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Background: Manual therapy (MT) is frequently used in combination with management of osteoarthritis of the knee, but there is no consensus on the exact efficacy of this treatment strategy. The purpose of this systematic review and meta-analysis was to evaluate the pain relief and safety of MT for treatment of knee osteoarthritis (KOA). Methods: Randomized controlled trials evaluating MT in patients with KOA in major English and Chinese journals were searched in the following databases: Wanfang, China Science and Technology Journal Database (VIP database), China National Knowledge Infrastructure (CNKI), PubMed, Embase, Web of Science, and the Cochrane Library databases through June 2023. The methodological quality and quality of evidence of the included studies were assessed using Cochrane's risk-of-bias 2 (ROB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Data analysis was performed using Stata version 15.0 software. After use of Galbraith plots to exclude studies that could lead to heterogeneity, random effects models were used to analyze the remaining data and test the consistency of the findings. We used meta-regression to assess the effect of treatment period, patient age, and sex ratio on outcomes. Funnel plots and Egger's test were used to evaluate publication bias. Sensitivity analyses were used to determine the reliability of the results. Results: A total of 25 studies, with 2376 participants, were included in this review. The overall methodological quality of the included studies was limited. Our findings suggest that MT has a positive impact on pain relief outcomes in KOA patients. The meta-analysis showed that MT was superior to usual care (SMD = 2.04, 95% CI 0.94, 3.14, I2 = 96.3%; low evidence quality) and exercise (SMD = 1.56, 95% CI 0.41, 2.71, I2 = 96.3%; low evidence quality) for reducing pain. In terms of improvement in visual analogue scale (VAS) scores, MT treatment beyond 4 weeks (SMD = 1.56, 95% CI 0.41, 2.71, I2 = 96.3%) may be superior to treatments less than or equal to 4 weeks (SMD = 1.24, 95% CI 0.56, 1.95, I2 = 94.7%). No serious adverse events associated with MT were reported. Conclusions: MT may be effective at reducing pain in patients with KOA and may be more effective after a 4-week treatment period. Compared with usual care and exercise therapy, MT may be superior at reducing KOA pain in the short term (9 weeks), but its long-term efficacy requires careful consideration of evidence-based outcomes. MT appears to be safe for KOA patients, though clinicians should inform patients of the potential risk of MT-related adverse events. [ABSTRACT FROM AUTHOR]

Spinel-type CuFe2O4 nanoparticles were synthesized by a solvothermal method using ethylene glycol as solvent and polyvinylpyrrolidone (PVP) as dispersant. The characterization results showed that the average diameter of the hollow-spherical CuFe2O4 was approximately 100 nm with homogeneous morphology and negligible agglomeration. CuFe2O4 was used as the active electrode material to explore its supercapacitive properties in different concentrations of KOH electrolytes. It was found that the CuFe2O4 hollow-spherical nanoparticles exhibit potential electronic performance in supercapacitor, with a specific capacitance of 368.2 F/g and capacitance stability retention of 91.0% after 2000 cycles at the current density of 5 A/g in 3 mol/L KOH electrolyte. The present findings demonstrate that the CuFe2O4 electrode materials can have important implications with practical prospects in energy storage systems. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is associated with changes in gait and posture, which increases the rate of falls and injuries in this population. Tai Chi (TC) training enhances the movement capacity of patients with PD. However, the understanding of the effect of TC training on gait and postural stability in PD is lacking. This study aims to examine the effect of biomechanical-based TC training on dynamic postural stability and its relationship with walking performance. Methods/design: A single-blind, randomized control trial of 40 individuals with early-stage PD was conducted (Hoehn and Yahr stages 1 to 3). Patients with PD will be randomly assigned to either the TC or control group. The TC group will participate in a biomechanical-based TC training program that is formed based on the movement analysis of TC and will be practiced thrice a week for 12 weeks. The control group will be required to engage in at least 60 min of regular physical activity (PA) on their own for three times per week for 12 weeks. The primary and secondary outcomes will be assessed at baseline and at 6 and 12 weeks after commencing the study protocol. The primary outcome measures will include dynamic postural stability indicated by the center of mass and center of pressure separation distance and clearance distance of the heel and toe measured during fixed-obstacle crossing. The secondary measures are gait speed, cadence, step length during level surface walking (simple task), and fixed-obstacle crossing (challenging task). The Unified Parkinson's Disease Rating Scale, single leg-stance test with eyes open and closed, and three cognitive scores (Stroop Test, Trail Making Test Part B, and the Wisconsin Card Sorting Test) were also employed. Discussion: This protocol could lead to the development of a biomechanics TC training program for the improvement of gait and postural stability among individuals with PD. The program could enhance the understanding of the effect of TC training on gait and postural stability and could help improve or preserve the postural stability, self-confidence, and active participation in social activities of the participants, thus enhancing their overall quality of life. Trial registration: ClinicalTrials.gov NCT04644367. Registered on 25 November 2020. [ABSTRACT FROM AUTHOR]

Storm surge has the potential to significantly increase suspended sediment flux to microtidal marshes. However, the overall effects of storm surge on microtidal marsh deposition have not been well quantified, with most modeling studies focusing on regular (astronomical) tidal flooding. Here we applied the Delft3D model to a microtidal bay‐marsh complex in Hog Bay, Virginia to quantify the contributions of storm surge to marsh deposition. We validated the model using spatially distributed hydrodynamic and suspended sediment data collected from the site and ran model simulations under different storm surge conditions with/without storm‐driven water level changes. Our results show that episodic storm surge events occurred 5% of the time at our study site, but contributed 40% of marsh deposition during 2009–2020. Our simulations illustrate that while wind‐driven waves control sediment resuspension on tidal flats, marsh deposition during storms was largely determined by tidal inundation associated with storm‐driven water levels. A moderate storm surge event can double sediment flux to most marshes around the bay and deliver more sediment to the marsh interior compared to simulations that include wind waves but not storm surge variations in water levels. Simulations of bay and marsh response to different storm surge events with varying magnitude of storm surge intensity reveal that total marsh deposition around the bay increased linearly with storm surge intensity, suggesting that future changes to storm magnitude and/or frequency would have significant implications for sediment supply to marshes at our study site. Plain Language Summary: Storm surge is a rise of water level beyond normal tidal levels caused by a storm. It can result in longer and deeper inundation on the marsh platform and potentially provide more sediment for microtidal marshes (tidal range <2 m) to gain elevation at a rate comparable to sea level rise. However, the overall importance of storm surge to sediment deposition on these marshes is not well understood. Here we used a well‐tested coastal model in a shallow microtidal bay fringed by intertidal salt marshes to run model simulations for different storm surge events with varying magnitude of storm surge intensity to determine the contributions of storm surge to marsh deposition. Our simulation results show that infrequently occurring storm surge events contributed ∼40% of marsh deposition at our study site and that total mass of marsh deposition around the bay increased linearly with the magnitude of storm surge events. Our findings have significant implications for predicting marsh change, especially if we experience a stormier future climate. Modeling studies that do not resolve storm surge effects on marsh deposition will likely underestimate rates of marsh elevation change. Key Points: A numerical model was used to quantify the contributions of storm surge on marsh deposition in a microtidal bay‐marsh complexStorm surge events occurred 5% of the time, but contributed 40% of marsh deposition during 2009–2020Marshes will likely be supplied with more sediment during storms if storm magnitudes and/or frequencies increase in the future [ABSTRACT FROM AUTHOR]

Seagrass meadows are important carbon sinks in the global coastal carbon cycle yet are also among the most rapidly declining marine habitats. Their ability to sequester carbon depends on flow–sediment–vegetation interactions that facilitate net deposition, as well as high rates of primary production. However, the effects of seasonal and episodic variations in seagrass density on net sediment and carbon accumulation have not been well quantified. Understanding these dynamics provides insight into how carbon accumulation in seagrass meadows responds to disturbance events and climate change. Here, we apply a spatially resolved sediment transport model that includes coupling of seagrass effects on flow, waves, and sediment resuspension in a seagrass meadow to quantify seasonal rates of sediment and carbon accumulation in the meadow. Our results show that organic carbon accumulation rates were largely determined by sediment accumulation and that they both changed non‐linearly as a function of seagrass shoot density. While seagrass meadows effectively trapped sediment at meadow edges during spring–summer growth seasons, during winter senescence low‐density meadows (< 160 shoots m−2) were erosional with rates sensitive to density. Small variations in winter densities resulted in large changes in annual sediment and carbon accumulation in the meadow; meadow‐scale (hundreds of square meters) summer seagrass dieback due to marine heatwaves can result in annual erosion and carbon loss. Our findings highlight the strong temporal and spatial variability in sediment accumulation within seagrass meadows and the implications for annual sediment carbon burial rates and the resilience of seagrass carbon stocks under future climate change. [ABSTRACT FROM AUTHOR]

Background: Local neuroinflammation secondary to spinal nerve compression in lumbar disk herniation (LDH) is a key driver contributing to neuropathic pain. Manual therapy (MT), a widely used nonsurgical therapy, can relieve LDH-mediated pain by reducing inflammation. MT has attracted extensive attention; however, its mechanism remains poorly understood. MicroRNAs (miRNAs) are important regulators of pain signaling transduction, but are rarely reported in the chronic compression of dorsal root ganglia (CCD) model, and further investigation is needed to decipher whether they mediate anti-inflammatory and analgesic effects of MT.Methods: We used a combination of in vivo behavioral and molecular techniques to study MT intervention mechanisms. Neuropathic pain was induced in a CCD rat model and MT intervention was performed according to standard procedures. Enzyme-linked immunosorbent assay (ELISA) was used to detect inflammatory cytokine levels in dorsal root ganglia (DRG). Small RNA sequencing, immunofluorescence, Western blot, and qRT-PCR were performed to screen miRNAs and their target genes and determine core factors in the pathway possibly regulated by miRNA-mediated target gene in DRG of MT-treated CCD rats.Results: Compared with naive rats, small RNA sequencing detected 22 differentially expressed miRNAs in DRG of CCD rats, and compared with CCD rats, MT-treated rats presented 19 differentially expressed miRNAs, which were functionally associated with nerve injury and inflammation. Among these, miR-547-3p was screened as a key miRNA mediating neuroinflammation and participating in neuropathic pain. We confirmed in vitro that its function is achieved by directly regulating its target gene Map4k4. Intrathecal injection of miR-547-3p agomir or MT intervention significantly reduced Map4k4 expression and the expression and phosphorylation of IκBα and p65 in the NF-κB pathway, thus reducing the inflammatory cytokine levels and exerting an analgesic effect, whereas intrathecal injection of miR-547-3p antagomir led to opposite effects.Conclusions: In rats, CCD-induced neuropathic pain leads to variation in miRNA expression in DRG, and MT can intervene the transcription and translation of inflammation-related genes through miRNAs to improve neuroinflammation and alleviate neuropathic pain. MiR-547-3p may be a key target of MT for anti-inflammatory and analgesia effects, which is achieved by mediating the Map4k4/NF-κB pathway to regulate downstream inflammatory cytokines. [ABSTRACT FROM AUTHOR]

Background: The chronic pain of patients with knee osteoarthritis (KOA) seriously affects their quality of life and leads to heavy social and economic burden. As a nondrug therapy in Traditional Chinese Medicine (TCM), Tuina is generally recognised as safe and effective for reducing the chronic pain of KOA. However, the underlying central mechanisms of Tuina for improving the pain of KOA are not fully understood.Methods/design: This study will be a randomised controlled trial with a parallel-group design. A total of 60 eligible participants will be assigned to the Tuina group or healthcare education group (Education group) at 1:1 ratio using stratified randomisation with gender and age as factors. The interventions of both groups will last for 30 min per session and be conducted twice each week for 12 weeks. This study will primarily focus on pain evaluation assessed by detecting the changes in brain grey matter (GM) structure, white matter (WM) structure, and the cerebral functional connectivity (FC) elicited by Tuina treatment, e.g., thalamus, hippocampus, anterior cingulate gyrus, S1, insula, and periaqueductal grey subregions (PAG). The two groups of patients will be evaluated by clinical assessments and multimodal magnetic resonance imaging (MRI) to observe the alterations in the GM, WM, and FC of participants at the baseline and the end of 6 and 12 weeks' treatment and still be evaluated by clinical assessments but not MRI for 48 weeks of follow-up. The visual analogue scale of current pain is the primary outcome. The Short-Form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, 36-Item Short Form Health Survey, Hamilton Depression Scale, and Hamilton Anxiety Scale will be used to evaluate the pain intensity, pain feeling, pain emotion, clinical symptoms, and quality of life, respectively. MRI assessments, clinical data evaluators, data managers, and statisticians will be blinded to the group allocation in the outcome evaluation procedure and data analysis to reduce the risk of bias. The repeated measures analysis of variance (2 groups × 6 time points ANOVA) will be used to analyse numerical variables of the clinical and neuroimaging data obtained in the study. P<0.05 will be the statistical significance level.Discussion: The results of this randomised controlled trial with clinical assessments and multimodal MRI will help reveal the influence of Tuina treatment on the potential morphological changes in cortical and subcortical brain structures, the white matter integrity, and the functional activities and connectivity of brain regions of patients with KOA, which may provide scientific evidence for the clinical application of Tuina in the management of KOA.Trial Registration: Chinese Clinical Trial Registry ChiCTR2000037966 . Registered on Sep. 8, 2020.Dissemination: The results will be published in peer-reviewed journals and disseminated through the study's website, and conferences. [ABSTRACT FROM AUTHOR]

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This study examined the biomechanics of the lower limbs during four typical Tai Chi (TC) movements: wave hand in cloud, leaning fly side, repulse monkey, and brush knee and twist step, in order to provide biomechanical evidence-based recommendations for patients with knee osteoarthritis (OA) practicing TC. Joint angles and joint moments of the hip, knee, and ankle in frontal and sagittal plane as well as ground reaction forces were examined while performing TC and regular walking in an experienced 38 years old TC master. The results showed that relative to walking, the four TC movements are characterized by a wide motion range of lower limbs, slow increase in joint loading, and strong muscle activity during performance. Therefore, these TC movements could be suitable for patients with knee OA to practice for improving the muscle strength of their lower limbs and functional ability. [ABSTRACT FROM AUTHOR]

Background: Post-stroke depression (PSD) is a common complication after stroke which hinders functional recovery and return to social participation of stroke patients. Efficacy of conventional drug therapies for patients with PSD is still uncertain. Therefore, many patients prefer to use complementary and alternative therapies for PSD. Tuina (traditional Chinese manual manipulation) with herbal ointment is an integration of manual therapy, and ointment is an important part of traditional Chinese medicine (TCM) therapy. Preliminary experiments have shown that the Tuina with herbal ointment can improve the mental state of patients with PSD. The purpose of this study is to observe and verify the efficacy of Tuina combined with herbal ointment for patients with post-stroke depression, and to lay a foundation for further research on its mechanism of action.Methods/design: In this study, a randomized controlled trial will be conducted in parallel, including two intervention groups: Tuina with herbal ointment group and herbal ointment for control group. A total of 84 eligible participants will be randomly assigned to the groups in a 1:1 ratio. All participants will receive conventional antidepressant venlafaxine treatment (75 mg QD), on which they received two different interventions. The interventions for both groups will be carried out 5 times each week for a period of 2 weeks. The primary outcome will be the Hamilton Rating Scale for Depression (HAMD). Secondary outcomes will include transcranial magnetic stimulation (TMS), as well as 36-item Short-Form Health Survey (SF-36) and Treatment Emergent Symptom Scale (TESS). They will be assessed at the baseline, at the end of the intervention (2 weeks), and during the 1 month and 3 months of follow-up by repeated measures analysis of variance. The significance level is 5%. Adverse events will be monitored at each visit to assess safety. All outcomes will be assessed and analyzed by researchers blinded to the treatment allocation. The purpose of this study will focus on observing the efficacy of Tuina with herbal ointment for patients with post-stroke depression, and to explore further the mechanisms of its effects.Discussion: This study may evaluate clinical application value and safety of Tuina with herbal ointment in PSD patients, which can provide basis for clinical research and mechanism exploration of PSD.Trial Registration: Chinese Clinical Trial Registry ChiCTR2000033887 . Registered on 15 June 2020.Dissemination: The results will be published in peer-reviewed journals and disseminated through the study's website and conferences. [ABSTRACT FROM AUTHOR]

Objective. This meta-analysis aimed to evaluate the effects of manual therapy (MT) on cancer pain, so as to provide clinical evidence for application. Methods. Five English and Chinese databases were searched until February 29, 2020, for randomized controlled trials (RCTs) of MT for cancer pain. Articles published in the English or Chinese language were included. Two authors independently reviewed all articles and extracted the data, and any disagreements in the above process were discussed with other reviewers until the authors reached consensus. Review Manager 5.3 was used to calculate the effect size and 95% confidence intervals. This review was registered in PROSPERO, number CRD42020172053. Results. The intensity of cancer pain is our primary outcome measure, and compared with standard care, MT can significantly relieve the pain of patients with cancer (SMD, 0.63; 95% CI [0.18, 1.08]; P = 0.006 < 0.01); the effects of MT plus active activity were significantly different from AT alone (SMD, 0.79; 95% CI [0.28, 1.30]; P = 0.002 < 0.01); there was no statistical difference in the efficacy of MT and AT alone (SMD, -0.24; 95% CI [-1.09, 0.62]; P = 0.53 > 0.05). In other related symptoms, the above evidence cannot support that MT had a good effect on fatigue (SMD, 0.77; 95% CI [-0.09, 1.63]; P = 0.08 > 0.05), nausea (SMD, 0.24; 95% CI [-0.00, 0.48]; P = 0.05), anxiety (SMD, 0.76; 95 % CI [-0.32, 1.84]; P = 0.17 > 0.05), and depression (SMD, 0.67; 95 % CI [-0.28, 1.62]; P = 0.17 > 0.05); however, MT intervention can improve physical function (n = 271; SMD, 0.35; 95 % CI [-0.04, 0.74]; P = 0.04 < 0.05) and global well-being (SMD, 0.50; 95 % CI [0.02, 0.98]; P = 0.04 < 0.05). In addition, MT had a significant effect on pain relief (SMD, 0.52; 95% CI [0.03, 1.01]; P = 0.04 < 0.05) and improvement of physical function (SMD, 0.28; 95% CI [0.02, 0.53]; P = 0.03 < 0.05) even after a period of time after treatment. Conclusion. MT was an effective intervention, which may have immediate effect on cancer pain and may improve physical function and global well-being. In the view of follow-up effects, MT had good effects for the reduction of pain and the recovery of physical function. However, because of limitations, the seemingly promising results should be interpreted with caution. [ABSTRACT FROM AUTHOR]

The aim of this review was to examine the effects of shoes and insoles on low back pain (LBP). Seven electronic databases were searched from their inception to May 2020. The methodological quality of the 14 included studies was assessed by PEDro scale. Quality of evidence was assessed using GRADE. Moderate evidence on the disability questionnaire score (SMD, 0.52; 95% CI, 0.28 to 0.77; P < 0.001) and pain score (SMD, 0.61; 95% CI, 0.36 to 0.85; P < 0.001) of the custom-made orthotics for chronic LBP compared with no orthotics/insoles intervention was found. Meta-analysis results also showed moderate evidence on the disability questionnaire score (SMD, 0.44; 95% CI, 0.05 to 0.82; P =0.03) in patients who wore unstable shoes compared with regular shoes. Pain and life quality scores showed low-quality evidence of unstable shoes for chronic LBP. Custom-made orthotics and unstable shoes can be recommended to patients as a management option of chronic LBP. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is one of the major concerns of the current health care. The guidelines for chronic LBP recommend traditional Chinese exercise as an effective treatment. As one of the representatives of traditional Chinese exercise, Wuqinxi has been famous in China for its effects on improving health and treating chronic diseases for thousands of years. The objectives of the study were to assess the effects of Wuqinxi in the patients with chronic LBP on pain intensity, trunk muscle strength, and quality of life. The primary outcome measure was assessed by the Short-Form McGill Pain Questionnaire (SF-MPQ), including the Visual Analog Scale (VAS) and Present Pain Intensity (PPI) as the subtables. The effects of Wuqinxi on the quality of life were also assessed by the Short-Form Health Survey (SF-36) and the Pittsburgh Sleep Quality Index (PSQI) from physical component summary (PCS), mental component summary (MCS), and sleep quality. Besides, the electrical activities of the rectus abdominis (RA), obliquus externus abdominis (OEA), lumbar erector spinae (ES), and multifidus (MF) were assessed by integrated electromyogram (iEMG) after the end of the intervention. Both the groups showed statistically significant improvement in SF-MPQ, SF-36, PSQI, and iEMG at 12 weeks and 24 weeks when compared with baseline (P < 0.05). However, Wuqinxi demonstrated better effects in SF-MPQ and MCS after 24 weeks of intervention compared with the general exercise (P < 0.05). The patients in the Wuqinxi group (WQXG) also showed a significantly higher iEMG on OEA than the general exercise group (GEG) in 30°/s and 90°/s (P < 0.05). Our results showed that Wuqinxi had better effects on chronic LBP for a long time compared with general exercise, including pain intensity and quality of life. Thus, Wuqinxi should be recognized as a possible standalone therapy and self-management skill in chronic LBP, which is suitable for long-term practice. [ABSTRACT FROM AUTHOR]

Background: Low back pain is a common reason for medical care and carries a heavy social burden. The efficacy of Tuina or health care education for low back pain has been evaluated in previous systematic reviews. However, there is no evidence to support the superiority of one form of treatment over another. The aim of this study is to compare the efficacy of Tuina with health care education in the management of low back pain.Methods/design: This study is a randomized controlled trial with parallel-group design including two groups: a Tuina group and a health care education group. A total of 160 eligible participants will be randomly assigned to the groups in a 1:1 ratio. The interventions of both groups will last for 20 min and be carried out twice each week for a period of 12 weeks. The primary outcome is the Oswestry Disability Index. The secondary outcomes include a visual analogue scale and the 36-item Short Form Health Survey. They will be assessed at baseline, at the end of the intervention every month, and during 6 months and 9 months of follow-up by repeated measures analysis of variance. The significance level is 5%. The safety of Tuina and health care education will be evaluated after each treatment session. This study will focus on the value of Tuina and health care education for low back pain and will highlight any differences in the efficacy of the treatments.Discussion: This study will evaluate the efficacy and safety of Tuina intervention for low back pain, which could provide reliable evidence for clinical decision making for patients with low back pain.Trial Registration: Chinese Clinical Trial Registry, ChiCTR1900022656. Registered on 23 April 2019. [ABSTRACT FROM AUTHOR]

Background: Chronic neck pain (CNP) is a common and disabling musculoskeletal disorder in developing and developed countries. Previous studies have shown that tuina and traditional Chinese massage are effective treatments for patients with CNP. However, there is little evidence to support the use of one intervention over the other. The aim of this study is to compare the effects of tuina and traditional Chinese massage in the treatment of pain and disability in patients with CNP.Methods/design: This is a multicenter, assessor- and analyst-blinded, randomized controlled trial with two parallel arms: a tuina group and a traditional Chinese massage group. A total of 356 eligible CNP patients will be randomly assigned to the groups in a 1:1 ratio. The intervention in the tuina group includes both structural and relaxation massage, while the traditional Chinese massage group will receive relaxation massage only. The interventions for both groups will last for 15 min and will be carried out three times a week for a period of 4 weeks. The primary outcome will be changes in the Northwick Park Neck Pain Questionnaire. Secondary outcomes will be measured by a visual analogue scale (VAS), the Neck Disability Index (NDI), and the 36-item Short-Form Health Survey (SF-36). The data will be analyzed at the baseline, at the end of the intervention, and during the 3 months of follow-up by repeated measures analysis of variance. The significance level is 5%. The safety of tuina and traditional Chinese massage will be evaluated after each treatment session. The results of this trial will help clarify the value of tuina and traditional Chinese massage as treatments for CNP and will highlight any differences in the efficacy of the treatments.Discussion: The purpose of this trial is to determine whether tuina is more effective than traditional Chinese massage in adults with CNP. This trial will, therefore, contribute to providing a solid foundation for clinical treatment of CNP, as well as future research in massage therapy.Trial Registration: Chinese Clinical Trial Registry, ChiCTR-INR-17013763 . Registered 8 December 2017. [ABSTRACT FROM AUTHOR]

The evaluation on sinews and bones in tuina of traditional Chinese medicine (TCM) refers to a systematic approach to evaluate the patient's physical state, so as to select appropriate tuina therapies and achieve safe and efficient goals. Through summarizing the characteristics of evaluation on sinews and bones in main schools of modern TCM tuina including assessments of bone landmarks, soft tissues and pain, and Western manual therapies including assessments of palpation of spine, postures (positions), pain and surrounding soft tissues, the key elements of promotion mode of evaluation on sinews and bones in TCM tuina are proposed, namely the evaluation on muscle tissue morphology, postures, tenderness points and joint motions. The purpose is to provide a reference for establishing a scientific, standard and feasible mode of evaluation on sinews and bones. [ABSTRACT FROM AUTHOR]

Intertidal (tidal flat) reclamation along the Chinese coastline, especially which is in Jiangsu Province, has increased markedly in recent years. However, the hydrodynamic disturbance and environmental impacts of this activity are not yet fully understood. In this study, a process-based depth-averaged model is used to evaluate quantitatively the possible impacts of intertidal reclamation for the southern Yellow Sea region. The simulation results show that reclamation of both inshore and offshore intertidal areas of ~1800 km (according to the approved governmental reclamation scheme) would result in three remarkable changes in tidal patterns: enhanced M and M tidal amplitudes in coastal areas, strengthened negative tidal asymmetry in the southern region of the sand ridge system, and an enhanced tidal energy flux toward offshore through the main channels in the south. These changes would result in some negative impacts. The enhancement in local tidal amplitude could increase the probability of coastal hazards, and the offshore sediment transport tendency resulting from negative tidal asymmetry in the south could lead to severe erosion. The enhanced energy flux transported offshore may also affect far-field regions. On the other hand, alternative reclamation of ~400 km of offshore intertidal area could significantly minimize hydrodynamic disturbances to the local tidal system. Offshore reclamation with lower environment impacts may be the future for coastal development. To cope with the potential environmental risks caused by reclamation, it is recommended to strengthen environmental impact assessment and overseeing of reclamation plans, and advance international cooperation in terms of coastal management. Our findings provide a reference for coastal management in countries with substantial areas of tidal flats. [ABSTRACT FROM AUTHOR]

Human activities, such as tidal sluice gate construction and reclamation, are prevalent along northern coastline of China and influence significantly sedimentary environments. The Sheyang River estuary is a small estuary situated on the Jiangsu coast. For the objective of storing fresh water, maintaining river channel depth and managing the land resource, a tidal sluice gate was constructed. At the same time, estuarine wetlands have been reclaimed extremely in recent decades. A numerical model based upon Delft3D was developed to quantify the impact of these human activities, and four simulation schemes were designed (a) tidal sluice gate present, but always closed; (b) tidal sluice gate not present; (c) tidal sluice gate present, but closed during flood and open during the ebb; and (d) intertidal area reclamation taking place in the estuary. A bathymetric survey confirmed the erosion and deposition results of the simulation. The rate of sediment deposition increased significantly after the gate was closed. However, during the third scheme, the sediment deposition rate reduced considerably; that was because the ebb current increased the scouring force when the gate was open, especially within the channel area close to the gate. Meanwhile, reclamation lessened erosion behind the gates and may have been enhanced by siltation. The coastline shifted seaward as the siltation area increased; it extended farther because of reclamation. Appropriate coastal management planning strategies must be developed to reduce negative effects of the channel siltation, resulting from the various forms of human activity. The results of this study can provide input to governmental recommendations on more effective tidal gate management strategies. [ABSTRACT FROM AUTHOR]

Objectives: Efficacy of conventional treatment plus the complementary therapy Liu-zi-jue (a mind-body exercise) to treat patients with mild COVID-19.Trial Design: The study is a single-center 2 arm, randomized controlled trial with parallel-group design. [ABSTRACT FROM AUTHOR]

Background: In December 2019, pneumonia associated with the 2019 novel coronavirus (COVID-19) emerged in Wuhan, China. The number of cases has increased rapidly. Patients with severe disease have a poor prognosis, and there are no effective therapies for COVID-19. Only rapid advice guidelines for symptomatic supportive care have been used. A traditional Chinese medicine rehabilitation (TCMR) program consisting of acupressure therapy and Liu Zi Jue Qigong can be used as a complementary therapy for COVID-19. Hence, we designed a randomized trial to evaluate the efficacy and advantages of TCMR for treating patients with severe COVID-19.Methods/design: This is a parallel-design, two-arm, analyst assessor-blinded, randomized controlled trial. A total of 128 patients with COVID-19 aged from 20 to 80 years will be recruited and assigned randomly into a guideline therapy group and a guideline therapy plus TCMR group at a 1:1 ratio. Patients in both groups will receive guideline therapy. The patients in the intervention group will perform acupressure therapy and Liu Zi Jue Qigong exercises in addition to conventional treatments twice a day and will be persistent from admission to discharge. The primary outcome will be measured with the Modified Medical Research Council Dyspnea Scale, and the secondary outcomes will include the Activities of Daily Living Barthel Index Scale, Patient Health Questionnaire-9 Scale, and the Respiratory Symptoms Scale. The assessments of the clinical scales will be performed at three points (before treatment, the 7th day during hospitalization, and the discharge day). Adverse events will be noted and recorded for the safety evaluation.Discussion: This trial will provide high-quality evidence of the value of TCMR, which consists of acupressure therapy and Liu Zi Jue Qigong exercises, for treating patients with severe COVID-19.Trial Registration: Chinese Clinical Trial Registry ChiCTR2000029994 . Registered on 18 February 2020. [ABSTRACT FROM AUTHOR]

The bottom friction velocity (U*), which controls seabed erosion and deposition, plays a critical role in sediment transport in tidal coastal bottom boundary layers. Approaches have been proposed to calculate U*, including the log profile (LP) estimation, the direct covariance (COV) measurement, and the turbulent kinetic energy (TKE) method. However, the LP method assumes homogeneous flow and the effects of stratification need to be taken into account. Here, field investigations of hydrodynamics and sediment dynamics were carried out on the Jiangsu Coast, China. Two acoustic Doppler velocimeters (ADV) velocity measurements at 0.2 and 1 m above the seabed have been used to estimate U*, based on the aforementioned three methods. The COV and TKE methods provided reasonable estimations of U*, while a pronounced overestimation was identified when using the LP method. This overestimation can be attributed to the stratification effects associated with the vertical suspended sediment concentration (SSC) gradient near the bottom. Then, three models were utilized to correct the overestimation, in which the gradient/flux Richardson number was modified with empirical constants α, β, and A to parameterize the stratification effects in the logarithmic velocity distribution. The values of α, β, and A derived from the observation are smaller than the results from previous investigations. These modified logarithmic velocity distribution models can be applied in numerical simulations when sediment stratification is important. [ABSTRACT FROM AUTHOR]