OBJECTIVE: To screen the optimal regimen of acupuncture and moxibustion for obstructive sleep apnea hypopnea syndrome (OSAHS), so as to provide the evidences for clinical decision-making. METHODS: From 7 databases in Chinese and English i.e. the Full-Text Database of China Journal Network (CNKI), Wanfang Data Knowledge Service Platform (Wanfang), VIP Information Chinese Journal Service Platform (VIP), Chinese Biomedical Literature Database (SinoMed), PubMed, Web of Science (WOS) and Cochrane Library, randomized controlled trial (RCT) articals of OSAHS treated with acupuncture and moxibustion were searched. The quality of evidence was evaluated with the modified Jadad scale, the evaluation index was established and the optimal regimen of acupuncture and moxibustion for OSAHS was screened by multi-index decision analysis. RESULTS: A total of 10 RCTs were included, and the filiform needling therapy was optimal in treatment of OSAHS. The acupoints included Lianquan (CV23), Danzhong (CV17), Zhongwan (CV12), and bilateral Kongzui (LU6), Pishu (BL20), Fenglong (ST40), Zusanli (ST36), Yinlingquan (SP9) and Zhaohai (KI6). Zusanli (ST36) received the reinforcing method, Pishu (BL20) and Fenglong (ST40) were stimulated with the reducing technique, and the rest acupoints with the uniform reinforcing-reducing. Each acupoint was manually manipulated once every 10 min during the needle retention for 30 min. Acupuncture was delivered once a day, 5 times a week and for consecutive 4 weeks. Among the included literature, the severity of disease was not reported in detail, the filiform needling was the dominant intervention, the local acupoints such as Lianquan (CV23) and Panglianquan (Extra) were mainly selected. The apnea-hypopnea index and the minimum oxygen saturation were taken as the evaluation indexes, and the effect was evaluated in reference to the generally accepted standards. The attention to safety evaluation was insufficient, the report on methodology was not adequate and the quality was low. CONCLUSION Filiform needling is the dominant therapy of acupuncture and moxibustion for OSAHS, and the local acupoints are considered specially. But the quality of clinical research should be improved.
Humans ; Moxibustion ; Acupuncture Therapy ; Sleep Apnea, Obstructive/therapy* ; Acupuncture Points ; Randomized Controlled Trials as Topic

Gene therapy, harnessing the power of CRISPR-Cas9 and/or DNAzyme systems, stands as a pivotal approach in cancer therapy, enabling the meticulous manipulation of genes pivotal to tumorigenesis and immunity. However, the pursuit of precise gene therapy encounters formidable hurdles. Herein, a near-infrared upconversion theranostic nanomachine is devised and tailors for CRISPR-Cas9/DNAzyme systems mediate precise gene therapy. An ingenious logic DNAzyme system consists of Chain 1 (C1)/Chain 2 (C2) and endogenous lncRNA is designed. We employ manganese modified upconversion nanoparticles for carrying ultraviolet-responsive C1-PC linker-C2 (C₂P) chain and Cas9 ribonucleoprotein (RNP), with outermost coats with hyaluronic acid. Upon reaching tumor microenvironment (TME), the released Mn²⁺ ions orchestrate a trifecta: facilitating endosomal escape, activating cGAS-STING signaling, and enabling T1-magnetic resonance imaging. Under near-infrared irradiation, Cas9 RNP/C₂P complex dissociates, releasing Cas9 RNP into the nucleus to perform gene editing of Ptpn2, while C1/C2 chains self-assemble with endogenous lncRNA to form a functional DNAzyme system, targeting PD-L1 mRNA for gene silencing. This strategy remodels the TME by activating cGAS-STING signaling and dual immune checkpoints blockade, thus realizing tumor elimination. Our theranostic nanomachine armed with the CRISPR-Cas9/DNAzyme logic systems, represents a resourceful and promising strategy for advancing cancer systemic immunotherapy and precise gene therapy.

AIM:To compare the effects of 0.01% with 0.05% atropine eye drops on pupil diameter(PD)and intraocular pressure(IOP)in myopic children.METHODS: Prospective non-randomized controlled study. A total of 232 myopic children who treated at the Department of Ophthalmology, the Second People's Hospital of Puyang from March 2021 to February 2022 were included. They were divided into 0.01% atropine eye drops group(81 cases), 0.05% atropine eye drops group(77 cases), and control group(74 cases)according to patients' will, respectively. The control group received placebo eye drops(isotonic excipient). The PD and IOP of the three groups of patients were measured before medication and at 6 and 12 mo after medication.RESULTS: Finally, 181 cases(181 eyes)(with all right eye data included in the study)completed a 1-year follow-up, with a loss to follow-up rate of 22.0%(51/232). Among them, 62 cases(62 eyes)belonged to the 0.01% atropine eye drops group, 54 cases(54 eyes)belonged to the 0.05% atropine eye drops group, and 65 cases(65 eyes)belonged to the control group. There was no significant difference in baseline PD and IOP among the three groups(all P<0.05). After 12 mo of medication, the changes in PD among the 0.01% atropine eye drops group, 0.05% atropine eye drops group, and control group were 0.79±0.70, 1.29±0.66, and 0.06±0.74 mm, respectively(P<0.001). The change in PD in the 0.05% atropine eye drops group was significantly greater than that in both the 0.01% atropine eye drops group and the control group. Similarly, the change in PD in the 0.01% atropine eye drops group was significantly greater than that in the control group(all P<0.05). After 12 mo of medication, the changes in IOP among the 0.01% atropine eye drops group, 0.05% atropine eye drops group, and control group were -0.70±1.94, -0.22±1.79, and 0.25±2.03 mmHg, respectively(P<0.05). The changes in IOP in the 0.05% atropine eye drops group showed statistically significant difference compared to both the 0.01% atropine eye drops group and the control group(all P>0.05), and the changes in IOP in the 0.01% atropine eye drops group were statistically significant compared to the control group(P<0.05). Multivariate linear regression analysis revealed that baseline refractive error and baseline PD were significant factors influencing the change in PD among children treated with atropine eye drops(β=0.230, 95%CI: 0.005-0.455, SE=0.114, t=2.025, P=0.045; β=-0.562, 95%CI: -0.729--0.396, SE=0.084, t=6.697, P<0.001). Additionally, baseline IOP was significant factor influencing the change in IOP among children in the atropine eye drop groups(β=-0.285, 95%CI: -0.439--0.131, SE=0.078, t=3.662, P<0.001).CONCLUSION: The PD of myopic children increased after using 0.01% and 0.05% atropine eye drops, and the change in PD after using 0.05% atropine eye drops was significantly greater than that of 0.01% atropine eye drops. No risk was found in the use of 0.01% and 0.05% atropine eye drops and elevated IOP.

Objective:To investigate the predictive value of low-grade inflammation (LGI) score for the outcome of endovascular thrombectomy (EVT) in patients with anterior circulation large vessel occlusive stroke.Methods:Patients with anterior circulation large artery occlusive stroke received EVT at two stroke centers, Nantong Haimen District People's Hospital and Nanjing First Hospital from August 2020 to February 2023 were included retrospectively. The LGI score was calculated based on C-reactive protein, leukocyte count, platelet count, and neutrophil/lymphocyte ratio. At 90 days after onset, the modified Rankin Scale was used for outcome evaluation, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the correlation between LGI scores and outcome. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of LGI score and its individual biomarkers for poor outcome. Results:A total of 575 patients were enrolled, including 326 males (56.7%), aged 70.7±10.8 years. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 14.8±7.4, and the baseline Alberta Stroke Program Early CT Score (ASPECTS) was 8.6±1.1. Two hundred and ten patients (36.5%) received intravenous thrombolysis, 295 (51.3%) had poor collateral circulation, and 505 (87.8%) had successful recanalization. Sixty-five patients (11.3%) experienced symptomatic intracranial hemorrhage (sICH) within 72 hours after EVT, 256 (44.5%) had poor outcome at 90 days after onset, and 88 (15.3%) died within 90 days after onset. Univariate analysis showed that age, hypertension, diabetes, baseline NIHSS score, baseline ASPECTS, LGI score, sICH, stroke etiology classification, baseline blood glucose level, number of attempts to pass, location of occluded vessels, degree of vessel recanalization, and collateral status were associated with the poor outcome (all P<0.05). Multivariate logistic regression analysis showed that high LGI score was the independent predictive factor of poor outcome (odds ratio [ OR] 1.127, 95% confidence interval [ CI] 1.078-1.178; P=0.001), sICH ( OR 1.111, 95% CI 1.053-1.171; P=0.001), and death ( OR 1.120, 95% CI 1.057-1.186; P=0.001). ROC curve analysis showed that the area under the curve of LGI score predicting poor outcome was 0.705 (95% CI 0.663-0.747; P=0.001). The optimal cutoff value was -1.5 points. The sensitivity and specificity were 75.8% and 52.0%, respectively. Conclusions:A higher LGI score is associated with sICH within 72 hours after EVT, and poor outcome and death within 90 days after EVT in patients with anterior circulation large vessel occlusive stroke. LGI score has certain predictive value for the poor outcome after EVT.

Objective To investigate the factors associated with atrial fibrillation(AF)in patients with Type 2 Diabetes Mellitus(T2DM).Methods Through a case-control study,We selected 688 patients with T2DM who were hospitalized at the First Affiliated Hospital of Kunming Medical University from January 2015 to November 2021.Based on the AF diagnostic criteria,all the patients were divided into a case group(AF group)of 368 cases and a control group(non-AF group)of 320 cases.All patients'clinical data were collected and used Stata 15.1 st-atistical software were used for analyze the relevant influencing factors of AF in patients with T2DM.Results Age,duration of DM,glycated hemoglobin level,body mass index,left atrial diameter,creatinine,C2HEST score,and heart failure might be risk factors for AF in T2DM patients(P＜0.05);among them,age,glycated hemoglobin level,left atrial diameter,C2HEST score might be independent risk factors for AF in T2DM patients;the use of sodium-glucose co-transporter 2 inhibitors(Sodium/Glucose Co-transporter 2 Inhibitor,SGLT2i)and β-blockers(P＜0.05)might be its protective factors.Conclusion Old age,high HbA1c level,increased left atrial diameter,and high C2HEST score maight be independent risk factors for atrial fibrillation in T2DM patients.The use of SGLT2i and β-blockers in T2DM patients may have a protective effect on the occurrence of atrial fibrillation.

Objective:To explore the relationship among internet / reality alienation, irrational beliefs and depression in medical college students.Methods:In October 2021, a total of 501 students from five medical colleges in Shandong were selected by the convenient sampling method.All the participants were assessed by the internet alienation scale, general alienation scale, irrational beliefs scale and self rating depression scale.SPSS 24.0 software was used for descriptive analysis, correlation analysis, and AMOS 21.0 software was used to conduct structural equation modeling and Bootstrap mediated effect test.Results:The scores of internet/reality alienation, irrational beliefs and depression were 3.12±1.35, 2.04±0.57, 2.72±0.72, 2.07±0.42, respectively.There was a statistically significant positive correlation among internet/reality alienation, irrational beliefs and depression( r=0.56-0.64, P<0.01). Structural equation modeling showed that the mediating effect of irrational beliefs between internet alienation and depression was 0.05(95% CI=0.01-0.11). The mediating effect of irrational beliefs between reality alienation and depression was 0.16(95% CI=0.06-0.30). Conclusion:Internet/ reality alienation can indirectly effect depression of medical college students through the mediation of irrational beliefs.

Autoimmune diseases (ADs) are due to the lack ofautoantigen immune tolerance and they are chronic and heterogeneous conditions that affect specific target organs or multiple organ systems.Polyautoimmunity (PA) is defined as the presence of more than one AD in a single patient.It provides a major clinical evidence for autoimmune tautology and emphasizes that different immune phenotypes can coexist in the same individual (i.e.,individual carries a unique genotype).When three or more ADs coexist,this condition is called multiple autoimmune syndrome (MAS).This article will make a summary about the pathogenesis of autoimmune diseases and PA and MAS in several common clinical autoimmune diseases in order to help clinical work and further research.