Reliability and stability of ultrasound-guided attenuation parameter in evaluating hepatic steatosis.

PURPOSE: This study aimed to explore the reliability and stability of ultrasound-guided attenuation parameter (UGAP) values obtained by two measuring methods and different measuring times. METHODS: Patients who underwent liver UGAP examinations in our hospital from September 2022 to December 2022 were retrospectively analyzed. The clinical data and UGAP measurements results were collected. Two different measuring methods: static single-frame multi-point measuring and dynamic multi-frame single-point measuring, were performed for each patient, and 10 UGAP values of each measuring method were recorded. The medians of the UGAP values of the 1st-3rd, 1st-5th, 1st-7th and 1st-10th by each measuring method were taken as the final UGAP values of measuring 3, 5, 7 and 10 times. The UGAP values obtained by the two different measuring methods and different measuring times (3, 5, 7 or 10 times) were compared. RESULTS: 206 patients were included in this study. There was no statistical difference between UGAP values measured by static single-frame multi-point measuring and dynamic multi-frame single-point measuring (P = 0.689, P = 0.270, P = 0.298, P = 0.091), regardless of measuring times (3, 5, 7, 10 times). No significant difference between the UGAP values obtained by 3, 5, 7 and 10 measurements was found (P = 0.554, P = 0.916). CONCLUSION: The UGAP values obtained by the two different measuring methods and different measuring times (3, 5, 7 and 10 times) are stable and reliable. Additionally, 3 times of UGAP measurements might be enough for each patient in clinical practice.

Corrigendum: Assessing the causal relationship between genetically determined inflammatory biomarkers and low back pain risk: a bidirectional two-sample Mendelian randomization study.

[This corrects the article DOI: 10.3389/fimmu.2023.1174656.].

Efficacy and Safety of Microwave Ablation Assisted by Ultrasound Fusion Imaging for Primary and Secondary Liver Cancers with a Diameter of 3-7 Cm.

Purpose: To investigate the efficacy and safety of microwave ablation (MWA) assisted by ultrasound fusion imaging (FI) for primary and secondary liver cancers with a diameter of 3-7 cm. Patients and Methods: A retrospective analysis was conducted on patients with primary and secondary liver cancers (3-7 cm) who underwent MWA with ultrasound FI assistance in our hospital from April 2020 to May 2022. Technical success, technique efficacy, local tumor progression (LTP), major complication, intrahepatic distant recurrence (IDR), and overall survival (OS) were assessed during the follow-up period. In addition, the ablation results of tumors between the medium-sized group (3.1-5.0 cm) and large-sized group (5.1-7.0 cm) were compared. Results: 31 patients with 35 primary and secondary liver cancers were treated with MWA assisted by ultrasound FI. Complete ablation was achieved in 34 lesions with a technical success rate of 97.1%. Major complications occurred in 6.5% of patients (2/31), while no ablation-related deaths were reported. The median follow-up time of this study was 24 months (range:10 to 35 months). The technique efficacy rate was 97.1% (34/35), with LTP occurring in three lesions at a rate of 8.8% (3/34). The incidence of IDR was 38.7% (12/31) and the 2-year cumulative OS rate reached 96.7%. Moreover, there were no statistical differences in technique efficacy rate (p=0.286), LTP rate (p=0.328), major complication rate (p=0.503), IDR (p=0.857), and OS (p=0.118) between medium-sized group and large-sized group. Conclusion: Ultrasound FI-assisted MWA has the potential to be an effective and safe therapeutic strategy for primary and secondary liver cancers ranging from 3-7 cm in size.

Prediction of ablation zone disappearance after microwave ablation for the patients with papillary thyroid microcarcinoma using nomograph.

Objectives: To construct a prognostic nomogram to predict the ablation zone disappearance for patients with papillary thyroid microcarcinoma (PTMC) after microwave ablation (MWA). Materials and methods: From April 2020 to April 2022, patients with PTMC who underwent MWA treatment were collected retrospectively. Ultrasound (US) or contrast-enhanced ultrasound (CEUS) was performed at 1 day, 1, 3, 6, 12, 18 and 24 months after MWA to observe the curative effect after ablation. The volume, volume reduction rate (VRR) and complete disappearance rate of the ablation zone at each time point were calculated. Univariate and multivariate logistic regression analysis were used to determine the prognostic factors associated with the disappearance of the ablation zone after MWA, and the nomogram was established and validated. Results: 72 patients with PTMCs underwent MWA were enrolled into this study. After MWA, no tumor progression (residual, recurrence or lymph node metastasis) and major postoperative complications occurred. The ablation zone in 28 (38.89%) patients did not completely disappear after MWA in the follow-up period. Three variables, including age (odds ratio [OR]: 1.216), calcification type (OR: 12.283), initial maximum diameter (OR: 2.051) were found to be independent prognostic factors predicting ablation zone status after MWA by multivariate analysis. The above variables and outcomes were visualized by nomogram (C-index=0.847). Conclusions: MWA was a safe and effective treatment for PTMC. Older patients with macrocalcification and larger size PTMCs were more unlikely to obtain complete disappearance of ablation zones. Incomplete disappearance of ablation zone was not related to recurrence.

Assessing the causal relationship between genetically determined inflammatory biomarkers and low back pain risk: a bidirectional two-sample Mendelian randomization study.

Background: Observational studies have suggested an association between inflammatory markers and low back pain (LBP), but the causal relationship between these factors remains uncertain. Methods: We conducted a bidirectional two-sample Mendelian randomization analysis (MR) study to investigate whether there is a causal relationship between inflammatory markers and low back pain. We obtained genetic data for CRP, along with its upstream inflammatory markers IL-6, IL-8, and IL-10, as well as low back pain from publicly available genome-wide association studies (GWAS). We applied several MR methods, including inverse variance weighting, weighted median, MR-Egger, Wald Ratio, and MR-PRESSO, to test for causal relationships. Sensitivity analyses were also conducted to assess the robustness of the results. Results: Our analyses utilizing the Inverse Variance Weighted (IVW) method, the MR-Egger method, and the weighted median method indicated that IL-6 may be associated with an increased risk of LBP (Effect Size: -0.009, 95% Confidence Interval: -0.013-0.006, p = 9.16e-08); however, in the reverse direction, there was no significant causal effect of LBP on inflammatory markers. Conclusion: Our study used a Mendelian randomization approach and found that elevated IL-6 levels may reduce the risk of LBP.

Hemodynamic Responses in Carotid Bifurcation Induced by Enhanced External Counterpulsation Stimulation in Healthy Controls and Patients With Neurological Disorders.

Enhanced external counterpulsation is a Food and Drug Administration-approved, non-invasive, assisted circulation therapy for ischemic cardiovascular and cerebrovascular diseases. Previous studies have confirmed that EECP stimulation induces largely different cerebral hemodynamic responses in patients with ischemic stroke and healthy controls. However, the underlying mechanisms remain uncertain. We hypothesize that different blood redistributions at the carotid bifurcation may play a key role. Ten subjects were enrolled in this study, namely, five patients with neurological disorders and five young healthy volunteers as controls. Magnetic resonance angiography (MRA) was performed on the carotid artery. All the subjects received a single session of EECP treatment, with external cuff pressures ranging from 20 to 40 kPa. Vascular ultrasound measurements were taken in the common carotid artery (CCA), external carotid artery (ECA) and internal carotid artery (ICA). Three-dimensional patient-specific numerical models were developed to calculate the WSS-derived hemodynamic factors. The results indicated that EECP increased CCA and ECA blood flow in both groups. The ICA blood flow in the patient group exhibited a mean increase of 6.67% during EECP treatment compared with the pre-EECP condition; a mean decrease of 9.2% was observed in the healthy control group. EECP increased the averaged wall shear stress (AWSS) throughout the carotid bifurcation in the patient group; the ICA AWSS of the healthy group decreased during EECP. In both groups, the oscillatory shear index (OSI) in the ICA increased proportionally with external cuff pressure. In addition, the relative resident time (RRT) was constant or slightly decreased in the CCA and ECA in both groups but increased in the ICA. We suggest that the benefits of EECP to patients with neurological disorders may partly result from blood flow promotion in the ICA and increase in WSS at the carotid bifurcation. In the healthy subjects, the ICA blood flow remained constant during EECP, although the CCA blood flow increased significantly. A relatively low external cuff pressure (20 kPa) is recommended as the optimal treatment pressure for better hemodynamic effects. This study may play an important role in the translation of physiological benefits of EECP treatment in populations with or without neurological disorders.

Effect of constant compressive stress induced by imitating Tuina stimulation with various durations on the cell cycle, cellular secretion, apoptosis, and expression of myogenic differentiation and myogenic factor 5 of rat skeletal muscle cells in vitro.

OBJECTIVE: To investigate the effect of constant compressive stress induced by imitating Tuina stimulation with various durations on the cell cycle, cellular secretion, apoptosis, and expression of myogenic regulatory factors (MRFs), myogenic factor 5(Myf5) and myogenic differentiation (MyoD) of rat skeletal muscle cells (RSkMCs) in vitro. METHODS: Third passage RSkMCs were subjected to constant compressive stresses with various durations at 2000 strain for 15, 30, 60, 90, and 120 min via a four-point bending system. The control group (CG) was cultured in the absence of mechanical loading. Alterations of the cell cycle and apoptosis rate were detected by flow cytometry (FCM). The concentrations of interleukin 6 (IL-6) / prostaglandin E2 (PGE2) and nitric oxide (NO) in supernatants were determined by enzyme-linked immunosorbent assays and the nitrate reductase method, respectively. Expression of Myf5 and MyoD was detected by immunohistochemistry. RESULTS: Compared with the CG, a significant alteration was observed in the synthesis phase fraction (SPF) (P < 0.01). The SPF and proliferation index (PI) were reduced from 15 to 90 min, but reached levels similar to those at 120 min. Apoptosis was increased significantly at 30 min (P < 0.05) and especially at 90 and 120 min (P < 0.01). Expression of MyoD and Myf5 was increased significantly at 15, 30, and 90 min (P < 0.01). Compared with 15 and 30 min, MyoD and Myf5 expression at 60 and 120 min was decreased significantly (P < 0.01). Compared with 60 min, MyoD expression at 90 min was increased significantly (P < 0.05), whereas MyoD and Myf5 expression at 120 min was significantly lower (P < 0.05). The IL-6 concentration was increased at 60 min compared with the CG and 15 min (P < 0.05), whereas the concentrations of PGE2 and NO were the highest at 15 and 30 min, respectively, compared with the CG and other time points (P < 0.05). CONCLUSION: The cell cycle, secretion, apoptosis, and Myf5 and MyoD expression of RSkMCs were regulated by compressive stress in a time-dependent manner. SPF and PI were inhibited at short durations (< 90 min), but NO and PGE2 secretion was the highest at shorter durations (< 30 min). With the prolongation of stimulation time, SPF, PI, and apoptosis were increased, but Myf5 and MyoD expression was decreased gradually at 15-30 min.

Moxibustion benignantly regulates circadian rhythm of REV-ERBα in RA rats.

The key clinical symptoms and previous findings of RA show a circadian variation, with more prominent joint swelling, stiffness, and pain occurring in the early morning. Moxibustion is able to relieve RA in various pass ways, however, there is no verifying study results for the pathological rhythm of RA. Therefore, we conducted this work to verify whether moxibustion could adjust RA circadian rhythm according to regulate core clock genes. Based on these previous findings that circadian timekeeping is disturbed in RA at molecular level, the aim of this study was to observe the influence of moxibustion on expression level and circadian rhythm of REV-ERBα at different tissues of RA rats. Furthermore, the expression level of core clock genes closely related to RA were evaluated by RT-PCR. 96 SD rats were randomly assigned as 1:1:1:1 ratio to 4 groups for normal control group, RA model group, 5-7 am moxibustion group, and 5-7 pm moxibustion group. RT-PCR was used to measure the relatively expression quantity of REV-ERBα, CLOCK, BMAL1, and PER2 in hypothalamus, hippocampus, and adrenal gland. In RA rats, the expression level of REV-ERBα mRNA were up-regulated in different tissues, and moxibustion potentially up-regulated them in different degrees. In untreated RA rats, the circadian rhythm of REV-ERBα mRNA in hippocampus and adrenal gland both disappeared (P>0.05) and moxibustion was able to recover them (P<0.05). The expression level of CLOCK and PER2 mRNA in hippocampus and adrenal gland were down-regulated significantly (P<0.05) in RA model rats, while moxibustion up-regulated both of them in hippocampus (P<0.05). These results suggested together that moxibustion can benign regulate circadian rhythm of REV-ERBα in different tissues of RA rats. It was revealed that moxibustion not only recovered the losing diurnal oscillation of REV-ERBα in hippocampus and adrenal gland, but also adjusted the circadian rhythm of REV-ERBα in hypothalamus, hippocampus, and adrenal gland to close the normal circadian pattern.

Effect of electroacupuncture at the ST36 and GB39 acupoints on apoptosis by regulating the p53 signaling pathway in adjuvant arthritis rats.

p53 and mouse double minute 2 homolog (MDM2) serve key regulatory roles in the apoptosis of synovial cells. The present study aimed to investigate the effects of electroacupuncture (EA) at the 'Zusanli' (ST36) and 'Xuanzhong' (GB39) acupoints on apoptosis in an adjuvant arthritis (AA) rat model. A total of 40 male Sprague­Dawley rats were randomly divided into Control, AA, AA + EA and AA + sham EA groups (n=10 rats in each group). Rats in all the groups, with the exception of the control group, were injected with Complete™ Freund's adjuvant into the bilateral hindlimb footpad to establish the AA model. Rats in the AA + EA group were treated with EA at the ST36 and GB39 acupoints. Rats in the AA + sham EA group were treated with percutaneous electrical stimulation at a position of 5 mm away from the ST36 and GB39 acupoints. The arthritis index scores and hindlimb paw volumes of the rats in each group were recorded. Subsequently, pathological changes in the synovial tissue were evaluated by hematoxylin and eosin (H&E) staining, and the apoptotic rate of the synovial cells was detected by TUNEL staining. In addition, the expression levels of the apoptosis­associated proteins, Bax, phorbol­12­myristate­13­acetate­induced protein 1 (Noxa) and p53 upregulated modulator of apoptosis (PUMA), were determined by western blot analysis. The expression of both the gene and protein of p53 and MDM2 in synovial tissue was detected by reverse transcription­quantitative polymerase chain reaction (RT­qPCR) and western blot analysis, respectively. The results indicated that the arthritis index scores and hindlimb paw volumes upon EA stimulation were significantly decreased compared with those of the AA group (P<0.05). H&E staining revealed that the synovial inflammation of EA stimulation was significantly decreased compared with the AA group (P<0.05). The TUNEL assay results indicated that the apoptotic rate of synovial cells in the AA + EA group was significantly increased compared with that in the AA group (P<0.05). Furthermore, an increased expression of proapoptotic proteins was confirmed by the increased expression levels of Bax, Noxa and PUMA in the AA + EA group. The results of RT­qPCR and western blot analysis demonstrated that, compared with the AA group, EA stimulation led to a marked increase in p53 (P<0.05) and a significant decrease in MDM2 (P<0.05) gene and protein expression. Taken together, these results demonstrated that EA performed on the ST36 and GB39 acupoints led to a significant amelioration in AA injury of model rats, by regulating the p53 signaling pathway and inducing apoptosis.

Moxibustion of Zusanli (ST36) and Shenshu (BL23) Alleviates Cartilage Degradation through RANKL/OPG Signaling in a Rabbit Model of Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a systemic and chronic autoimmune inflammatory disease characterized by severe synovial hyperplasia associated with progressive cartilage degradation. Due to the severe pain and disability caused by RA, effective therapeutic strategies that could simultaneously alleviate the inflammatory response and delay the disease progression are urgently needed. As a major alternative therapy in traditional Chinese medicine, moxibustion has been demonstrated that it could reduce the chronic inflammatory responses of a series of musculoskeletal diseases; however, whether moxibustion has protective effects on RA is still unclear. To investigate the effects of moxibustion on RA, moxibustion was applied to Zusanli (ST36) and Shenshu (BL23) acupoints in a RA rabbit model. HE staining of articular cartilage showed that moxibustion alleviated the cartilage degradation and bone destruction. In addition, moxibustion decreased the osteoclast number in RA rabbits. Real-time PCR revealed that moxibustion decreased the expression of RANKL mRNA while increased the expression of OPG mRNA, indicating a restoration of the balance between osteogenesis and osteoclastogenesis. Taken together, our results indicated that moxibustion had promising antiarthritic effects and could be an useful alternative method in RA therapeutics.

The Association between Genes Polymorphisms of Heparan Sulfate Proteoglycan 2 (HSPG2) and Chondroitin Sulfate Proteoglycan 2 (CSPG2) and Intracranial Aneurysm Susceptibility: A Meta-Analysis.

BACKGROUND: We aimed to investigate whether the polymorphisms of gene heparan sulfate proteoglycan 2 (HSPG2) and chondroitin sulfate proteoglycan 2 (CSPG2) are associated with increased risk of intracranial aneurysms (IAs) susceptibility. METHODS: The Cochrane Library, Medline, PubMed, and Embase databases were carefully searched for potential researches before Mar 30, 2018. The title, abstract, and full text were assessed to determine whether the paper was suitable for inclusion. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were presented to assess the associations between CSPG2 and HSPG2 polymorphisms and IAs susceptibility. RESULTS: We enrolled 7 papers, 4 matched single nucleotide polymorphisms (SNPs) of CSPG2 (rs173686, rs251124) or HSPG2 (rs173686, rs251124), and a total of 8651 participations (3674 with IAs and 4977 for control). For the rs251124 polymorphism of CSPG2, the quantitative synthesis from 5 studies showed significant difference in the gene allele comparison of T vs. C (OR, 1.129; 95% CI, 1.029, 1.238; P=0.01). Similar results were found for rs3767137 of HSPG2 (A vs. G, OR, 0.842, 95% CI=0.759-0.935, P=0.001). However, for the rs173686 polymorphism of CSPG2 and rs7556412 polymorphism of HSPG2, no significant difference was found (P=0.259 and P=0.474, respectively). CONCLUSION: The SNPs rs251124 of CSPG2 and rs3767137 of HSPG2 had statistically significant associations with IAs susceptibility. The minor allele T of rs251124 demonstrated a harmful effect but the minor allele A of rs3767137 demonstrated a protective role with regard to the risk of IAs. However, no such associations were found in the SNPs rs173686 of CSPG2 and rs7556412 of HSPG2.

[Effects of moxibustion at different time points on foot swelling, serum level of TNF-α and circadian rhythm in rats with rheumatoid arthritis].

OBJECTIVE: To study the effects of moxibustion at different time points on serum level of tumor necrosis factor-α (TNF-α) in rats with rheumatoid arthritis (RA), and to explore its regulation mechanism on circadian rhythm. METHODS: A total of 96 Sprague-Dawley (SD) adult rats were randomly assigned into a blank group, a model group, a moxibustion at 5-7 AM group and a moxibustion at 5-7 PM group, 24 rats in each group, half male and half female. Each group was further divided into a 0 AM group, a 6 AM group, a 12 N group and a 6 PM group, 6 rats in each group. All rats were treated with the 12 h/12 h light-dark cycle in the whole process of experiment. Except for the blank group, all rats were treated with intracutaneous injection of freund's complete adjuvant (FCA) at right foot pad to establish the RA model. The rats at the two moxibustion groups were treated with grain-sized moxibustion at "Shenshu" (BL 23) and "Zusanli" (ST 36) at 5-7 AM and 5-7 PM, respectively, one side per treatment, once a day; six treatments were taken as one course and 3 courses were given with an interval of one day between courses. The rats in the remaining groups were treated with identical fixation but without moxibustion intervention. The right foot volume was measured before model establishment, after model establishment and after treatment. The blood samples were collected after treatment and the serum level of TNF-α was measured by ELISA. The SPSS 21.0 software and Halberg Cosinor were adopted to analyze the experiment data. RESULTS: After treatment, compared with the blank group, the foot swelling severity was significantly increased in the model group, moxibustion at 5-7 AM group and moxibustion at 5-7 PM group (all P<0.01); compared with the model group, the foot swelling severity was significantly reduced in the moxibustion at 5-7 AM group and moxibustion at 5-7 PM group (both P<0.01). Compared with the blank group, the serum level of TNF-α was increased significantly in the model group and moxibustion at 5-7 AM group (both P<0.05); compared with the model group, the serum level of TNF-α was reduced significantly in the moxibustion at 5-7 AM group and moxibustion at 5-7 PM group (both P<0.05). The serum level of TNF-α showed circadian rhythm in all the groups (all P<0.05), and the peak appeared at night phase; compared with the blank group, the median value of TNF-α was increased significantly in the model group (P<0.05), the peak phase was delayed and the amplitude was increased (P<0.05); compared with the model group, the median value of TNF-α was significantly reduced in the moxibustion at 5-7 AM group and moxibustion at 5-7 PM group (P<0.01), the peak phase was advanced and the amplitude was reduced (P<0.05). CONCLUSION: Moxibustion could effectively reduce the serum level of TNF-α to relieve the foot swelling severity in RA rats. Moxibustion could regulate the circadian rhythm of TNF-α to play its effects on the inhibition of the synthesis of TNF-α. No efficacy is observed between the treatment at 5-7 AM and 5-7 PM.

[Anterior-posterior acupoint combination for low back pain].

The meridian diseases, abnormal psoas and abdominal muscles and abdominal pressure are key causes of low back pain. We treat low back pain mainly with lumbar back area, neglecting abdomen. The anterior-posterior acupoint combination, regulating yin to treat yang, is effective. Based on the Chinese meridian-collateral and contemporary anatomy related to low back pain, the combination method, tuina and its mechanism are introduced, so as to develop the thought and method for low back pain. A typical case is added.

[Current situation of research and problems in diagnosis and treatment of senile depression with integrative traditional Chinese and Western medicine].

This paper summarized the researches on diagnosis and treatment of senile depression with integrative Chinese and Western medicine in the recent 5 years, and some problems existed at present were also submitted. It is pointed out that it's necessary to expand the study with senior electrocerebral neurotransmitter analysis technique (SET) for the diagnosis and efficacy evaluation of senile depression by either traditional Chinese or Western medicine. By which it would also be able to offer convincing evidence for diagnosis of depression, TCM syndrome differentiation dependant therapy and the efficacy evaluation.