Background: Painful diabetic neuropathy (PDN) is a common chronic neurological complication of diabetes mellitus. Medications are often used to relieve pain, but with significant side effects. Acupuncture is now a component of pragmatic and integrative treatment for PDN. An increasing number of relevant randomized controlled trials have been published in recent years, but a comprehensive meta-analysis has not yet been performed. The aim of this paper is to verify the effectiveness and safety of acupuncture for PDN by meta-analysis and trial sequential analysis (TSA).Methods: All participants in this study should have had a PDN diagnosis and the trial group was treated with acupuncture. Eight databases, including EMbase, PubMed, Web of science, Cochrane Library, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), Wanfang and Chongqing VIP (CQVIP) were retrieved from inception to 5 April 2023. Meta-analysis was conducted utilizing RevMan 5.3 and Stata 15.0. TSA was performed to assess the adequacy of sample size for the outcomes.Results: A total of 36 studies, comprising 2,739 PDN patients, were included. Among them, 1,393 patients were assigned to the trial group and 1,346 patients were treated in the control group. Outcomes covers the primary indicator Total effective rate (RR = 1.42, 95%CI [1.34, 1.52], p < 0.00001), with 21 studies reported, Pain intensity (SMD = −1.27, 95%CI [−1.58, −0.95], p < 0.00001), with 23 studies reported, and other outcomes, including motor nerve conduction velocity (MCV; MD = 3.58, 95%CI [2.77, 4.38], p < 0.00001), sensory nerve conduction velocity (SCV; MD = 3.62, 95%CI [2.75, 4.49], p < 0.00001), Depression score (SMD = −1.02, 95%CI [1.58, 0.46]), Toronto clinical scoring system (TCSS; MD = −2.41, 95%CI [−3.37, −1.45], p < 0.00001), Quality of life (SMD = 1.06, 95%CI [0.66, 1.46]), traditional Chinese medicine (TCM) syndrome score (MD = −4.99, 95%CI [−6.79, −3.18], p < 0.00001), suggesting that acupuncture have an ameliorating effect on PDN in various respect. Egger’s test revealed publication bias for four outcomes. TSA showed that as for Total effective rate, Pain Intensity, MCV and SCV, the number of included studies was sufficient to support the conclusions.Conclusion: Acupuncture demonstrates significant effectiveness in improving PDN outcomes, including Total effective rate, Pain intensity, MCV, SCV, Depression score, TCSS, Quality of life, TCM syndrome score. But the Adverse events rate is no different in trail group and control group. The publication bias presented in Total effective rate, Pain intensity, MCV and SCV can be remedied by Trim and filling method.Systematic review registration: Prospero, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=477295.

The early lesions of Hashimoto's thyroiditis are inconspicuous, and the ultrasonic features of these early lesions are indistinguishable from other thyroid diseases. This paper proposes a Hashimoto Thyroiditis ultrasound image classification model HT-RCM which consists of a Residual Full Convolution Transformer (Res-FCT) model and a Residual Channel Attention Module (Res-CAM). To collect the low-order information caused by hypoechoic signals accurately, the residual connection is injected between FCTs to form Res-FCT which helps HT-RCM superimpose the low-order input information and high-order output information together. Res-FCT can make HT-RCM focus more on hypoechoic information while avoiding gradient dispersion. The initial feature map is inserted into Res-FCT again through a down-sampling component, which further helps HT-RCM exact multi-level original semantic information in the ultrasound image. Res-CAM is constructed by implementing a residual connection between a channel attention module and a convolution layer. Res-CAM can effectively increase the weights of the lesion channels while suppressing the weights of the noise channels, which makes HT-RCM focus more on the lesion regions. The experimental results on our collected dataset show that HT-RCM outperforms the mainstream models and obtains state-of-the-art performance in HT ultrasound image classification.

Distinguishing Hashimoto's thyroiditis (HT) lesions from ordinary thyroid tissues is difficult with ultrasound images. Challenges in achieving high performance of HT ultrasound image classification include the low resolution, blurred features and large area of irrelevant noise. To address these problems, we propose a Feature-level Boosting Ensemble Network (FBENet) for HT ultrasound image classification. Specifically, to capture the features of suspicious HT lesions efficiently, an Ensemble Feature Boosting Module (EFBM) is introduced into the feature-level ensemble to boost the blurred features. Then, the spatial attention mechanism is adopted in backbone models to improve the feature focusing performance and representation ability. Furthermore, feature-level ensemble technique is employed in the training process to achieve more comprehensive feature representation ability. Experimentally, FBENet was trained on 6,503 HT ultrasound images, and tested on 1,626 HT ultrasound images with 82.92% accuracy and 89.24% AUC on average.

Objective: Tangbi capsule (TBC) is a traditional Chinese medicine prescription, which has the potential to improve the vascular insufficiency of lower extremities and limb numbness in diabetes. However, the potential mechanism remains unknown. This study aims to investigate the pharmacological effects and mechanism of TBC on rats with diabetic lower extremities arterial disease (LEAD).Methods: The mechanism of TBC on diabetic LEAD was investigated through metabolomics and transcriptomics analysis, and the main components of TBC were determined by mass spectrometry. The efficacy and mechanism of TBC on diabetic LEAD rats were investigated through in vitro experiments, histopathology, blood flow monitoring, western blot, and real-time polymerase chain reaction.Results: Mass spectrometry analysis identified 31 active chemical components in TBC including (2R)-2,3-Dihydroxypropanoic acid, catechin, citric acid, miquelianin, carminic acid, salicylic acid, formononetin, etc. In vitro analysis showed that TBC could reduce endothelial cell apoptosis and promote angiogenesis. Histopathological analysis showed that TBC led to an obvious improvement in diabetic LEAD as it improved fibrous tissue proliferation and reduced arterial wall thickening. In addition, TBC could significantly increase the expression levels of HIF-1α, eNOS, and VEGFA proteins and genes while reducing that of calpain-1 and TGF-β, suggesting that TBC can repair vascular injury. Compared with the model group, there were 47 differentially expressed genes in the whole blood of TBC groups, with 25 genes upregulated and 22 downregulated. Eighty-seven altered metabolites were identified from the serum samples. Combining the changes in differentially expressed genes and metabolites, we found that TBC could regulate arginine biosynthesis, phenylalanine metabolism, pyrimidine metabolism, arachidonic acid metabolism, pyrimidine metabolism, arachidonic acid metabolism, nucleotide metabolism, vitamin B6 metabolism and other metabolic pathways related to angiogenesis, immune-inflammatory response, and cell growth to improve diabetic LEAD.Conclusion: TBC improved vascular endothelial injury, apoptosis, lipid accumulation, liver and kidney function, and restored blood flow in the lower extremities of diabetic LEAD rats. The mechanism of TBC in the treatment of diabetic LEAD may be related to the modulation of inflammatory immunity, lipid metabolism, and amino acid metabolism. This study presented preliminary evidence to guide the use of TBC as a therapy option for diabetic LEAD.