with AIIRD.Methods::In the training cohort, 60 AIIRD with PE cases and 180 age-, gender-, and disease-matched AIIRD non-PE cases were identified from 7254 AIIRD cases in Tongji Hospital from 2014 to 2022. Univariable logistic regression (LR) and least absolute shrinkage and selection operator (LASSO) were used to select the clinical features for further training with machine learning (ML) methods, including random forest (RF), support vector machines (SVM), neural network (NN), logistic regression (LR), gradient boosted decision tree (GBDT), classification and regression trees (CART), and C5.0 models. The performances of these models were subsequently validated using a multicenter validation cohort.Results::In the training cohort, 24 and 13 clinical features were selected by univariable LR and LASSO strategies, respectively. The five ML models (RF, SVM, NN, LR, and GBDT) showed promising performances, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.962-1.000 in the training cohort and 0.969-0.999 in the validation cohort. CART and C5.0 models achieved AUCs of 0.850 and 0.932, respectively, in the training cohort. Using D-dimer as a pre-screening index, the refined C5.0 model achieved an AUC exceeding 0.948 in the training cohort and an AUC above 0.925 in the validation cohort. These results markedly outperformed the use of D-dimer levels alone.Conclusion::ML-based models are proven to be precise for predicting the onset of PE in patients with AIIRD exhibiting clinical suspicion of PE.Trial Registration::Chictr.org.cn: ChiCTR2200059599.

Objective To analyze the detection efficiency of p16INK4a protein combined with human papillomavirus and liquid-based cytology(LCT)in the screening of cervical precancerous lesions,and to provide a basis for cervical cancer preven-tion and treatment.Methods The results of p16INK4a staining of cervical epithelial cells,human papillomavirus testing and cer-vical cytology were analyzed in 139 inpatients at Guangzhou Women's and Children's Medical Center between January 2019 and December 2020.Of them,there were 111 patients with cervical intraepithelial neoplasia(CIN)and 28 cases of cervical inflam-matory disease.The efficacy of the three methods alone and in combination to screen for CIN lesions was compared.Results In the detection of CIN patients,the sensitivity of p16INK4a,microfluidic microarray and cervical cytology for detecting CIN and a-bove lesions was 91.89% ,94.59% and82.88% ,with specificity of 57.14% ,17.86% and46.43% ,and AUC of 0.75,0.56 and 0.65,respectively;while the sensitivity of"p16INK4a+LCT","p16INK4a+hrHPV","LCT+hrHPV"and their sen-sitivity were 96.40% ,97.30% ,94.59% and 99.10% ,their specificity was 85.71% ,92.86% ,89.29% and 92.86% ,and the AUC was 0.91,0.95,0.92 and 0.96,respectively.Conclusion The combined p16INK4a and hrHPV test helps to improve diagnostic accuracy and early detection,thus allowing for earlier intervention or treatment.This combined application allows for more accurate identification of low-grade and high-grade cervical intraepithelial neoplasia,providing more information for indi-vidualized patient management.