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Acupuncture is a therapeutic modality in Traditional Chinese Medicine which aims to improve the flow of Qi (chi) or energy around the body by applying needles to specific points on the skin. Traditional Chinese Medicine teaches that Qi must flow freely through the body’s meridians, or channels, to ensure health and well-being. Traditionally, Chinese Medicine practitioners used a wooden, copper or bronze acupuncture model to show the points where needles should be applied to the skin and the meridians through which Qi flows around the body. However, as traditional models depict acupuncture points which are too rigid for teaching purposes, understanding the descriptions of acupuncture points from textbooks in 2D is also another hurdle for beginners to apply them to the human body in 3D. With modern computing and 3D-printing technologies, this article introduces a realistic human model in the form of a 6-foot copper acupuncture sculpture with over 370 virtual acupuncture points using state-of-the-art Augmented Reality (AR) and metal 3D-printing techniques for enhanced teaching, learning, and demonstration of acupuncture principles. It will be a new training model for Western and Chinese medical practitioners as well as for the public to gain interactive acupuncture experience that is beneficial to their own health.

A 60-year-old woman with a past medical history of asthma presented with fulminant myocarditis 9 days after testing positive for SARS-CoV-2 and 16 days after developing symptoms consistent with COVID-19. Her hospital course was complicated by the need for veno-arterial extracorporeal membrane oxygenation, ventricular arrhythmias, and pseudomonas bacteremia. She ultimately recovered and was discharged to home with normal left ventricular systolic function. Thereafter, she developed symptomatic ventricular tachycardia, for which she received an implantable cardioverter-defibrillator and antiarrhythmic drug therapy.

Tinea capitis is still common in developing countries, such as China. Its pathogen spectrum varies across regions and changes over time.This study aimed to clarify the current epidemiological characteristics and pathogen spectrum of tinea capitis in China.A multicentre, prospective descriptive study involving 29 tertiary hospitals in China was conducted. From August 2019 to July 2020, 611 patients with tinea capitis were enrolled. Data concerning demography, risk factors and fungal tests were collected. When necessary, the pathogens were further identified by morphology or molecular sequencing in the central laboratory.Among all enrolled patients, 74·1% of the cases were in patients aged 2-8 years. The children with tinea capitis were mainly boys (56·2%) and were more likely than adults to have a history of animal contact (57·4% vs. 35·3%, P = 0·012) and zoophilic dermatophyte infection (73·5% vs. 47%). The adults were mainly female (83%) and were more likely than children to have anthropophilic agent infection (53% vs. 23·9%). The most common pathogen was zoophilic Microsporum canis (354, 65·2%), followed by anthropophilic Trichophyton violaceum (74, 13·6%). In contrast to the eastern, western and northeastern regions, where zoophilic M. canis predominated, anthropophilic T. violaceum predominated in central China (69%, P 0·001), where the patients had the most tinea at other sites (20%) and dermatophytosis contact (26%) but the least animal contact (39%). Microsporum ferrugineum was the most common anthropophilic agent in the western area, especially in Xinjiang province.Boys aged approximately 5 years were the most commonly affected group. Dermatologists are advised to pay more attention to the different transmission routes and pathogen spectra in different age groups from different regions.

Objective Laser interstitial thermal therapy (LITT) is a minimally invasive surgery for mesial temporal lobe epilepsy (mTLE), but the effects of individual patient anatomy and location of ablation volumes affect seizure outcomes. The purpose of this study is to see if features of individual patient structural connectomes predict surgical outcomes after LITT for mTLE. Methods This is a retrospective analysis of seizure outcomes of LITT for mTLE in 24 patients. We use preoperative diffusion tensor imaging (DTI) to simulate changes in structural connectivity after laser ablation. A two-step machine-learning algorithm is applied to predict seizure outcomes from the change in connectomic features after surgery. Results Although node-based network features such as clustering coefficient and betweenness centrality have some predictive value, changes in connection strength between mesial temporal regions predict seizure outcomes significantly better. Changes in connection strength between the entorhinal cortex (EC), and the insula, hippocampus, and amygdala, as well as between the temporal pole and hippocampus, predict Engel Class I outcomes with an accuracy of 88%. Analysis of the ablation location, as well as simulated, alternative ablations, reveals that a more medial, anterior, and inferior ablation volume is associated with a greater effect on these connections, and potentially on seizure outcomes. Significance Our results indicate (1) that seizure outcomes can be retrospectively predicted with excellent accuracy using changes in structural connectivity, and (2) that favorable connectomic changes are associated with an ablation volume involving relatively mesial, anterior, and inferior locations. These results may provide a framework whereby individual pre-operative structural connectomes can be used to optimize ablation volumes and improve outcomes in LITT for mTLE.

Purpose Cardiac radioablation using stereotactic body radiation therapy is gaining popularity as a noninvasive treatment for otherwise refractory ventricular arrhythmias. As radiation oncologists might be unaccustomed to the lexicon used by cardiologists to describe the location of arrhythmogenic foci, a preliminary guide to cardiac-specific anatomy and orientation is needed to foster effective communication between the radiation oncologist and cardiology team. Methods and Materials Electrocardiogram-gated and respiratory-gated computed tomography imaging was acquired per institutional protocol. Additional relevant imaging modalities are described. The American Heart Association 17-segment model is described in detail because this framework is used frequently by cardiologists to describe the location left ventricular abnormalities. Results A step-by-step guide is provided for properly rotating the heart from standard orthogonal views obtained during radiation simulation to the cardiac-specific orientation needed to appreciate the 17-segment model. Once the proper configuration is achieved, the location of each segment is defined in detail. Conclusions This atlas serves as an introduction to the relevant anatomy and principles, and it provides a suggested approach to help delineate cardiac radioablation targets using the established American Heart Association 17-segment model.

To establish an animal model of sparganosis mansoni through oral administration ofDomestic cats were infected withAmong the 15 mice in the experimental group, six were positive for the serum specific IgG antibody againstA mouse model of sparganosis mansoni is successfully created through oral administration of

Diabetic foot ulcers (DFUs) add billions of dollars to the direct annual costs associated with diabetes. Despite various treatments, many DFUs do not heal and become infected. Both skin-associated microbial communities and glycemic control are believed to be important in nonhealing DFUs. Recent studies have linked serum Vitamin C levels with glycemic control and DFUs. This cross-sectional study assessed skin microbiome in DFUs, intact diabetic skin, and nondiabetic skin to identify correlations between hemoglobin A1c (HbA1c), Vitamin C, and microbial community structure. Correlations between Vitamin C, HbA1c, wound size, and ulcer duration were also determined.Participants had their DFUs or intact skin culture swabbed. HbA1c was obtained via point-of-care fingerstick testing and serum Vitamin C was obtained via venipuncture. All participants completed a dietary questionnaire. Participants with ulcers were stratified into the controlled (≤8.0%) or uncontrolled (8.0%) HbA1c group. Analysis of microbial communities was performed via 16S ribosomal RNA (rRNA) gene amplicon sequencing and bacterial load was measured by the domain-level quantitative polymerase chain reaction of the 16S rRNA gene.Forty-two patients were recruited over 6 months. Bacteria from the generaUnderstanding the link between Vitamin C and HbA1c and DFU microbiome may aid in new therapies.

Medical societies have embraced advocacy as a core professional competency, but little is known about how entering medical students view physician advocacy. This study examined how first year medical students define advocacy, their motivations for and anticipated challenges to advocacy, and whether they believe advocacy should be a core competency.This study used a qualitative content analysis approach to analyze first year medical student narrative responses about physician advocacy. The analysis included the written responses of 95% of the first-year medical students at the University of California, San Francisco (UCSF) School of Medicine during two academic years.Students shared consensus that physicians should advocate on behalf of their individual patients. Students had varying opinions on whether all physicians should engage in societal level advocacy and whether it should be a core competency in medical school. Students find several compelling reasons for physicians to engage in societal advocacy but nevertheless anticipate challenges to physician advocacy.Given increasing consensus that advocacy is a core competency of physicians, providing medical students the skills to successfully engage in advocacy is increasingly important. Any new mandatory curricula will need to focus on how to engage learners with varied views on advocacy.

MN55 is an apple (Malus ×domestica Borkh.) cultivar recently released by the University of Minnesota apple breeding program, with fruit marketed in the U.S. as Rave®. When stored for 4 months at 0 to 4 °C, MN55 fruit can develop several storage disorders, including skin dimpling. Skin dimpling incidence was greater for fruit harvested 1 week later than those harvested earlier. Dimpling was not alleviated by prestorage treatments of 1-methylcyclopropene or diphenylamine or by holding fruit at room temperature for 1 day before long-term cold storage. However, dimpling incidence was very low when fruit were stored at 6 to 7 °C. Because viruses have been implicated in other fruit dimpling disorders, the presence of viruses in MN55 leaves and fruit was studied. Apple stem pitting virus (ASPV) was detected by microscopy, reverse transcriptase polymerase chain reaction (RT-PCR) methodology, and high throughput sequencing (HTS) in peel of fruit from MN55 trees that exhibited skin dimpling after 4 months of storage at 0 to 1 °C. ASPV was also detected in supermarket-purchased fruit of other cultivars with noticeable skin dimpling. Although ASPV was not conclusively demonstrated to cause skin dimpling in our work, its prevalence indicates that further investigations are warranted to determine the relationship between viruses and skin deformities in stored apples.

The purpose of this research is to investigate the effectiveness of Digital Content Marketing (DCM) on a Mixed Reality (MR) training platform environment with the consideration of online purchase intention (OPI) through social media. E-commerce today encounters several common issues that cause customers to have reservations to purchase online. With the absence of physical contact points, customers often perceive more risks when making purchase decisions. Furthermore, online retailers often find it hard to engage customers and develop long-term relationships. In this research, a Structural Equation Model (SEM) is proposed to examine the efficacy of DCM from both immediate and long-term OPI. The results examine whether adopting DCM on an MR training platform environment through social media brings positive results in OPI. Empirical research was carried out through online questionnaires collected in 2021 and 2022. A total of 374 questionnaires were qualified for data analysis in this study, conducted with IBM SPSS and AMOS. The results imply that DCM is critical to stimulating both immediate and long-term OPI. The immediate OPI is positively affected by increasing perceived value through MR in DCM. Regarding the long-term OPI, increased customer engagement with DCM under MR environment can cultivate brand trust and significantly affect the long-term OPI.

Study question To determine the causal effect of in-vitro fertilisation (IVF) on primary school-age childhood developmental and educational outcomes, compared with outcomes following spontaneous conception. Summary answer The school-age developmental and educational outcomes for children conceived by IVF are equivalent to those of spontaneously conceived peers. What is known already More than 8 million children have been conceived globally with the assistance of in-vitro fertilization (IVF). Large cohort studies have suggested an increase in the frequency of congenital abnormalities, autism spectrum disorder, developmental-delay and intellectual disability in children conceived via IVF. Educational and cognitive outcomes following IVF conception have not yet been adequately established. Two large Scandinavian studies (Norrman et al 2018 and Wienecke et al 2020) found poorer educational outcomes in children born after IVF-conception. Study design, size, duration Causal inference methods (based on the potential outcomes approach) were used to analyse observation data in a way that emulates the results of a target randomised clinical trial. The study cohort comprised state-wide linked maternal and childhood administrative data from Victoria, Australia. Participants/materials, setting, methods The study included singleton infants conceived spontaneously or via IVF and born between 2005-2014. The exposure of interest was conception via IVF, with those born after spontaneous conception as the control group. Two separate measures of childhood outcome were examined: The Australian Early Developmental Consensus (AEDC), (age 4-6); and the National Assessment Program – Literacy and Numeracy (NAPLAN) at age 7-9. We combined inverse probability weighting with regression adjustment to estimate population average causal effects. Main results and the role of chance The final cohort included 412,713 children across the two outcome cohorts. Linked records were available for 4,697 IVF-conceived cases and 168,503 controls for AEDC outcome data, and 8,976 cases and 333,335 controls for NAPLAN data. The mothers of IVF-conceived children were older, more highly educated mothers, who lived in more socio-economic advantaged areas and were less likely to be from non-English speaking backgrounds. There was no causal effect of IVF-conception on the on the risk of developmental vulnerability at school-entry compared to spontaneously conceived children, as defined by AEDC metrics; with an adjusted risk difference of -0.3% (95% CI -3.7% to 3.1%) and an adjusted risk ratio of 0.97 (95% CI 0.77 to 1.25). At age 7-9 years, there was no causal effect of IVF-conception on the NAPLAN overall z-score, adjusted mean difference of 0.030 (95% CI -0.018 to 0.077) between IVF-conceived and spontaneously conceived children. Given the use of observational data, there were missing data and inherent differences in the covariate profile of the exposure cohorts. Multiple imputation and doubly robust inverse probability weighting regression adjustment modelling was utilised to allow a causal interpretation of results. Limitations, reasons for caution Children who did not attend school due to severe disability were not included, possibly leading to selection bias. It is possible that unmeasured common cause confounders could have led to bias in estimating the average treatment effects. Wider implications of the findings This study, in contrast to previous evidence, suggests that conception via IVF does not affect early childhood developmental and educational outcomes. These findings provide important reassurance for current and prospective parents, and clinicians alike. Trial registration number Not applicable

Phenomenon: The format of medical knowledge assessment can promote students’ use of effective learning strategies from the learning sciences literature, such as elaboration, interleaving, retrieval...

A 60-year-old woman with a past medical history of asthma presented with fulminant myocarditis 9 days after testing positive for SARS-CoV-2 and 16 days after developing symptoms consistent with COVID-19. Her hospital course was complicated by the need for veno-arterial extracorporeal membrane oxygenation, ventricular arrhythmias, and pseudomonas bacteremia. She ultimately recovered and was discharged to home with normal left ventricular systolic function. Thereafter, she developed symptomatic ventricular tachycardia, for which she received an implantable cardioverter-defibrillator and antiarrhythmic drug therapy.

Genetic studies reveal that single-nucleotide polymorphisms (SNPs) of SPI1 are associated with Alzheimer's disease (AD), while their effects in the Chinese population remain unclear.We aimed to examine the AD-association of SPI1 SNPs in the Chinese population and investigate the underlying mechanisms of these SNPs in modulating AD risk.We conducted a genetic analysis of three SPI1 SNPs (i.e., rs1057233, rs3740688, and rs78245530) in a Chinese cohort (n = 333 patients with AD, n = 721 normal controls). We also probed public European-descent AD cohorts and gene expression datasets to investigate the putative functions of those SNPs.We showed that SPI1 SNP rs3740688 is significantly associated with AD in the Chinese population (odds ratio [OR] = 0.72 [0.58-0.89]) and identified AD-protective SPI1 haplotypes β (tagged by rs1057233 and rs3740688) and γ (tagged by rs3740688 and rs78245530). Specifically, haplotypes β and γ are associated with decreased SPI1 gene expression level in the blood and brain tissues, respectively. The regulatory roles of these haplotypes are potentially mediated by changes in miRNA binding and the epigenetic landscape. Our results suggest that the AD-protective SPI1 haplotypes regulate pathways involved in immune and neuronal functions.This study is the first to report a significant association of SPI1 with AD in the Chinese population. It also identifies SPI1 haplotypes that are associated with SPI1 gene expression and decreased AD risk.

The increasing prevalence of diabatic foot ulcers (DFUs) is not only costly, but carries a large mortality burden. In this article, we discuss important traditional concepts in the management of DFUs and elaborate on how new technologies have expanded our ability to treat DFUs effectively. New supplies and wound care products have been developed to target the following traditional areas of focus: tissue, infection/inflammation, moisture, and edge. Offloading strategies have grown from standard orthotics or insoles to total contact casting and three-dimensional-printed orthotics to produce the optimum material stiffness for each patient. The concepts of pressure and temperature monitoring have led to the development of multiple devices that transmit continuous monitoring in real time, giving a dynamic picture of plantar stress and training patients in new walking strategies for self-offloading. Surgical approaches have also evolved from the classic surgical debridement and correcting deformities that cause friction to creation of acellular and bio-printed cellular skin substitutes that can be used for grafting. Surveillance and long-term follow-up with a multidisciplinary team have also changed in the face of smartphones and watches that allow patients to monitor themselves in real time with daily prompts and reminders to shape desired behaviors in between clinic visits. Modern technology is changing management of DFUs by expanding on traditional concepts and improving standard therapies.

To investigate the prevalence ofFrom 2018 to 2019, nine counties (cities, districts) were randomly selected from Jiangsu Province as the survey sites, and 100 healthy individuals were randomly selected to perform the serological test ofThe prevalence ofSparganosis mansoni is prevalent in Jiangsu Province. Health education pertaining to the damages of sparganosis mansoni and the route of

In cardiac amyloidosis (CA), amyloid infiltration results in increased left ventricular (LV) mass disproportionate to electrocardiographic (EKG) voltage. We assessed the relationship between LV mass–voltage ratio with subsequent heart failure hospitalization (HHF) and mortality in CA. Patients with confirmed CA and comprehensive cardiovascular magnetic resonance (CMR) and EKG exams were included. CMR-derived LV mass was indexed to body surface area. EKG voltage was assessed using Sokolow, Cornell, and Limb–voltage criteria. The optimal LV mass–voltage ratio for predicting outcomes was determined using receiver operating characteristic curve analysis. The relationship between LV mass–voltage ratio and HHF was assessed using Cox proportional hazards analysis adjusting for significant covariates. A total of 85 patients (mean 69 ± 11 years, 22% female) were included, 42 with transthyretin and 43 with light chain CA. At a median of 3.4-year follow-up, 49% of patients experienced HHF and 60% had died. In unadjusted analysis, Cornell LV mass–voltage ratio was significantly associated with HHF (HR, 1.05; 95% CI 1.02–1.09, p = 0.001) and mortality (HR, 1.05; 95% CI 1.02–1.07, p = 0.001). Using ROC curve analysis, the optimal cutoff value for Cornell LV mass–voltage ratio to predict HHF was 6.7 gm/m2/mV. After adjusting for age, NYHA class, BNP, ECV, and LVEF, a Cornell LV mass–voltage ratio > 6.7 gm/m2/mV was significantly associated with HHF (HR 2.25, 95% CI 1.09–4.61; p = 0.03) but not mortality. Indexed LV mass–voltage ratio is associated with subsequent HHF and may be a useful prognostic marker in cardiac amyloidosis.

We evaluated regional variation in the Delta Absorbance Meter® index of absorbance difference (IAD) as a measure of harvest maturity and for predicting the occurrence of storage disorders in ‘McIntosh’ apples [Malus ×sylvestris (L.) var. domestica (Borkh.) Mansf.] in 2016 and ‘Honeycrisp’ apples in 2016 and 2017. Apples were grown in Maine (ME), Minnesota (MN), and Ontario (ON), and they were harvested from one orchard in each region, and two to three times each year, followed by cold storage at 0.5 °C for 2 months in 2016 and 4 months in 2017. In 2016, ‘Honeycrisp’ IAD values were similar in ME and ON, but lower than in MN. In 2017, IAD was greater in ME than in the other two regions during the first harvest, and it similar to MN in the latter two harvests and lower in ON than in the other regions. In ‘Honeycrisp’ apples, IAD was more strongly related to starch pattern index (SPI), internal ethylene concentration, and fruit peel blush than to chlorophyll or soluble solids concentration. Soft scald incidence (SSI) of ‘Honeycrisp’ fruit was greater in ME than in MN and ON in both years. In ME, SSI was related to IAD at harvest in both years, but with an inverse relationship with the first harvest and a positive relationship in the second harvest. A positive relationship also occurred in ON in 2017. SSI was not related to IAD at harvest in MN in both years and ON in 2016. Regional similarities in patterns of change in ‘Honeycrisp’ fruit IAD were not consistent from year to year, and this indicates that a single IAD standard should not be used to assess fruit maturity in different regions. In ‘McIntosh’, IAD values were variable among the three regions and were not related to other maturity indicators. IAD was not useful for measuring maturity in ‘McIntosh’ apples, but it was weakly related to core browning incidence.

Bacterial products can act on neurons to alter signaling and function. Here, we find that dorsal root ganglia (DRG) sensory neurons are enriched for ANTXR2, the high-affinity receptor for anthrax toxins. Anthrax toxins are composed of protective antigen (PA), which binds to ANTXR2, and the protein cargoes Edema Factor (EF) and Lethal Factor (LF). Intrathecal administration of Edema Toxin (ET; PA+EF) targeted DRG neurons and induced analgesia in mice. ET inhibited mechanical and thermal sensation, and pain caused by formalin, carrageenan, and nerve injury. Analgesia depended on ANTXR2 expressed by Na(v)1.8(+) or Advillin(+) neurons. ET modulated PKA signaling in mouse sensory and human iPS-derived sensory neurons and attenuated spinal cord neurotransmission. We further engineered anthrax toxins to introduce exogenous protein cargoes, including botulinum toxin, into DRG neurons to silence pain. Our study highlights interactions between a bacterial toxin and nociceptors which may lead to the development of novel pain therapeutics.

Background: While cardiac amyloidosis (CA) classically involves the left ventricle (LV), less is known about its impact on the right ventricle (RV) and pulmonary vasculature. Objectives: We aimed to determine the prevalence and types of PH profiles in CA, and to determine hemodynamic and cardiovascular magnetic resonance (CMR) predictors of major adverse cardiovascular events (MACE). Methods: CA patients who underwent CMR and right heart catheterization (RHC) from 2010-2019 were included. Patients were assigned the following hemodynamic profiles: no PH, pre-capillary PH, isolated post-capillary PH (IPCPH), or combined pre- and post-capillary PH (CPCPH). Transpulmonary gradient (TPG)—the difference between mean pulmonary artery and wedge pressures, was calculated. The relationship between PH profile and MACE (death, heart failure hospitalization) was assessed using survival analysis. CMR and RV parameters were correlated with MACE using Cox-Regression analysis. To evaluate the importance of parameters for predicting MACE, Random Forest algorithm for survival analysis were applied. Results: A total of 52 patients were included (age 69±9 years, 85% male, 60% transthyretin, and 40% light chain CA). PH was present in 50 (96%) patients. RHC was performed during biopsy in 44(85%) and for clinical indications in 8(15%) patients. Rates of no PH, pre-capillary PH, IPC-PH, and CPCPH were 5(10%), 3(6%), 29(55%) and 15(29%) respectively (Panel A). Hemodynamic PH profile did not correlate with death (p=0.98) or MACE (p=0.67) (Panel B). TPG (HR 0.88, CI 0.80-0.97), RV, (HR 0.95, CI 0.92-0.98), and LV ejection fraction (HR 0.95, CI 0.92-0.98) were significantly associated with MACE. In Random Forest analysis, LVEF, RVEF, and TPG were the most important predictors of MACE (Panel C). Conclusions: PH is highly prevalent in CA, even at the time of diagnosis. While IPC-PH was most common, CPCPH is not infrequent. TPG and RVEF are prognostic markers in this population.