Neoadjuvant Chemotherapy With CAPOX Versus Chemoradiation for Locally Advanced Rectal Cancer With Uninvolved Mesorectal Fascia (CONVERT): Initial Results of a Phase III Trial.

OBJECTIVE: To compare neoadjuvant chemotherapy (nCT) with CAPOX alone versus neoadjuvant chemoradiotherapy (nCRT) with capecitabine in locally advanced rectal cancer (LARC) with uninvolved mesorectal fascia (MRF). BACKGROUND DATA: nCRT is associated with higher surgical complications, worse long-term functional outcomes, and questionable survival benefits. Comparatively, nCT alone seems a promising alternative treatment in lower-risk LARC patients with uninvolved MRF. METHODS: Patients between June 2014 and October 2020 with LARC within 12 cm from the anal verge and uninvolved MRF were randomly assigned to nCT group with 4 cycles of CAPOX (Oxaliplatin 130 mg/m2 IV day 1 and Capecitabine 1000 mg/m2 twice daily for 14 d. Repeat every 3 wk) or nCRT group with Capecitabine 825 mg/m² twice daily administered orally and concurrently with radiation therapy (50 Gy/25 fractions) for 5 days per week. The primary end point is local-regional recurrence-free survival. Here we reported the results of secondary end points: histopathologic response, surgical events, and toxicity. RESULTS: Of the 663 initially enrolled patients, 589 received the allocated treatment (nCT, n=300; nCRT, n=289). Pathologic complete response rate was 11.0% (95% CI, 7.8-15.3%) in the nCT arm and 13.8% (95% CI, 10.1-18.5%) in the nCRT arm ( P =0.33). The downstaging (ypStage 0 to 1) rate was 40.8% (95% CI, 35.1-46.7%) in the nCT arm and 45.6% (95% CI, 39.7-51.7%) in the nCRT arm ( P =0.27). nCT was associated with lower perioperative distant metastases rate (0.7% vs. 3.1%, P =0.03) and preventive ileostomy rate (52.2% vs. 63.6%, P =0.008) compared with nCRT. Four patients in the nCT arm received salvage nCRT because of local disease progression after nCT. Two patients in the nCT arm and 5 in the nCRT arm achieved complete clinical response and were treated with a nonsurgical approach. Similar results were observed in subgroup analysis. CONCLUSIONS: nCT achieved similar pCR and downstaging rates with lower incidence of perioperative distant metastasis and preventive ileostomy compared with nCRT. CAPOX could be an effective alternative to neoadjuvant therapy in LARC with uninvolved MRF. Long-term follow-up is needed to confirm these results.

Critical Role of Simultaneous Reduction of Atmospheric Odd Oxygen for Winter Haze Mitigation.

The lockdown due to COVID-19 created a rare opportunity to examine the nonlinear responses of secondary aerosols, which are formed through atmospheric oxidation of gaseous precursors, to intensive precursor emission reductions. Based on unique observational data sets from six supersites in eastern China during 2019-2021, we found that the lockdown caused considerable decreases (32-61%) in different secondary aerosol components in the study region because of similar-degree precursor reductions. However, due to insufficient combustion-related volatile organic compound (VOC) reduction, odd oxygen (Ox = O3 + NO2) concentration, an indicator of the extent of photochemical processing, showed little change and did not promote more decreases in secondary aerosols. We also found that the Chinese provinces and international cities that experienced reduced Ox during the lockdown usually gained a greater simultaneous PM2.5 decrease than other provinces and cities with an increased Ox. Therefore, we argue that strict VOC control in winter, which has been largely ignored so far, is critical in future policies to mitigate winter haze more efficiently by reducing Ox simultaneously.

The influence of anastomotic leakage for rectal cancer oncologic outcome: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Anastomotic leakage is a serious complication after arterial resection of rectal cancer. It has been found that anastomotic leakage is related to the oncological outcome. The purpose of the study is to evaluate the long-term outcome of the rectal tumor after anastomotic leakage. METHODS: The effect of anastomotic leakage on the oncological outcome of rectal cancer was studied by electronic literature retrieval. Using the DerSimonian Laird random effect model to calculate the odds ratio and 95% confidence interval. Research heterogeneity was evaluated by Q statistics and I2 , and bias was evaluated by funnel plot and Begg's test. RESULTS: A total of 35 studies and 44 698 patients were included in the study. The studies have shown that anastomotic leakage is associated with local recurrence (OR = 1.93; 95% CI, 1.57-2.38; P < .0001), overall survival (OR = 1.64; 95% CI, 1.37-1.95; P < .00001), disease-free survival (OR = 2.07; 95% CI, 1.50-2.87; P < .00001) and cancer-specific survival (OR = 1.32; 95% CI, 1.02-1.70; P = .012), while it was not related to distant recurrence (OR = 1.25; 95% CI, 0.95-1.65; P = .12). CONCLUSIONS: The results showed that anastomotic leakage after anterior resection increased the risk of local recurrence, decreased the overall survival, cancer-specific survival and disease-free survival.

The Redox Coupling Effect in a Photocatalytic RuII -PdII Cage with TTF Guest as Electron Relay Mediator for Visible-Light Hydrogen-Evolving Promotion.

A nanocage coupling effect from a redox RuII -PdII metal-organic cage (MOC-16) is demonstrated for efficient photochemical H2 production by virtue of redox-guest modulation of the photo-induced electron transfer (PET) process. Through coupling with photoredox cycle of MOC-16, tetrathiafulvalene (TTF) guests act as electron relay mediator to improve the overall electron transfer efficiency in the host-guest system in a long-time scale, leading to significant promotion of visible-light driven H2 evolution. By contrast, the presence of larger TTF-derivatives in bulk solution without host-guest interactions results in interference with PET process of MOC-16, leading to inefficient H2 evolution. Such interaction provides an example to understand the interplay between the redox-active nanocage and guest for optimization of redox events and photocatalytic activities in a confined chemical nanoenvironment.

[Quantifiable changes in HBeAg expression predict therapeutic efficacy of peg-interferon alfa-2a in patients with HBeAg-positive chronic hepatitis B].

OBJECTIVE: To investigate whether quantifiable changes in serum levels of hepatitis B e antigen (HBeAg) in response to 24 weeks of pegylated-interferon alfa-2a (Peg-IFN-a 2a) treatment are predictive of therapeutic efficacy at 48 weeks of treatment in HBeAg-positive chronic hepatitis B (CHB) patients and to investigate the efficacy of using an individualized antiviral treatment strategy. METHODS: Ninety-six HBeAg-positive CHB patients with detectable HBeAg at week 24 of Peg-IFN-a 2a treatment were categorized according to the quantitative change in HBeAg (vs. pre-treatment baseline): group A, HBeAg decline more than 2 log; group B, HBeAg decline between 1 - 2 log; group C, HBeAg decline less than 1 log, which was then randomly divided into two sub-groups: C1 and C2. Group A, B, and C1 patients continued the original therapy for an additional 24 weeks, while group C2 patients were supplemented with lamivudine (3TC + Peg-IFN-a 2a) for the additional 24 weeks of treatment. All patients underwent liver biopsy at the end of treatment (week 48), and HBV covalently-closed circular (ccc)DNA was quantified as a measure of therapeutic efficacy. A, B, and C1 between-group multiple comparisons were made by the Nemenyi test; C1 and C2 between-group comparison was made by the Mann-Whitney U test. The significance of between-group differences in decreased HBV cccDNA vs. HBeAg/anti-HBe seroconversion was made by the Chi-squared test. RESULTS: At week 48, the mean decrease of serum HBV cccDNA in each group was: A, 5.8 log10 copy/ml; B, 3.8 log10 copy/ml; C1, 2.8 log10 copy/ml; C2, 5.7 log10 copy/ml. Statistically significant differences were observed for group A vs. B and C1 (P less than 0.01) and C1 vs. C2 (P less than 0.01); however, the difference between group B and C1 did not reach statistical significance (P = 0.19). The mean decrease of HBeAg in each group was: A, 2.7 log10 S/CO; B, 1.9 log10 S/CO; C1, 0.9 log10 S/CO; C2, 1.6 log10 S/CO. Statistically significant differences were observed for group A vs. B and C1 (P less than 0.01) and C1 vs. C2 (P less than 0.01). The rate of patients who achieved undetectable HBV DNA in each group was: A, 87.5%; B, 34.5%; C1, 17.4%; C2, 85.0%. Statistically significant differences were observed for group A vs. B and C1 (P less than 0.01) and C1 vs. C2 (P less than 0.01). The HBeAg seroconversion rates were: A, 75.0%; B, 24.1%; C1, 13.0%; C2, 25.0%. Statistically significant differences were observed only for group A vs. B and C1 (P less than 0.01). Finally, group A achieved greater reduction in levels of cccDNA in liver tissues than B or C1 (P less than 0.01); however, the differences between B and C1 and between C1 and C2 did not reach statistical significance. CONCLUSION: CHB patients who showed an HBeAg decline of more than 2 log at week 24 of Peg-IFN-a 2a treatment had better treatment outcome at week 48 than those who showed HBeAg decline less than 2 log at week 24. Augmenting the Peg-IFN-a 2a treatment with 3TC can improve the clinical response. A change of quantifiable HBeAg at week 24 of Peg-IFN-a 2a treatment may be a useful predictor of therapeutic efficacy of a 48-week antiviral regimen.

[The clinical application of compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx in controlling presacral venous plexus hemorrhage during rectectomy].

OBJECTIVE: To evaluate the effect of compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx in controlling presacral venous plexus hemorrhage during rectectomy. METHODS: From October 2002 to October 2012, 52 patients with rectal cancer received neoadjuvant radiotherapy and developed presacral venous plexus hemorrhage during rectectomy, included 36 male and 26 female cases. Their age were 36-65 years. The hemostasis time and blood loss were analyzed. RESULTS: All 52 patients achieved R0 resection. Of which 13 patients achieved suture hemostasis within 15 minutes, whereas 22 patients unsuccessfully treated within 15 minutes received compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx. The median blood loss was (196 ± 44)ml and hospitalization time was (15.2 ± 1.7)days in this group. Additionally, 7 patients achieved suture hemostasis within 20 minutes except 4 patients who received compression hemostasis, with a median blood loss of (1016 ± 86)ml and hospitalization time of (21.7 ± 6.3)days. Other 6 patients achieved suture hemostasis within 30 minutes except 3 patients who received compression hemostasis, with a median blood loss of (2508 ± 73)ml and the hospitalization time was (28.8 ± 3.3)days. There was statistically significant difference of bleeding (F = 4289.562) and hospitalization time (F = 50.121) in 3 groups of patients (P = 0.000). CONCLUSIONS: Once intraoperative presacral venous plexus hemorrhage can't be stopped timely, compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx is an effective alternative for the patients with rectal cancer who received neoadjuvant radiotherapy.

The Effect of Arthroscopic Extra-Articular Entire Coracohumeral Ligament Release for Patients with Recalcitrant Frozen Shoulder.

OBJECTIVE: The thickened coracohumeral ligament (CHL) is an important part of the typical manifestations and magnetic resonance imaging of frozen shoulder. However, only a few clinical studies with limited cases on arthroscopic extra-articular entire CHL release exist in the literature. This study was to evaluate the effect of arthroscopic extra-articular entire CHL release for patients with recalcitrant frozen shoulder. METHODS: From February 2014 to February 2020, 81 cases of recalcitrant frozen shoulder patients treated with surgery in a single-center shoulder department and followed for more than 2 years were analyzed. Arthroscopic 360° capsular release was performed with intra-articular partial release (IPR group) or additional extra-articular entire release (IPR + EER group) of CHL. The same rehabilitation program was performed after surgery in both groups. Visual analogue scale (VAS) for pain, range of motion (ROM), and the Constant-Murley scoring system was evaluated before operation, at 3 months after operation, 6 months after operation, and the final follow-up. T-test, Mann-Whitney U-test and chi-squared test were used to compared data. RESULTS: There were 39 patients in the IPR group, with an average follow-up of 29.2 months. A total of Forty-two patients in the IPR + EER group completed a mean follow-up of 25.7 months. All incisions healed in stages. There were significant differences in Constant-Murley shoulder score, VAS score, and ROM before operation and at the final follow-up in both groups (both P < 0.001). The VAS score of the IPR + EER group was lower than that of the IPR group at 3 months after surgery (P < 0.05), and 6 months after operation (P < 0.05). External rotation, internal rotation, and abduction of ROMs and Constant-Murley shoulder score were significantly greater in the IPR + EER group at 3 months (P < 0.001, P < 0.05, P < 0.001, P < 0.05, respectively) and 6 months after operation (P < 0.001, P < 0.05, P < 0.001, P < 0.05, respectively). At the last follow-up, there was no significant difference in forward flexion, internal rotation, and abduction of ROMs, VAS, and the Constant-Murley shoulder score between the IPR and IPR + EER groups. The external rotation of the IPR + EER group was still greater than that of the IPR group at the last follow-up (P < 0.001). CONCLUSION: Arthroscopic extra-articular entire coracohumeral ligament release could solve early pain of shoulder joint, recover shoulder joint functions effectively, and achieve a satisfactory efficacy in the treatment of recalcitrant frozen shoulder.

Emission characteristics of particulate matter emitted by typical off-road construction machinery.

Off-road machinery, especially construction equipment, is one of the most important pollutant sources of the deterioration in the air quality of Chinese urban areas owing to its large quantity and to the absence of stringent emission requirements. In this study, we used a portable emission measurement system (PEMS) to measure the exhaust pollutant emission characteristics for 13 pieces of construction machinery including excavators and hydraulic crushers under different working conditions, such as real-world operating condition, free accelerating condition, and overloading condition, innovatively adopting the method of synchronizing video recording and emission measurement to divide the operation process of construction machinery under different working conditions into different action stages. In addition, the relationship between the emission characteristics and the maintenance history of 13 pieces of construction machinery was analyzed. The present study exploits this recent progress to enrich the measurement method of off-road mobile machinery light absorption coefficient (LAC), which does not depend on the measurement environment and the type of equipment. There are three significant findings from the study that can be noted. To begin with, the exhaust LAC in the excavation operation stage was the highest in the real-world operating condition. The main reason for it is that the engine load was suddenly increased during this stage; due to the response lag characteristics of the turbocharger, the intake charge was delayed, so the quality of oil and gas mixture in the cylinder becomes worse, and the concentration of local mixture is higher. Therefore, insufficient combustion of the mixture leads to a large amount of soot formation. Second, when the real-world operation is unavailable, the free accelerating condition was not applicable, but the overflow loading condition is suitable for replacing the real-world operating condition to measure the excavator exhaust LAC. Finally, as for in-use construction machinery, regular maintenance is an effective measure to reduce the engine exhaust LAC. Our findings contribute to improving the efficiency and accuracy of the environmental protection department's evaluation of the exhaust LAC of off-road mobile machinery and promoting the application of different technologies for high-emission off-road mobile machinery to reduce pollutant emissions so that it can continue to be used.

Protection against chemotherapy- and radiotherapy-induced side effects: A review based on the mechanisms and therapeutic opportunities of phytochemicals.

BACKGROUND: Although great achievements have been made in the field of cancer therapy, chemotherapy and radiotherapy remain the mainstay cancer therapeutic modalities. However, they are associated with various side effects, including cardiocytotoxicity, nephrotoxicity, myelosuppression, neurotoxicity, hepatotoxicity, gastrointestinal toxicity, mucositis, and alopecia, which severely affect the quality of life of cancer patients. Plants harbor a great chemical diversity and flexible biological properties that are well-compatible with their use as adjuvant therapy in reducing the side effects of cancer therapy. PURPOSE: This review aimed to comprehensively summarize the molecular mechanisms by which phytochemicals ameliorate the side effects of cancer therapies and their potential clinical applications. METHODS: We obtained information from PubMed, Science Direct, Web of Science, and Google scholar, and introduced the molecular mechanisms by which chemotherapeutic drugs and irradiation induce toxic side effects. Accordingly, we summarized the underlying mechanisms of representative phytochemicals in reducing these side effects. RESULTS: Representative phytochemicals exhibit a great potential in reducing the side effects of chemotherapy and radiotherapy due to their broad range of biological activities, including antioxidation, antimutagenesis, anti-inflammation, myeloprotection, and immunomodulation. However, since a majority of the phytochemicals have only been subjected to preclinical studies, clinical trials are imperative to comprehensively evaluate their therapeutic values. CONCLUSION: This review highlights that phytochemicals have interesting properties in relieving the side effects of chemotherapy and radiotherapy. Future studies are required to explore the clinical benefits of these phytochemicals for exploitation in chemotherapy and radiotherapy.

[Effect of Tongdu Tiaoshen acupuncture on serum GABA and CORT levels in patients with chronic insomnia].

OBJECTIVE: To observe the clinical effect of Tongdu Tiaoshen acupuncture on chronic insomnia, and explore its possible mechanism. METHODS: A total of 60 patients with chronic insomnia were randomly divided into an observation group (30 cases) and a control group (30 cases, 1 case dropped off ). The observation group was treated with Tongdu Tiaoshen acupuncture at Baihui (GV 20), Yintang (GV 29), Shenting (GV 24), etc. once every other day, 3 times a week. The control group was treated with estazolam tablets (1 mg) orally before going to bed every night. The treatments of both groups were required 4 weeks. The Pittsburgh sleep quality index (PSQI) scores, serum gamma-aminobutyric acid (GABA) and cortisol (CORT) levels were observed before and after treatment in the two groups, and the clinical effect was compared. RESULTS: After treatment, the sleep quality, day dysfunction scores of PSQI in the observation group and the falling asleep time, sleep time, sleep efficiency, sleep disturbance scores and total scores of PSQI in the two groups were lower than before treatment (P<0.01, P<0.05). After treatment, the daytime dysfunction score of PSQI in the observation group was lower than that in the control group (P<0.05). After treatment, the serum GABA levels in the two groups were higher than before treatment (P<0.05), and the serum CORT levels were lower than before treatment (P<0.01). The total effective rate was 90% (27/30) in the observation group and 93.1% (27/29) in the control group, the difference was not statistically significant (P>0.05). CONCLUSION: Tongdu Tiaoshen acupuncture has the same effect as western medication estazolam tablets in the treatment of patients with chronic insomnia, and has little effect on daytime dysfunction. The mechanism may be related to the increase of serum GABA level and the inhibition of the hyperactivation of hypothalamus-pituitary-adrenal (HPA) axis.

[Effect of acupuncture at Tiaoshen acupoints on hyperarousal state in chronic insomnia].

OBJECTIVE: To observe the clinical effect of acupuncture at Tiaoshen (regulating the spirit) acupoints on chronic insomnia and hyperarousal state, and explore its possible mechanism. METHODS: A total of 60 patients with chronic insomnia were randomly divided into an acupuncture group (30 cases, 1 case dropped off) and a sham acupuncture group (30 cases, 1 cases dropped off). Both groups were given basic sleep health education. The acupuncture group was treated with acupuncture at Tiaoshen acupoints including Baihui (GV 20), Shenting (GV 24), Yintang (GV 29), Shenmen (HT 7) and Sanyinjiao (SP 6). The sham acupuncture group was treated with non-effective point shallow acupuncture. Both groups were treated once every other day, 3 times a week for 4 weeks. The Pittsburgh sleep quality index (PSQI) score, pre-sleep arousal scale (PSAS) score, hyperarousal scale (HAS) score, and serum gamma-aminobutyric acid (GABA) level before and after treatment were compared between the two groups. RESULTS: Compared before treatment, the sleep quality, time to fall asleep, sleep time, sleep efficiency, sleep disturbance, daytime dysfunction scores and total score of PSQI, various scores and total score of PSAS, and HAS score in the acupuncture group after treatment were decreased (P<0.05, P<0.01); in the sham acupuncture group, the time to fall asleep, daytime dysfunction scores and total score of PSQI, and cognitive arousal score of PSAS after treatment were decreased (P<0.05). After treatment, the sleep quality, time to fall asleep, sleep time, sleep efficiency, sleep disturbance, daytime dysfunction scores and total score of PSQI, various scores and total score of PSAS, and HAS score in the acupuncture group were lower than those in the sham acupuncture group (P<0.05, P<0.01). Compared before treatment, the serum GABA level in the acupuncture group were increased (P<0.05), and the serum GABA level in the acupuncture group was higher than that in the sham acupuncture group after treatment (P<0.05). CONCLUSION: Acupuncture at Tiaoshen acupoints can obviously improve the sleep and hyperarousal state of patients with chronic insomnia, and up-regulating serum GABA content is one of its possible mechanisms.

The efficacy of acupuncture on the sleep structure of patients with insomnia: A systematic review and meta-analysis.

This study aims to evaluate the efficacy of acupuncture on the sleep structure of patients with insomnia, so as to provide a valuable basis for the effectiveness of acupuncture in the treatment of insomnia. We conducted searches based on MeSH terms and free words in Cochrane Library, PubMed, Web of science, CKNI (China Knowledge Resource Integrated Database), WanFang Database, and Chongqing VIP Information from the inception of these database until 10 July 2020 for randomized controlled trials (RCTs) that investigated acupuncture treatment in patients with insomnia, and pertinent details of the results were saved. Comprehensive analysis showed that: (1) compared with the Western medicine groups, the acupuncture groups showed significant advantages in reducing the percentage of N1 sleep stage and N2 sleep stage, as well as increasing that of N3 sleep stage and REM sleep stage. However, no significant difference was found in increasing the effective rate, reducing total PSQI score, improving the total sleep time, reducing sleep latency, and improving sleep efficiency between the Western medicine groups and the acupuncture groups. (2) Compared with the sham acupuncture groups, the acupuncture treatment showed advantages in increasing the effective rate, reducing Pittsburgh Sleep Quality Index (PSQI) score, increasing the total sleep time, and improving sleep efficiency. However, no significant difference was observed between the sham acupuncture groups and the acupuncture groups with regard to reducing sleep latency, the percentage of N1 sleep stage and N2 sleep stage, as well as increasing that of N3 sleep stage and REM sleep stage.

[Effect of Tiaoshen needling on plasma melatonin and cortisol in patients with chronic insomnia].

OBJECTIVE: To observe the clinical efficacy of Tiaoshen needling (dredging Governor Vessel and regulating mind)in the treatment of chronic insomnia (CI) and its effect on plasma melatonin (MT) and cortisol (CORT) levels, so as to explore its underlying mechanism. METHODS: Sixty patients with CI were randomly divided into the treatment group and the control group, with 30 cases in each group. Both groups were given sleep hygiene education before treatment. Patients in the treatment group received acupuncture or electroacupuncture at Baihui (GV20), Shenting (GV24), Yintang (GV29), bilateral Shenmen (HT7) and Sanyinjiao (SP6). Patients in the control group received acupuncture or electroacupuncture at bilateral Shousanli (LI10), Futu (ST32) and Feiyang(BL58). Both groups were treated every other day, 3 times a week, for a total of 4 weeks. Before and after treatment, Pittsburgh sleep quality index (PSQI) and fatigue severity scale (FSS) were used to evaluate sleep qua-lity and daytime fatigue, the plasma MT and CORT levels were measured by enzyme-linked immunosorbent assay. RESULTS: Compared with before treatment, the PSQI scores and total FSS score of the treatment group decreased significantly (P<0.01，P<0.05), and the plasma MT content increased and CORT decreased significantly in the treatment group (P<0.01)，while the sleep-onset time score, sleep disturbance score and the PSQI total score of the control group decreased significantly (P<0.05). Compared with the control group, the PSQI sleep disorder score and total score, and the total FSS score as well as plasma CORT level were significantly down-regulated (P<0.01，P<0.05), while the plasma MT content was up-regulated (P<0.05) in the treatment group. CONCLUSION: Tiaoshen acupuncture can significantly improve the sleep quality of patients with CI and relieve daytime fatigue, which may be related to the increase of plasma MT content in patients with CI, thereby inhibiting the excessive activation of the hypothalamic-pituitary-adrenal axis.

High time for ease the doctor-patient relationship in China.

As doctors, we find it disturbing to read the paper "Burnout in physicians who are exposed to workplace violence" (January 2020).1 Workplace violence experienced by doctors has been documented both in developed and developing countries. Reports show that Chinese medical professionals are being injured, disabled, or even killed by patients or their family members.2,3 The killing of a doctor in Beijing in 2019 attracted national attention. China's top legislative body has approved the first fundamental and comprehensive law to protect health-care professionals. The bill will take effect on June 1, 2020. However, the law alone will not solve the problem. We need to treat it from the root and address the issues that have led to this health-care-related violence. A multi-faceted action must be launched to reduce violence against doctors in China urgently.

[Insomnia treated with three acupuncture combinations guided by theory of Tongdu Tiaoshen: a randomized controlled trial].

OBJECTIVE: To compare the clinical therapeutic effect and safety on insomnia among three acupuncture combinations, named Tongdu Tiaowei (promoting the circulation of the governor vessel and regulating the defensive system), Tongdu Yangxin (promoting the circulation of the governor vessel and nourishing the heart) and Tongdu Tiaozang (promoting the circulation of the governor vessel and regulating zang functions). METHODS: A total of 90 patients with insomnia were randomized into a Tongdu Tiaowei group (30 cases, 1 case dropped off ), a Tongdu Yangxin group (30 cases, 2 cases dropped off ) and a Tongdu Tiaozang group (30 cases, 1 case dropped off ). Besides electroacupuncture (EA) applied to Baihui (GV 20) and Yintang (GV 29) in all of the three groups, acupuncture was added at Shenmai (BL 62) and Zhaohai (KI 6), Shenmen (HT 7) and Sanyinjiao (SP 6) as well as back-shu points of five zang organs [Feishu (BL 13), Xinshu (BL 15), Ganshu (BL 18), Pishu (BL 20) and Shenshu (BL 23)] in the Tongdu Tiaowei group, the Tongdu Yangxin group and the Tongdu Tiaozang group successively. The treatment was given once every two days, 3 times weekly, consecutively for 4 weeks. The score of Pittsburgh sleep quality index (PSQI) before and after treatment was observed, the therapeutic effect was evaluated and the adverse reactions were recorded in the patients of each group. RESULTS: After treatment, the score of each of 6 factors, named sleep quality, sleep latency, sleep time, sleep efficiency, sleep disturbance and daytime dysfunction, as well as the total score of PSQI scale were all reduced as compared with the scores before treatment in the patients of each group (P<0.05). After treatment, the scores of sleep latency and daytime dysfunction in the Tongdu Tiaowei group were lower than the other two groups (P<0.05). The score of sleep time in the Tongdu Yangxin group was lower than the other two groups (P<0.05) and the score of sleep quality in the Tongdu Tiaozang group was lower than the other two groups (P<0.05). After treatment, the total effective rates were 96.6% (28/29), 96.4% (27/28) and 96.6% (28/29) in the Tongdu Tiaowei group, the Tongdu Yangxin group and the Tongdu Tiaozang group successively, without significant difference in comparison among the three groups (P>0.05). During treatment, 1 case of mild adverse reaction occurred in each group. CONCLUSION: All of the three acupuncture combinations, named Tongdu Tiaowei, Tongdu Yangxin and Tongdu Tiaozang can effectively improve the sleep conditions in the patients with insomnia and are satisfactory in safety. The acupuncture combinations of Tongdu Tiaowei has the potential advantage in shortening sleep latency and relieving daytime dysfunction, the combinations of Tongdu Yangxin has the potential advantage in increasing sleep time and the combinations of Tongdu Tiaozang has the potential advantage in improving sleep quality.

A case report of neuroendocrine tumor (G3) at lower rectum with liver metastasis.

RATIONALE: Rectal neuroendocrine tumor is a rare disease that is difficult to diagnose by clinical and imageological examinations. The treatment of rectal neuroendocrine tumors is still controversial. PATIENT CONCERNS: A 50-year-old woman complained of abdominal pain beneath the xiphoid process for 1 day. Physical checkup revealed tenderness at the right upper abdomen. A fecal occult blood test was positive. MRI showed an occupation lesion in the right lobe of the liver. Colonoscopy examination showed a lesion at the lower rectum with an ulcerated surface that was tough in texture. No abnormality was found in the tumor markers. DIAGNOSIS: Rectal neuroendocrine tumor (G3) with liver metastasis. INTERVENTIONS: Neoadjuvant chemotherapy followed by laparoscopic surgery was given. OUTCOMES: The patient followed up regularly in the outpatient department for 13 months after surgery, and no sign of recurrence was found. LESSONS: Neoadjuvant chemotherapy followed by laparoscopic surgery is a new idea for the treatment of rectal neuroendocrine carcinoma with distant metastasis, which offers favorable conditions for saving the anus during the surgery to enhance the patient's quality of life.

[Clinical observation of modified Suan Zao Ren decoction on insomnia of chronic hepatitis B patients].

OBJECTIVE: To explore the effect of modified Suan Zao Ren Decoction (mediation decoction) on insomnia of chronic hepatitis B patients with stagnation of the Liver-Qi and deficiency of blood syndrome. METHODS: Sixty-five patients of chronic hepatitis B with stagnation of the Liver-Qi, deficiency of the spleen and damp-heat syndrome were randomly divided into two groups. Thirty-three patients in the treatment group were treated by modified Suan Zao Ren Decoction, and thirty-two patients in the control group were treated by Surazepam and Diammonium Glycyrrhizinate. The clinical syndromes of insomnia and liver function were observed before and after treatment. RESULTS: After one months of treatment, the main symptoms and signs of insomnia are improved in both groups, stage I and II sleep decreaed significantly while stage Il, IV and rapid eye movement increased in insomniacs after treatment of modified Suan Zao Ren Decoction (P < 0.05). The total effective rate was not significantly different between the two groups (P > 0.05), while the markedly effective rate was significantly different (P < 0.05). In the same time, ALT, AST, TB levels of two groups were obviously decreased (P < 0.01, P < 0.05), AST levels of two groups after treatment were significant different (P < 0.05). CONCLUSION: Modified Suan Zao Ren Decoction is effective for improving sleep composition, and therefore improve the quality of sleep with few side effect. In the same time, it has the function in improving liver function, and can be used to treat chronic hepatitis B patients with insomnia.

[Closed reduction and three Kirschner pin fixation at the radial side for the treatment of supracondylar fracture in children with Gartland type II and type III].

OBJECTIVE: To investigate the characteristics of supracondylar fracture of humerus in children and to explore the effect of closed reduction and internal fixation at radial side on the fracture. METHODS: The children with fractures of Gartland type II and type III in our hospital from June 2010 to June 2013 were reviewed. There were 28 males and 7 females, ranging in age from 1 year and 1 month to 2 years and 6 months, with an average of 2 years and 1 month. According to Gartland classification, 19 cases were type II, 16 cases were type III. There were 3 patients with radial nerve injuries, and 5 patients with anterior interosseous nerve injuries. There were no vascular injuries. All the patients were treated with closed reduction and three Kirschner fixation at the radial side, followed by the plaster external fixation with elbowed flexion at 90 °. The X-ray examination was performed at the second day after operation. The joint function exercise began about at 2 to 3 weeks after operation when the plaster fixation was removed, and opportune time for removal of Kirschners depends on the situation of fracture healing. The operation time, nerve recovery, and the elbow joint function were observed. RESULTS: All the children were followed up, and all the fractures had bony union. According to Flynn score system at the final follow-up, 28 patients got an excellent result, 4 good, 1 poor and 2 bad. CONCLUSION: Three Kirschner fixation at the radial side for the treatment of supracondylar fracture of humerus has advantages of minimally invasive, shorter time of hospitalization, simple removal of the internal fixation and reliable therapeutic effects.

[Strategy and effect of schistosomiasis emergency control after earthquake in Lushan County].

OBJECTIVE: To evaluate the effects of measures on the schistosomiasis control after the earth quake in Lushan County, so as to provide the experiences for post-disaster schistosomiasis control. METHODS: The measures taken in schistosomiasis control after the earth quake were reviewed in Lushan County in 2013, and the epidemic situation of schistosomiasis was investigated and the results were analyzed. RESULTS: The schistosomiasis control in floating population and the control of Oncomelania hupensis snails were enhanced, and no schistosome infections were found in both human and livestock. No infected snails and infested water were found. CONCLUSION: The measures of schistosomiasis control after the disaster are effective in Lushan County, and the goal to prevent major plague after the earth quake is achieved.