Acupuncture for hypertension.

BACKGROUND: Elevated blood pressure (hypertension) affects about one billion people worldwide. It is important as it is a major risk factor for stroke and myocardial infarction. However, it remains a challenge for the medical profession as many people with hypertension have blood pressure (BP) that is not well controlled. According to Traditional Chinese Medicine theory, acupuncture has the potential to lower BP. OBJECTIVES: To assess the effectiveness and safety of acupuncture for lowering blood pressure in adults with primary hypertension. SEARCH METHODS: We searched the Hypertension Group Specialised Register (February 2017); the Cochrane Central Register of Controlled Trials (CENTRAL) 2017, Issue 2; MEDLINE (February 2017); Embase (February 2017), China National Knowledge Infrastructure (CNKI) (January 2015), VIP Database (January 2015), the World Health Organisation Clinical Trials Registry Platform (February 2017)and ClinicalTrials.gov (February 2017). There were no language restrictions. SELECTION CRITERIA: We included all randomized controlled trials (RCTs) that compared the clinical effects of an acupuncture intervention (acupuncture used alone or add-on) with no treatment, a sham acupuncture or an antihypertensive drug in adults with primary hypertension. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies according to inclusion and exclusion criteria. They extracted data and assessed the risk of bias of each trial, and telephoned or emailed the authors of the studies to ask for missing information. A third review author resolved disagreements. Outcomes included change in systolic blood pressure (SBP), change in diastolic blood pressure (DBP), withdrawal due to adverse effects, and any adverse events. We calculated pooled mean differences (MD) with 95% confidence intervals (CI) for continuous outcomes using a fixed-effect or random-effects model where appropriate. MAIN RESULTS: Twenty-two RCTs (1744 people) met our inclusion criteria. The RCTs were of variable methodological quality (most at high risk of bias because of lack of blinding). There was no evidence for a sustained BP lowering effect of acupuncture; only one trial investigated a sustained effect and found no BP lowering effect at three and six months after acupuncture. Four sham acupuncture controlled trials provided very low quality evidence that acupuncture had a short-term (one to 24 hours) effect on SBP (change) -3.4 mmHg (-6.0 to -0.9) and DBP -1.9 mmHg (95% CI -3.6 to -0.3). Pooled analysis of eight trials comparing acupuncture with angiotensin-converting enzyme inhibitors and seven trials comparing acupuncture to calcium antagonists suggested that acupuncture lowered short-term BP better than the antihypertensive drugs. However, because of the very high risk of bias in these trials, we think that this is most likely a reflection of bias and not a true effect. As a result, we did not report these results in the 'Summary of findings' table. Safety of acupuncture could not be assessed as only eight trials reported adverse events. AUTHORS' CONCLUSIONS: At present, there is no evidence for the sustained BP lowering effect of acupuncture that is required for the management of chronically elevated BP. The short-term effects of acupuncture are uncertain due to the very low quality of evidence. The larger effect shown in non-sham acupuncture controlled trials most likely reflects bias and is not a true effect. Future RCTs must use sham acupuncture controls and assess whether there is a BP lowering effect of acupuncture that lasts at least seven days.

[Development of human embryonic stem cell platforms for human health-safety evaluation].

The human embryonic stem cells (hESCs) serve as a self-renewable, genetically-healthy, pluripotent and single source of all body cells, tissues and organs. Therefore, it is considered as the good standard for all human stem cells by US, Europe and international authorities. In this study, the standard and healthy human mesenchymal progenitors, ligament tissues, cardiomyocytes, keratinocytes, primary neurons, fibroblasts, and salivary serous cells were differentiated from hESCs. The human cellular health-safety of NaF, retinoic acid, 5-fluorouracil, dexamethasone, penicillin G, adriamycin, lead acetate PbAc, bisphenol A-biglycidyl methacrylate (Bis-GMA) were evaluated selectively on the standardized platforms of hESCs, hESCs-derived cardiomyocytes, keratinocytes, primary neurons, and fibroblasts. The evaluations were compared with those on the currently most adopted cellular platforms. Particularly, the sensitivity difference of PM2.5 toxicity on standardized and healthy hESCs derived fibroblasts, currently adopted immortalized human bronchial epithelial cells Beas-2B and human umbilical vein endothelial cells (HUVECs) were evaluated. The RESULTS showed that the standardized hESCs cellular platforms provided more sensitivity and accuracy for human cellular health-safety evaluation.

A prospective study of fertility-sparing treatment with megestrol acetate following hysteroscopic curettage for well-differentiated endometrioid carcinoma and atypical hyperplasia in young women.

PURPOSE: To investigate the feasibility and efficacy of curettage with hysteroscopy followed by megestrol acetate (MA) for well-differentiated endometrioid carcinoma (EC) confined to the endometrium and for atypical hyperplasia (AH) in young women. PATIENTS AND METHODS: Fourteen patients with EC and 12 patients with AH were prospectively enrolled in this study. All of the patients received at least 12 weeks of oral MA (160 mg/day) following thorough curettage with hysteroscopy. The response was assessed histologically every 12 weeks. The primary endpoint was the complete response rate. Adverse events, pregnancy rates and recurrence rates were secondary end points. RESULTS: Twenty-one (80.8 %) patients responded to treatment. The median time to response was 12 weeks. After a median follow-up of 32 months, 6 patients had recurrences. Significantly, more patients with infertility or PCOS experienced recurrence (P = 0.040, P = 0.015). Eight patients attempted to conceive after complete response; two spontaneous conceptions and one normal delivery were achieved. No disease-related or treatment-related deaths were observed. CONCLUSIONS: Fertility-sparing treatment with MA following entirely hysteroscopic curettage is effective, demonstrating the least toxicity for rigorously selected young women with well-differentiated EC confined to the endometrium or with AH; however, close follow-up is required for the potential consequences of improper patient selection and a substantial rate of recurrence.

A "4D" systemic view on meridian essence: Substantial, functional, chronological and cultural attributes.

The term Jingluo, translated as meridian or channel, is a core component of traditional Chinese medicine (TCM) and has played a fundamental role in guiding the clinical practice of acupuncture for thousands of years. However, the essence of the meridian remains elusive and is a source of both confusion and debate for researchers. In this study, a "4D" systemic view on the essence of the meridian, namely substantial, functional, chronological, and cultural dimensions, was proposed based on a review of the ancient medical classics, recent research developments, and results from clinical practice. Previous studies have primarily focused on the substantial dimension of the meridian system, with scant interpretation about its functional domain. Neither systemic data nor evaluations have been adequately documented. Additionally, a limited but increasing number of studies have focused on the chronological and cultural dimensions. More investigations that embody the holistic concept of TCM and integrate the systemic modes and advanced techniques with dominant diseases of TCM need to be performed to obtain a more comprehensive understanding of the essence of meridians. The goal of this study is to yield useful information in understanding the essence of meridians and provide a reference and perspective for further research.

Hysteroscopic Curettage Followed by Megestrol Acetate Plus Metformin as a Fertility-Sparing Treatment for Women with Atypical Endometrial Hyperplasia or Well-Differentiated Endometrioid Endometrial Carcinoma.

Background: In reproductive-aged women, the incidence of atypical endometrial hyperplasia (AEH) or endometrioid endometrial carcinoma (EEC) is rising globally. The study aimed to investigate the effectiveness of hysteroscopic curettage followed by megestrol acetate (MA) plus metformin as conservative treatment in AEH and early EEC. Methods: We retrospectively studied AEH and stage IA, grade 1 EEC patients treated with hysteroscopic curettage followed by MA (160 mg/d) plus metformin (1500 mg/d) from January 2010 to December 2020 at Fudan University Shanghai Cancer Center. Treatment outcomes were assessed by complete response (CR) rate, recurrence rate, and pregnancy outcomes. Univariate and multivariate analyses were performed via the logistic regression model. Results: The study included 79 patients, 31 (39.2%) with AEH and 48 (60.8%) with EEC. The medians of age (years) and follow-up time (months) were 30 and 39.5, respectively. Seventy-six patients (96.2%) finally achieved CR. The median time to CR was 3.6 (3.0-20.6) months. The CR rate after 3 months, 6 months, and 1 year was 55 (69.6%), 67 (84.8%), and 72 (91.1%), respectively. Recurrence occurred in 26 (34.2%) patients. Treatment duration ⩾9 months was associated with a lower recurrence rate after CR (P = .012). Fourteen (93.3%) of the 15 recurrent patients who received progestin re-treatment achieved CR again. Finally, 29 patients delivered live births. Conclusions: Hysteroscopy followed by MA plus metformin can achieve CR in short time and is overall safe. Consolidation treatment should be prolonged to decrease the recurrence rate, despite a shorter time to CR.

[Visual analysis of research hotspots and frontiers on randomized controlled trials of acupuncture and moxibustion in the past 10 years].

Retrieved the literature on randomized controlled trials (RCT) of acupuncture and moxibustion from 2011 to 2020 in the Web of Science (WOS) database, and explored research hotspots and frontiers in the field of acupuncture and moxibustion by visually analyze to countries, institutions, authors, keywords, cited literature, etc. using CiteSpace V5.6.R2. A total of 1147 articles were included. China has the largest number of publications, and the top 3 publications are Beijing University of Chinese Medicine, Capital Medical University and Kyung Hee University. The hot research interventions in acupuncture and moxibustion include acupuncture, electroacupuncture, and bee acupuncture. The hot research topics include nerve regeneration, spasms, nausea, pain, obesity, cancer, etc. The research frontiers include acupuncture analgesia, diversification of acupuncture and its clinical effects, brain effects of acupuncture and acupuncture clinical mechanisms. It is believed that the cooperation between countries and institutions should be strengthened in the future, and deeper research should be carried out on the research content that is both hot spot and frontier.

[Clinical implications of positive peritoneal cytology in endometrial cancer].

OBJECTIVE: To evaluate the clinical significance of positive peritoneal cytology in patients with endometrial cancer. METHODS: The records of 315 patients with endometrial cancer who were operated at Cancer Hospital, Fudan University between January 1996 and December 2008 were reviewed. Peritoneal cytology were performed and diagnosed in all patients. Factors related with peritoneal cytology were analyzed by correlation analysis. Log-rank test and Cox regression test was used for the analysis of prognosis, respectively. RESULTS: (1) Peritoneal cytology were positive in 30 (9.5%) patients. Positive peritoneal cytology was associated with pathological subtype (P = 0.013), stage (P = 0.000), myometrial invasion (P = 0.012), lymph-vascular space invasion (P = 0.012), serosal involvement (P = 0.004), cervical involvement (P = 0.016), adnexal involvement (P = 0.000), and omental involvement (P = 0.000), with no association with grade (P = 0.152) and lymph node metastasis (P = 0.066). (2) Three-year overall survival (OS) and progression-free survival (PFS) were 93.0% and 85.5%, respectively. Positive peritoneal cytology, surgical stage, pathological subtype, myometrial invasion, grade, and lymph-vascular space invasion were significantly associated with worse prognosis by univariate analysis (P < 0.05), while only surgical-pathology stage and myometrial invasion were independent prognostic factors by multivariate analysis (P < 0.05). For 30 cases with positive peritoneal cytology, the patients with no high risk factors shown significantly prognoses better than those with any risk factors. The results shown that for patients with late stage (stage III-IV) endometrial cancer with positive peritoneal cytology was significantly associated with the worse OS and PFS by multivariate analysis (P = 0.006). CONCLUSIONS: Positive peritoneal cytology was associated with serosal involvement, cervical involvement, adnexal involvement, omental involvement, and late stage. Therefore, peritoneal cytology should be performed and reported separately as a part of full surgical staging procedure.

Effectiveness and Safety of Acupoint Application of Guan Xin Su He Pill () for Patients with Chronic Stable Angina Pectoris: A Multi-Center, Randomized Controlled Trial.

OBJECTIVE: To assess the clinical effectiveness of acupoint application (AP) of Guan Xin Su He Pill (, GXSHP) for patients with chronic stable angina pectoris (CSAP). METHODS: This study was carried out in 3 local hospitals in Chengdu, China. After baseline evaluation, eligible patients were randomly assigned to the placebo application for acupoints (PAA) group or the herbal application for acupoints (HAA) group. Patients in the HAA group underwent AP with herbal powder, which was mainly GXSHP, and patients in the PAA group underwent AP with sham drugs. For each treatment session, unilateral acupoints including Neiguan (PC 6), Danzhong (RN 17), Xinshu (BL 15) and Jueyinshu (BL 14), were stimulated for both groups. AP was performed 3 times a week with a 2-day interval for 4 weeks. The primary outcome was the frequency of angina pectoris attacks per week, while the secondary outcomes included angina pain intensity measured by the Visual Analogue Scale (VAS), dose of rescue oral drugs (nitroglycerin), scores on the Seattle Angina Questionnaire (SAQ), Self-Rating Anxiety Scale scores (SAS) and Self-Rating Depression Scale scores (SDS). Clinical outcomes were measured at week 0, 4 and 8. The safety of AP of GXSHP treatment for CSAP were assessed. RESULTS: A total of 121 patients were enrolled. Baseline characteristics were comparable across the 2 groups. After treatment, the angina attack numbers in the HAA group were significantly reduced from 11.00 to 4.81 (P<0.05). While, for PAA group, the angina frequency was not significantly improved (baseline 10.55; post-treatment 11.05). The HAA group had significantly fewer angina attacks than the PAA group (P<0.05). Pain intensity measured by VAS in HAA group was significantly reduced from 4.06 to 3.02 (P<0.05). While, for PAA group, the VAS was significantly increased (baseline 3.62; post-treatment 3.96; P<0.05). Clinical outcomes showed better improvement after treatment in the HAA group than in the PAA group in terms of oral administration of rescue drugs, SAS, SDS and SAQ scores (P<0.05). The adverse events were also reported. CONCLUSION: AP of GXSHP is a safe and effective treatment for CSAP patients (Registration No. NCT02029118).

[Clinical significance of Her-2/neu status in patients with uterine papillary serous carcinoma].

OBJECTIVE: The purpose of this study was to evaluate gene amplification by chromogenic in situ hybridization (CISH) and the protein expression of Her-2/neu gene in patients with uterine papillary serous carcinoma (UPSC) and to determine its prognostic value. METHODS: Thirty-six patients with confirmed pathologic diagnosis of UPSC in Cancer Hospital of Fudan University from Jan. 1996 to Jan. 2006, were analysed retrospectively. CISH was performed to assess Her-2/neu gene amplification, and protein expression was evaluated by immunohistochemistry (IHC). The prognostic factors were analyzed by log-rank test or Cox proportional hazard model. RESULTS: Among 36 cases with UPSC, 13 patients (36.1%) showed moderate staining (++) to strong staining (+++) for Her-2/neu protein, while amplification of the Her-2/neu gene by CISH was observed in 4 of the 36 (11.1%) cases. Her-2/neu protein over-expression was significantly associated with advanced surgical stage and worse prognosis by univariate analysis (P=0.030 and P=0.002, respectively), while the multivariate analysis shown that only Her-2/neu protein over-expression and deep myometrial invasion were associated with a poor prognosis (P<0.05). In 13 patients with Her-2/neu protein over-expression, the mean survival period with chemotherapy was shorter than those without chemotherapy (20 vs. 42 months, P=0.370). CONCLUSION: Her-2/neu protein over-expression is significantly associated with advanced surgical stage UPSC and poor survival outcome, and might reduce the chemotherapy sensitivity.

[Application of keratinocytes derived from human embryonic stem cells for toxicological evaluation of drugs].

PURPOSE: To preliminarily explore the cytotoxicological responses of keratinocytes derived from human embryonic stem cells(K-hESCs) to drugs, and to provide a basis for the establishment of a new biosafety evaluation model. METHODS: CCK-8 assay was used to detect cell viability and cytotoxicity. The detection of pharmacological response was observed and compared when K-hESCs directly derived from human embryonic stem cells, human gingival epithelial cells (HGECs), and human immortalized oral epithelial cells (HIOECs) were treated with retinoic acid (RA), 5-fluorouracil(5-FU), dexamethasone(DEX), and penicillin G(PG). Statistical analysis was performed using SPSS 16.0 software package. RESULTS: After drugs were applied to HGECs, HIOEC and K-hESCs, the half inhibitory concentrations (IC50) of RA was 6.1±0.03, 5.62±0.05 and 6.58±0.02, respectively. The IC50 of 5-FU was 1.65±0.02，3.00±0.02 and 1.72±0.04, respectively. The IC50 of DEX was 113.67±0.014，328±0.002 and 126.17±0.05, respectively. The IC50 of PG was 2200±1.34，3795±2.42 and 2880±1.5, respectively. The IC50 of the four drugs between HIOEC and HGECs had significant differences(P<0.05), but there was no significant difference in IC50 between K-hESCs and HGECs(P>0.05). The IC50 of K-hESCs and HIOEC also had significant differences(P<0.05). CONCLUSIONS: IC50 of K-hESCs was closer to HGECs than HIOEC. It was speculated that K-hESCs could simulate the response of normal human cells in cytotoxicity study.

Effect and Safety of CX-DZ-II Intelligent Electroacupuncture Therapeutic Instrument for Neck Pain Caused by Cervical Spondylos: Study Protocol for A Randomized Controlled Trial.

BACKGROUND: Neck pain caused by cervical spondylosis (CS) is a chronic pain condition, with an increasingly high incidence in the general population. Electroacupuncture is a common analgesic modality that has been widely applied in neck pain treatment. However, current electroacupuncture instruments used in the clinic have low intelligence levels and obscure parameter standards. We here designed this study for assessing the effect and safety of a new, intelligent electroacupuncture instrument, the CX-DZ-II, in treating neck pain. METHODS: The present study is a prospective, two-center, randomized, controlled, open-label, non-inferiority trial for CX-DZ-II on treating neck pain caused by CS. Totally 160 eligible patients will be included in this trial and randomly assigned to an experimental group and a control group in a 1:1 ratio. A semi-standard acupoint selection strategy will be employed. In the experimental group, selected acupoints will be stimulated by CX-DZ-II. Electroacupuncture treatment will be accomplished by a pre-existing electroacupuncture instrument in the control group. The duration of treatment will be 2 weeks. The primary outcome is the change of Visual Analog Scale (VAS) score after one course of treatment. The secondary outcomes include the VAS scores after each treatment, the responder rate, drug-usage rate of non-steroidal antipyretic analgesics, the rate of adverse events occurrence, and the performance of instrument. DISCUSSION: This study will evaluate the effect and safety of the CX-DZ-II intelligent electroacupuncture therapeutic instrument in comparison with a pre-existing non-intelligent instrument in the treatment of neck pain caused by CS. The results will hopefully demonstrate a more optimal electroacupuncture instrument for the treatment of neck pain. (Trial registration No. gov NCT03005301).

[Research status and prospects on adenosine receptor mechanism of acupuncture for myocardial ischemia].

The relationship between adenosine receptor (AdoR) and myocardial ischemia (MI), effect of acupuncture for MI and action mechanism of acupuncture improving MI by regulating AdoR are summarized. The existing researches have preliminarily reflected that the improvement of MI treated with acupuncture may be achieved by influencing the expression of AdoR. However, there are still some limitations, e.g. most of the research regimens are single-acupoint, the research results are not entirely consistent and the interaction of AdoRs are ignored, all these need to be further verified and supplemented.

[Mechanism of acupoint selection along meridians to improve adenosine receptor of myocardial ischemia based on acupoint specificity].

OBJECTIVE: To explore the action mechanism of acupoint selection along meridians to improve adenosine receptor in myocardial ischemia (MI) rats by comparing the effects of acupoint selection along meridians, acupoint selection at other meridians and non-acupoint on expression of adenosine receptor. METHODS: A total of 120 SD rats were randomly divided into a blank group, a sham operation group, a model group, an acupoint-selection-along-meridians (ASAM) group, an acupoint-selection-at-other-meridians (ASAOM) group and a non-acupoint group, 20 rats in each group. The model of MI was not made in the blank group; the left anterior descending coronary artery was not ligated after thoracotomy in the sham operation group; the model of MI was made but acupuncture was not given in the model group. After the model of MI was made, electroacupuncture (EA) was applied at "Neiguan" (PC 6) in the ASAM group, at "Hegu" (LI 4) in the ASAOM group, and at the area between the third and fourth metatarsal bone in the non-acupoint group. EA was given 20 min per treatment, once a day for 5 days. After treatment, the TTC staining was used to detect myocardial infarction, the Tunel method was used to detect cardiomyocyte apoptosis, and the immunohistochemistry was used to detect the expression of adenosine receptors A1, A2a and A2b. RESULTS: Compared with the blank group and the sham operation group, the percentage of myocardial infarction and apoptotic rate of myocardial cells in the model group were increased significantly (P<0.01). After EA treatment, compared with the model group, the percentage of myocardial infarction and apoptotic rate of myocardial cells in the ASAM group were decreased significantly (P<0.01), and the expression levels of adenosine receptors A1, A2a and A2b were increased significantly (P<0.01). The percentage of myocardial infarction and apoptotic rate of myocardial cells in the ASAM group were significantly lower than those in the ASAOM group and the non-acupoint group (P<0.01), and the expression levels of adenosine receptors A1, A2a and A2b in the ASAM group were significantly higher than those in the ASAOM group and non-acupoint group (P<0.01). CONCLUSION: Compared with acupoint selection at other meridians or non-acupoints, acupoint selection along meridians can effectively regulate the expression of adenosine receptors A1, A2a and A2b, improve the condition of myocardial infarction, inhibit myocardial cell apoptosis, and consequently protect ischemic myocardium.

[Professor LIANG Fan-rong's clinical application of the guiding-qi acupuncture technique].

In clinical practice, professor LIANG Fan-rong integrates the guiding-qi acupuncture technique of slow insertion and withdrawal of the needle with the thought of needling sensation reaching the affected site. These two theories were recorded in Lingshu: Wuluan (Chapter 34 of Miraculous Pivot). Professor Liang proposes that in acupuncture, both acupuncture physician and patient should be in a tranquilizing state. Firstly, the needle is inserted slowly so as to conduct the reversed turbid qi in yang back to yin. After arrival of qi, with the compound manipulation for promoting qi, qi is guided to the affected site. When the treatment ends, the needle is removed slowly to guide the reversed clear qi in yin back to yang and to guide qi of nutrient and defensive systems back to the original layers. Such acupuncture technique is applicable for various disorders induced by the impairment of qi activity. In clinical practice, it is adopted for the disorders of heart, lung, stomach, intestines, emotions and nervous system, as well as the obstruction disorders of meridians. The ying-spring and shu-stream points of the affected meridians are selected as the main acupoints in prescription. According the theory of four seas and qi street, the corresponding the front-mu, back-shu and he-sea points are combined. In acupuncture, the needle is inserted and withdrawn slowly. After arrival of qi, the needle is manipulated to guide qi to the pathogenic locations.

[The sensitization phenomena and regularity of Hegu (LI 4) based on bibliometrics].

The sensitization phenomena and regularities of Hegu (LI 4) were preliminarily explored. The relevant literature regarding Hegu (LI 4) sensitization were collected by computer retrieval at Cochrane Library, Pubmed, Embase (OvidSP), China Journal Full Text Database (CNKI), China Biomedical Literature Database (CBM), VIP and Wanfang (WF) databases as well as manual searching, and a modern literature database of Hegu (LI 4) sensitization was established. The information of disease type, sensitization type, detection method and index were collected. Frequency statistics method was used for analysis. As a result, 47 literatures were included, of which heat sensitivity was the most common type of sensitization, and diseases of liver and gallbladder, limb meridians, lung system, and spleen-stomach system were the most common types of diseases. The detection method of sensitization was various, among them, potassium ion introduction method and hot-water tail-flick method were mainly used for pain sensitivity, while acupoint resistance measuring instrument was mainly used for electric sensitivity, while thermal infrared imager was mainly used for heat sensitivity, while infrared spectrometric analyzer was mainly used for light sensitivity, while pressing pain measuring instrument was used for pressing sensitivity. Detection index was different, pain sensitivity detected pain threshold, electric sensitivity mainly detected acupoint resistance, heat sensitivity mainly detected temperature, light sensitivity detected average sharpness and average energy of infrared radiation, pressing sensitivity detected pressing-pain threshold. In conclusion, the regularities of sensitization of Hegu (LI 4) were preliminarily summarized, which involved five sensitization types: heat sensitivity, electric sensitivity, pain sensitivity, pressing sensitivity and light sensitivity. The sensitization of Hegu (LI 4) was commonly seen in facial paralysis, bronchial asthma, allergic rhinitis, tinnitus, ulcerative colitis. The temperature, pain threshold, pressing-pain threshold, average sharpness and average energy of infrared radiation of Hegu (LI 4) in pathological condition were lower than those in healthy subjects, and the resistance value was higher than that of healthy subjects.

Purines Change at Acupoints along the Pericardium Meridian in Healthy and Myocardial Ischemic Rats.

OBJECTIVE: To quantify the purine concentrations of the acupoints along the pericardium and nonpericardium meridians under healthy and myocardial ischemia conditions to investigate the relationship between acupoint purine change and body functional status in rats. METHODS: A total of 70 rats underwent an operation for myocardial ischemia, while 40 of them survived. They were randomly assigned to the following 5 subgroups: Neiguan (PC 6), Quze (PC 3), Tianquan (PC 2), Quchi (LI 11), and Jianyu (LI 15). Simultaneously, another 40 healthy rats were also randomized into the same 5 subgroups as the control group. The tissue fluids at the acupoints were collected by microdialysis for 30 min. Subsequently, the concentration of adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), and adenosine (ADO) were quantified using the high-performance liquid chromatography method. RESULTS: Compared with the healthy group, the ADO at PC 6 (P=0.012), PC 3 (P=0.038), PC 2 (P=0.024), and LI 15 (P=0.042) obviously increased in the model group, while no significant difference was observed at LI 11 (P=0.201). However, ATP, ADP, and AMP manifested no significant changes in these areas, except for ATP at LI 15 (P=0.036). CONCLUSIONS: Myocardial ischemia could induce an increase in ADO at acupoints of the upper arm and shoulder area, suggesting that the body functional status could affect the responsiveness of acupoints. The status of these acupoints could be pathogenically activated by disease, and distribution following some specific courses.

[Combined treatment and prognostic factors for stage III and IV endometrial carcinoma].

OBJECTIVE: To evaluate prognostic factors and treatment of patients with advanced stage endometrial cancer. METHODS: One hundred and eighteen patients with advanced stage endometrial cancer were treated in our hospital between January 1996 and December 2006. The treatment and prognosis were retrospectively analyzed. The mean follow-up time was 26 months. RESULTS: During the follow-up, 33 cases (28.0%) died and 25 patients (21.2%) had disease progression. The 3-year overall survival for patients with stage III and stage IV was 78.3% and 39.4%, and for endometrioid and nonendometrioid endometrial carcinoma was 69.3% and 42.0%, respectively. Four patients with positive cytology only were followed closely after surgery and were free of disease up to the report time. Patients with late stages, deep myometrial invasion, nonendometrioid endometrial cancer, poor differentiation, without lymphadenectomy and without radiochemotherapy after surgery were associated with a worse prognosis by univariate analysis (P < 0.05), while in a multivariate analysis only late stages and deep myometrial invasion were associated with a poor prognosis (P < 0.05). The patients who received lymphadenectomy and whose residual disease after the surgery was less than 1 cm had better prognoses than those otherwise (P < 0.05). The patients who received postoperative radiochemotherapy had better prognoses than those who did not (P < 0.05). CONCLUSIONS: Pathological stage and myometrial invasion are independent prognostic factors for late stage endometrial cancer. Satisfactory cytoreduction surgery and lymphadenectomy, followed by postoperative radiochemotherapy, except for stage IIIa patients with positive cytology only, are recommended in order to improve prognosis.

Surgical and oncological outcomes of an improved nerve-sparing radical hysterectomy technique: 6 years of experience at two centres.

OBJECTIVE: An improved nerve-sparing radical hysterectomy (NSRH), which is based on the paravesico-vaginal space, has been recently introduced in a phase II, prospective clinical trial by our team. This study aims to report the surgical and oncological outcomes of this improved NSRH. METHODS: One hundred seventy-seven consecutive patients were enrolled in our study and underwent the improved NSRH. The proportion of successful catheter removal and postvoid residual urine volume (PVR) of 50 mL or less at postoperative day 7 or day 4 was used to assess surgical outcomes. The local control rate (LCR), disease free survival (DFS), and overall survival (OS) were used to assess oncological outcomes. RESULTS: Postoperative 30-day complications occurred in 27/177 (15.3%) patients. The rate of successful catheter removal and PVR of 50 mL or less were 85.2% (23/27) and 66.7% (18/27) at postoperative day 7, and 73.3% (110/150) and 35.3% (53/150) at postoperative day 4. A total of 13 (7.9%) patients showed recurrence after a median follow-up time of 39.2 months (range 3.2-68.1 months). The estimated 2-year and 5-year DFS rates were 92.2% and 91.1%, respectively. Seven (4.2%) patients presented local recurrence, and five (3.0%) patients were dead at the end of the follow-up period. The estimated 5-year LCR and OS were 95.1% and 96.2%, respectively. In univariate analysis, International Federation of Gynecology and Obstetrics (FIGO) stage, lymphovascular space invasion (LVSI), and lymph node metastasis were found to be the prognostic risk factors of DFS. Patients with LVSI were associated with a worse DFS according to the multivariate analysis. CONCLUSIONS: The improved NSRH in our study may provide better surgical outcomes without compromising the survival in patients with early cervical cancer.

[Clinical and pathologic analysis of 33 cases of uterine papillary serous carcinoma].

OBJECTIVE: To analyze the clinico-pathological characteristics, prognostic factors and the rational therapy for the uterine papillary serous carcinoma (UPSC). METHODS: Thirty-three cases of UPSC were treated in our hospital between January 1996 and December 2005. The clinico-pathologic characteristics, treatment and prognosis were retrospectively analyzed. RESULTS: The three-year overall survival for patients with stage I, III and IV was 77.4%, 53.3% and 12.1%, respectively. Patients with late stages and deep myometrial invasion were associated with a worse prognosis by univariate analysis (P < 0.05), while in a multivariate analysis only late stages and poor differentiation were associated with a poor prognosis (P < 0.05). The prognosis of patients in late stages treated with postoperative chemotherapy was significantly better than those without chemotherapy (P = 0.014). CONCLUSIONS: Most UPSC patients are in late stages at diagnosis. They often have extra-uterine metastasis and have a poor prognosis. Complete surgical staging is recommended, and postoperative chemotherapy seems to improve the prognosis.

[Regularities of Acupoint Combinations for Facial Paralysis in Chinese Ancient Times Analyzed in Accordance with Modern Complex Network Community Framework Partition].

OBJECTIVE: To analyze the characteristics of acupoint combinations (formula) for facial palsy in ancient lite-rature, so as to optimize the related acupoint prescriptions in clinical practice. METHODS: The database of ancient acupoint prescriptions for facial paralysis was established first after searching and collecting the related acu-moxibustion literature (178 categories as monographs, specific volumes of a book, etc.) by using key words of "facial palsy" or "deviation of the eye and mouth" including Chinese terms of "Diaoxianfeng ()" "Wopi ()"and "Kouwo()". The characteristics of acupoint selection were analyzed and acupoint prescriptions were optimized using bipartite network community structure partition. RESULTS: The results indicated that of the 56 acupoints for facial palsy collected in the literature, Shuigou (GV 26), Dicang (ST 4), Jiache (ST 6), Hegu(LI 4), Fengchi(GB 20), Zusanli (ST 36), Neiting (ST 44), Tinghui (GB 2), Chengjiang (CV 24) and Shangguan (GB 3) are the core acupoints in clinical application. The acupoints of Dicang (ST 4), Jiache (ST 6), Shuigou (GV 26), Fengchi(GB 20), Neiting (ST 44), Hegu (LI 4), Zusanli (ST 36), Lieque (LU 7), Shangguan (GB 3) and Erjian (LI 2) are most frequently selected for forming prescriptions.The optimized acupoint prescriptions are composed of Tinghui (GB 2), Fengchi (GB 20), Fengshi (GB 31), Xuanzhong (GB 39), Dicang (ST 4), Jiache (ST 6), Zusanli (ST 36), Dazhui (GV 14), Baihui (GV 20), Quchi (LI 11) and Jianyu (LI 15). Core acupoints were mainly distributed on the Stomach Meridian of Foot Yangming, Large Intestine Meridian of Hand Yangming and the Governor Vessel. Acupoints at the face and head are used more frequently than those in any other parts of the body. Specific acupoints are used more frequently than non-specific acupoints, among which Conf-luent Acupoints are most frequently used. CONCLUSIONS: In the treatment of facial paralysis in ancient China, selection of local acupoints is the basic principle and some specific acupoints are the core acupoints in ancient acupuncture prescriptions.