TM Group Research Articles

Microbiota modulation by the inclusion of Tenebrio molitor larvae as alternative to fermented soy protein concentrate in growing pigs diet.

Tenebrio molitor meal represents a promising protein source for animal nutrition due to its low environmental impact and high nutritional value. To date, there is limited data in the literature regarding the effects of Tenebrio molitor meal on the modulation of gut microbiota in growing animals, with most results focusing on poultry rather than pigs. The aim of this study was to evaluate the effects of replacing fermented soy protein concentrate with Tenebrio molitor meal on gut microbiota and feed digestibility in growing pigs. A total of 14 growing pigs (80 ± 2 days old) were randomly allotted to two groups: the control group (CON) was fed a commercial diet containing 4% fermented soy protein concentrate (48% crude protein), and the treatment group (TM) was fed a basal diet containing 5% of T. molitor larvae meal formulated to be isonitrogenous and isoenergetic. The study lasted 28 days. Animals were weekly weighted and feed refuse was routinely measured. Fecal, blood samples, and rectal swabs were collected for analysis. No differences were observed in growth and diet digestibility for the protein and lipid components throughout the trial. No differences in the serum concentrations of albumin, globulin, urea, and interleukin-6 were registered in both groups, suggesting an unaltered health status. The TM group showed a significant difference in the beta diversity index considering the total duration of the trial (treatment effect evaluated with PERMANOVA, R2 0.0771, p value = 0.0099) showing an increased abundance of Elusimicrobium spp. and a decrease in Asteroplasma spp. in TM compared to the CON group (p < 0.05). Obtained findings indicate that 5% T. molitor meal can be included as a partial replacement for soy in growing pig formula without impairing pig growth and gut microbiota composition.

Dietary Thymol Supplementation Promotes Antioxidant Responses and Thermal Stress Resistance in Rainbow Trout, Oncorhynchus mykiss.

Rainbow trout fingerlings were fed, in triplicate, diets supplemented with 0 (CTL), 50 (50 TM), 100 (100 TM), 200 (200 TM), 400 (400 TM) and 800 (800 TM) mg/kg of thymol, followed by 48 h of thermal stress. Growth performance and humoral immunological parameters showed no significant responses to dietary thymol concentrations. Fish fed 50-400 mg/kg thymol diets had significantly higher survival after heat stress. Plasma cortisol, glucose, hepatic glutathione peroxidase, glutathione reductase and erythrocyte catalase significantly increased after thermal stress, whereas total plasma antioxidant capacity, ascorbate, and hepatic/erythrocyte reduced-glutathione significantly decreased. There were significant elevations in plasma ascorbate and hepatic glutathione reductase in the 50 TM, 100 TM and 200 TM groups; plasma total antioxidant capacity in the 100 TM and 200 TM groups; hepatic glutathione peroxidase in the 200 TM group; and hepatic-reduced glutathione in the 100 TM, 200 TM and 400 TM groups, compared to CTL. The highest hepatic superoxide dismutase and lowest hepatic malondialdehyde were observed in the 100 TM group before heat stress. These parameters significantly increased after thermal stress in the treatment groups, except in the 100 TM and 200 TM groups. Hepatic catalase showed no significant difference among the treatment groups before thermal stress. Hepatic catalase significantly increased after heat stress in all treatment groups, except in the 100 TM group. Erythrocyte superoxide dismutase significantly increased in the 100 TM group before heat stress, whereas erythrocyte malondialdehyde significantly decreased in the 100 TM and 200 TM groups after thermal stress. Based on the results, 100 mg/kg of thymol can promote antioxidant power and thermal stress resistance in rainbow trout.

Effect of telemonitoring on the rate of dropout during home non-invasive ventilation: a retrospective study using a home care provider database

ObjectivesTelemonitoring (TM) of home non-invasive ventilation (NIV) has been shown to facilitate home/outpatient therapy set-up. However, the impact of long-term TM on therapy dropouts, compliance and leak control has not...

Application of bidirectional telemedicine in home CPAP for children with obstructive sleep apnea syndrome

BackgroundTraditional telemedicine follow-up proves unsuitable for home continuous positive airway pressure (CPAP) therapy in children with obstructive sleep apnea syndrome (OSAS). Accompanying advancements in mobile internet, this study explores the feasibility and effectiveness of a mobile communication and remote monitoring system as a novel bidirectional telemedicine approach to enhance adherence to home CPAP in children with OSAS. MethodsA prospective cohort utilizing bidirectional telemedicine follow-up from January to December 2022 (TM) was compared with a retrospective cohort receiving conventional phone follow-up from August 2018 to December 2021 (CP). Participants in TM group were subdivided into two groups based on the number of inquiries in the first week: a high-question group and a low-question group. The main endpoints included successful CPAP adaption and adherence at 2 months of follow-up. ResultsThe TM group exhibited a significantly lower termination rate within 2 months compared to the CP group (1/24 vs. 6/22, p = 0.037). In the first week of home CPAP, the high-question group reported shorter average nightly usage and fewer days with usage of ≥4 h compared to the low-question group (5 h per night vs. 8.5 h per night, 4.5 days vs. 7 days, both p < 0.001). However, the high-question group showed significant improvement in adherence from the second week onward for the remainder of the study period. ConclusionsBidirectional telemedicine represents an effective and feasible method to improve adherence to home CPAP therapy in children with OSAS. Considering the costs, researchers recommend applying bidirectional telemedicine for at least 1 week to better enhance long-term adherence.

Hematopoietic Stem Cell Transplantation in Children with Sickle Cell Disease and Thalassemia Major: A National Database Study

In patients with sickle cell disease (SCD) and beta-thalassemia major (TM), allogeneic hematopoietic stem cell transplantation (HSCT) was considered the only curative treatment option with a good survival rate. However, with the recent approval of gene therapies, more information is needed to understand the benefits and risks of these interventions. We performed a retrospective analysis of the Kids Inpatient Database to describe demographic features, short-term complications, and hospital charges of patients with SCD and TM treated with HSCT during 2006–2019 in the United States. The database was filtered using the International Classification of Diseases, 9th and 10th edition codes to identify children under 20 years of age with SCD or TM who underwent HSCT. A total of 513 children with SCD or TM who received HSCT were analyzed. The prevalence of HSCT per 1000,000 U.S. population increased from 0.31 in 2006 to 1.99 in 2019 (p < 0.001). The median age of children with SCD who underwent HSCT was 10 (6–15) years, and that for TM was 6 (3–11.5) years (p < 0.001). The combined mortality rate was 4% (2.4%–6.6%) but higher in the TM group. The length-of-stay and total charges were higher in the TM population (p < 0.01). This study provides national data on HSCT among hospitalized children with SCD and TM in the United States, demonstrating an increasing use of HSCT between 2006 and 2019. Although hospital mortality of HSCT in these conditions is low, it still represents a challenge, especially in TM patients.

Skoochies and its component substances induced testicular damage and impaired sperm function via increased generation of reactive oxygen species and impairment of the glutathione system in rats

ObjectiveTo study examined the effect of skoochies, an illicit cocktail drink, on testicular and sperm function in male rats. DesignTwenty-five adult male Wistar rats were assigned randomly into five groups (n = 5), as follows: Normal saline (NS group), skoochies (SK group), cannabis sativa (CS group), codeine (CO group), and tramadol (TM group). The cocktail (skoochies) used for this study was formulated using the following composition: codeine (5mg/kg), tramadol (20mg/kg) and cannabis extract (2mg/kg). These doses are as previously reported. Administration was done once daily for twenty-eight (28) days. ResultsSkoochies increased reactive oxygen species generation and impaired the antioxidant system resulting in inflammation that eventually damage the testicular tissue. Skoochies causes oxido-inflammatory injury to the testicular tissues resulting in impaired testicular functions. This was evident by the distorted cytoarchitecture, reduced sperm count, motility and impaired testicular DNA integrity. ConclusionThus, our results infer that Skoochies induced the impairment of testicular and sperm function through the increased generation of reactive oxygen species and impairment of the glutathione system.

Effect of Etomidate Versus Midazolam-Sodium Thiopental on Attenuating the Cardiovascular Response to Laryngoscopy and Tracheal Intubation.

Laryngoscopy and tracheal intubation lead to an increased sympathetic reflex response, which is associated with increased heart rate and blood pressure. This response can be detrimental in patients with myocardial ischemia. This study aimed to investigate the effects of etomidate in comparison to a combination of midazolam and sodium thiopental in reducing the sympathetic response to laryngoscopy and tracheal intubation. This double-blind, randomized clinical trial study was conducted on two groups of 39 candidates for elective surgery under general anesthesia. Anesthesia was induced by etomidate (E) 0.3 mg/kg in the first group and sodium thiopental 2.5 mg/kg and midazolam 0.075 mg/kg in the second group (TM); then, the patients were intubated. Laryngoscopy findings and cardiovascular response were evaluated during the study. Finally, the data were analyzed using SPSS version 23 (IBM SPSS, Armonk, NY, USA). There was no significant difference between the two groups in terms of age (P = 0.82), weight (P = 0.42), height (P = 0.201), body mass index (P = 0.78), gender (P = 0.65), American Society of Anesthesiologists (ASA) physical status (P = 0.36), and laryngoscopy view grading (P = 0.83). The average laryngoscopy time in the E group was less than the TM group (P = 0.019). In the TM group, at 10 minutes after intubation, mean diastolic blood pressure (P = 0.029) and mean arterial blood pressure (P = 0.023) were significantly lower; however, at other times, there was no significant difference between the two groups (P > 0.05). There was no significant difference between the two groups in terms of adverse responses to laryngoscopy and intubation (P = 0.19). The results of the present study showed that etomidate (E) and a combination of midazolam-sodium thiopental (TM) acted similarly in attenuating the cardiovascular response to laryngoscopy and tracheal intubation, and it seems that TM can be used instead of E if needed.

The Association between "Knee Movement" Method and Traditional Radiograph Positioning Procedure with the Incidence of True Lateral Knee Radiograph Achieved.

This study aimed to find the association between the Knee Movement or KM method versus the traditional lateral knee radiograph positioning procedure and the incidence of true lateral knee radiographs achieved. A cross-sectional study of patients with knee problems that underwent lateral knee radiograph using the knee movement method (KM method), starting from March 2022 until August 2022. Fifty knee radiograph results using the KM method (KM group) were compared to retrospective data from fifty knee radiograph from the patients before March 2022 using the traditional method of lateral knee radiograph as the control (TM group). The data were analysed using the Chi-Square test to see if the KM method is associated with more true lateral knee radiograph results achieved compared to the traditional procedure. Fifty patients in the KM method group had 80% (n=40) true lateral knee radiographs and 20% (n=10) untrue lateral knee radiographs, while in the Traditional Procedure group from the retrospective data of 50 patients had 44% (n=22) true lateral knee radiographs and 56% (n=28) untrue lateral knee radiographs (P<0.05). There is no significant association between the type of procedure applied with the types of error (P=0.432). Nevertheless, it helps us as it gives a gross picture that most of the errors are under-rotation of the knee, either from the KM method Group 90% (n=9) or the Traditional procedure Group 79% (n=22). The KM method was associated with achievement of a more true and accurate lateral knee radiograph. Additional studies with a larger sample should be done to evaluate the reliability of this method.

Аnnual results of the use of spectacle lenses with embedded rings of high-spherical microlenses Stellest™ for the control of myopia

AIM: To evaluate the effect of continuous wearing of Stellest™ spectacle lenses on refractive dynamics, accommodation, and binocular interaction after 6 months and 1 year.&#x0D; MATERIAL AND METHODS: Children aged 8–13 years who had mild-to-moderate myopia were included. Stellest™ spectacle lenses were prescribed to 35 children with myopia (3.15±0.19 D on average). The control group consisted of 32 children with myopia (2.68±0.18 D on average) using single-vision correction. Refraction, axial length of the eye, accommodation, and binocular interaction were evaluated.&#x0D; RESULTS: After 1 year, the average increase in refraction in the Stellest™ group was 0.19±0.07 D. A decrease in the annual progression gradient (APG) was observed in 82.4% of cases and averaged 0.72±0.1 D. The axial length of the eye increased by an average of 0.08±0.02 mm. In the control group, after 1 year of observation, the average increase in refraction was 0.6±0.07 D. A decrease in APG was observed in 51.6% of the cases and averaged 0.26±0.12 D. The axial length of the eye increased by an average of 0.26±0.03 mm. After 1 year, the increase in refraction and growth of the axial length of the eye in the Stellest ™ group was less than that in the control group by 68.3% and 69.2%, respectively. In the Stellest™ group, positive relative accommodation (PRA) increased after 1 year by 1.06±0.14 D and that in the control group by 0.6±0.16 D. The difference was significant (p 0.02). No differences were found between the groups in terms of objective indicators of accommodation. The stabilization effect in Stellest™ spectacle lenses was the least pronounced with esophoria.&#x0D; CONCLUSION: The use of Stellest™ spectacle lenses slows down the progression of myopia in children and reduces APG by more than two times. A significant increase in PRA was found in children using Stellest™ spectacle lenses for 1 year compared with children using single-vision correction.

Establishment of a novel ER-stress induced myopia model in mice

BackgroundRecent studies have indicated a strong correlation between endoplasmic reticulum (ER) stress and myopia and that eyedrops containing the ER stress inducer tunicamycin (Tm) can induce myopic changes in C57BL/6 J mice. Therefore, this study aimed to create a new myopia model using Tm eyedrops and to explore the mechanism of ER stress-mediated myopia development.MethodsThree-week-old C57BL/6 J mice were treated with different concentrations (0, 25, 50, and 100 μg/mL) and/or number of applications (zero, one, three, and seven) of Tm eyedrops. Refraction and axial length (AL) were measured before and one week after Tm treatment. Scleral collagen alterations were evaluated under polarised light after picrosirius red staining. ER stress-related indicators, such as the expression of collagen I and cleaved collagen were detected using Western blotting.ResultsCompared with the control group, mice administered eyedrops with 50 μg/mL Tm only once showed the greatest myopic shifts in refraction and AL elongation and reduced scleral expression of collagen I. Picrosirius red staining showed a lower percentage of bundled collagen in the Tm group. Expression of ER-stress indicators increased in the Tm groups. Furthermore, optimised administration of Tm induced matrix metalloproteinase-2 (MMP2) expression in the sclera, which plays a major role in collagen degradation.ConclusionsWe have demonstrated that ER stress in the sclera is involved in myopia progression. Tm eyedrops induced myopic changes, loosening of the scleral collagen and decreased expression of collagen I. This process may be associated with ER stress in the sclera, which upregulates the expression of MMP2 leading to collagen degradation.

Plasma profile of Pregnancy Associated Glycoproteins during Postpartum period in Konya Merino ewes lambing single and twin

This study investigated the plasma profile of Pregnancy Associated Glycoproteins (PAGs) after lambing in Konya Merino ewes using specific cattle pregnancy test kit. A total of 16 Konya Merino ewes were used as a material. Four groups were set up, ewes birthing a male lamb (SM group, n=4), a female lamb (SF group, n=4), twin male lambs (TM group, n=4) or twin female lambs (TF group, n=4). Blood plasma samples were taken on days 0 (lambing day), 3, 7, 10, 14 and then weekly until day 35. All samples were analysed using a bovine pregnancy test kit to detect of PAGs level. It was determined that there was a strong negative correlation between PAGs levels in peripheral blood and days after lambing (r2=0.969; P&lt;0.01). However, no relationship was found between PAGs level and lamb gender or birth type. In conclusion, plasma PAGs level decreases rapidly in Konya Merino ewes regardless of lamb gender and birth type. Moreover, the results showed that the plasma profile of PAGs after lambing in Konya Merino ewes can be monitored with a bovine commercial ELISA–based pregnancy test kit, and the test results can be used in decisions and assessments based on the levels of PAG molecules.

A Study on Morphometric Changes of the Pinna Following Ear Surgery.

Morphometry of pinna may change following ear surgeries. This study gives information about postoperative changes following ear surgeries. This study aims to measure the variation of ear morphology following surgery and to correlate the type of surgery with post-operative variations. Eighty patients with Chronic Otitis Media(COM) undergoing surgery by post aural approach were grouped into Modified Radical Mastoidectomy (MRM), Cortical Mastoidectomy + Tympanoplasty (CM + TM) and Tympanoplasty groups(TM). The MRM, CM + TM and TM groups had 14, 46 and 20 participants respectively. Various morphometric measurements were taken pre and post operatively. In all groups, the mean Concho-Mastoid Angle (CMA) was increased post operatively, with increase of 11.1 degrees in MRM (p value-0.002), 8.9 degrees in CM + TM (p value-0.000) and 4.8 degrees (p value- 0.657) in TM group. Similarly, the Cepahlo-auricular distances (D1 and D2) showed statistically significant changes in MRM and CM + TM groups (p value < 0.05). Mean CMA of MRM group compared with other groups did not show any statistically significant difference. However, when the CMA of CM + TM group was compared with TM group showed significant difference of 14.53 degree (p value 0.002). Similarly, the D1 and D2 showed statistically significant changes between the CM + TM and TM groups (p value 0.005 and 0.000 respectively). Prominence of pinna following ear surgery is a not a myth. It happens mostly in cases requiring drilling of the mastoid, rather than Tympanoplasty alone. This needs to be explained to the patient beforehand to prevent any confusion post operatively.

Acute normal tissue responses in a murine model following fractionated irradiation of the head and neck with protons or X-rays

Background The purpose of this study was to investigate acute normal tissue responses in the head and neck region following proton- or X-irradiation of a murine model. Materials and methods Female C57BL/6J mice were irradiated with protons (25 or 60 MeV) or X-rays (100 kV). The radiation field covered the oral cavity and the major salivary glands. For protons, two different treatment plans were used, either with the Bragg Peak in the middle of the mouse (BP) or outside the mouse (transmission mode; TM). Delivered physical doses were 41, 45, and 65 Gy given in 6, 7, and 10 fractions for BP, TM, and X-rays, respectively. Alanine dosimetry was used to assess delivered doses. Oral mucositis and dermatitis were scored using CTC v.2.0-based tables. Saliva was collected at baseline, right after end of irradiation, and at day 35. Results The measured dose distribution for protons (TM) and X-rays was very similar. Oral mucositis appeared earlier, had a higher score and was found in a higher percentage of mice after proton irradiation compared to X-irradiation. Dermatitis, on the other hand, had a similar appearance after protons and X-rays. Compared to controls, saliva production was lower right after termination of proton- and X-irradiation. The BP group demonstrated saliva recovery compared to the TM and X-ray group at day 35. Conclusion With lower delivered doses, proton irradiation resulted in similar skin reactions and increased oral mucositis compared to X-irradiation. This indicates that the relative biological effectiveness of protons for acute tissue responses in the mouse head and neck is greater than the clinical standard of 1.1. Thus, there is a need for further investigations of the biological effect of protons in normal tissues.

Homeostatic Regulation of the Duox-ROS Defense System: Revelations Based on the Diversity of Gut Bacteria in Silkworms (Bombyx mori).

The Duox-ROS defense system plays an important role in insect intestinal immunity. To investigate the role of intestinal microbiota in Duox-ROS regulation herein, 16S rRNA sequencing technology was utilized to compare the characteristics of bacterial populations in the midgut of silkworm after different time-periods of treatment with three feeding methods: 1-4 instars artificial diet (AD), 1-4 instars mulberry leaf (ML) and 1-3 instars artificial diet + 4 instar mulberry leaf (TM). The results revealed simple intestinal microbiota in the AD group whilst microbiota were abundant and variable in the ML and TM silkworms. By analyzing the relationship among intestinal pH, reactive oxygen species (ROS) content and microorganism composition, it was identified that an acidic intestinal environment inhibited the growth of intestinal microbiota of silkworms, observed concurrently with low ROS content and a high activity of antioxidant enzymes (SOD, TPX, CAT). Gene expression associated with the Duox-ROS defense system was detected using RT-qPCR and identified to be low in the AD group and significantly higher in the TM group of silkworms. This study provides a new reference for the future improvement of the artificial diet feeding of silkworm and a systematic indicator for the further study of the relationship between changes in the intestinal environment and intestinal microbiota balance caused by dietary alterations.

Postoperative sensitivity in posterior restorations restored with self-adhesive and conventional bulk-fill resin composites: A randomized clinical split-mouth trial

ObjectiveTo compare the postoperative sensitivity (POS) of a self-adhesive bulk-fill resin composite with that of a conventional bulk-fill resin composite in posterior restorations. MethodsClass I and II (n = 166) cavities of at least 3 mm depth, in 83 participants were restored by: (TEST: Surefil one™ Self-Adhesive bulk-fill (n = 83); and CONTROL: Filtek™ Bulk-Fill posterior composites (n = 83). The presence and intensity of POS associated with the restorations was evaluated at 24 h, 1 week and 1 month intervals using the Visual Analogue Scale (VAS). Comparisons of POS presence between the two treatment groups were made using the Chi-square and Fisher exact tests, while Mann-Whitney and Friedman tests were used to compare the intensity of POS (α=0.05). ResultsForty-two of participants (25.3%; 95% CI 19.3 to 32.4) reported presence of POS after 24 h and none of the participants reported POS after 1 month. The presence of POS was not significantly affected by the restorative material after 24 h, 1 week and 1 month (p>0.05). After 1 week, the participants in the Surefil one™ group reported significantly less intensity of POS than the participants in the Filtek™ Bulk-Fill group (p = 0.02). ConclusionsThe use of Surefil one™ self-adhesive resin composite did not significantly increase the presence of POS compared to the use of the conventional bulk-fill resin composite. However, the intensity of POS was significantly less in the Surefil one ™ group after one week. Clinical significanceThe use of a self-adhesive bulk-fill resin composite in posterior restorations did not increase the presence of POS more than the use of a conventional bulk-fill resin composite. However, it decreased the intensity of POS after one week. This clinical trial was registered at ClinicalTrials.gov; the registration number is NCT05567263.

Comparison of translucency, thickness, and gap width of thermoformed and 3D-printed clear aligners using micro-CT and spectrophotometer

The present study compared the thickness and gap width of thermoformed and 3D-printed clear aligners (CAs) using micro-computed tomography (micro-CT) and evaluated their translucency using spectrophotometer. Four groups of CAs were tested: thermoformed with polyethylene terephthalate glycol (TS) or copolyester-elastomer combination (TM), and 3D-printed TC-85 cleaned with alcohol (PA) or with centrifuge (PC). CIELab coordinates were measured (n = 10) to evaluate translucency. CAs (n = 10) were fitted onto respective models and micro-CT was performed to evaluate the thickness and gap width. Thickness and gap width were measured for different tooth type and location in sagittal sections on all sides. The PC group showed significantly higher translucency than the PA group, which was similar to the TS and TM groups (p < 0.01). After the manufacturing process, thickness reduction was observed in the thermoformed groups, whereas thickness increase was observed in the 3D printed-groups. The TM group showed the least gap width amongst the groups (p < 0.01). Thermoformed and 3D-printed CAs had significantly varied thicknesses and regions of best fit depending on the tooth type and location. Differences in the translucency and thickness of the 3D-printed CAs were observed depending on the cleaning methods.

Prokineticin 2 and Cytokine Content in the Synovial Fluid of Knee Osteoarthritis and Traumatic Meniscal Tear Patients: Preliminary Results.

Knee osteoarthritis (OA) is a chronic degenerative inflammatory-based condition caused by a cascade of different intra-articular molecules including several cytokines. Among the cytokines, prokineticins (PKs) have recently been identified as important mediators of inflammation and pain. This observational study examined the potential involvement of PK2 in degenerative or traumatic knee disease. Fifteen patients presenting knee osteoarthritis (OA group) and 15 patients presenting a traumatic meniscal tear (TM group) were studied. Synovial fluid samples from affected knees were assessed for PK2, IL-10, and TNF-α using the ELISA method. At a long-term follow-up (minimum 5 years, mean = 6.1 years), patients in the TM group underwent clinical re-evaluation with PROMs (Tegner Activity Scale, IKDC, Lysholm, SKV); in addition, X-ray visualization was used to assess the presence of secondary OA. PK2 was detected in synovial fluids of both TM and OA patients and the levels were comparable between the two groups, while IL-10 levels were significantly greater in the OA group than those in TM patients. PK2 levels correlated with those of IL-10. PK2 levels were greater in blood effusions compared to clear samples, did not differ significantly between sexes, nor were they related to differences in weight, height, or injury (meniscal laterality, time since dosing). No correlation was found between PROMs and radiological classifications in patients in the TM group at final follow-up. These data are the first observations of PK2 in synovial fluid following traumatic meniscus injury. These findings suggest possible further prognostic indices and therapeutic targets to limit the development of secondary OA.

Student standardized patients versus occupational standardized patients for improving clinical competency among TCM medical students: a 3-year prospective randomized study

BackgroundStandardized patient (SP) simulations are well-recognized patterns for practicing clinical skills and interactions. Our previous study showed that a simulation program using occupational SP for Traditional Chinese Medicine (OSP-TCMs) was efficient, however, a high cost and time-intensive nature have limited its use. TCM postgraduates trained as student SPs (SSP-TCMs) present a potentially cost-effective alternative. The purpose of this study was to examine and determine whether SSP simulation offered more benefits over didactic training alone for improving clinical competency among TCM medical students, and conduct a multifaceted analysis comparing SSP-TCMs and OSP-TCMs.MethodsThis was a prospective, single-blinded, randomized controlled trial. Fourth-year TCM undergraduates were recruited as trainees from the Clinical Medical School, Chengdu University of TCM. Data were collected from September 2018 to December 2020. Trainees were randomly divided into the three following groups: traditional method training group, OSP-TCM training group, and SSP-TCM training group (1:1:1). At the end of a 10-week curriculum, trainees received a two-station examination comprising a systematic online knowledge test and an offline clinical performance examination. Post-training and post-exam questionnaires were administered to collect feedback from these trainees.ResultsStudents assigned to the SSP-TCM training and OSP-TCM training groups received favorable marks for the “systematic knowledge test” and “TCM clinical skills” (2018, Pa=0.018, Pb=0.042; 2019, Pa=0.01, Pb=0.033; 2020, Pa=0.035, Pb=0.039) compared to the TM trainees. Additionally, trainees in the intervention groups demonstrated a positive post-training edge in scores of “medical records” (2018, Pa=0.042, Pb=0.034; 2019, Pa=0.032, Pb=0.042; 2020, Pa=0.026, Pb=0.03) and “TCM syndrome differentiation and therapeutic regimen” (2018, Pb=0.032; 2019, Pa=0.037, Pb=0.024; 2020, Pa=0.036, Pb=0.043). For the simulation encounter assessment given by SP-TCMs, OSP-TCM trainees and SSP-TCM trainees scored higher than TM trainees (2018, Pa=0.038, Pb=0.037; 2019, Pa=0.024, Pb=0.022; 2020, Pa=0.019, Pb=0.021). For the feedback questionnaires, the students in TM group provided less positive feedback for training efficacy and test performance compared to those in the SSP-TCM and OSP-TCM groups. The trainees responded that the training effect of clinical simulations was similar between the SSP-TCM and OSP-TCM groups. SSP-TCMs were more responsive to unexpected emergencies (Pa=0.022, Pb>0.05) and more likely to encourage questioning (Pa=0.029, Pb>0.05) but tended to provide implied hints (Pc=0.015) and utilize medical jargon (Pc=0.007) as compared to OSP-TCMs.ConclusionSimulation training for SSP-TCMs and OSP-TCMs showed great benefits for enhancing clinical competency. SSP-TCM simulation was feasible, practical, and cost-effective, and may serve as an alternative method to OSP-TCM simulation.

Comparison of full-endoscopic and tubular-based microscopic decompression in patients with lumbar spinal stenosis: a randomized controlled trial.

We aimed to demonstrate non-inferiority in terms of functional outcomes in patients with lumbar spinal stenosis who underwent full-endoscopic decompression compared with tubular-based microscopic decompression. This prospective, randomized controlled, non-inferiority trial included 60 patients with single-level lumbar spinal stenosis who required decompression surgery. The patients were randomly assigned in a 1:1 ratio to the full-endoscopic group (FE group) or the tubular-based microscopic group (TM group). Based on intention-to-treat analysis, the primary outcome was the Oswestry Disability Index score at 24 months postoperative. The secondary outcomes included the visual analog scale (VAS) score for back and leg pain, European Quality of Life-5 Dimensions (EQ-5D) score, walking time, and patient satisfaction rate according to the modified MacNab criteria. Surgery-related outcomes were also analyzed. Of the total patients, 92% (n = 55) completed a 24-month follow-up. The primary outcomes were comparable between the two groups (p = 0.748). However, the FE group showed a statistically significant improvement in the mean VAS score for back pain at day 1 and at 6, 12, and 24months after surgery (p < 0.05). No significant difference was observed in the VAS score for leg pain, EQ-5D score, or walking time (p > 0.05). Regarding the modified MacNab criteria, 86.7% of patients in the FE group and 83.3% in the TM group had excellent or good results at 24months after surgery (p = 0.261). Despite the similar results in surgery-related outcomes, including operative time, radiation exposure, revision rate, and complication rate, between the two groups (p > 0.05), less blood loss and shorter length of hospital stay were observed in the FE group (p ≤ 0.001 and 0.011, respectively). This study suggests that full-endoscopic decompression is an alternative treatment for patients with lumbar spinal stenosis because it provides non-inferior clinical efficacy and safety compared with tubular-based microscopic surgery. In addition, it offers advantages in terms of less invasive surgery. Trial registration number (TRN): TCTR20191217001.

Chlorogenic acid alleviated testicular inflammation and apoptosis in tunicamycin induced endoplasmic reticulum stress

Chlorogenic acid (CA) is a polyphenolic compound, found in many herbs and foods including coffee, berries and potatoes. Anti-inflammatory, anti-oxidant, anti-cancer and anti-apoptotic effects of CA have been proven in many tissues. Testicular inflammation and apoptosis are essential factors in male infertility that could result from endoplasmic reticulum (ER) stress. ER stress leads to unfolding and misfolding of nascent proteins and thereby provokes cellular inflammatory and apoptotic pathways. This study was designed to assess the effects of CA on ER stress-induced testis inflammation and apoptosis. To do this, male mice were divided into six groups. The control, vehicle and CA groups received saline, DMSO and 50 mg kg-1 CA. Tunicamycin (TM (was injected to induce ER stress (TM group). In the CA20-TM and CA50-TM groups, 20 mg kg-1 CA and 50 mg kg-1 CA were administered one hour before TM injection. After thirty hours, animals were sacrificed and testes were removed. Hematoxylin & eosin staining, ELISA assay and real-time PCR were performed. CA administration significantly downregulated gene expression of TNFα, IL6, P53, Bax/Bcl2 ratio and caspase3. It also reduced testis levels of ALP, NF-κB, TNFα and caspse3. Finally, CA relieved structural changes in seminiferous tubules. This study demonstrated that the positive effects of CA on the attenuation of ER-stress induced inflammation and apoptosis might be due to the inhibition of NF-κB and thereby suppression of inflammatory and apoptotic pathways.