Oridonin inhibits bladder cancer survival and immune escape by covalently targeting HK1.

BACKGROUND: Hexokinase I (HK1) is highly expressed in a variety of malignancies, regulates glycolytic pathway in cancer cells, and thus considered to be one of the promising molecular targets for cancer therapy. Nonetheless, the development of a specific inhibitor against HK1 remains elusive. PURPOSE: This study aims to elucidate the mechanism by which oridonin inhibits the proliferation and immune evasion of bladder cancer cells, specifically through the suppression of HK1. METHODS: To examine the mechanisms by which oridonin directly binds to cysteines of HK1 and inhibits bladder cancer growth, this study utilized a variety of methods. These included the Human Proteome Microarray, Streptavidin-agarose affinity assay, Biolayer Interferometry (BLI) ainding analysis, Mass Spectrometry, Cellular Thermal Shift Assay, Extracellular Acidification Rate measurement, and Xenotransplant mouse models. RESULTS: As indicated by our current findings, oridonin forms a covalent bond with Cys-813, located adjacently to glucose-binding domain of HK1. This suppresses the enzymatic activity of HK1, leading to an effective reduction of glycolysis, which triggers cell death via apoptosis in cells derived from human bladder cancer. Significantly, oridonin also inhibits lactate-induced PD-L1 expression in bladder cancer. Furthermore, pairing oridonin with a PD-L1 inhibitor amplifies the cytotoxicity of CD8+ T cells against bladder cancer. CONCLUSION: This research strongly suggests that oridonin serves as a covalent inhibitor of HK1. Moreover, it indicates that functional cysteine residue of HK1 could operate as viable targets for selective inhibition. Consequently, oridonin exhibits substantial potential for the evolution of anti-cancer agents targeting the potential therapeutic target HK1 via metabolism immunomodulation.

Economic burden of adult patients with ß-thalassaemia major in mainland China.

BACKGROUND: ß-thalassaemia major poses a substantial economic burden, especially in adults. We aimed to estimate the economic burden of adult patients with ß-thalassaemia major from a societal perspective using the real-world data. According to the clinical guideline, we also estimated the annual medical costs for patients with the same body weight and calculated the lifetime medical costs over 50 years in mainland China. METHODS: This was a retrospective cross-sectional study. An online survey with snowball sampling covering seven provinces was conducted. We extracted patient demographics, caregiver demographics, disease and therapy information, caring burden, and costs for adult patients diagnosed with ß-thalassaemia major and their primary caregivers. In the real world, we estimated the annual direct medical cost, direct nonmedical cost, and indirect cost. In addition, we calculated the annual direct medical cost and lifetime direct medical cost by weight with discounted and undiscounted rates according to the clinical guideline. RESULTS: Direct medical costs was the main driver of total cost, with blood transfusion and iron chelation therapy as the most expensive components of direct medical cost. In addition, adult patients with ß-thalassaemia major weighing 56 kg were associated with an increase of $2,764 in the annual direct medical cost using the real-world data. The undiscounted and discounted (5% discount rate) total lifetime treatment costs were $518,871 and $163,441, respectively. CONCLUSIONS: Patients with ß-thalassaemia major often encounter a substantial economic burden in mainland China. Efforts must be made to help policymakers develop effective strategies to reduce the burden and pevalence of thalassaemia.

2D/2D Phosphorus-Doped g-C3N4/Bi2WO6 Direct Z-Scheme Heterojunction Photocatalytic System for Tetracycline Hydrochloride (TC-HCl) Degradation.

Bi2WO6-based heterojunction photocatalyst for antibiotic degradation has been a research hotspot, but its photocatalytic performance needs to be further improved. Therefore, 2D/2D P-doped g-C3N4/Bi2WO6 direct Z-scheme heterojunction photocatalysts with different composition ratios were prepared through three strategies of phosphorus (P) element doping, morphology regulation, and heterojunction, and the efficiency of its degradation of tetracycline hydrochloride (TC-HCl) under visible light was studied. Their structural, optical, and electronic properties were evaluated, and their photocatalytic efficiency for TC-HCl degradation was explored with a detailed assessment of the active species, degradation pathways, and effects of humic acid, different anions and cations, and water sources. The 30% P-doped g-C3N4/Bi2WO6 had the best photocatalytic performance for TC-HCl degradation. Its photocatalytic rate was 4.5-, 2.2-, and 1.9-times greater than that of g-C3N4, P-doped g-C3N4, and Bi2WO6, respectively. The improved photocatalytic efficiency was attributed to the synergistic effect of P doping and 2D/2D direct Z-scheme heterojunction construction. The stability and reusability of the 30% P-doped C3N4/Bi2WO6 were confirmed by cyclic degradation experiments. Radical scavenging experiments and electron spin resonance spectroscopy showed that the main active species were •O2- and h+. This work provides a new strategy for the preparation of direct Z-scheme heterojunction catalysts with high catalytic performance.

Dietary supplementation with Tolypocladium sinense mycelium prevents dyslipidemia inflammation in high fat diet mice by modulation of gut microbiota in mice.

Obesity is a risk factor for many serious health problems, associated with inflammation, hyperlipidemia, and gut dysbiosis. Prevention of obesity is especially important for human health. Tolypocladium sinense is one of the fungi isolated from Chinese caterpillar fungus, which is a traditional Chinese medicine with putative gut microbiota modulation effects. Here, we established a high-fat diet (HFD)-induced hyperlipidemia mice model, which was supplemented with lyophilized T. sinense mycelium (TSP) daily to evaluate its anti-obesity effects. The results indicated that TSP supplementation can effectively alleviate the inflammatory response and oxidative stress levels caused by obesity. TSP significantly prevented obesity and suppressed dyslipidemia by regulating the expression of lipid metabolism genes in the liver. TSP is also effective in preventing the HFD-induced decline in short-chain fatty acid (SCFA) content. Gut microbiota profiling showed that TSP supplementation reversed HFD diet-induced bacterial abundance and also altered the metabolic pathways of functional microorganisms, as revealed by KEGG analysis. It is noteworthy that, correlation analysis reveals the up-regulated gut microbiota (Lactobacillus and Prevotella_9) are closely correlated with lipid metabolism parameters, gene expression of liver lipid metabolism and inflammatory. Additionally, the role of TSP in the regulation of lipid metabolism was reconfirmed by fecal microbiota transplantation. To sum up, our results provide the evidence that TSP may be used as prebiotic agents to prevent obesity by altering the gut microbiota, alleviating the inflammatory response and regulating gene expression of liver lipid metabolism.

Impact of Petroleum Contamination on the Structure of Saline Soil Bacterial Communities.

Petroleum contamination may lead to variations in soil microbial community structure and activities. The bioremediation of petroleum-contaminated soil typically depends on the characteristics and activities of oil-degrading microorganisms, which can be introduced or be part of the native soil microbiota. Thus, analyzing the structure of the microbial community and internal relationships in the bioremediation process is critical. Our study characterized the physical and chemical properties, microbial community structure, and microbial diversity of surface soil collected near an oilfield. The total carbon (TC), total organic carbon (TOC), and microbial diversity in oil-contaminated soil was found higher than in uncontaminated samples. Proteobacteria abundance was inhibited with oil pollution, while Actinomycetes abundance was enhanced. Some indigenous hydrocarbon-degrading bactera were enriched by oil pollution, such as Bacillus, Actinomarinales norank, Balneolaceae uncultured, Marinobacter, and Pseudomonas. Furthermore, Rokubacteria, Nitrospirae, and Entotheonellaeota were significant differences in the contaminated group. There were 16 genera with significant differences in the polluted group, such as Woeseia, Pelagibius, Pontibacillus, IS_44, Aliifodinibius, while Halothiobacillus, Algoriphagus, Novosphingobium, etc. had significant differences in the uncontaminated group. Redundancy analysis demonstrated that the responses of the microorganisms to the evaluated environmental factors were different, and TC was the most important driver of microbial community variation. Moreover, TOC was the largest contributor to operational taxonomic unit (OTU) and Chao index variations. Our results provide a theoretical basis for the enhancement of microbial activity in oil-contaminated soil, which might improve bioremediation efficacy.

Supplementation with Ginseng, Lilii Bulbus, and Poria induces alterations in the serum metabolic profile of healthy adults.

The preventive and therapeutic effects of herbal supplementation containing Ginseng, Lilii Bulbus, and Poria (GLP) on inflammation and oxidative stress in healthy adults have been demonstrated in our previous studies. However, the underlying mechanisms of organism protection by GLP remain unclarified, and few studies have used metabolomics to investigate comprehensive changes before and after GLP supplementation. Based on previous research, we conducted a placebo-controlled trial among 82 healthy adults in Wuhan, China, using a metabolomics approach with ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS/MS) and multivariate statistical methods to analyze serum metabolite alterations in participants before and after GLP supplementation. Furthermore, 14 discriminant metabolites related to lipid metabolism, inflammation and oxidative stress, energy metabolism, and coenzyme A metabolism were significantly different between the before- and after-GLP groups (P < 0.0001). Nine metabolites were significantly decreased in the serum samples from the after-GLP group compared with the before-GLP group, while five metabolites were significantly increased. These metabolites could be critical components associated with the anti-inflammatory, antioxidant, and hypolipidemic activities of GLP, indicating the potential complementary role of GLP supplements in the primary prevention of dysfunctional metabolism caused by potential diseases such as cardiovascular disease. This study provides a valuable reference for cardiovascular health protection and disease prevention.

[Clinical anatomical study on the treatment of tarsal tunnel syndrome with four-point vertical acupotomy].

OBJECTIVE: To explore safety and accuracy of four-point acupotomy for the treatment of tarsal tunnel syndrome regarding release of ankle tunnel flexor retinaculum to provide an anatomical basis of clinical treatment. METHODS: Twenty-nine adult specimens (15 males and 14 females) fixed with 10% formalin, aged from 47 to 98 years old with an average age of (81.10±11.14) years old, 29 on the right side and 29 on the left side, which were selected for the study from September 2020 to October 2020. Simulate the operation of loosening flexor retinaculumt with a needle knife on the human specimen, and place the specimen on the frog position of lower limbs with medial malleolus upward to determine the center of medial malleolus. Choose 4 different positions near the flexor retinaculum to insert the needle so that the needle body was perpendicular to skin and cutting edge direction was perpendicular to the running direction of the flexor retinaculum. The needle knife penetrates the skin and explores slowly. When the flexor retinaculum was reached, the needle tip may touch the tough tissue. At this time, the cutting is loosened for 4 times. After acupotomy release operation was completed, make a lateral incision on the skin surface along acupotomy direction, open the area of the exposed flexor retinaculum, dissecting layer by layer, observe and record the needle knife and its surrounding anatomical structure. The length of acupotomy cutting marks of flexor retinaculum was measured by electronic vernier caliper. The safety and accuracy of acupotomy loosening of ankle canal flexor retinaculum were evaluated by observing the number and degree of ankle canal contents such as tendons and nerves injured by needle knife. The safety is to count the number of cases of acupotomy injury to the contents of the ankle canal, and to calculate the injury rate, that is, the number of injury cases/total cases × 100%. The effective release was defined as the release length L ≥ W/2(W is the width of the flexor retinaculum, defined as 20 mm). RESULTS: For safety, there were no acupotomy injuries to nerves or blood vessels in 58 cases, 26 cases injuried to posterior tibial tendon which 17 of these tendon injury cases, the tendon was penetrated and severely injured, and flexor digitorum longus tendon was injured in 12 cases. Among these cases, tendon was penetrated and severely injured in 4 cases, and total injury rate was 32.14%. No nerve and vessel injury on c3 and c4 point. For accuracy, 58 specimens were successfully released. The length Lc of releasing trace for acupotomy was (10.40±1.36) cm, and length range 6.38 to 12.88 cm. Among all cases, the length of releasing trace was ≥10 mm in 37 cases. The overall success rate of release was 100.00%. Layered structure of ankle tube flexor retinaculumt:fiber diaphragm from flexor retinaculum divides contents of ankle tube into different chambers inward, and fiber diaphragm meets here to synthesize a complete flexor retinaculum at the midpoint of the line between the medial malleolus tip and calcaneal tubercle(above the neurovascular course). CONCLUSION: Four-point needle-knife method of releasing flexor retinaculum for the treatment of tarsal tunnel syndrome is performed at the attachment of the two ends of flexor retinaculum;the tendon, but not the nerves and blood vessels, is easily damaged. It is safe to insert needle on the side of calcaneus. The extent of release is relatively complete, but due to the "layered" structure of the flexor retinaculum, classic surgical technique could only release one layer of flexor retinaculum when a needle is inserted at the edge of the bone and cannot achieve complete release of the full thickness of the flexor. Therefore, it remains to be determined whether the desired effect can be achieved clinically.

The Urban-Rural Disparities and Associated Factors of Health Care Utilization Among Cancer Patients in China.

Objective: This study aimed to examine the urban-rural disparities and associated factors of health care utilization among cancer patients in China. Methods: This study used the data collected from a cross-sectional survey conducted in China. A total of 1,570 cancer survivors from three urban districts and five rural counties were selected by using a multistage stratified random sampling method. We measured health care utilization with the way of cancer diagnosis, the number of hospitals visited, and receiving alternative therapies. Chi-square test was used to examine the differences between urban and rural cancer patients. Binary logistic regression analysis was performed to explore the determinants of health care utilization. Results: Among 1,570 participants, 84.1% were diagnosed with cancer after developing symptoms, 55.6% had visited two and above hospitals, and 5.7% had received alternative therapies. Compared with urban cancer patients, rural ones were more likely to be diagnosed with cancer after developing symptoms (χ2 = 40.04, p < 0.001), while they were less likely to visit more than one hospital (χ2 = 27.14, p < 0.001). Residence area (urban/rural), health insurance type, household income, age at diagnosis, tumor site, stage of tumor, and survival years were significantly associated with health care utilization of cancer patients (p < 0.01). Conclusions: Health care utilization was suboptimal among cancers patients in China. Rural cancer patients had less health care utilization including screenings and treatments than urban ones. Policymakers should implement specific strategies to ensure equitable utilization of cancer care. More attention should be paid to the disadvantaged groups and rural cancer patients. Prioritizing health resources allocation is needed to prevent, screen, and treat cancers in rural areas.

Novel approach to improving wastewater treatment and sewage sludge combustion using pulverized coal-activated sludge.

Sewage and sludge are usually treated separately. Considering improving sludge treatment while improving sewage treatment is beneficial to the synergetic effect of sewage treatment and sludge treatment. The efficiency of pulverized coal-activated sludge (PAS) on contaminant removal, sludge calorific value, and combustion characteristic was investigated in contrast to conventional activated sludge (CAS) using the laboratory-scale sequencing batch reactor (SBR). Results indicated that the average chemical oxygen demand, ammonium nitrogen, total nitrogen, and total phosphorus removal efficiency of PAS were highest under a dosage of 0.4 g/L, which were 98.56%, 94.22%, 68.60%, and 95.96%, respectively. The average effluent concentration satisfied the Level A discharge standard of pollutants for municipal wastewater treatment plants (GB18918-2002). The calorific value and maximum weight loss of PAS gradually increased adjusting the dosage of pulverized coal. At the pulverized coal dosage of 0.2 g/L, the calorific value of PAS with 70% water content is 3,824.07 kJ/kg, which can satisfy the requirement of self-maintained combustion. Overall, the pulverized coal can simultaneously improve the treatment of wastewater in SBR and promote the sludge combustion by increasing calorific value. Therefore, PAS system is an innovation based on improving the sewage treatment sludge combustion. PRACTITIONER POINTS: An innovative method to simultaneously improving wastewater treatment and sewage sludge combustion using pulverized coal-activated sludge was developed. The average COD, NH 4 + - N , TN, and TP removal efficiency of PAS-0.4 is best. The 70% moisture content sludge calorific values of 3,824.07 kJ/kg in PAS-0.2 can satisfy the requirement of self-maintained combustion.

The effects of tacrolimus plus phototherapy in the treatment of vitiligo: a meta-analysis.

The objective of this meta-analysis was performed to compare the effects of tacrolimus plus phototherapy in the treatment of patients with vitiligo. Relevant studies were identified by searching PubMed, Embase, and Web of Science databases. The main outcomes of interest included excellent response (≥ 75% repigmentation), good response (50-75% repigmentation), moderate response (25%-50% repigmentation), and poor response (< 25% repigmentation). Risk ratio (RR) with 95% confidence intervals (95% CIs) was used to calculate the data. Eleven studies were included in this study. Compared with phototherapy alone, combination treatment of tacrolimus and phototherapy significantly improved excellent response rate (RR = 1.40, 95% CI 1.16, 1.69; P < 0.001) and reduced the poor response rate (RR = 0.37, 95% CI 0.22, 0.61; P = 0.001). However, the good response rate (RR = 1.00, 95% CI 0.59, 1.69, P = 1.000) and moderate response rate (RR = 0.91, 95% CI 0.60, 1.38; P = 0.653) were not significantly different between the two treatments. Subgroup analysis suggested that combination treatment had a higher excellent response rate than phototherapy alone for lesions located in the face and proximal limbs. Both NB-UVB and EL, when added to tacrolimus, resulted in a significantly higher excellent response rate than they were used alone. Meta-regression analysis showed that age was a predictive factor that influenced the effect of combination treatment on an excellent response, in which children had a high excellent response to the treatment. Other demographic and clinical variables, including gender, disease duration, family history, and type of vitiligo, did not have any impact on the treatment effect. Combination treatment with tacrolimus and phototherapy was more effective than phototherapy monotherapy for patients with vitiligo, especially in the lesions located in the face and proximal limbs. More large-scale, well-performed trials are needed to verify our findings.

Protective effect of supplementation with Ginseng, Lilii Bulbus and Poria against PM2 .5 in air pollution-induced cardiopulmonary damage among adults.

Exposure to PM2.5 (particulate matter with an aerodynamic diameter ≤ 2.5 µm) has been associated with increased cardiopulmonary outcomes, mediated by a hypothesized biological mechanism of systemic inflammation and oxidation. This randomized, double-blinded and placebo-controlled trial among 120 healthy adults in Wuhan, China, was conducted to evaluate whether the supplementation of herbal product composed of Ginseng, Lilii Bulbus and Poria (GLP) which have been shown to have anti-inflammatory and anti-oxidant activity offers protective effects on PM2.5 -induced damage to cardiopulmonary health. Participants received four rounds of health examinations and two rounds of blood sample collection from November 2018 to January 2019. Compared to the placebo group, the GLP group showed significant increased antioxidant biomarkers such as superoxide dismutase (SOD) and paraoxonase1 (PON1). What is more, interleukin-6 (IL-6), an inflammatory biomarker, was significantly decreased in the GLP group. In addition, nitric oxide and club cell secretory protein (CC16) were increased but heart rate was decreased in the GLP group. As for pulmonary function indicators, significantly increased fractional exhaled nitric oxide (FeNO) was observed in the GLP group. Taken together, we concluded that GLP supplementation is associated with decreased inflammatory biomarker and increased antioxidant biomarkers suggesting cardiopulmonary benefits against PM2.5 exposure among young adults in China.

Acupotomy for patients with tarsal tunnel syndrome: A protocol for systematic review and meta analysis.

BACKGROUND: Tarsal tunnel syndrome (TTS) is a painful condition of the ankle that affects patients' quality of life and ability to work. Multiple clinical studies of nerve decompression by acupotomy have been published in China, and the results are encouraging. However, the efficacy and security of this treatment have not been evaluated scientifically and systematically. The purpose of this systematic review protocol is to evaluate the efficacy and security of acupotomy treatment in patients with TTS, which will be helpful to clinical acupotomy doctors. METHODS: Relevant randomized controlled trials will be identified by searching 9 databases (PubMed, Embase, Cochrane Library, Chinese literature databases, the Chinese Biomedical Literature Database, China National Knowledge Infrastructure, SinoMed, Technology Journal and the Wanfang Database. Randomized controlled trials examining the use of acupotomy for TTS patients will be identified independently by 2 reviewers by searching the databases from inception to March 2020. Clinical effects will be evaluated as the primary outcome. Visual analog scale scores will be assessed as a secondary outcome. Review Manager 5.3 will be used to perform a fixed effects meta-analysis, and the evidence level will be evaluated by using the Grading of Recommendations Assessment, Development, and Evaluation framework. Continuous outcomes will be presented as mean differences or standard mean differences, while dichotomous data will be expressed as relative risks. RESULTS: This study will evaluate the effectiveness and safety of acupotomy in the treatment of TTS in randomized controlled trials with high-quality visual analog scale and Roles and Maudsley score. CONCLUSION: This systematic review will provide evidence to determine whether acupotomy is an effective intervention for patients with TTS. REGISTRATION NUMBER: DOI 10.17605/OSF. IO/9PYC2 (https://osf.io/9pyc2/).

[Clinical anatomical study on the treatment of carpal tunnel syndrome with classic Acupotomy].

OBJECTIVE: To explore the safety of classic Acupotomy in the treatment of carpal tunnel syndrome. METHODS: Twenty six adult specimens (15 males and 11 females), aged 60 to 95(82.54±6.94) years old, were selected from 10% formalin antiseptic fixation. There were 52 sides(two of them could not be tested). The study period was from November 2017 to May 2018. The specimens were collected from the body donation center of the school of basic medicine, Peking University. The operation of releasing the transverse carpal ligament on the human body specimen was simulated by the classic acupotomy, and the distance from the four points to the surrounding anatomical structure was measured to calculate the direct injury rate to the nerve and blood vessels, and the shortest distance between the acupotomy and the nerve and blood vessels was defined as ≥2 mm as safety. RESULTS: In the experimental operation, the direct injury rate of nerve and blood vessel was 14% and 12% respectively. There was significant difference in the rate of direct nerve injury between the four injection points (P<0.05). There was no significant difference in the rate of direct vascular injury between the four injection points (P>0.05). Among the four points, there was a statistically significant difference in the safety of nerves(P<0.05), and the safety of point 1 and point 3 of radial injection was higher than that of point 2 and point 4 of ulnar injection(P<0.05). There was significant difference in the safety of blood vessels between the four points(P<0.05), and the safety of radial point 1 was higher than that of ulnar point 2 and point 4 (P<0.05). CONCLUSION: The safety of the classic Acupotomy for carpal tunnel syndrome is related to the location of the needle entry point, and the safety of theradial proximal end of the needle is the highest.

Acupotomy for patients with carpal tunnel syndrome: A systematic review protocol.

BACKGROUND: This systematic review program is designed to provide an assessment of the effectiveness and safety of needle-knife therapy for the treatment of carpal tunnel syndrome (CTS). METHODS: A cumulative search till October 2018 will be conducted in the following 8 databases: PubMed, EMBASE, Cochrane Controlled Trials Register, MEDLINE, China National Knowledge Infrastructure, China Biomedical Literature Database, VIP Database, and Wanfang Database, with no language or Publication status restrictions. All randomized controlled trials (RCT) for carpal tunnel syndrome will be considered eligible. The primary outcomes will include changes in the Boston carpal tunnel questionnaire (BCTQ) and visual analogue score (VAS), as well as safety and adverse events. Study inclusion, data extraction, and quality assessment will be done independently by 2 reviewers. If no substantial heterogeneity is detected, a meta-analysis will be performed. Continuous results will be expressed as mean differences or standard average differences, while binary data will be expressed as relative risks. The deviation risk and data synthesis will be assessed using the Review Manager software. RESULTS: This study will provide a high-quality synthesis of BCTQ and VAS to assess the effectiveness and safety of acupotomy for carpal tunnel syndrome patients. CONCLUSION: This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with carpal tunnel syndrome. PROSPERO REGISTRATION NUMBER: CRD42018108787.

Comparison between acupotomy and local steroid injection for the management of de Quervain disease: A systematic review protocol.

BACKGROUND: De Quervain disease (dQD) is a painful condition of the wrist that affects patients' quality of life and work ability. Acupotomy has been widely used in the treatment of dQD. It has been reported in many articles that acupotomy can improve the clinical symptoms of dQD. However, the efficacy has not been evaluated scientifically and systematically. The aim of this systematic review protocol is to evaluate the efficacy and safety of acupotomy treatment compared with local steroid injection in patients with de Quervain disease. METHODS: Relevant randomized controlled trials will be identified by searching 9 databases (PubMed, EMBASE, Cochrane Library, Chinese literature databases, the Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], SinoMed, Technology Journal [VIP], and the Wanfang Database). Randomized controlled trials (RCTs) of Acupotomy for dQD patients will be identified independently by 2 reviewers by searching the databases from inception to October 2018. Clinical effects will be evaluated as the primary outcome. The VAS (visual analog scale) score will be assessed as a secondary outcome. RevMan V.5.3 will be used to perform a fixed effect meta-analysis, and the evidence level will be evaluated by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. Continuous outcomes will be presented as the mean differences or standard mean differences, while dichotomous data will be expressed as relative risks. RESULTS: This study will evaluate the effectiveness and safety of acupotomy in the treatment of de Quervain disease in RCTs with high-quality VAS and RM. CONCLUSION: This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with de Quervain disease. PROSPERO REGISTRATION NUMBER: CRD42018108786.

Acupotomy by an ultrasound-guided technique: A protocol for a systematic review.

BACKGROUND: Acupotomy is a miniature surgery instrument. It can cut and detach the abnormal, cicatricial, and contractured tissues by causing only microtrauma. Acupotomy has been widely used clinically with a satisfactory efficacy. With the development of ultrasound technology, ultrasound-guided acupotomy has shown great value in clinical practice. But it is not yet clear that ultrasound-guided acupotomy is very effective and safe. Therefore, it is important to re-evaluate the available evidence to reach a relatively convincing conclusion that acupotomy by ultrasound-guided technique is a better choice than traditional acupotomy. The purpose of this systematic review is to provide a method for evaluating the effectiveness and safety of acupotomy by ultrasound-guided technique. METHODS: This systematic review will be performed by searching relevant randomized controlled trials (RCTs) without any language or publication status restriction from inception to December 2019 by 2 researchers in nine databases (PubMed, Medline, Embase, Cochrane Library, Chinese literature databases, Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], China Science and Journal Database [CSJD], and Wanfang Database). All RCTs evaluating acupotomy by the ultrasound-guided technique will be included in this study. Visual analog scale (VAS) and change of symptom will be assessed as the primary outcomes. The change in the ultrasound image, safety and adverse events, and acceptability will be assessed as secondary outcomes. The selection of study, data collection and analysis, and assessment of the study quality will be completed independently by 2 researchers. RevMan v.5.3 will be used for meta-analysis if no significant heterogeneity is detected. Continuous outcomes will be presented as the mean difference (MD) or standardized MD, while dichotomous data will be expressed as the relative risk. RESULTS: This study will provide a high-quality synthesis of QL and AR to assess the effectiveness and safety of acupotomy by ultrasound-guided technique. CONCLUSION: This systematic review will provide evidence to judge whether acupotomy by ultrasound-guided technique is an effective the efficacy and safety intervention. PROSPERO REGISTRATION NUMBER: CRD42018109070.

Acupotomy for patients with trigger finger: A systematic review protocol.

BACKGROUND: Trigger finger is thought to be caused by aseptic inflammation of the A1 pulley and subsequent thickening and narrowing of the fibrous sheath. Acupotomy has been an important treatment for trigger finger. But an updated systematic review about this issue has not yet been released. This systematic review protocol is aimed at providing a higher quality method used to evaluate the efficacy and safety of acupotomy treatment for trigger finger. METHODS: The following databases will be searched from the study inception to July 2019: the Cochrane Central Register of Controlled Trials (Cochrane Library), MEDLINE, EMBASE, PubMed, China National Knowledge Infrastructure, Wan-Fang Data, and Chinese Biomedical Literature Database. All English or Chinese randomized controlled trials related to acupotomy for trigger finger will be included. Two reviewers will independently perform the processes of study inclusion, data extraction, and quality assessment. The primary outcome will be assessed by improvement of the pain symptoms and finger activity. Secondary outcomes will be assessed through Safety assessment. Meta-analysis will be completed by RevMan V.5.3 software. RESULTS: This systematic review will provide an assessment of the current state of acupotomy for trigger finger, aiming to show the efficacy and safety of treatment. CONCLUSION: This systematic review will re-evaluate a higher-quality systematic review to obtain a relatively convincing conclusion that finds acupotomy to be a better choice for trigger finger patients. PROSPERO REGISTRATION NUMBER: CRD42018118663.

Association between prenatal nickel exposure and preterm low birth weight: possible effect of selenium.

There is a proposed link between prenatal nickel (Ni) exposure and preterm low birth weight (PLBW); however, this association remains unclear. Selenium (Se) may modify this relationship by protecting against Ni toxicity. Concentrations of Ni and Se were measured in urine samples collected from 408 pregnant women (102 PLBW cases and 306 matched controls) in China. Conditional logistic regression was utilized to explore the association between Ni levels and PLBW, as well as the effect modification by Se on this association. A significant association was observed between higher maternal urinary Ni levels and risk of PLBW [adjusted odds ratio (OR) = 2.80 (95% confidence interval (CI): 1.44, 5.44) for the highest tertile], and this association was more apparent among female infants than that among male infants. Further analyses showed that mothers with high urinary Ni and low urinary Se levels had a significantly increased risk for PLBW [adjusted OR = 2.87 (95% CI: 1.09, 7.56)] compared with the mothers with low urinary Ni and high urinary Se levels. Our study indicates that prenatal exposure to Ni was a risk factor for PLBW. Se might provide protection against the toxicity of Ni.