The clinical progress and potential mechanism of massage therapy on knee osteoarthritis

Knee osteoarthritis （KOA） is a disease due to the degenerative pathological change of knee joint, which commonly occurs in the elderly. The main clinical characters of KOA are the pain, stiffness, and dysfunction of knee joint. Western medicine regarding to the treatment of KOA aims to relieve the pain and delay the progress of disease such as intra-articular injection and functional exercise. Traditional Chinese medicine （TCM） therapy includes massage, herb, acupuncture, microwave, etc. Among them, the massage technique has the advantages of simpleness, effectiveness and non-invasive manipulation. The present study compared the curative effects of different therapies on KOA including Western medicine therapeutic method, single massage, complementary TCM therapeutic method containing massage and integrated TCM and western medicine therapeutic method containing massage. We found that the effectiveness of single massage method is better than that of joint cavity injection. The effectiveness of massage in combination with herb and acupuncture is better than that of massage alone. The effectiveness of joint cavity injection or functional exercise combined with massage and acupuncture is better than that of the single articular cavity injection or functional exercise. However, more research and clinical trials are still needed to determine the exact mechanism of massage.

Interleukin-1 receptor antagonist enhances chemosensitivity to fluorouracil in treatment of Kras mutant colon cancer

BACKGROUND Kras mutant colon cancer shows abnormal activation of the nuclear factor kappa-B(NF-κB)pathway,resulting in the proliferation of tumor cells.Treatment with fluorouracil(5-FU)might not achieve the expected inhibition of proliferation of malignant cells based on the fluorouracil-induced activation of the NF-κB pathway.AIM To detect whether interleukin(IL)-1 receptor antagonist(IL-1RA)could increase the chemosensitivity to 5-FU by decreasing the activation of the NF-κB pathway and reducing the proliferation of colon cancer cells.METHODS Western blot analysis was performed to detect the persistent activation of the NF-κB pathway in colon cancer cell lines.Reverse transcription-polymerase chain reaction was used to detect the IL-1RA-reduced expression levels of IL-6,IL-8,IL-17,IL-21 and TLR4 in colon cancer cell lines.We used a xenograft nude mouse model to demonstrate the downregulation of the NF-κB pathway by blocking the NF-κB-regulated IL-1αfeedforward loop,which could increase the efficacy of chemotherapeutic agents in inhibiting tumor cell growth.RESULTS IL-1 receptor antagonist could decrease the expression of IL-1αand IL-1βand downregulate the activity of the NF-κB pathway in Kras mutant colon cancer cells.Treatment with 5-FU combined with IL-1RA could increase the chemosensitivity of the SW620 cell line,and decreased expression of the TAK1/NF-κB and MEK pathways resulted in limited proliferation in the SW620 cell line.CONCLUSION Adjuvant chemotherapy with IL-1RA and 5-FU has a stronger effect than single chemotherapeutic drugs.IL-1RA combined with fluorouracil could be a potential neoadjuvant chemotherapy in the clinic.

Study on mechanism of astragaloside Ⅳ in treatment of pulmonary fibrosis with epithelial-mesenchymal transition

OBJECTIVE Currently discussing the clinical treatment of pulmonary fibrosis commonly used drugs astragalus main active ingredient astragalosideⅣ(ASTⅣ) in vitro after transforming growth factor-β1 induced lung adenocarcinoma A549 epithelial cells after epithelial cell interstitial EpithelialMesenchymal Transition(EMT).METHODS The effect of astragalosideIV on the proliferation of A549 cells was detected by MTT assay for the first time.No significant effect of astragaloside on the prolifera.tion of A549 cells was found in the range of 1.25-20 μmol/L.A549 cells in vitro were divided into 5 groups:normal group,control group,low,medium and high experimental groups,which were treated for 72 hours,and the morphological changes of cells in each group were observed by light microscope.Real-time quantitative PCR(qPCR) and Western blotting were performed.Detection of gene and protein expression levels.RESULTS The results of real-time fluorescence quantitative PCR showed that the quantitative analysis of high-dose astragalosideⅣ in the experimental group was lower than that of the control group in the α-SMA analysis,and the difference was statistically significant(P<0.05).The dose of Astragaloside Ⅳ in the experimental group was higher than that of the control group in the E-Cad analysis,and the difference was statistically significant(P<0.05).Western Blot results showed that the expression of α-SMA antibody in the high-dose and low-dose experimental group was lower than that in the control group,the difference was statistically significant(P<0.05).The high-dose experimental group had a significantly higher expression of E-Cad antibody than the control group,the difference was statistically significant(P<0.01).CONCLUSION This study uses A549 epithelial cells as a model,A549 cells were modeled and confirmed that Astragaloside can effectively inhibit TGF-β1-induced epithelialmesenchymal transition(EMT) and provide a new basis for the treatment of pulmonary fibrosis.

Perinatal outcomes of re-recurrent gestational diabetes mellitus and their prognostic factors:A retrospective cohort study in China

To the Editor:Gestational diabetes mellitus(GDM)is a pathologic condition in which glucose intolerance and insulin resistance develop to different degrees during pregnancy.Women with GDM have higher odds of adverse maternal and fetal outcomes.Patients with a history of GDM were at a significantly increased risk for recurrence of GDM in subsequent pregnancies.Our previous and some other studies found an increased incidence of adverse perinatal outcomes in pregnant with recurrent GDM.^([1])So far,women with a prior history of GDM are not recommended to refrain from subsequent pregnancy in light of the limited available data.What about those women with a history of recurrent GDM?Should women with recurrent GDM be recommended to avoid further pregnancy?Currently,studies on perinatal outcomes of women with re-recurrent GDM and their prognostic factors are very rare.Therefore,this retrospective cohort study was performed to explore perinatal outcomes of pregnant woman with re-recurrent GDM and their prognostic factors.

Evaluation of the Effectiveness of the Competency Model for Nursing Managers in the Training of Newly Appointed Head Nurses

Objective:To explore the effectiveness of the competency model for nursing managers in the training of newly appointed head nurses.Methods:Eighteen newly appointed head nurses from Yichang Central People’s Hospital,selected between August 2023 and July 2024,were chosen as the research subjects.Based on the nursing manager competency model,corresponding training programs were developed,and these 18 head nurses were trained accordingly.Results:After the training,all newly appointed head nurses passed the theoretical assessments,with a pass rate of 100.00%.The pass rates for two rounds of assessment were 100.00%and 94.54%,respectively.There was no significant difference in the performance evaluation scores between new and senior head nurses in terms of standardized services,nursing quality,nursing research and teaching,and patient satisfaction(P>0.05).Conclusion:The competency model for nursing managers has a significant effect on the training of newly appointed head nurses.It effectively enhances management awareness,facilitates role transition,and,to some extent,improves the management and leadership capabilities of head nurses.It holds high value for broader implementation.

Status of the neonatal follow‑up system in China:survey and analysis

Background There is little information about neonatal follow-up programs(NFUPs)in China.This study aimed to conduct a survey of hospitals participating in the Chinese Neonatal Network(CHNN)to determine the status of NFUPs,including resources available,criteria for enrollment,neurodevelopmental assessments,and duration of follow-up.Methods We conducted a descriptive study using an online survey of all 72 hospitals participating in CHNN in 2020.The survey included 15 questions that were developed based on the current literature and investigators’knowledge about followup practices in China.Results Sixty-four(89%)of the 72 hospitals responded to the survey,with an even distribution of children’s(31%),maternity(33%)and general(36%)hospitals.All but one(98%)hospital had NFUPs,with 44(70%)being established after 2010.Eligibility criteria for follow-up were variable,but common criteria included very preterm infants<32 weeks or<2000 g birth weight(100%),small for gestational age(97%),hypoxic ischemic encephalopathy(98%)and postsurgery(90%).The average follow-up rate was 70%(range:7.5%–100%).Only 12%of hospitals followed up with patients for more than 24 months.There was significant variation in neurodevelopmental assessments,follow-up schedule,composition of staff,and clinic facilities and resources.None of the staff had received formal training,and only four hospitals had sent staff to foreign hospitals as observers.Conclusions There is significant variation in eligibility criteria,duration of follow-up,types of assessments,staffing,training and facilities available.Coordination and standardization are urgently needed.

Maternal weight,blood lipids,and the offspring weight trajectories during infancy and early childhood in twin pregnancies

Background The intrauterine environment has a profound and long-lasting influence on the health of the offspring.However,its impact on the postnatal catch-up growth of twin children remains unclarified.Therefore,this study aimed to explore the maternal factors in pregnancy associated with twin offspring growth.Methods This study included 3142 live twin children born to 1571 mothers from the Beijing Birth Cohort Study conducted from 2016 to 2021 in Beijing,China.Original and corrected weight-for-age standard deviation scores of the twin offspring from birth to 36 months of age were calculated according to the World Health Organization Child Growth Standards.The corresponding weight trajectories were identified by the latent trajectory model.Maternal factors in pregnancy associated with the weight trajectories of the twin offspring were examined after adjustment for potential confounders.Results Five weight trajectories of the twin children were identified,with 4.9%(154/3142)exhibiting insufficient catch-up growth,30.6%(961/3142),and 46.8%(1469/3142)showing adequate catch-up growth from different birth weights,and 15.0%(472/3142)and 2.7%(86/3142)showing various degrees of excessive catch-up growth.Maternal short stature[adjusted odds ratio(OR)=0.691,95%confidence interval(CI)=0.563–0.848,P=0.0004]and lower total gestational weight gain(GWG)(adjusted OR=0.774,95%CI=0.616–0.972,P=0.03)were associated with insufficient catch-up growth of the offspring.Maternal stature(adjusted OR=1.331,95%CI=1.168–1.518,P<0.001),higher pre-pregnancy body mass index(BMI)(adjusted OR=1.230,95%CI=1.090–1.387,P<0.001),total GWG(adjusted OR=1.207,95%CI=1.068–1.364,P=0.002),GWG rate(adjusted OR=1.165,95%CI=1.027–1.321,P=0.02),total cholesterol(TC)(adjusted OR=1.150,95%CI=1.018–1.300,P=0.03)and low-density lipoprotein-cholesterol(LDL-C)(adjusted OR=1.177,95%CI=1.041–1.330)in early pregnancy were associated with excessive growth of the offspring.The pattern of weight trajectories was similar between monochorionic and dichorionic twins.Maternal height,pre-pregnancy BMI,GWG,TC and LDL-C in early pregnancy were positively associated with excess growth in dichorionic twins,yet a similar association was observed only between maternal height and postnatal growth in monochorionic twins.Conclusion This study identified the effect of maternal stature,weight status,and blood lipid profiles during pregnancy on postnatal weight trajectories of the twin offspring,thereby providing a basis for twin pregnancy management to improve the long-term health of the offspring.

The pharmacology, toxicology and therapeutic potential of anthraquinone derivative emodin

Emodin(1, 3, 8-trihydroxy-6-methylanthraquinone) is a derived anthraquinone compound extracted from roots and barks of pharmaceutical plants, including Rheum palmatum, Aloe vera, Giant knotweed, Polygonum multiflorum and Polygonum cuspidatum. The review aims to provide a scientific summary of emodin in pharmacological activities and toxicity in order to identify the therapeutic potential for its use in human specific organs as a new medicine. Based on the fundamental properties, such as anticancer, anti-inflammatory, antioxidant, antibacterial, antivirs, anti-diabetes, immunosuppressive and osteogenesis promotion, emodin is expected to become an effective preventive and therapeutic drug of cancer, myocardial infarction, atherosclerosis, diabetes, acute pancreatitis, asthma, periodontitis, fatty livers and neurodegenerative diseases. This article intends to provide a novel insight for further development of emodin, hoping to reveal the potential of emodin and necessity of further studies in this field.

Pericollapse Stage of Osteonecrosis of the Femoral Head： A Last Chance for Joint Preservation

Objective： To propose a new definition of the pericollapse stage of osteonecrosis of the femoral head （ONFH） and review its significance in disease diagnosis and treatment selection. Data Sources： A search for eligible studies was conducted in three electronic databases including PubMed, Cochrane Library, and Embase up to August 10, 2018, using the following keywords： ＂osteonecrosis＂, ＂prognosis＂, and ＂treatment＂. Study Selection： Investigations appraising the clinical signs, symptoms, and imaging manifestations in different stages of ONFH were included. Articles evaluating the prognosis of various joint-preserving procedures were also reviewed. Results： The pericollapse stage refers to a continuous period in the development of ONFH from the occurrence of subchondral fracture to early collapse （〈2 mm）, possessing specific imaging features that mainly consist of bone marrow edema and joint effusion on magnetic resonance imaging （MR1）, crescent signs on X-ray films, and clinical manifestations such as the sudden worsening of hip pain. Accumulating evidence has indicated that these findings may be secondary to the changes after subchondral fractures. Of note. computed tomography provides more information for identifying possible subchondral fractures than does MRI and serves as the most sensitive tool for grading the pericollapse lesion stage. The pericollapse stage may indicate a high possibility of progressive disease but also demonstrates satisfactory long- and medium-term outcomes fbr joint-preserving techniques. In tact, if the articular surface subsides more than 2 mm, total hip arthroplasty is preferable. Conclusions： The pericollapse stage with distinct clinical and imaging characteristics provides a last good opportunity for the use of joint-preserving techniques. It is necessary to separate the pericollapse stage as an independent state in evaluating the natural progression of ONFH and selecting an appropriate treatment regimen.

Relationship between adrenal function and prognosis in patients with severe sepsis

Background It is known that the hypothalamic-pituitary-adrenal （HPA） axis is highlighted by stimulation, such as sepsis, trauma, etc, when corticortropin increases and plasma cortisol levels enhance. Relative adrenal insufficiency is not uncommon in critically ill patients and may occur in severe sepsis patients with high plasma cortisol levels. It has been demonstrated that a short corticotropin test has a good prognostic value and is helpful in identifying patients with septic shock at high risk for death, but it has not been established for all severe sepsis patients, especially in China. The aim of this study is to explore the relationship between adrenal function and prognosis in patients with severe sepsis. Methods This prospective study was conducted between July and December 2004 in 6 teaching hospitals. Two hundred and forty patients with severe sepsis were enrolled in this study. A short corticotropin stimulation test was performed in all patients by intravenous injection of 250 pg of corticotropin. Blood samples were taken immediately before the test （TO）, 30 （T30） and 60 （T60） minutes afterward, and the plasma cortisol concentration was measured by radio-immunoassay. At the onset of severe sepsis, the following parameters were recorded： age, sex, Acute Physiology and Chronic Health Evaluation （APACHE） II, heart rate, mean arterial pressure （MAP）, arterial partial pressure of oxygen （PaO2）/fraction of inspired oxygen （FiO2）, peripheral blood of hemoglobin, platelets and leukocyte concentration and the number of organ failure. Patients were designated into two groups （survival and non-survival groups） according to the 28-day mortality. Relative adrenal insufficiency was defined as the difference between TO and the highest value of T30 or T60 （△Tmax） ≤9 μg/dl. Results （1） Two hundred and forty patients with severe sepsis were included in this study, with 134 patients in the survival group and 106 in the non-survival group. The 28-day mortality was 44.2%. （2） Between the survival group and non-survival group age, APACHE II, peripheral blood of platelets, the number of organ failures, TO and ATmax showed significant differences. TO was （23±10） μg/dl and （36＋18） μg/dl in the survival group and nonsurvival group respectively. △Tmax was （18±9） and （10±8） μg/dl in the survival group and non-survival group respectively. The areas under the ROC curve for TO and ATmax were both 0.72, and the area under the ROC curve for APACHE II was 0.70. By multivariate analysis age, TO, the number of organ failures and relative adrenal insufficiency （△Tmax ≤9 μg/dl） were independent predictors of death. （3） The incidence of relative adrenal insufficiency was 38.3% in total, 19.4% in the survival group and 62.3% in the non-survival group （P〈0.001）. The 28-day mortality was 71.7% among the relative adrenal insufficiency patients but 27.0% among normal adrenal function patients. Conclusions The prevalence of relative adrenal insufficiency is high in severe sepsis. Relative adrenal insufficiency has a good prognostic value for severe sepsis.