Short-term effects of cupping and scraping therapy for chronic nonspecific low-back pain: A prospective, multicenter randomized trial

BACKGROUND

As one of the most common musculoskeletal ailments, chronic nonspecific low-back pain (CNLBP) causes persistent disability and substantial medical expenses. Epidemiological evidence shows that the incidence rate of CNLBP in young and middle-aged people who are demanded rapidly recovery and social contribution is rising. Recent guidelines indicate a reduced role for medicines in the management of CNLBP.

OBJECTIVE

The present study investigates the short-term effects of cupping and scraping therapy using a medicated balm, compared to nonsteroidal anti-inflammatory drug (NSAID) with a capsaicin plaster, in the treatment of CNLBP.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

We designed a prospective multicenter randomized clinical trial enrolling patients from January 1, 2022 to December 31, 2022. A total of 156 patients with CNLBP were randomized into two parallel groups. Diclofenac sodium-sustained release tablets were administered orally to participants in the control group for one week while a capsaicin plaster was applied externally. Patients in the test group were treated with cupping and scraping using a medical device and medicated balm.

MAIN OUTCOME MEASURES

Primary outcome was pain recorded using the visual analogue scale (VAS). Two secondary outcomes were recorded using the Japanese Orthopedic Association low-back pain scale (JOA) and the traditional Chinese medicine (TCM) syndrome integral scale (TCMS) as assessment tools.

RESULTS

Between baseline and postintervention, all changes in outcome metric scales were statistically significant (P < 0.001). Compared to the control group, patients in the test group had a significantly greater treatment effect in all outcome variables, as indicated by lower VAS and TCMS scores and higher JOA scores, after the one-week intervention period (P < 0.001). Further, according to the findings of multivariate linear regression analysis, the participants' pain (VAS score) was related to their marital status, age, smoking habits and body mass index. No adverse reactions were reported for any participants in this trial.

CONCLUSION

The effectiveness of TCM combined with the new physiotherapy tool is superior to that of NSAID combined with topical plasters, regarding to pain intensity, TCM symptoms and quality of life. The TCM plus physiotherapy also showed more stable and long-lasting therapeutic effects.

TRIAL REGISTRATION

This study was registered at Chinese Clinical Trial Registry (ChiCTR2200055655). Please cite this article as: He JY, Tu XY, Yin ZF, Mu H, Luo MJ, Chen XY, Cai WB, Zhao X, Peng C, Fang FF, Lü C, Li B. Short-term effects of cupping and scraping therapy for chronic nonspecific low-back pain: A prospective, multicenter randomized trial. J Integr Med. 2024; 22(1): 39-45.

[Multiple primary malignancies combined with SWI/SNF complex-deficient gastric cancer: a case report and literature review]

Multiple primary malignancies combined with SWI/SNF complex-deficient gastric cancer is a rare clinical entity and poorly documented. Herein we report a case of this disease in an 81-year-old male patient treated in our hospital. Before the established diagnosis of metachronous multiple primary malignancies, the patient received left lower lobectomy for a spaceoccupying mass in the left lung, which was confirmed by postoperative pathology as early stage lung cancer. SWI/SNF complex-deficiency gastric cancer with metastasis was subsequently detected by gastroscopy, and high-throughput sequencing identified ARID1A and TMB-H gene mutations in the tumor tissues. The patient received chemotherapy combined with immunotherapy but failed to respond to the treatment, and died 13 months later. We conducted a literature review and analyzed the occurrence, pathological and immunohistochemical characteristics, diagnosis, treatment and prognosis of this disease.

Physical exercise suppresses hepatocellular carcinoma progression by alleviating hypoxia and attenuating cancer stemness through the Akt/GSK-3β/β-catenin pathway

OBJECTIVE

Physical exercise, a common non-drug intervention, is an important strategy in cancer treatment, including hepatocellular carcinoma (HCC). However, the mechanism remains largely unknown. Due to the importance of hypoxia and cancer stemness in the development of HCC, the present study investigated whether the anti-HCC effect of physical exercise is related to its suppression on hypoxia and cancer stemness.

METHODS

A physical exercise intervention of swimming (30 min/d, 5 d/week, for 4 weeks) was administered to BALB/c nude mice bearing subcutaneous human HCC tumor. The anti-HCC effect of swimming was assessed in vivo by tumor weight monitoring, hematoxylin and eosin (HE) staining, and immunohistochemistry (IHC) detection of proliferating cell nuclear antigen (PCNA) and Ki67. The expression of stemness transcription factors, including Nanog homeobox (NANOG), octamer-binding transcription factor 4 (OCT-4), v-Myc avian myelocytomatosis viral oncogene homolog (C-MYC) and hypoxia-inducible factor-1α (HIF-1α), was detected using real-time reverse transcription polymerase chain reaction. A hypoxia probe was used to explore the intratumoral hypoxia status. Western blot was used to detect the expression of HIF-1α and proteins related to protein kinase B (Akt)/glycogen synthase kinase-3β (GSK-3β)/β-catenin signaling pathway. The IHC analysis of platelet endothelial cell adhesion molecule-1 (CD31), and the immunofluorescence co-location of CD31 and desmin were used to analyze tumor blood perfusion. SMMC-7721 cells were treated with nude mice serum. The inhibition effect on cancer stemness in vitro was detected using suspension sphere experiments and the expression of stemness transcription factors. The hypoxia status was inferred by measuring the protein and mRNA levels of HIF-1α. Further, the expression of proteins related to Akt/GSK-3β/β-catenin signaling pathway was detected.

RESULTS

Swimming significantly reduced the body weight and tumor weight in nude mice bearing HCC tumor. HE staining and IHC results showed a lower necrotic area ratio as well as fewer PCNA or Ki67 positive cells in mice receiving the swimming intervention. Swimming potently alleviated the intratumoral hypoxia, attenuated the cancer stemness, and inhibited the Akt/GSK-3β/β-catenin signaling pathway. Additionally, the desmin⁺/CD31⁺ ratio, rather than the number of CD31⁺ vessels, was significantly increased in swimming-treated mice. In vitro experiments showed that treating cells with the serum from the swimming intervention mice significantly reduced the formation of SMMC-7721 cell suspension sphere, as well as the mRNA expression level of stemness transcription factors. Consistent with the in vivo results, HIF-1α and Akt/GSK-3β/β-catenin signaling pathway were also inhibited in cells treated with serum from swimming group.

CONCLUSION

Swimming alleviated hypoxia and attenuated cancer stemness in HCC, through suppression of the Akt/GSK-3β/β-catenin signaling pathway. The alleviation of intratumoral hypoxia was related to the increase in blood perfusion in the tumor. Please cite this article as: Xiao CL, Zhong ZP, Lü C, Guo BJ, Chen JJ, Zhao T, Yin ZF, Li B. Physical exercise suppresses hepatocellular carcinoma progression by alleviating hypoxia and attenuating cancer stemness through the Akt/GSK-3β/β-catenin pathway. J Integr Med. 2022; Epub ahead of print.

Core muscle functional strength training for reducing the risk of low back pain in military recruits: An open-label randomized controlled trial

BACKGROUND

Core muscle functional strength training (CMFST) has been reported to reduce injuries to the lower extremity. However, no study has confirmed whether CMFST can reduce the risk of low back pain (LBP).

OBJECTIVE

This study identified the effects of CMFST on the incidence of LBP in military recruits.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTION

We performed a prospective, open-label, randomized, controlled study in a population of young healthy male naval recruits from a Chinese basic combat training program. Participants were randomly assigned to either the core group or the control group. In additional to normal basic combat training, recruits in the core group underwent a CMFST program for 12 weeks, while recruits in the control group received no extra training.

MAIN OUTCOME MEASURES

At the beginning of the study and at the 12th week, the number of participants with LBP was counted, and lumbar muscle endurance was measured. In addition, when participants complained of LBP, they were assessed using the visual analog scale (VAS) and Roland Morris Disability Questionnaire (RMDQ).

RESULTS

A total of 588 participants were included in the final analysis (295 in the core group and 293 in the control group). The incidence of LBP in the control group was about twice that of the core group over the 12-week study (20.8% vs 10.8%, odds ratio: 2.161-2.159, P < 0.001). The core group had better lumbar muscle endurance at 12 weeks than the control group ([200.80 ± 92.98] s vs [147.00 ± 84.51] s, P < 0.01). There was no significant difference in VAS score between groups, but the core group had a significantly lower RMDQ score at week 12 than the control group (3.33 ± 0.58 vs 5.47 ± 4.41, P < 0.05).

CONCLUSION

This study demonstrated that the CMFST effectively reduced the incidence of LBP, improved lumbar muscle endurance, and relieved the dysfunction of LBP during basic military training.

Aerobic exercise suppresses hepatocellular carcinoma by downregulating dynamin-related protein 1 through PI3K/AKT pathway

OBJECTIVE

Exercise, as a common non-drug intervention, is one of several lifestyle choices known to reduce the risk of cancer. Mitochondrial division has been reported to play a key role in the occurrence and transformation of hepatocellular carcinoma (HCC). This study investigated whether exercise could regulate the occurrence and development of HCC through mitosis.

METHODS

Bioinformatics technology was used to analyze the expression level of dynamin-related protein 1 (DRP1), a key protein of mitochondrial division. The effects of DRP1 and DRP1 inhibitor (mdivi-1) on the proliferation and migration of liver cancer cells BEL-7402 were observed using cell counting kit-8, plate colony formation, transwell cell migration, and scratch experiments. Enzyme-linked immunosorbent assay, Western blot and real-time polymerase chain reaction were used to detect the expression of DRP1 and its downstream phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway. A treadmill exercise intervention was tested in a nude mouse human liver cancer subcutaneous tumor model expressing different levels of DRP1. The size and weight of subcutaneous tumors in mice were detected before and after exercise.

RESULTS

The expression of DRP1 in liver cancer tissues was significantly upregulated compared with normal liver tissues (P < 0.001). The proliferation rate and the migration of BEL-7402 cells in the DRP1 over-expression group were higher than that in the control group. The mdivi-1 group showed an inhibitory effect on the proliferation and migration of BEL-7402 cells at 50 μmol/L. Aerobic exercise was able to inhibit the expression of DRP1 and decrease the size and weight of subcutaneous tumors. Moreover, the expression of phosphorylated PI3K (p-PI3K) and phosphorylated AKT (p-AKT) decreased in the exercise group. However, exercise could not change p-PI3K and p-AKT levels after knocking down DRP1 or using mdivi-1 on subcutaneous tumor.

CONCLUSION

Aerobic exercise can suppress the development of tumors partially by regulating DRP1 through PI3K/AKT pathway.

[Expert consensus on the strategy and measures to interrupt the transmission of schistosomiasis in China]

Since 2015 when the transmission of schistosomiasis was controlled in China, the country has been moving towards elimination of schistosomiasis, with the surveillance-response as the main interventions for schistosomiasis control. During the period of the 13th Five-Year Plan, the transmission of schistosomiasis had been interrupted in four provinces of Sichuan, Jiangsu, Yunnan and Hubei and the prevalence of schistosomiasis has been at the historically lowest level in China. As a consequence, the goal set in The 13th Five-Year National Schistosomiasis Control Program in China is almost achieved. However, there are multiple challenges during the stage moving towards elimination of schistosomiasis in China, including the widespread distribution of intermediate host snails and complicated snail habitats, many types of sources of Schistosoma japonicum infections and difficulty in management of bovines and sheep, unmet requirements for the current schistosomiasis control program with the currently available tools, and vulnerable control achievements. During the 14th Five-Year period, it is crucial to consolidate the schistosomiasis control achievements and gradually solve the above difficulties, and critical to provide the basis for achieving the ultimate goal of elimination of schistosomiasis in China. Based on the past experiences from the national schistosomiasis control program and the challenges for schistosomiasis elimination in China, an expert consensus has been reached pertaining to the objectives, control strategy and measures for The 14th Five-Year National Schistosomiasis Control Program in China, so as to provide insights in to the development of The 14th Five-Year National Schistosomiasis Control Program in China.

[Surveillance and control strategy of imported schistosomiasis mansoni: an expert consensus]

In 1980s, Biomphalaria straminea, an intermediate host of Schistosoma mansoni, was found in Shenzhen City, Guangdong Province, China, and currently, this snail has colonized in Shenzhen City and spread to peripheral cities involving of Dongguan and Huizhou. Since imported cases infected with S. mamoni have been reported from time to time in China, Mainland China is facing the potential risk of transmission of schistosomiasis mansoni. With the deepening of the opening-up policy, notably the implementation of the Belt and Road Initiative, there is an increase in the risk of transmission of schistosomiasis mansoni in Mainland China. Increasing the understanding on schistosomiasis mansoni, improving the awareness toward schistosomiasis mansoni prevention and control, and identifying, reporting and managing imported cases with S. mansoni infection or pathogen carriers, are of particular importance to prevent the development of entire life cycle of S. mansoni and the resultant schistosomiasis mansoni transmission in China. To protect public health, a consensus has been reached pertaining to the surveillance and control strategy of imported schistosomiasis mansoni by Chinese infectious disease experts and parasitologists, with aims to improve the awareness and capability for the diagnosis, treatment and control of imported schistosomiasis mansoni among Chinese disease control and prevention institutions and medical institutions, and decrease and even eliminate the risk of schistosomiasis mansoni transmission in China.

[The significance of Titin antibody in diagnosing myasthenia gravis with thymoma]

OBJECTIVE

To investigate the clinical significance of Titin antibody (Titin-ab) in diagnosing myasthenia gravis with thymoma (MGT).

METHODS

Titin-ab and acetylcholine receptor antibody (AChR-ab) in the sera of 73 MGT patients with different thymic pathological patterns and 58 MG patients without thymoma (NTMG) were detected by ELISA.

RESULTS

The positive rate of Titin-ab in MGT group was 76.7%, significantly higher than those of NTMG group, other neurologic diseases group and healthy control group (P < 0.01). The sensitivity of Titin-ab in diagnosis of MGT was significantly lower than that of CT scan or MR of thymus (P < 0.05), but the specificity of Titin-ab in diagnosis of MGT was significantly higher than that of CT scan or MR of thymus (P < 0.05). The positive rate of Titin-ab was mainly related to the thymic pathology and was the highest in the thymic epithelial thymoma (TET) subgroup (95.1%). There was no significant correlation between the positive rate of Titin-ab and the Masaoka's stage of thymoma (P > 0.05). The titer of Titin-ab was highly correlated to the titer of AChR-ab in MGT group (r = 0.496, P < 0.01), but not in MGH group (r = 0.385, P > 0.05).

CONCLUSION

Detection of Titin-ab is a rather sensitive, specific, handy method in diagnosis of MGT (especially TET). It may play an important role in the pathogenesis of MGT.

[Study on the level of plasma calcitonin gene-related peptide and adrenomedullin in subjects with primary osteoporosis]

OBJECTIVES

To explore if there is any change of the level of plama CGRP and ADM in primary osteoporosis.

METHODS

75 female subjects complaining of back pain, aged from 34-70 years, were included in present study. The plasma level of CGRP and ADM was determined by radioimmunoassay. The bone mineral density (BMD) of lumber spine and hip of these patients was also examined by dual-energy X-ray absorptiometry (DEXA). According to the WHO osteoporosis criteria, these patients were divided into three groups: normal BMD (as control), osteopenia and osteoporosis.

RESULTS

Plasma level of CGRP and ADM of lumbar osteoporosis are 37 ng/L +/- 7 ng/L and 50 ng/L +/- 11 ng/L respectfully, while those of lumber osteopenia are 38 ng/L +/- 7 ng/L and 49 ng/L +/- 11 ng/L, they are significantly higher than those of normal lumber bone mineral density, which are 29 ng/L +/- 6 ng/L and 38 ng/L +/- 8 ng/L(F = 5.60 or 9.60, P < 0.05 or 0.01). The plasma level of ADM of hip and ward's osteoporosis (49 ng/L +/- 13 ng/L and 49 ng/L +/- 11 ng/L) is also higher than that of the control (F = 5.43 and 4.66, P < 0.05). Group of lumbar osteopenia also has higher level of CGRP and ADM than the control. (37 ng/L +/- 7 ng/L) and 38 ng/L +/- 6 ng/L, P < 0.05).

CONCLUSIONS

Plasma level of CGRP and ADM is significantly increased in subjects with osteoporosis. CGRP and ADM may play a role in the mechanism of etiology of primary osteoporosis.

[Relationship between growth potential of pine, population density of Monochamus alternatus and pathogenicity of Bursaphlenchus xyloophilus]

The results showed that the growth potential of pine (x) is negative related to the population density of Monochamus alternatus (y) and the pathoyenecity of Bursaphlenchus xyloophilus (z). But the population density of Monochamus alternatus is positively related to the pathogenicity of Bursaphlenchus xyloophilus. Three linear equations regression line were established as y = 1793.771 - 16404.47x, z = 31.80989 - 241.9274x, y = -407.611 + 70.51478z. Correlation coefficient is -0.8139, -0.8770 and +0.9864 respectively.

[In vitro studies on the bioactive materials released by lung fibroblasts in experimental pulmonary fibrosis]

OBJECTIVES

The purpose of the present study was to clarify the consecutive changes and roles of hyaluronan (HA), interleukin-8 (IL-8) and collagen production by lung fibroblasts in the course of pulmonary fibrosis.

METHODS

Quantitative and comparative assessments of the HA, IL-8 and collagen (presented by hydroproline; HYP) levels in lung fibroblast-conditioned media were made at various stages during the development of bleomycin-induced pulmonary fibrosis in rats.

RESULTS

In lung fibroblast-conditioned media of bleomycin-treated animals: (1) The HA levels increased significantly on day 1, peaked on day 3, and then gradually declined and returned to control values on days 14 - 28. (2) The IL-8 levels strikingly increased on day 1, reached the peak values on day 7, thereafter, gradually decreased, regained control values by day 28. (3) The collagen levels increased significantly on day 7, peaked on day 14, and then gradually declined, However, remained significantly above normal values on day 28. (4) In bleomycin group, the HA and IL-8 levels both significantly correlated to cell components in BALF.

CONCLUSIONS

The lung fibroblasts were activated, produced increased HA and IL-8, and were the main source of HA and IL-8 within the lung in the early stage of pulmonary fibrosis; increased HA and IL-8 synthesis of lung fibroblasts might reflect the intensity of alveolitis and the disease activity; The excessive collagen deposition within the lung primarily occurred at the middle stage of pulmonary fibrosis.

[Studies on pulmonary fibrosis induced by interstitial macrophages]

OBJECTIVE

To evaluate the role of interstitial macrophages (IMs) in modulating the proliferative capacity of fibroblast(FB).

METHOD

IMs isolated by collagenase IA digestion of disaggreted lung tissues from bleomycin-treated rats were studied in this regard. The culture supernatants of alveolar macrophages(AMs) and of IMs were added to culture media of FBs.

RESULT

The releases of growth factors by the two sub-populations of macrophage were already elevated on 1st day following bleomycin instillation, and peaked on 7th day at a level nearly 3-fold above that of control groups(IM 342%, AM 332%, P < 0.01), the proliferative capacity was correlated well with the levels of TNF alpha and PDGF (r = 0.657, 0.713, P < 0.01).

CONCLUSION

Not only AMs, but also IMs could release growth factors to modulate the proliferation of FBs in vitro. IMs might be of more significance in maintenance of the process of pulmonary fibrosis because of its proximity to FBs.

Homozygous deletion of the p16/MTS1 gene in pediatric acute lymphoblastic leukemia is associated with unfavorable clinical outcome

The p16 gene (MTS1, CDKN2, p16INK4A, CDKI) encoding an inhibitor of cyclin-dependent kinase 4 (cdk4) has been found to be deleted in various types of tumors, including leukemia, and is thought to code for a tumor suppressor gene. Our preliminary findings on eight pediatric patients with acute lymphoblastic leukemia (ALL) suggested that the survival of patients carrying a homozygous p16 gene deletion was significantly inferior to that of those without a deletion. The present study on 48 patients tested the hypothesis that the clinical outcome for pediatric ALL patients is correlated with the presence or absence of the p16 gene. Overall, nine of 48 children (18.3%) carried a homozygous p16 deletion. Such deletions were significantly more common (P = .003) among T-ALL patients (five of eight, 62.5%) than among precursor-B-ALL patients (four of 40, 10.0%). Of nine patients exhibiting p16 deletions, eight (88.9%) were classified as high-risk patients by the recognized prognostic factors of age, white blood cell count, and T-cell phenotype. The 4-year event-free survival in the study population as a whole was 72.7%. Without adjustment for other risk factors (univariate model), the presence of a homozygous p16 deletion was associated with a markedly increased probability of both relapse (P = .0003) and death (P = .002). These findings raise the question of whether the p16 deletion itself confers an increased risk of relapse after adjusting for the known risk factors. In this analysis, the estimated risk multiplier factor for relapse in patients carrying the p16 deletion was 14.0 (P = .0004) and for the risk of death 15.6 (P = .0008). We therefore conclude that the presence of a homozygous p16 deletion may well be an important risk factor for both relapse and death in childhood ALL, and that its prognostic effect is not a consequence of confounding by other factors already known to influence outcome in this disease.

[The influence of basement membrane matrix on the attachment of human gingival epithelial cell to titanium: a scanning electron microscopic study]

In order to investigate the factors which could enhance the integrity of the biological seal between implant and epithelial cells, basement membrane matrigel was coated on the surface of smooth pure titanium. SEM observations showed that the spreading of primary cultured human gingival epithelial cells on Matrigel coated titanium surface was better than that of control groups on the third and the sixth day. This result suggests that the attachment of human gingival epithelial cells to titanium can be enhanced by the basement membrane matrigel.

[Frequency of medical consultation as reflected in 2 representative surveys: DHP-Survey and EVaS-Study (German Cardiovascular Disease Prevention and Survey of Ambulatory Care)]

The frequency of patient-doctor contacts in outpatient care is determined via two representative inquiries supplying complementary perspectives. They concern, on the one hand, a sample of contacts in the consultation room, and, on the other hand, contacts as stated in a population-based survey. In the 25-69 years age bracket, both surveys yielded a contact incidence of 2 to more than 5 contacts per person and quarter of a year. The figure is higher in women than in men. Both surveys agree very well if the consultation-room survey is limited to personal contacts between the doctor and the patient. The distribution of contacts over specialties is similar in both surveys. Compared to other countries, the frequency of outpatient consultations is high in the Federal Republic of Germany. Periodic surveys help to get insight into frequency and structure of medical services.

[Rapid diagnosis of experimental tumor by FITC-Con A lectin--a comparative study of smear and section specimens]

FITC-Con A staining as a rapid diagnostic method for tumor cells was applied to the tumors smeared on glass slide and section specimens to evaluate the reactivity with FITC-Con A. Good staining results were obtained in smear specimens with clear fluorescence on the membrane of tumor cells. Con A and LCH lectins bound well with tumor cells to produce strong fluorescence in comparison with PEA and DBA. It indicates that tumor cells expressed dominantly the receptors of alpha-D-glucose and alpha-D-mannose sugar chain on the membrane of tumor cells. From these results it was concluded that FITC-Con A staining method applied to smear specimens is more advantageous in the rapidity and the simplicity for tumor cell diagnosis than section specimen method.