Iron Status and Risk of Heart Disease, Stroke, and Diabetes: A Mendelian Randomization Study in European Adults.

BACKGROUND: The relevance of iron status biomarkers for coronary artery disease (CAD), heart failure (HF), ischemic stroke (IS), and type 2 diabetes (T2D) is uncertain. We compared the observational and Mendelian randomization (MR) analyses of iron status biomarkers and hemoglobin with these diseases. METHODS AND RESULTS: Observational analyses of hemoglobin were compared with genetically predicted hemoglobin with cardiovascular diseases and diabetes in the UK Biobank. Iron biomarkers included transferrin saturation, serum iron, ferritin, and total iron binding capacity. MR analyses assessed associations with CAD (CARDIOGRAMplusC4D [Coronary Artery Disease Genome Wide Replication and Meta-Analysis Plus The Coronary Artery Disease Genetics], n=181 522 cases), HF (HERMES [Heart Failure Molecular Epidemiology for Therapeutic Targets), n=115 150 cases), IS (GIGASTROKE, n=62 100 cases), and T2D (DIAMANTE [Diabetes Meta-Analysis of Trans-Ethnic Association Studies], n=80 154 cases) genome-wide consortia. Observational analyses demonstrated J-shaped associations of hemoglobin with CAD, HF, IS, and T2D. In contrast, MR analyses demonstrated linear positive associations of higher genetically predicted hemoglobin levels with 8% higher risk per 1 SD higher hemoglobin for CAD, 10% to 13% for diabetes, but not with IS or HF in UK Biobank. Bidirectional MR analyses confirmed the causal relevance of iron biomarkers for hemoglobin. Further MR analyses in global consortia demonstrated modest protective effects of iron biomarkers for CAD (7%-14% lower risk for 1 SD higher levels of iron biomarkers), adverse effects for T2D, but no associations with IS or HF. CONCLUSIONS: Higher levels of iron biomarkers were protective for CAD, had adverse effects on T2D, but had no effects on IS or HF. Randomized trials are now required to assess effects of iron supplements on risk of CAD in high-risk older people.

The Efficacy of Acupuncture and Acupoint Massage in Enhancing Lumbar Mobility and Alleviating Pain in Individuals with Lumbar Disc Herniation.

Background: Lumbar disc herniation (LDH) is a prevalent condition in spinal surgery, and Traditional Chinese Medicine (TCM) acupuncture has gained clinical attention as a potential treatment for LDH in recent years. Objective: This study aimed to assess the therapeutic efficacy of acupuncture combined with acupoint massage in LDH patients. Methods: We enrolled a total of 135 LDH patients treated at our hospital from May 2021 to February 2023. Among them, 63 patients received acupuncture treatment (control group), while the remaining 72 received acupuncture combined with acupoint massage (observation group). We compared treatment efficacy and the time it took for lumbar stiffness, lower back and leg pain, bending and flexing difficulties, and other symptoms to disappear between the two groups. The Visual Analogue Scale (VAS) and Japanese Orthopedic Association Scoring System (JOA) were used to evaluate patients' pain levels and lumbar vertebral function before and after treatment. Additionally, we assessed patients using the Generic Quality of Life Inventory-74 (GQOL-74) and recorded their treatment satisfaction. Results: The observation group exhibited a slightly higher total effective rate compared to the control group, with a shorter time for the resolution of lumbar stiffness, lower back pain, leg pain, and other symptoms (P < .05). Furthermore, the observation group had lower VAS scores and higher JOA scores (P < .05). They also achieved higher GQOL-74 scores and reported greater treatment satisfaction (P < .05). Conclusions: Acupuncture combined with acupoint massage effectively alleviated clinical symptoms and pain in LDH patients, demonstrating significant clinical utility.

A single-center experience of parathyroidectomy in 1500 cases for secondary hyperparathyroidism: a retrospective study.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem. With the deterioration of renal function, a certain proportion of CKD patients enter the uremic stage, and secondary hyperparathyroidism (SHPT) becomes a challenge. For refractory hyperparathyroidism, parathyroidectomy (PTX) plays a key role in reducing mortality and improving prognosis. Nevertheless, no consensus has been reached on the optimal surgical method. We aimed to provide evidence for the effectiveness of surgical treatment by summarizing the experience from our center. METHODS: Clinical data from 1500 patients undergoing parathyroidectomy were recorded, which included 1419 patients in a total parathyroidectomy without autotransplantation (tPTX) group, 54 patients in a total parathyroidectomy plus autotransplantation (tPTX + AT) group, and 27 patients in the other group. Perioperative basic data, intact parathyroid hormone (i-PTH) levels, serum calcium levels, serum phosphorus levels, pathological reports, coexisting thyroid diseases, short-term outcomes and complications were analyzed. Moreover, postoperative complications were compared between the tPTX and tPTX + AT groups. RESULTS: Parathyroid hormone, serum calcium and phosphorus levels decreased significantly post-surgery. Two patients died during the perioperative period. As the two most common complications, the incidences of severe hypocalcemia and hyperkalemia were 36.20% (543 cases) and 24.60% (369 cases), respectively. Pre-iPTH levels (OR = 1.001, 95% CI: 1.001-1.001, p < 0.01), serum alkaline phosphatase (ALP) levels (OR = 1.002, 95% CI: 1.001-1.002, p < 0.01) and the mass of excised parathyroid gland (OR = 3.06, 95% CI: 1.24-7.55, p = 0.02) were positively associated with postoperative severe hypocalcemia, while age and serum calcium were negatively associated with it. Pathological reports of resected parathyroid and thyroid glands indicated that 96.49% had parathyroid nodular hyperplasia, 13.45% had thyroid nodular hyperplasia, and 4.08% had thyroid papillary carcinoma. CONCLUSIONS: Parathyroidectomy is a safe and effective treatment for refractory secondary hyperparathyroidism. Severe hypocalcemia is the main complication, and coexistent thyroid diseases should never be neglected.

[Trans-Douglas Retzius' space-sparing robot-assisted simple prostatectomy for large-volume benign prostate hyperplasia].

OBJECTIVE: To report the safety and efficacy of trans-Douglas Retzius' space-sparing robot-assisted simple prostatectomy (RSS-RASP) in the treatment of large-volume BPH. METHODS: This retrospective study included 24 cases of large-volume (>80 ml) BPH treated by trans-Douglas RSS-RASP from August 2019 to June 2021. The patients ranged in age from 55 to 80 (mean 68.5) years, with an average body mass index of 25.1 (20.5－34.9) kg/m2 , median prostate volume of 132.4 (85.6－235.7) ml, and preoperative tPSA of 10.8 (0.5－37.9) ng/ml, IPSS of 25 (3－35) and quality of life (QOL) score of 5 (3－8). Before surgery, 12 of the patients received catheterization for urinary retention, 1 underwent cystostomy, 2 were complicated with hydronephrosis, 1 had stones and diverticulum in the bladder, and 14 were excluded from the cases of PCa by prostatic biopsy. The operation time, intraoperative blood loss, hemoglobin level on the first day after surgery, blood transfusion, and intra- and postoperative complications were recorded. The patients were followed up for 3 to 21 months postoperatively. Comparisons were made before and after operation in the IPSS, maximum urinary flow rate (Qmax), postvoid residual volume (PVR), QOL score, IIEF score and Male Sexual Health Questionnaire (MSHQ) score. RESULTS: Trans-Douglas RSS-RASP was successfully completed in all the 24 cases, with a mean operation time of 175 (100－285) min, intraoperative blood loss of 200 (50－800) ml, hemoglobin decrease of 25 (4－57) g/L on the first day after surgery, postoperative drainage tube indwelling of 3 (2－7) d, and urinary catheterization of 12 (4－18) d. Six (25%) of the patients received intraoperative blood transfusion, 1 underwent transurethral electrocoagulation hemostasis 1 month after surgery because of postoperative bleeding, and 1 received transurethral resection of the cicatrical adhesive tissue of the bladder neck 12 months after surgery. No other complications occurred postoperatively. The IPSS (3 ［1－7］), Qmax (19.6 ［9.9－32.1］ ml/s), PVR (0 ［0－34.9］ ml) and QOL score (2 ［0－3］) of the patients were significantly improved after surgery (P < 0.05), but no statistically significant differences were observed in the IIEF (20 ［19－24］) and MSHQ scores (14 ［13－14］) as compared with the baseline (P > 0.05). CONCLUSION: Trans-Douglas RSS-RASP is a safe and effective minimally invasive method for the treatment of large-volume (>80 ml) BPH, which can improve the urinary function of the patient after operation.

Effect of Massage on the TLR4 Signalling Pathway in Rats with Neuropathic Pain.

This study set out to investigate the effect of massage on the Toll-like receptor 4 (TLR4) signalling pathway in the dorsal root ganglia of rats that had undergone spinal nerve ligation (SNL), with the hypothesis that massage could be used as an analgesic. Forty female SD rats were randomly divided into 5 groups: the control group, sham-operated group, model group, sham massage group, and massage group. There were 8 rats in each group. SNL rat models were established in the model group, sham massage group, and massage group. Rats in the sham-operated group underwent surgery to expose the vertebral nerves, but no further procedures were performed. The control group consisted of intact animals. The rats in the massage group underwent massage using a massage simulation machine once a day for 14 d in succession; the hind limbs of the rats in the sham massage group were gently touched with a cloth bag once a day for 14 continuous days. The rats in the control group, the sham-operated group, and the model group did not receive any intervention and were observed for 14 d. Paw withdrawal thermal latency (PWTL) and paw withdrawal mechanical threshold (PWMT) of rats in each group were detected 1 d before modelling and at 1, 3, 7, and 14 d after modelling. Fourteen days after modelling, the expression levels of TLR4, IRAK1, TRAF6, TNF-α, and IL-6 were detected in all rats. The PWTL and PWMT of SNL rats were decreased, while these parameters were elevated after massage. SNL rats showed higher levels of TLR4, IRAK1, TRAF6, IL-6, and TNF-α, and massage effectively lowered the expression levels of these molecules. Inhibiting activation of the TLR4 signalling pathway, which can reduce the release of inflammatory factors, may be one mechanism by which massage treats neuropathic pain.

Conjugated linoleic acid supplements preserve muscle in high-body-fat adults: A double-blind, randomized, placebo trial.

BACKGROUND AND AIMS: Conjugated linoleic acid (CLA) has been used to improve body composition in weight management. However, clinical trial results are inconsistent and limited among Asians. We aimed to investigate the effect of CLA on body composition of Chinese adults with elevated body fat percentage. METHODS AND RESULTS: In this double-blind, randomized, placebo-controlled trial, 66 Chinese adults (aged 18-45 years old, 37.9% male) with elevated body fat percentage were provided with 3.2 g/day CLA (n = 33) or 3.2 g/day placebo (sunflower oil; n = 33) for 12 weeks. Both groups received lifestyle counseling, featured with low fat and low sugar diet, and moderate physical activity. Body composition was measured using dual-energy X-ray absorptiometry at the baseline and end of the trial. Sixty-four participants finished this study. Compared with the placebo group, the CLA group showed increased trunk muscle mass (MM) (0.6 ± 1.7 vs. -0.3 ± 1.2 kg, P = 0.019). Among those with an adherence score higher than 0.80 (n = 56, 87.5%), a greater increase in both total and trunk MM was observed in the CLA group (both P < 0.05). Moreover, the effect on MM appeared to be more evident in men, those with a body mass index <25 kg/m2, or those with higher self-rated physical activity. CONCLUSIONS: In Chinese adults with elevated body fat percentage, 3.2 g/day CLA supplementation may be effective in preserving MM, especially in the trunk region. REGISTRATION: This study was registered at ClinicalTrials.gov as NCT03915808 on April 9, 2019.

Efficacy of electroacupuncture combined with probiotics for depression and chronic diarrhea in patients and effect on serum inflammatory cytokines, NE and BDNF.

Efficacy of electroacupuncture combined with probiotics for depression and chronic diarrhea in patients, and its effect on the levels of serum inflammatory cytokines, norepinephrine (NE) and brain-derived neurotrophic factor (BDNF) were investigated. A total of 104 patients with depression and chronic diarrhea admitted to The First Clinical Faculty, Guangxi University of Traditional Chinese Medicine from July 2014 to June 2018 were randomly divided into the observation group (n=56) and the control group (n=48). The observation group was treated with electroacupuncture combined with probiotics, and the control group was given conventional drugs for depression and chronic diarrhea. The Hamilton Depression Rating Scale (HAM-D) score and the abdominal symptom score were evaluated before treatment and at 3 weeks after treatment. Changes in the levels of serum inflammatory cytokines [interleukin (IL)-6, IL-2 and tumor necrosis factor (TNF)-α] as well as the levels of NE and BDNF in the two groups of patients before and after treatment were determined using radioimmunoassay. Compared with those in the control group, the symptoms of depression and diarrhea in the observation group were remarkably alleviated (p<0.05). After treatment, the serum cytokine levels in the two groups of patients were decreased, and the decreased level of serum inflammatory cytokines in the observation group was not obviously different from that in the control group. Besides, the serum BDNF level in the observation group was also reduced (p<0.05). The overall efficacy of the observation group was superior to that of the control group, showing a statistical difference. Electroacupuncture combined with probiotics brings good efficacy to patients with depression and chronic diarrhea, which is worthy of clinical promotion and development.

The prevalence, characteristics, expenditure and predictors of complementary medicine use in Australians living with gastrointestinal disorders: A cross-sectional study.

AIMS: To determine the prevalence, characteristics, expenditure and predictors of complementary medicine (CM) use in Australian adults living with gastrointestinal disorders (GID). METHODS: A cross-sectional study involving 2,025 Australian adults was conducted. Participants were recruited through purposive convenience sampling. Descriptive statistics were conducted to report the prevalence of people living with GIDs and their CM use, including CM products, mind-body practices and CM practitioner services. Chi-square test and independent-samples t-test were used to determine the associations between sociodemographic or health-related variables with CM use. Binary logistic regression was conducted to determine the significant predictors of CM use in GID participants. Economic data was calculated based on the mean out-of-pocket expenditure on CM. RESULTS: Of the 293 participants reporting a GID, 186 (63.5%) used CM products, 55 (18.8%) used a mind-body practice and 141 (48.1%) visited at least one CM practitioner in the last 12 months. Collectively, the majority of GID participants using any type of CM were female, aged 40-49 years, married and employed. The mean score for health-related quality of life was 49.6 out of 100 in GID participants and 68.2 in participants without a GID (p < 0.001). Average annual out-of-pocket expenditure on CM products was AUD127.29 by CM products users with a GID. The predictors of CM products, mind-body practices and CM practitioner services use differed. Of the 111 CM product users with a GID, 103 (92.8%) disclosed all or some of their CM use to general practitioner, 89 (80.2%) to specialist doctor, 79 (71.2%) to pharmacist and 69 (62.1%) to hospital doctor. CONCLUSIONS: A substantial proportion of Australian adults living with GID use CM products, mind-body practices and CM practitioner services. This study provides important insights to inform and guide the development of a more coordinated health care services for individuals living with GID.

The prevalence and characteristics of complementary medicine use by Australian and American adults living with gastrointestinal disorders: A systematic review.

AIM: To report the prevalence and sociodemographic characteristics of complementary medicine (CM) use by Australian and American adults living with gastrointestinal (GI) disorders. METHOD: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, Pubmed, Scopus and Web of Science were searched for studies published in English language between 1st January 2008 and 8th April 2018. Additionally, a Google Scholar search and risk of bias assessment were conducted. RESULTS: Twelve (five American and seven Australian) studies, involving 53,991 adults were included. Data were extracted from studies reporting CM use by both specific populations with medically diagnosed GI disorders and the general population with self-reported GI disorders. CM use ranged from 23.6% to 44% (American) and 27.2% to 58% (Australian) by adults with medically diagnosed GI disorders. Whilst CM use was higher amongst females, with higher incomes and education levels. The prevalence of CM use by those with self-reported GI disorders varied from 0.31% to 80%. Herbal, probiotic supplements and mind-body practices were the most prevalent CMs used. The risk of bias assessment identified weaknesses in the external validity, principally related to poor study design. CONCLUSIONS: There is a substantial use of CMs by American and Australian adults with GI disorders. Females with higher education and income are predominant users. There is a need to conduct up-to-date and well-designed prevalence and sociodemographic studies. Additionally, future studies should consider including health literacy and medicines disclosure scales in order to better understand CM use by this population.

[Systematic evaluation on treatment of sub-health with acupuncture-moxibustion and Tuina in clinical researches].

OBJECTIVE: To evaluate the therapeutic effect of acupuncture-moxibustion and Tuina massage for treatment of sub-health. METHODS: A systematic evaluation on randomized controlled trial, quasi-randomized control trial or controlled clinical trial of treatment of sub-health with acupuncture-moxibustion and Tuina was carried out according to the assessment methods recommended by the Cochrane Collaboration. RESULTS: There are totally 9 articles and 937 subjects met the inclusion criteria and are included into the assessment system. The average quality of methodologies adopted is not so high, and with many limitations. Meta-analysis or descriptive analysis on the data collected: (1) General effect: Tuina massage therapy is better than auricular-point-pressing therapy; acupuncture is better than self health care; acupoint injection is better than intramuscular injection, Tuina is similar to Chinese herb. (2) Quality of life and pain score: Tuina is better than blank control. (3) Individual effect: the effect of Tuina massage on lassitude is better than acupuncture. (4) Effect on sleep quality index: Tuina massage is better than acupuncture. CONCLUSION: There are not enough evidences to approve that the effect of acupuncture-moxibustion and Tuina massage on sub-health is better than that of other therapies. Therefore, more high quality randomized controlled trials with strict and scientific designation are necessary for obtaining more and better evidences.

[Randomized controlled trial on effect of Tuina for treatment of sub-health people of somatic pain].

OBJECTIVE: To evaluate the clinical effect and safety of Tuina for treatment of somatic pain of sub-health. METHODS: A randomized, double-blind and blank parallel controlled trial was done. The experiment group was treated with Tuina and the control group lied down for rest, 45 minutes each time, twice each week for three weeks. RESULTS: Tuina treatment could improve more on sensory, affective, evaluation, pain rating index and extant pain intensity of the pain index, and score of subjective sensation of life quality and health status together with physiology and psychology field of life quality. CONCLUSION: Massage is an effective therapy for treatment of somatic pain of sub-health without adverse reactions and it should be generalized to application.

[The effect of Yunnan Baiyao on reduction of intra-operative bleeding of the patients undergoing transurethral resection of prostate].

OBJECTIVE: To investigate the effect of Yunnan Baiyao on reduction of intra-operative bleeding of the patients undergoing transurethral resection of prostate (TURP). METHODS: A randomized placebo-control double-blind multi-center trial was conducted. 203 patients with benign prostate hyperplasia (BPH), aged 50 - 80, who were to undergo TURP were randomly divided into 2 groups: Yunnan Baiyao group, given 500 mg Yunnan Baiyao four times daily since the third day before the operation for 3 days, and placebo group, given empty capsules for 3 days. The amount of intra-operative bleeding, bleeding index and bleeding intensity were compared. The side effect of Yunnan Baiyao was also evaluated. RESULTS: The amount of intra-operative bleeding of the Yunnan Baiyao group was 147 ml +/- 144 ml, significantly less than that of the control group (182 ml +/- 157 ml, P < 0.05). The amount of intra-operative bleeding of the per protocol (PP) population in the Yunnan Baiyao group (n = 58) was 146 ml +/- 116 ml, significantly less than the PP population in the control group (n = 66) (220 ml +/- 207 ml, P = 0.0361). When the weight of the resected prostate tissue was more than 20 gram, the amount of intraoperative bleeding, bleeding index, and bleeding intensity of the ITT population in the Yunnan Baiyao group (n = 60) were all significantly lower than those of the ITT population in the control group (n = 68) (all P < 0.05); the bleeding intensity of the PP population in the Yunnan Baiyao group was 2.4 ml/min +/- 1.8 ml/min, significantly lower than that of the PP population in the control group (3.6 ml/min +/- 3.7 ml/min, P = 0.0072); the bleeding index of the PP population in the Yunnan Baiyao group was 4.7 ml/g +/- 4.6 ml/g, significantly lower than that of the PP population in the control group (7.1 ml/g +/- 8.3 ml/g, P = 0.025). No side effect was found in the 2 groups. CONCLUSION: Yunnan Baiyao is effective on reducing the amount of intraoperative bleeding of TURP without side effect.

[Omission factors in detecting early stage prostate cancer by TRUS needle biopsy].

OBJECTIVE: To analyze and reduce the omission factors in detecting early stage prostate cancer by TRUS needle biopsy, and to improve the diagnosis of the disease. METHODS: A total of 80 benign prostatic hyperplasia patients suspected of prostatic carcinoma underwent TRUS sextant biopsies. The pathological results being negative, the patients received transurethral resection of the prostate (TURP). RESULTS: After TURP, 25 cases were pathologically diagnosed as prostate cancer, with an omission rate of 31.25% (25/80). Of the diagnosed cancer patients, 10 were treated by radical perineum prostatectomy, 8 by surgical castration, and 7 by medical castration. CONCLUSION: Some tumors may fail to be detected by TRUS needle biopsy. Serial or multi-core needle biopsies can decrease the omission rate in the diagnosis of organ confined cancer.

[Effect of ligustrazine on injury of vascular endothelial cells ECV-304 induced by hypoxia and lack of glucose].

OBJECTIVE: To investigate the effects of ligustrazine on nitric oxide (NO), malonaldehyde (MDA) production, release of intracellular lactate dehydrogenase (LDH) and membrane fluidity of the injured human umbilical vein vascular endothelial cell line (ECV-304) with hypoxia and lack of glucose. METHOD: The experiments were performed in culture of ECV-304 injured with hypoxia and lack of glucose in vitro. The released LDH of ECV-304 was measured with automatic biochemistry analyse. NO content of ECV-304 was monitored with colorimetry. Lipid peroxidation of ECV-304 was monitored as MDA with a fluorometric assay. The membrane fluidity of ECV-304 was measured with the fluorescence polarization method. RESULT: After culture ECV-304 in hypoxia and lack of glucose for 24 h, the LDH release, MDA production and the membrane fluidity increased significantly and NO level was decreased. Preincubation of ECV-304 with ligustrazine for 24 h reduced LDH release, MDA production, membrane fluidity increasing and increased the level of NO in ECV-304 due to hypoxia and lack of glucose. CONCLUSION: Ligustrazine has protective effect on injury of ECV-304 induced by hypoxia and lack of glucose.