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This multicenter, randomized, noninferiority trial compared electroacupuncture with prucalopride for the treatment of severe chronic constipation (SCC). Participants with SCC (≤ 2 mean weekly complete spontaneous bowel movements [CSBMs]) were randomly assigned to receive either 28-session electroacupuncture over 8 weeks with follow-up without treatment over 24 weeks or prucalopride (2 mg/d before breakfast) over 32 weeks. The primary outcome was the proportion of participants with ≥3 mean weekly CSBMs over weeks 3-8, based on the modified intention-to-treat population, with -10% as the noninferior margin. Five hundred sixty participants were randomized, 280 in each group. Electroacupuncture was noninferior to prucalopride for the primary outcome (36.2% vs 37.8%, with a difference of -1.6% [95% confidence interval, -8% to 4.7%], P < 0.001 for noninferiority); almost the same results were found in the per-protocol population. The proportions of overall CSBM responders through weeks 1-8 were similar in the electroacupuncture and prucalopride groups (24.91% vs 25.54%, with a difference of -0.63% [95% confidence interval, -7.86% to 6.60%, P = 0.864]). Except during the first 2-week treatment, no between-group differences were found in outcomes of excessive straining, stool consistency, and quality of life. Adverse events occurred in 49 (17.69%) participants in the electroacupuncture group and 123 (44.24%) in the prucalopride group. One non-treatment-related serious adverse event was recorded in the electroacupuncture group. Electroacupuncture was noninferior to prucalopride in relieving SCC with a good safety profile. The effects of 8-week electroacupuncture could sustain for 24 weeks after treatment. Electroacupuncture is a promising noninferior alternative for SCC (see Visual Abstract, http://links.lww.com/AJG/B776).

Polygonatum sibiricum polysaccharide (PsP), one of the main components of Polygonatumsibiricum used in traditional Chinese food and medicine, has important bioactive functions, but it is difficult to fully utilize PsP because of the degradative effect of digestive gastric juices. This study aimed to innovatively synthesize a new food formulation for PsP, namely, a PsP–hydroxyapatite (HAP) sustained-release system, so as to reduce its degradation. The new food formulation was optimized and evaluated by the response surface method (RSM) and by in vitro experiments. The optimal stirrer temperature, reaction pH, etching pH, and loading time for synthesizing PsP-HAP were 85.62 °C, pH 11.12, pH 8.40, and 5.10 h, respectively, all of which were different from the findings of other similar research studies. The average encapsulation rate of PsP-HAP reached (40.16 ± 1.54)%, and the content of PsP was 8.98%. Additionally, PsP-HAP appeared to be pH-responsive, and its continuous antioxidative effect was first proven by the DPPH assay and then cytologically by a total antioxidative capacity assay. The CCK-8 assay indicated that PSP-HAP did not induce toxicity. This study successfully developed a new food formulation for PsP which appears to have the potential to reduce the degradative effect of digestive gastric juices. Thus, it is possible to achieve full utilization of PsP by using this new sustained-release food formulation.

Equipped with one degree of freedom in one-dimensional translation of the base, a mobile dual-arm robot (MDAR) is proposed in this paper, and the two arms and the base move simultaneously. As a result, the motion of the base has a significant influence on the motion of both end-effectors at the same time, and the relative positions of the two end-effectors change all the time. Therefore, this paper focuses on the main issues related to the presented MDAR in two key areas: the relative dynamics and relative force/position hybrid control. First, based on the D-H parametric method, the relative kinematics of the proposed MDAR is established, and the relative Jacobian matrix of the robot is derived. Secondly, the dynamic model of the proposed MDAR is constructed using the Lagrangian method. Furthermore, a closed-loop control strategy for relative force/position hybrid control of the MDAR based on the relative dynamics is proposed to enable the two end-effectors of the MDAR to track the planned trajectory accurately. Finally, a simulation is carried out on a dual-arm cutting robot (DACR) for a coal mine to prove the effectiveness of the proposed relative dynamics and the proposed relative force/position hybrid control law in terms of the absolute error (AE) and root mean square error (RMSE). The results show that the proposed relative dynamic model and relative force/position hybrid control can significantly reduce error of the DACR, effectively improve the adaptability and operation accuracy of the system to complex environment, and verify the feasibility and superiority of the method in practical application.

Carbonaceous aerosols have been attracting attention due to the influence on visibility, air quality, and regional climate. Statistical analyses based on concentration levels, spatial-temporal variations, correlations, and organic carbon (OC) to element carbon (EC) ratios from published data of OC and EC in particulate matter (PM₂.₅ and PM₁₀) were carried out in order to give a carbonaceous aerosol profile in China. The results showed maxima for OC of 29.5 ± 18.2 μg C m⁻³ and for EC of 8.4 ± 6.3 μg C m⁻³ in winter and minima for OC of 12.9 ± 7.7 μg C m⁻³ in summer and for EC of 4.6 ± 2.8 μg C m⁻³ in spring. In addition, OC and EC both had higher concentrations in urban than those in rural sites. Carbonaceous aerosol levels in China are about three to seven times higher compared to those in the USA and Europe. OC and EC occupied 20 ± 6 and 7 ± 3 % of PM₂.₅ mass and 17 ± 7 and 5 ± 3 % of PM₁₀ mass, respectively, implying that carbonaceous aerosols are the main component of PM, especially OC. Secondary organic carbon (SOC) was a significant portion of PM and contributed 41 ± 26 % to OC and 8 ± 6 % to PM₂.₅ mass. The OC/EC ratio was 3.63 ± 1.73, which, along with the good correlation between OC and EC and the OC to EC slope of 2.29, signifies that coal combustion and/or vehicular exhaust is the dominated carbonaceous aerosol source in China. These provide a primary observation-based understanding of carbonaceous aerosol pollution in China and have a great significance in improving the emission inventory and climate forcing evaluation.

Background This study aims to develop an evidence-based clinical practice guideline of acupuncture in the treatment of patients with moderate and severe cancer pain. Methods The development of this guideline was triggered by a systematic review published in JAMA Oncology in 2020 . We searched databases and websites for evidence on patient preferences and values, and other resources of using acupuncture for treatment of cancer pain. Recommendations were developed through a Delphi consensus of an international multidisciplinary panel including 13 western medicine oncologists, Chinese medicine/acupuncture clinical practitioners, and two patient representatives. The certainty of evidence, patient preferences and values, resources, and other factors were fully considered in formulating the recommendations. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to rate the certainty of evidence and the strength of recommendations. Results The guideline proposed three recommendations: (1) a strong recommendation for the treatment of acupuncture rather than no treatment to relieve pain in patients with moderate to severe cancer pain; (2) a weak recommendation for the combination treatments with acupuncture/acupressure to reduce pain intensity, decrease the opioid dose, and alleviate opioid-related side effects in moderate to severe cancer pain patients who are using analgesics; and (3) a strong recommendation for acupuncture in breast cancer patients to relieve their aromatase inhibitor-induced arthralgia. Conclusion This proposed guideline provides recommendations for the management of patients with cancer pain. The small sample sizes of evidence limit the strength of the recommendations and highlights the need for additional research.

The purpose of the work was to investigate whether electroacupuncture (EA) could ameliorate migraine central sensitization by modulating microglial activation and the subsequent release of inflammatory cytokines in the trigeminal nucleus caudalis (TNC) in a rat model. Establishment of a rat model of recurrent migraine was achieved through repeated dural electrical stimulation (DES). After nine sessions of acupuncture treatment at Fengchi (GB20), facial mechanical thresholds were measured by electronic von Frey measurements. Microglial activation and cytokine receptors of TNC were evaluated by immunofluorescence staining. The expression of microglial biological marker Ibal-1, proinflammatory cytokines, and cytokine receptors in the TNC were evaluated by Western blot and/or real-time polymerase chain reaction. In addition, the effects of inhibition of microglial activation on facial thresholds and neuronal activation (i.e., expression of c-Fos in the TNC) induced by DES were observed. After consecutive EA-GB20 treatments, the facial withdrawal threshold was significantly higher than in the model group at different time points (p < 0.05). The hyperreactivity of microglia induced by DES was significantly inhibited, and the expressions of Ibal-1, interleukin-1β, tumor necrosis factor-α, and their receptors in the TNC were also significantly decreased (p < 0.05). Inhibition of microglia by minocycline demonstrated an acupuncture-like role, which was manifested by ameliorated mechanical hyperalgesia and decreased neuronal expression of c-Fos, Iba-1, and inflammatory factors. EA at GB20 could ameliorate migraine facial allodynia by inhibiting microglial activation and the subsequent release of inflammatory cytokines and their receptors in the TNC.

Acupuncture has a therapeutic effect similar to that of prophylactic drugs and can be considered a treatment option for migraineurs. However, the mechanism of acupuncture treatment's effect on migraine is uncertain. An approach based on anti-inflammatory effects is an important treatment strategy for migraine because non-steroidal anti-inflammatory drugs (NSAIDs) are usually used during migraine attacks. Meningeal inflammation is thought to be responsible for the activation of the trigeminovascular system. Our previous study found that electroacupuncture (EA) decreased neurogenic inflammation mediator expression in the trigeminal ganglion (TG) and alleviated hyperalgesia. The present study examined whether EA would inhibit hyperalgesia by alleviating neurogenic inflammatory factors. A rat model of migraine was established using dural electrical stimulation (DES). Five groups were analyzed in this study. The Model group received DES three times to mimic migraine attacks, a Control group had sham DES, and three groups received electroacupuncture after DES: a Non-Acu group at a non-acupuncture point, a GB20 group at GB20, and a GB20/34 group at GB20 and GB34 acupuncture points. We evaluated mechanical hyperalgesia using an electronic von Frey esthesiometer in the awake state. After sacrifice, the dura mater was analyzed using immunofluorescence. Serum calcitonin gene-related peptide, cyclooxygenase-2, brain-derived neurotrophic factor, IL-1β, IL-6, and TNF levels were determined using enzyme-linked immunosorbent assays to evaluate the anti-inflammatory effect of acupuncture. After repeated DES, we observed facial and hind paw mechanical hyperalgesia, which was inhibited by electroacupuncture. Electrical stimulation increased the number of mast cells and macrophages and serum levels of inflammatory factors. GB20 and GB20/34 electroacupuncture significantly decreased the number of mast cells and macrophages and serum levels of inflammatory factors. Moreover, electroacupuncture at GB20/34 was superior to that at GB20 alone in inhibiting hyperalgesia and alleviating inflammatory factors. Electroacupuncture inhibits DES-induced hyperalgesia by alleviating inflammatory factors. Inhibition of dural mast cells, macrophages, and serum inflammatory factors may be one of the mechanisms involved in acupuncture treatment's effect on migraine.

While neuroplasticity changes measured by transcranial magnetic stimulation have been proved to be highly correlated to motor recovery and have been tested in various forms of interventions, it has not been applied to investigate the neurophysiologic mechanism of acupuncture therapy. The aim of this study is to investigate neuroplasticity changes induced by a single session of acupuncture therapy in healthy adults, regarding the excitability change on bilateral primary motor cortex and interhemispheric inhibition. Ten subjects took a 30-minute acupuncture therapy and the same length relaxing phase in separate days. Transcranial magnetic stimulation measures, including resting motor threshold, amplitudes of motor-evoked potential, and interhemispheric inhibition, were assessed before and 10 minutes after intervention. Acupuncture treatment showed significant changes on potential amplitude from both ipsilateral and contralateral hemispheres to acupuncture compared to baseline. Also, interhemispheric inhibition from the contralateral motor cortex to the opposite showed a significant decline. The results indicated that corticomotoneuronal excitability and interhemispheric competition could be modulated by acupuncture therapy on healthy subjects. The following question about whether these changes will be observed in the same way on stroke patients and whether they correlate with the therapeutic effect on movement need to be answered by following studies. This trial is registered with ISRCTN13074245.

A year-long study was performed to comprehensively investigate the mass concentration, water-soluble ions, organic and elemental carbons, and elemental components of atmospheric fine particles from March 2006 to February 2007 in Qingdao. The results showed that PM2.5 concentration was over twice the National Ambient Air Quality Standards of 35 μg/m3 (GB3095-2012), with the highest value in winter (110 μg/m3) and the lowest in summer (42.8 μg/m3). Non-sea salt-SO42− (nss-SO42−), NO3−, and NH4+ were the dominant water-soluble ions in PM2.5, and showed the highest concentrations in autumn, winter and autumn, respectively, and all had the lowest concentrations in summer. Organic carbon (OC) and elemental carbon (EC) had the lowest levels in summer and the highest values in winter and autumn, respectively. The lower acetic/formic acid (A/F) ratio in summer suggested a predominant secondary formation of water-soluble organic acids. Cl-depletion mainly occurred in summer, along with the largest sea salt proportion in particles in a year when winds came from the southeastern sea. The enrichment factors (EFs) of elements followed an increasing order: Si, Al, Ti, Mg, Ca, Fe, Na, Sr, K, Mn, Ba, V, Cr, Ni, Co, Sc, Cu, As, Cl, Zn, Pb, S, Br, Cd, and Se. The higher EFs from 10.1 to 10,487 for Sr, K, Mn, Ba, V, Cr, Ni, Co, Sc, Cu, Cl, Zn, Pb, S, Br, Cd, and Se suggested the significant influence of anthropogenic sources in the area. Mass closure showed that (NH4)2SO4, organic matter, and NH4NO3 were the main components, and contributed 31.0%, 25.2%, and 14.0% of PM2.5 mass in Qingdao, respectively. Source apportionment results showed that secondary sulfate, nitrate, and coal combustion were the main sources. Based on this study and previous publications, the PM2.5 characteristics—including seasonality in mass and chemical species concentrations and Cl-depletion in summer—were obtained across coastal cities in China.

Post-stroke complex regional pain syndrome (CRPS) is a devastating disease that causes severe physical and emotional consequences. Conventional therapies are limited due to the insufficient benefits and side effects, and fire needling therapy is considered an alternative for post-stroke CRPS of the upper limb. This is a study protocol for a pilot randomised, two-arm, single-centre, clinical trial at Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University. The trial started in March 2023 and is expected to end in December 2024. A total of 60 patients (aged 40-75 years, male or female) with post-stroke CRPS of the upper limb will be randomly assigned to treatment group (fire needling therapy, 5 sessions per week for 2 weeks) or control group (manual acupuncture, 5 sessions per week for 2 weeks) in a 1:1 ratio using block randomisation and opaque envelopes. Fire needling therapy or manual acupuncture will be performed in ten acupoints. Participants will complete the trial by visiting the research centre at Week 14 for a follow-up assessment. The primary outcome is the response rate. Secondary outcomes include FMA, Barthel Scale/Index (BI), pain threshold (PPT), and muscle elasticity modulus (using shear wave elastography [SWE]). A chi-squared test will be used for response rate. A mixed-effects linear model and a mixed-effects model will be used for FMA, BI, PPT, and SWE, respectively. This is the first standardised protocol to compare the effectiveness of fire needling therapy and manual acupuncture. We will use a rigorous methodology to minimise bias and set up supervising committees to ensure the quality of our study, thus providing trustworthy evidence for better understanding of fire needling therapy in treating post-stroke CRPS of the upper limb.