Urinary kallikrein reverses neuropathic pain by inhibiting ectopic neural discharges, neural inflammation and oxidative stress.

Background: Neuropathic pain is a refractory disease and badly impacts the lives of patients. Urinary kallikrein (UK) acted as a glycoprotein has been discovered to play a pivotal role in neuroprotection. However, the regulatory impacts and correlative pathways of UK in the progression of neuropathic pain remain dimness. Methods: The chronic constriction injury (CCI) rat model was firstly established to mimic neuropathic pain. The withdrawal threshold was measured through the Von Frey test. The levels of TNF-α, IL-1ß and IL-6 were determined through ELISA. The levels of ROS, GSH, SOD and GSH-Px were examined through the commercial kits. The ectopic discharges were assessed. The protein expressions were inspected through western blot. Results: It was demonstrated that withdrawal threshold was reduced in CCI rat model, but this change was reversed after UK treatment, indicating that UK relieved mechanical allodynia. Moreover, UK alleviated the inflammatory response through reducing TNF-α, IL-1ß and IL-6 levels. It was uncovered that oxidative stress was strengthened in CCI rat model, but this impact was restrained after UK treatment. Additionally, UK suppressed ectopic discharge. At last, it was proved that UK triggered the Nrf2/ARE signaling pathway in CCI rat model. Conclusion: This study manifested that UK reversed neuropathic pain by inhibiting ectopic neural pathways, neural pathways and oxidation via the Nrf2/ARE pathway. This study may offer useful proofs the regulatory functions of UK in the cure of neuropathic pain.

Causal association between brain structure and obstructive sleep apnea: A mendelian randomization study.

OBJECTIVE: Previous studies have reported contradictory findings regarding the relationship between obstructive sleep apnea (OSA) and abnormal brain morphology. Furthermore, the causal relationship between OSA and brain morphology has not been clearly established. The aim of this study was to utilize Mendelian randomization (MR) analysis to investigate the impact of obstructive sleep apnea (OSA) on brain morphology and determine its potential causal relationship. METHODS: Firstly, the inverse-variance weighted (IVW) method was employed to assess the causal effects of OSA on cortical surface area and brain structure volume. Additionally, two additional MR methods, namely weighted median and MR-Egger, were used to supplement the results from IVW. Subsequently, a reverse MR analysis was conducted to determine the direction of causality. Furthermore, sensitivity analyses were performed including Cochrane's Q test, MR-Egger intercept test, MR-PRESSO global test, and leave-one-out analysis. RESULTS: The results of the study showed that OSA patients had a tendency towards decreased cortical surface area and hippocampal volume in the precuneus region compared to individuals without OSA, while the superior temporal cortical surface area showed an increase. The results from the weighted median and MR-Egger analyses were consistent with those from the IVW analysis. Sensitivity tests confirmed the reliability of the causal estimates. CONCLUSIONS: This study provides preliminary evidence of an association between OSA and brain structure using large-scale genome-wide association data. The results demonstrate that OSA is associated with changes in brain structure. Therefore, individuals with OSA should be vigilant about the risks of related diseases due to alterations in brain tissue.

Difficult Airway Assessment Based on Multi-View Metric Learning.

The preoperative assessment of difficult airways is of great significance in the practice of anesthesia intubation. In recent years, although a large number of difficult airway recognition algorithms have been investigated, defects such as low recognition accuracy and poor recognition reliability still exist. In this paper, we propose a Dual-Path Multi-View Fusion Network (DMF-Net) based on multi-view metric learning, which aims to predict difficult airways through multi-view facial images of patients. DMF-Net adopts a dual-path structure to extract features by grouping the frontal and lateral images of the patients. Meanwhile, a Multi-Scale Feature Fusion Module and a Hybrid Co-Attention Module are designed to improve the feature representation ability of the model. Consistency loss and complementarity loss are utilized fully for the complementarity and consistency of information between multi-view data. Combined with Focal Loss, information bias is effectively avoided. Experimental validation illustrates the effectiveness of the proposed method, with the accuracy, specificity, sensitivity, and F1 score reaching 77.92%, 75.62%, 82.50%, and 71.35%, respectively. Compared with methods such as clinical bedside screening tests and existing artificial intelligence-based methods, our method is more accurate and reliable and can provide a reliable auxiliary tool for clinical healthcare personnel to effectively improve the accuracy and reliability of preoperative difficult airway assessments. The proposed network can help to identify and assess the risk of difficult airways in patients before surgery and reduce the incidence of postoperative complications.

Association between weekend catch-up sleep and depression of the United States population from 2017 to 2018: A cross-sectional study.

Insufficient sleep on weekdays has become a societal norm, and studies have shown that sleep deprivation increases the risk of depression. Although individuals often resort to weekend catch-up sleep (CUS) as a compensatory measure, the present evidence supporting its efficacy in mitigating the risk of depression is limited. This article attempts to explore the relationship between CUS and depression. In this study, a total of 5510 participants were included, characterized into two groups: nondepressed (n = 5051) and depressed (n = 459), with data extracted from the National Health and Nutrition Examination Survey (NHANES). Compared with people without CUS, those practicing CUS exhibited a significantly lower risk of depression (OR = 0.81, P = 0.048). In subgroup analysis, this reduction effect was only observed in males (OR = 0.70, 95 % CI 0.05 to 0.99, P = 0.04), middle-aged (>40, ≤60) (OR: 0.57, 95 % CI: 0.40 to 0.81, P = 0.002), married or living with parents (OR: 0.61, 95 % CI: 0.44 to 0.86, P = 0.004), groups with three or more family members (OR: 0.69, 95 % CI: 0.52 to 0.93, P = 0.01), and individuals without alcohol intake (OR: 0.24,95 % CI: 0.09 to 0.67, P = 0.006). Therefore, in the realm of depression treatment, doctors may consider advising patients to get adequate sleep on weekends as part of their overall treatment plan. At the same time, individuals can also choose weekend sleep as a proactive strategy for regulating their psychological status.

Near-resonant twin-beam generation from degenerate four-wave mixing in hot 133Cs vapor enabled by field-dressed energy levels.

Squeezed light near an atomic resonance is beneficial for efficient atom-light quantum interfaces. It is desirable but challenging to directly generate in atoms due to excess noise from spontaneous emission and reabsorption. Here, we report on the use of energy-level modulation to actively control atomic coherence and interference in degenerate four-wave mixing (DFWM) and then to enhance the DFWM gain process for the generation of near-resonant squeezed twin beams. With this technique, we obtain a -2.6 dB intensity-difference squeezing detuned 100 MHz from the D1 F = 4 to F' = 4 transition of 133Cs.

Endogenous FGF21 attenuates blood-brain barrier disruption in penumbra after delayed recanalization in MCAO rats through FGFR1/PI3K/Akt pathway. / å† æºæ€§FGF21通过FGFR1/PI3K/Akt通路减轻MCAOå¤§é¼ å»¶è¿Ÿè¡€ç®¡å†é€šåŽåŠæš—å¸¦çš„è¡€è„‘å±éšœæŸä¼¤ï¼ˆè‹±æ–‡ï¼‰.

OBJECTIVES: Restoration of blood circulation within "time window" is the principal treating goal for treating acute ischemic stroke. Previous studies revealed that delayed recanalization might cause serious ischemia/reperfusion injury. However, plenty of evidences showed delayed recanalization improved neurological outcomes in acute ischemic stroke. This study aims to explore the role of delayed recanalization on blood-brain barrier (BBB) in the penumbra (surrounding ischemic core) and neurological outcomes after middle cerebral artery occlusion (MCAO). METHODS: Recanalization was performed on the 3rd day after MCAO. BBB disruption was tested by Western blotting, Evans blue dye, and immunofluorescence staining. Infarct volume and neurological outcomes were evaluated on the 7th day after MCAO. The expression of fibroblast growth factor 21 (FGF21), fibroblast growth factor receptor 1 (FGFR1), phosphatidylinositol-3-kinase (PI3K), and serine/threonine kinase (Akt) in the penumbra were observed by immunofluorescence staining and/or Western blotting. RESULTS: The extraversion of Evans blue, IgG, and albumin increased surrounding ischemic core after MCAO, but significantly decreased after recanalization. The expression of Claudin-5, Occludin, and zona occludens 1 (ZO-1) decreased surrounding ischemic core after MCAO, but significantly increased after recanalization. Infarct volume reduced and neurological outcomes improved following recanalization (on the 7th day after MCAO). The expressions of Claudin-5, Occludin, and ZO-1 decreased surrounding ischemic core following MCAO, which were up-regulated corresponding to the increases of FGF21, p-FGFR1, PI3K, and p-Akt after recanalization. Intra-cerebroventricular injection of FGFR1 inhibitor SU5402 down-regulated the expression of PI3K, p-Akt, Occludin, Claudin-5, and ZO-1 in the penumbra, which weakened the beneficial effects of recanalization on neurological outcomes after MCAO. CONCLUSIONS: Delayed recanalization on the 3rd day after MCAO increases endogenous FGF21 in the penumbra and activates FGFR1/PI3K/Akt pathway, which attenuates BBB disruption in the penumbra and improves neurobehavior in MCAO rats.

Engineering the NASICON electrolyte/Na anode interface with amorphous bismuth oxide for sodium batteries.

Amorphous BiOx, prepared on the surface of NASICON electrolyte by the photochemical metal-organic deposition method, can substantially improve the interfacial properties at the anode side. The Na symmetric cell delivers a critical current density of 1.2 mA cm-2 and cycles stably at 0.5 mA cm-2 for 1000 h at 30 °C.

Propagation of noninteger cylindrical vector vortex beams in a gradient-index fiber.

The characteristics of two noninteger cylindrical vector vortex beams (NCVVBs) propagating through a radial gradient-index (GRIN) fiber are analyzed on the basis of the generalized Huygens-Fresnel principle. The NCVVBs exhibit periodic and stable transmission characteristics in the radial GRIN fiber. Polarization changes, the presence of spin angular momentum (SAM), and changes in the orbital angular momentum (OAM) of the NCVVBs are observed at the focal plane of the radial GRIN fiber. Spin-orbit interactions of NCVVBs are verified in the radial GRIN fiber for the first time, to the best of our knowledge.

Prognostic factors and outcomes of surgical intervention for patients with spinal metastases secondary to lung cancer: an update systematic review and meta analysis.

PURPOSE: Lung cancer is one of the most common malignant tumors. Most patients develop spinal metastases during the course of cancer and suffer skeletal-related events. Currently, no consensus has been reached on the prognostic factors in patients undergoing surgeries. This study aimed to answer two questions: (1) what are the effects of surgical intervention, and (2) what are the factors associated with postoperative survival. METHODS: Searches were performed on electronic databases including PubMed, Ovid/MEDLINE, Cochrane, and Scopus for articles published before February of 2022, involving the survival factors of patients with spinal metastasis. Multiple data items were considered, such as baseline demographics, surgical details, clinical outcome, and prognostic factors. The analysis was performed in Review Manager (RevMan) 5.5. The prognostic factors of survival were analyzed with univariate and multivariate cox regression analysis. RESULTS: Finally, 14 studies with 813 patients were identified. Their 6, 12, and 24 months survival rates ranged from 18 to 58%, 18 to 22.4%, and 0 to 58.5%, respectively. The pooled hazard ratio of preoperative ambulatory status and the number of involved vertebrae demonstrated statistical significance, while no significant prognostic effect on the overall survival was found for targeted therapy, visceral metastases, chemotherapy, radiotherapy, or postoperative ambulatory status. CONCLUSION: Overall, surgical intervention could achieve significant pain relief and neurological function improvements. For patients receiving surgery for spinal metastasis from lung cancer, preoperative ambulatory status and the number of involved vertebrae were significant prognostic factors associated with their survival.

Neuroinflammation in epileptogenesis: from pathophysiology to therapeutic strategies.

Epilepsy is a group of enduring neurological disorder characterized by spontaneous and recurrent seizures with heterogeneous etiology, clinical expression, severity, and prognosis. Growing body of research investigates that epileptic seizures are originated from neuronal synchronized and excessive electrical activity. However, the underlying molecular mechanisms of epileptogenesis have not yet been fully elucidated and 30% of epileptic patients still are resistant to the currently available pharmacological treatments with recurrent seizures throughout life. Over the past two decades years accumulated evidences provide strong support to the hypothesis that neuroinflammation, including microglia and astrocytes activation, a cascade of inflammatory mediator releasing, and peripheral immune cells infiltration from blood into brain, is associated with epileptogenesis. Meanwhile, an increasing body of preclinical researches reveal that the anti-inflammatory therapeutics targeting crucial inflammatory components are effective and promising in the treatment of epilepsy. The aim of the present study is to highlight the current understanding of the potential neuroinflammatory mechanisms in epileptogenesis and the potential therapeutic targets against epileptic seizures.

Propagation of Gaussian vortex beams in electromagnetically induced transparency media.

Electromagnetically induced transparency (EIT) is an important phenomenon in quantum optics, and has a wide range of applications in the fields of quantum information processing and quantum precision metrology. Recently, with the rapid progress of the generation and detection of structured light, the EIT with structured light has attracted enormous interests and offers new and novel functionalities and applications. Here, we theoretically study the propagation and evolution of Gaussian vortex beams, a typical type of structured light, in an EIT medium with Λ-type three-level atoms. Based on the generalized Huygens-Fresnel principle, we derive the analytical expressions of fully and partially coherent Gaussian vortex beams propagating in the EIT medium, and study the evolution of the intensity and phase distributions of the beams and their dependencies on parameters such topological charge, coherence length, Rabi frequency, etc. It is shown that both the fully and partially coherent Gaussian vortex beams undergo focusing and diverging periodically during propagation. The phase singularity of the fully coherent beam keeps unchanged, while the phase singularity of the partially coherent beam experiences splitting and recombination periodically. In addition, new phase singularities with opposite topological charge are generated in the latter case. Our results not only advance the study of the interaction between structured light and coherent media, but also pave the avenue for manipulating structured light via EIT.

Detecting the transverse spin density of light via electromagnetically induced transparency.

For light that is transversely confined, its field vector spins in a plane not orthogonal to the propagation direction, leading to the presence of transverse spin, which plays a fundamental role in the field of chiral quantum optics. Here, we theoretically propose a scheme to detect the transverse spin density (TSD) of light by utilizing a multilevel atomic medium. The scheme is based on the electromagnetically induced transparency effect, which enables the TSD-dependent modulation of the susceptibility of the atomic medium by using a coupling field whose TSD is to be detected. The modulated susceptibility results in a spin-dependent absorption for a probe beam passing through the atomic medium. We show that there exists a corresponding relationship between the TSD distribution of the coupling field and the polarization distribution of the transmitted probe beam through a theoretical study of two typical cases, in which the coupling field is provided by a tightly focused field and a two-beam interference field, respectively. Based on this relationship, the key features of the TSD of the coupling field, such as the spatial distribution, the symmetry property, and the spin-momentum locking, can be inferred from the transmitted probe beam. Benefiting from the fast response of the atomic medium to the variation of the coupling field, the present scheme is capable of detecting the TSD in real time, offering new possibilities for developing transverse-spin-based techniques.

Top 50 Most Cited Articles on Thoracic Ossification of Posterior Longitudinal Ligament.

Study Design: Bibliometric analysis. Objective: Over the last several decades, the field of thoracic ossification of the posterior longitudinal ligament (T-OPLL) has evolved unprecedentedly, and the literature on T-OPLL has increased significantly. The purpose of this study is to identify and review the top 50 most cited publications related to T-OPLL. Methods: The most frequently cited 50 articles in this field until 30 October 2021 were identified by searching Web of Science. We ranked the articles based on the citation number. Through the bibliometric method, we evaluated the following information: article title, first author, year of publication, journal of publication, total number of citations, country, and study topic. Results: The number of citations of included studies ranged from 20 to 108, with a mean number of 45.4. The journal Spine published most articles (20), followed by Spinal Cord (5), and European Spine (5). All of these articles were contributed by 38 first authors, Yamazaki (4), Fujimura (3), and Aizawa (3) who published more than 2 articles. In the respect of productive countries, Japan (39) contributed most papers. Tomita contributed the most cited article in 1990 on Spine, which was the first-ever report of circumferential decompression for thoracic myelopathy due to T-OPLL. Conclusion: The top 50 influential articles on T-OPLL were identified and analyzed in this study. It will undoubtedly provide a comprehensive and detailed basis for the orthopedic and neurosurgery physicians to make a clinical decision and assimilate the research focus of spine surgery.

Mannose inhibits proliferation and promotes apoptosis to enhance sensitivity of glioma cells to temozolomide through Wnt/ß-catenin signaling pathway.

BACKGROUND: Temozolomide (TMZ) is generally applied for glioma treatment, while drug resistance of TMZ limits its therapeutic efficacy. Mannose exerts evident anti-tumor effect. We intended to investigate whether mannose enhanced TMZ sensitivity to glioma and examined the underlying mechanism. METHODS: MTT and clone formation assays were performed to detect cell viability and proliferation. Cell apoptosis was measured by flow cytometry. The protein and gene expression levels were detected by Western blot and qRT-PCR assays. Xenograft glioma model was established to explore the influence of mannose in vivo. RESULTS: Mannose inhibited glioma cell growth, which was facilitated by knockdown of phosphomannose isomerase (PMI) while reversed by overexpression of PMI. Mannose enhanced the sensitivity of glioma cells to TMZ, indicated by the further inhibited cell viability and colony formation and the aggravated cell apoptosis, which was reversed by overexpression of O6-methylguanine DNA methyltransferase (MGMT). Furthermore, mannose and TMZ inhibited MGMT expression and Wnt/ß-catenin activation. Moreover, activating Wnt/ß-catenin pathway blocked anti-proliferative effect induced by mannose and TMZ, which was further suppressed by overexpressed MGMT. Mannose inhibited glioma growth, suppressed Ki67 and downregulated MGMT and ß-catenin in vivo. CONCLUSION: Mannose inhibited MGMT to enhance sensitivity of glioma cells to TMZ, with Wnt/ß-catenin pathway involvement. Our data suggested that mannose could be an innovative agent to improve glioma treatment, particularly in TMZ-resistant glioma with high MGMT.

Experimental realization of efficient nondegenerate four-wave mixing in cesium atoms.

Nondegenerate four-wave mixing (FWM) in diamond-type atomic systems has important applications in a wide range of fields, including quantum entanglement generation, frequency conversion, and optical information processing. Although the efficient self-seeded nondegenerate FWM with amplified spontaneous emission (ASE) has been realized extensively, the seeded nondegenerate FWM without ASE is inefficient in reported experiments so far. Here we present the experimental realization of the seeded nondegenerate FWM in cesium atoms with a significantly improved efficiency. Specifically, with two pump lasers at 852 and 921 nm and a seed laser at 895 nm, a continuous-wave laser at 876 nm is efficiently generated via FWM in a cesium vapor cell with a power up to 1.2 mW, three orders of magnitude larger than what has been achieved in previous experiments. The improvement of the efficiency benefits from the exact satisfaction of the phase-matching condition realized by an elaborately designed setup. Our results may find applications in the generation of squeezing and entanglement of light via nondegenerate FWM.

Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial.

Importance: In adults undergoing hip fracture surgery, regional anesthesia may reduce postoperative delirium, but there is uncertainty about its effectiveness. Objective: To investigate, in older adults undergoing surgical repair for hip fracture, the effects of regional anesthesia on the incidence of postoperative delirium compared with general anesthesia. Design, Setting, and Participants: A randomized, allocation-concealed, open-label, multicenter clinical trial of 950 patients, aged 65 years and older, with or without preexisting dementia, and a fragility hip fracture requiring surgical repair from 9 university teaching hospitals in Southeastern China. Participants were enrolled between October 2014 and September 2018; 30-day follow-up ended November 2018. Interventions: Patients were randomized to receive either regional anesthesia (spinal, epidural, or both techniques combined with no sedation; n = 476) or general anesthesia (intravenous, inhalational, or combined anesthetic agents; n = 474). Main Outcomes and Measures: Primary outcome was incidence of delirium during the first 7 postoperative days. Secondary outcomes analyzed in this article include delirium severity, duration, and subtype; postoperative pain score; length of hospitalization; 30-day all-cause mortality; and complications. Results: Among 950 randomized patients (mean age, 76.5 years; 247 [26.8%] male), 941 were evaluable for the primary outcome (6 canceled surgery and 3 withdrew consent). Postoperative delirium occurred in 29 (6.2%) in the regional anesthesia group vs 24 (5.1%) in the general anesthesia group (unadjusted risk difference [RD], 1.1%; 95% CI, -1.7% to 3.8%; P = .48; unadjusted relative risk [RR], 1.2 [95% CI, 0.7 to 2.0]; P = .57]). Mean severity score of delirium was 23.0 vs 24.1, respectively (unadjusted difference, -1.1; 95% CI, -4.6 to 3.1). A single delirium episode occurred in 16 (3.4%) vs 10 (2.1%) (unadjusted RD, 1.1%; 95% CI, -1.7% to 3.9%; RR, 1.6 [95% CI, 0.7 to 3.5]). Hypoactive subtype in 11 (37.9%) vs 5 (20.8%) (RD, 11.5; 95% CI, -11.0% to 35.7%; RR, 2.2 [95% CI, 0.8 to 6.3]). Median worst pain score was 0 (IQR, 0 to 20) vs 0 (IQR, 0 to 10) (difference 0; 95% CI, 0 to 0). Median length of hospitalization was 7 days (IQR, 5 to 10) vs 7 days (IQR, 6 to 10) (difference 0; 95% CI, 0 to 0). Death occurred in 8 (1.7%) vs 4 (0.9%) (unadjusted RD, -0.8%; 95% CI, -2.2% to 0.7%; RR, 2.0 [95% CI, 0.6 to 6.5]). Adverse events were reported in 106 episodes in the regional anesthesia group and 102 in the general anesthesia group; the most frequently reported adverse events were nausea and vomiting (47 [44.3%] vs 34 [33.3%]) and postoperative hypotension (13 [12.3%] vs 10 [9.8%]). Conclusions and Relevance: In patients aged 65 years and older undergoing hip fracture surgery, regional anesthesia without sedation did not significantly reduce the incidence of postoperative delirium compared with general anesthesia. Trial Registration: ClinicalTrials.gov Identifier: NCT02213380.

Experimental realization of wavelength multiplexed nonlinear upconversion in cesium atoms.

Blue-violet wavelength multiplexing offers the capability to enhance the operational capacity and efficiency in optical information processing, underwater communications, biology, and medicine. Here we present a specially designed atomic scheme of cesium for simultaneously generating two blue-violet lasers at 456 and 459 nm via four-wave-mixing (FWM)-based upconversion processes. We experimentally and theoretically show that a double-diamond-type coherent system pumped with 852 and 921 nm lasers is responsible for the efficient generation of the two blue-violet lasers. In this system, the large population inversions lead to self-amplified spontaneous emissions at 15.6 and 12.1µm, which, in turn, serve as the seeds for enhanced double FWM processes with dual-wavelength upconversions.

Clinical control study of traditional Chinese medicine hot compress combined with traction in the treatment of cervical spondylotic radiculopathy: Study protocol.

ABSTRACT: Cervical spondylotic radiculopathy (CSR) is the most common type of cervical spondylosis, accounting for about 60% of the incidence of cervical spondylosis. Both cervical traction and traditional Chinese medicine hot compress are common and effective treatment for CSR. This study will be performed to investigate the effect of a combination of cervical traction and traditional Chinese medicine hot compress on CSR. In this non-blinded, randomized controlled trial, 100 eligible patients will be randomly divided into a treatment group (intermittent cervical traction combines with traditional Chinese medicine hot compress) and a control group (intermittent cervical traction combined with hot compresses). Before and after the intervention, the Visual Analog Scale score, Neck Disability Index score, and 20-score scale of symptoms will be evaluated at baseline and at 7, 14, 21, and 28 days. During the treatment period, any signs of acute adverse events, such as paralysis of aggravated pain, nausea, dizzy, and even syncope, will be recorded at each visit. Although intermittent cervical traction and traditional Chinese medicine hot compress have been used in the treatment of CSR in China for many years, there is no consensus on its effectiveness of combination therapy. This experiment will provide convincing evidence of the efficacy of intermittent cervical traction combined with traditional Chinese medicine hot compress in the treatment of CSR.

Metabolic Control of Epilepsy: A Promising Therapeutic Target for Epilepsy.

Epilepsy is a common neurological disease that is not always controlled, and the ketogenic diet shows good antiepileptic effects drug-resistant epilepsy or seizures caused by specific metabolic defects via regulating the metabolism. The brain is a vital organ with high metabolic demands, and epileptic foci tend to exhibit high metabolic characteristics. Accordingly, there has been growing interest in the relationship between brain metabolism and epilepsy in recent years. To date, several new antiepileptic therapies targeting metabolic pathways have been proposed (i.e., inhibiting glycolysis, targeting lactate dehydrogenase, and dietary therapy). Promising strategies to treat epilepsy via modulating the brain's metabolism could be expected, while a lack of thorough understanding of the role of brain metabolism in the control of epilepsy remains. Herein, this review aims to provide insight into the state of the art concerning the brain's metabolic patterns and their association with epilepsy. Regulation of neuronal excitation via metabolic pathways and antiepileptic therapies targeting metabolic pathways are emphasized, which could provide a better understanding of the role of metabolism in epilepsy and could reveal potential therapeutic targets.

A randomized controlled study for the treatment of middle-aged and old-aged lumbar disc herniation by Shis spine balance manipulation combined with bone and muscle guidance.

ABSTRACT: Ninety percent of elderly patients with lumbar disc herniation (LDH) have problems with the mechanics of the spine and muscle tissue. Shi-style spine balance manipulation combined with guidance (Daoyin) of muscle and bone as an alternative therapy for LDH can tone the muscle groups around the spine and maintain optimal mechanical and static sagittal balance of the spine. This study will be performed to investigate the effect of a combination of Shi-style spine balance manipulation and Daoyin therapy on LDH in middle-aged and elderly patients. In this non-blinded, randomized controlled trial, 72 eligible patients will be randomly divided into a treatment group (Shi-style spine balance manipulation combined with Daoyin therapy) and a control group (lumbar mechanical traction). Before and after the intervention, lumbar X-ray and magnetic resonance imaging examinations will be performed to observe the sagittal balance parameters of the spine and pelvis and the lumbar muscle strength. The visual analog scale score, Oswestry disability index score, and pressure pain threshold will be evaluated at baseline and at 2, 4, 12, and 24 weeks. During the treatment period, any signs of acute adverse events, such as paralysis of the lower extremities or cauda equina syndrome, will be recorded at each visit. Although Shi-style spine manipulation combined with Daoyin therapy has been used in the treatment of LDH in middle-aged and elderly people in China for many years, there is no consensus on its effectiveness. This experiment will provide convincing evidence of the efficacy of Shi-style spine manipulation combined with Daoyin therapy in the treatment of LDH in middle-aged and elderly people.