Association of hypoglycemic events with cognitive impairment in patients with type 2 diabetes mellitus: Protocol for a dose-response meta-analysis.

INTRODUCTION: With an incidence rate as high as 46%-58%, hypoglycemia is a common complication of glycemic management among those suffering from type 2 diabetes mellitus(T2DM). According to preclinical research, hypoglycemia episodes may impair cognition by harming neurons. However, there is still controversy regarding the clinical evidence for the relationship between hypoglycemic events and the likelihood of cognitive impairment. Furthermore, little research has been done on the dose-response association between hypoglycemia incidents and the possibility of cognitive impairment. To address these knowledge gaps, the present research intends to update the comprehension of the association among hypoglycemic events and the risk of cognitive impairment and to clarify the correlation between dose and response by incorporating the most recent investigations. METHOD AND ANALYSIS: This work has developed a protocol for a systematic review and meta-analysis that will examine, via a well-organized assessment of several databases, the relationship between the incidence of hypoglycemia and the probability of cognitive impairment. Observational studies investigating the connection between hypoglycemia episodes and cognitive impairment will be included. The databases that will be searched are PubMed, Web of Science, the Chinese Biomedical Literature Database (CBM), Cochrane Library, Embase, the China National Knowledge (CNKI), Wan Fang, the Chinese Science and Technology Periodical Database (VIP), and Du Xiu. Literature from the establishment of each database to December 2023 will be included in the search. Two researchers will independently screen the studies that satisfy the requirements for both inclusion and exclusion. A third researcher will be asked to mediate any disputes. The methodological caliber of the studies included will be assessed utilizing the Newcastle-Ottawa Scale (NOS) or the Joanna Briggs Institute (JBI) critical appraisal method. With regard to GRADE, which stands for Grading of Recommendations, Assessment, Development, and Evaluation, the quality of the evidence will be evaluated. ROBIS Tool will be used to evaluate the risk of bias in the development of the systematic review. If the data is accessible, meta-analysis and dose-response curve analysis will be employed by Stata software. However, if the data does not allow for such analysis, a descriptive review will be performed. DISCUSSION AND CONCLUSION: Hypoglycemic episodes may raise the likelihood of cognitive impairment, according to earlier investigations. This study will update the relevant evidence and explore the dose-response connection between hypoglycemic episodes and cognitive impairment. The results of this review will have significant effects on decision-making by individuals with diabetes, healthcare providers, and government policy institutions. TRIAL REGISTRATION: Prospero registration number: CRD42023432352.

A comparison of neurological event and mortality rates between transcatheter aortic valve implantation and surgical aortic valve replacement.

Introduction: Transcatheter aortic valve implantation (TAVI) is the treatment of choice for patients with symptomatic severe aortic stenosis. Aim: To evaluate the neurological event and mortality rates of TAVI in comparison with those of surgical aortic valve replacement (SAVR). Material and methods: A systematic literature search identified pertinent full-text journal articles published from 2000 to 2022 that were taken as the study materials. Results: Patients were at the age of 79.3 ±2.8 years and 79.9 ±2.9 years at the time of intervention/open surgery in the TAVI and SAVR groups, respectively. Patients' age and preoperative comorbidity rates were similar in both groups. A self-expanding valve prosthesis and a percutaneous transfemoral route were the most commonly used in patients receiving TAVI. The duration of the procedure and the hospital stay were much shorter, and the number of transfused blood units was much lower in the TAVI group than in the SAVR group. No significant intergroup difference was found in the prevalence of postoperative stroke, 1-month all-cause mortality, and 1-month and 1-year cardiovascular mortality rates. However, 1-year all-cause mortality was much lower in the TAVI than the SAVR group. The subgroups of risk stratification showed better outcomes for non-high-risk patients compared with high-risk patients. Conclusions: Irrespective of other postoperative complications of TAVI, this study emphasizes the postoperative major neurological events and mortality. TAVI appears to be superior to SAVR with regard to 1-year all-cause mortality. TAVI is thus recommended for elderly patients with symptomatic severe aortic stenosis at very high surgical risk contraindicated for SAVR.

[Acupuncture for chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial].

OBJECTIVE: To observe the short-term efficacy, long-term efficacy and safety of acupuncture for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: Forty-two patients with CP/CPPS were randomly divided into an acupuncture group (21 cases, 1 case dropped off) and a sham acupuncture group (21 cases). The patients in the acupuncture group were treated with acupuncture at bilateral Zhongliao (BL 33), Huiyang (BL 35), Shenshu (BL 23) and Sanyinjiao (SP 6); the needling depth of Zhongliao (BL 33) and Huiyang (BL 35) was 60 to 80 mm, while Shenshu (BL 23) and Sanyinjiao (SP 6) was directly punctured of 30 mm. The patients in the sham acupuncture group were treated with acupuncture at non-acupoints, including points 2 cm next to Shenshu (BL 23), Zhongliao (BL 33) and Huiyang (BL 35), and the midpoint of the connecting line between the spleen meridian and the kidney meridian. All the non-acupoints were treated with directly puncture of 2 to 3 mm. The needles were left for 30 min in both groups, once every other day in the first four weeks, three times a week, and twice a week in the next four weeks, totally 20 treatments. Before treatment, after treatment and in follow-up of 24 weeks after treatment completion, the National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI) score and urinary flow rate were observed in both groups; the clinical efficacy and safety were evaluated. RESULTS: Compared with those before treatment, the pain and discomfort scores, urination symptoms scores, quality of life scores and total scores of NIH-CPSI in both groups were reduced after treatment in the two groups (P<0.01), while each item score and total score of NIH-CPSI in the acupuncture group were reduced in follow-up (P<0.01, P<0.05). After treatment and in follow-up, each item score and total score of NIH-CPSI in the acupuncture group were lower than those in the sham acupuncture group (P<0.05, P<0.01). After treatment, the maximum and average urinary flow rates in the acupuncture group were higher than those before treatment (P<0.05), and the average urinary flow rate in the acupuncture group was higher than that in the sham acupuncture group (P<0.05). The total effective rate was 75.0% (15/20) in the acupuncture group, which was higher than 42.9% (9/21) in the sham acupuncture group (P<0.05). No significant adverse reactions were observed in the two groups, and there was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). CONCLUSION: Acupuncture could effectively alleviate the clinical symptoms, improve quality of life, and has a sustained, safe and reliable therapeutic effect in patients with CP/CPPS.

[Moxibustion improves learning-memory ability by regulating apoptosis related proteins of hippocampus in diabetic rats with cognitive impairment].

OBJECTIVE: To investigate the effect of moxibustion on the proteins related with apoptosis and nuclear transcription factor kappa B (NF-κB) in hippocampus of diabetic rats with cognitive impairment (CI), so as to explore its mechanism underlying improvement of learning-memory ability. METHODS: Thirty SD rats were randomly divided into normal, model and moxibustion groups (n=10 rats/group). The diabetic model was established by i.p. injection of streptozotocin solution (25 mg·kg-1·d-1), followed by high-fat diet raising for 4 weeks, and the CI model was confirmed by Morris water maze test. The rats in the moxibustion group were given moxibustion at "Shenting" (GV24), "Baihui" (GV20) and "Dazhui" (GV14) for 20 min each time, the treatment was conducted 6 times a week for 4 weeks. The learning-memory ability was detected by Morris water maze test, the random blood glucose of rats was measured by glucometer and test strips. The protein and mRNA expression levels of Bcl-2, Bax, Caspase-3 and NF-κB p65 in hippocampus were detected by Western blot and quantitative real-time PCR, separately. RESULTS: After modeling, the random blood glucose, escape latency, and the expression levels of Bax, Caspase-3 and NF-κB p65 proteins and mRNAs in the model group were significantly increased, while the expression levels of Bcl-2 protein and mRNA were decreased (P<0.001，P<0.01, P<0.05) in comparison with the normal group. Following the treatment, the modeling induced increase of blood glucose, escape latency, and the expression levels of Bax, Caspase-3 and NF-κB p65 proteins and mRNAs, as well as decrease of Bcl-2 protein and mRNA expression levels were reversed (P<0.05, P<0.01, P<0.001). CONCLUSION: Moxibustion can improve learning-memory ability in diabetic rats with cognitive impairment, which may be related to its function in regulating the expression levels of hippocampal Bcl-2, Bax, Caspase-3 and NF-κB.

Mycotic subclavian artery aneurysms: a scoping review.

Introduction: Mycotic subclavian artery aneurysms (SAAs) are a very rare disorder. Aim: To provide an overview of current knowledge on clinical features, management strategies and outcome evaluations of mycotic SAAs. Material and methods: The study materials were based on comprehensive literature retrieval of publications of mycotic SAAs published between 2000 and 2023. Results: Contaminated mechanical injuries and abscess erosions of the arterial walls are mechanisms of mycotic SAAs. The diagnosis relies on detection of pathogenic microorganisms by cultures or microbiological investigations of blood, other fluids and infected tissues as well as medical imaging visualization. The indications for an interventional therapy were poor general condition, high surgical risk, and rescue exclusion for a ruptured pseudoaneurysm. Three (9.1%) pre-treatment deaths were a result of sudden rupture of the mycotic SAAs and thus they lost the opportunity of treatment. All post-treatment deaths occurred in the interventional patient group, whereas the causes of death seemed to be unrelated to mycotic SAAs per se or to treatments of choice. Patient outcome evaluations revealed no significant difference between different treatments of choice. No significant predictive risk factors were responsible for patient outcomes. Conclusions: Once a diagnosis of mycotic SAA is made, sensitive antibacterial drugs are applied immediately to control the infection and control aneurysmal progression. Early treatment is conducted as soon as possible to avoid aneurysmal rupture. A decision on treatment of choice is made based on the patient's specific condition. Antibacterial drug use is continued for about 6 weeks after surgical or interventional therapy.

[Huayu Tongluo moxibustion combined with intradermal needling in patients with mild to moderate depression after cerebral infarction].

OBJECTIVE: To observe the effect of Huayu Tongluo (resolving stasis and promoting collateral circulation) moxibustion combined with intradermal needling on depressive symptoms, quality of life and cognitive impairment in patients with mild to moderate depression after cerebral infarction on the basis of western medicine treatment. METHODS: Fifty patients with mild to moderate depression after cerebral infarction were randomly divided into an acupuncture combined with western medication group (group A, 25 cases) and a western medication group (group B, 25 cases). In the group B, paroxetine hydrochloride tablets were taken orally, 20 mg after breakfast, once a day, and the dose could be adjusted to the maximum 40 mg/d according to the patients' condition, for 4 weeks totally. On the basis of the treatment in the group B, the group A was treated with Huayu Tongluo moxibustion, namely aconite cake-separated moxibustion at Baihui (GV 20) and suspended moxibustion at Dazhui (GV 14) and Shenting (GV 24), combined with intradermal needling at Shenmen (HT 7), Jianshi (PC 5), Zusanli (ST 36), etc. Huayu Tongluo moxibustion was performed 6 times a week, and intradermal needling was performed 3 times a week，for 4 weeks totally. In the two groups, the scores of Hamilton depression scale (HAMD), stroke specific quality of life scale (SS-QOL) and mini mental state examination (MMSE) were observed before and after treatment, and the clinical efficacy and safety were compared. RESULTS: After treatment, the HAMD score in the each group was decreased compared with that before treatment (P<0.05), and that in the group A was lower than the group B (P<0.05); after treatment, the SS-QOL score in the group A and MMSE score in the two groups were increased compared with those before treatment (P<0.05), and the SS-QOL score in the group A was higher than the group B (P<0.05). The total effective rate was 88.0% (22/25) in the group A, which was higher than 60.0% (15/25) in the group B (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (4.0% [1/25] vs 16.0%[4/25], P>0.05). CONCLUSION: On the basis of the treatment of western medication paroxetine hydrochloride tablets, Huayu Tongluo moxibustion combined with intradermal needling therapy can effectively improve the depressive symptoms, quality of life and cognitive impairment of patients with mild to moderate depression after cerebral infarction.

[YANG Jun's clinical experience of acupuncture for oculomotor paralysis].

Professor YANG Jun's clinical experience of acupuncture and moxibustion for oculomotor paralysis is summarized. Professor YANG Jun pays attention to disease differentiation and syndrome differentiation in the treatment of this disease. According to the characteristics of oculomotor paralysis, "early diagnosis and seeking treatment from the source" is advocated. According to the etiology and pathogenesis, professor YANG divides oculomotor paralysis into three types: the syndrome of wind-evil attacking collaterals, the syndrome of spleen-stomach weakness and the syndrome of qi-deficiency and blood-stasis. As such, the acupoints are selected according to syndrome differentiation, and several different acupuncture methods (pricking needling at eyelids, penetrating needling and lifting eyelids and contralateral- balance needling on the healthy side) are adopted to improve the symptoms of oculomotor paralysis. It is also suggested to use the combination of scalp acupuncture and electroacupuncture to achieve the best dose-effect state. Moreover, local stimulation around the eyes is important to achieve the effects of "qi reaching affected area".

[Electroacupuncture improves learning-memory ability by down-regulating expression of hippocampal Aß1-42 and Tau and NF-κB proteins in diabetic rats with cognitive impairment].

OBJECTIVE: To observe the effect of electroacupuncture(EA) on the expression of nuclear transcription factors κB (NF-κB) and Tau protein and content of amyloid (Aß) in diabetic rats with cognitive impairment, so as to explore its mechanism underlying improvement of learning-memory ability. METHODS: Male SD rats were randomly divided into normal control (n=9), model (n=9) and EA (n=9) groups. The diabetic mellitus model was established by feeding the rats with high fat and high sugar for 1 month and intraperitoneal injection of STZ (25 mg·kg-1·d-1) for 2 days. EA was applied to "Zusanli"(ST36) and "Neiting"(ST44) for 20 min, alternatively on both side every day, and "Yishu"(EX-B3) was stimulated by twirling the acupuncture needle with uniform reinforcing-reducing method for 1 min, followed by retaining it for 20 min. The treatment was conducted 6 times a week for 4 weeks. The learning-memory ability was evaluated by using Morris water maze swimming test. The blood glucose level was randomly detected by using a glucometer, the content of Aß1-42 in the hippocampal tissue was detected by ELISA, and the relative expression levels of hippocampal Tau and NF-κB p65 proteins and mRNAs were determined by Western blot and fluorescence quantitative real-time PCR, separately. RESULTS: After modeling, the blood glucose, escape latency, Aß1-42 content and the expression levels of Tau and NF-κB p65 proteins and mRNAs in the model group were significantly increased (P<0.01, P<0.05) in comparison with the normal control group. Following EA intervention, the modeling induced increase of blood glucose, escape latency, Aß1-42 content and the expression levels of Tau and NF-κB p65 proteins and mRNAs were reversed (P<0.05, P<0.01). CONCLUSION: EA can improve the learning-memory ability in rats with diabetic cognitive impairment, which may be related to its function in down-regulating the levels of hippocampal Aß1-42, Tau and NF-κB proteins.

[Professor YANG Jun's experience in treatment of refractory facial paralysis based on acupuncture manipulation].

To summarize professor YANG Jun's experience in treatment of refractory facial paralysis by different acupuncture manipulation. Professor YANG Jun believes that refractory facial paralysis has prolonged course, qi and blood deficiency and collaterals injury after a long illness, and it is difficult to obtain obvious curative effect with routine acupuncture. Aimed at the etiology, pathogenesis and characteristics of disease, professor YANG Jun adopts 3 kinds of acupuncture manipulations, such as "penetration needling with long needle" "pulling technique exert after needle stuck" "contralateral-balance needling on the healthy side", to relieve deviation.

[Electroacupuncture improves learning-memory ability in diabetic rats with cognitive impairment via inhabitating proinflammatory cytokine production through p38 MAPK and STAT3 pathway].

OBJECTIVE: To investigate the effect of electroacupuncture (EA) on the p38 mitogen-activated protein kinase (p38 MAPK) and signal transducer and activator of transcription 3 (STAT3) pathway in hippocampus and frontal cortex of diabetic rats with cognitive impairment (CI), as well as the mechanism of EA in protection against CI in diabetic rats. METHODS: Thirty SD rats were divided into normal, model and EA groups (n=10 rats/group). The diabetic model was established by i.p.injection of Streptozotocin solution(25 mg/kg), followed by high-fat diet raising for 1 month, and the CI rats was confirmed by Morris water maze tasks. The rats in the EA group were given acupuncture at "Zusanli" (ST36) "Neiting" (ST44) and "Yishu" (EX-B3) 20 min/d, among which ST36 and ST44 were treated with EA. The treatment was conducted 6 times a week for 4 weeks. The fasting blood glucose (FBG) contents were assayed by glucometer before and after treatment. The rats' learning-memory ability was detected by Morris water maze tasks. The expression levels of IL-6、IL-1ß、TNF-α、p38 MAPK、p-p38 MAPK、STAT3 and p-STAT3 in hippocampus and frontal cortex were detected by Western blot and quantitative real-time PCR, separately. The mean fluorescence intensity of p38 MAPK and STAT3 was observed by immunofluorescence histochemistry. RESULTS: After modeling, FBG and the escape latency of Morris water maze tasks were significantly increased in the model group compared with the normal group (P<0.001, P<0.01). Following EA treatment, the increased FBG and average escape latency were markedly reversed in the EA group relevant to the model group (P<0.05). Compared with the normal group, the proteins and mRNAs expression of IL-6, IL-1ß, TNF-α, p38 MAPK, p-p38 MAPK, STAT3 and p-STAT3 in hippocampus and frontal cortex were significantly increased in the model group (P<0.001), as well as the mean fluorescence intensity of p38 MAPK and STAT3 in hippocampus and frontal cortex (P<0.001). Following EA intervention, the proteins and mRNAs expression of IL-6, IL-1ß, TNF-α, p38 MAPK, p-p38 MAPK, STAT3 and p-STAT3, and the mean fluorescence intensity of p38 MAPK and STAT3 in hippocampus and frontal cortex were down-regulated(P<0.001, P<0.05). CONCLUSION: EA can inhibit the over production of pro-inflammatory cytokines in diabetic rats with CI, possibly by regulating the expression of p38 MAPK and STAT3 pathway.

[Professor YANG Jun's experience of infantile spastic cerebral palsy treated with the combination of acupuncture and herbal medicine].

Professor YANG Jun believes that infantile cerebral palsy is located in the brain and closely related to the kidney. The clinical treatment should focus on the brain theory and root at the kidney. In pathogenesis, infantile spastic cerebral palsy refers to flaccidity of yang and spasticity of yin. The principle of treatment should be balancing yin and yang, promoting the circulation of the governor vessel and regulating the spirit/mind. In clinical treatment, the comprehensive therapy of acupuncture and herbal medicine is adopted. In acupuncture, the acupoints on the head and the face are dominant and the body acupoints are selected rigorously and precisely. The herbal formula with Carya cathayensis Sarg and Scorpio is used and taken orally with warm water. In acupoint application treatment, Borneolum Syntheticum and Radix et Rhizoma Asari are the main herbal medicines for the external application at Shenque (CV 8) and Baihui (GV 20). All of the above therapies are used in combination to co-achieve the effect of regaining consciousness, opening orifices and benefiting the intelligence. The clinical therapeutic effect of this comprehensive therapy is significant.

[Professor YANG Jun's clinical characteristics in the treatment of chronic diarrhea with acupuncture and herbal medicine based on qi activity theory in Huangdi Neijing].

Professor YANG Jun believes that chronic diarrhea is located in the "intestine" and its pathogenesis focuses on the dysfunction of the spleen and the stomach which results in the impairment of qi activity. In the treatment, the comprehensive therapy is adopted, including acupuncture, moxibustion, herbal medicine, cupping method, etc. Regarding acupuncture therapy, Tianshu (ST 25) is selected specially for regulating the spleen and stomach function, Xiabai (LU4) for dispersing the lung qi to stop diarrhea, as well as Yintang (GV 29), Shuigou (GV 26), Chengjiang (CV 24), Qihai (CV 6), Guanyuan (CV 4) and Zhongwan (CV 12) for promoting the circulation of the conception vessel and the governor vessel. Regarding moxibustion therapy, moxibustion is exerted at the abdominal region to regulate qi and blood circulation and unblocking the meridians. Moreover, the retained cupping method is used at Shenque (CV 8) to consolidate the primary qi and the modified sijunzi tang, the herbal decoction is supplemented to tonify the acquired foundation for assisting the congenital one. All of these therapies co-work on promoting and regulating qi activity so as to stop diarrhea.

[Clinical observation on therapeutic effect of moxibustion on cognitive decline in type 2 diabetes mellitus].

OBJECTIVE: To observe the effect of moxibustion on cognitive function in patients with cognitive decline of type 2 diabetes mellitus (T2DM). METHODS: A total of 47 patients with cognitive decline of T2DM were randomized into an observation group (24 cases, 4 cases dropped off ) and a control group (23 cases, 3 cases dropped off ). Conventional hypoglycemic intervention was adopted in the control group. On the basis of the treatment in the control group, Huayu Tongluo moxibustion (moxibustion for removing stasis and clearing collaterals) was applied at Baihui (GV 20), Dazhui (GV 14), Shenting (GV 24), once every 2 days, 4 weeks were as one course, totally 3 courses were required. Before and after treatment, scores of auditory verbal learning test (AVLT), complex figure test (CFT), Montreal cognitive assessment (MoCA) and trail making test-A (TMT-A) were observed in the both groups, and the clinical effective rates were compared. RESULTS: After treatment, the scores of immediate memory and delayed memory of AVLT in the observation group were higher than those before treatment and those in the control group (P<0.05). After treatment, the scores of visual space and executive function, delayed memory, attention and orientation of MoCA in the observation group were higher than those before treatment and those in the control group (P<0.05). The effective rate was 85.0% (17/20) in the observation group, which was superior to 10.0% (2/20) in the control group (P<0.05). CONCLUSION: Huayu Tongluo moxibustion has a definite effect on cognitive decline of type 2 diabetes mellitus.

[Effect of acupuncture and moxibustion on brain functional connectivity network in patients with refractory facial paralysis].

OBJECTIVE: To observe the effects of acupuncture on resting-state functional connectivity (rs-FC) in patients with refractory peripheral facial paralysis, and to preliminarily explore the central mechanism of acupuncture for this disease. METHODS: Twenty patients with refractory peripheral facial paralysis were selected as subject and treated with acupuncture at Qianzheng (EX-HN 16), Fengchi (GB 20), Cuanzhu (BL 2), Dicang (ST 4), Jiache (ST 6), Shuigou (GV 26), Chengjiang (CV 24), Yifeng (TE 17), Touwei (ST 8), Sibai (ST 2), Yingxiang (LI 20) and Hegu (LI 4), once every other day, three times a week, 15 times as a course of treatment. The 1-course treatment was given. The score of Sunnybrook (Toronto) facial grading system was used to evaluate the clinical efficacy before and after the treatment. In addition, 20 healthy volunteers were selected as control. For patients, the resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed before and after treatment, for healthy volunteers, the scans were performed when they were recruited. The brain magnetic resonance images were analyzed with left primary motor area (LMⅠ) and right primary motor area (RMⅠ) as regions of interest. The differences of rs-FC between patients with refractory peripheral facial paralysis before and after treatment and healthy volunteers were compared. RESULTS: Compared before treatment, the Sunnybrook score was increased after the treatment (P<0.05). Compared with healthy volunteers, the functional connection between bilateral primary motor areas (MⅠ) and multiple brain areas were enhanced in patients before treatment, and most of brain areas were located in the anterior motor area (middle frontal gyrus, superior frontal gyrus), posterior central gyrus, anterior cuneiform lobe, middle temporal gyrus, inferior temporal gyrus and cerebellum lobe. Compared before treatment, the left inferior frontal gyrus was the strong functional connection area between LMⅠ and whole brain after acupuncture treatment, and there was no significant difference between RMⅠ and resting-state whole brain. Compared with healthy volunteers, the functional connections between bilateral MⅠ and multiple brain regions were enhanced after acupuncture, and most of the main brain regions were consistent with those before treatment. CONCLUSION: (1) Acupuncture could effectively improve the clinical symptoms of refractory peripheral facial paralysis. (2) The brain function of patients with refractory peripheral facial paralysis has been changed before acupuncture, which may be caused by the reactive compensation of the brain. (3) Acupuncture could enhance the functional connection between LMⅠ and left inferior frontal gyrus to promote the compensatory response, which may be one of the central mechanisms of acupuncture for refractory peripheral facial paralysis.

[Brief introduction of the academic thoughts of Xin'an medical scholars on acupuncture and moxibustion].

Xin'an region is enriched in humanities and talents, in which a regional medicine school was generated, named Xin'an medicine. The representative medical scholars have profound knowledge in acupuncture and moxibustion, such as WANG Guo-rui 's theory on "identification the reinforcing from the reducing" and "corresponding between acupoints and needling techniques", WANG Ji 's theory on "moxibustion for heat syndrome and boils and sores" and "selecting optimal points accordingly in treatment", WU Kun's theory on "the same principles shared in acupuncture and herbal medicine" and "the application of five-shu points", ZHENG Mei-jian's innovation about "ZHENG 's three needling technique" and WU Yi-ding's theory on "identifying symptoms/patterns and determining acupoints" and "contraindication of moxibustion". In this paper, the academic thoughts of the Xin'an medical representatives were collected and sorted out on acupuncture and moxibustion and summarized so as to provide the references for further research.

[Acupuncture Treatment Reduces Body Weight Possibly by Down-regulating Insulin and Leptin Resistance, and Up-regulating Soluble Leptin Receptor Level in Prediabetic Patients].

OBJECTIVE: To observe the effect of acupuncture of Feishu (BL 13), Pishu (BL 20), etc. on body weight, blood lipid, leptin (LP) and soluble leptin receptor (sOB-R) levels in prediabetic patients, so as to explore its mechanisms underlying treatment and prevention of prediabetes. METHODS: A total of 100 prediabetic patients were randomly assigned to medication (Metformin) group (n＝35), acupuncture group (n＝35) and simple lifestyle intervention group (n＝30) with random number table method. All the patients of the 3 groups were treated with lifestyle intervention (reasonable diet and moderate physical exercise) and ordered to stop administration of any hypoglycemic drugs during the treatment period. Bilateral Feishu (BL 13), Pishu (BL 20), Weishu (BL 21), Shenshu (BL 23), Zusanli (ST 36) and Sanyinjiao (SP 6) were punctured with filiform needles which were manipulated by lifting, thrusting and twirling repeatedly for about 2 min every 5 min during 30 minutes' needle retaining. The acupuncture treatment was conducted once every other day for 12 weeks. Patients of the medication group were ordered to orally take Metformin tablets (0.5 g/time, twice a day) for continuous 12 weeks. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), 2 h-postprandial blood glucose (2 h-PBG), fasting blood glucose (FBG), glycosyla-ted hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), fasting insulin (FINS), serum LP and sOB-R levels were measured before and after the treatment. RESULTS: After the treatment, the BMI in the acupuncture group, and BMI, WC and WHR in the medication group were significantly decreased relevant to their own pre-treatment in each group (P<0.05, P<0.01). Following the treatment, the levels of FBG, 2 h-PBG, HbA1C, TC, TG, FINS, HOMA-IR and LP in both acupuncture and medication groups, and FBG in the simple lifestyle intervention group were significantly decreased in comparison with their own pre-treatment in each group (P<0.01, P<0.05), and the levels of FBG, 2 h-PBG, HbA1C, TC and TG, HOMA-IR and LP in both acupuncture and medication groups were all considerably lower than those of the simple lifestyle intervention group (P<0.01，P<0.05). The level of FINS in the medication group was significantly lower than that of the simple lifestyle intervention group (P<0.05). Additionally, following the treatment, serum sOB-R contents in both acupuncture and medication groups were obviously increased compared with their own pre-treatment in each group and also relevant to the simple lifestyle intervention group (P<0.01). No significant changes were found in the simple lifestyle intervention group in all the above-mentioned blood indexes except FBG (P>0.05). CONCLUSION: Acupuncture can induce body weight loss, down-regulate FINS, insulin resistance and LP resistance, and up-regulate sOB-R content in prediabetic patients, displaying a positive role in the treatment of prediabetes.

Alcohol-induced severe acute pancreatitis followed by hemolytic uremic syndrome managed with continuous renal replacement therapy.

BACKGROUND: Acute kidney injury in patients with acute pancreatitis carries a poor prognosis. Hemolytic uremic syndrome (HUS) is characterized by non-immune hemolytic anemia, thrombocytopenia, and renal failure caused by platelet thrombi in the microcirculation of the kidney, and though rare in adults it is associated with high mortality and a high rate of chronic renal failure. CASE PRESENTATION: Herein, we report a case of alcohol-induced acute pancreatitis in a 38-year-old Chinese female complicated by HUS. Her renal function progressively deteriorated in 2 days, and daily continuous renal replacement therapy (CRRT) was thus performed for a total of 13 treatments. She also received intermittent transfusions of fresh frozen plasma. Her renal failure was successfully managed, with subsequent return of normal renal function. She was discharged 1 month after admission and follow-up at 3 months revealed normal urea and creatinine. CONCLUSION: CRRT was shown to be useful for the treatment of HUS following acute pancreatitis. Prior case reports and our case should remind clinicians that HUS is a possible complication of acute pancreatitis. This study highlights the importance of early diagnosis and prompt initiation of CRRT to prevent mortality and improve outcomes.

[Effects of salvianolate combined with alprostadil and reduced glutathione on progression of chronic renal failure in patients with chronic kidney diseases: a long-term randomized controlled trial].

BACKGROUND: Effects of traditional Chinese medicine salvianolate combined with alprostadil and reduced glutathione on delay of progression in patients with acute kidney injury has been confirmed, but the role of this combination therapy on the progression of chronic renal failure is uncertain. OBJECTIVE: To investigate the long-term effects of regular administration of salvianolate combined with Western medicine on the progression of chronic renal failure in patients with chronic kidney diseases (CKDs). DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: The study was performed at the ward of the Nephrology Department, Changhai Hospital, Second Military Medical University from August 2004 to October 2010. Thirty patients with CKDs at stage 2 to 4 and impaired renal function were recruited and randomly assigned to a treatment group or a control group, which consisted of 15 patients in each. Based on conventional therapy with the same oral medicines in the control group, patients in the treatment group were treated with salvianolate combined with alprostadil and reduced glutathione liquid intravenously for 7 to 10 d. Patients in the control group did not receive this combination therapy. The therapy was repeated monthly in patients in the treatment group. The follow-up time was an average of four years. MAIN OUTCOME MEASURES: Assessment of renal function, count of white blood cells, and test of serum hemoglobin, electrolytes and albumin were performed before and every year after treatment. Study endpoints were the serum creatinine level doubled from baseline or receiving replacement therapy. Number of remaining patients in each group was calculated at the end of every year. RESULTS: White blood cell count, serum albumin and electrocyte levels changed little in two groups after four years (P>0.05). Average serum hemoglobin levels in patients in the treatment group was elevated markedly compared with that in the control group after being treated for two years (P<0.01). The percentage of patients reaching the study termination in the treatment group (40%) decreased significantly compared with that (93%) in the control group (P<0.01). CONCLUSION: The regular integrated traditional Chinese and Western medicine can effectively delay the deterioration of renal function in patients with CKDs over a period of four years.

[Effect of acupuncture on serum leptin level in patients with type II diabetes mellitus].

OBJECTIVE: To study the relationship between serum leptin and insulin resistance, and to analyze the effect of acupuncture on serum leptin level in patients with type-II diabetes mellitus (DM). METHODS: A total of 80 type-II DM patients were randomized into acupuncture and medication groups. Acupuncture was applied to Yishu (EX), Feishu (BL13), Pishu (BL 20), etc. according to syndrome identification. The treatment was given once every other day for 12 weeks. For patients in the medication group, Glibenclamide (2.5-7.5 mg/time, 1-2 times/d according to blood sugar level) was given for 12 weeks. Fasting blood glucose (FBG), fasting insulin (FINS) and fasting leptin (FLP) were detected by using glucose oxidase method, radioimmunoassay and ELISA, respectively. Insulin sensitivity index (ISI) and homeostasis model assessment-insulin resistance (HOMA-IR) were calculated. RESULTS: In comparison with pre-treatment, FBG levels and HOMA-IR in both acupuncture and medication groups, and FINS and FLP levels in the acupuncture group were decreased significantly (P < 0.01), while ISI in both acupuncture and medication groups, and FINS level in the medication group were increased remarkably after the treatment (P < 0.01). Comparison between two groups showed that after the treatment, FINS and FLP levels, and HOMA-IR of the acupuncture group were considerably lower than those of the medication group (P < 0.01), while ISI of the acupuncture group was significantly higher than that of the medication group (P < 0.01). CONCLUSION: Acupuncture therapy is effective in lowering FLP level, which may contribute to its clinical effect in improving type-II DM.