Serum bile acid and unsaturated fatty acid profiles of non-alcoholic fatty liver disease in type 2 diabetic patients.

BACKGROUND: The understanding of bile acid (BA) and unsaturated fatty acid (UFA) profiles, as well as their dysregulation, remains elusive in individuals with type 2 diabetes mellitus (T2DM) coexisting with non-alcoholic fatty liver disease (NAFLD). Investigating these metabolites could offer valuable insights into the pathophy-siology of NAFLD in T2DM. AIM: To identify potential metabolite biomarkers capable of distinguishing between NAFLD and T2DM. METHODS: A training model was developed involving 399 participants, comprising 113 healthy controls (HCs), 134 individuals with T2DM without NAFLD, and 152 individuals with T2DM and NAFLD. External validation encompassed 172 participants. NAFLD patients were divided based on liver fibrosis scores. The analytical approach employed univariate testing, orthogonal partial least squares-discriminant analysis, logistic regression, receiver operating characteristic curve analysis, and decision curve analysis to pinpoint and assess the diagnostic value of serum biomarkers. RESULTS: Compared to HCs, both T2DM and NAFLD groups exhibited diminished levels of specific BAs. In UFAs, particular acids exhibited a positive correlation with NAFLD risk in T2DM, while the ω-6:ω-3 UFA ratio demonstrated a negative correlation. Levels of α-linolenic acid and γ-linolenic acid were linked to significant liver fibrosis in NAFLD. The validation cohort substantiated the predictive efficacy of these biomarkers for assessing NAFLD risk in T2DM patients. CONCLUSION: This study underscores the connection between altered BA and UFA profiles and the presence of NAFLD in individuals with T2DM, proposing their potential as biomarkers in the pathogenesis of NAFLD.

Investigating the impact of sebum secretion on liquid makeup foundation darkening and its solution.

OBJECTIVES: Darkening has been an issue of concern for foundation products. The secretion of sebum plays a significant role in the process of foundation darkening, but the underlying mechanisms and solutions have been rarely reported. The aim of this study was to explore the relationship between sebum secretion and liquid foundation darkening and to provide possible solutions for reducing sebum-induced darkening in liquid foundation. METHODS: Artificial sebum in different concentrations was added to a basic liquid foundation to simulate different stages of sebum secretion. The colour of the mixture was then measured by a spectrophotometer on the standard opacity chart. Potential technical solutions for anti-darkening were applied to a basic liquid foundation, and its ability to anti-darkening was further verified in vivo. RESULTS: (1) The influences of sebum addition on liquid foundation darkening had a significant positive correlation with the increase in transmissivities (R2 = 0.852, p < 0.01). (2) A certain range of sebum addition can reduce the darkening of volatile foundations. (3) The liquid foundations using pigments with high dispersibility in sebum were less influenced by sebum. (4) The replacement of pigments with oil-fixing ability could effectively reduce the darkening of liquid foundations induced by sebum (p < 0.01). CONCLUSION: The effect of sebum on the darkening of liquid foundation was accompanied by a greater transmissivity as its pigment concentration decreased. Balanced volatility, the addition of powders with higher sebum dispersibility and the replacement of oil-fixing powders could reduce the darkening of the liquid foundation caused by sebum secretion.

OBJECTIFS: L'assombrissement a été un problème de préoccupation pour les produits de fond de teint. La sécrétion de sébum joue un rôle significatif dans le processus d'assombrissement du fond de teint, mais les mécanismes sous-jacents et les solutions ont été rarement rapportés. L'objectif de cette étude était d'explorer la relation entre la sécrétion de sébum et l'assombrissement du fond de teint liquide, et de fournir des solutions possibles pour réduire l'assombrissement induit par le sébum dans le fond de teint liquide. MÉTHODES: Du sébum artificiel à différentes concentrations a été ajouté à un fond de teint liquide de base pour simuler différents stades de sécrétion de sébum. La couleur du mélange a ensuite été mesurée par un spectrophotomètre sur le tableau standard d'opacité. Des solutions techniques potentielles pour l'anti-assombrissement ont été appliquées à un fond de teint liquide de base et leur capacité à prévenir l'assombrissement a été vérifiée in vivo. RÉSULTATS: (1) Les influences de l'ajout de sébum sur l'assombrissement du fond de teint liquide avaient une corrélation significativement positive avec l'augmentation des transmissivités (R2 = 0.852 p < 0.01). (2) Une certaine plage de concentration de sebum peut réduire l'assombrissement des fondations volatiles. (3) Les fonds de teint liquides utilisant des pigments à haute dispersibilité dans le sébum étaient moins influencés par le sébum. (4) Le remplacement des pigments par des poudres à capacité de fixation d'huile pouvait efficacement réduire l'assombrissement des fonds de teint liquides induit par le sébum (p < 0.01). CONCLUSION: L'effet du sébum sur l'assombrissement du fond de teint liquide était accompagné d'une plus grande transmissivité à mesure que la concentration de son pigment diminuait. La volatilité équilibrée, l'ajout de poudres à plus grande dispersibilité de sébum et le remplacement de poudres à capacité de fixation d'huile pourraient réduire l'assombrissement du fond de teint liquide causé par la sécrétion de sébum.

Effects of chronic diazepam exposure on the behaviors and oxidative stress homeostasis in the eyes and brains of female Japanese medaka.

Diazepam (DZP) residue has been frequently detected in wastewater, surface water, and groundwater due to its extensive use over the decades. In this study, we exposed female Japanese medaka (Oryzias latipes) to environmentally relevant doses of DZP (800 and 8000 ng/L) for 4 weeks, aimed to investigate their behavioral responses and possible links with ocular and brain oxidative stress homeostasis. As a result, DZP exposure could significantly reduce swimming activity (800 ng/L) and anxiety (800 and 8000 ng/L), indicating a sedative effect on medaka. The DZP exposure also significantly increased the social interaction in medaka at 8000 ng/L. Furthermore, exposure to DZP could alter the ocular and brain oxidative stress homeostasis in medaka. The ocular CAT activities significantly increased in the 800 ng/L-DZP groups, and the brain SOD, CAT, GST and MDA levels also significantly increased in both DZP exposure groups. Correlation analysis revealed that the ocular and brain oxidative stress induced by DZP exposure might play an important role in their behavioral toxicity to medaka. Our findings highlight the necessity to clarify the exact link between DZP exposure-induced oxidative stress in the neural and sensor systems and its behavioral toxicity to better assess the risks on nontarget aquatic species.

Diazepam at environmentally relevant concentrations disturbed social interactions and brain neurotransmitters in adult Japanese medaka (Oryzias latipes).

Pollution by diazepam (DZP) is increasingly recognized as a major threat to aquatic organisms, but knowledge about its potential risk to fish is still limited. In this study, we exposed female and male Japanese medaka (Oryzias latipes) to environmentally relevant DZP (0.8 and 8 µg/L) for 28 days and investigated variation in their behavior (on days 7, 14, and 28) and brain neurotransmitter levels (on day 28). The results showed that DZP could be accumulated in the brain and gonads in Japanese medaka. When two fish of the same sex were placed in an aquarium, DZP exposure exhibited typical sedative effects on females (on day 7) and males (on days 7 and 14). However, these sedative effects on both sexes were no longer present after 28 days of exposure. Exposure to DZP induced sex-specific impacts on the social interactions of medaka on days 7, 14, and 28 of exposure in a time-dependent manner. When both sexes were placed into an aquarium in a ratio of 1:1, DZP could significantly alter their locomotor activity and social interaction on days 14 and 28 of the exposure. After 28 days of exposure, DZP significantly altered the levels of several neurotransmitters in the brain of medaka, also in sex-specific manners. The alterations in dopamine and serotonin levels exhibited significant correlations with the increased social interaction between females. At the same time, that of γ-aminobutyric acid significantly correlated to the decreased social interaction between males. Our findings suggest that chronic exposure to DZP, even at environmentally relevant concentrations, can accumulate in the brains and gonads of fish, and alter their behaviors by mediating brain neurotransmitter levels, which may further disturb their reproduction and population dynamics.

Asymmetric Formal Coupling of ß-Ketoesters with Quinones Promoted by a Chiral Bifunctional N-Heterocyclic Olefin.

A highly enantioselective formal coupling of ß-ketoesters with quinones was accomplished by a chiral bifunctional N-heterocyclic olefin organocatalyst. With as low as 1 mol % catalyst loading, a number of enantioenriched quinone derivatives were afforded in good yields with high enantioselectivities and regioselectivities (up to 96% yield, 98% ee, and 19:1 rr). Gram-scale synthesis and the high inhibitory effect of several products on the viability of cancer cells demonstrate the potential utility of the current method.

Evaluation of the antiwear-ability/scratch-resistance efficacy of makeup products by in vitro test method application.

OBJECTIVE: The objective of this study is to propose a method for assessing the antiwear-ability (AW) or surface scratch-resistance (SR) efficacy of makeup products through in vitro experiments. MATERIALS AND METHOD: The method primarily involves measuring the change in weight as a means of evaluating the overall effectiveness. AW/SR effects are evaluated by applying a fixed amount of makeup product on artificial fake skin and comparing the weight difference after simulated friction/scratch. RESULTS: The in vitro results indicate that this method is easy to operate and yields repeatable data. It consistently reflects differences between samples when compared to clinical studies. CONCLUSIONS: This method effectively compares the AW/SR effects of makeup products and demonstrates utility in evaluating product efficacy and difference. It holds great scientific and practical value.

ZIF-8 Nanoparticles Induce Behavior Abnormality and Brain Oxidative Stress in Adult Zebrafish (Danio rerio).

Zeolitic imidazolate framework-8 nanoparticles (ZIF-8 NPs) are typical metal-organic framework (MOF) materials and have been intensively studied for their potential application in drug delivery and environmental remediation. However, knowledge of their potential risks to health and the environment is still limited. Therefore, this study exposed female and male zebrafish to ZIF-8 NPs (0, 9.0, and 90 mg L-1) for four days. Subsequently, variations in their behavioral traits and brain oxidative stress levels were investigated. The behavioral assay showed that ZIF-8 NPs at 90 mg/L could significantly decrease the locomotor activity (i.e., hypoactivity) of both genders. After a ball falling stimulation, zebrafish exposed to ZIF-8 NPs (9.0 and 90 mg L-1) exhibited more freezing states (i.e., temporary cessations of movement), and males were more sensitive than females. Regardless of gender, ZIF-8 NPs exposure significantly reduced the SOD, CAT, and GST activities in the brain of zebrafish. Correlation analysis revealed that the brain oxidative stress induced by ZIF-8 NPs exposure might play an important role in their behavioral toxicity to zebrafish. These findings highlight the necessity for further assessment of the potential risks of MOF nanoparticles to aquatic species and the environment.

Association of Serum Bile Acid and Unsaturated Fatty Acid Profiles with the Risk of Diabetic Retinopathy in Type 2 Diabetic Patients.

Aim: We aimed to identify the ability of serum bile acids (BAs) and unsaturated fatty acids (UFAs) profiles to predict the development of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) patients. Methods: We first used univariate and multivariate analysis to compare 15 serum BA and 11 UFA levels in healthy control (HC) group (n = 82), T2DM patients with DR (n = 58) and T2DM patients without DR (n = 60). Forty T2DM patients were considered for validation. Then, the receiver operating characteristic curve (ROC) and decision curve analysis were used to assess the diagnostic value and clinical benefit of serum biomarkers alone, clinical variables alone or in combination, and the area under the curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were used to further assess whether the addition of biomarkers significantly improved the predictive ability of the model. Results: Orthogonal partial least squares-discriminant analysis (OPLS-DA) of serum BAs and UFAs separated the three cohorts including HC, T2DM patients with or without DR. The difference in serum BA and UFA profiles of T2DM patients with or without DR was mainly manifested in the three metabolites of taurolithocholic acid (TLCA), tauroursodeoxycholic acid (TUDCA) and arachidonic acid (AA). Together, they had an AUC of 0.785 (0.918 for validation cohort) for predicting DR in T2DM patients. After adjusting for numerous confounding factors, TLCA, TUDCA, and AA were independent predictors that differentiated T2DM with or without DR. The results of AUC, IDI, and NRI demonstrated that adding these three biomarkers to a model with clinical variables statistically increased their predictive value and were replicated in our independent validation cohort. Conclusion: These findings highlight the association of three metabolites, TLCA, TUDCA and AA, with DR and may indicate their potential value in the pathogenesis of DR.

Fecal microbiota transplantation ameliorates type 2 diabetes via metabolic remodeling of the gut microbiota in db/db mice.

INTRODUCTION: Gut microbiome (GM) deregulation has been implicated in major conditions such as obesity and type 2 diabetes (T2DM). Our previous prospective study indicated that fecal microbiota transplantation (FMT) successfully improved patients with T2DM. We hypothesized that FMT may be a potential therapeutic method for T2DM, but its precise mechanisms in T2DM remains to be elucidated. RESEARCH DESIGN AND METHODS: Eight db/m mice were FMT donors and control mice, and 16 genetically diabetic db/db mice were equally divided into two groups (db/db+phosphate-buffered saline (PBS) group, db/db+FMT group). The db/db+FMT group was administered fresh fecal suspension (0.2 mL/mice) daily for 4 weeks. Analysis of the GM and serum metabolome was carried out by 16S ribosomal RNA sequencing and liquid chromatogram-mass spectrometry, respectively. Effects of FMT on the gut barrier and pancreas were assessed using protein assays, messenger RNA, immunohistology and clinical indicators testing. RESULTS: Our results showed that FMT treatment of db/db mice relieves a series of clinical indicators, including fasting plasma glucose, serum insulin and oral glucose tolerance test among others. Compared with non-diabetic control mice, db/db+PBS mice exhibited decreased abundance of Ruminococaceae, Porphyromonadaceae and increased abundance of Rikenellaceae and Lactobacillaceae. FMT treatment reversed this effect on the microbiome. Eleven metabolites were changed between the db/db+PBS and db/db+FMT groups. Correlation analysis showed that the structural changes of the GM were correlated with host metabolite levels. We further showed that FMT treatment of db/db mice improved intestinal barrier function, reduced inflammation and caused an alteration in the number of circulating immune cells. CONCLUSIONS: FMT-mediated changes in the GM, serum metabolites, intestinal epithelial barrier, inflammation and circulating immune cells play an important role in the efficacy of FMT on T2DM disease progression.

Exports Widen the Regional Inequality of Health Burdens and Economic Benefits in India.

Both the ever-complex international and subnational supply chains could relocate health burdens and economic benefits across India, leading to the widening of regional inequality. Here, we simultaneously track the unequal distribution of fine particle matter (PM2.5) pollution, health costs, and value-added embodied in inter- and intranational exports for Indian states in 2015 by integrating a nested multiregional input-output (MRIO) table constructed based on EXIOBASE and an Indian regional MRIO table, Emissions Database for Global Atmospheric Research (EDGAR), the Community Multi-Scale Air Quality (CMAQ) model, and a concentration-response function. The results showed that the annual premature deaths associated with PM2.5 pollution embodied in inter- and intranational exports were 757,356 and 388,003 throughout India, accounting for 39% and 20% of the total premature deaths caused by PM2.5 pollution, respectively. Richer south and west coastal states received around half of the national Gross Domestic Product (GDP) induced by exports with a quarter of the health burden, while poorer central and east states bear approximately 60% of the health burden with less than a quarter of national GDP. Our findings highlight the role of exports in driving the regional inequality of health burdens and economic benefits. Therefore, tailored strategies (e.g., air pollution compensation, advanced technology transfer, and export structure optimization) could be formulated.

Lifting Triplet Energy and Bipolar Characteristics by Limiting the Rotation of the Peripheral Groups in Host Materials to Achieve High-Efficiency Blue OLED.

Bipolar host materials with high triplet energy are of great significance for highly efficient blue organic light-emitting diodes (OLEDs). In this work, three donor-acceptor-donor (D-A-D) type host materials with identical non-rigid diphenylsulfone center but differing in rotation degree of peripheral amino substituted derivatives from rotating freely diphenylamine (SODP) to rotating partially iminodibenzyl (SOId) and rotating restricted carbazole (SOCz) were designed and synthesized. It was demonstrated that the triplet energy (ET ) level of the materials promoted by limiting the rotation degree of the peripheral groups, which was 2.72 eV for SODP, 2.73 eV for SOId and 2.78 eV for SOCz, respectively. Besides, the results of the single-carrier devices indicate SOCz possess better bipolar characteristic. Using FIrpic as guest emitter, the blue OLED with SOCz as host material exhibited superior device performance with a low turn-on voltage of 3.3 V, a maximum current efficiency (CE) of 30.1 cd A-1 , a maximum power efficiency (PE) of 32.2 lm W-1 , and a maximum external quantum efficiency (EQE) of 14.0%. This work provides a beneficial guideline for realizing promising host materials in efficient blue OLEDs.

Mutual interplay between ArcA and σE orchestrates envelope stress response in Shewanella oneidensis.

To survive and thrive in harsh and ever-changing environments, intricate mechanisms have evolved for bacterial cells to monitor perturbations impacting the integrity of their envelope and to mount an appropriate response to contain or repair the damage. In this study, we report in Shewanella oneidensis a previously undescribed mechanism for the envelope defect resulting from the loss of Arc, a two-component transcriptional regulatory system crucial for respiration. We uncovered σE , a master regulator establishing and maintaining the integrity of the cell envelope in γ-proteobacteria, as the determining factor for the cell envelope defect of the arcA mutant. When ArcA is depleted, σE activity is compromised by enhanced production of anti-σE protein RseA. Surprisingly, S. oneidensis σE is not essential for viability, but becomes so in the absence of ArcA. Furthermore, we demonstrated that there is an interplay between these two regulators as arcA expression is affected by availability of σE . Overall, our results underscore functional interplay of regulatory systems for envelope stress response: although each of the systems may respond to perturbation of particular components of the envelope, they are functionally intertwined, working together to form an interconnected safety net.

Lewis acid catalysed asymmetric cascade reaction of cyclopropyl ketones: concise synthesis of pyrrolobenzothiazoles.

Utilizing the C4 reactive site of cyclopropyl ketones and a chiral N,N'-dioxide-scandium(iii) complex as a catalyst, a concise ring-opening/cyclization/thio-Michael cascade method was developed for the synthesis of chiral benzothiazole derivatives from a simple 2-aminothiophenol material. The kinetic resolution and the origin of stereoselectivity were elucidated via a possible catalytic model.

Preliminary study on phonetic characteristics of patients with pulmonary nodules.

OBJECTIVE: Pulmonary nodules (PNs) are one of the imaging manifestations of early lung cancer screening, which should receive more attention. Traditional Chinese medicine believes that voice changes occur in patients with pulmonary diseases. The purpose of this study is to explore the differences in phonetic characteristics between patients with PNs and able-bodied persons. METHODS: This study explores the phonetic characteristics of patients with PNs in order to provide a simpler and cheaper method for PN screening. It is a case-control study to explore the differences in phonetic characteristics between individuals with and without PNs. This study performed non-parametric statistics on acoustic parameters of vocalizations, collected from January 2017 to March 2018 in Shanghai, China, from these two groups; it explores the differences in third and fourth acoustic parameters between patients with PNs and a normal control group. At the same time, computed tomography (CT) scans, course of disease, combined disease and other risk factors of the patients were collected in the form of questionnaire. According to the grouping of risk factors, the phonetic characteristics of the patients with PNs were analyzed. RESULTS: This study was comprised of 200 patients with PNs, as confirmed by CT, and 86 healthy people that served as a control group. Among patients with PNs, 43% had ground glass opacity, 32% had nodules with a diameter ≥ 8 mm, 19% had a history of smoking and 31% had hyperlipidemia. Compared with the normal group, there were statistically significant differences in pitch, intensity and shimmer in patients with PNs. Among patients with PNs, patients with diameters ≥ 8 mm had a significantly higher third formant. There was a significant difference in intensity, fourth formant and harmonics-to-noise ratio (HNR) between smoking and non-smoking patients. Compared with non-hyperlipidemia patients, the pitch, jitter and shimmer of patients with PNs and hyperlipidemia were higher and the HNR was lower; these differences were statistically significant. CONCLUSION: This measurable changes in vocalizations can be in patients with PNs. Patients with PNs had lower and weaker voices. The size of PNs had an effect on the phonetic formant. Smoking may contribute to damage to the voice and formant changes. Voice damage is more pronounced in individuals who have PNs accompanied by hyperlipidemia.

Asymmetric Synthesis of Axially Chiral Anilides via Organocatalytic Atroposelective N-Acylation.

A highly atroposelective N-acylation reaction of aniline-derived sulfonamides has been developed with chiral isothiourea as the catalyst. This approach provides a facile and efficient route to an array of atropoisomeric sulfonyl substituted anilide products in good yields with high to excellent enantioselectivities.

Metal-free cascade reactions of aziridines with arylalkynes and aryldiazoniums: facile access to arylazopyrrolines.

A novel and facile approach to synthesize arylazopyrroline scaffolds via metal-free cascade reactions of aziridines with arylalkynes and aryldiazoniums has been developed, providing access to a variety of 4-arylazo-2-pyrrolines in a highly concise fashion. This efficient process, which can be performed at the gram scale, enjoys operational simplicity and mild and metal-free conditions.

Kinetic Resolution of Propargylic Ethers via [2,3]-Wittig Rearrangement to Synthesize Chiral α-Hydroxyallenes.

An efficient kinetic resolution of propargyloxy dicarbonyl compounds via asymmetric [2,3]-Wittig rearrangement was achieved by using a chiral N,N'-dioxide/NiII complex catalyst. Various chiral α-allenyl alcohols were obtained in high enantioselectivities under mild conditions. The utility of this method was readily demonstrated in the asymmetric synthesis of the chiral 2,5-dihydrofuran derivative.

Promiscuous Enzymes Cause Biosynthesis of Diverse Siderophores in Shewanella oneidensis.

The siderophore synthetic system in Shewanella species is able to synthesize dozens of macrocyclic siderophores in vitro with synthetic precursors. In vivo, however, although three siderophores are produced naturally in Shewanella algae B516, which carries a lysine decarboxylase (AvbA) specific for siderophore synthesis, only one siderophore can be detected from many other Shewanella species. In this study, we examined a siderophore-overproducing mutant of Shewanella oneidensis which lacks an AvbA counterpart, and we found that it can also produce these three siderophores. We identified both SpeC and SpeF as promiscuous decarboxylases for both lysine and ornithine to synthesize the siderophore precursors cadaverine and putrescine, respectively. Intriguingly, putrescine is mainly synthesized from arginine through an arginine decarboxylation pathway in a constitutive manner, not liable to the concentrations of iron and siderophores. Our results provide further evidence that the substrate availability plays a determining role in siderophore production. Furthermore, we provide evidence to suggest that under iron starvation conditions, cells allocate more putrescine for siderophore biosynthesis by downregulating the expression of the enzyme that transforms putrescine into spermidine. Overall, this study provides another example of the great flexibility of bacterial metabolism that is honed by evolution to better fit living environments of these bacteria.IMPORTANCE The simultaneous production of multiple siderophores is considered a general strategy for microorganisms to rapidly adapt to their ever-changing environments. In this study, we show that some Shewanella spp. may downscale their capability for siderophore synthesis to facilitate adaptation. Although S. oneidensis lacks an enzyme specifically synthesizing cadaverine, it can produce it by using promiscuous ornithine decarboxylases. Despite this ability, this bacterium predominately produces the primary siderophore while restraining the production of secondary siderophores by regulating substrate availability. In addition to using the arginine decarboxylase (ADC) pathway for putrescine synthesis, cells optimize the putrescine pool for siderophore production. Our work provides an insight into the coordinated synthesis of multiple siderophores by harnessing promiscuous enzymes in bacteria and underscores the importance of substrate pools for the biosynthesis of natural products.

Acupoint Embedding of Polyglactin 910 Sutures in Patients with Chronic Pain due to Cervical Spondylotic Radiculopathy: A Multicenter, Randomized, Controlled Clinical Trial.

OBJECTIVE: We aimed to investigate the effectiveness of acupoint polyglactin 910 (PGLA) embedding in patients with cervical spondylotic radiculopathy (CSR). METHODS: A total of 102 CSR patients with neck and shoulder pain were recruited and assigned randomly into three groups: the sham acupoint embedding (SAE) group, the middle-layer acupoint PGLA embedding (MAPE) group, and the deep-layer acupoint PGLA embedding (DAPE) group. The primary outcomes were Visual Analog Scale (VAS) scores showing the analgesic effects of treatment. Secondary outcomes included clinical symptoms (evaluated by the Yasuhisa Tanaka 20 (YT-20) score and the neck disability index (NDI)) and patient health status (evaluated by the 36-item short-form survey (SF-36)) as reported in the trial. RESULTS: Compared with the SAE group, VAS scores were significantly reduced at 1, 2, 3, 4, and 10 weeks after the first treatment in both the DAPE and MAPE groups (P < 0.001). Moreover, there were statistically significant increases in the weekly YT-20 scores and significant reductions of the weekly NDI scores compared with baseline values in both the DAPE and MAPE groups (P < 0.001). Compared with baseline values, both the physical component summary (PCS) and the mental component summary scores of the SF-36 at 2, 3, 4, and 10 weeks were significantly higher in the DAPE and MAPE groups (P < 0.001). There were significant lower VAS scores (P < 0.01), higher PCS scores (P < 0.05) at 3 weeks, and lower NDI scores (P < 0.05) at 4 weeks in the DAPE group compared with the MAPE group. CONCLUSIONS: Both DAPE and MAPE showed significant and long-lasting effects on alleviating pain and improving clinical symptoms as well as quality of life in CSR patients with neck and shoulder pain. A more intense effect was seen in the DAPE group compared with the MAPE group.