Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial.

BACKGROUND: Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief. OBJECTIVE: This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room. OUTCOMES AND MEASURES: Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy. RESULTS: The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy. CONCLUSION: Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; 21(2): 168-175.

[Estimation on the HIV-1 incidence among high risk groups using the pooling RNA technique].

OBJECTIVE: To timely identify the HIV-1 infection in window-period and to estimate the HIV-1 incidence among people who came for voluntary counseling and testing (VCT) service as well as men who have sex with men (MSM), respectively. METHODS: HIV antibody negative samples that were determined by screening tests between January and October 2012, were collected and tested with pooling HIV-1 RNA testing technique (2-staged pooling by 50:1, 10:1). Positive cases were followed-up for HIV antibody testing while HIV incidence was calculated under Ron Brookmeyer' s method, among VCT and MSM populations. RESULTS: Among 1400 HIV antibody negative samples of VCT, two showed HIV-1 RNA positive during the antibody window period with the HIV-1 incidence as 1.87% per year (95% CI: 1.23%-2.65% ). Among 500 HIV antibody negative samples from MSM population, two showed HIV-1 RNA positive in the antibody window period, with HIV-1 incidence as 5.31% per year (95% CI: 3.52%-7.45% ). CONCLUSION: Pooling HIV-1 RNA testing seemed a powerful tool for HIV antibody testing in the window-period. Measures should be taken to strengthen the HIV diagnostic programs among MSM and other high risk groups,during the HIV antibody window-period. More frequent detection approach as pooling HIV-1 RNA testing might be a good choice.

[Evaluation of PIMA analyzer detecting CD4 cell count of venous and capillary blood in HIV-infected individuals].

OBJECTIVE: This study is aimed at evaluating the utility of the portable CD4 analyzers (PIMA). METHODS: The paired finger prick blood (25 µl) and 5 ml venous blood samples were collected from 196 HIV infected patients, who came to Yunnan CDC voluntary counseling and testing (VCT) clinic for CD4 test services, from May to August, 2012. The absolute CD4 cell counts were measured by PIMA (using venous and finger-prick blood) and by Calibur (using venous blood) as the reference. The PIMA and Calibur CD4 results were compared using the Wilcoxon matched-pairs test, and the Spearman's rank correlation coefficients were estimated. The Bland-Altman plots were used to assess the consistency of the two methods. RESULTS: The median absolute CD4 counts of 196 venous blood samples obtained by PIMA and by Calibur were 268 (range:169-403) cells/µl and 302 (range:181-474) cells/µl respectively, which showed significant difference (Z = -7.31, P < 0.01). The median absolute CD4 counts measured by PIMA and by Calibur (using 188 finger-prick and venous blood samples respectively) were 271 (range: 165-450) cells/µl and 304 (range:188-476) cells/µl, which also showed significant difference (Z = -7.60, P < 0.01). The CD4 counts obtained by PIMA CD4 analyzer (using venous and finger-prick blood) showed strong positive correlation with the CD4 counts obtained by the reference method (using venous blood), and the r values were 0.94 and 0.92 respectively (P < 0.01) . The mean biases (limit of agreement) were -38.7 (-210.9-133.5)cells/µl and -45.4 (-221.8-131.0) cells/µl, respectively.Using 350 CD4 counts as the threshold for ART treatment initiation, the sensitivity and specificity of PIMA were 99.1% and 79.3% for venous blood samples, and 97.2%and 78.5% for finger-prick blood samples, respectively. CONCLUSION: The CD4 counts obtained by PIMA are lower than that obtained by Calibur, while the sensitivity is high.

[Early detection of HIV infection with Dried Blood Spot testing among infants in Yunnan province].

OBJECTIVE: To explore the application of Dried Blood Spot (DBS) testing for early detection of HIV infection among infants. METHODS: All of the infants aged between 6 weeks and 18 months and born by HIV positive mothers from 14 Maternity and Child Health Care Hospitals in Kunming, Dali, Dehong, Lincang of Yunnan province were investigated from 2010 to 2011. By using DBS and Roche HIV-1 DNA test techniques, 286 infants were tested for HIV early diagnosis and compared with HIV antibody results of 18 months infants. DBS from uninfected infants were taken periodically and screened of HIV antibody to find their time of antibody-disappearing. The information of treatment for pregnant women and feeding methods for infants was also investigated. RESULTS: A total of 286 infants were tested with HIV-1 DNA among which 148 infants were male and 138 infants female, and 8 infants were HIV-1 DNA positive and the infection rate was 2.8% (8/286) that was in accord with their antibodies results in 18 months old; the other 278 infants whose HIV-1 DNA was negative was also negative with their antibodies. By following up the antibody test of 143 HIV negative infants the cumulate rates of antibody-disappearing at the age of 6, 9, 12 and 18 months were 14.0% (20/143), 61.5% (88/143), 88.1% (126/143) and 100.0% (143/143), respectively. Among 286 HIV positive pregnant women, the group with anti-viral treatment had a lower rate of HIV infection with their infants that was 2.14% (6/280) while the group without anti-viral treatment had a high rate of HIV infection with their infants that was 33.33% (2/6). There was significantly different in the rates of two groups (P < 0.01). The HIV infection rate of infants fed with milk powder was 2.55% (7/274) and the rate was 8.33% (1/12) with breast milk. CONCLUSION: The HIV-1 DNA detection techniques with DBS sample was effective for the early diagnosis of HIV in infants from 6 weeks to 18 months.

[Survey on the transmission of HIV drug resistance in Kunming, Yunnan province in 2010].

OBJECTIVE: To study the HIV drug resistance (HIVDR) transmission in Kunming city of Yunnan province in 2010. METHODS: Referring to the guidelines for HIV drug resistance threshold survey (HIVDR-TS) set by WHO, 62 plasma samples of recently reported HIV-infected individuals who were older than 25 years of age, were collected from January to August 2010. Genotyping of pol genetic mutations associated with HIVDR with reverse transcriptional PCR was performed and the prevalence of HIV-1 drug resistance transmission was evaluated. RESULTS: Of the 62 plasma samples, 54 were successfully sequenced and genotyped on pol sequence. Based on the pol sequences, HIV subtypes including CRF08_BC (53.2%), CRF07_BC (25.5%), CRF01_AE (19.1%) and C (2.1%) were identified. According to the time of sampling, the first 47 sequenced samples were used for drug resistance prevalence analysis. A protease inhibitor (PI) relative mutation was found in one sample. Based on the WHO standard, the prevalence of transmitted HIV-1 drug resistance was < 5%. CONCLUSION: HIV-1 drug resistant strains transmission was still catalogued as low prevalence level in Kunming. To prevent the increase of HIVDR prevalence, normative treatment and scientific management to AIDS patients seemed to be quite important.

[Distribution of HIV-1 subtypes among different populations in Dehong prefecture, Yunnan province, in 2011].

OBJECTIVE: To investigate the distribution of HIV-1 subtypes in Dehong prefecture, Yunnan province, in 2011. METHODS: 300 HIV-1 positive plasma samples were collected from Jan. 2011 to May 2011 in Dehong prefecture. HIV-1 gag genes and env genes were amplified by nested-polymerase chain reaction (PCR) from viral RNA. After sequencing, the HIV-1 subtypes were determined by phylogenetic analysis. RESULTS: Based on the phylogenetic trees of gag gene and env gene fragments, a total of 222 samples were genotyped. Subtype C was the predominant strain in Dehong (43.2%, 96/222), followed by unique recombinant forms (URFs, 27.0%, 60/222), CRF01_AE (21.2%, 47/222), CRF08_BC (5.0%, 11/222), B' (2.3%, 5/222) and CRF07_BC (1.4%, 3/222). Subtype C strains were predominant in both heterosexually transmitted population and intravenous drug users (IDUs), but different subtype distribution patterns were found in these two populations. All 6 genotypes including subtype C (40.7%, 70/172), CRF01_AE (25.0%, 43/172), and URFs (25.0%, 43/172) found in this area among heterosexually transmitted population, which showed the diversity of genotypes in this population. Except subtype B' and CRF07_BC, the other 3 subtypes and URFs were detected among IDUs, mainly including subtype C (54.8%, 23/42) and URFs (38.1%, 16/42), which showed the concentration trend of genotypes distribution among IDUs. The proportion of URFs increased significantly in this area, including the new BC recombinants (41.7%, 25/60) and CRF01_AE relative URFs (58.3%, 35/60). However, the distributions of these two URFs among heterosexually transmitted population and IDUs showed no statistical significance. CONCLUSION: The distribution of HIV-1 strains prevailing in Dehong prefecture was diversity, including 5 subtypes and a variety of URFs, of which subtype C was the predominant strain. The distribution patterns of subtype were different among different populations.

[Phylogeny analysis and identification of two bacterial strains sourcing from human intestine and having resistance to acid and bile].

OBJECTIVE: To screen bacteria for the engineering bacteria expressing and secreting high activity beta-galactosidase, and two bacterial strains called as R92-2 and R111 with acid and bile resistances would be isolated from health human intestine to strain identification and phylogenetic analysis. METHODS: These two strains were first been identified with phenotype characteristic analysis. Then the 16S rDNAs of these two bacterial strains were amplified and sequenced with the primers designed by the conserve sequences. DNA sequences were blasted against GenBank, and the phylogenetic trees were constructed. RESULTS: Phenotype characteristic analysis showed that both of the bacterial strains belonged to lactic acid bacteria. Results of Blastn showed that 16S rDNAs of R92-2 and Weissella cibaria had 100% homology; 16S rDNAs of R111 and Enterococcus faecium had 100% homology too. CONCLUSION: R92-2 belongs to Weissella cibaria strain; R111 belongs to Enterococcus faecium strain. These two stains may be used to construct the engineering bacteria expressing and secreting high activity beta-galactosidase.

[A dynamic analysis on incidence and trend of HIV-1 epidemics among intravenous drug users, attendants at the STD clinics and pregnant women in Yunnan province, China].

OBJECTIVE: BED-CEIA assay was used in HIV/AIDS surveillance sentinel sites to identify recent HIV-1 infection, to estimate HIV-1 incidence and to understand the epidemic trends in Yunnan province. METHODS: Serum specimens were collected from IDUs in sentinel sites, attendants in STD clinics and pregnant women under a cross sectional study from 2000 to 2007. Specimens confirmed as HIV-1 positive were tested with BED-CEIA to find recent HIV-1 infection, then the annual HIV-1 incidence for each group was calculated and the trends of HIV-1 incidence observed. RESULTS: 144 780 serum specimens were collected and 4932 of them were confirmed as HIV-1 positive. 4678 positive specimens were tested with BED-CEIA and 723 ont of them were identified as recent infections. Specimens from the two years were combined for testing. The average HIV-1 prevalence among IDUs was 18.2% - 26.9% from 2000 to 2007 and the annual incidence were 14.65%, 6.21%, 4.06%, 2.23% respectively. The average HIV-1 prevalence among attendants in STD clinics was 1.6% - 3.2% and the annual incidence rates were 1.46%, 0.76%, 0.52%, 0.33% respectively. The average HIV-1 prevalence among pregnant women was 0.2% - 0.5% and the annual incidence rates were 0.16%, 0.11%, 0.10%, 0.09% respectively. CONCLUSION: HIV-1 incidence rates among IDUs, STDs and pregnant women showed a steady decrease.

[The analysis of human immunodeficiency virus-1 subtypes in Yunnan province].

OBJECTIVE: To analyze the geographical distribution and risk factors of HIV-1 subtypes in Yunnan province. METHODS: Blood samples from 1319 HIV positives were collected in Yunnan Province from 2001 to 2006. The nested polymerase chain reaction was used to amplify the gag (p24)-protease fragments from RNA extracted from plasma or sera. The sequences were used for subtype determination by phylogenetic tree analysis. RESULTS: Among 1319 samples studied, the subtypes has been successfully obtained from 644 samples that were constituted of seven subtypes: CRF08_BC, CRF07_BC, CRF07/08_BC, CRF01_AE, C, B' and URFB/C. C/CRF07_BC/CRF08_BC were distributed in the whole province, but CRF01_AE were mainly distributed in the boarding areas with Myanmar such as Dehong, Baoshan, Xishuangbanna and Puer. Moreover, injecting drugs users accounted for 61.6% (270/438) among C/CRF07_BC/CRF08_BC infections, while only 8.5% (15/177) among CRF01_AE infections. CONCLUSION: Our data indicated that at least seven subtypes were identified in Yunnan province, the relationship between subtypes and transmission routes were analyzed, and the geographic difference of subtypes was also observed.