The gut virome is an emerging but underexplored component of the human microbiota, especially in pediatric Crohn's disease (CD). This study aimed to characterize the fecal virome in children with CD and evaluate its association with clinical response to infliximab (IFX) therapy. A total of 85 participants, including 60 pediatric CD patients and 25 healthy controls (HC), were recruited. Among the CD patients, 53 received ≥3 IFX infusions, 41 achieved remission (IFX-R), and 12 did not (IFX-NR). Viral-like particles in fecal samples were enriched and profiled by metagenomic sequencing, while bacterial communities were assessed via 16S rRNA gene sequencing. Pediatric CD patients exhibited significantly reduced viral richness and altered viral community compared to HCs. Functional analyses revealed that CD patients exhibit a shift in fecal virome function from DNA repair to viral replication and assembly. Trans-kingdom correlations were disrupted in CD, particularly between Torque teno viruses and beneficial bacteria, such as Blautia. An integrated machine learning model combining viral and bacterial markers achieved a certain level of diagnostic accuracy for pediatric CD (area under the curve [AUC] = 89.3%). IFX treatment influences the gut virome, with remission associated with higher abundances of Microviridae and Siphoviridae, while Anelloviridae, Myoviridae, and Podoviridae were enriched in IFX-NR at baseline. These findings suggest the virome as a potential biomarker for predicting clinical outcome in pediatric CD, offering a novel avenue for disease diagnosis and personalized treatment strategies. IMPORTANCE:Crohn's disease (CD) in children poses a growing clinical challenge, with increasing incidence and variable response to biologic therapies such as infliximab (IFX). While gut bacterial dysbiosis has been extensively studied, the role of the gut virome in pediatric CD remains largely unexplored. This study provides the first longitudinal characterization of the fecal virome in children with CD undergoing IFX therapy. We reveal distinct viral community patterns, functional alterations, and virus-bacteria interactions in pediatric CD patients. Notably, integration of virome and bacteriome profiles enhances diagnostic accuracy, offering a promising avenue for predictive biomarker development. Furthermore, virome changes may be associated with the IFX treatment outcomes in children with CD. These findings highlight the gut virome as a critical but overlooked dimension of host-microbiome interactions in pediatric CD, with potential implications for personalized therapy and mechanistic understanding of treatment resistance.

Objective: To investigate the relationship between the composition of traditional Chinese medicine (TCM) and depression/anxiety/sleep disturbances (D/A/S) in patients with chronic pain. Methods: This cross-sectional study was conducted at 13 tertiary hospitals across China, enrolling patients who experienced chronic pain between November 2023 and May 2024. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Pittsburgh Sleep Quality Index, and TCM constitution categories were used to assess the patients. The association between the TCM constitution and the D/A/S ratio was analyzed using multivariable logistic regression. Results: A total of 1107 patients (63.2% women) were analyzed. Compared with those with a balanced constitution, patients who had qi-deficiency and yin-deficiency were at a higher risk of depression. Qi-deficiency and yin-deficiency were associated with anxiety. Sleep disturbances were common in patients with qi-deficiency constitution (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.42–3.81), yang-deficiency constitution (OR: 1.94, 95% CI: 1.26–2.98), yin-deficiency constitution (OR: 2.03, 95% CI: 1.24–3.32), blood stasis constitution (OR: 2.07, 95% CI: 1.01–4.22), and qi-stagnation constitution (OR: 2.66, 95% CI: 1.35–5.25). Conclusion: In patients with chronic pain, specific TCM constitutions may be associated with D/A/S. Further longitudinal studies are needed to clarify the potential causal relationships between TCM constitution types and these conditions.

Objective:To observe the clinical efficacy and safety of acupuncture combined with blade needle therapy for knee osteoarthritis (KOA). Methods:A total of 60 patients with KOA were randomly divided into an observation group and a control group, 30 cases each group. The control group received acupuncture at Neixiyan (EX-LE4)，Dubi (ST35), Yinlingquan (SP9), Liangqiu (ST34), Xuehai (SP10), Yanglingquan (GB34) and Zusanli (ST36) on the affected side, once every other day, 3 times a week. The observation group received blade needle therapy on the basis of the treatment in the control group, once every 3 days, 2 times a week. Both groups were treated for 4 weeks. Before treatment, after 2, 4 weeks of treatment, and after 1 month of treatment completion (in follow-up), the scores of pain visual analogue scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and Lequesne index were observed in the two groups, and the clinical efficacy and safety were evaluated. Results:After 2, 4 weeks of treatment and in follow-up, the pain VAS scores, Lequesne index scores, and pain, stiffness, function scores of WOMAC in both groups were decreased compared with those before treatment (P<0.05), and the VAS scores, Lequesne index scores and pain, function scores of WOMAC in the observation group were lower than those in the control group (P<0.05). The effective response rate in the observation group was 76.7% (23/30), while that in the control group was 70.0% (21/30), there was no statistically significant difference in the effective response rates between the two groups (P>0.05). No adverse reactions were observed in either group. Conclusion:Acupuncture combined with blade needle therapy could alleviate pain and promote functional recovery in KOA patients, and achieve long-lasting improvements.

BACKGROUND & AIMS:Irritable bowel syndrome (IBS) affects 4.1% of the adult population, with many reporting ongoing symptoms despite first-line therapies. Acupuncture is widely used for IBS, but without sufficient evidence. We aimed to assess the efficacy of acupuncture in patients with diarrhea-predominant IBS (IBS-D). METHODS:This was a multicenter randomized controlled trial in 6 hospitals in China. Patients aged 18 to 75 years with IBS-D per Rome IV diagnostic criteria were randomly allocated (1:1) to receive 15 sessions of acupuncture or sham acupuncture (blunt-tipped needle at non-acupoints) over 6 weeks with a 12-week follow-up. The primary outcome was the composite response rate at week 6, defined as at least a 30% improvement in the mean worst abdominal pain and a 50% or more reduction in the number of days with diarrhea from baseline during week 6. RESULTS:Between May 2021 and August 2022, 584 patients were assessed for eligibility, of whom 280 were randomly allocated. The primary outcome was reached by 71 (57.9%) patients in the acupuncture group compared with 47 (41.4%) patients in the sham acupuncture group (risk ratio 1.40; P = .008). The between-group difference became significant from week 3 and maintained throughout the study except week 16. No severe adverse event was reported. CONCLUSIONS:Acupuncture improved abdominal pain and stool consistency in patients with IBS-D, with sustained efficacy over 18 weeks. The results of this trial suggest that acupuncture may serve as an alternative treatment for IBS-D. (ACTION Chinese Clinical Trial Registry number, ChiCTR2100044762).

Objective:This study aimed to investigate the prevalence of depression/anxiety/sleep disturbance (D/A/S), as well as factors associated with these conditions, among patients with moderate-to-severe chronic pain. Methods:This cross-sectional study was conducted at 13 tertiary hospitals in 10 provinces, enrolling consecutive patients with chronic pain from November 2023 to May 2024. Depression was defined using the Patient Health Questionnaire-9 cutoff of 5 or higher, categories of depression were defined as none (scores: 0-4); anxiety was defined using the Generalized Anxiety Disorder-7 cutoff of 5 or higher, categories of anxiety were defined as none (scores: 0-4); sleep disturbance was defined as a total Pittsburgh Sleep Quality Index score of > 5, categories of sleep disturbance were defined as none (scores: 0-5). Sociodemographic, lifestyle behaviors, and clinical characteristics were collected. Pearson correlation analysis was used to examine correlations among D/A/S. Univariate and multivariate logistic regression analyses were applied to identify factors associated with these conditions. Results:A total of 1107 patients were analyzed. D/A/S were identified in 36.6%, 19.1%, and 46.3% of the patients with chronic pain, respectively. The co-occurrence of two or three symptoms was 12.8-26.6%. In the multivariate analysis, patients who reported poor self-rated health (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.33-2.68) and neuroticism (OR 1.06, 95% CI 1.02-1.09) were associated with depression. Neck pain (OR 2.60, 95% CI 1.53-4.42), alcohol consumption (OR 1.83, 95% CI 1.12-2.99), neuroticism (OR 1.09, 95% CI 1.05-1.13), and pain interference (OR 1.33, 95% CI 1.17-1.50) were correlated with anxiety. Alcohol consumption (OR 1.64, 95% CI 1.16-2.32) and pain interference (OR 1.12, 95% CI 1.03-1.23) were associated with sleep disturbance. Conclusion:Among patients with chronic pain, D/A/S are prevalent and linked to distinct factors. Alcohol consumption and pain interference may be associated with both anxiety and sleep disturbance, while neuroticism may be linked to both depression and anxiety. Future systematic management of multifactorial factors may improve their mental health.

Background Post-stroke spasticity (PSS) is a common complication that affects recovery and quality of life. Traditional rehabilitation approaches may benefit from complementary therapies.Objective This study aims to evaluate the efficacy of Tuina massage combined with conventional treatment for PSS through a meta-analysis, providing a scientific basis for clinical decision-making and future research directions.Method A literature search was conducted across both English-language (PubMed, Embase, Cochrane, Web of Science) and Chinese-language (CNKI, Wanfang, VIP) databases. Inclusion criteria were limited to randomized controlled trials. Data analysis was performed using Cochrane Collaboration's Review Manager 5.3 and Stata 12.0 software, with detailed inclusion and exclusion criteria and quality assessment using the Jadad scoring system.Results Eighteen studies met the inclusion criteria, involving 1937 patients treated with various Tuina techniques alone or in combination with other therapies. Results indicated that Tuina significantly improved symptoms and quality of life, with the Tuina treatment group outperforming the control group in the Modified Ashworth Scale (MAS), Modified Barthel Index (MBI), and Fugl-Meyer Assessment (FMA).Conclusion This meta-analysis demonstrates that Tuina massage combined with conventional treatment significantly reduces PSS severity and enhances functional abilities and quality of life, highlighting its potential integration into rehabilitation programs for comprehensive PSS management.

Previous studies have confirmed that acupuncture for irritable bowel syndrome (IBS) provided an additional benefit over usual care alone. Therefore, we performed a multicenter, randomized, sham-controlled trial to assess the efficacy and safety of acupuncture versus sham acupuncture for refractory IBS in patients in the context of conventional treatments. Patients in the acupuncture and sham acupuncture groups received real or sham acupuncture treatment in 3 sessions per week for a total of 12 sessions. The primary outcome was a change in the IBS-Symptom Severity Scale (IBS-SSS) score from baseline to week 4. A total of 521 participants were screened, and 170 patients (85 patients per group) were enrolled and included in the intention-to-treat analysis. Baseline characteristics were comparable across the two groups. From baseline to 4 weeks, the IBS-SSS total score decreased by 140.0 (95% CI: 126.0 to 153.9) in the acupuncture group and 64.4 (95% CI: 50.4 to 78.3) in the sham acupuncture group. The between-group difference was 75.6 (95% CI: 55.8 to 95.4). Acupuncture efficacy was maintained during the 4-week follow-up period. There were no serious adverse events. In conclusion, acupuncture provided benefits when combined with treatment as usual, providing more options for the treatment of refractory IBS.

ObjectiveThis study aimed to analyse the research hotspots and frontiers in the field of paediatric fever between 2013 and 2023.MethodsThe included articles were visually analysed using CiteSpace 6.1.R6 software.ResultsA total of 2,662 Chinese-language articles and 1,456 English-language articles were included in the study. Based on the Chinese literature, research groups were identified represented by Xinmin Li, Jinling Hong and Hongshuang Luo. Based on the English literature, research groups were formed represented by Henriette Moll, Santiago Mintegi and Elizabeth Alpern. Tianjin University of Traditional Chinese Medicine was the institution with the largest number of publications in the Chinese literature, and the Centers For Disease Control And Prevention was the institution with the largest number of publications in the English literature. The research on paediatric fever mainly focused on mechanism exploration, green treatment and clinical management.ConclusionSeveral relatively stable research groups have been formed. Future studies on the differential diagnosis, rational drug use, standardised management and clinical practice guidelines for paediatric fever are needed.

Objective:To observe the efficacy of different needling depths for knee osteoarthritis(KOA)and the effects on effusion,cartilage thickness,and synovium under ultrasound imaging. Methods:A total of 90 patients with KOA were randomly divided into a conventional acupuncture group,a Western medication group,and a shallow acupuncture group,with 30 cases in each group.In the conventional acupuncture group,the needling depth was 15-30 mm,and the needle was twisted for a few moments after insertion so that a sore,numb,distending,and electrified sensation was obtained;in the shallow acupuncture group,the points were punctured perpendicularly by 2 mm,and no manipulation was performed after insertion.The same points were used in the two acupuncture groups,and the needles were retained for 20 min.The treatment was performed 3 times a week.The Western medication group was given glucosamine sulfate capsules for oral administration,2 capsules once,3 times a day.All three groups were treated for 8 weeks.The Western Ontario and McMaster Universities osteoarthritis index(WOMAC)and the visual analog scale(VAS)were scored before treatment,after 4 weeks and 8-week treatment,respectively;while the changes in knee cartilage,synovial membrane,and joint fluid were observed by knee ultrasound before and after 8-week treatment.The clinical efficacy was evaluated after 8-week treatment. Results:After 8-week treatment,the effusion and the synovial thickness improved significantly in both the conventional and shallow acupuncture groups compared with that before treatment(P<0.01);the effusion improved in the Western medication group compared with that before treatment(P<0.05);the synovial thickness improved better in the conventional acupuncture group than in the Western medication group(P<0.05).There was no statistically significant difference in the cartilage thickness among the three groups compared with that before treatment(P>0.05).The WOMAC(pain,stiffness,and function)and VAS scores decreased in all three groups after 4-and 8-week treatment compared with those before treatment(P<0.05).After 4-and 8-week treatment,the pain scores in WOMAC of the conventional acupuncture group were lower than those of the Western medication group and the shallow acupuncture group(P<0.05),and the VAS scores of the conventional acupuncture group were lower than those of the shallow acupuncture group(P<0.05).After 8-week treatment,the stiffness and functional scores in WOMAC of the conventional acupuncture group were lower than those of the Western medication group(P<0.05). Conclusion:Conventional acupuncture,oral Western medication,and shallow acupuncture all relieved knee pain and improved knee stiffness and functional movement.Among them,conventional acupuncture had the best efficacy in relieving knee pain and the best efficacy in improving joint function after 8-week treatment.Both conventional acupuncture and shallow acupuncture significantly reduced synovial thickness lesions in the knee;all three groups improved joint effusion and were more effective with conventional and shallow acupuncture.

The effects of acupuncture on the protein and gene expression of oestrogen receptors (ERs) alpha (α) and beta (β) in testosterone-induced benign prostatic hyperplasia (BPH) in rats remains unclear. In this study, rats were randomly divided into four groups (n = 10 per group). The rats in the blank group did not receive any treatment, while the rats in the model group were injected intraperitoneally with testosterone propionate for 28 days to establish the BPH model and then randomly sub-divided into a control group, an acupuncture group and a finasteride group (positive control group). Dissections were performed after rats were anesthetized with isoflurane, and then the weight and volume of the prostate were then measured. The expression of ERs was detected via immunohistochemistry, western blot and real-time polymerase chain reaction. The results showed that ERα was discontinuously distributed in epithelial cells and expressed in large quantities in stromal cells, and ERβ was aggregated and expressed in hyperplastic nodules. Acupuncture and finasteride could significantly improve the distribution of ERα and ERβ which suggested that acupuncture and finasteride could improve BPH. There was no significant difference in ERα messenger ribonucleic acid (mRNA) expression among the groups, but the ERβ mRNA expression in the finasteride group showed a significant difference compared with the control and acupuncture groups. The mechanism of the acupuncture treatment of BPH may be related to the increased transcription level of ERβ mRNA in prostate tissues, the improved distribution of ERα expression in epithelial cells and the aggregation expression of ERs in hyperplastic nodules.

OBJECTIVE: To investigate the effect of Tuina on the plasma metabolites of lipopolysaccharide-induced febrile in infant rabbits. METHODS: Twenty-four infant New Zealand rabbits were selected and randomly divided into three groups: saline, model, and Tuina. The fever model was established by injecting LPS intravenously through the ear margin vein in the model group and Tuina group, respectively. The modeling was considered successful when the anal temperature increased by 0.5℃ or above within 1 h. In the Tuina group, six Tuina techniques(i.e., opening Tianmen/the heaven gate, pushing Kangong/the superciliary arch, kneading Taiyang and the prominent bone behind the ears, clearing Tianheshui, spine pinching) that alleviate fever were performed on the young rabbits 1 h after the modeling, whereas the model and saline groups were not given Tuina treatment, with the real-time anal temperature monitored during the experiment. The plasma was taken 3 h after the modeling for liquid chromatography-mass spectrometry(LC-MS) untargeted metabolomics study. RESULTS: Our results showed a fever-reducing effects of Tuina therapy on lipopolysaccharide-induced fever in young rabbits, as indicated by a significantly lower anal temperature, maximum rise in body temperature, and body response index at 2 and 3 h after modeling in the Tuina group compared to the model group, with reductions in the PGE2 expression observed in the blood and hypothalamus. The differential metabolites including riboflavin, nicotinamide N-oxide, porphobilinogen, 5-hydroxyindoleacetic acid, gamma-aminobutyric acid, and lysoPC(16:1(9Z)/0:0) were found following the Tuina intervention. Tuina primarily involves glycine-serinethreonine, arginine-proline, porphyrin-chlorophyll, pyrimidine, primary bile acid biosynthesis, and cyanoamino acid metabolic pathways. CONCLUSION: Tuina therapy has proven to be effective in reducing body temperature and down-regulating PGE2 expression in LPS-induced febrile young rabbits, with its mechanism of fever-reducing action possibly associated with the changes in plasma metabolites and metabolic pathways.

Background:The management of LT patients during COVID-19 pandemic is important. Immunosuppressants (IS) are key therapy agents after liver transplant. Different ISs have different side effects. Calcineurin inhibitor (CNI) may lead to metabolic acidosis while mycophenolate mofetil (MMF) showed rare nephrotoxicity. We report a post-liver transplant girl who was infected with SARS-CoV-2, developing a severe mixed acidosis 3 months after the transplantation. Her acidosis was improved after withdrawing of MMF, leading the suspicion that acidosis maybe a rare side effect of MMF.Case presentation:A girl was admitted to our hospital due to SARS-CoV-2 infection, 3 months before admission the patient received LT due to Niemann-Pick disease (NPD). During hospitalization, blood gas analysis showed severe mixed acidosis. To relieve mixed acidosis, the patient was given oral rehydration salt and liquid replacement therapy. Considering that immunosuppressants may cause metabolic acidosis, dose of CsA was decreased and MMF was discontinued.Results:However, liquid replacement therapy and decreased CsA dose cannot improve the condition. As an attempt, MMF was discontinued, and 3 days later, the girl's acidosis was relieved, the latest blood gas analysis was normal with the original dose of CsA and no use of MMF or other IS. In addition, we used Naranjo Scale to see if adverse drug reactions (ADRs) existed. The final score was 6 which means MMF contributes to acidosis probably.Conclusion:The girl's mixed acidosis cannot be explained by Niemann-Pick disease and SARS-CoV-2 infection. CNIs could cause metabolic acidosis but declining the dose of CsA didn't improve her acidosis while withdrawing MMF showed a good effect. Together with the Naranjo Scale result, we suspect that acidosis maybe a rare side effect of MMF.

BACKGROUND:Gut microbiota alterations have been implicated in the pathogenesis of coronavirus disease 2019 (COVID-19). This study aimed to explore gut microbiota changes in a prospective cohort of COVID-19 children and their asymptomatic caregivers infected with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) Omicron variant.METHODS:A total of 186 participants, including 59 COVID-19 children, 50 asymptomatic adult caregivers, 52 healthy children (HC), and 25 healthy adults (HA), were recruited between 15 April and 31 May 2022. The gut microbiota composition was determined by 16S rRNA gene sequencing in fecal samples collected from the participants. Gut microbiota functional profiling was performed by using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) software.RESULTS:The gut microbiota analysis of beta diversity revealed that the fecal microbial community of COVID-19 children remained far distantly related to HC. The relative abundances of the phyla Actinobacteria and Firmicutes were decreased, whereas Bacteroidetes, Proteobacteria, and Verrucomicrobiota were increased in COVID-19 children. Feces from COVID-19 children exhibited notably lower abundances of the genera Blautia, Bifidobacterium, Fusicatenibacter, Streptococcus, and Romboutsia and higher abundances of the genera Prevotella, Lachnoclostridium, Escherichia-Shigella, and Bacteroides than those from HC. The enterotype distributions of COVID-19 children were characterized by a high prevalence of enterotype Bacteroides. Similar changes in gut microbiota compositions were observed in asymptomatic caregivers. Furthermore, the microbial metabolic activities of KEGG (Kyoto Encyclopedia of Genes and Genomes) and COG (cluster of orthologous groups of proteins) pathways were perturbed in feces from subjects infected with the SARS-CoV-2 Omicron variant.CONCLUSION:Our data reveal altered gut microbiota compositions in both COVID-19 children and their asymptomatic caregivers infected with the SARS-CoV-2 Omicron variant, which further implicates the critical role of gut microbiota in COVID-19 pathogenesis.

脑-肠轴理论是基于脑肠之间经络相通、生成充养与神明共统的生理特点而形成的.腹泻型肠易激综合征(IBS-D)病位在肠,与脑神密切相关.本研究以脑-肠轴相关理论阐释IBS-D的发病特点,认为邪客肠腑为发病的直接原因,肝郁脾虚为本病的主要病机,脾肾阳虚为疾病迁延难愈的关键因素.在脑-肠轴理论指导下,针对病因病机提出脑肠同调取主穴,通肠腑取上巨虚、天枢、足三里与公孙,调脑神取百会、神庭、本神与内关,同时根据症状辨证论治选取配穴,以期为针灸治疗IBS-D提供一定的理论依据.

临床中周围性面瘫是常见的神经性病变,与中枢性面瘫具有明确鉴别要点.但脑干梗死导致周围性面瘫,易与Bell麻痹相混淆,两者在临床中的针刺治疗策略各有侧重,因此准确判断病因具有重要意义.

Background:Intestinal dysbiosis has been increasingly implicated in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Acupuncture has been shown to have beneficial effects on NAFLD, but the mechanism is not yet clear. This study explores the potential beneficial effects of acupuncture on intestinal microbiota in NAFLD.Methods:An NAFLD model in Sprague Dawley rats was established using a high-fat diet (HFD) for 10  weeks. NAFLD rats were randomly divided into control, model, and acupuncture groups. Following acupuncture treatment over 6 weeks, automated biochemical analysis was used to measure serum lipid metabolism parameters, including levels of alanine transferase, aspartate transferase, alkaline phosphatase, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. The level of serum inflammatory factors interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha (TNF-α) were measured by enzyme-linked immunosorbent assay. The characteristics of steatosis were evaluated using quantitative computed tomography, hematoxylin and eosin staining, and Oil Red O staining in the liver, while the intestinal microbiota was determined using 16S rRNA gene sequencing.Results:Acupuncture decreased the systemic inflammatory response, ameliorated dyslipidemia, and improved liver function indexes in NAFLD model rats. Tomography and staining indicated that acupuncture reduced steatosis and infiltration of inflammatory cells in the liver. 16S rRNA analysis showed that acupuncture reduced the Firmicutes to Bacteroidetes (F/B) ratio, increased the abundance of microbiota, including Bacteroidales_S24-7_group, Prevotellaceae, Bacteroidaceae, Blautia, norank_f_Bacteroidales_S24-7_group, Bacteroides, and Prevotella_9, and decreased the abundance of Ruminococcaceae_UCG-014. Correlation analysis suggested a close correlation between lipid metabolism, inflammation factors, hepatic steatosis, and the changed intestinal microbiota.Conclusion:Acupuncture can significantly improve lipid metabolism and the systemic inflammatory response in HFD-induced NAFLD rats, potentially by regulating intestinal microbiota composition.

Objective To compare the effects of 2 Hz continuous wave and 2 Hz/100 Hz dilatational wave set-ting in electroacupuncture(EA)on ovulation frequency,hormone levels,body fat parameters,quality of life and depression-anxiety level in polycystic ovary syndrome(PCOS)patients with abdominal obesity.Methods PCOS pa-tients with abdominal obesity were randomly divided into low-frequency group(n=29)and dilatational wave group(n= 29).Patients in both groups were treated with"Tongtiaodaimai"(regulating Dai Meridian)acupuncture therapy,and EA was applied to bilateral Daimai(GB26),Tianshu(ST25),Shenshu(BL23)and Ciliao(BL32).The low-frequency group received EA using a continuous wave at a frequency of 2 Hz,while the dilatational wave group received dilata-tional wave at a frequency of 2 Hz/100 Hz.Both groups received treatment for 30 min each time,3 times per week for 12 consecutive weeks.Ovulation frequency was calculated according to the ovulation cycle.The contents of serum anti-Mullerian hormone(AMH)and sex hormone binding globulin(SHBG)were detected with electrochemiluminescence method.Body weight(BW)and waist circumference(WC)were measured,and body mass index(BMI)and waist-height ratio(WHtR)were calculated.PCOS questionnaire(Chi-PCOSQ),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were evaluated.Results Compared with before treatment,both the low-frequency group and the dilatational wave group showed an increase in ovulation frequency(P<0.01,P<0.05),and a decrease in BW,BMI,WC,WHtR,and SDS score(P<0.01,P<0.05);the dilatational wave group showed decreased serum AMH contents(P<0.05)and increased serum SHBG contents(P<0.05),the scores related to acne,fatigue,and dysmenor-rhea in the Chi-PCOSQ increased(P<0.01,P<0.05).Compared with the low-frequency group,the dilatational wave group showed a reduction(P<0.05)in WC after treatment.Conclusion 2 Hz/100 Hz dilatational wave EA is equally effective as 2 Hz low-frequency EA in improving ovulation frequency.In terms of reducing WC in abdominal obesity type PCOS patients,2 Hz/100 Hz dilatational wave EA is superior to 2 Hz low-frequency EA.2 Hz/100 Hz dilatational wave EA can decrease serum AMH,increase serum SHBG,and improve symptoms of acne,fatigue,and dysmenorrhea.

针灸学是一门以经络腧穴理论为基础,实践性很强的临床医学学科,要求学生能够理论联系实践完成专业知识的学习.腧穴解剖结构是针灸理论的主要内容,肌骨超声可对肌肉、肌腱、韧带、神经等组织进行成像,已广泛应用于临床与教学.针对肌骨超声的优势和CBL教学模式的特点,将肌骨超声引入CBL教学模式中,可推动临床情景式、病案驱动式教学改革,提高针灸科临床实践教学质量.

Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare X-linked recessive immunodeficiency caused by mutations in the forkhead box protein 3 (FOXP3) gene. IPEX is characterized by the onset of intractable diarrhea, type 1 diabetes mellitus (T1DM), and eczema in the early stages of life. The typical clinic triad for IPEX is not always seen. Here, we report a 15-year-old male patient with atypical IPEX syndrome complicated with severe eosinophilic gastritis (EG) and pyloric stenosis. The patient had noticeable eczema during the first year of life and had a history of food allergies. At the age of 3 years, the patient was diagnosed with EG, Helicobacter pylori (HP) infection, pyloric stenosis with recurrent vomiting, and failure to thrive. The patient did not respond to long-term symptomatic treatments in the following years, including methylprednisolone, proton pump inhibitors (PPI), L-glutamine and sodium gualenate granules, anti-HP therapy, and balloon dilation. At the age of 12 years, the patient received surgical interventions, including a laparoscopic jejunostomy feeding tube placement, gastrojejunal anastomosis bypass, and jejunal-jejunal end-to-side anastomosis. Intractable diarrhea and T1DM were not present in the patient. At the age of 14 years, the patient was diagnosed with IPEX syndrome due to a c.748-750del (plys250del) mutation in the leucine zipper domain of the FOXP3 protein. The patient underwent matched sibling peripheral blood hematopoietic stem cell transplantation (HSCT) and showed good evolution after 3 months of HSCT. In summary, this case report provides information of unusual gastrointestinal findings in IPEX syndrome and highlights the need for increased awareness and early diagnosis of IPEX syndrome, which is vital for improving the patient's outcome.