Enhancement of bicycle exercise capacity in patients with chronotropic incompetence through closed-loop stimulation: a randomized crossover trial.

AIMS: This study aimed to investigate the effectiveness of closed-loop stimulation (CLS) pacing compared with the traditional DDD mode in patients with chronotropic incompetence (CI) using bicycle-based cardiopulmonary exercise testing (CPET). METHODS AND RESULTS: This single-centre, randomized crossover trial involved 40 patients with CI. Patients were randomized to receive either DDD-CLS or DDD mode pacing for 2 months, followed by a crossover to the alternative mode for an additional 2 months. Bicycling-based CPET was conducted at the 3- and 5-month follow-up visits to assess exercise capacity. Other cardiopulmonary exercise outcome measures and health-related quality of life (QoL) were also assessed. DDD-CLS mode pacing significantly improved exercise capacity, resulting in a peak oxygen uptake (14.8 ± 4.0 vs. 12.0 ± 3.6 mL/kg/min, P < 0.001) and oxygen uptake at the ventilatory threshold (10.0 ± 2.2 vs. 8.7 ± 1.8 mL/kg/min, P < 0.001) higher than those of the DDD mode. However, there were no significant differences in other cardiopulmonary exercise outcome measures such as ventilatory efficiency of carbon dioxide production slope, oxygen uptake efficiency slope, and end-tidal carbon dioxide between the two modes. Patients in the DDD-CLS group reported a better QoL, and 97.5% expressed a preference for the DDD-CLS mode. CONCLUSION: DDD-CLS mode pacing demonstrated improved exercise capacity and QoL in patients with CI, highlighting its potential as an effective pacing strategy for this patient population.

[Concept Analysis of Fusion Leadership].

Important concepts in leadership management related to the field of medical care management include servant leadership, charismatic leadership, and transformational leadership. Since the 2020 emergence of the coronavirus pandemic, the world has faced the immediate challenges of epidemic prevention and control. Although national government and medical system officials as well as scholars have weighed in on this issue, their leadership does not appear to line up the core ideas of leadership. Daft and Lengel (2000) examined the influence of fusion leadership on individuals and organizations. The fusion of many nuclei of leadership intentions will produce great power and influence. To elucidate the concept of integrated leadership for individuals and organizations in the post-pandemic healthcare system, this paper summarizes the defining characteristics of fusion leadership based on the conceptual analysis method of Walker and Avant (2019). Concurrently, we confirm the antecedents and consequences of fusion leadership, use different cases to illustrate the analysis, and share the reference indicators and measurements of fusion leadership to provide a reference for healthcare system administrators.

[Prevention and treatment of non-alcoholic fatty liver disease by regulation of mitochondrial function with Chinese medicine].

Non-alcoholic fatty liver disease(NAFLD), as a metabolic stress liver injury disease, is one of the most common chronic liver diseases, which seriously threatens people's health. The pathogenesis of NAFLD is very complex. A large number of studies show that the hepatic mitochondrial dysfunction leads to the disorder of hepatic glucose and lipid metabolism, oxidative stress, and inflammation, thus inducing hepatocyte apoptosis, which plays an important role in the progression of NAFLD. In recent years, researchers have begun to focus on developing drugs that slowed the progression of NAFLD by regulating the hepatic mitochondrial function. Chinese medicine has a good curative effect on the treatment of NAFLD, with the advantages of high safety and few side effects. Various studies have shown that Chinese medicine prevented and treated NAFLD by regulating the mitochondrial function. Therefore, this paper summarized the relationship between NAFLD and mitochondria, and the mechanism of Chinese medicine(single Chinese medicine, Chinese medicine monomer, and Chinese medicine compound prescription) in the prevention and treatment of NAFLD by regulating mitochondrial function. This paper is expected to provide references for clinical application of traditional Chinese medicine in the treatment of NAFLD by regulating mitochondrial function.

Dysregulation of cystathionine γ-lyase promotes prostate cancer progression and metastasis.

Hydrogen sulfide (H2 S), an endogenous signaling gaseous molecule, is involved in various physiological activities, including vessel relaxation, regulation of cellular bioenergetics, inflammation, and angiogenesis. By using xenograft orthotopic implantation of prostate cancer PC3 cells and subsequently comparing bone metastatic with primary tumor-derived cancer cells, we find that H2 S-producing enzyme cystathionine γ-lyase (CTH) is upregulated in bone-metastatic PC3 cells. Clinical data further reveal that the expression of CTH is elevated in late-stage prostate cancer patients, and higher CTH expression correlates with poor survival from The Cancer Genome Atlas (TCGA) prostate cancer RNA-seq datasets. CTH promotes NF-κB nuclear translocation through H2 S-mediated sulfhydration on cysteine-38 of the NF-κB p65 subunit, resulting in increased IL-1ß expression and H2 S-induced cell invasion. Knockdown of CTH in PC3 cells results in the suppression of tumor growth and distant metastasis, while overexpression of CTH in DU145 cells promotes primary tumor growth and lymph node metastasis in the orthotopic implanted xenograft mouse model. Together, our findings provide evidence that CTH generated H2 S promotes prostate cancer progression and metastasis through IL-1ß/NF-κB signaling pathways.

[A Nursing Experience Enhancing the Resilience Capacity of a Patient With Chronic Schizophrenia].

The article describes the author's nursing experience providing psychiatric homecare to a patient with chronic schizophrenia using the concept of resilience. Holistic nursing assessments were conducted via clinical observations during home visits every two weeks from May 24th to September 20th, 2018. Through these assessments, the main health problems of the patient were defined as ineffective self-health management, ineffective coping skills, and insufficient resilience. The nursing interventions implemented were designed to establish the patient's capacity to effectively and correctly self-manage health status, achieve emotional accommodation, and reduce parent-child conflicts. In order to enhance the resilience of the patient, the patient was guided to review important support resources over the course of illness, to detect the barriers of returning society, to apply the beneficial skills of health management, and then extend the status of employment and to enhance self-fulfillment.

Self-rated health is associated with subsequent functional decline among older adults in Japan.

BACKGROUND: Previous studies have reported that self-rated health (SRH) predicts subsequent mortality. However, less is known about the association between SRH and functional ability. The aim of this study was to examine whether SRH predicts decline in basic activities of daily living (ADL), even after adjustment for depression, among community-dwelling older adults in Japan. METHODS: A three-year prospective cohort study was conducted among 654 residents aged 65 years and older without disability in performing basic ADL at baseline. SRH was assessed using a visual analogue scale (range; 0-100), and dichotomized into low and high groups. Information on functional ability, sociodemographic factors, depressive symptoms, and medical conditions were obtained using a self-administered questionnaire. Logistic regression analysis was used to examine the association between baseline SRH and functional decline three years later. RESULTS: One hundred and eight (16.5%) participants reported a decline in basic ADL at the three-year follow-up. Multiple logistic regression analysis showed that the low SRH group had a higher risk for functional decline compared to the high SRH group, even after controlling for potential confounding factors (odds ratio (OR) = 2.4; 95% confidence interval (CI) = 1.3-4.4). Furthermore, a 10-point difference in SRH score was associated with subsequent functional decline (OR = 1.37; 95% CI = 1.16-1.61). CONCLUSIONS: SRH was an independent predictor of functional decline. SRH could be a simple assessment tool for predicting the loss or maintenance of functional ability in community-dwelling older adults. Positive self-evaluation might be useful to maintain an active lifestyle and stay healthy.

Evaluation of three-dimensional scapular kinematics and shoulder function in patients with short malunion of clavicle fractures.

BACKGROUND: The presence of short malunion of clavicle fractures could result in alterations in static scapular position and dynamic scapular motion. Nevertheless, no report has ever addressed the kinematic changes of the scapula in patients with short malunion of clavicular fractures. The goal of this study was to compare the changes of shoulder function, and the consequent scapular kinematic changes between the fractured side and the sound side of the shoulder in non-surgically treated patients. METHODS: Fourteen patients with a short malunion (>10 mm) of midshaft clavicular fracture following conservative treatment were recruited. Outcome analysis included standard clinical follow-up, plain radiography, Shoulder Pain and Disability Index (SPADI) score, shoulder range of motion (ROM), shoulder muscle strength and scapular resting position. The 3-dimensional scapular motion during arm movement in the scapular plane was recorded using an electromagnetic tracking device. The kinematic changes between the fractured side and sound side were analyzed. RESULTS: The mean shortening length of the clavicle was 12.9 ± 2.8 mm. The fractured sides showed a significantly higher SPADI score and limited ROM in both shoulder flexion and abduction. Significantly weaker shoulder external rotators (1.1 kg, p = 0.017) and lower trapezius (0.7 kg, p = 0.041) were found in the fractured sides when compared with the sound side. The fractured side exhibited significantly more forward shoulder (3.9 mm, p = 0.034) and slightly more anteriorly tilted scapula (5.8°, p = 0.094) in static scapular position. Scapular kinematics showed that the fractured side trended toward greater scapular internal rotation and smaller posterior tilt during arm elevation and lowering phases, especially after the arm rising above horizontal level. CONCLUSIONS: This study showed that significant changes in scapular kinematics and shoulder function were found after short malunion of clavicle fractures. Recognition and evaluation of the changes could lead to a comprehensive framework regarding the treatment of shortened clavicle fractures.

Dysregulation of the TGFBI gene is involved in the oncogenic activity of the nonsense mutation of hepatitis B virus surface gene sW182*.

The nonsense mutations of the hepatitis B virus (HBV) surface (S) gene have been reported to have oncogenic potential. We have previously identified several transforming nonsense mutations of the HBV S gene from hepatocarcinoma (HCC) patients. Among them, the sW182* mutant (the stop codon for tryptophan 182) showed the most potent oncogenicity in a mouse xenograft model using stably transfected mouse fibroblast cells. This study is aimed at understanding the molecular mechanisms leading to the oncogenic activity of the sW182* mutant. A gene expression microarray in combination with gene set enrichment analysis (GSEA) revealed differentially expressed gene sets in the sW182* cells, including those related to cell-cycle regulation, deoxyribonucleic acid repair, and genome instability. Of the differentially expressed genes, the transforming growth factor-ß-induced (TGFBI) gene was further validated to be dysregulated in the sW182* cells. This dysregulation was accompanied by hypermethylation of the TGFBI promoter. The level of cyclin D1, a negatively regulated TGFBI target, was highly elevated in the sW182* mutant cells, which is consistent with the potent oncogenicity. Furthermore, frequent abnormal mitosis and multinucleation were observed in the mutant cells. Exogenous expression of TGFBI alleviated the oncogenic activity of the sW182* cells. In human HBV-related HCC cancerous tissue, expression of TGFBI was downregulated in 25 of the 55 (45%) patients examined, suggesting that TGFBI dysregulation could occur in HBV-related HCC development in some cases. These results suggest that dysregulation of TGFBI is involved in the oncogenic activity of the sW182* mutant of the hepatitis B virus S gene.

Occurrence of nonylphenol and bisphenol A in household water pipes made of different materials.

We assessed the occurrence of nonylphenol (NP) and bisphenol A (BPA) in tap water supplied through polyvinyl chloride (PVC), stainless steel, and galvanized pipes. Water samples were collected from selected households in Taipei and Kaohsiung (Northern and Southern Taiwan, respectively) in different seasons to elucidate the effects of pipeline materials and ambient temperatures on NP and BPA concentrations in tap water. We detected higher concentrations of NP in tap water from households using PVC pipes (64-195 ng/L) than from those using stainless steel pipes (17-44 ng/L) and galvanized pipes (27-96 ng/L). To verify that water can absorb NP and BPA from PVC pipes, we sealed Milli-Q and tap water in PVC and stainless steel pipes to assess the potential release of NP and BPA from the pipes into the water. Both NP and BPA concentrations initially increased with contact time in the PVC pipes, and the concentration profiles during the retention appeared to be more strongly affected by ambient temperatures. Concentration variations in the stainless steel pipes were smaller than those in the PVC pipes.

[Depression and related factors in mothers of school-aged children with attention-deficit hyperactivity disorder].

BACKGROUND: The mothers of children with attention-deficit hyperactivity disorder tend to experience depression at higher levels because of the poor social interaction and deviant behaviors of their children. These depressed mothers often harm themselves and negatively impact their family and community. PURPOSE: This study examines maternal depression and its related factors in the mothers of school-aged children with attention-deficit hyperactivity disorder. METHODS: A cross-sectional study with a purposive sampling of 100 mothers of school-age children with attention-deficit hyperactivity disorder was developed. Data were collected using a structured questionnaire that included the Parenting Stress Index (PSI), social support scale, and the Beck Depression Inventory (BDI). The Pearson product moment correlation and stepwise multiple regression were used to analyze data. RESULTS: The findings showed that almost half of the mothers with school-aged ADHD children suffered higher pa-renting stress and that 34% required professional psychiatry referral. In addition, 40% of the participants suffered from depression. Higher levels of parenting stress were associated with a higher incidence of depression (r = .647, p < .001). Participants with better social support had lower depression levels (r = -.327, p < .01). 'Parenting stress' and having a monthly total household income of ≤ NT$40,000 were significant predictors of maternal depression. 'Maternal stress' was the most significant predictor, with a total explained variance of 41.9% (R(2) change = 41.9%). CONCLUSIONS: The results of this study are intended to help medical staff better care for the mothers of school-aged children with ADHD. These results will assist in the evaluation of maternal depression, parenting stress, and levels of required social support. It will especially help in the evaluation of maternal depression symptoms of those mothers of low socioeconomic status with high parenting stress. Providing these mothers with parental training, education on effective parenting and discipline strategies, and better social support may effectively reduce maternal depression, which will help minimize the negative impacts of this depression on the family and the community.

Ipsative imputation for a 15-item Geriatric Depression Scale in community-dwelling elderly people.

BACKGROUND: Missing data are inevitable in almost all medical studies. Imputation methods using the probabilistic model are common, but they cannot impute individual data and require special software. In contrast, the ipsative imputation method, which substitutes the missing items by the mean of the remaining items within the individual, is easy and does not need any special software, but it can provide individual scores. The aim of the present study was to evaluate the validity of the ipsative imputation method using data involving the 15-item Geriatric Depression Scale. METHODS: Participants were community-dwelling elderly individuals (n = 1178). A structural equation model was constructed. The model fit indexes were calculated to assess the validity of the imputation method when it is used for individuals who were missing 20% of data or less and 40% of data or less, depending on whether we assumed that their correlation coefficients were the same as the dataset with no missing items. Finally, we compared path coefficients of the dataset imputed by ipsative imputation with those by multiple imputation. RESULTS: When compared with the assumption that the datasets differed, all of the model fit indexes were better under the assumption that the dataset without missing data is the same as that that was missing 20% of data or less. However, by the same assumption, the model fit indexes were worse in the dataset that was missing 40% of data or less. The path coefficients of the dataset imputed by ipsative imputation and by multiple imputation were compatible with each other if the proportion of missing items was 20% or less. CONCLUSION: Ipsative imputation appears to be a valid imputation method and can be used to impute data in studies using the 15-item Geriatric Depression Scale, if the percentage of its missing items is 20% or less.

The highly efficient photodegradation of 4-bromophenol by TiO2/g-C3N4 nano photocatalyst with LED visible light.

Since traditional photocatalysts have suffered from higher charge carrier recombination and moderate photocatalytic efficiency, developing photocatalysts is crucial for water treatment objectives. Hence, the various ratios of TiO2 on g-C3N4 (CN) to form nano photocatalysts were synthesized by the solvothermal method. The 30%TiO2/CN showed the best performance to degradation and debromination of 4-bromophenol (4-BP) solution completely (kobs = 6.6 × 10-2 min-1) under visible light emitted by LED (420 nm) in 30 min. Remarkably, the photocatalyst showed superior stability and reusability, maintaining its efficiency after four cycles of 4-BP degradation. The dominant ROS participating in 4-BP degradation were ●O-2 and photogenerated holes (h+), as investigated by free radical scavenging tests. The optical properties analysis revealed that the introduction of TiO2 to the bulk CN decreases electron-hole recombination and improve photocatalytic performance by facilitating electrons transfer through the TiO2 nanoparticles in a chain. The findings of this study showed that the TiO2/CN photocatalyst is a promising catalyst for the degradation of 4-BP. It exhibits a higher rate constant and photocatalytic efficiency compared with previous studies conducted under visible light irradiation.

Facile preparation of environmental benign LED white light active humic acid nanolayer coated titanium dioxide photocatalyst for bisphenol A degradation.

Natural organic matter is a mixture of microbial decomposition products widely found in surface and groundwater. These organic materials have great potential as carbon-based precursors for chemical synthesis. This work demonstrated the development of a green photocatalyst via a facile adsorption process that combined colloidal titanium dioxide (TiO2) with humic acid. The resulting photocatalyst was visible light active and able to completely degrade 5 mg/L of BPA within 6 h under the irradiation of energy-efficient LED white light. The first-order kinetic rate constant of the reaction was determined to be 1.7 × 10-2 min-1. The enhanced photocatalytic activity was attributed to the decreased band gap energy and effective charge separation that limits the photogenerated electron-hole recombination. The outcome of this research opened an opportunity for the development of sustainable functional materials using natural organic matter.

Ultrasound imaging for preoperative assessment of extensor tendon tear following distal radius fracture.

Open reduction with internal fixation is a common approach for treating distal radius fractures. However, complications such as extensor tendon rupture can occur following this procedure. In this case report, we present a patient who experienced extensor tendon rupture following volar plate fixation of a distal radius fracture. The rupture was diagnosed preoperatively using ultrasound. We highlight the potential usefulness of ultrasound as a convenient and sensitive tool for diagnosing tendon injuries in patients with suspected complications following internal fixation of distal radius fractures. Furthermore, we discuss how ultrasound images can aid in localizing the site of tendon rupture and guide surgical incisions for smaller postoperative wound care, resulting in improved cosmetic outcomes.

Remote Health Management via WeChat to Improve the Quality of Life of Patients After PCI.

OBJECTIVES: The purpose of this research was to assess the effect of telehealth management via WeChat on improving the quality of life of patients after percutaneous coronary intervention (PCI). METHODS: In this study, we retrospectively collected the clinical data of 118 patients who underwent PCI and received remote health management from our hospital via WeChat from June 2021 to September 2021 (WeChat group). The clinical data of 114 patients who underwent PCI but did not receive remote health management from our hospital from September 2020 to December 2020 were also collected (conventional group). Anxiety, depression, and quality of life scale scores were compared between the 2 groups at 6 months postdischarge. RESULTS: Six months postdischarge, patients in the WeChat group had significantly lower Self-rating Anxiety Scale (SAS) (55.7 ± 7.2 vs 58.8 ± 6.4, P = .001) and Self-rating Depression Scale (SDS) (56.0 ± 5.9 vs 58.2 ± 6.2, P = .007) scores than did those in the conventional group. Compared to those in the conventional group, the patients in the WeChat group had significantly greater 6 months post-discharge The World Health Organization Quality of Life - BREF scores in the following domains: physical (14.3 ± 1.7 vs 13.1 ± 1.7, P < .001 psychological (15.2 ± 1.3 vs 13.5 ± 1.5, P < .001 social relationship (12.9 ± 1.7 vs 12.3 ± 1.8, P = .01) and environmental (12.7 ± 2.0 vs 12.0 ± 1.9, P = .006). CONCLUSION: The use of WeChat to carry out remote health management for patients who underwent PCI can be an effective way to provide high-quality hospital medical services to patients' families and can effectively alleviate patients' anxiety and depression and enhance their quality of life.

Enhancement of hepatitis B virus replication by androgen and its receptor in mice.

Hepatitis B virus (HBV) is an important pathogen that chronically infects more men than women. To understand the molecular mechanism of this gender disparity, we analyzed HBV replication in transgenic mice that carried the HBV genome with or without the ability to express the HBV X protein (HBx). We found that gender had no effect on HBV surface antigen (HBsAg), DNA, and RNA levels in mice before puberty, but its effect on HBV after puberty was apparent, with HBV replicating approximately twice more efficiently in male mice than in female mice whether or not HBx was expressed. The castration of male mice resulted in a reduction of HBV HBsAg, DNA, and RNA levels, which could be partially restored by the injection of the androgen agonist R1881, indicating a positive role of androgen in HBV replication. The introduction of HBV genomic DNA and androgen receptor (AR) short hairpin RNA (shRNA) into the liver of naïve mice by hydrodynamic injection revealed that the effect of androgen on HBV was dependent on its receptor, which apparently could also stimulate HBV replication via an androgen-independent pathway. Further studies indicated that the two previously identified androgen response elements (AREs) in the HBV genome could indeed mediate the effect of androgen on HBV RNA transcription and DNA replication in vivo. These effects of androgen and its receptor on HBV thus provide an explanation for why men have a higher risk of HBV infection than women.

Viral-load-dependent effects of liver injury and regeneration on hepatitis B virus replication in mice.

Hepatitis B virus (HBV) is a hepatotropic virus that can cause severe liver diseases. By conducting studies using four different transgenic mouse lines that carry either the wild-type HBV genome or the HBV genome incapable of expressing the X gene, we found that liver injury and regeneration induced by a partial hepatectomy (PHx) could have different effects on HBV replication depending on the mouse lines. Further studies using hydrodynamic injection to introduce different amounts of the HBV genomic DNA into the mouse liver revealed that liver injury and regeneration induced by PHx enhanced HBV replication when viral load was low and suppressed HBV replication when viral load was high. These effects of liver injury and regeneration on HBV were independent of the HBV X protein and apparently due to alpha and beta interferons (IFN-α/ß), as the effects could be abolished by the injection of anti-IFN-α/ß antibodies. Further analysis indicated that PHx could induce the expression of hepatocyte nuclear factor 3 gamma (HNF3γ) when viral load was low and activate the signal transducer and activator of transcription 3 (Stat3) and suppress the expression of the suppressor of cytokine signaling 3 (SOCS3) irrespective of viral load. As both HNF3γ and Stat3 are required to activate the HBV enhancer I to stimulate HBV gene expression and replication, these results provided an explanation to the viral-load-dependent effect of liver injury and regeneration on HBV replication. Our studies thus revealed a novel interaction between HBV and its host and provided important information for understanding HBV replication and pathogenesis during liver injury.

Effects of interferon-α/ß on HBV replication determined by viral load.

Interferons α and ß (IFN-α/ß) are type I interferons produced by the host to control microbial infections. However, the use of IFN-α to treat hepatitis B virus (HBV) patients generated sustained response to only a minority of patients. By using HBV transgenic mice as a model and by using hydrodynamic injection to introduce HBV DNA into the mouse liver, we studied the effect of IFN-α/ß on HBV in vivo. Interestingly, our results indicated that IFN-α/ß could have opposite effects on HBV: they suppressed HBV replication when viral load was high and enhanced HBV replication when viral load was low. IFN-α/ß apparently suppressed HBV replication via transcriptional and post-transcriptional regulations. In contrast, IFN-α/ß enhanced viral replication by inducing the transcription factor HNF3γ and activating STAT3, which together stimulated HBV gene expression and replication. Further studies revealed an important role of IFN-α/ß in stimulating viral growth and prolonging viremia when viral load is low. This use of an innate immune response to enhance its replication and persistence may represent a novel strategy that HBV uses to enhance its growth and spread in the early stage of viral infection when the viral level is low.

Comparison of intra-articular hyaluronic acid injections with transcutaneous electric nerve stimulation for the management of knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To compare the effects of intra-articular hyaluronic acid (HA; ARTZ) and transcutaneous electric nerve stimulation (TENS) in the treatment of patients with knee osteoarthritis. DESIGN: A prospective, randomized controlled trial. SETTING: Rehabilitation clinic of a teaching hospital. PARTICIPANTS: Patients with knee osteoarthritis (N=50; aged 51-80y) were randomly assigned to the HA group (n=27) or the TENS group (n=23). INTERVENTIONS: The HA group received intra-articular HA injection into the affected knee once a week for 5 consecutive weeks, and the TENS group received a 20- minute session of TENS 3 times a week for 4 consecutive weeks. MAIN OUTCOME MEASURES: The primary outcome measures used were the visual analog scale (VAS) for pain and the Lequesne index. The secondary outcome measures were range of motion of the knee, walking time, pain threshold, patient global assessment, and disability in activities of daily living. All subjects were assessed at baseline, and at 2 weeks, 2 months, and 3 months after the treatments were completed. RESULTS: The TENS group exhibited a significantly greater improvement in VAS than the HA group at 2 weeks' follow-up (4.17 ± 1.98 vs 5.31 ± 1.78, respectively; P=.03). In addition, the TENS group also exhibited a significantly greater improvement in the Lequesne index than the HA group at 2 weeks' follow-up (7.78 ± 2.08 vs 9.85 ± 3.54, respectively; P=.01) and at 3 months' follow-up (7.07 ± 2.85 vs 9.24 ± 4.04, respectively; P=.03). CONCLUSIONS: TENS with silver spike point electrodes was observed to be more effective than intra-articular HA injection for patients with knee osteoarthritis in improving the VAS for pain at 2 weeks' follow-up as well as the Lequesne index at 2 weeks' and 3 months' follow-up.

The early autophagic pathway is activated by hepatitis B virus and required for viral DNA replication.

Autophagy is a catabolic process by which cells remove long-lived proteins and damaged organelles for recycling. Viral infections may also induce autophagic response. Here we show that hepatitis B virus (HBV), a pathogen that chronically infects approximately 350 million people globally, can enhance autophagic response in cell cultures, mouse liver, and during natural infection. This enhancement of the autophagic response is not coupled by an increase of autophagic protein degradation and is dependent on the viral X protein, which binds to and enhances the enzymatic activity of phosphatidylinositol 3-kinase class III, an enzyme critical for the initiation of autophagy. Further analysis indicates that autophagy enhances HBV DNA replication, with minimal involvement of late autophagic vacuoles in this process. Our studies thus demonstrate that a DNA virus can use autophagy to enhance its own replication and indicate the possibility of targeting the autophagic pathway for the treatment of HBV patients.