Effectiveness of acupuncture combined with auricular acupressure in the treatment of postoperative ileus: a study protocol for a randomized controlled trial.

Background: About one-third of patients experience postoperative ileus (POI) after abdominal surgery, which can cause various complications and has not been treated well in clinical practice. The comprehensive treatment offered by traditional Chinese medicine may be a good choice for promoting intestinal mobility. Therefore, the aim of this study protocol is to observe the effectiveness of acupuncture combined with auricular acupressure in decreasing the incidence and related symptoms of POI. Methods: This is a single-center, assessor-blinded, randomized controlled trial. A total of 160 participants are supposed to recruit at Shanghai Tenth People's Hospital and randomly divided into two parallel groups in a 1:1 ratio. The intervention group are planned to receive manual acupuncture combined with auricular acupressure, while the control group are planned to receive regular enhanced recovery after surgery treatment. The primary outcome is the time to first defecation and first flatus after surgery. The secondary outcomes include the length of postoperative hospital stay, intensity of postoperative abdominal pain and distension, severity of postoperative nausea and vomiting, time to tolerate diet, inflammatory index, and incidence of prolonged postoperative ileus. Discussion: The results of this research will provide substantial evidence regarding the efficacy of comprehensive traditional Chinese treatment, specifically auricular acupressure and manual acupuncture, in treating and preventing POI. Trial registration: ClinicalTrials.gov, Identifier: ChiCTR2300075983, registered on September 21, 2023.

Critical bloodstream infection caused by Chromobacterium violaceum: a case report in a 15-year-old male with sepsis-induced cardiogenic shock and purpura fulminans.

Chromobacterium violaceum (C. violaceum) is a gram-negative bacillus that is widespread in tropical and subtropical areas. Although C. violaceum rarely infects humans, it can cause critical illness with a mortality rate above 50%. Here, we report the successful treatment of a 15-year-old male who presented with bloodstream infection of C. violaceum along with sepsis, specific skin lesions, and liver abscesses. Cardiogenic shock induced by sepsis was reversed by venoarterial extracorporeal membrane oxygenation (VA ECMO). Moreover, C. violaceum-related purpura fulminans, which is reported herein for the first time, was ameliorated after treatment. This case report demonstrates the virulence of C. violaceum with the aim of raising clinical awareness of this disease.

The prevalence, disability-adjusted life years, and mortality of hypertensive heart disease and its attributable risk factors: results from the Global Burden Disease study 2019.

Introduction: No survey has evaluated hypertensive heart disease (HHD) burden with statistics from the Risk Factors Study, Injuries, and the Global Burden of Diseases (GBD) 2019. Material and methods: The evaluated annual percentage changes (EAPCs) were obtained to assess the trend in prevalence standardized by age, mortality rates standardized by age, and DALYs standardized by age between 1990 and 2019. We also evaluated the contribution of risk factors to HHD-associated DALYs and mortality. Results: Between 1990 and 2019, the worldwide prevalence rate standardized by age increased (EAPC = 0.17; 95% confidence interval (CI) 0.15 to 0.18), but the death rate standardized by age (EAPC = -0.74; 95% CI: -0.91 to -0.57) and DALYs standardized by age rate decreased (EAPC = -1.02; 95% CI: -1.18 to -0.86). The prevalence rate of HHD standardized by age increased the most in the high-middle areas of SDI (EAPC = 0.43). The biggest increases in the prevalence rate standardized by age were in Andean Latin America (EAPC = 0.43), Western Sub-Saharan Africa (EAPC = 0.30), and the Middle East and North Africa (EAPC = 0.24). The largest decrease in mortality that could be attributed to rate and DALYs in both sexes between 1990 and 2019 was consistent with a high BMI. Conclusion: The worldwide prevalence rate standardized by age increased during 1990-2019, especially in Andean Latin America, North Africa, the Middle East, and Western Sub-Saharan Africa. Future HHD prevention tactics should be focused on males, high-risk areas, and control of high BMI.

A deep reinforcement learning-based wireless body area network offloading optimization strategy for healthcare services.

Wireless body area network (WBAN) is widely adopted in healthcare services, providing remote real-time and continuous healthcare monitoring. With the massive increase of detective sensor data, WBAN is largely restricted by limited storage and computation capacity, resulting in severely decreased efficiency and reliability. Mobile edge computing (MEC) technique can be combined with WBAN to resolve this issue. This paper studies the joint optimization problem of computational offloading and resource allocation (JCORA) in MEC for healthcare service scenarios. We formulate JCORA as a Markov decision process and propose a deep deterministic policy gradient-based WBAN offloading strategy (DDPG-WOS) to optimize time delay and energy consumption in interfered transmission channels. This scheme employs MEC to mitigate the computation pressure on a single WBAN and increase the transmission ability. Further, DDPG-WOS optimizes the offloading strategy-making process by considering the channel condition, transmission quality, computation ability and energy consumption. Simulation results verify the effectiveness of the proposed optimization schema in reducing energy consumption and computation latency and increasing the utility of WBAN compared to two competitive solutions.

Case report of Salmonella derby septicemia complicated with co-occurrence of disseminated intravascular coagulation and thrombotic microangiopathy.

BACKGROUND: Both disseminated intravascular coagulation and thrombotic microangiopathy are complications of sepsis as Salmonella septicemia, respectively. They are related and have similar clinical characteristics as thrombopenia and organ dysfunctions. They rarely co-occur in some specific cases, which requires a clear distinction. CASE PRESENTATION: A 22-year-old woman had just undergone intracranial surgery and suffered from Salmonella derby septicemia with multiorgan involvement in the hospital. Laboratory workup demonstrated coagulation disorder, hemolytic anemia, thrombocytopenia, and acute kidney injury, leading to the co-occurrence of disseminated intravascular coagulation and secondary thrombotic microangiopathy. She received antibiotics, plasma exchange therapy, dialysis, mechanical ventilation, fluids, and vasopressors and gained full recovery without complications. CONCLUSION: Disseminated intravascular coagulation and secondary thrombotic microangiopathy can co-occur in Salmonella derby septicemia. They should be treated cautiously in diagnosis and differential diagnosis. Thrombotic microangiopathy should not be missed just because of the diagnosis of disseminated intravascular coagulation. Proper and timely identification of thrombotic microangiopathy with a diagnostic algorithm is essential for appropriate treatment and better outcomes.

The risk factors of type 2 diabetes in hypertensive subjects.

Objective: Hypertension (HTN) and type 2 diabetes (T2DM) share common risk factors and usually co-occur. This study examined the relationship between HTN history and T2DM incidence in a cohort of Chinese hypertensive subjects. Methods: We recruited 443 cases (T2DM and HTN) and 443 sex- and age-matched controls (HTN). The history of peak systolic blood pressure (SBP) was divided into 140-159, 160-179, and ≥ 180 mmHg, and that of peak diastolic blood pressure (DBP) was divided into 90-99, 100-109, and ≥ 110 mmHg. Multiple binary logistic regression models were used to explore the association between controlled HTN status and T2DM. Results: Creatinine concentrations were higher in the cases than in the controls (P < 0.05). The HTN duration was longer in the cases than in the controls (14.7 years vs. 13.2 years; P < 0.05). Significant differences were also found in the history of peak SBP and DBP between the cases and controls (both P < 0.05). Creatinine, HTN duration, and family history of T2DM were risk factors for T2DM in hypertensive subjects, with odds ratios (95% confidence intervals) of 1.013 (1.004-1.022), 1.025 (1.003-1.047), and 5.119 (3.266-8.026), respectively. Compared with the lowest level of peak DBP, the odds ratio for T2DM at the highest level of peak DBP was 1.757 (1.074-2.969). Subgroups analyses showed that the effect of the history of peak DBP on T2DM was significantly modified by sex (P-interaction = 0.037). Conclusion: The highest DBP and the longest HTN duration were both independently associated with T2DM in hypertensive subjects.

Metformin protects against insulin resistance induced by high uric acid in cardiomyocytes via AMPK signalling pathways in vitro and in vivo.

High uric acid (HUA) is associated with insulin resistance (IR) in cardiomyocytes. We investigated whether metformin protects against HUA-induced IR in cardiomyocytes. We exposed primary cardiomyocytes to HUA, and cellular glucose uptake was quantified by measuring the uptake of 2-NBDG, a fluorescent glucose analog. Western blot was used to examine the levels of signalling protein. Membrane of glucose transporter type 4 (GLUT4) was analysed by immunofluorescence. We monitored the impact of metformin on HUA-induced IR and in myocardial tissue of an acute hyperuricaemia mouse model established by potassium oxonate treatment. Treatment with metformin protected against HUA-reduced glucose uptake induced by insulin in cardiomyocytes. HUA directly inhibited the phosphorylation of Akt and the translocation of GLUT4 induced by insulin, which was blocked by metformin. Metformin promoted phosphorylation of AMP-activated protein kinase (AMPK) and restored the insulin-stimulated glucose uptake in HUA-induced IR cardiomyocytes. As a result of these effects, in a mouse model of acute hyperuricaemia, metformin improved insulin tolerance and glucose tolerance, accompanied by increased AMPK phosphorylation, Akt phosphorylation and translocation of GLUT4 in myocardial tissues. As expected, AICAR, another AMPK activator, had similar effects to metformin, demonstrating the important role of AMPK activation in protecting against IR induced by HUA in cardiomyocytes. Metformin protects against IR induced by HUA in cardiomyocytes and improves insulin tolerance and glucose tolerance in an acute hyperuricaemic mouse model, along with the activation of AMPK. Consequently, metformin may be an important potential new treatment strategy for hyperuricaemia-related cardiovascular disease.

High Uric Acid Inhibits Cardiomyocyte Viability Through the ERK/P38 Pathway via Oxidative Stress.

BACKGROUND/AIMS: Clinical studies have shown that hyperuricaemia is strongly associated with cardiovascular disease. However, the molecular mechanisms of high uric acid (HUA) associated with cardiovascular disease remain poorly understood. In this study, we investigated the effect of HUA on cardiomyocytes. METHODS: We exposed H9c2 cardiomyocytes to HUA, then cell viability was determined by MTT assay, and reactive oxygen species' (ROS) production was detected by a fluorescence assay. Western blot analysis was used to examine phosphorylation of extracellular signal-regulated kinase (ERK), p38, phosphatidylinositol 3-kinase (PI3K) and Akt. We monitored the impact of HUA on phospho-ERK and phospho-p38 levels in myocardial tissue from an acute hyperuricaemia mouse model established by potassium oxonate treatment. RESULTS: HUA decreased cardiomyocyte viability and increased ROS production in cardiomyocytes; pre-treatment with N-acetyl-L-cysteine, a ROS scavenger, and PD98059, an ERK inhibitor, reversed HUA-inhibited viability of cardiomyocytes. Further examination of signal transduction pathways revealed HUA-induced ROS involved in activating ERK/P38 and inhibiting PI3K/Akt in cardiomyocytes. Furthermore, the acute hyperuricaemic mouse model showed an increased phospho-ERK/p38 level in myocardial tissues. CONCLUSION: HUA induced oxidative damage and inhibited the viability of cardiomyocytes by activating ERK/p38 signalling, for a novel potential mechanism of hyperuricaemic-related cardiovascular disease.

Chitooligosaccharides promote radiosensitivity in colon cancer line SW480.

AIM: To investigate the anti-proliferation and radiosensitization effect of chitooligosaccharides (COS) on human colon cancer cell line SW480. METHODS: SW480 cells were treated with 0, 1.0, 2.0, 3.0, 4.0 and 5.0 mg/mL of COS for 48 h. CCK-8 assay was employed to obtain the cell survival ratio of SW480 cells, and the anti-proliferation curve was observed with the inhibition ratio of COS on SW480 cells. The RAY + COS group was treated with 1.0 mg/mL of COS for 48 h, while both the RAY and RAY+COS groups were exposed to X-ray at 0, 1, 2, 4, 6 and 8 Gy, respectively. Clonogenic assay was used to analyze cell viability in the two groups at 10 d after treatment, and a cell survival curve was used to analyze the sensitization ratio of COS. The RAY group was exposed to X-ray at 6 Gy, while the RAY+COS group was treated with 1.0 mg/mL of COS for 48 h in advance and exposed to X-ray at 6 Gy. Flow cytometry was employed to detect cell cycle and apoptosis rate in the non-treatment group, as well as in the RAY and RAY + COS groups after 24 h of treatment. RESULTS: COS inhibited the proliferation of SW480 cells, and the inhibition rate positively correlated with the concentration of COS (P < 0.01). Cell viability decreased as radiation dose increased in the RAY and RAY+COS groups (P < 0.01). Cell viabilities in the RAY+COS group were lower than in the RAY group at all doses of X-ray exposure (P < 0.01), and the sensitization ratio of COS on SW480 cells was 1.39. Compared with the non-treatment group, there was a significant increase in apoptosis rate in both the RAY and RAY + COS groups; while the apoptosis rate in the RAY+COS group was significantly higher than in the RAY group (P < 0.01). In comparing these three groups, the percentage of G2/M phase in both the RAY and RAY + COS groups significantly increased, and the percentage of the S phase and G0/G1 phase was downregulated. Furthermore, the percentage in the G2/M phase was higher, and the percentage in the S phase and G0/G1 phase was lower in the RAY + COS group vs RAY group (P < 0.01). CONCLUSION: COS can inhibit the proliferation of SW480 cells and enhance the radiosensitization of SW480 cells, inducing apoptosis and G2/M phase arrest.

Anti-proliferation effect of zoledronic acid on human colon cancer line SW480.

OBJECTIVE: To investigate the anti-proliferation effect and mechanism of zoledronic acid (ZOL) on human colon cancer line SW480. METHODS: SW480 cells were treated with 0, 12.5, 25, 50, 100 and 200 µmoL/L of ZOL for 48 h, and CCK-8 assay was employed to obtain the survival rate of SW480 cells. SW480 cells were treated with 25 µmoL/L of ZOL for 0, 12, 24, 48 and 72 h, and then the survival rate was obtained. SW480 cells of the ZOL group were treated with 25 µmoL/L of ZOL for 48 h, while cells of the CsA + ZOL group were pretreated with 10 µmoL/L of CsA for 0.5 h and then treated with 25 µmoL/L of ZOL for 48 h. Then the survival rates of SW480 cells of the control group, ZOL group and CsA + ZOL group were determined. Flow cytometry was employed to detect the apoptosis rate and the mitochondrial transmembrane potential (△Ψm) of the three groups and Western blot was used to detect the expressions of cyt C in the cytosol of the three groups. RESULTS: ZOL inhibited the proliferation of SW480 cells, and the inhibition rate positively correlated with the concentration of ZOL and the action time (P < 0.01). The cell survival rate and the △Ψm of the ZOL group were greatly lower than those of the control group, while the apoptosis rate and the expression of cyt C in the cytosol were obviously higher than those of the control group. All the differences showed distinctly statistical significances (P < 0.01). The cell survival rate and the △Ψm of the CsA + ZOL group were all lower than those of the control group, but substantially higher than those of the ZOL group; while the apoptosis rate and the expression of cyt C in the cytosol were higher than those of the control group, but distinctly lower than those of the ZOL group. All the differences were statistically significant (P < 0.01). CONCLUSIONS: ZOL can induce the apoptosis in human colon cancer line SW480 and then inhibit the proliferation of SW480 cells directly by opening the mitochondrial permeability transition pore abnormally, decreasing △Ψm, and releasing the cyt C into the cytosol. And the effect enhances with the increases of the concentration of ZOL and the action time.