Reducing exposure to COVID-19 by improving access to fever clinics: an empirical research of the Shenzhen area of China.

BACKGROUND: The current 2019 coronavirus disease (COVID-19) pandemic is hitting citizen's life and health like never before, with its significant loss to human life and a huge economic toll. In this case, the fever clinics (FCs) were still preserved as one of the most effective control measures in China, but this work is based on experience and lacks scientific and effective guidance. Here, we use travel time to link facilities and populations at risk of COVID-19 and identify the dynamic allocation of patients' medical needs, and then propose the optimized allocation scheme of FCs. METHODS: We selected Shenzhen, China, to collect geospatial resources of epidemic communities (ECs) and FCs to determine the ECs' cumulative opportunities of visiting FCs, as well as evaluate the rationality of medical resources in current ECs. Also, we use the Location Set Covering Problem (LSCP) model to optimize the allocation of FCs and evaluate efficiency. RESULTS: Firstly, we divide the current ECs into 3 groups based on travel time and cumulative opportunities of visiting FCs within 30 min: Low-need communities (22.06%), medium-need communities (59.8%), and high-need communities (18.14%) with 0,1-2 and no less than 3 opportunities of visiting FCs. Besides, our work proposes two allocation schemes of fever clinics through the LSCP model. Among which, selecting secondary and above hospitals as an alternative in Scheme 1, will increase the coverage rate of hospitals in medium-need and high-need communities from 59.8% to 80.88%. In Scheme 2, selecting primary and above hospitals as an alternative will increase the coverage rate of hospitals in medium-need and high-need communities to 85.29%, with the average travel time reducing from 22.42 min to 17.94 min. CONCLUSIONS: The optimized allocation scheme can achieve two objectives: a. equal access to medical services for different types of communities has improved while reducing the overutilization of high-quality medical resources. b. the travel time for medical treatment in the community has reduced, thus improving medical accessibility. On this basis, during the early screening in prevention and control of the outbreak, the specific suggestions for implementation in developing and less developed countries are made.

Gua sha therapy for chronic low back pain: A protocol for systematic review.

BACKGROUND: Non-specific chronic low back pain (LBP) is a debilitating disease that profoundly impacts patients' daily physical function and quality of life. Gua sha therapy, as an easy-to-use and noninvasive complementary modality, has been widely used clinically in patients with non-specific chronic LBP. The aim of this study is to test the potential benefits and harms of gua sha therapy on patients with non-specific chronic LBP. METHODS: Ten English databases, 3 Korean databases, 6 Chinese databases, 1 Japanese database, and 2 Brazilian databases will be searched from their inception to September 2019. Randomized controlled trials will be included if gua sha therapy was used as the sole treatment or as a part of combination therapy with other treatments in patients with non-specific chronic LBP. Two reviewers will independently extract the data and assess the methodological quality using the Cochrane criteria for risk of bias. The meta-analysis will be performed using Review Manager 5.3 software. RESULTS: The findings of this systematic review will be published in a peer-reviewed journal. CONCLUSION: This systematic review will provide more evidence regarding the clinical usage of gua sha therapy for non-specific chronic LBP. TRIAL REGISTRATION NUMBER: CRD42019134567.

[Preventing role of warmth-promotion needling in reducing intracellular Ca2＋ overload of in vitro hippocampal neuronal cells of vascular dementia rats].

OBJECTIVE: To investigate the underlying mechanisms of warming-promotion needling (WPN) for vascular dementia (VD) by observing its effect on the expression of L-type calcium channel current (Ica.L), changes of intracellular [Ca2＋]i in neurons and pathomorphological changes of brain in VD rats. METHODS: One hundred and eight male SD rats were randomized into normal control, model, medication, WPN, uniform reinforcing-reducing needling (URRN), and needle-twirling groups (n＝18 in each group). The VD model was established by repeated occlusion and reperfusion of the bilateral common carotid arteries. Rats of the medication group were treated by gavage of Nimodipine twice a day for 14 days. For rats of the 3 acupuncture groups, WPN or URRN or needle-twirling was applied to "Dazhui" (GV14), "Baihui"(GV20) and "Shuigou"(GV26) for 30 min, once a day for 14 days. Changes of Ica.L in hippocampal neurons were observed by whole-cell patch clamp technique, and levels of [Ca2＋]i in neuronal cells of living brain slice of hippocampal CA1 area were observed by laser confocal microscope. Histopathological changes of hippocampal CA1 area were observed under light microscope after H．E. stain. RESULTS: Compared with the normal control group, the current density of Ica.L, and the intracellular[Ca2＋]i levels were significantly increased (P<0.05), and the I-V curves of Ica.L was apparently shifted down in the model group. In comparison with the model group, the current density of Ica.L was obviously reduced (P<0.05), the I-V curves of Ica.L shifted up and the intracellular Ca2＋ content notably decreased in the medication, WPN, URRN and needle-twirling groups (P<0.05). The effect of WPN was significantly superior to those of URRN and needle-twiiling (P<0.05). H．E. stain showed a reduction in the number of hippocampal neurons, dilation of intercellular space, swelling of cell body, karyopyknosis, disordered arrangement and increased number of gliacytes in the model group, which was apparently milder in the medication and 3 acupuncture groups (the WPN group in particular). CONCLUSION: The WPN can reduce Ica.L current density and [Ca2＋]i content of hippocampal neurons in brain slices of VD rats, which may contribute to its effect in relieving VD by suppressing calcium overload.

[Warming-promotion needling improves learning-memory ability by up-regulating expression of hippocampal nicotinic acetylcholine receptor subunit in rats with vascular dementia].

OBJECTIVE: To investigate the mechanism of Warming-promotion needling underlying improvement of vascular dementia (VD) by observing its effect on learning-memory ability and expression of hippocampal nicotinic acetylcholine receptor(nAChR)subunit proteins and mRNAs in rats with VD. METHODS: Sixty male SD rats were randomized into normal control, model, medication, warming-promotion needling(WPN), uniform reinforcing-reducing needling (URRN), and needle-twirling groups (n=10 in each group). The VD model was established via repeated occlusion and reperfusion of the bilateral common carotid arteries. Rats of the medication group were fed with Nimodipine twice a day for 14 days. For rats of the 3 acupuncture groups, WPN, or URRN or needle-twirling was applied to"Dazhui"(GV14),"Baihui"(GV20) and"Shuigou"(GV26) for 30 min, once a day for 14 days. The learning-memory ability was detected by Morris water maze tests, and the expression levels of nAChR α4, α7 and ß2 subunit proteins and mRNAs in the hippocampus were detected by Western blot and real-time PCR, separately. RESULTS: Compared with the normal group, the escape latency of Morris water maze tests was significantly prolonged (P<0.05), and the number of the original safe-platform quadrant crossing was significantly reduced in the model group (P<0.05). The expression levels of nAChR α4, α7, ß2 subunit proteins and mRNAs (except ß2 mRNA) in the hippocampus were significantly decreased in the model group relevant to the normal group (P<0.05). Following the interventions, the increased escape latency, and the reduced safe-platform quadrant crossing times, and the down-regulated expression levels of hippocampal nAChR α4, α7, ß2 subunit proteins and mRNAs in the medication, WPN, URRN and needle-twirling groups were all reversed (P<0.05). The effects of WPN were significantly superior to those of URRN and needle-twirling in up-regulating nAChR α4, α7, ß2 subunit proteins and mRNAs (P<0.05). CONCLUSION: The warming-promotion needling can improve the learning and memory ability in VD rats, which may be related to its effects in up-regulating the expression of nAChR su-bunits in the hippocampus.