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It has been suggested that COVID-19 patients have distinct tongue features, which may help to monitor the development of their condition. To determine if there was any specific tongue coating feature in COVID-19, this study investigated the difference in tongue coating between COVID-19 subjects and subjects with other acute inflammatory diseases characterized by fever. Tongue images taken with smartphones from three age-matched groups, namely, COVID group (n=92), non-COVID febrile group (n=92), and normal control group (n=92), were analyzed by two blinded raters according to a tongue coating scoring scheme, which assessed the levels of thick fur, slimy or greasy fur, discolored fur and composite index of tongue coating. Compared with control, significant increases in all coating indexes were found in the COVID group (P

Background Lateral elbow pain (LEP) due to tendinosis is one of the most common musculoskeletal pains of the upper limbs, yet there is no satisfactory treatment. This study was an international, prospective, multi-centre, randomized, controlled, clinical trial to evaluate the efficacy of acupuncture compared to sham laser in the treatment of LEP. Methods The study used a parallel and stratified design (1:1 allocation using a computer-generated sequence) and was participant-, outcome assessor- and statistician-blinded. Subjects from 18 to 80 years with unilateral chronic LEP (minimum three months) were recruited at four centres in Australia, China, Hong Kong and Italy. The treatment group received manual acupuncture at acupoints LI 10 and LI 11 on the affected side whereas the control group received sham laser acupuncture at the same acupoints. The primary endpoint was disabilities of the arm, shoulder, and hand (DASH) questionnaire score at the three-week post-treatment follow-up visit. Three VAS scales (pain at rest, pain on motion and pain during exertion) were secondary outcomes measures. Ninety-six subjects were allocated to either the treatment group (n = 47) or control group (n = 49) and were all included in the analysis. Results At the follow-up visit, we found significant differences in DASH score between the two groups (p = .015). The median change to baseline for the treatment group was -11.7 (interval: -50.83 to 23.33), and for the control group -7.50 (interval: -36.67 to 29.10). The estimated effect size was 0.47, indicating a medium effect. Significant differences were also found for secondary outcome measures for VAS of pain. There were no severe adverse events. Our findings suggest that acupuncture has a moderate efficacy in the treatment of LEP. Conclusions Acupuncture was shown to be efficacious in improving the function of the arm associated with lateral elbow tendinosis. Both the DASH score and the pain VAS on two occasions (at rest and during motion) showed a significant change over time indicating acupuncture as a potential treatment for LEP due to tendinosis.

Protein adsorption and platelet activation on biomedical devices contacting blood may lead to the formation of thrombus. The thrombogenicity of biomaterials could be minimized or prevented by anchoring a cell membrane mimetic antifouling coating (CMMAC). Here, we report the construction of a CMMAC by a newly designed 2-methacryloyloxyethyl phosphorylcholine (MPC) copolymer (PMPCC) containing 5-20 carboxylic long arm side chains. The long arm provides its end carboxylic group with more freedom and a larger reaction space for an easier and more efficient surface anchoring. With the assistance of mussel-inspired universal adhesive polydopamine (PDA), different material surfaces precoated with PDA can immobilize the PMPCC via multipoint anchoring of the randomly distributed carboxylic side chains. The multipoint anchoring results in a stabilized and condensed PDA-PMPCC coating. The phosphorylcholine zwitterions of the densely immobilized PMPCC polymers form a cell outer membrane mimetic interface in an aqueous environment, endowing excellent properties of resisting protein adsorption, platelet activation and blood cell adhesion. More importantly, the PDA-PMPCC-coated glass surface can suppress thrombus formation for more than 24 h, while the bare glass surface forms obvious thrombus in 6 h tested in the same blood. Furthermore, the fabrication of the PDA-PMPCC coating is simple and material-independent. Therefore, the simple synthesis, facile surface coating and excellent hemocompatibility of the PMPCC make it a promising material for biomimetic surface modification.

UiO-66 is a potential material for adsorption heat transformation (AHT) with high specific surface area, and excellent thermal and chemical stability. However, the low water adsorption capacity of UiO-66 in the low relative pressure range (0 < P/P 0 < 0.3) limits its application in AHT. We prepare the UiO-66 modified by MgCl2 through using the solvothermal method and impregnation method, and study their water vapor adsorption performances and heat storage capacities. Attributed to the extremely high saturated water uptake and excellent hydrophilicity of MgCl2, the water adsorption performance of UiO-66 is improved, although the introduction of MgCl2 reduces its specific surface area and pore volume. The water adsorption capacity at P/P 0 = 0.3 and the saturated water adsorption capacity of the UiO-66 (with MgCl2 content of 0.57 wt%) modified by the solvothermal method are 0.27 g/g and 0.57 g/g at 298 K, respectively, which are 68.8% and 32.6% higher than the counterparts of pure UiO-66, respectively. Comparing with pure UiO-66, the water adsorption capacity of the UiO-66 (with MgCl2 content of 1.02 wt%) modified by the impregnation method is increased by 56.3% and 14.0% at the same pressure, respectively. During 20 water adsorption/desorption cycles, the above two materials show high heat storage densities (∼ 1293 J/g and 1378 J/g). Therein, the UiO-66 modified by the solvothermal method exhibits the excellent cyclic stability. These results suggest that the introduction of an appropriate amount of MgCl2 makes UiO-66 more suitable for AHT applications.

Increasing the phonon scattering center by adding nanoparticles to thermoelectric materials is an effective method of regulating the thermal conductivity. In this study, a series of Ca3Co4O9/x wt.% CNTs (x = 0, 3, 5, 7, 10) polycrystalline ceramic thermoelectric materials by adding carbon nanotubes (CNTs) were prepared with sol-gel method and cold-pressing sintering technology. The results of x-ray diffraction and field emission scanning electron microscopy show that the materials have a single-phase structure with high orientation and sheet like microstructure. The effect of adding carbon nanotubes to the thermoelectric properties of Ca3Co4O9 was systematically measured. The test results of thermoelectric properties show that the addition of carbon nanotubes reduces the electrical conductivity and Seebeck coefficient of the material. Nevertheless, the thermal conductivity of the samples with carbon nanotubes addition is lower than that of the samples without carbon nanotubes. At 625 K, the thermal conductivity of Ca3Co4O9/10 wt.% CNTs sample is reduced to 0.408 W⋅m−1⋅K−1, which is about 73% lower than that of the original sample. When the three parameters are coupled, the figure of merit of Ca3Co4O9/3 wt.% CNTs sample reaches 0.052, which is 29% higher than that of the original sample. This shows that an appropriate amount of carbon nanotubes addition can reduce the thermal conductivity of Ca3Co4O9 ceramic samples and improve their thermoelectric properties.

Background There is a growing trend in the use of mobile health (mHealth) technologies in traditional Chinese medicine (TCM) and telemedicine, especially during the coronavirus disease (COVID-19) outbreak. Tongue diagnosis is an important component of TCM, but also plays a role in Western medicine, for example in dermatology. However, the procedure of obtaining tongue images has not been standardized and the reliability of tongue diagnosis by smartphone tongue images has yet to be evaluated. Objective The first objective of this study was to develop an operating classification scheme for tongue coating diagnosis. The second and main objective of this study was to determine the intra-rater and inter-rater reliability of tongue coating diagnosis using the operating classification scheme. Methods An operating classification scheme for tongue coating was developed using a stepwise approach and a quasi-Delphi method. First, tongue images (n=2023) were analyzed by 2 groups of assessors to develop the operating classification scheme for tongue coating diagnosis. Based on clinicians’ (n=17) own interpretations as well as their use of the operating classification scheme, the results of tongue diagnosis on a representative tongue image set (n=24) were compared. After gathering consensus for the operating classification scheme, the clinicians were instructed to use the scheme to assess tongue features of their patients under direct visual inspection. At the same time, the clinicians took tongue images of the patients with smartphones and assessed tongue features observed in the smartphone image using the same classification scheme. The intra-rater agreements of these two assessments were calculated to determine which features of tongue coating were better retained by the image. Using the finalized operating classification scheme, clinicians in the study group assessed representative tongue images (n=24) that they had taken, and the intra-rater and inter-rater reliability of their assessments was evaluated. Results Intra-rater agreement between direct subject inspection and tongue image inspection was good to very good (Cohen κ range 0.69-1.0). Additionally, when comparing the assessment of tongue images on different days, intra-rater reliability was good to very good (κ range 0.7-1.0), except for the color of the tongue body (κ=0.22) and slippery tongue fur (κ=0.1). Inter-rater reliability was moderate for tongue coating (Gwet AC2 range 0.49-0.55), and fair for color and other features of the tongue body (Gwet AC2=0.34). Conclusions Taken together, our study has shown that tongue images collected via smartphone contain some reliable features, including tongue coating, that can be used in mHealth analysis. Our findings thus support the use of smartphones in telemedicine for detecting changes in tongue coating.

Background: Repeated administrations of insulin injection on daily basis accompany pain and arise numerous complications with adverse effects on the diabetic patients life quality. Moreover, wearing insulin pump is also associated with several problems of diabetic ketoacidosis, catheter site infection, contact dermatitis and high cost. Methods: We have developed an in situ gel system, consisting of insulin-loaded liposomes dispersed within a thermoreversible gel (Pluronic® F127 gel), which increases the duration of insulin action for the treatment of diabetes. Vesicular phospholipid gel technique was used to encapsulate the insulin into liposomes. Results: The resulting liposomal gel formulation had a longer drug-release period in vitro than a free insulin solution or liposomes and Pluronic® F127 gel individually. Furthermore, the addition of liposomes to the Pluronic® F127 gel improved the stability of the encapsulated insulin at a physiological temperature. In vivo study was performed to investigate the bioactivity and absorption of insulin released from the liposomal gel and other formulations. The liposomal gel released insulin into the bloodstream continuously for up to 7 days and significantly enhanced drug bioavailability compared to insulin released from liposomes or Pluronic® F127 gel individually. Blood glucose levels were reduced for up to 4 days. Histology data demonstrated excellent biocompatibility of the Pluronic® F127 gel-based delivery systems, with no observable inflammatory response in rat subcutaneous tissues. Conclusion: Obtained results exhibit that the insulin-loaded liposomes dispersed within Pluronic® F127 gel can be used as a long-acting drug delivery system, and replacement for conventional insulin therapy.

© 2017 Background Similar to De Qi psychophysical responses, propagated sensation along the channels (PSC) is considered an important phenomenon in traditional Chinese acupuncture. In acupuncture clinical trials, different acupuncture manipulation techniques are used to enhance the propagation of sensation along the channels to facilitate an optimum therapeutic result. Aim To examine and compare the PSC reported by participants in a clinical trial following the administration of acupuncture and inactive mock laser. Methods The study was embedded in a two-arm parallel design multicenter, randomized clinical trial, the Tennis Elbow Acupuncture—International Study—China, Hong Kong, Australia, Italy (TEA IS CHAI). Needle sensations were measured using a validated instrument, the Massachusetts General Hospital Acupuncture Sensation Spreading Scale. Ninety-six participants with lateral elbow pain were randomly allocated into two groups in a 1:1 ratio; the acupuncture treatment group (n = 47) and the mock laser control group (n = 49). Participants in both groups received the intervention at two acupoints, LI10 and LI11, consisting of 2 minutes of either standardized needle manipulation or mock laser at each acupoint with a rest period between each intervention period. Data were collected immediately following the interventions at the first and the ninth session within the clinical trial. Results Although participants in both groups perceived PSC radiating to similar sites along the upper limb, the frequency of the reported radiation sites among the two intervention groups for both radiation up the limb (p < 0.05) and radiation down the limb (p < 0.001) were statistically significantly different. Among the radiating sensation sites recorded within the two study groups, the sensations were reported as radiating a greater distance down the forearm to the wrist compared to up the arm. Evaluation of PSC across the four study sites revealed a statistically significant difference in frequency of the reported radiation down the limb sites in each study group and radiation up the limb sites only in control group only (p < 0.001). Conclusion The findings of the study demonstrated that the PSC phenomenon is not just associated with needling but can be perceived when using a mock laser. Trial registration Australian and New Zealand Clinical Trial Registry reference: ACTRN12613001138774 on 11th of October 2013.

The purpose of this exploration was to detect the biological effects of miR-10b/FAM46C pair on osteosarcoma (OS) development. By accessing to the Gene Expression Omnibus (GEO) database, we achieved expressional profiles of miR-10b and FAM46C. Kaplan-Meier method was applied to determine the overall survival rates of OS patients. MiR-10b mimic/inhibitor were utilized to alter miR-10b expression. Overexpression of FAM46C was induced by pcDNA3.1-FAM46C. QRT-PCR and western blot were conducted to assess the expression levels. Cell counting kit-8 (CCK-8) and transwell assays were employed to evaluate the proliferative, invasive and migratory properties of OS cells. Pearson correlation analysis was performed to confirm the association between miR-10b and FAM46C. Dual-luciferase reporter assay was conducted to determine the target of miR-10b. The overall survival of OS patients was inversely correlated with miR-10b expression. MiR-10b was increased in OS compared with normal controls. Depletion of miR-10b attenuated the proliferation, invasion and migration of MG-63 cells. FAM46C was considered as a target gene of miR-10b and inversely related with miR-10b. Overexpression of FAM46C could inhibit cell growth, invasion and migration in OS; furthermore, it also can enforced the miR-10b inhibitor-induced effects on cell behaviors of OS cells. Down-regulation of miR-10b played a suppressive effect on the cell activity in OS cells, which provides a novel insight into the advance of OS therapeutic therapies.

BACKGROUND There is a growing trend in the use of mobile health (mHealth) technologies in traditional Chinese medicine (TCM) and telemedicine, especially during the coronavirus disease (COVID-19) outbreak. Tongue diagnosis is an important component of TCM, but also plays a role in Western medicine, for example in dermatology. However, the procedure of obtaining tongue images has not been standardized and the reliability of tongue diagnosis by smartphone tongue images has yet to be evaluated. OBJECTIVE The first objective of this study was to develop an operating classification scheme for tongue coating diagnosis. The second and main objective of this study was to determine the intra-rater and inter-rater reliability of tongue coating diagnosis using the operating classification scheme. METHODS An operating classification scheme for tongue coating was developed using a stepwise approach and a quasi-Delphi method. First, tongue images (n=2023) were analyzed by 2 groups of assessors to develop the operating classification scheme for tongue coating diagnosis. Based on clinicians’ (n=17) own interpretations as well as their use of the operating classification scheme, the results of tongue diagnosis on a representative tongue image set (n=24) were compared. After gathering consensus for the operating classification scheme, the clinicians were instructed to use the scheme to assess tongue features of their patients under direct visual inspection. At the same time, the clinicians took tongue images of the patients with smartphones and assessed tongue features observed in the smartphone image using the same classification scheme. The intra-rater agreements of these two assessments were calculated to determine which features of tongue coating were better retained by the image. Using the finalized operating classification scheme, clinicians in the study group assessed representative tongue images (n=24) that they had taken, and the intra-rater and inter-rater reliability of their assessments was evaluated. RESULTS Intra-rater agreement between direct subject inspection and tongue image inspection was good to very good (Cohen κ range 0.69-1.0). Additionally, when comparing the assessment of tongue images on different days, intra-rater reliability was good to very good (κ range 0.7-1.0), except for the color of the tongue body (κ=0.22) and slippery tongue fur (κ=0.1). Inter-rater reliability was moderate for tongue coating (Gwet AC2 range 0.49-0.55), and fair for color and other features of the tongue body (Gwet AC2=0.34). CONCLUSIONS Taken together, our study has shown that tongue images collected via smartphone contain some reliable features, including tongue coating, that can be used in mHealth analysis. Our findings thus support the use of smartphones in telemedicine for detecting changes in tongue coating.

Traditional Chinese Medicine (TCM) uses a sophisticated diagnostic system called pattern differentiation, which allows for the tailor-made treatment of individuals.This study aimed to identify the commonly used TCM patterns for lateral elbow pain (LEP), as well as the clinical features associated with these patterns.Journal literature in 15 major Chinese and English databases and textbooks from five medical libraries as well as Chinamaxx were reviewed.Five hundred and fifty-five full-text journal articles, as well as 465 textbooks, were retrieved for further assessment, but only eight studies and seven books that mentioned LEP patterns could be identified and included in this study. The top four patterns that were identified were the wind-cold-dampness pattern, the qi stagnation and blood stasis pattern, the dual deficiency of qi and blood pattern, and the retained dampness-heat pattern, each of which was associated with unique features that were made up of distinct signs and symptoms.The unique features identified for each of the major patterns might be the key to understanding TCM individualized treatment based on pattern differentiation. Furthermore, the approach taken in studying TCM pattern of LEP may also be useful for studying the TCM patterns of other musculoskeletal conditions.

Introduction Acupuncture is commonly used as a complementary and alternative medicine therapy for insomnia. Traditional Chinese medicine (TCM) diagnosis is sometimes used to guide treatment decisions. This study aimed to examine whether TCM diagnosis and symptom clusters were related to acupuncture response in subjects with insomnia. Methods Two-hundred and seven participants diagnosed with dual deficiency of the heart-spleen, non-interaction between the heart and kidney, depressed liver qi transforming into fire, or yin deficiency with effulgent fire who were randomly allocated to receive real acupuncture, completed treatment and had available follow-up data were analyzed. Standardized electroacupuncture was administered 3 times per week for 3 weeks. Primary outcome measure was Insomnia Severity Index (ISI). A 92-item symptom checklist was used to assist TCM diagnosis. A final agreed TCM diagnosis was made based on 2 Chinese medicine practitioners. Results Participants with depressed liver qi transforming into fire had the highest response rate of 36.6% from baseline to 1-week posttreatment, while the lowest response rate occurred in yin deficiency with effulgent fire at 13.0%; however, the difference was not statistically significant. There was a significant negative correlation between ISI change score and ratings on weary limbs, sore knees, or backache (ρ = –0.17, P Conclusion The response to acupuncture was unrelated to TCM diagnosis, possibly because the zang fu system was not sensitive to detect individual difference in acupuncture or the acupuncture points chosen were non-specific.

In planning for a large-scale multicenter trial to evaluate the effect of acupuncture for the treatment of lateral elbow pain, a pilot study was conducted. This was a prospective, investigator- and patient-blinded, nonrandomized, placebo controlled trial. Subjects were evaluated at baseline, before fourth, seventh, and ninth treatment, and at a two-week posttreatment follow-up. The treatment group received unilateral acupuncture at LI 10 and LI 11 at the affected side with manual needle manipulation; the control group received sham-laser acupuncture at the same acupoints. Measures included (i) disabilities of the arm, shoulder, and hand (DASH) questionnaire, (ii) pain-free grip strength (PFGS), and (iii) a visual analogue scale (VAS) for pain. Significant differences in DASH score, PFGS, and VAS between treatment and control group were found at the ninth treatment (n=20for each group,P<0.05). Only DASH showed significant differences compared to the control for all the measurement time points after treatment commenced and appears to be a sensitive and appropriate primary outcome measure for the future multisite trial. Results from this pilot study provided relevant information about treatment efficacy, credibility of control treatment, and sensitivity of different outcome measures for the planning of the future trial.

The purpose of this exploration was to detect the biological effects of miR-10b/FAM46C pair on osteosarcoma (OS) development. By accessing to the Gene Expression Omnibus (GEO) database, we achieved expressional profiles of miR-10b and FAM46C. Kaplan-Meier method was applied to determine the overall survival rates of OS patients. MiR-10b mimic/inhibitor were utilized to alter miR-10b expression. Overexpression of FAM46C was induced by pcDNA3.1-FAM46C. QRT-PCR and western blot were conducted to assess the expression levels. Cell counting kit-8 (CCK-8) and transwell assays were employed to evaluate the proliferative, invasive and migratory properties of OS cells. Pearson correlation analysis was performed to confirm the association between miR-10b and FAM46C. Dual-luciferase reporter assay was conducted to determine the target of miR-10b. The overall survival of OS patients was inversely correlated with miR-10b expression. MiR-10b was increased in OS compared with normal controls. Depletion of miR-10b attenuated the proliferation, invasion and migration of MG-63 cells. FAM46C was considered as a target gene of miR-10b and inversely related with miR-10b. Overexpression of FAM46C could inhibit cell growth, invasion and migration in OS; furthermore, it also can enforced the miR-10b inhibitor-induced effects on cell behaviors of OS cells. Down-regulation of miR-10b played a suppressive effect on the cell activity in OS cells, which provides a novel insight into the advance of OS therapeutic therapies.

Objective To evaluate the efficacy of using electroacupuncture as an adjunct treatment in enhancing the benzodiazepine cessation rate in long-term benzodiazepine users. Methods This was a randomized, assessor- and subject-blinded, controlled trial. One hundred and forty-four long-term benzodiazepine users were randomly assigned to receive either electroacupuncture or placebo acupuncture (a sham itervention using non-invasive placebo needles) combined with a gradual benzodiazepine tapering schedule for 4 weeks. The primary outcome was the cessation rate of benzodiazepine use. Subjects were assessed on their benzodiazepine usage, benzodiazepine withdrawal symptoms, insomnia severity, and anxiety and depressive symptoms at baseline, week 6 and week 16. Results The cessation rates of the electroacupuncture and placebo acupuncture groups at 12 weeks post-treatment were 9.17% and 10.83%, respectively. Both groups showed a reduction in benzodiazepine usage by a self-completed drug record at week 16 (compared to baseline: electroacupuncture group −40.23% versus placebo acupuncture group −48.76%). However, no significant between-group differences were found in the benzodiazepine cessation rate, reduction in benzodiazepine usage, and other secondary measures across all the study time points. Conclusions Electroacupuncture showed a similar cessation rate in benzodiazepine use to that of non-invasive placebo acupuncture in long-term users during a 4-week gradual tapering schedule. The evidence did not support advantages of electroacupuncture over non-invasive placebo acupuncture on reducing insomnia, anxiety, depression, or other withdrawal symptoms during the gradual tapering schedule. Despite a 40% decrease in the benzodiazepine usage in both groups, the effects may be attributed to the non-specific effects of acupuncture. Trial Registration ClinicalTrials.gov # NCT02475538.

© 2018 Acupuncture has been broadly applied in the management of many diseases and conditions; however, its mechanism of action has been partially elucidated. Additionally, assessment of psychophysical responses in the acupuncture therapy is not common regarding anxiety disorder studies. Taken together, the therapeutic effect of acupuncture appears when De Qi psychophysical response is experienced following stimulation of the afferent sensory nerves. The present study investigates the level of anxiety perceived at different occasions in acupuncture and mock laser group. Furthermore, it examines the relationship between perceived De Qi psychophysical response and the level of anxiety experienced during administration of each intervention. The study was embedded in a two-arm parallel design multi-center, randomized clinical trial, the Tennis Elbow Acupuncture-International Study-China, Hong Kong, Australia, Italy. Participants’ level of anxiety was measured using a validated instrument, the Massachusetts General Hospital Acupuncture Sensation Mood Scale. Ninety-six participants with Lateral Elbow Pain were randomly allocated into two groups; the acupuncture treatment group (n = 47) and the inactive mock laser control group (n = 49). Data were collected immediately following the interventions at the first and the ninth session within the clinical trial. Acupuncture with De Qi did not induce higher level of anxiety compared to prior administration of acupuncture. In fact, participants were more relaxed after receiving acupuncture than those who received mock laser. There was also a weak association between participants’ perception of anxiety during acupuncture and the MASS De Qi Index in session nine only (p < 0.01). Further investigation of the result revealed weak positive correlation between anxiety perceived during administration of acupuncture and the following De Qi characteristics; ‘soreness’ (p < 0.01), ‘Deep pressure’ (p < 0.05), ‘Heaviness’ (p < 0.05), and ‘Fullness/distension’ (p < 0.05). Acupuncture can be regarded as a potential therapy for preoperative anxiety through its possible regulatory function of emotion. While culture may not alter the expectation of the individual regarding anxiety, symptomology associated with anxiety should be understood within the context of the cultural background.

Objectives Mild adverse events (AEs) are common with acupuncture, but the collection of AEs is generally poor. The objective of this study was to develop and test a new instrument for acupuncture-related AEs. Materials and methods After literature review, consultation with experts, and pilot-testing, the acupuncture-related AE report form (AcupAE), a 20-item scale on local and systemic AEs was tested in 150 adults who were randomized to receive acupuncture, minimal acupuncture, and placebo acupuncture. AE was assessed using open-ended questioning, followed by the AcupAE after the third, sixth, and ninth treatment. Results The incidence of any AEs per patient, as derived from the AcupAE, was 42.4% with acupuncture, 42.2% with minimal acupuncture, and 16.7% with placebo acupuncture; the respective incidence was 6.8%, 5.1%, and 3.3% with open-ended questioning. There was a significant difference in the incidence of any AEs between the 3 groups based on the AcupAE, and the incidence rates of any AEs were significantly higher when assessed by the AcupAE than by open-ended questioning in the acupuncture and minimal acupuncture groups. Discussion The AcupAE was able to detect differences in AE between true, minimal, and simulated acupuncture, whereas the open-ended questioning was not sensitive enough. The results support the use of AcupAE as an effective instrument for the assessment of acupuncture-related AEs. Although the checklist approach can result in overreporting and the causality may be unclear for some events, it is the first step for collecting standardized information and allowing comparison between different acupuncture approaches and patient groups in future studies.

In this paper, experiments have been carried out to determine the effect of carbonation on the resistance of sulfate attack of concrete materials. The accelerated carbonate testing was used to prepare the carbonated specimens, and wetting-drying cycles were used to evaluate the resistance of sulfate attack. Results show that longer carbonate time leads to greater depth of carbonation, and fly ash may accelerate the carbonation of concrete materials. The loss of flexural strength was greater than that of compressive strength under the condition of sulfate attack. Carbonation is detrimental to the resistance of sulfate attack.

Objective To evaluate the efficacy and safety of acupuncture for residual insomnia and other residual symptoms associated with major depressive disorder (MDD). Method 150 participants having significant insomnia for more than 3 months and a history of MDD (both based on DSM-IV-TR criteria) were recruited from 4 psychiatric outpatient clinics in Hong Kong from May 2011 to August 2013 to receive 9 sessions of treatment over 3 weeks. They were randomized to receive acupuncture, minimal acupuncture, or placebo acupuncture. Primary outcome was sleep diary-derived sleep efficiency. Secondary outcomes included other sleep diary parameters, actigraphy, anxiety and depressive symptoms, daytime functioning, and adverse events. Results The mean difference in sleep diary-derived sleep efficiency at 1-week posttreatment was -1.40 (95% CI, -7.08 to 4.28) between the acupuncture and minimal acupuncture groups and was 3.10 (95% CI, -3.64 to 9.84) between the acupuncture and placebo acupuncture groups. A χ(2) test showed that acupuncture produced a significantly higher proportion of participants achieving sleep-onset latency ≤ 30 minutes than did minimal acupuncture at 1-week posttreatment (P = .04). However, there was no significant between-group difference in most of the other outcomes. Treatment blinding was successful, as a majority of participants did not know which treatment they had received. Conclusions Acupuncture was well tolerated, but the efficacy was only mild and similar to that of minimal acupuncture and placebo acupuncture. A high proportion of patients remained clinically significantly affected by insomnia after treatment. The finding raises certain doubts about the value of acupuncture and underscores the difficulties in the treatment of residual insomnia in MDD. Trial registration ClinicalTrials.gov identifier: NCT01707706.

Mussel inspired polydopamine (PDA) coating has been proven to be a simple and effective method for surface modification of biomaterials. However, the adhesive functional groups remaining on the surface of PDA coating may promote the attachment of nonspecific proteins and microorganisms and hinder anti-biofouling performance. In this study, the PDA coating formation process is monitored in real-time by a sensitive surface plasmon resonance (SPR) technique at different pH values, initial dopamine concentrations and deposition times. The coating morphology is observed by atomic force microscopy (AFM). Nonspecific protein adsorption, platelet and fibroblast cell adhesion, as well as bacteria attachment on the PDA coatings of different thicknesses are measured to evaluate their anti-biofouling performance. Thickness-dependent biofouling of the PDA coatings is demonstrated by the accumulation of adhesive functional groups within the PDA matrix. In order to reduce the biofouling, we treat the PDA coating by FeCl3 coordination, NaIO4 oxidation, heating in air and grafting with a phosphorylcholine copolymer bearing active ester groups. The modified surfaces are characterized by X-ray photoelectron spectroscopy (XPS) and attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy measurements. Interestingly, all the treatments help to resist protein adsorption significantly. More excitingly, the simple grafting strategy with a phosphorylcholine copolymer can resist more than 99% of platelet, fibroblast, and bacteria cell attachment, 98% of bovine serum albumin and 95% of bovine plasma fibrinogen adsorption on the PDA coating. These results may find applications in the vast area of surface antifouling, especially for most biomedical devices.

Traditional Chinese medicine (TCM) treatments are often prescribed based on individuals’ pattern diagnoses. A systematic review of randomized controlled trials in Chinese and English literatures on TCM pattern-based treatment for depression has therefore been conducted. A total of 61 studies, 2504 subjects, and 27 TCM patterns were included. Due to the large variation of TCM pattern among participants, we only analyzed the top four commonly studied TCM patterns:liver qi depression, liver depression and spleen deficiency, dual deficiency of the heart, and spleenandliver depression and qi stagnation. We found that Xiaoyao decoction was the most frequently used herbal formula for the treatment ofliver qi depressionandliver depression with spleen deficiency, while Chaihu Shugan decoction was often used forliver depression and qi stagnation. Bai Shao (Paeonia lactifloraPall.) and Chai Hu (Bupleurum chinenseDC.) were commonly used across different TCM patterns regardless of the prescribed Chinese herbal formulas. The rationale underlying herb selection was seldom provided. Due to the limited number of studies on TCM pattern-based treatment of depression and their low methodological quality, we are unable to draw any conclusion regarding which herbal formulas have higher efficacy and which TCM patterns respond better to CHM.

Background. Tongue diagnosis is one of the main diagnostic methods in Chinese Medicine (CM). In addition to being used with other techniques to generate a CM diagnosis, methods derived from CM tongue diagnosis may have new applications, especially in early detection of certain diseases. Therefore, we believe that automating the collection and analysis of tongue images is of great benefit. While several methods for capturing images, extracting features and analyzing the data have been proposed over the years, most have limitations in reliability, accuracy, cost and usability. Nonetheless, recent advances in the field of image processing and machine learning (ML), together with improved hardware capabilities are rapidly enabling novel solutions to the problem. This paper describes a new mobile phone-based image acquisition method and reports our assessment of image quality from a clinical perspective. Methodology. A mobile phone-based system that uses a phone's flash and back camera to collect images with automatic white balance was developed. The usability and image quality were tested on forty (40) volunteers. Information pertaining to CM diagnosis of the tongue was collected through direct visual inspection, and by inspecting images produced by a commercially available tongue image diagnostic instrument, and by our newly developed system. The data collected amongst the three methods were compared using Cohen's kappa coefficient to evaluate the practical value of the images collected by the new system. Result. Our system is able to collect good quality tongue images and in general provides information comparable to those obtained through direct visual inspection or by the commercial instrument. Compared with the commercial instrument, our system has better inter-rater agreement with direct visual inspection in detecting the presence of tooth marks (kappa value: 0.633 vs 0.259), but inferior in detecting tongue coating greasiness (kappa value: 0.217 vs 0.739). Main contributions of this paper. We have presented a new mobile phone-based tongue image acquisition system that is low cost and convenient to use. Because of these desirable features, the system has the potential for mass public use to collect big data, paving the way for development of automatic tongue analysis using deep learning techniques.

Background Few high-quality, large-scale, controlled trials comparing the effectiveness and safety of acupuncture, auricular acupuncture and combined acupuncture treatment for insomnia are available. Objective To carry out a randomised, assessor-blinded, waitlist-controlled trial to test the superiority of combination treatment. Methods After in-person and polysomnography screening, 224 subjects (mean age 53.4 years; 75.4% female) with DSM-5 insomnia disorder, who were free from major psychiatric disorders and with sleep-diary-derived sleep efficiency averaged over 1 week of Results There was no significant difference between acupuncture and combination treatment in the primary outcome and most secondary outcomes at all time points. However, both treatments were better than waitlist in reducing insomnia, anxiety/depressive symptoms and fatigue, and improving function. Within-group improvements were maintained at 13 weeks after treatment. Of 260 adverse events, 243 were mild (93.5%). Discontinuation due to adverse events was 2.1% and 3.1% for acupuncture and combination treatment, respectively. Conclusions Limited by short-term treatment and follow-up, the attempt to augment acupuncture by auricular acupuncture was not supported. Acupuncture and combination treatment were safe and had mild hypnotic effects, which lasted for at least 13 weeks. Trial Registration Number NCT01891097; Results.

© 2017 The Author(s). Background: The psychophysical responses induced by verum acupuncture are characterized by a constellation of unique subjective sensory responses commonly termed De Qi. Furthermore, a variety of sham interventions have been used as a control for acupuncture clinical trials. Indeed, one such control has been mock laser which has been used as control intervention in several acupuncture clinical controlled trials. The current study aim was to examine the De Qi sensory responses and its related characteristics elicited from acupuncture and compare them to those reported following sham laser in participants enrolled in a clinical trial. Methods: The study was embedded in a multi-center, two-arm randomised clinical trial, which evaluated the effect of acupuncture on lateral elbow pain. De Qi was assessed using the Massachusetts General Hospital Acupuncture Sensation Scale (MASS). Ninety-six participants were randomly allocated to receive either acupuncture (n = 47) or mock laser (n = 49) at the acupoints LI 10 and LI 11. Results: Participants in both intervention groups reported similar De Qi psychophysical characteristics; however, both intensity and frequency of the individually perceived De Qi characteristics were significantly higher in the acupuncture group. 'Soreness', 'deep pressure', and 'fullness-distension' in the acupuncture group and 'tingling', and 'sharp pain' in mock laser group, were identified as the leading characteristics. Similar level of MASS De Qi Index (MDI) scores were reported for 'Hong Kong-China' and 'Australia-Italy' with a significantly higher level of De Qi reported by 'Hong Kong-China'. Furthermore, two distinct De Qi categories were identified, namely De Qi (in line with classical sensory responses of Suan, Ma, Zhang, and Zhong) and pain. Conclusions: Subjective 'somatic or interoceptive awareness' should be taken into account when De Qi psychophysical responses are examined. The study accentuates the necessity and the significance of further research into interoception phenomenon which may contribute to a better understanding of the placebo effect and De Qi psychophysical responses. Trial registration: Australian and New Zealand Clinical Trial Registry reference: ACTRN12613001138774on 11th of October 2013.

In order to effectively ascertain the failure mechanism of piled wharf affected by slope deformation in earthquake, numerical analysis is conducted by Finite Element Method in this paper. In the computational model, elastic plastic characteristic of subsoil, discontinuous behavior of pile soil interface, and nonlinearity of structure material are considered to conduct seismic computation in time domain. Numerical results show the possible locations of wharf structure which generate cracks and plastic hinges. Some conclusions are drawn and can be reference for engineering design and practical project.

Background Conventional approaches for benzodiazepine tapering have their limitations. Anecdotal studies have shown that acupuncture is a potential treatment for facilitating successful benzodiazepine tapering. As of today, there was no randomized controlled trial examining its efficacy and safety. The purpose of the study is to evaluate the efficacy of using electroacupuncture as an adjunct treatment to gradual tapering of benzodiazepine doses in complete benzodiazepine cessation in long-term benzodiazepine users. Methods/Design The study protocol of a randomized, assessor- and subject-blinded, controlled trial is presented. One hundred and forty-four patients with histories of using benzodiazepines in ≥50% of days for more than 3 months will be randomly assigned in a 1:1 ratio to receive either electroacupuncture or placebo electroacupuncture combined with gradual benzodiazepine tapering schedule. Both experimental and placebo treatments will be delivered twice per week for 4 weeks. Major assessments will be conducted at baseline, week 6 and week 16 post-randomization. Primary outcome is the cessation rate of benzodiazepine use. Secondary outcomes include the percentage change in the doses of benzodiazepine usage and the severity of withdrawal symptoms experienced based on the Benzodiazepine Withdrawal Symptom Questionnaire, insomnia as measured by the Insomnia Severity Index, and anxiety and depressive symptoms as evaluated by the Hospital Anxiety and Depression Scale. Adverse events will also be measured at each study visit. Discussion Results of this study will provide high quality evidence of the efficacy and safety of electroacupuncture as an adjunct treatment for benzodiazepine tapering in long-term users. Trial registration ClinicalTrials.gov NCT02475538. Electronic supplementary material The online version of this article (doi:10.1186/s12906-017-1692-5) contains supplementary material, which is available to authorized users.

Seepage is important influence factors of degradation and instability to the water or under water concrete structure, it is also the difficult point in geotechnical engineering research.Through the concrete seepage experiment，combined with the Seep/W module of GeoStudio software，simulation of unsteady seepage of concrete，it was obtained that the seepage field under the action of a variable water head in 24 hr,And the results were compared with laboratory data，For further research on concrete permeability structure in practical engineering, foundation stability and durability.

Control over cell-material surface interactions is the key to many new and improved biomedical devices. In this study, we present a simple yet effective surface modification method that allows for the surface reconstruction and formation of cell outer membrane mimetic structure on coatings that have significantly increased hemocompatibility. To achieve this, a phosphorylcholine end-capped poly(butylene succinate) (PBS-PC) was synthesized and dip-coated on coverslips. The surface structure of the amphiphilic PBS-PC film was reconstructed by heating in a vacuum oven to obtain the less hydrophilic surface and by immersing in hot water to obtain the more hydrophilic surface. Significant changes in the surface element concentration were observed by X-ray photoelectron spectroscopy analysis and changes in surface wettability were measured by sensitive dynamic contact angle technique. Scanning electron microscope images showed different morphologies of the reconstructed surfaces. Interestingly, the reconstruction between the less hydrophilic and more hydrophilic surfaces is reversible. More importantly, both the reconstructed surfaces are stable in room condition for more than 6 months, and both the surfaces show significant improvement in hemocompatibility as revealed by protein adsorption and platelet adhesion measurements. This reversible surface reconstruction strategy and the interesting results may be significant for fabricating stable and hemocompatible surfaces on differently shaped biomedical devices.

This paper presents an effective approach for the optimization of the wire electric discharge machining (WEDM) process with multiple performance characteristics based on the grey relational analysis. Twenty five experimental runs based on the Taguchi method of orthogonal arrays were performed to determine the best factor level condition. The response table and response graph for each level of the machining parameters were obtained from the grey relational grade. In this study, the machining parameters such as the machining voltage, the number of power amplifier tube, pulse width and pulse interval are optimized with consideration of multiple-performance characteristics, such as machining time and surface roughness. It is clearly shown that the above performance characteristics in WEDM process can be improved effectively through this approach. keywords: WEDM; grey relational analysis; parameter optimization; performance characteristics

Chinese herbal medicine (CHM), either in single herb or in herbal formula, has been used to treat insomnia for more than 2000 years. A systematic review including Chinese and English literature of randomized controlled trials was conducted to examine the efficacy, safety, and composition of CHM for insomnia. Among the 217 studies we have reviewed, only eight had a Jadad score ≥3, and seven out of these eight studies had at least one domain with high risks of bias. Meta-analyses of the studies with Jadad score ≥3 found that CHM was similar to Western medication (three studies) and placebo (three studies) in treating insomnia. Due to the poor methodological quality of the studies and the small number of trials included in meta-analyses, the current evidence is insufficient to support the efficacy of CHM for insomnia. The frequency of adverse events associated with CHM was similar to that of placebo, but lower than with Western medication. Gui Pi Tang was the most commonly used standardized formula, while Suan Zao Ren (Ziziphus jujuba) was the most frequently used single herb. Further studies with a double-blind placebo-controlled design are needed to accurately determine the benefits and risks of CHM for insomnia.

A piezoelectric vibration table was designed for seeding precisely small size of vegetable seed, tree seed, flower seed, etc., it worked under the converse piezoelectric effect of piezoelectric element, piezoelectric vibration driving system produced mechanical micro-displacements with applied electric field, micro-displacements amplified by amplification mechanism driven the seed dish vibrating, producing the boiling movement beneficial to sucking seeds. The mathematical model of piezoelectric vibration was established, static and dynamic state properties of vibration table were analyzed and tested. Experimental results showed that piezoelectric vibration system had a higher drive capacity when 90～110 V electric voltage was loaded, vibration amplitude was above 1.31 mm, vibration frequency was at 13～55Hz and adjustable (resonant frequency about at 25Hz). The piezoelectric vibration table is expected to reach to favorable dynamic characteristics and higher seeding performance, runs smoothly, and meets the agronomic demands for precise tray seeding.

Based on domestic and foreign research situations of variable-rate fertilizing technology, the overall structure and working mechanism of variable-rate fertilizing machine were described, control content and strategy of control system were studied, AT89C5 SCM was used as a core control element in control system, control system hardware and software were designed and integrated. Variable-rate fertilizing experiments in space and paddy field showed that working efficiency of the spreader was up to 6 hm2/h, fertilizing error was less than 5%, fertilizing stability variation coefficient was less than 6.2%, working performance and control system design of the fertilizer can satisfy the demand of variable-rate fertilization in paddy field.

Combining an example of rock slope engineering, the finite element model of excavation, reinforcement with rainfall infiltration conditions is built up. The process of stage excavation and reinforcement of the slope are simulated, and the stress and deformation law and displacement change of the slope during each stage period are analyzed, and the stability of slope is evaluated under some conditions. Moreover, the discontinuous deformatioanalysis model is set up, the limited internal friction angle of the sliding face of slope is obtained, and the slope stability is evaluated. It was shown that the conclusion of two methods was consistent, and the slope was basically stable.

This paper presents the results of testing performed to evaluate the influence of steel fiber on the performance of concrete materials. The performance of concrete materials was studied through frost resistance, carbonation testing and restraint cracking testing. Experimental results show that the steel fibers can improve the frost resistance and carbonation of concrete, compared with plain concrete. Steel fibers can also reduce cracking, and improve the cracking resistance of concrete materials.

Lineage analysis of a single cell provides a powerful mean to delineate its functions during animal development, which, however, has been hindered by the complex nature of tissues that consist of many different types of cells with divergent morphologies, structures and functions. Mosaic technique and various labeling methods have provided ideal genetic tools for such studies. In this review, we described seven lineage analysis techniques that have been generally applied in Drosophila melanogaster, including FRT-mediated mitotic recombination, MARCM (Mosaic analysis with a repressible cell marker), TSG (Twin spot generator), Twin-spot MARCM, Q-MARCM (Q system-based MARCM), Coupled MARCM, and G-TRACE (Gal4 technique for real-time and clonal expression). These techniques enable researchers to perform genetic manipulations at a single cell level, and trace its development in complicated systems such as the nervous system. These methods may also be applied to lineage analysis in other model organisms.

Vanadium nitride (VN) particulate reinforced Fe-based composite was produced with ferrovanadium, Ferromolybdenum, ferrochromium and nitrogen gas by in situ synthesis process. The microstructure of the composites was characterized by X-ray diffraction and scanning electron microscopy. With the help of differential thermal analysis, reaction process of Fe-V-N system was discussed. The results show that the composite consists of VN and α-Fe phase. VN particles exhibit fine size and homogeneous distribution in Fe matrix. Formation of VN at 674°C is due to the reaction between ferrovanadium and nitrogen gas.

The support of soft rock roadway is the worldwide problem in Coal resources exploitation, and this problem affect production safety and efficiency of coal mining serious. The surrounding rock of Ronghua coal mine is complex soft rock with expansibility, complex geological structure and deep high stress, large deformation of rocks, floor heave serious , supporting difficulties, frequent overhaul, waste a lot of manpower and material resources, and serious threats to the mine's safety production. After many years of practicing, a new idea of supporting the soft rock in different time periods, which is” avoiding first, then resistance”, was propounded. Based on the lithology of surrounding rock and geologic structure, the roadway’s length of service, application, and service condition were considered, several pointed support schemes of roadway in -650m level: Super-strong supporting, High-strong supporting, Flexibility combined supporting and Retractable U-shaped supporting were confirmed. A whole soft rock supporting technology system has been formed which effectively solved the difficult problems of soft rock supporting. These achievements can provide useful experience for similar engineering problems.

It is difficult to build a strict mathematical model for WEDM due to the complication of the machining process and the nonlinear relation between process parameters and process targets. The neural network is suited to the modeling of complex system, because it has the functions of self-organized, self-learning and associative memory, and properties of distributed parallel type and high robustness. Therefore, this paper attempts to use the RBF neural network for the process modeling of WEDM.

A systematic review was conducted to examine traditional Chinese medicine (TCM) patterns commonly diagnosed in subjects with insomnia and clinical features associated with the TCM patterns, and an insomnia symptom checklist for TCM diagnostic purpose was developed based on the review. Two independent researchers searched the China Academic Journals Full-Text Database and 10 English databases. A total of 103 studies and 9499 subjects were analyzed. There was a wide variation in terminology relating to symptomatology and TCM pattern. We identified 69 patterns, with the top 3 patterns (i.e., deficiency of both the heart and spleen, hyperactivity of fire due to yin deficiency, and liver-qi stagnation transforming into fire) and the top 10 patterns covering 51.8 and 77.4 of the 9499 subjects, respectively. There were 19 sleep-related, 92 non-sleep-related, 14 tongue, and 7 pulse features included as diagnostic criteria of the top 10 TCM patterns for insomnia. Excessive dreaming, dizziness, red tongue, and fine pulse were the most common sleep-related, non-sleep-related, tongue, and pulse features. Overlapping symptomatology between the TCM patterns was present. A standardized symptom checklist consisted of 92 items, including 13 sleep-related, 61 non-sleep-related, 11 tongue, and 7 pulse items, holds promise as a diagnostic tool and merits further validation. © 2012 Maggie Man-Ki Poon et al., published_or_final_version

When the pressure of CO2 is 2 MPa, through the autoclave corrosion tests of annealed N80 steel specimens in simulated oil field water solution at different temperature, the mechanism of corrosion and the change rule of corrosion resistance with the change of temperature were discussed. In the autoclave tests, some iron elements of the specimens become Fe2+ions and the Fe2+ ions go into the solution, which results in the corrosion weight loss. Scaling develops because the CO32- ions in the simulated oil field water solution react with iron elements of the specimen. To QPQ treated specimens, with the increase of temperature, the compactness of the scaling increase, the corrosion weight loss and the weight of scaling decrease. In the same temperature, the corrosion weight loss and the weight of scaling of QPQ treated specimens are both lower than that of untreated specimens.