Observation on efficacy and underlying mechanism of cheek acupuncture on ovulation induction for infertile women with PCOS: Case series.

RATIONALE: Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder among women of childbearing age and is the primary cause of anovulatory infertility, accounting for 70% to 80% of cases. Ovulation induction is the main treatment approach for infertile patients with PCOS. Commonly utilized medications for this purpose are clomiphene citrate (CC) and letrozole (LE). Clomiphene citrate administration results in an ovulation rate ranging from 60% to 85%, while the pregnancy rate is limited to 35% to 40%, and a further reduction is observed in live birth rates. Letrozole demonstrates a slightly higher pregnancy rate and live birth rate compared to clomiphene citrate, although challenges persist in terms of longer stimulation cycles, multiple pregnancies, and the risk of ovarian hyperstimulation syndrome (OHSS). Clinical reports indicate that acupuncture therapy shows promising efficacy in treating patients with PCOS-related infertility, despite a partially unclear understanding of its underlying mechanisms. PATIENT CONCERNS: In this study, one patient did not achieve pregnancy despite more than a year of ovulation induction using clomiphene citrate and letrozole. However, after 3 months of receiving cheek acupuncture therapy, she successfully conceived and gave birth to a liveborn baby. Another patient achieved natural conception and live birth after 2 months of exclusive cheek acupuncture therapy. DIAGNOSIS: PCOS. INTERVENTIONS: Cheek acupuncture therapy. OUTCOMES: Both of them successfully conceived and gave birth to a liveborn baby. LESSONS: These findings suggest that cheek acupuncture therapy can effectively stimulate follicle development and ovulation, potentially improving endometrial receptivity. According to holographic theory, there is a biologically holographic model within the cheek region that shares a homology with the human body structure. This model provides an explanation for the regulatory effects of cheek acupuncture point stimulation on the Hypothalamic-Pituitary-Ovarian axis (HPO), which subsequently influences follicle development and ovulation in patients. Consequently, when cheek acupuncture therapy is applied alone or in combination with ovulation induction medication, patients have the ability to achieve successful pregnancy and experience a smooth delivery.

Clinical efficacy of Gualou Xiaoyong Decoction and painless lactation manipulation in treating lactation acute mastitis and breast abscess: An observational study.

Information on the effects of Chinese medicine in the treatment of lactational acute mastitis and breast abscess is limited; thus, we conducted an observational study to analyze the clinical efficacy of Gualou Xiaoyong Decoction combined with painless lactation manipulation in the treatment of lactational acute mastitis and breast abscess. A total of 41 patients with lactational acute mastitis and breast abscess who were treated with Gualou Xiaoyong Decoction and painless lactation manipulation from October 2021 to October 2022 were included in this study. The age, fetal times(primiparous/multiparous), delivery mode (cesarean section/vaginal delivery), onset time, breast lump diameter, skin rash diameter, body temperature, visual analogue score, blood routine, C-reactive protein, procalcitonin, bacterial culture in milk, B ultrasound and other data of these patients were statistically analyzed. After treatment, the breast lump diameter of these patients decreased significantly, the skin rash diameter was reduced or disappeared, the body temperature decreased or returned to a normal range, and the visual analogue score also decreased. Besides, these patients had a decreased total number of white blood cells and a reduced percentage of neutrophils, C-reactive protein, and procalcitonin after treatment. In addition, bacteria in the milk of most patients disappeared, and there was no abnormality in B ultrasonic imaging. Except for 2 patients with breast abscess who stopped breastfeeding on the affected side for 1 day and 3 days respectively, all other patients continued to provide breast milk for their infants, and no adverse reactions were observed in these infants. The combination of Gualou Xiaoyong Decoction and painless lactation manipulation can achieve favorable clinical effects in the treatment of lactational acute mastitis and breast abscess. This combined therapy has good efficacy, short course of treatment, low costs, and great convenience with the avoidance of pain, hospitalization, influence on lactation, breast scar and other adverse outcomes.

Zwitterionic Peptide Enhances Protein-Resistant Performance of Hyaluronic Acid-Modified Surfaces.

A convenient and efficient approach for the surface modification of antifouling materials is highly desirable in numerous applications like affinity-based biosensors. Herein, we fabricated a hybrid antifouling coating on Au surfaces, with thiolated hyaluronic acid (HA) being chemically adsorbed to Au surfaces by the "graft to" approach, followed by a self-assembly of a smaller zwitterionic peptide named p-EK to obtain HA/p-EK-modified surfaces. The real-time sensorgrams of surface plasmon resonance biosensor manifested the successful modification of HA and p-EK on Au surfaces, indicating that there were some bare Au substrates on the HA-modified surfaces for peptide binding. The obtained HA/p-EK surfaces exhibited high hydrophilicity with a water contact angle of 9°. Quartz crystal microbalance and surface plasmon resonance experiments verified that further grafting the zwitterionic p-EK peptide on HA-modified surfaces could enhance the antifouling performance by one time. The improved protein resistance could be mainly contributed by the modification of the zwitterionic peptide that shields the exposed Au substrates from interacting with protein foulings. This strategy by grafting a smaller zwitterionic peptide might provide a novel way to achieve an enhanced protein-resistant performance of the macromolecular coating obtained by the "graft to" surface modification approach.

Superior Antifouling Performance of a Zwitterionic Peptide Compared to an Amphiphilic, Non-Ionic Peptide.

The aim of this study was to explore the influence of amphiphilic and zwitterionic structures on the resistance of protein adsorption to peptide self-assembled monolayers (SAMs) and gain insight into the associated antifouling mechanism. Two kinds of cysteine-terminated heptapeptides were studied. One peptide had alternating hydrophobic and hydrophilic residues with an amphiphilic sequence of CYSYSYS. The other peptide (CRERERE) was zwitterionic. Both peptides were covalently attached onto gold substrates via gold-thiol bond formation. Surface plasmon resonance analysis results showed that both peptide SAMs had ultralow or low protein adsorption amounts of 1.97-11.78 ng/cm2 in the presence of single proteins. The zwitterionic peptide showed relatively higher antifouling ability with single proteins and natural complex protein media. We performed molecular dynamics simulations to understand their respective antifouling behaviors. The results indicated that strong surface hydration of peptide SAMs contributes to fouling resistance by impeding interactions with proteins. Compared to the CYSYSYS peptide, more water molecules were predicted to form hydrogen-bonding interactions with the zwitterionic CRERERE peptide, which is in agreement with the antifouling test results. These findings reveal a clear relation between peptide structures and resistance to protein adsorption, facilitating the development of novel peptide-containing antifouling materials.

[Relationship between factors of labour pain and delivery outcomes].

OBJECTIVE: To evaluate factors associated with labor pain and delivery outcomes. METHODS: From Jul. to Dec. 2009, 111 normal singleton cephalic presentation pregnancies (including 5 elderly parturient) who delivered at the Department of Obstetrics and Gynecology, Second Affiliated Hospital, Zhejiang Chinese Medical University were enrolled in this study to evaluate the relationship between factors of labor pain and delivery outcomes. The labor pain of latent phase and active phase were scored by the visual analogue scale (VAS). Factors associated with pain included the age of parturient, the number of gravidity and parity, occupation, education profile, dwell location, etc. The questionnaire was designed by ourselves. Childbirth awareness, psychological preparation of delivery, emotional controllability, couple relationship, the relationship of parturient and mother-in-law, the relationship of parturient and parents, family economic status, use of sedative during the labor process and delivery outcomes were collected and analyzed. RESULTS: (1) Factors associated with pain: in the latent phase, the rate of moderate labour pain of 1/5 in women with more than 35 years old was statistically lower than 76.4% (81/106) in suitable age group (P < 0.05). The women with a good understanding about delivery had a statistically lower rate of moderate pain of 64.7% (44/68) than 88.4% (38/43) of those having a poor understanding (P < 0.05). The women who had a better couple relationship had a significantly higher rate of moderate pain of 77.2% (78/101) than 4/10 of those who had a general couple relationship (P < 0.05). There was significant difference in rate of moderate pain between pluripara group (50.0%, 11/22) and primipara group (79.8%, 71/89; P < 0.01). In the active phase, women with tense, scared or a poor emotion control expressed significantly severe labour pain (59.0%, 36/61) than 35.6% (16/45) in well-prepared group. The rate of severe labour pain in good control of emotion group of 44.8% (43/96) was a statistically lower than 9/10 in poor control group. There was a statistically lower severe labour pain in women given by sedatives (29.2%, 7/24) than 54.9% (45/82) in women without sedatives treatment (P < 0.05). (2) Delivery outcomes: in latent phase, the rates of fetal distress and cesarean section were 36.6% (30/82) and 39.0% (32/82) in moderate pain group, which were significantly higher than 13.8% (4/29) and 17.2% (5/29) in mild pain group. In active phase, the rate of fetal distress, cesarean section and postpartum hemorrhage were 36.5% (19/52), 40.4% (21/52) and 13.5% (7/52) in severe pain group, which were significantly higher than [18.5% (10/54); 20.4% (11/54); 0] in moderate pain group (P < 0.05). CONCLUSIONS: Women with poor understanding of delivery, tense, scared, poor emotion control, young age and uniparous have severe labour pain. Sedative use could alleviate pain in active phase. Women with mild labour pain have good delivery outcomes.

Pioglitazone reduces tumor necrosis factor-alpha serum concentration and mRNA expression of adipose tissue in hypercholesterolemic rabbits.

BACKGROUND: Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory cytokine involved in atherogenesis. Adipose tissue is an important source of endogenous TNF-alpha production. Pioglitazone, a member of the thiazolidinediones (TZDs), has anti-inflammatory and anti-atherogenic properties, while underlying mechanism has not been fully elucidated. The aim of this study was to evaluate the effect of pioglitazone on TNF-alpha serum concentration and mRNA expressions of subcutaneous adipose tissue in hypercholesterolemic rabbits. METHODS: Ten rabbits fed with high-cholesterol diet for 8 weeks were randomly divided into two groups: (1) high cholesterol group (n=5): maintained high cholesterol diet for 4 weeks; (2) pioglitazone group (n=5): the same cholesterol diet plus pioglitazone (3 mg/kg/day) for 4 weeks. Control group (n=5) was fed with normal diet for 12 weeks. Subcutaneous adipose tissue was collected for RNA analysis. The direct effect of pioglitazone on TNF-alpha release was assayed in primary rabbit adipocytes. TNF-alpha levels in serum and adipocytes culture supernatant were measured by ELISA. RT-PCR was used to evaluate TNF-alpha mRNA expressions in adipose tissue and adipocytes. RESULTS: Compared with control group, rabbits fed with high cholesterol diet showed significantly higher levels of serum total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and TNF-alpha. Though having no effect on serum glucose level and lipid profile, pioglitazone administration significantly reduced circulating TNF-alpha concentrations, which were positively correlated with TNF-alpha mRNA expressions of adipose tissue (r=0.53, P<0.01). Pioglitazone dose-dependently inhibited lipopolysaccharide (LPS)-induced TNF-alpha secretion and mRNA expression in cultured adipocytes. CONCLUSION: Pioglitazone significantly reduced serum TNF-alpha level in hypercholesterolemic rabbits independent of its metabolic actions, which may at least partly be due to its direct inhibition of TNF-alpha expression and secretion of adipocytes. This may help to explain the mechanism by which pioglitazone exert anti-atherosclerotic effects.

Anti-atherogenic properties of fibrates may be largely due to their anti-inflammatory effects.

Current understanding of the pathophysiology of atherosclerosis has undergone a remarkable evolution. Compelling evidence has evolved at both the basic science and clinical level for the importance of inflammation in the pathogenesis of atherosclerosis and its complications. Recent research has shown that both systemic and local inflammation plays a central role in all phases of the atherosclerotic process. Inflammatory cells dominate early atherosclerotic lesions, inflammatory cytokines accelerate progression of the lesions, and activation of inflammation can elicit acute coronary syndromes. Robust clinical studies have affirmed that fibrates are anti-atherogenic and can improve the cardiovascular risk profile. Fibrates not only modulate the serum concentrations of triglyceride and cholesterol, but also inhibit systemic inflammatory statue and inflammatory response in vascular cells. Fibrates act anti-inflammatory effects in monocyte/macrophage, T lymphocyte, endothelial cells, vascular smooth muscle cells and adipocytes. Since atherosclerosis is now regarded as an inflammatory disease and those inflammatory cells play critical important roles in the initiation and development of atherosclerosis, we hypothesize that anti-atherogenic properties of fibrates may be largely due to their anti-inflammatory effects.

Gemfibrozil reduces release of tumor necrosis factor-alpha in peripheral blood mononuclear cells from healthy subjects and patients with coronary heart disease.

BACKGROUND: Inflammatory process plays an important role in the pathogenesis of coronary heart disease (CHD). With the growing use of gemfibrozil and other fibrates, their anti-inflammatory effects have been noted. But little is known about the effect of gemfibrozil on tumor necrosis factor (TNF)-alpha secretion in peripheral blood mononuclear cells (PBMC) from patients with coronary heart disease. METHODS: PBMC were obtained from CHD patients (n=16) and healthy controls (n=13). PBMC (2x10(6) cells/ml) were cultured in 24-well plates with or without Ang II (10(-8), 10(-7), 10(-6) mol/l), or Ang II (10(-6) mol/l) plus gemfibrozil (10(-6), 10(-5), 10(-4) mol/l). After 24-h incubation, the supernatants were separated, and TNF-alpha was measured by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Spontaneous release of TNF-alpha was 299.2+/-110.7 pg/ml in PBMC from CHD patients and 179.3+/-78.2 pg/ml in PBMC from control subjects (P<0.05). Incubated with Ang II (10(-8), 10(-7), 10(-6) mol/l), TNF-alpha secretion was 307.7+/-141.8, 318.9+/-135.6, 328.6+/-123.9 pg/ml in PBMC from CHD patients, and 225.3+/-135.4, 224.1+/-141.0,218.7+/-134.8 pg/ml in PBMC from control subjects, respectively. Ang II did not significantly trigger TNF-alpha secretion in both groups. Compared with that incubated with Ang II (10(-6) mol/l) alone, release of TNF-alpha intervened by gemfibrozil (10(-6),10(-5),10(-4) mol/l) decreased to 279.4+/-132.2, 268.0+/-132.7, 226.6+/-102.7 pg/ml in PBMC from CHD patients, and 177.6+/-94.4, 156.1+/-69.4, 105.3+/-52.7 pg/ml in the control group, respectively. Gemfibrozil (10(-5),10(-4) mol/l) significantly inhibited TNF-alpha secretion in both groups (P<0.05). CONCLUSIONS: Our data demonstrated that gemfibrozil reduced release of TNF-alpha in PBMC both from CHD patients and controls. This effect may partially be relevant to the clinical benefits of gemfibrozil in the treatment of dyslipidemia and atherosclerosis.