The autophagy-lysosome pathway: a potential target in the chemical and gene therapeutic strategies for Parkinson's disease.

Parkinson's disease is a common neurodegenerative disease with movement disorders associated with the intracytoplasmic deposition of aggregate proteins such as α-synuclein in neurons. As one of the major intracellular degradation pathways, the autophagy-lysosome pathway plays an important role in eliminating these proteins. Accumulating evidence has shown that upregulation of the autophagy-lysosome pathway may contribute to the clearance of α-synuclein aggregates and protect against degeneration of dopaminergic neurons in Parkinson's disease. Moreover, multiple genes associated with the pathogenesis of Parkinson's disease are intimately linked to alterations in the autophagy-lysosome pathway. Thus, this pathway appears to be a promising therapeutic target for treatment of Parkinson's disease. In this review, we briefly introduce the machinery of autophagy. Then, we provide a description of the effects of Parkinson's disease-related genes on the autophagy-lysosome pathway. Finally, we highlight the potential chemical and genetic therapeutic strategies targeting the autophagy-lysosome pathway and their applications in Parkinson's disease.

A systematic review of prediction models on arteriovenous fistula: Risk scores and machine learning approaches.

OBJECTIVE: Failure-to-mature and early stenosis remains the Achille's heel of hemodialysis arteriovenous fistula (AVF) creation. The maturation and patency of an AVF can be influenced by a variety of demographic, comorbidity, and anatomical factors. This study aims to review the prediction models of AVF maturation and patency with various risk scores and machine learning models. DATA SOURCES AND REVIEW METHODS: Literature search was performed on PubMed, Scopus, and Embase to identify eligible articles. The quality of the studies was assessed using the Prediction model Risk Of Bias ASsessment (PROBAST) Tool. The performance (discrimination and calibration) of the included studies were extracted. RESULTS: Fourteen studies (seven studies used risk score approaches; seven studies used machine learning approaches) were included in the review. Among them, 12 studies were rated as high or unclear "risk of bias." Six studies were rated as high concern or unclear for "applicability." C-statistics (Model discrimination metric) was reported in five studies using risk score approach (0.70-0.886) and three utilized machine learning methods (0.80-0.85). Model calibration was reported in three studies. Failure-to-mature risk score developed by one of the studies has been externally validated in three different patient populations, however the model discrimination degraded significantly (C-statistics: 0.519-0.53). CONCLUSION: The performance of existing predictive models for AVF maturation/patency is underreported. They showed satisfactory performance in their own study population. However, there was high risk of bias in methodology used to build some of the models. The reviewed models also lack external validation or had reduced performance in external cohort.

Dialysis nurses' knowledge, attitude, practices, and self-efficacy regarding vascular access care: A multicenter cross-sectional survey in Singapore.

BACKGROUND: Dialysis nurses play a pivotal role in the management of vascular access (VA), physician-patient liaison, and patient education for hemodialysis patients. This multicenter study aims to review the dialysis nurses' knowledge, attitude, practice, and self-efficacy toward providing care for patients' VA. METHODS: A multi-centered study was conducted using a self-administered survey. Nurses from 47 Singapore dialysis centers (five hospital-based and 42 community-based) providing hemodialysis were invited to participate on a voluntary and anonymous basis from April to November 2022. The survey consists of nurses' knowledge on VA (10 items), attitude on VA care (six items), usual practices (seven items), and self-efficacy in VA cannulation and management (six items). The total scores for the knowledge, attitude, and self-efficacy components were 50, 30, and 30 respectively. The instrument has been validated in a pilot study. RESULTS: In total, five hundred sixteen dialysis nurses participated the survey. The mean (±SD) knowledge score of the participants toward VA care was 30.0 (±8.1) over a total score of 50. The means (±SD) of their attitude and self-efficacy scores were 24.4 (±4.1) and 24.2 (±3.1) over 30 respectively. The majority of the nurses (84.1% in hospital-based centers and 98.9% in community-based centers) conducted patient education in some aspects of VA care. The percentage of nurses indicated need for referral to access specialists due to various abnormalities varied significantly between the hospital-based and community-based settings. In the multivariable linear regression analysis, longer working experience was a significant factor for higher knowledge score (B = 0.26; p = 0.001), attitude score (B = 0.08; p = 0.01), and self-efficacy score (B = 0.34; p < 0.001). CONCLUSION: Dialysis nurses in Singapore have satisfactory knowledge, practice, and self-efficacy on VA care. The majority of them expressed positive opinions toward the VA-related training they received, new technologies, and communications. The identified knowledge and practice gaps could be incorporated into the future training programs.

A portable optical pulsatile flowmetry demonstrates strong clinical relevance for diabetic foot perfusion assessment.

We present a robust, cost-effective (<2000 USD), and portable optical diffuse speckle pulsatile flowmetry (DSPF) device with a flexible handheld probe for deep tissue blood flow measurement in the human foot as well as a first-in-man observational clinical study using the proposed optical device for tissue ischemia assessment and peripheral artery disease (PAD) diagnosis. Blood flow in tissue is inherently pulsatile in nature. However, most conventional methods cannot measure deep tissue-level pulsatile blood flow noninvasively. The proposed optical device can measure tissue-level pulsatile blood flow ∼6 mm underneath the skin surface. A new quantitative tissue perfusion index (TPIDSPF) based on frequency domain analysis of the pulsatile blood flow waveform is defined to assess tissue ischemia status. Through a clinical study involving 66 subjects, including healthy individuals and diabetes patients with and without PAD, TPIDSPF demonstrated strong correlations of 0.720 with transcutaneous tissue partial oxygen pressure (TcPO2) and 0.652 with toe-brachial index (TBI). Moreover, among the three methods, TPIDSPF demonstrated the highest area under the curve for PAD diagnosis among diabetes patients, with a notable value of 0.941. The promising clinical results suggest that the proposed optical method has the potential to be an effective clinical tool for identifying PAD among the diabetic cohort.

Effectiveness of a native vein arteriovenous fistula tracking system.

OBJECTIVE: This study aims to evaluate the effectiveness of a tracking program on the functional maturation rate of arteriovenous fistula (AVF). METHODS: Two major clinical outcomes (commencement of cannulation and functional maturation) of created AVFs were compared between two cohorts. (i) Cohort 1: historical cohort; (ii) Cohort 2: AVFs created after implementation of the tracking project. Multivariable Cox regression models were used to assess the association between cohort allocation and the two major clinical outcomes. RESULTS: Data of 114 and 141 patients were analyzed respectively from Cohorts 1 (historical data) and 2 (with AVF tracking). After adjustment of covariates in the multivariable analysis, the AVFs created in Cohort 2 were more likely to be cannulated earlier (adjusted HR: 2.82; 95% CI: 1.97-4.05; p < 0.001), compared to those in Cohort 1. Similarly, the AVFs of Cohort 2 patients had significantly higher probability of functional maturation (adjusted HR: 1.81; 95% CI: 1.31-2.48; p < 0.001) than fistulas in Cohort 1. Cannulation was commenced for half of the AVFs by 4.1 months post-creation in the historical cohort (Cohort 1), whereas in the post-tracking cohort, 50% of the AVFs were cannulated by 2.3 months after creation (p < 0.001). It took 5.5 and 4.3 months for 50% of the AVFs created in Cohort 1 and Cohort 2 patients to achieve catheter-free functional maturation, respectively (p = 0.06). CONCLUSION: An AVF tracking program with maturation target for the access surgeons, together with a standardized tracking, feedback, and clinical strategy adjustment system is able to improve the AVF functional maturation rate.

Dialysis nurses' knowledge, attitude, practice and self-efficacy regarding vascular access: A cross-sectional study in Singapore.

INTRODUCTION: Dialysis nurses play a paramount role in vascular access (VA) management. The aim of this study is to evaluate dialysis nurses' knowledge, attitude, practice and self-efficacy (KACP-SE) pertaining to VA cannulation and evaluation. METHOD: An anonymous self-administered survey was administered to dialysis nurses from two tertiary hospitals (four dialysis units) and two community dialysis centres from April to May 2022. The 37-items survey consists of four dimensions of questions relating to VA cannulation and management: knowledge, attitude, practice and self-efficacy. The content validity and face validity of the survey was reviewed by three experienced VA professionals and five dialysis nurses respectively. The internal consistency and construct validity of the survey have been assessed with psychometric tests. RESULTS: There were 23 and 47 nurses, working in the participated community and tertiary hospital dialysis centres respectively, responded to the survey. The internal consistency coefficients indicated acceptable reliability of the instrument (KR-20 coefficient was 0.55 and 0.76 for knowledge and practice domains; Cronbach's α was 0.85 and 0.64 for self-efficacy and attitude domains). In the exploratory factor analysis for attitude and self-efficacy, the instrument could account for 64.0% and 53.0% of the total variance respectively. In the knowledge domain, five out of eight single-select multiple-choice questions were correctly answered by >70% of the participants. Overall, the mean (±SD) of participants' total self-efficacy score was 24.3 (±3.1) over total score of 30. The majority of the participants (82.4%) either agreed or strongly agreed that ultrasound guidance is useful for cannulation. CONCLUSION: This KAP-SE instrument can be used to evaluate knowledge, attitude, practice and self-efficacy of dialysis nurses toward VA management. The participants demonstrated acceptable knowledge level, but with some knowledge gaps identified. It also revealed nurses' good self-efficacy level and welcoming attitude towards adopting ultrasound in VA cannulation among the participants.

The burden of costs on health services by patients with neuro-ischaemic ulcers in Singapore.

The economic burden of neuro-ischaemic ulcers (NIU) is expected to increase because of rising prevalence of comorbidities in an aging population. We aim to estimate healthcare resources consumed by NIU patients, and to quantify the extent to which factors explain variation in cost-related outcomes. We analysed retrospective patient-level cohort data for NIU patients from a tertiary hospital registry in Singapore, from 2013 to 2017, using generalised linear regression models. The outcome variables were the length of stay per admission; inpatient and outpatient bill per admission; and, if they had an Emergency Department visit. Cost outcomes were reported in Singapore dollars (S$). A total of 1682 patients were included, and the mean age was 69.9 years (±13.0). An average patient incurred a length of stay of 38.7 days, 7.9 inpatient dressing sessions, an inpatient bill of S$33 096, 11.3 outpatient dressing sessions, and an outpatient bill of S$8780. Inpatient services per patient cost 73.5% higher than outpatient services. NIU patients with multiple (>3) comorbid conditions, peripheral artery disease, or chronic kidney disease incurred longer hospitalisation and higher inpatient bill. Patients with diabetes mellitus and coronary artery disease had higher odds of incurring an ED visit. Patients with coronary artery disease, hyperlipidaemia, kidney complications, or obesity incurred higher outpatient bills. NIU treatment imposes a significant economic burden, especially with inpatient services.

The burden of costs on health services from patients with venous leg ulcers in Singapore.

Healthcare costs arising from venous leg ulcers (VLU) are expected to increase due to an aging population and increased prevalence of comorbidities. We aim to estimate the healthcare resources incurred by VLU patients, and to quantify the extent to which predictors explain variation in cost-related outcomes. Retrospective patient-level cohort data for VLU patients were analysed using generalised linear regression models. Data were extracted from a tertiary hospital registry in Singapore, between 2013 and 2017. The outcome variables were length of stay per admission; inpatient and outpatient bill per admission; whether a patient underwent a surgical treatment of the venous system; and, whether they visited the emergency department. Cost outcomes were reported in Singapore dollars (S$). A total of 162 VLU patients were included with a mean age of 67.5 (±14.4). For the inpatient setting the mean length of stay was 8.1 days and the mean inpatient bill was S$7886. For outpatients, the mean number of dressings was 29.4, and mean outpatient bill was S$6962. Heart disease patients incurred longer hospital stays and larger inpatient bills per admission and females had greater odds of undergoing a surgical procedure on the venous system. Certain VLU patient groups were found to be associated with larger cost outcomes.

The regulatory mechanism and therapeutic potential of transcription factor EB in neurodegenerative diseases.

The autophagy-lysosomal pathway (ALP) is involved in the degradation of protein aggregates and damaged organelles. Transcription factor EB (TFEB), a major regulator of ALP, has emerged as a leading factor in addressing neurodegenerative disease pathology, including Alzheimer's disease (AD), Parkinson's disease (PD), PolyQ diseases, and Amyotrophic lateral sclerosis (ALS). In this review, we delineate the regulation of TFEB expression and its functions in ALP. Dysfunctions of TFEB and its role in the pathogenesis of several neurodegenerative diseases are reviewed. We summarize the protective effects and molecular mechanisms of some TFEB-targeted agonists in neurodegenerative diseases. We also offer our perspective on analyzing the pros and cons of these agonists in the treatment of neurodegenerative diseases from the perspective of drug development. More studies on the regulatory mechanisms of TFEB in other biological processes will aid our understanding of the application of TFEB-targeted therapy in neurodegeneration.

The pattern of brain metabolism in chronic steno-occlusive cerebral artery disease.

Background: Dispersion of gray matter and white matter and abnormal hemodynamic changes are common in patients with chronic stenosis cerebral artery disease. It is not easy to capture these abnormal changes with conventional magnetic resonance imaging (MRI). Magnetic resonance spectroscopy (MRS) is useful for obtaining metabolic information in either preclinical or clinical applications. The aim of our study was to apply MRS to non-invasively investigate changes in brain metabolism in MRI-negative patients with chronic cerebral artery steno-occlusive disease. Methods: We performed MRS examinations with 3.0T MRI on 34 patients with severe unilateral middle cerebral artery (MCA) stenosis or occlusion without parenchymal abnormalities. Additionally, N-acetylaspartic acid (NAA), creatine (Cr), choline (Cho), NAA/Cr, and Cho/Cr in the coronal, parenchymal, and thalamic regions of the affected brain and contralateral brain were determined. The mean concentrations of NAA, Cr, Cho, NAA/Cr, and Cho/Cr in the coronal, parenchymal, and thalamic regions of the ipsilateral and contralateral brains were compared using the 2-tailed paired t-test. Results: At the ipsilateral corona radiata and lenticular nucleus, the mean NAA was significantly lower, whereas the Cho and Cho/Cr were significantly higher than the contralateral corona radiata and lentiform nucleus (P<0.05). In addition, the creatine and NAA/Cr values in the coronal region of the affected side were significantly lower than those in the opposite side (P<0.05), but there was no significant difference between the pectin nuclei on both sides. No metabolic changes were found at the ipsilateral thalamus. Conclusions: In this study, we demonstrated that MRS could reveal metabolic changes and that the NAA, NAA/Cr, Cho, and Cho/Cr concentration might be used as indexes for evaluating neuronal damage in the chronic steno-occlusive cerebral artery disease, treatment strategies, and treatment effectiveness.

A Study on the Application of BP Neural Network Based on Visual Recognition in Regional Economic Forecasting.

The economic growth in the new normal is no longer limited to the total amount and scale of economic growth in the traditional and neoclassical periods, but has changed to "quality" and "development" under the dual requirements of historical changes and tasks of the times. The quality of regional economic growth is an important part of the quality of China's economic development and an important part of the quality of China's economic development in the new era. Therefore, this paper proposes a BP neural network based on visual recognition in a regional economic prediction model and conducts application experiments. This regional economic forecasting model is relying on data technology for economic panel data mining, then graphical processing of panel data, followed by the selection of visual recognition technology for economic panel map analysis, to derive its various component coefficients, and finally then using the BP neural network to fit the prediction, at the same time, through long-term and short-term prediction, to predict the future development quality of each region's change trends and fluctuations, to predict the institution's role, so as to avoid major transitions and deteriorating alarms, and to provide support for the macroregulation of regional economic development quality.

The phytochemical and pharmacological profile of taraxasterol.

Taraxasterol is one of the bioactive triterpenoids found in dandelion, a member of the family Asteraceae. In the animal or cellular models of several ailments, including liver damage, gastritis, colitis, arthritis, pneumonia, tumors, and immune system diseases, taraxasterol has been shown to have significant preventive and therapeutic effects. This review aims to evaluate the current state of research and provide an overview of the possible applications of taraxasterol in various diseases. The reported phytochemical properties and pharmacological actions of taraxasterol, including anti-inflammatory, anti-oxidative, and anti-carcinogenic properties, and its potential molecular mechanisms in developing these diseases are highlighted. Finally, we further explored whether taraxasterol has protective effects on neuronal death in neurodegenerative diseases. In addition, more animal and clinical studies are also required on the metabolism, bioavailability, and safety of taraxasterol to support its applications in pharmaceuticals and medicine.

Effect of exercises on the maturation of newly created arteriovenous fistulas over distal and proximal upper limb: A systematic review and meta-analysis.

The aims of our review were: (i) to evaluate the effect of post-operative upper extremity exercise on maturation of AVFs, stratified by their locations. (ii) To evaluate the effect of pre-operative arm exercise on patients' superficial vein caliber of patients. Literature search was performed on PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and China National Knowledge Infrastructure (CNKI) to identify eligible articles. The quality of the randomized controlled trials (RCTs) were assessed using the Cochrane Risk of Bias tool 2.0. In the Meta-analysis, Risk ratios (RRs) of clinical maturation and ultrasonographic maturation were pooled from studies focused on post-operative exercise program; Mean difference (MD) of venous caliver was pooled from those studied pre-operative exercise. Nine studies (six for post-operative exercise; three for pre-operative exercise) were included in the review. Among the AVFs created in distal region (158 patients in exercise group and 144 patients in control group), there was a significantly superior clinical maturation (RR: 1.28; 95% CI: 1.10-1.48, p = 0.001; I2 = 0), and ultrasonographic maturation (RR: 1.30; 95% CI: 1.07-1.59, p = 0.009; I2 = 0) in the exercise group in comparison to the control group. For the AVFs created in proximal region (93 and 96 patients in exercise group and control group respectively), there is no significant difference in clinical maturation (RR:1.25, 95% CI: 0.88-1.78, p = 0.27, I2 = 74%) and ultrasonographic maturation (RR: 1.17, 95% CI: 0.97-1.40, p = 0.11, I2 = 43%) between the exercise group and controls. For pre-operative exercise, the mean difference of 0.34 mm (95% CI: 0.23-0.46, p < 0.001, I2 = 87% ) was found for vein size. In conclusion, existing upper extremity exercise programs appear to be useful in facilitating maturation of AVFs created in distal region, while its effect on fistulas created in proximal region is less certain. However, more robust trials are warranted to establish these findings.

Surface-enhanced coherent anti-Stokes Raman scattering based on coupled nanohole-slit arrays.

Metal nanohole arrays show excellent performance when applied for sensing, optical fibers, and surface-enhanced spectroscopy, but they are not ideal candidates for surface-enhanced coherent anti-Stokes Raman scattering (SECARS) because of their low enhancement factor (EF). Here, the finite element method was used to study the dependence of the period, width, and thickness of nanoslits on the EF of SECARS and optical transmission in Au nanohole-slit arrays. Nanoslits across the nanoholes significantly modulated the SECARS signal, and we observed an ∼106 improvement in the EF of SECARS compared with the nanohole-only structure. Uniform and stable 2D hotspots at the open surface of plasmonic nanohole-slit structures provided a huge SECARS EF as high as 18 orders of magnitude. Directional SECARS emission revealed strong forward and backscattering with high directionality, showing a smaller divergence angle of 14° on the reflective side of the nanohole-slit array. These results provide a fundamental understanding of SECARS in coupled nanohole-slit arrays and are useful for designing a SECARS platform with high sensitivity.

The clinical journey and healthcare resources required for dialysis access of end-stage kidney disease patients during their first year of hemodialysis.

BACKGROUND: Creation and maintenance of dialysis vascular access (VA) is a major component of healthcare resource utilization and cost for patients newly started on hemodialysis (HD). Different VA format arises due to patient acceptance of anticipatory care versus late preparation, and clinical characteristics. This study reviews the clinical journey and resource utilization required for different VA formats in the first year of HD. METHOD: Data of patients newly commenced on HD between July 2015 and June 2016 were reviewed. Patients were grouped by their VA format: (A) pre-emptive surgically created VA (SCVA), (B) tunneled central venous catheter (CVC) followed by SCVA creation, (C) long-term tunneled CVC only. Clinical events, number of investigations and procedures, hospital admissions, and incurred costs of the three groups were compared. RESULTS: In the multivariable analysis, the cost incurred by the group A patients had no significant difference to that incurred in the group B patients (p = 0.08), while the cost of group C is significantly lower (p < 0.001). Both the 62.7% of group A with successful SCVA who avoided tunneled CVC usage, and those with a functionally matured SCVA in group B (66.1%), used fewer healthcare resources and incurred less cost for their access compared to those did not (p = 0.01, p = 0.02, respectively) during the first year of HD. CONCLUSION: With comparable cost, a pre-emptive approach enables avoidance of tunneled CVC. Tunneled CVC only access format incurred lower cost and is suitable for carefully selected patients. Successful maturation of SCVA greatly affects patients' clinical journey and healthcare cost.

Functional conservation and divergence in plant-specific GRF gene family revealed by sequences and expression analysis.

Unique to plants, growth regulatory factors (GRFs) play important roles in plant growth and reproduction. This study investigated the evolutionary and functional characteristics associated with plant growth. Using genome-wide analysis of 15 plant species, 173 members of the GRF family were identified and phylogenetically categorized into six groups. All members contained WRC and QLQ conserved domains, and the family's expansion largely depended on segmental duplication. The promoter region of the GRF gene family mainly contained four types of cis-acting elements (light-responsive elements, development-related elements, hormone-responsive elements, and environmental stress-related elements) that are mainly related to gene expression levels. Functional divergence analysis revealed that changes in amino acid site evolution rate played a major role in the differentiation of the GRF gene family, with ten significant sites identified. Six significant sites were identified for positive selection. Moreover, the four groups of coevolutionary sites identified may play a key role in regulating the transcriptional activation of the GRF protein. Expression profiles revealed that GRF genes were generally highly expressed in young plant tissues and had tissue or organ expression specificity, demonstrating their functional conservation with distinct divergence. The results of these sequence and expression analyses are expected to provide molecular evolutionary and functional references for the plant GRF gene family.

In situ Raman enhancement strategy for highly sensitive and quantitative lateral flow assay.

As a paper-based analytical platform, lateral flow assay (LFA) gets benefit from the rapid analysis, low cost, high selectivity, good stability, and user-friendliness, and thus has been widely used in rapid screening or assisted diagnosis. Nevertheless, LFA still suffers from low detection sensitivity via the naked eye, limiting its applications to qualitative and semi-quantitative tests. To enhance the signal readout, various nanoparticle signal tags have been employed to replace traditional colloidal gold nanoparticles (AuNPs), such as fluorescent nanoparticles (FNPs), magnetic nanoparticles (MNPs), and Raman reporter-labeled nanoparticles. In particular, Raman reporter-labeled nanoparticles are extremely sensitive due to remarkable signal enhancement effect on metal surface. However, the application of LFA is still hampered by the poor stability of Raman reporter-labeled nanoparticles. Herein, we developed an in situ Raman enhancement strategy to create a surface-enhanced Raman scattering (SERS) signal on the AuNPs, shortened as "i-SERS," which not only preserves the original advantages of the colloidal gold strip (AuNPs-LFA), but also realizes highly sensitive and quantitative detection. We applied the i-SERS for procalcitonin (PCT) detection. The experimental process takes only 16 min, and the limit of detection (LOD) is 0.03 ng mL-1, far below the value using AuNPs-LFA. These results indicate that i-SERS assay was highly sensitive and suitable for the rapid detection of PCT.

Major limb amputation and mortality in patients with neuro-ischaemic lower extremity wounds managed in a tertiary hospital: Focus on the differences among patients with diabetes, peripheral arterial disease and both.

A majority of lower extremities neuro-ischaemic wounds (NIU) are related to: (a) only diabetes (DM); (b) only peripheral artery disease (PAD); (c) co-existing diabetes and peripheral artery disease (DM-PAD). This study aims to characterise the major clinical outcomes of forementioned three groups of lower extremity wound patients in Singapore. Patients hospitalised for lower extremity NIU between January 2014 and October 2017 in a tertiary hospital in Singapore were analysed. Patients' major limb amputation and mortality were assessed using Cox regression models. Cumulative survival and amputation-free survival among the three classified groups were calculated using Kaplan-Meier analysis. Compared with patients with only DM, those in the PAD group and the DM-PAD group had higher risk of major limb amputation (adjusted hazard ratio: 2.47, 95% CI: 1.65-3.70; adjusted hazard ratio: 2.01, 95% CI: 1.53-2.65 respectively) and mortality (adjusted hazard ratio: 2.36, 95% CI: 1.57-3.55; adjusted hazard ratio: 2.46, 95% CI: 1.86-3.26 respectively). The 3-year survival and amputation-free survival were lowest in the DM-PAD group (52.1% and 41.5% respectively), followed by the PAD group (53.3% and 44.6% respectively) and the DM group (74.2% and 68.5% respectively). Lower extremity NIU patients with PAD or DM-PAD were found to have poorer clinical prognosis than those with DM only.

Effect and Safety of Penetrating Moxibustion in Treatment of Migraine without Aura: A Randomized Controlled Trial.

OBJECTIVE: To observe the clinical effect of penetrating moxibustion on migraine without aura (MO) patients. METHODS: Totally 60 MO patients from the Acupuncture Clinic of the Third Affiliated Hospital of Henan University of Chinese Medicine were collected from November 2015 to February 2017. All patients were assigned to a treatment group and a control group using a random number table, 30 cases in each group. The treatment group was treated with penetrating moxibustion, and the control group was treated with mild moxibustion, thrice a week for 4 consecutive weeks. The total effective rate, Visual Analogue Scale (VAS) scores, headache intensity, and Migraine Specific Quality of Life Questionnaire (MSQ) scores of patients after treatment were compared between the two groups. The moxibustion sensation and reaction after moxibustion were observed, and the adverse reactions were evaluated. All patients were followed up at 4 and 16 weeks after treatment. RESULTS: The total effective rate of the treatment group was significantly higher than that of the control group (93.33% vs. 80.00%, P<0.05). The improvement of VAS scores, headache intensity, and the role restrictive and role preventive scores in MSQ in the treatment group was better than those in the control group (P<0.05). The person-time of moxibustion sensations of itching, numbness and cold as well as flushing and sweating after moxibustion in the treatment group was all significantly higher than that in the control group (P<0.01). There was no significant difference in safety evaluation between the two groups (P>0.05). CONCLUSIONS: Penetrating moxibustion can significantly relieve pain and improve quality of life of MO patients. After penetrating moxibustion, flushing and sweating of patients were obvious, and the curative effect was superior to the mild moxibustion.

Surface and coherent contributions of plasmon fields to ultraviolet tip-enhanced coherent anti-Stokes Raman scattering.

Design of plasmonic substrates is of immense importance for high sensitivity and spatial resolution in plasmon-enhanced spectroscopy. In this study, the enhancement factors (EFs) of tip-enhanced coherent anti-Stokes Raman scattering (TECARS) contributed by surface and quantum coherent effects in the ultraviolet region are theoretically analyzed using three-dimensional finite-difference time-domain (3D-FDTD) method. In the multi-resonant TECARS configuration, surface and coherent EFs of 1018 and 109, respectively, can be achieved by considering the synthetic effect of surface and coherent enhancement mechanisms, providing the total TECARS EF of 1027 and sub-5 nm spatial resolution. Our theoretical results not only provide a deeper understanding of ultraviolet (UV)-TECARS but also can be used as a highly efficient reference for the experimental design of TECARS platform.