This study was supported by a grant from the Science and Technology Development Fund of the Hospital of Chengdu University of Traditional Chinese Medicine (20HL01) and the Sichuan Province cadre health research project (2023-505).&#160;This study was supported by a grant from the Sichuan Provincial Cadre Health Department (Chuan Gan Yan 2023-505).

This study strictly adheres to the principle of ethical respect, beneficence, and justice. There were 30 subjects in each group, a total of 90 cases. This subject was approved by the ethics committee of the Hospital of Chengdu University of Traditional Chinese Medicine (2021KL-040). Informed consent was obtained from patients included in this study.
1. Study subjects
<ol>
	<li>Select 3 communities in Chengdu using the convenience sampling method.</li>
	<li>Recruit patients with T2DM peripheral neuropathy from three communities.</li>
	<li>Use the following inclusion criteria.
	<ol>
		<li>Include patients of age 40-75.</li>
		<li>Include patients diagnosed with DPN.</li>
		<li>Include patients who can perform moderate-intensity aerobic exercises.</li>
		<li>Include patients who do not use any other complementary or integrative therapies during the study period.</li>
	</ol>
	</li>
	<li>Exclude patients with the following conditions: neurological conditions caused by other conditions, such as cervical and lumbar spondylosis, cerebrovascular illness, Guillain-Barr&#233; syndrome, and vasculopathy; pregnant or lactating women; the inability of mental anomalies to cooperate.</li>
	<li>Draw lots to assign patients from the three communities at random to the control group (CG), the Tai Chi group (TCG), and the mindfulness and Tai Chi group (MTCG).</li>
</ol>
2. Method 1: Practice methods of the CG
<ol>
	<li>Conduct 3 collective health education sessions, each lasting 40 min. 
	&#8203;NOTE: The health education content mainly consisted of diabetes diet, exercise, medication, blood glucose monitoring, foot care, and prevention and care of foot complications12. Three groups conduct health education separately.</li>
</ol>
3. Method 2: Practice methods of the TCG
<ol>
	<li>Select a public, quiet area to practice one of the 24 style simplified Tai Chi33. 
	NOTE: Implementation methods: It was divided into 3 parts: warm-up, training, and relaxation. The focused exercise was performed 3 times a week for 60 min each for 12 weeks.</li>
	<li>Instruct the participants to complete two sets of adductor (i.e., internal rotation), abductor (i.e., external rotation), hamstring (i.e., single stiff leg forward bending stretch), gluteal (i.e., hip flexion and extension), and ankle-oriented (i.e., ankle rotation) dynamic stretching exercises for 10 min, as part of a warm-up preparation exercise34.</li>
	<li>Under the direction of Tai Chi instructors, let the participants perform Tai Chi movements to Tai Chi music for 40 min. 
	NOTE: The movements of the Tai Chi include commencing from part the wild horse&#39;s mane on both sides, white crane spreads its wings, brush knee and twist step on both sides, play pipa, repulse monkey, grasp the bird&#39;s tail, single whip, wave hands like clouds, high pat on horse, kick with right heel, strike opponent&#39;s ears with both fists, turn and kick with left heel, snake creeps down, jade lady weaves shuttles, needle at sea bottom, flash the arm turn, deflect downward, parry and punch, cross hands and closing form33.</li>
	<li>Do upper and lower limb relaxation exercises and breathing adjustment exercises for 10 min as a relaxation exercise35. 
	&#8203;NOTE: First, stand and repeatedly shake shoulders and arms. Then beat and massage legs. Finally, sit and adjust the breathing pattern.</li>
</ol>
4. Method 3: Practice methods of the MTCG
<ol>
	<li>Choose an open and quiet place to spread Yoga mats to sit. 
	NOTE: Mindfulness training combined with Tai Chi practice was performed 3 times a week for 60 min each for 12 week sessions. Subjects were encouraged to adhere to mindfulness exercises daily at home. The aim is to integrate mindfulness into daily life.</li>
	<li>Start mindfulness training combined with Tai Chi. 
	NOTE: The specific training arrangement is shown in Table 1.
	<ol>
		<li>Mindfulness training combined with Tai Chi-specific practice methods
		<ol>
			<li>Mindfulness meditation:
			<ol>
				<li>Sit on Yoga mats.</li>
				<li>Slowly inhale and exhale 3-4 deep breaths.</li>
				<li>Feel the air entering the nose, filling the chest and abdomen, and leaving the body as exhaled.</li>
				<li>Adjust the breathing rhythm back to normal. Do not try to control breathing.</li>
				<li>Adjust the breathing rhythm back to normal. Do not try to control breathing.</li>
				<li>Pay attention to the things such as breathing, body, voice, thoughts, and emotions, slowly relaxing the body.</li>
			</ol>
			</li>
			<li>Mindfulness body scan:
			<ol>
				<li>Supine on yoga mats with legs naturally apart, eyes barely closed, and arms naturally seated without touching the body.</li>
				<li>Pay attention to how the complete body feels, from the toes to the brain. Choose to sit to prevent falling asleep when doing mindfulness body scanning exercises.</li>
			</ol>
			</li>
			<li>Mindfulness movement (Tai Chi):
			<ol>
				<li>Focus on each movement of Tai Chi. 
				NOTE: In Tai Chi practice, use gentle language to guide the practitioner to feel the pressure and relaxation brought by the alternating contraction and relaxation of the leg muscles and feel the sensation of contact between the feet and the ground.</li>
				<li>Try to maintain a state of mindfulness at all times as much as possible.</li>
				<li>Feel stress and relaxation as the leg muscles alternately contract and relax. At the same time, feel the sensation of the feet touching the ground.</li>
			</ol>
			</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>End activities
	<ol>
		<li>Do upper and lower limb relaxation exercises and breathing adjustment exercises for 10 min as a relaxation exercise35. 
		&#8203;NOTE: First, stand and repeatedly shake shoulders and arms. Then beat and massage legs. Finally, sit and adjust breathing.</li>
		<li>Sit in meditation without making any judgments about the various thoughts that enter the mind, and accept these concepts always.</li>
		<li>Convert each daily task, such as brushing the teeth, showering, or cooking, into a mindfulness exercise.</li>
	</ol>
	</li>
</ol>
5. Collect information
<ol>
	<li>Select data collection staff and carry out unified training. 
	NOTE: Collect data before and after the intervention, respectively. Data collectors were solely responsible for data collection and were blinded to group allocation to reduce data collector subjectivity bias.
	<ol>
		<li>Collect data for Toronto clinical scoring system (TCSS)36, visual simulation scale (VAS)37, mindfulness and attention awareness scale (MAAS)38, diabetes-specific quality of life scale (DSQL)39, and serum tumor necrosis factor-&#945;(TNF-&#945;) levels.</li>
	</ol>
	</li>
	<li>Before the study begins, debate and decide on the detailed collecting criteria for each indicator by the research team members.</li>
	<li>Thoroughly explain to the subjects what the scale means, what each item means, and how to use it.</li>
	<li>Help the participants get into position, do physical evaluations, and record in detail.</li>
	<li>Collect the blood samples from the participants at neighborhood hospitals, then send them immediately to the lab.</li>
	<li>Promptly check the accuracy and completeness of the information gathered.</li>
</ol>
6. Statistical analysis
<ol>
	<li>Collect and analyze data using any statistical analysis software. 
	NOTE: In this study, SPSS 24.0 was used.</li>
	<li>Depict data by mean &#177; standard error of mean, frequency, or composition ratio.</li>
	<li>Use chi-square test, ANOVA, Kruskal Wallis H test, paired t-test, and Wilcoxon signed rank test.</li>
	<li>Take readings at least three times at all time points for each sample.</li>
</ol>

Tai Chi with Mindfulness Training to Manage Diabetic Peripheral Neuropathy

The authors have nothing to disclose.

Many previous studies have reported how to apply Tai Chi to treat and rehabilitate chronic diseases40,41. Although Tai Chi has shown positive effects in the treatment and rehabilitation of chronic diseases, truly achieving physical and mental exercise is vital to the enhanced effects of Tai Chi. This study combined Tai Chi with mindfulness training, which successfully improved the practice effectiveness of Tai Chi and indeed achieved physical and mental movement.
This study successfully integrated mindfulness training into Tai Chi. Participants must understand the significance of mindfulness training and the combination of Tai Chi. Tai Chi is a traditional Chinese mind-body exercise different from other aerobic exercises. The entire set of actions of Tai Chi is done under the guidance of consciousness and emphasizes controlling the activities of the limbs with consciousness. Most Tai Chi practitioners, particularly beginners, pay more attention to whether the movements are correct but ignore attention and awareness. In this study, mindfulness breathing was the first step in mindfulness training with Tai Chi exercise. The subjects were then progressively encouraged to become cognizant of what is occurring and direct their attention to performing Tai Chi. Previous studies suggest that mindfulness training as a complementary therapy may not have a direct therapeutic effect on disease42. But mindfulness training can enhance treatment effects by increasing self-efficacy, illness cognition, mindfulness levels, and improving adverse emotions43. Therefore, the significance of mindfulness training combined with Tai Chi should be explained in detail before formally beginning the exercises.
It is also essential to guide the subjects to focus on the present and improve their attention to the body during exercise. First, a comfortable, quiet, and safe environment is favorable for entering the state of mindfulness. Secondly, we should not start Tai Chi in a hurry. The purpose is to make the participant completely relax physically and mentally before starting to practice Tai Chi. If necessary, we can extend the time of mindfulness meditation. Meanwhile, guiding the participant to focus on body sensations with mild language during Tai Chi exercises is also essential. For example, the practitioner is guided to focus on the arm while doing the reaching movements of the upper limbs, feeling the Qi in the body running from the shoulder to the fingertip. In addition, the participant is reminded to feel the sensation of pressure and relaxation brought about by the alternating contraction and relaxation of muscles in both legs. Therefore, it is important to remind the participants to be consciously aware of each action of Tai Chi. 
As the understanding of mindfulness has advanced, some participants may perceive physical or psychological discomfort. At this time, the participants should be guided not to evaluate the discomfort subjectively but to accept the objective existence of the discomfort.
This protocol has several advantages. Mindfulness training combined with Tai Chi belongs to moderate-intensity exercise and is suitable for most people. Tai Chi and mindfulness training is simple and easy to learn, requires no equipment and is not limited by place43. Thus, Tai Chi is easy to promote in the population. Although mindfulness training combined with Tai Chi has unique advantages over Tai Chi, it also has limitations. First, mindfulness training combined with Tai Chi is inappropriate for those unable to be calm. Second, the concept of mindfulness needs to be correctly understood. Third, mindfulness training combined with Tai Chi requires long-term adherence to practice. 
It was confirmed that the addition of mindfulness training to Tai Chi could effectively enhance the training effect of Tai Chi. Therefore, mindfulness combined with Tai Chi is worthy of promotion and application in patients with DPN.

Diabetes Mellitus (DM) is a serious health concern globally, affecting millions of people worldwide1. The International Diabetes Federation (IDF) reveals that the prevalence of DM could increase up to 12.2% by 20452. Type 2 diabetes (T2DM) accounts for about 90% of DM2. Patients with T2DM, particularly those who struggle to control their blood glucose levels, are likely to suffer from adverse complications, including macrovascular disease, microangiopathy, and diabetic peripheral neuropathy (DPN)3. DPN is a prevalent microvascular complication, with at least 50% of DM patients showing DPN signs and symptoms over time4. Unfortunately, DPN is often ignored, and the actual figures of patients suffering are much higher than reported in most cases2.
Patients with poor glycemic control are prone to developing DPN with an insidious onset. The initial symptoms of DPN are often unremarkable, which makes it easy for patients to overlook the condition. When obvious symptoms and functional impairment appear, irreversible neurological damage has been caused5. DPN has a complex clinical presentation. Patients suffer from long-term metabolic disturbances and oxidative stress damage. This can result in symmetrical limb numbness, pain, or paresthesia6,7. As the disease progresses, neurological and vascular injuries are further aggravated, eventually leading to irreversible tissue damage8. The incidence of diabetic foot ulcers and amputations is associated with mortality from DPN9. In addition, as symptoms of DPN often persist, many patients experience depression, sleep disturbances, and activity limitations, leading to a decrease in overall quality of life and even disability10.
Currently, lifestyle interventions (including exercise, diet, psychotherapy, etc.) are well recognized as effective treatments for DPN patients in addition to glycemic control and pharmacotherapy11. According to the American Diabetes Association (ADA), &#34;valuable exercise is beneficial to all patients with DM&#34;. For example, it can improve glycolipid metabolism and insulin resistance1. Studies have shown that exercise can improve metabolic, vascular damage, and neurological function in patients with DPN12,13. However, patients with DPN are reluctant to exercise due to a lack of motility, pain, and fear of foot injury.
The diabetic peripheral neuropathy (DPN) patients&#39; physical discomfort and limitations on daily activities, according to the Fear-Avoidance Model (FAM), can reduce their capacity for social interaction, which in turn can contribute to negative emotional reactions like anxiety and depression14. Conversely, negative emotions can affect glycemic control and increase the rate of complications15,16,17,18. Therefore, mind-body therapy is recommended for DPN, which focuses on the interaction between thoughts, emotions, bodies, and behaviors. The aim is to achieve homeostasis of the body and mind.
Tai Chi is a traditional Chinese mind-body exercise. Tai Chi has received much attention from scholars worldwide because of its unique exercise modes and therapeutic effects on diseases. Multiple high-quality clinical trials published in international journals have confirmed the effectiveness of Tai Chi for the treatment and rehabilitation of chronic diseases such as Parkinson&#39;s disease19, stroke20, metabolic syndrome21, knee arthritis22, and breast cancer23. Tai Chi belongs to a class of moderate-intensity aerobic exercises that uses continuous body spiral exercise and regulated breathing to improve aerobic capacity, muscle strength, balance, and exercise capacity. Traditional Chinese medicine holds that Tai Chi can balance yin and Yang, run Qi and blood, and relax meridians24. It is a suitable form of exercise for patients with DPN. Many studies have found that Tai Chi improves insulin resistance and blood lipids, and reduces the incidence of anxiety and depression25,26. In addition, Tai Chi could improve quality of life and decrease body mass index for patients with T2DM 27.
Mindfulness training is another prominent mind-body intervention that focuses on cultivating an intentional, moment-to-moment, nonjudgmental awareness of experience28. It helps to enhance attention to the present experience, including thoughts, feelings, breathing, and body sensations. Zeidan&#39;s research found that mindfulness training could make patients more objectively evaluate discomfort and improve self-regulation29. Wielgosz&#39;s study showed that the biggest problem of exercise intervention was poor compliance, which could be solved by adding mindfulness training to exercise30. Mindfulness training combined with exercise could effectively improve patients&#39; willingness to move, increase the time and frequency of movement, and promote patients&#39; perceiving body sensations in activity.
Meanwhile, exercise combined with mindfulness training can expand patients&#39; vision and enhance their understanding of themselves. This helps the body to become more flexible, relaxed, and balanced, effectively relieving the negative experience of patients. The concept of mindfulness training is consistent with the idea of &#34;unity of form and spirit&#34; of Tai Chi. Most patients with DPN often receive misinformation from the feet provided by the brain due to impaired sensory function31. Mindfulness training can enhance the effect of movement through psychological regulation and nervous regulation32. Therefore, this study aims to verify the feasibility of mindfulness training combined with Tai Chi and explore its effect on DPN patients.

<table><tbody><tr><td>SPSS 24.0&amp;nbsp;</td><td>IBM</td><td>version&amp;nbsp;24.0&amp;nbsp;</td><td>Statistical analysis</td></tr></tbody></table>

effects of mindfulness training combined with tai chi in patients with diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. One of its crucial therapy approaches is mind-body exercise. Recently, various exercise modalities, including stepping, resistance, aerobics, balance, and whole-body vibration, were investigated to construct the most suitable form of exercise for patients with DPN. The purpose of this study is to describe a standard protocol for mindfulness training combined with Tai Chi. The convenience sampling method was used to select 90 patients with DPN who met the inclusion and exclusion criteria from three communities. The three communities were randomly divided into the control group (CG), the Tai Chi group (TCG), and the mindfulness training combined with the Tai Chi group (MTCG). The CG was given routine health education guidance once a month, a total of three times. Based on the CG, the TCG practiced Tai Chi three times; the MTCG received mindfulness training combined with Tai Chi exercise a week for a total of 12 weeks. Before the intervention and 12 weeks after the intervention, the clinical symptoms, neurological function, attention awareness level, pain, and quality of life of the subjects were evaluated by Toronto Clinical Scoring System (TCSS), Mindful Attention Awareness Scale (MAAS), Visual analog scale (VAS), Diabetes Specificity Quality of life Scale (DSQL) and tumor necrosis factor-&#945;. Overall, the addition of mindfulness training to Tai Chi effectively enhances the exercise effects of Tai Chi. Therefore, mindfulness training combined with Tai Chi is worthy of promotion and application.

In this study, 7 individuals failed to complete the trial. All necessary data were gathered from 83 individuals who completed the trial. There were 38 women and 45 men. The age ranged from 44 to 75 years old, with an average age of (60.57 + 8.76). DM might last anywhere between 4 and 22 years, with an average of 14.10 + 4.85 years. DPN lasted anywhere from one and fifteen years, with a mean of 5.76 + 2.78 years. The general data of the three groups did not differ significantly (p&#62;0.05).
After the intervention, there was a statistically significant difference in the TCSS scores of the three groups (P &#60; 0.001) (see&#160;Table 2). Further multiple comparisons showed that the TCSS score of the MTCG was significantly lower than that of the TCG and lower than the CG, and the difference was statistically significant (P &#60; 0.05) (see Figure 1). These results revealed that the neurological symptoms improved after the intervention.
After the intervention, the MAAS scores of the three groups were significantly different (P &#60; 0.05) (see&#160;Table 2). Further multiple comparisons showed no significant difference in the MAAS scores between the CG and the TCG (P &#62; 0.05). The MAAS score of MTCG was significantly higher than that of TCG and CG (P &#60; 0.05) (see Figure 2). The MAAS score revealed that mindfulness training combined with Taijiquan could improve the subjects&#39; mindfulness levels. At the same time, it shows that the improvement of the exercise effect may be related to the improvement of mindfulness level.
After the intervention, there was a statistically significant difference in the VAS score between the three groups (P &#60; 0.05) (see&#160;Table 3). Further multiple comparisons showed that the pain relief effect of mindfulness combined with MTCG was significantly better than that of TCG and CG, and the difference was statistically significant (P&#60;0.05). (see Figure 3)
After the intervention, there was a statistically significant difference in the levels of TNF-&#945; among the three groups (P &#60; 0.05) (see&#160;Table 3). Further multiple comparisons showed that the level of serum TNF-&#945; in the MTCG was significantly lower than that in the TCG and lower than that in the CG, and the difference was statistically significant (P &#60; 0.05). (see Figure 4)
After the intervention, there was a statistically significant difference in the DSQL scores (P&#60;0.05) (see Table 4). Further multiple comparisons showed that the DSQL score of the CG was significantly lower than that of the TCG and lower than the MTCG, and the difference was statistically significant (P &#60; 0.05) (see Figure 5). This suggests that mindfulness training combined with Tai Chi can significantly improve the quality of life of patients with DPN.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65421/65421fig01.jpg" /> 
Figure 1: Comparison of TCSS scores among the three groups. **P &#60; 0.01 intergroup comparisons, *P &#60; 0.05 intergroup comparisons, ##P &#60; 0.01 within-group comparisons, #P &#60; 0.01 within-group comparisons. TCSS, Toronto Clinical Scoring System; CG, the control group; TCG, the Tai Chi group; MTCG, the mindfulness training combined with Tai Chi group. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65421/65421fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65421/65421fig02.jpg" /> 
Figure 2. Comparison of MASS scores among the three groups.**P &#60; 0.01 intergroup comparisons, ##P &#60; 0.01 within-group comparisons, and #P &#60; 0.01 within-group comparisons. MAAS, Mindful Attention Awareness Scale; CG, the control group; TCG, the Tai Chi group; MTCG, the mindfulness training combined with Tai Chi group. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65421/65421fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/65421/65421fig03.jpg" /> 
Figure 3. Comparison of VAS scores among the three groups. **P &#60; 0.01 intergroup comparisons, and ##P &#60; 0.01 within-group comparisons. VAS, Visual analog scale; CG, the control group; TCG, the Tai Chi group; MTCG, the mindfulness training combined with Tai Chi group. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65421/65421fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/65421/65421fig04.jpg" /> 
Figure 4. Comparison of serum TNF- &#945; level among the three groups. **P &#60; 0.01 intergroup comparisons, *P &#60; 0.01 intergroup comparisons, and ##P &#60; 0.01 within-group comparisons. TNF-&#945;, Serum tumor necrosis factor-&#945;; CG, the control group; TCG, the Tai Chi group; MTCG, the mindfulness training combined with Tai Chi group. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65421/65421fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/65421/65421fig05.jpg" /> 
Figure 5. Comparison of DSQL scores among the three groups. **P &#60; 0.01 intergroup comparisons, ##P &#60; 0.01 within-group comparisons. DSQL, Diabetes Specificity Quality of life Scale; CG, the control group; TCG, the Tai Chi group; MTCG, the mindfulness training combined with Tai Chi group. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65421/65421fig05large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
Table 1: Mindfulness training combined with Tai Chi training program schedule. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65421/Table 1.xlsx" target="_blank">Please click here to download this Table.</a>
Table 2: Comparison of TCSS and MAAS and scores among the three groups. TCSS, Toronto Clinical Scoring System; MAAS, Mindful Attention Awareness Scale; CG, the control group; TCG, the Tai Chi group; MTCG, the mindfulness training combined with the Tai Chi group. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65421/Table 2.xlsx" target="_blank">Please click here to download this Table.</a>
Table 3: Comparison of VAS scores and TNF-&#945; among the three groups.&#160;VAS, Visual analog scale; TNF-&#945;, Serum tumor necrosis factor-&#945;; CG, the control group; TCG, the Tai Chi group; MTCG, the mindfulness training combined with the Tai Chi group. DSQL, Diabetes Specificity Quality of Life Scale; CG, the control group; TCG, the Tai Chi group; MTCG, the mindfulness training combined with the Tai Chi group. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65421/Table 3.xlsx" target="_blank">Please click here to download this Table.</a>
Table 4: Comparison of DSQL scores among the three groups.&#160;DSQL, Diabetes Specificity Quality of Life Scale; CG, the control group; TCG, the Tai Chi group; MTCG, the mindfulness training combined with the Tai Chi group. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65421/Table 4.xlsx" target="_blank">Please click here to download this Table.</a>

Watch this Scientific Journal Video about Integrating Tai Chi with Mindfulness Training to Achieve an Effective Mind-Body Exercise at JoVE.com

Author Spotlight: Integrating Tai Chi with Mindfulness Training to Achieve an Effective Mind-Body Exercise 

When studying exercise for treating diabetic peripheral neuropathy (DPN), achieving mind-body exercise is essential. This study proposes a protocol for mindfulness training combined with Tai Chi to achieve mind-body exercise.

Effects of Mindfulness Training Combined with Tai Chi in Patients with Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. One of its crucial therapy approaches is mind-body ...

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1.5K Views.  Hospital of Chengdu University of Traditional Chinese Medicine. When studying exercise for treating diabetic peripheral neuropathy (DPN), achieving mind-body exercise is essential. This study proposes a protocol for mindfulness training combined with Tai Chi to achieve mind-body exercise.

Video: Author Spotlight: Integrating Tai Chi with Mindfulness Training to Achieve an Effective Mind-Body Exercise 

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In both the East and West, traditional teachings say that the mind and heart are somehow closely correlated, especially during spiritual practice. One ...

Alleviation of Diabetic Tendon Injury via Activation of Tendon Fibroblasts Autophagy under Berberine Treatment

Berberine (BBR) is an isoquinoline alkaloid isolated from Coptis chinensis and possesses valuable pharmacological activities, including anti-inflammatory, anti-tumor, and alleviating several complications of type 2 diabetes mellitus (T2DM). However, the role of BBR in regulating diabetic tendon injury remains poorly understood. In this study, a rat model of T2DM was constructed, and cell apoptosis and autophagy were assessed in tendon tissues after BBR treatment through TdT-Mediated dUTP nick-end labeling (TUNEL) assay and immunohistochemical analysis. Tendon fibroblasts were obtained from the rat Achilles tendon, and the role of BBR in regulating cell apoptosis, the production of inflammatory cytokines, and autophagy activation were assessed using flow cytometry, quantitative real-time PCR (qRT-PCR), and western blot analysis. We demonstrated that BBR treatment significantly increased autophagy activation and decreased cell apoptosis in tendon tissues of T2DM rats. In tendon fibroblasts, BBR repressed High glucose (HG)-induced cell apoptosis and production of proinflammatory cytokines. HG treatment resulted in a decrease of autophagy activation in tendon fibroblasts, whereas BBR restored autophagy activation. More important, pharmacological inhibition of autophagy by 3-MA weakened the protective effects of BBR against HG-induced tendon fibroblasts injury. Taken together, the current results demonstrate that BBR helps relieve diabetic tendon injury by activating autophagy of tendon fibroblasts.

Berberine (BBR) is an isoquinoline alkaloid isolated from Coptis chinensis and possesses valuable pharmacological activities, including anti-inflammatory, ...

Biochemistry

Cognitive Improvement in Chronic Hypoxia Mice with Acupuncture

Acupuncture Treatment in a Mouse Model of Chronic Hypoxia-Induced Cognitive Dysfunction

The treatment of central nervous disorders has consistently posed significant challenges to the medical field. Acupuncture, a non-pharmacological practice rooted in traditional Chinese medicine, entails the insertion of fine needles into precise points on the body and is commonly employed for the management of diverse conditions. Recently, acupuncture has emerged as a promising therapeutic intervention for a range of neurological diseases, including anxiety and respiratory disorders. However, the potential of acupuncture in treating cognitive dysfunction induced by chronic hypoxia has not yet been explored. This paper presents a comprehensive protocol for establishing a mouse model of chronic hypoxia-induced cognitive impairment, administering mild anesthesia, performing acupuncture treatment, and assessing behavioral changes and memory abilities using open field tests and water mazes. The step-by-step protocol provides detailed instructions on accurately locating and positioning acupoints and needles for cognitive improvement. By employing this protocol, researchers can conduct systematic studies to thoroughly evaluate the therapeutic potential of acupuncture for cognitive dysfunction.

Author Spotlight: Improving Anesthesia Protocols for Enhanced Mouse Acupuncture Research

Here, we describe a protocol for implementing mild anesthesia and acupuncture treatment on a chronic hypoxia mouse model and conducting behavioral tests to assess the cognitive alterations post-treatment.

The treatment of central nervous disorders has consistently posed significant challenges to the medical field. Acupuncture, a non-pharmacological practice ...

Prospective, Randomized, and Controlled Study of a Human Umbilical Cord Mesenchymal Stem Cell Injection for Treating Diabetic Foot Ulcers

With the development of society and the economy, the incidence of diabetic foot ulcers continues to increase. Currently, conventional debridement with dressing changes, hyperbaric oxygen, and vacuum sealing drainage are the main conservative treatments in clinical practice, and large wounds often require skin grafts or skin flap grafts. However, the treatment effects are not ideal, and many complications exist. Due to its complex pathogenesis, long treatment time, significant associated difficulties, and high disability rate, diabetic foot ulcers cause a heavy burden to patients, society, and medical care. According to our previous study, the pharmacological effects of human umbilical cord blood stem cells include nonspecific immune regulation; increased secretion of growth factors, vasoactive factors, and anti-inflammatory factors; enhanced anti-infectious ability of the human body; elimination of inflammation; and promotion of angiogenesis and ulcer healing. These effects suggest stem cells may be useful as an autologous or allogeneic treatment for refractory wounds. Therefore, we are conducting a clinical trial to treat refractory diabetic wounds with human umbilical cord stem cells in our clinic for diabetic foot ulcer patients who meet the inclusion criteria.

The present protocol describes a prospective, randomized, controlled clinical study that evaluates a human umbilical cord mesenchymal stem cell injection for the treatment of chronic diabetic foot ulcers.

With the development of society and the economy, the incidence of diabetic foot ulcers continues to increase. Currently, conventional debridement with ...

Bioengineering

Combining Behavior and EEG to Study the Effects of Mindfulness Meditation on Episodic Memory

Although there has been recent interest in how mindfulness meditation can affect episodic memory as well as brain structure and function, no study has examined the behavioral and neural effects of mindfulness meditation on episodic memory. Here we present a protocol that combines mindfulness meditation training, an episodic memory task, and EEG to examine how mindfulness meditation changes behavioral performance and the neural correlates of episodic memory. Subjects in a mindfulness meditation experimental group were compared to a waitlist control group. Subjects in the mindfulness meditation experimental group spent four weeks training and practicing mindfulness meditation. Mindfulness was measured before and after training using the Five Facet Mindfulness Questionnaire (FFMQ). Episodic memory was measured before and after training using a source recognition task. During the retrieval phase of the source recognition task, EEG was recorded. The results showed that mindfulness, source recognition behavioral performance, and EEG theta power in right frontal and left parietal channels increased following mindfulness meditation training. In addition, increases in mindfulness correlated with increases in theta power in right frontal channels. Therefore, results obtained from combining mindfulness meditation training, an episodic memory task, and EEG reveal the behavioral and neural effects of mindfulness meditation on episodic memory.

Here we present a protocol for combining mindfulness meditation training, an episodic memory task, and EEG to understand the behavioral and neural effects of mindfulness meditation on episodic memory.

Although there has been recent interest in how mindfulness meditation can affect episodic memory as well as brain structure and function, no study has ...

Neuroscience

Scalp Acupuncture Synchronizing Dual Task Gait for Enhancing Prefrontal Cortex Response

Studies have shown that motor-cognitive dual task can greatly improve motor/cognitive function. However, the therapeutic effect of motor-cognitive dual task is still limited. How to improve dual-task performance is the key to solving this problem. Scalp acupuncture is a non-drug intervention method of traditional Chinese medicine to treat brain-derived diseases by acupuncturing the corresponding projection area of cerebral cortex function on the scalp. Studies have shown that scalp acupuncture helps improve neuronal damage and cognitive dysfunction and plays a neuroprotective function in central nervous system diseases. However, no relevant studies have discussed the synergistic gain effect of motor-cognitive dual task and scalp acupuncture. Therefore, this protocol aims to demonstrate the standardized operation of scalp acupuncture synchronizing motor-cognitive dual task and motor-cognitive dual task and compares the differences between these two tasks in healthy subjects through a randomized cross-over trial. This protocol initially revealed the possible influence mechanism of scalp acupuncture synchronizing motor-cognitive dual task on cognitive performance, gait control, and cortical brain function, which can provide new ideas and a theoretical basis for clinical exploration of new and effective non-drug treatment of integrated Chinese and Western medicine.

This protocol demonstrates the standardized procedure of scalp acupuncture synchronizing motor-cognitive dual task and motor-cognitive dual task. This can provide an important reference for the clinical exploration of the new and effective non-drug treatment of integrated Chinese and Western medicine.

Studies have shown that motor-cognitive dual task can greatly improve motor/cognitive function. However, the therapeutic effect of motor-cognitive dual ...

Exploring T2DM Exercise Interventions: A Static Training Device for Mice

Static Strength Training Method for Type 2 Diabetic Mice

The treatment of type 2 diabetes mellitus (T2DM) is a major difficulty in improving patient health. Exercise is one of the main interventions for T2DM. Static strength training is one of the key forms of traditional sports in China. Research shows that static strength training is an effective clinical method for T2DM intervention, but there is no experimental device suitable for static training in mice. One of the difficulties in moving from clinical to basic research is to design appropriate experimental devices. In order to further study the mechanism of static training intervention in T2DM, a simple method for making a static training device for mice is introduced in this paper. This device has the advantages of simple operation, cheap material, and high feasibility. Previous studies conducted under this protocol have shown that static training can effectively reduce blood glucose levels and improve the mitochondrial function of skeletal muscle cells in T2DM mice. The purpose of introducing this device is to promote research on the mechanism of traditional exercise in the intervention of T2DM and to lay a foundation for the quantitative intervention of exercise.

Author Spotlight: Advancing Diabetes Research with Static Exercise Training in Mice

This protocol provides a simple method of making static training equipment for mice. The device maintains the muscle isometric contraction of the limbs of mice so as to verify the intervention effect of traditional exercise on type 2 diabetes (T2DM) and provides new exercise therapy for the clinical treatment of T2DM.

The treatment of type 2 diabetes mellitus (T2DM) is a major difficulty in improving patient health. Exercise is one of the main interventions for T2DM. ...

Fixation and Operational Method for Abdominal Massage in T2DM Mice

Type 2 diabetes mellitus (T2DM) is a rapidly growing global public health issue, affecting over 500 million people worldwide. Although abdominal massage has shown potential benefits in managing T2DM, its effectiveness remains unclear, particularly in animal studies, where challenges such as animal compliance and the need for precise pressure control complicate implementation. To address these challenges, this study introduces a novel abdominal massage simulation device specifically designed for mice. This device provides a practical solution for conducting abdominal massage interventions in a controlled manner while minimizing stress and tissue damage to the animals. It securely restrains the mice's limbs, allowing them to remain conscious during the massage, and offers precise control over both the pressure and frequency of the massage applied to the abdomen. The device's ability to simulate manual abdominal massage with accuracy opens new possibilities for experimental studies assessing its effects on T2DM. The primary goal of this protocol is to investigate the impact of abdominal massage on key T2DM markers such as blood glucose levels, lipid metabolism, and insulin sensitivity in mice. By providing a reliable and reproducible method for abdominal massage, this device can offer valuable insights into its potential as a non-invasive therapeutic intervention for T2DM. The findings from this research may contribute to advancing clinical strategies for diabetes prevention and treatment, particularly in enhancing the understanding of traditional therapies like abdominal massage in modern medical practice.

This study introduces an abdominal massage device for mice that replicates manual massage while minimizing stress and tissue damage. The device significantly lowers blood glucose levels, improves lipid metabolism, and enhances insulin sensitivity in type 2 diabetes mice, offering a promising, non-invasive therapeutic approach with clinical potential.

Type 2 diabetes mellitus (T2DM) is a rapidly growing global public health issue, affecting over 500 million people worldwide. Although abdominal massage ...