1
|
Xu MM, Li N, Hu TN, Zhou ZK, Chen Y, Huang X, Wei Y, Guo Y. Efficacy and underlying mechanisms of three-circle post standing qigong on insomnia in college students: a four-arm, double-blind, randomized controlled trial protocol. BMC Complement Med Ther 2024; 24:239. [PMID: 38890651 PMCID: PMC11184881 DOI: 10.1186/s12906-024-04544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Insomnia is common in college students, but its impact on health and wellbeing is often neglected. Enhancing sleep quality through targeted interventions could improve overall health and reduce the risk of consequent co-morbidities and mental health problems. Qigong exercises have been shown to significantly improve sleep quality and relieve insomnia. Three-circle Post Standing (TCPS) can help integrate body, breath, and mind, a fundamental principle of Qigong that promotes holistic wellbeing. In this clinical trial, we aim to (1) evaluate the feasibility, safety, and therapeutic efficacy of administering TCPS to improve sleep quality and quality of life in college students with insomnia; (2) explore the neurophysiological mechanisms underlying the mind adjustments mediated by TCPS in insomnia; (3) investigate body and breath pathophysiology mediated by TCPS in insomnia; and (4) assess the long-term efficacy of TCPS in terms of sleep quality and quality of life. METHODS This will be a prospective, parallel, four-arm, double-blind randomized controlled trial to investigate the effects and underlying mechanisms of TCPS on college students with insomnia. One hundred college students meeting diagnostic criteria for insomnia will be randomly assigned to receive either 14 weeks of standardized TCPS training (two weeks of centralized training followed by 12 weeks of supervised training) or sham-control Post Standing training. Efficacy outcomes including sleep quality, quality of life, neurophysiological assessments, plantar pressure, biomechanical balance, and physical measures will be collected at baseline, eight weeks (mid-point of supervised training), and 14 weeks (end of supervised training). Sleep quality and quality of life will also be evaluated during the four- and eight-week follow-up. DISCUSSION This trial will be an important milestone in the development of new therapeutic approaches for insomnia and should be easily implementable by college students with insomnia. The neuro- and pathophysiological assessments will provide new insights into the mechanisms underlying TCPS. CLINICAL TRIAL REGISTRATION This trial has been registered in the China Clinical Trials Registry (registration number: ChiCTR2400080763).
Collapse
Affiliation(s)
- Ming-Min Xu
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Nan Li
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Tian-Nuo Hu
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Zheng-Kun Zhou
- International Liaison Department, World Federation of Chinese Medicine Societies, Beijing, China
| | - Yue Chen
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xue Huang
- Yangfang Outpatient Department, Northern District of People's Liberation Army General Hospital, Beijing, China.
| | - Yulong Wei
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
| | - Yu Guo
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, China.
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China.
| |
Collapse
|
2
|
Wang M, Lyu B. Effect of 24-form simplified Tai Chi on executive inhibitory control of college students: a randomized controlled trial of EEG. Front Psychol 2024; 15:1344989. [PMID: 38515964 PMCID: PMC10955120 DOI: 10.3389/fpsyg.2024.1344989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
Background College students, undergoing crucial cognitive development, face challenges during the COVID-19 pandemic that impact their executive functions. While existing research indicates positive effects of Tai Chi (TC) on college students' cognitive abilities, there is a scarcity of studies investigating its impact on executive functions and frontal brain activity. Objective This study aimed to compare the effects of 24-form simplified TC training on college students' executive functions and frontal brain electrical activity. The hypothesis posited that the TC group would exhibit superior performance compared to the control group during COVID-19 pandemic. Method Seventy college students were randomly assigned to either TC group or control group, engaging in 36 sessions (3 sessions per week, 45 min each) over 12 weeks. Executive inhibitory control was assessed using the Stroop Color and Word Test, and resting brain electrical activity in the frontal area was recorded through Electroencephalography. Result ACC was influenced by group, group-time interaction, and Stroop task-time interaction. RT was affected by time, task condition, task condition-time interaction, and task condition-group interaction. Notably, the TC group showed improved ACC (from 96.54 ± 3.27% to 98.90 ± 1.32%) and decreased RT (from 0.73 ± 0.12 to 0.66 ± 0.07 s), particularly in the inconsistent task. Regarding EEG band power, significant Group and Time interaction effects were found in F3-θ, F3-α, F3-β, F4-θ, and F4-α. Moreover, within the TC group, significant increases in F3-θ band power (from 4.66 ± 3.55 to 7.71 ± 8.44) and F4-θ band power (from 4.41 ± 2.82 to 8.61 ± 9.51) (10-3·μV·Hz) were noted pre-and post-tests. In the control group, significant decreases were observed in F3-α band power (from 5.18 ± 4.61 to 2.79 ± 2.11) and F4-α band power (from 5.57 ± 6.58 to 2.48 ± 1.95) (10-3·μV·Hz). Conclusion The pandemic-induced panic may impact frontal lobe brain activity in college students. TC training not only improves executive inhibitory control but may also enhance localized brain activity, suggesting its potential as a holistic intervention for cognitive and neurological well-being during stressful periods.
Collapse
Affiliation(s)
- Min Wang
- Public Sports Department, Institute of Physical Education, Huzhou University, Huzhou, Zhejiang, China
| | - Bei Lyu
- Chinese Graduate School, Panyapiwat Institute of Management, Nonthaburi, Thailand
| |
Collapse
|
3
|
Dong Y, Zhang X, Zhao R, Cao L, Kuang X, Yao J. The effects of mind-body exercise on anxiety and depression in older adults: a systematic review and network meta-analysis. Front Psychiatry 2024; 15:1305295. [PMID: 38384592 PMCID: PMC10879425 DOI: 10.3389/fpsyt.2024.1305295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Background Limited research directly compares the clinical effects of different types of mind-body exercises on anxiety and depression in older adults. Therefore, we conducted a systematic review and network meta-analysis of randomized controlled trials that meet the inclusion criteria to explore the intervention effects of five different types of mind-body exercises in improving anxiety and depression in older adults. Methods We followed the PRISMA-NMA guidelines and conducted searches in the Web of Science, PubMed, the Cochrane Library, and Embase databases up to July 28, 2023. The language was limited to English. Two independent reviewers conducted literature screening and data extraction. Review Manager 5.4 was used to perform Pairwise meta-analysis and risk assessment, while STATA version 15 software was used for network meta-analysis. Result A total of 42 studies, involving 2974 participants, were included. The results of the traditional meta-analysis showed that mind-body exercises were superior to the control group in alleviating anxiety (SMD: -0.87, 95% CI: -1.43, -0.31, p<0.05, I2 = 95%) and depressive (SMD: -0.52, 95% CI: -0.71, -0.34, p<0.05, I2 = 80%). In the network meta-analysis, the ranking of treatment effects for anxiety showed that Tai Chi > Qigong > Yoga > Dance > control group, while for depression, the ranking showed Tai Chi > Pilates > Yoga > Qigong > Dance > control group. Conclusion This study found that mind-body exercises have positive effects on improving anxiety and depression in older adults. Among the five different types of mind-body exercise interventions, Tai Chi was considered an effective approach for improving anxiety and depression. However, we encourage older adults to choose exercise modalities that suit their interests to enhance adherence. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023464296.
Collapse
Affiliation(s)
- Yangjian Dong
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
- College of Physical Education, China Three Gorges University, Yichang, China
| | - Xinxin Zhang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Rongting Zhao
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Lan Cao
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Xiaoqin Kuang
- College of Physical Education and Health, Guilin University, Guilin, China
| | - Jiwei Yao
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| |
Collapse
|
4
|
Laskosky NA, Huston P, Lam WC, Anderson C, Zhong LLD. Are Tai Chi and Qigong effective in the treatment of traumatic brain injury? A systematic review. BMC Complement Med Ther 2024; 24:78. [PMID: 38321432 PMCID: PMC10845721 DOI: 10.1186/s12906-024-04350-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) adversely affects both young and old and is a growing public health concern. The common functional, psychological, and cognitive changes associated with TBI and recent trends in its management, such as recommending sub-threshold aerobic activity, and multi-modal treatment strategies including vestibular rehabilitation, suggest that Tai Chi/Qigong could be beneficial for TBI. Tai Chi and Qigong are aerobic mind-body practices with known benefits for maintaining health and mitigating chronic disease. To date, no systematic review has been published assessing the safety and effectiveness of Tai Chi/Qigong for traumatic injury. METHODS The following databases were searched: MEDLINE, CINAHL Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. All people with mild, moderate, or severe TBI who were inpatients or outpatients were included. All Types of Tai Chi and Qigong, and all comparators, were included. All measured outcomes were included. A priori, we chose "return to usual activities" as the primary outcome measure as it was patient-oriented. Cochrane-based risk of bias assessments were conducted on all included trials. Quality of evidence was assessed using the grading of recommendation, assessment, development, and evaluation (GRADE) system. RESULTS Five trials were assessed; three randomized controlled trials (RCTs) and two non-RCTs; only two trials were conducted in the last 5 years. No trial measured "return to normal activities" or vestibular status as an outcome. Four trials - two RCTs and two non-RCTS - all found Tai Chi improved functional, psychological and/or cognitive outcomes. One RCT had a low risk of bias and a high level of certainty; one had some concerns. One non-RCTs had a moderate risk of bias and the other a serious risk of bias. The one Qigong RCT found improved psychological outcomes. It had a low risk of bias and a moderate level of certainty. Only one trial reported on adverse events and found that none were experienced by either the exercise or control group. CONCLUSION Based on the consistent finding of benefit in the four Tai Chi trials, including one RCT that had a high level of certainty, there is a sufficient signal to merit conducting a large, high quality multi-centre trial on Tai Chi for TBI and test it against current trends in TBI management. Based on the one RCT on TBI and Qigong, an additional confirmatory RCT is indicated. Further research is indicated that reflects current management strategies and includes adverse event documentation in both the intervention and control groups. However, these findings suggest that, in addition to Tai Chi's known health promotion and chronic disease mitigation benefits, its use for the treatment of injury, such as TBI, is potentially a new frontier. SYSTEMATIC REVIEW REGISTRATION PROSPERO [ CRD42022364385 ].
Collapse
Affiliation(s)
| | - Patricia Huston
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Institut du Savoir Montfort (Research), University of Ottawa, Ottawa, Canada
| | - Wai Ching Lam
- School of Chinese Medicine, Hong Kong Baptist University, kowloon tong, Hong Kong, SAR, China
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Linda L D Zhong
- School of Chinese Medicine, Hong Kong Baptist University, kowloon tong, Hong Kong, SAR, China.
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore.
| |
Collapse
|
5
|
Sun J, Zhuo J, Chu H, Wang J, Chen T, Li B, Lu T, Zheng H, Xu Y, Dong J, Cicchella A. Effects of 3-month Qigong exercise on heart rate variability and respiration in anxious college students. Scand J Med Sci Sports 2024; 34:e14521. [PMID: 37815004 DOI: 10.1111/sms.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 09/18/2023] [Accepted: 10/01/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE This longitudinal study aimed to investigate the effects of Qigong on the anxiety state, heart rate variability (HRV), and breathing of anxious college students. METHODS A total of 37 individuals (18-25 years old) were randomly allocated to the control (n = 19) and intervention (n = 18) groups. Qigong interventions were conducted five times weekly for 12 weeks, with each session lasting 60 min. Hamilton Anxiety Scale, Fatigue Scale 14, Pittsburgh Sleep Quality Index, and 36-item Short Form Survey, HRV, and respiration data were collected before and after the 3-month intervention. RESULTS Individuals who participated in the three-month Qigong exercise intervention showed a significant reduction in anxiety, particularly mental anxiety (p < 0.05). Subjects in the intervention group presented a decrease in skin temperature (p < 0.05) and an increase in blood volume pulsation (p < 0.05). Meanwhile, HRV exhibited a significant increase in the standard deviation of interbeat interval before and after comparisons (p < 0.05) and between the two groups (p = 0.039) and a reduction in the normalized low-frequency power after the intervention. Moreover, the intervention group experienced increased abdominal breathing depth and abdominal breathing per minute (p < 0.05). CONCLUSION These findings indicate that Qigong is an effective mind-body exercise strategy for relieving anxiety. HRV and breathing were improved accordingly among college students after the completion of the 3-month Qigong program.
Collapse
Affiliation(s)
- Jingyu Sun
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Jiatong Zhuo
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Hang Chu
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Jing Wang
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Tao Chen
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Bin Li
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Tianfeng Lu
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Hao Zheng
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Yaning Xu
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Jingmei Dong
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Antonio Cicchella
- International College of Football, Tongji University, Shanghai, People's Republic of China
| |
Collapse
|
6
|
Zhang T, Tian J, Fan J, Liu X, Wang R. Exercise training-attenuated insulin resistance and liver injury in elderly pre-diabetic patients correlates with NLRP3 inflammasome. Front Immunol 2023; 14:1082050. [PMID: 36817440 PMCID: PMC9929576 DOI: 10.3389/fimmu.2023.1082050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Background Diabetes is one of the most common metabolic diseases and continues to be a leading cause of death worldwide. The NLRP3 inflammasome has been shown to exert detrimental effects on diabetic models. However, evidence linking NLRP3 inflammasome and pre-diabetes has been scarcely explored. Herein, we aimed to determine whether the NLRP3 inflammasome correlates with insulin resistance and liver pathology in a cohort of pre-diabetic subjects. Methods 50 pre-diabetic subjects were randomly assigned to a Pre-diabetes Control (DC, n=25) and a Pre-diabetes exercise (DEx, n=25) group. 25 Normal subjects (NC) were selected as controls. The DEx group performed a 6-month combined Yijingjing and resistance training intervention, while DC and NC group remained daily routines. Clinical metabolic parameters were determined with an automatic biochemistry analyzer; inflammatory cytokines were quantified by the ELISA assay; the protein expressions of NLRP3 inflammasome components in PBMCs were evaluated by Western Blot. Results The insulin resistance, liver injury and NLRP3 inflammasome activity were higher in pre-diabetic individuals than in normal control group. However, 6-month exercise intervention counteracted this trend, significantly improved insulin sensitivity, reduced liver injury and inhibited the overactivation of NLRP3 inflammasome in pre-diabetic subjects. Moreover, positive correlations between insulin resistance, liver pathology and NLRP3 inflammasome were also found. Conclusions Our study suggests that exercise training is an effective strategy to alleviate insulin resistance and liver injury in elderly pre-diabetic subjects which is probably associated with the inhibition of NLRP3 inflammasome activity.
Collapse
Affiliation(s)
- Tan Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, China
| | - Jingjing Tian
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, China
| | - Jingcheng Fan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, China
| | - Xiangyun Liu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, China
| | - Ru Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
7
|
Cheng ZJ, Zhang SP, Gu YJ, Chen ZY, Xie FF, Guan C, Fang M, Yao F. Effectiveness of Tuina Therapy Combined With Yijinjing Exercise in the Treatment of Nonspecific Chronic Neck Pain: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2246538. [PMID: 36512354 PMCID: PMC9856335 DOI: 10.1001/jamanetworkopen.2022.46538] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Both tuina therapy and yijinjing exercise were beneficial to patients with nonspecific chronic neck pain, but the evidence for this combination is limited. OBJECTIVE To investigate the effectiveness of tuina therapy combined with yijinjing exercise compared with tuina therapy alone for patients with nonspecific chronic neck pain. DESIGN, SETTING, AND PARTICIPANTS A 12-week, open-label, analyst-blinded randomized clinical trial (8-week intervention plus 4-week observational follow-up) was conducted from September 7, 2020, to October 25, 2021. A total of 102 participants with nonspecific chronic neck pain were recruited, and data were analyzed from December 10, 2021, to March 26, 2022. INTERVENTIONS Participants in the tuina group or tuina combined with yijinjing group received 3 sessions of tuina therapy per week for 8 weeks, for a total of 24 sessions. Participants in the tuina combined with yijinjing group practiced yijinjing 3 times a week for 8 weeks, including an instructor-guided exercise at the hospital and 2 self-practice exercises at home. MAIN OUTCOMES AND MEASURES The primary outcome was change in visual analog scale (VAS) score from baseline to week 8. Secondary outcomes included Neck Disability Index scores, Self-rating Anxiety Scale scores, tissue hardness, and active range of motion. RESULTS This randomized clinical trial recruited 102 patients (mean [SD] age, 36.5 [4.9] years; 69 [67.6%] female) who were randomized to 2 groups. All 102 patients (100%) completed all the outcome measurements. The mean difference in VAS scores from baseline at week 8 for the tuina combined with yijinjing group was -5.4 (95% CI, -5.8 to -5.1). At week 8, the difference in VAS score was -1.2 (95% CI, -1.6 to -0.8; P < .001) between the tuina group and the tuina combined with yijinjing group. The effectiveness of tuina combined with yijinjing in treating nonspecific chronic neck pain remained at the 12-week follow-up. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, for patients with nonspecific chronic neck pain, tuina combined with yijinjing was more effective than tuina therapy alone in terms of pain, functional recovery, and anxiety at week 8, and effectiveness remained at week 12. A combination of tuina and yijinjing should be considered in the management of nonspecific chronic neck pain. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2000036805.
Collapse
Affiliation(s)
- Zi-ji Cheng
- Tuina Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuai-pan Zhang
- Tuina Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuan-jia Gu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zi-ying Chen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fang-fang Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chong Guan
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Tuina Department, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Yao
- Tuina Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|