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Previous research suggested that parent-administered pediatric tuina could improve symptoms of attention-deficit/hyperactivity disorder (ADHD), such as sleep quality and appetite. This study aimed to explore the experiences and perceptions of parents administering pediatric tuina to school-aged children with ADHD in Hong Kong. This qualitative study was embedded in a pilot randomized controlled trial on parent-administered pediatric tuina for improving sleep and appetite in school-aged children diagnosed with ADHD. Purposive sampling was used to invite 12 parents who attended a pediatric tuina training program and delivered the intervention to their children at home for at least 8 weeks. Data were collected through semistructured focus group interviews and individual interviews, which were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Two main themes emerged: (1) effects of parent-administered pediatric tuina and (2) parents' experience of administering pediatric tuina. Parents reported significant improvements in children's sleep quality, appetite, behavior, mental state, and academic performance. Facilitators provided professional guidance and applied a user-friendly course design. Challenges included difficulties in mastering techniques, locating acupuncture points, and time management. Participants suggested the need for more traditional Chinese medicine pattern diagnostic sessions, real-time supervision methods, and extended follow-up to better observe long-term effects. Parent-administered pediatric tuina was perceived to improve children's sleep quality and appetite significantly, along with other aspects of well-being. Professional guidance and a structured training program facilitated implementation, and challenges highlighted the need for more frequent diagnostic sessions, real-time supervision, and extended follow-up.

To determine the comparative effects and safety of traditional Chinese medicine (TCM) interventions based on meridian theory for pain relief in patients with primary dysmenorrhea (PD). This is a systematic review with network meta-analysis. Randomized controlled trials (RCTs) comparing meridian-based TCM interventions with waitlist, placebo, western medicine, and conventional therapies for PD pain. A SUCRA was used to estimate the probability ranking for the effects of interventions. 57 RCTs involving 3,903 participants and 15interventions were included. Thirty-two RCTs were rated as low risk of bias. A network diagram was drawn with 105 pairs of comparisons. Compared with NSAIDs and waitlist, significantly better effects were found in acupressure [SMD = -1.51, 95%CI (-2.91, -0.12)/SMD = -2.31, 95%CI (-4.61, -0.02)], warm needling [SMD = -1.43, 95%CI (-2.68, -0.18)/SMD = -2.23, 95%CI (-4.43, -0.03)], moxibustion [SMD = -1.21, 95%CI (-1.85, -0.57)/SMD = -2.10, 95%CI (-3.95, -0.07)], and acupuncture [SMD = -1.09, 95%CI (-1.62, -0.55)/SMD = -1.89, 95%CI (-3.67, -0.11)]. No adverse events were detected. For PD pain, the effects of acupressure, acupuncture, warm needling, and moxibustion were superior to those of NSAIDs and waitlist. Oral contraceptive pill, electro-acupuncture, acupressure, and warm needling demonstrated higher probabilities of being better interventions. More high-quality clinical trials are needed to provide more robust evidence of this network. PROSPERO CRD42022373312.

Background Moxibustion is widely used in mainland China but rarely used in Hong Kong. This study was conducted among traditional Chinese medicine (TCM) practitioners in Hong Kong to collect and explore their experiences and views on the barriers to and possibilities of using moxibustion in Hong Kong. Methods This qualitative study was conducted via semi-structured individual interviews. Purposive sampling was employed to recruit 13 TCM practitioners who have clinically practiced in Hong Kong for 2 years or more. The interviews were audio-recorded and transcribed verbatim, and the data were subsequently analyzed using template analysis. Results Three main themes were identified as follows: (1) expectations of moxibustion use in Hong Kong, (2) barriers to moxibustion use in Hong Kong, and (3) possible solutions to enhance moxibustion use in Hong Kong. For the expectation of moxibustion use, the subthemes were (a) merits of moxibustion therapy, (b) effectiveness of moxibustion therapy, and (c) applicability of moxibustion in Hong Kong. For the barriers to moxibustion use in Hong Kong, the subthemes were (a) limits of moxibustion use in clinics, (b) limits of self-help use of moxibustion, and (c) limits of local TCM practitioners’ experience of practicing moxibustion. For the suggestions to enhance moxibustion use in Hong Kong, the subthemes were (a) improvements in moxibustion and its accessories, (b) clinic upgrade, (c) government support, and (d) promotion of self-administered moxibustion. Conclusion Moxibustion is anticipated to gain traction in Hong Kong due to its acceptability and feasibility for clinical and self-help applications, its broad applicability across diverse populations and medical conditions, and its suitability for the Hong Kong climate. Barriers to its clinical use in Hong Kong include strict fire safety regulations for buildings and high labor costs. The public’s lack of understanding of moxibustion practice and knowledge in managing potential adverse events limits its self-use. Moxibustion could be promoted in Hong Kong by improving moxa quality and moxibustion equipment, optimizing the layout and ventilation of clinics, refining government support, and popularizing self-administered moxibustion.

Background Pediatric tuina treatment program is an intervention of traditional Chinese medicine that involves specific manual techniques applied to the bodies of infants and children to promote health and treat conditions such as congenital muscular torticollis (CMT). This study was conducted to understand facilitators, barriers, and influencing factors in the implementation of pediatric tuina treatment program based on parents’ experiences. Methods Semi-structured individual interviews were conducted with parents’ experience in Shandong province, China. Purposive sampling was applied to recruit 13 parents whose children had received a pediatric tuina training program for at least three months to participate voluntarily. Interviews were audio-recorded, transcribed verbatim, and analyzed using template analysis to identify key themes and subthemes. NVivo 12 software was used to facilitate the organization and coding of the data. Results Three themes were identified: (1) facilitators to the use of pediatric tuina treatment program, (2) barriers to the use of pediatric tuina treatment program, and (3) modulating factors of the use of pediatric tuina treatment program. The theme of the facilitators of intervention implementation included the subthemes of (a) merits of pediatric tuina , (b) perceived benefits by patients, and (c) parents’ concerns and expectations. The theme of barriers to intervention implementation included the subthemes of (a) perceived problems by patients, (b) limited medical resources, (c) family pressure, and (d) manipulation particularity. Modulating factors included (a) parents’ perception, (b) patients’ adherence, and (c) parents’ mentality. Conclusion Perceived beneficial effects on improving children’s CMT symptoms and constitutions as well as the conservative nature of pediatric tuina treatment mainly facilitated the treatment. Disease recurrence limited medical resources, long-term family pressure, and noncooperation of children were the dominant barriers to treatment implementation. Parents’ adherence, mentality, and perceptions on CMT and intervention selection modulated the effects of the treatment. Further research is needed to confirm these findings and explore additional factors affecting the effectiveness and implementation of pediatric tuina treatment.

Introduction Few studies have investigated the predictors of the treatment response after attending sleep hygiene education (SHE). We aimed to explore the patient characteristics associated with a response to SHE for insomnia. Methods A secondary analysis was conducted to pool the data of two randomized controlled trials for insomnia (Trial registration number ClinicalTrials.gov: #NCT04227587; NCT03623438), in which the subjects in the comparison group had attended two 2-hour sessions (total 4 hours) of small-group based SHE. We examined the association of sociodemographic variables, clinical characteristics, baseline sleep-wake variables, and Sleep Hygiene Practice Scale (SHPS) items to the treatment response. Subjects with a reduction in insomnia severity index (ISI) scores of ≥ 6 points from baseline to week 8 were classified as responders. Factors were compared between responders and non-responders and by univariate and multivariate logistic regression analysis. Results A total of 170 subjects with insomnia disorder who had received the SHE program were included and 42 (24.7%) of them were classified as responders. At 8 weeks after baseline, the subjects showed a 2.88 points reduction in ISI total score, 11.5 minutes reduction in sleep onset latency, 10.4 minutes reduction in waketime after sleep onset, 20.3 minutes increase in total sleep time, and 4.42% increase in sleep efficiency. Univariate logistic regression analysis has identified 12 potential predictors for SHE responders, including age, gender, baseline sleep parameters, and SHPS items. In the multivariate logistic regression analysis, age, ever tried exercise for improving sleep, and baseline ISI score remained significant predictors of SHE treatment response (age, adjusted OR 0.88, 95%CI 0.79, 0.97, p = 0.011; ever tried exercise for improving sleep, adjusted OR 11.0, 95%CI 1.16, 104.9, p = 0.037; baseline ISI score, adjusted OR 1.59, 95%CI 1.15, 2.19, p = 0.005). Conclusion Lower age, higher baseline ISI score, and ever-tried exercise for improving sleep were shown to predict the response of SHE. Our findings inform individuals who have insomnia to select the treatment for chronic insomnia in the future. Support (if any) The RCTs were supported by the Research Grants Council, General Research Fund (NCT04227587, Project no.: 15100419), and Health and Medical Research Fund (NCT03623438, Project no.: 19200171).

Multiferroic materials have ignited enormous interest owing to their co-existence of ferroelectricity and ferromagnetism, which hold substantial promise for advanced device applications. However, the size effect, dangling bonds, and interface effect in traditional multiferroics severely hinder their potential in nanoscale device applications. Recent theoretical and experimental studies have evidenced the possibility of realizing two-dimensional (2D) multiferroicity in van der Waals (vdW) layered CuCrP 2 S 6 . However, the incorporation of magnetic Cr ions in the ferroelectric framework leads to antiferroelectric and antiferromagnetic orderings, while macroscopic spontaneous polarization is always absent. Herein, we report the direct observation of robust out-of-plane ferroelectricity in 2D vdW CuCrP 2 S 6 at room temperature with a comprehensive investigation. Modification of the ferroelectric polarization states in 2D CuCrP 2 S 6 nanoflakes is experimentally demonstrated. Moreover, external electric field-induced polarization switching and hysteresis loops are obtained in CuCrP 2 S 6 down to ~2.6 nm (4 layers). By using atomically resolved scanning transmission electron microscopy, we unveil the origin of the emerged room-temperature ferroelectricity in 2D CuCrP 2 S 6 . Our work can facilitate the development of multifunctional nanodevices and provide important insights into the nature of ferroelectric ordering of this 2D vdW material. CuCrP 2 S 6 is a potential candidate for realizing low-dimensional multiferroicity. Here, authors report direct observation of robust out-of-plane ferroelectricity in the two-dimensional van der Waals layered CuCrP 2 S 6 at room temperature down to 2.6 nm and study its origin from an atomic perspective. (299 in total)

Owing to their high robustness and conductivity, 2D transition metal carbides and nitrides known as MXenes are considered as a promising material class for electrochemical catalysis, energy conversion, and storage applications. Nevertheless, conventional hazardous fluoride‐based synthesis routes and the intense intralayer bonding restrict the development of MXenes. Herein, a fluoride‐free, facile, and rapid method for synthesizing self‐assembled 1D architecture from an MXene‐based compound is reported. The MXene nanowire (NW) not only provides a robust connection to the flexible substrate but also effectively increases the electrochemically active surface area. The kinetics‐favorable structure yields a boosted performance for the hydrogen/oxygen evolution reaction and the intake of the zinc ion. The 1D NW based on MXene compound maintains high stability in a quite low overpotential of 236 mV for 24 h without detachment from the substrate and manifests an exceptional high‐power density of 420 W kg−1 over 150 cycles as a flexible aqueous zinc ion battery. This work paves a novel and non‐toxic synthesis method for the 1D nanofiber structure from MXene composition and demonstrates its multifunctional applications for energy conversion and storage. With the facile technique in alkali hydrolysis and HF‐free electrochemical etching, MXene nanowire is fabricated in a shortened etching time without the utilization of hazardous HF acid. The MXene NW@3D substrate not only renders a boosted kinetics and shortened diffusion length, but also offers a stable hydrogen evolution activity and flexible zinc ion battery application even during the deformation progress.

Two-dimensional (2D) ferroelectric materials with unique structure and extraordinary optoelectrical properties have attracted intensive research in the field of nanoelectronic and optoelectronic devices, such as optical sensors, transistors, photovoltaics and non-volatile memory devices. However, the transition temperature of the reported ferroelectrics in 2D limit is generally low or slightly above room temperature, hampering their applications in high-temperature electronic devices. Here, we report the robust high-temperature ferroelectricity in 2D α-In 2 Se 3 , grown by chemical vapor deposition (CVD), exhibiting an out-of-plane spontaneous polarization reaching above 200 °C. The polarization switching and ferroelectric domains are observed in In 2 Se 3 nanoflakes in a wide temperature range. The coercive field of the CVD grown ferroelectric layers illustrates a room-temperature thickness dependency and increases drastically when the film thickness decreases; whereas there is no large variance in the coercive field at different temperature from the samples with identical thickness. The results show the stable ferroelectricity of In 2 Se 3 nanoflakes maintained at high temperature and open up the opportunities of 2D materials for novel applications in high-temperature nanoelectronic devices.

In hepatocellular carcinoma (HCC) patients with extrahepatic metastasis, the lung is the most frequent site of metastasis. However, how the lung microenvironment favors disseminated cells remains unclear. Here, it is found that nidogen 1 (NID1) in metastatic HCC cell‐derived extracellular vesicles (EVs) promotes pre‐metastatic niche formation in the lung by enhancing angiogenesis and pulmonary endothelial permeability to facilitate colonization of tumor cells and extrahepatic metastasis. EV‐NID1 also activates fibroblasts, which secrete tumor necrosis factor receptor 1 (TNFR1), facilitate lung colonization of tumor cells, and augment HCC cell growth and motility. Administration of anti‐TNFR1 antibody effectively diminishes lung metastasis induced by the metastatic HCC cell‐derived EVs in mice. In the clinical perspective, analysis of serum EV‐NID1 and TNFR1 in HCC patients reveals their positive correlation and association with tumor stages suggesting the potential of these molecules as noninvasive biomarkers for the early detection of HCC. In conclusion, these results demonstrate the interplay of HCC EVs and activated fibroblasts in pre‐metastatic niche formation and how blockage of their functions inhibits distant metastasis to the lungs. This study offers promise for the new direction of HCC treatment by targeting oncogenic EV components and their mediated pathways. Nidogen 1‐enriched extracellular vesicle (EV‐NID1) activates pulmonary fibroblasts to secrete tumor necrosis factor receptor 1 (TNFR1) which favors lung metastasis of liver cancer. Serum EV‐NID1 and TNFR1 are potential noninvasive biomarkers for the early detection of liver cancer. This study also provides insights into a new direction of treatment by blocking the signals of EVs derived from tumor cells.

Background Knee osteoarthritis (KOA) is a common degenerative joint condition that causes disability and pain in the elderly population. The prevalence of KOA among persons aged 63 or above is approximately 30%. Previous studies have reported the positive effects of Tui-na treatment and the Chinese herbal formula Du-Huo-Ji-Sheng Decoction (DHJSD) for KOA treatment. The current study aims to evaluate the add-on therapeutic effect of oral administration of DHJSD on KOA in addition to Tui-na. Methods We conducted a prospective, randomized, controlled clinical trial. Seventy study subjects with KOA were randomly assigned to the treatment and control groups in a 1:1 ratio. Both two groups received eight sessions of Tui-na manipulation for 4 weeks. The DHJSD was only administered to the study subjects in the treatment group. The primary outcome measure was rated using the WOMAC at the end of treatment (4 weeks). Secondary outcomes were assessed using EQ-5D-5L, a health-related quality of life with 5-level EQ-5D version at end of treatment (week 4) and follow-up (week 8). Results No statistically significant difference was found between two groups on WOMAC scores at the end of treatment. The mean WOMAC Pain subscale score was significantly lower in the treatment group than control group at week 8 follow up (mean difference, MD − 1.8, 95% CI − 3.5 to − 0.02, P = 0.048). The mean WOMAC Stiffness subscale score was significantly lower in the treatment group than in the control group at week 2 (MD 0.74, 95% CI 0.05 to 1.42, P = 0.035) and week 8 follow up (MD 0.95, 95% CI 0.26 to 1.65, P = 0.008). The mean EQ-5D index value was significantly improved in the treatment group than in the control group at week 2 (MD 0.17, 95% CI 0.02 to 0.31, P = 0.022). The analysis of WOMAC scores and EQ-5D-5L in both groups showed statistically significant improvement with time. No significant adverse effect was found during the trial. Conclusion DHJSD may have an add-on effect in addition to Tui-na manipulation relieving pain and improving stiffness as well as quality of life (QOL) in patients with KOA. The combined treatment was generally safe and well tolerated. Trial registration The study was registered at the ClinicalTrials.gov (website: https://clinicaltrials.gov/ct2/show/NCT04492670 , registry number: NCT04492670), registered on 30 July 2020.