Effect of Tongluo Juanbi Granules on Inflammatory Injury and Apoptosis of Osteoarthritis Based on TLR4/MyD88/NF-κB Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the effects of Tongluo Juanbi granules on chondrocyte apoptosis and Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor-κB （NF-κB） signaling pathway of rabbits with knee osteoarthritis （KOA） and study the mechanism of Tongluo Juanbi granules in the prevention and treatment of KOA. MethodThirty New Zealand rabbits were randomly assigned to the following five groups （n=6）： sham group， model group， low-dose and high-dose groups of Tongluo Juanbi granules （4.1 and 8.2 g·kg-1·d-1）， and celecoxib group （10.9 mg·kg-1·d-1）. The KOA model was established by destabilization of the medial meniscus （DMM） for six weeks. Six weeks after the modeling， the drug was given once a day for eight weeks. The pathological changes of cartilago articularis were observed by hematoxylin-eosin （HE） staining and Safranin O-Fast Green staining. Terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） staining was performed to detect chondrocyte apoptosis. Enzyme-linked immunosorbent assay （ELISA） was used to detect the contents of interleukin-1β （IL-1β） and tumor necrosis factor-α （TNF-α） in synovial fluid. The mRNA and protein expression levels of genes related to the TLR4/MyD88/NF-κB signaling pathway were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultCompared with the sham group， the cartilago articularis of the model group significantly degenerated. Mankin's score was increased （P<0.01）， and the contents of IL-1β and TNF-α in synovial fluid were increased （P<0.01）. The number of apoptosis of chondrocytes was increased （P<0.01）. The mRNA and protein expressions of TLR4， MyD88， and NF-κB p65 in cartilage tissue were up-regulated （P<0.01）， while the mRNA and protein expressions of Bcl-2 were down-regulated （P<0.01）. Compared with the model group， chondrocyte degeneration in both low-dose and high-dose groups of Tongluo Juanbi granules was improved， and Mankin's score was decreased （P<0.01）. The contents of IL-1β and TNF-α were decreased （P<0.01）， and the number of apoptosis of chondrocytes was decreased （P<0.01）. The mRNA and protein expressions of TLR4， MyD88， and NF-κB p65 in cartilage tissue were down-regulated （P<0.01）， while the mRNA and protein expressions of Bcl-2 were up-regulated （P<0.01）. In addition， in the above observation indicators， the high-dose group of Tongluo Juanbi granules was significantly superior to the low-dose group of Tongluo Juanbi granules. ConclusionTongluo Juanbi granules could inhibit chondrocyte apoptosis in rabbits with KOA and improve cartilage degeneration， which may be related to inhibiting inflammatory responses mediated by TLR4/MyD88/NF-κB signaling pathway.

Mental health conditions and unsafe driving behaviors: A naturalistic driving study on ADHD and depression.

INTRODUCTION: Road injuries remain a persistent public health concern across the world. The task of driving is complicated by mental health conditions, which may affect drivers' executive functioning and cognitive resource allocation. This study examines whether attention-deficit/hyperactivity disorder (ADHD) and depression are associated with unsafe driving behaviors. METHOD: Generalized linear mixed models were employed to estimate the association of self-reported ADHD and depression with 18 unsafe driving behavior types found prior to at-fault crashes and near-crashes using a large-scale naturalistic driving dataset. Driver demographics, cognitive traits, environmental factors, and driver random effects were included to reduce confounding and biases. RESULTS: Controlling for other covariates, people with self-reported ADHD were more likely to have performed improper braking or stopping (OR = 4.89, 95% CI 1.82-13.17) prior to an at-fault crash or near-crash, while those with self-reported depression did not have a significant association with any unsafe driving behavior. CONCLUSIONS: After accounting for demographic, cognitive, and environmental covariates, individuals with ADHD and depression were not prone to purposefully aggressive or reckless driving. Instead, drivers with self-reported ADHD may unintentionally execute unsafe driving behaviors in particular driving scenarios that require a high level of cognitive judgment. PRACTICAL APPLICATIONS: These findings can inform the curriculum design of driver's education programs that help learners with mental health conditions gain practice in certain road scenarios, for example, more practice on preemptively reducing speed instead of making sudden brakes and smooth turning on curved roads for students with ADHD. Furthermore, specific advanced driver assistance systems may prove particularly helpful for drivers with ADHD, such as detection of leading objects and curve speed warning.

How are different sources of distraction associated with at-fault crashes among drivers of different age gender groups?

INTRODUCTION: Distracted driving has been well researched, however the comparison between different age-gender groups on the impact of distracted driving has not been explored. Most crash analysis research does not distinguish driver responsibility, so the role that distractions has in at-fault crashes is unknown. Without distinguishing at-fault crashes from all-cause crashes, distracted driving's detrimental effects could be underestimated. OBJECTIVE: This study aims to systematically assess the risk of at-fault crashes associated with different sources of distraction among six groups by driver age (Teens 16-19, Adults 20-64, Seniors 65+) and gender. METHODS: Crashes where a study participant was deemed at fault were identified using human expert annotated variables from the Strategic Highway Research Program 2 (SHRP2) Naturalistic Driving Study dataset. Generalized linear mixed models were performed to assess the adjusted odds ratios of 10 distraction types associated with the at-fault crashes while controlling for environmental factors. RESULTS: The main findings are (1) The highest contributing distraction types in at-fault crashes were In-Cabin Objects, Mobile Device, External Scenes, and In-Vehicle Information Systems (IVIS) as indicated by their influence on multiple age-gender groups and the magnitude of odds ratios; (2) Teens and adults were more distraction-prone than seniors, although seniors had the greatest at-fault crash risks associated with In-Cabin Objects, Mobile Device, and IVIS; (3) Distractions impacted females and males similarly; (4) At-fault crashes were more likely to have the significant distraction types present than all-cause crashes. CONCLUSION: This study adds to the limited literature on at-fault crashes particularly as it explores the role of driver demographics and distracted driving. Analyzing the risks of distracted driving by age-gender group shows that specific activities can be riskier for a certain population. The effects of distractions may be overlooked without fault determination. Distractions by external scenes, in-vehicle technologies, and in-cabin objects should not be overlooked, in addition to mobile device use.

Determining the risk of driver-at-fault events associated with common distraction types using naturalistic driving data.

INTRODUCTION: Studies thus far have focused on automobile accidents that involve driver distraction. However, it is hard to discern whether distraction played a role if fault designation is missing because an accident could be caused by an unexpected external event over which the driver has no control. This study seeks to determine the effect of distraction in driver-at-fault events. METHOD: Two generalized linear mixed models, one with at-fault safety critical events (SCE) and the other with all-cause SCEs as the outcomes, were developed to compare the odds associated with common distraction types using data from the SHRP2 naturalistic driving study. RESULTS: Adjusting for environment and driver variation, 6 of 10 common distraction types significantly increased the risk of at-fault SCEs by 20-1330%. The three most hazardous sources of distraction were handling in-cabin objects (OR = 14.3), mobile device use (OR = 2.4), and external distraction (OR = 1.8). Mobile device use and external distraction were also among the most commonly occurring distraction types (10.1% and 11.0%, respectively). CONCLUSIONS: Focusing on at-fault events improves our understanding of the role of distraction in potentially avoidable automobile accidents. The in-cabin distraction that requires eye-hand coordination presents the most danger to drivers' ability in maintaining fault-free, safe driving. Practical Applications: The high risk of at-fault SCEs associated with in-cabin distraction should motivate the smart design of the interior and in-vehicle information system that requires less visual attention and manual effort.

The Exchange of Informational Support in Online Health Communities at the Onset of the COVID-19 Pandemic: Content Analysis.

BACKGROUND: Online health communities (OHCs) provide social support for ongoing health-related problems. COVID-19, the disease caused by SARS-CoV-2, has been an acute and substantial stressor worldwide. The disease and its impact, especially in the beginning phases, left many people with questions about the nature, treatment, and prevention of COVID-19. Unlike typical chronic ailments discussed on OHCs, which are more established, COVID-19, at least at the onset of the pandemic, is distinct in that it lacks a consensus of clinical diagnosis and an existing community foundation. OBJECTIVE: The study aims to investigate a newly formed OHC for COVID-19 to determine the topics and types of information exchange as well as the sources of information this community referenced during the early phases of the COVID-19 pandemic in the United States. METHODS: A total of 357 posts from a COVID-19 OHC on the MedHelp platform were annotated according to an open-coding process. Participants' engagement patterns, topics of posts, and sources of information were quantified. RESULTS: Participants who offered informational support had a significantly higher percentage of responding more than once than those seeking information (P<.001). Among the information-seeking topics, symptoms and public health practice and psychological impacts were the most frequently discussed, with 26% (17/65) and 15% (10/65) of posts, respectively. Most informational support was expressed through feedback/opinion (181/220, 82.3%). Additionally, the most frequently referenced source of information was news outlets/websites, at 55% (11/20). Governmental websites were referenced less frequently. CONCLUSIONS: The trends of this community could be useful in prioritizing public health responses to address the most common questions asked by the public during crisis communication and in identifying which venue of communication is most effective in reaching a public audience during such times.

The Efficacy of Plant-Based Ionizers in Removing Aerosol for COVID-19 Mitigation.

Small-sized droplets/aerosol transmission is one of the factors responsible for the spread of COVID-19, in addition to large droplets and surface contamination (fomites). While large droplets and surface contamination can be relatively easier to deal with (i.e., using mask and proper hygiene measures), aerosol presents a different challenge due to their ability to remain airborne for a long time. This calls for mitigation solutions that can rapidly eliminate the airborne aerosol. Pre-COVID-19, air ionizers have been touted as effective tools to eliminate small particulates. In this work, we sought to evaluate the efficacy of a novel plant-based ionizer in eliminating aerosol. It was found that factors such as the ion concentration, humidity, and ventilation can drastically affect the efficacy of aerosol removal. The aerosol removal rate was quantified in terms of ACH (air changes per hour) and CADR- (clean air delivery rate-) equivalent unit, with ACH as high as 12 and CADR as high as 141 ft3/minute being achieved by a plant-based ionizer in a small isolated room. This work provides an important and timely guidance on the effective deployment of ionizers in minimizing the risk of COVID-19 spread via airborne aerosol, especially in a poorly-ventilated environment.

Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts.

BACKGROUND: The current opioid crisis in the United States impacts broad population groups, including pregnant women. Opioid use during pregnancy can affect the health and wellness of both mothers and their infants. Understanding women's efforts to self-manage opioid use or misuse in pregnancy is needed to identify intervention points for improving maternal outcomes. OBJECTIVE: This study aims to identify the characteristics of women in an online health community (OHC) with opioid use or misuse during pregnancy and the self-management support needs of these mothers. METHODS: A total of 200 web posts by pregnant women with opioid use participating in an OHC were double coded. Concepts and their thematic connections were identified through an inductive process until theoretical saturation was reached. Statistical tests were performed to identify patterns. RESULTS: The majority of pregnant women (150/200, 75.0%) in the OHC exhibited signs of misuse, and 62.5% (125/200) of the participants were either contemplating or pursuing dosage reduction. Self-managed withdrawal was more common (P<.001) than professional treatment among the population. A total of 5 themes of self-management support needs were identified as women sought information about the potential adverse effects of gestational opioid use, protocols for self-managed withdrawal, pain management safety during pregnancy, hospital policies and legal procedures related to child protection, and strategies for navigating offline support systems. In addition, 58.5% (117/200) of the pregnant women expressed negative emotions, of whom only 10.2% (12/117) sought to address their emotional needs with the help of the OHC. CONCLUSIONS: OHCs provide vital self-management support for pregnant women with opioid use or misuse. Women pursuing self-managed dosage reduction are prone to misinformation and repeated relapses, which can result in extreme measures to avoid testing positive for drug use at labor. The study findings provide evidence for public policy considerations, including universal screening of substance use for pregnant women, emphasis on treatment rather than legal punishment, and further expansion of the Drug Addiction Treatment Act waiver training program. The improvement of web-based platforms that can organize geo-relevant information, dispense clinically validated withdrawal schedules, and offer structured peer support is envisioned for harm reduction among pregnant women who opt for self-management of opioid misuse.

Connectedness Based on Shared Engagement Predicts Remote Biochemically Verified Quit Status Within Smoking Cessation Treatment Groups on Facebook.

INTRODUCTION: Engagement with online content and online social network integration are associated with smoking behavior change, but less is known about social dynamics of shared engagement between participants in group-based social media interventions. METHODS: Participants were 251 young adult smokers aged 18 to 25 assigned to one of 29 secret Facebook groups tailored to their readiness to quit smoking ("pre-contemplation," "contemplation," and "preparation"). Groups varied in size and were randomly assigned to receive monetary incentives for engagement. All groups received daily posts for 90 days and were assessed for remote biochemically verified smoking abstinence at the end of the intervention. Across 29 groups, we examined associations between group features (group size, incentive condition, readiness to quit) with how connected members were within the group based on shared engagement with the same content (measured by density). At the individual level, we examined associations between 7-day biochemically verified smoking abstinence and how connected an individual was within the group (measured by degree centrality). RESULTS: After adjusting for comment volume, being in a contemplation group (vs. pre-contemplation group) was associated with a decrease in comment-based density. Individual degree centrality was significantly associated with biochemically verified smoking abstinence for both comments and likes. CONCLUSIONS: Future group-based social media interventions for smoking cessation may want to focus on promoting connected engagement between participants, rather than simply quantity of engagement. IMPLICATIONS: Participants in a smoking cessation intervention delivered through Facebook groups were more likely to have biochemically verified smoking abstinence if they were more connected to the rest of the group via shared engagement. Promoting shared engagement between participants may be more likely to promote behavior change than volume of engagement alone.

Imputation of Missing Data in Electronic Health Records Based on Patients' Similarities.

Using electronic health records (EHR) as the source of data for mining and analysis of different health conditions has become an increasingly common approach. However, due to irregular observation times and other uncertainties inherent in medical settings, the EHR data sets suffer from a large number of missing values. Most of the traditional data mining and machine learning approaches are designed to operate on complete data. In this paper, we propose a novel imputation method for missing data to facilitate using these approaches for the analysis of EHR data. The imputation is based on a set of interpatient, multivariate similarities among patients. For a missing data point in a patient's lab results during his/her intensive care unit stay, the method ranks other patients based on their similarities with the ego patient in terms of lab values, then the missing value is estimated as a weighted average of the known values of the same laboratory test from other patients, considering their similarities as weights. A comparison of the estimated values by the proposed method with values estimated by several common and state-of-the-are methods, such as MICE and 3D-MICE, shows that the proposed method outperforms them and produces promising results.

Detecting Patterns of Prescription Drug Use During Pregnancy and Lactation with Visualization Techniques.

BACKGROUND: Pharmacovigilance studies for the pregnancy population are an important tool to address the teratogenic and maternal effects of prescription drugs. OBJECTIVES: We sought to leverage existing data to provide empirical evidence that reflects current drug utilization by pregnant/lactating women for pharmacovigilance and effective study designs. METHODS: Temporal patterns of prescription drug use during pregnancy and lactation for four clinical conditions were visualized using a R package and an administrative claims dataset representing nationwide privately-insured women. RESULTS: During the years 2010 to 2014, there was a significant increase (p < 0.001) in overall use of opioid, antidepressant, antihypertensive, and antidiabetic prescriptions. Hydrocodone, sertraline, labetalol, and metformin were the most common prescriptions for perinatal use in its respective category. Trimester-specific prescription patterns were reported. CONCLUSIONS: Visualization of administrative claims data can quickly detect temporal patterns of prescription drug use during pregnancy and lactation.

Thoracic Oncology Multidisciplinary Clinic Reduces Unnecessary Health Care Expenditure Used in the Workup of Patients With Non-small-cell Lung Cancer.

BACKGROUND: National costs of lung cancer care exceed $12 billion. We investigate the resource-savings benefit of a single-day thoracic oncology multidisciplinary clinic (MDC) in the diagnostic period prior to non-small-cell lung cancer (NSCLC) treatment. MATERIALS AND METHODS: From July 2007 to January 2015, patients with NSCLC treated with multimodality therapy at a tertiary hospital-based cancer center in Maryland were identified. Patient and treatment details were collected. Health care resources utilized in the 90 days prior to receipt of first oncologic treatment were identified using billed activity codes. Associated total charges, including professional fees and hospital-based technical fees, were identified and inflated to 2014 dollars using the Consumer Price Index. Codes were categorized into provider visits, procedures, pathology/laboratory, radiology, and other tests. χ2, Student t, and Wilcoxon rank-sum tests compared charges of patients seen in and out of the MDC. RESULTS: Two-hundred ninety-seven (non-MDC = 161, 54%; MDC = 136, 46%) of 308 patients identified had total charges available. Patients seen through MDC had on average a 23% decrease in total charges per patient incurred ($5839 savings; range, $5213-$6464) compared with patients seen through non-MDC settings. Evaluation through MDC reduced the average number of provider visits per patient (non-MDC, 6.8 vs. MDC, 4.8; P < .01) prior to treatment start, which led to a 50% (average $3092; range, $2451-$3732) reduction in provider charges per patient (P < .01). CONCLUSIONS: Evaluation of patients with NSCLC through a coordinated single-day MDC reduced hospital charges per patient by 23% during the diagnostic period prior to treatment when compared with evaluation through traditional referral-based thoracic oncology clinics.

Establishing cleft services in developing countries: Complications of cleft lip and palate surgery in rural areas of Indonesia

BACKGROUND@#Cleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery.@*METHODS@#This prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene.@*RESULTS@#In this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ²=0.02; P0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ²=0.031; P<0.05).@*CONCLUSIONS@#Further evaluation of these outcomes would help direct patient management toward decreasing the complication rate.

Vacuum sealing drainage with anterolateral thigh perforator flap for repair foot soft tissue defect / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effect of vacuum sealing drainage(VSD) with anterolateral thigh perforator flap for repair foot soft tissue defect.</p><p><b>METHODS</b>From September 2014 to September 2016, 45 patients with foot soft tissue defect repaired by VSD with anterolateral thigh perforator flap, including 31 males and 14 females aged from 17 to 55 years with an average of 36 years old. Thirty patients were dorsal soft tissue defects, and 15 patients were plantar soft tissue defects. Sizes of soft tissue defect ranged from 7 cm×10 cm to 11 cm×18 cm, the wound was contaminated seriously and assisted with deep soft tissue exposure. Emergency surgical wound debridement with VSD treatment were performed, and wound surface was cleaned after 5 to 7 days, free anterolateral thigh flap were repaired. Sizes of flap ranged from 9 cm×12 cm to 13 cm×21 cm. Appropriate method was used to repair flap donor area.</p><p><b>RESULTS</b>All 45 free propeller flap were survived without skin edge necrosis, ulcerative infection. Forty patients were followed up from 3 to 24 months with an average of 13 months. Flap showed good color, beautiful appearance, good elasticity, soft texture, but without obvious bloated, the wood of leg healed well.</p><p><b>CONCLUSIONS</b>VSD with anterolateral thigh perforator flap for repair foot soft tissue defect could effective control wound soft tissue infection, receive reliable flap blood supply and skin flap could repaired at stage I. It is an effective method for repairing foot soft tissue defects.</p>

Clinic Efficacy and Action Mechanism of Promoting Repairment of Knee Osteoarthritis's Cartilage Corpuscle via Modified Duhuo Jisheng Mixture / 中国中医药信息杂志

Objective To discuss the clinic efficacy and its mechanism of action in promoting the cell proliferation of knee osteoarthritis's cartilage corpuscle via modified Duhuo Jisheng Mixture. Methods Totally 60 cases were divided into treatment group and control group by random number table method, with 30 cases in each group. Treatment group was given modified Duhuo Jisheng Mixture, 62.5 mL each time, twice a day, orally, and sulfoglycan sulfate capsules, 1 capsule a day, three times a day, orally; while control group was given diacerein capsules, 1 pill a day, twice a day, orally, and sulfoglycan sulfate capsules, the same as treatment group. Patients were required to do quadriceps muscle systolic and functional exercise, and keep warm. The treatment lasted for 6 weeks. VAS score and WOMAC of the two group were observed before and after treatment. IL-1, NO, Wnt5a, β-catenin, Sox9, Collagen Ⅱ in knee joint fluid were detected. Adverse reactions were monitored. Results Compared with pre-treatment, the contents of IL-1, NO, Wnt5a and β-catenin in two groups were reduces (P<0.05); while the contents of Sox9 and Collagen Ⅱ were raised (P<0.05). The VAS scores and WOMAC were reduced in two groups after treatment (P<0.05). There was no statistical significance between the two group in the above indexes (P>0.05). There were no obvious adverse reactions in both groups.Conclusion Modified Duhuo Jisheng Mixture can reduce inflammatory factors of the joint fluid and inhibit the Wnt signal pathway through regulating the expression of Sox9 and Collagen Ⅱ in the pathway, which can promote the cell proliferation of knee osteoarthritis's cartilage corpuscle and benefit the repairment of cartilage corpuscle in order to relieve pains and improve functions of knee joint.

Cultivation of Traditional Chinese medicine thinking in tendon and muscle injury / 国际中医中药杂志

Traditional Chinese medicine thinking is the core method of diagnosis and treatment of traditional Chinese medicine. Thus, cultivating the clinical thinking of traditional Chinese medicine in the orthopeadics department has become the importance. TCM tendon and muscle injuries were well characterised by the TCM, becoming an important part of TCM orthopedics., The tendon and muscle injuries were used to explore the application and cultivation of traditional Chinese medicine thinking. This will help to improve the clinical curative effect, complement the modern Chinese medicine.

Improved mesenchymal stem cell survival in ischemic heart through electroacupuncture / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate whether electroacupuncture (EA) can promote cell survival and enhance heart function of mesenchymal stem cells (MSCs) therapy.</p><p><b>METHODS</b>MSCs were isolated from bone marrow and expanded in Minimum Essential Medium Alpha (α-MEM). MI was induced in 72 Sprague-Dawley (S-D) rats by ligation of the left anterior descending coronary artery (LAD) for 30 min and reperfusion. MI rats randomly received injection of 1×10(6) DiI-labeled MSCs alone (n =24, MSC group), or plus electroacupuncture (EA) at Neiguan (PC6, n=24, EA+MSC group), or saline (n =24, saline group). EA treatment was performed for 4 days. Another 24 rats were subjected to chest-open surgery without LAD occlusion and treatment (sham group). Three time points, 4, 14 and 28 days (n =8 for each group) were included in this study. The survival of transplanted MSCs and the protective gene expression were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) and Western blot at day 4 and 14. Left ventricular remodeling, cardiac function, infarction area, fibrosis and capillary density were analyzed at day 28.</p><p><b>RESULTS</b>EA can enhance MSC survival (2.6-fold up) at day 4. Big capillary density was 53% higher in EA+MSC treated group than MSC alone group. Furthermore, the rats treated by EA reduced the fibrosis and had 36% smaller infarct size comparing to MSC alone. EA also attenuated left ventricular remodeling and enhanced the functional recovery of infarcted hearts at week 4.</p><p><b>CONCLUSION</b>EA at Neiguan acupoint can promote the stem cell survival and improve ischemic heart function. EA could become a useful approach in stem cell therapy for ischemia heart diseases.</p>

Tradition meets technology: building caring community online.

Community has historically provided an essential psycho-spiritual framework for nursing. Changes in communication technology pose challenges for nurses internationally who create communities across borders. This article discusses The Bamboo Bridge online community, a project responding to the global call for nursing education about the complementarity of nursing and healing traditions. The project explores how technologies such as Centra and Ning promote community building and encourage belonging in members from 5 continents and 10 countries. This article includes detailed accounts of the project design, examples of cultural diplomacy as the emerging theoretical framework, and an African member's perspective of online community.

Effects of acupuncture on post-cesarean section pain / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Post-operation pain is a very subjective phenomenon. The aim of this study was to find out the effects of acupuncture or electro-acupuncture on post-cesarean pain.</p><p><b>METHODS</b>Sixty women, who had had spinal anesthesia during cesarean section at the Department of Obstetrics of China Medical University Hospital, were randomly assigned to the control group, the acupuncture group, and the electro-acupuncture group. After the operation, we applied subjects with acupuncture or electro-acupuncture on the bilateral acupuncture point, San Yin Jiao (Sp6), and the patient controlled analgesia (PCA). The first time of requesting morphine, the frequency of PCA demands in 24 hours, and the doses of PCA used were recorded double blindly. In addition, monitoring the subjects' vital signs, the opioid-related side effects, and the pain scores was done.</p><p><b>RESULTS</b>The results showed that the acupuncture group and the electro-acupuncture group could delay the time of requesting morphine up to 10 - 11 minutes when compared with the control group. The total dose of PCA used within the first 24 hours was 30% - 35% less in the acupuncture group and the electro-acupuncture group when compared with the control group, which was indicated in statistical significance. However, there was no significant difference between the acupuncture group and the electro-acupuncture group. The electro-acupuncture group's and the acupuncture group's pain scores were lower than the control group's within the first 2 hours. Both were statistically significant. However, two hours later, there were no significant differences of the visual analogue scale (VAS) scores between either of the treatment groups and the control group. Finally, the incidence of opioid-related side effects, such as dizziness, was less in the acupuncture group and electro-acupuncture group than in the control group.</p><p><b>CONCLUSIONS</b>This study shows that the application of acupuncture and electro-acupuncture could definitely delay the time of requesting pain relief medication after cesarean section and decrease the PCA doses used within the first 24 hours.</p>