BACKGROUND:Electromyographic biofeedback therapy has demonstrated unique advantages of non-invasive,real-time feedback,personalized treatment and promotion of neuroplasticity,and can promote the recovery of motor function in patients with spinal cord injury.OBJECTIVE:To review the current application status and therapeutic effects of electromyographic biofeedback combined with exercise therapy,robotic exoskeletons,and virtual reality technology in the recovery of motor function after spinal cord injury.METHODS:Relevant literature was retrieved from CNKI and PubMed databases up to May 2024.The search terms included"spinal cord injury,EMG biofeedback,physical therapy,robotic exoskeleton,VR,motor function,exercise"in both English and Chinese.Finally,71 articles were included for review.RESULTS AND CONCLUSION:Mechanisms by which electromyographic biofeedback therapy promotes spinal cord injury rehabilitation include promoting neural plasticity changes,strengthening neuromuscular connections and improving movement patterns.Electromyographic biofeedback,as an emerging tool for treating spinal cord injury,is often used in conjunction with other therapeutic methods,including exercise therapy,robotic exoskeletons,and VR,to promote the recovery of motor function after spinal cord injury.The effectiveness of combination therapy has been significantly improved.However,there are still some problems and challenges,such as the lack of detailed analysis of the mechanism,the lack of large-scale trials that provide strong evidence for combined efficacy,and the limited adaptability of the technology.Future research can focus on these aspects:to improve the personalization and accuracy of electromyographic biofeedback;to develop new rehabilitation equipment and expand the application areas of electromyographic biofeedback combined with more advanced technologies or engineering equipment;to apply electromyographic biofeedback to gait training systems,respiratory training systems,and limb-linkage rehabilitation systems,so as to improve the accuracy of the feedback and the effect of personalized treatment plans.At the same time,the ease of use and comfort of the equipment will be improved.

Objective:To investigate the management of cancer pain and the clinical practices of hospice care across 11 cities in Zhejiang Province.Methods:From May 22 to 29, 2023, the Zhejiang Provincial Health Commission conducted a survey to assess the current status of hospice care practitioners regarding cancer pain management, the practices employed by medical staff in managing cancer pain, and the understanding of medical personnel concerning self-controlled analgesia for cancer pain treatment in Zhejiang Province.Results:A total of 505 questionnaires were collected from 198 hospitals across 11 cities in the province.Among the medical staff in secondary and tertiary medical institutions, 85.71%(198 out of 231)participated in the management of cancer pain in patients.Oral analgesics emerged as the most commonly used treatment for pain outbreaks, accounting for 38.53%(89 out of 231)of cases.Additionally, 37.66%(87 out of 231)of medical personnel were involved in the development of self-controlled analgesia devices within their institutions.Conclusions:In the management of cancer pain within hospice care, it is essential to enhance the theoretical training of medical staff, ensure the availability of basic analgesic medications, and establish standardized management protocols for the entire process as promptly as possible.

BACKGROUND:Electromyographic biofeedback therapy has demonstrated unique advantages of non-invasive,real-time feedback,personalized treatment and promotion of neuroplasticity,and can promote the recovery of motor function in patients with spinal cord injury.OBJECTIVE:To review the current application status and therapeutic effects of electromyographic biofeedback combined with exercise therapy,robotic exoskeletons,and virtual reality technology in the recovery of motor function after spinal cord injury.METHODS:Relevant literature was retrieved from CNKI and PubMed databases up to May 2024.The search terms included"spinal cord injury,EMG biofeedback,physical therapy,robotic exoskeleton,VR,motor function,exercise"in both English and Chinese.Finally,71 articles were included for review.RESULTS AND CONCLUSION:Mechanisms by which electromyographic biofeedback therapy promotes spinal cord injury rehabilitation include promoting neural plasticity changes,strengthening neuromuscular connections and improving movement patterns.Electromyographic biofeedback,as an emerging tool for treating spinal cord injury,is often used in conjunction with other therapeutic methods,including exercise therapy,robotic exoskeletons,and VR,to promote the recovery of motor function after spinal cord injury.The effectiveness of combination therapy has been significantly improved.However,there are still some problems and challenges,such as the lack of detailed analysis of the mechanism,the lack of large-scale trials that provide strong evidence for combined efficacy,and the limited adaptability of the technology.Future research can focus on these aspects:to improve the personalization and accuracy of electromyographic biofeedback;to develop new rehabilitation equipment and expand the application areas of electromyographic biofeedback combined with more advanced technologies or engineering equipment;to apply electromyographic biofeedback to gait training systems,respiratory training systems,and limb-linkage rehabilitation systems,so as to improve the accuracy of the feedback and the effect of personalized treatment plans.At the same time,the ease of use and comfort of the equipment will be improved.

Objective:To investigate the management of cancer pain and the clinical practices of hospice care across 11 cities in Zhejiang Province.Methods:From May 22 to 29, 2023, the Zhejiang Provincial Health Commission conducted a survey to assess the current status of hospice care practitioners regarding cancer pain management, the practices employed by medical staff in managing cancer pain, and the understanding of medical personnel concerning self-controlled analgesia for cancer pain treatment in Zhejiang Province.Results:A total of 505 questionnaires were collected from 198 hospitals across 11 cities in the province.Among the medical staff in secondary and tertiary medical institutions, 85.71%(198 out of 231)participated in the management of cancer pain in patients.Oral analgesics emerged as the most commonly used treatment for pain outbreaks, accounting for 38.53%(89 out of 231)of cases.Additionally, 37.66%(87 out of 231)of medical personnel were involved in the development of self-controlled analgesia devices within their institutions.Conclusions:In the management of cancer pain within hospice care, it is essential to enhance the theoretical training of medical staff, ensure the availability of basic analgesic medications, and establish standardized management protocols for the entire process as promptly as possible.

Objective:To analyze the research trend and hotspot of hospice palliative care needs, in order to provide reference for hospice palliative care research and clinic work base on the needs in China.Methods:A review of literature on hospice palliative care needs from February 1, 1999 to February 1, 2023 was conducted using CNKI(China National Knowledge Infrastructure)as the data source.Visual analysis was performed using CiteSpace 6.2.R3 software.Results:A total of 1 280 pieces of literature were retrieved, of which 113 met the inclusion criteria.The number of publications has been steadily increasing over the years, with a significant growth observed since 2017.Research on hospice palliative care needs was conducted by 73 journals, 161 institutions, and 247 authors.The main hotspots identified were the needs of nursing, community, and quality of life from the service recipients, as well as the training needs from the service providers.Methodological hotspots included qualitative research and studies on influencing factors.The research focus has shifted from end-of-life care to hospice palliative care with a multidisciplinary approach, catering not only to older adults or cancer patients but also to a wider range of individuals with non-cancer severe diseases.Current cutting-edge topics revolve around community-based, home hospice palliative care, and quality of life.Conclusions:The research on hospice palliative care needs in China is currently in the exploratory stage, showing significant potential for further development in both research and practice.

Objective To compare H_p(3) calibration with a homemade (A) thermoluminescent dosimeter (TLD) and an imported (B) TLD in a standard X-ray RQR radiation field, to explore the different responses of A and B, and to provide foundation for the calibration of H_p(3). Methods A column mode was selected. H_p(3) calibration was performed using A and B in a standard X-ray RQR radiation field in the Secondary Standard Dosimetry Laboratory, National Institute for Radiological Protection, China Center for Disease Control and Prevention. Angle response, energy response, and linear response were calibrated with RQR4 (60 kV), RQR7 (90 kV), and RQR9 (120 kV), respectively. Results In terms of angle response, the calibration results of A were relatively high, while the calibration results of B were relatively low. In terms of energy response, the calibration results showed a similar pattern to angle response. In terms of linear response, the calibration results of both A and B were satisfactory. Conclusion Both A and B can be used for normal calibration of H_p(3) in a standard X-ray RQR radiation field. However, in actual monitoring, attention should be paid to the energy and angle response values of TLDs.

Objective:To explore the risk factors of postoperative depression in patients with esophageal cancer, and to develop a risk prediction model which providing a theoretical basis for the early detection of depression in high-risk groups by clinical staff.Methods:From September 2022 to March 2023, at the South Campus of Affiliated Hospital of Jiangnan University, 269 hospitalized patients with esophageal cancer (191 in depression group, 78 in non-depression group) were selected as the model construction set. From March to May 2023, at the South Campus of Affiliated Hospital of Jiangnan University, 78 hospitalized patients with esophageal cancer were selected as the external validation set. The patients with Beck depression inventory-Ⅱ score ≥5 and depression diagnosed by two experts (chief psychiatrists of the Department of Psychiatry of Affiliated Hospital of Jiangnan University) were considered as depression and included in the depression group, and the other patients were enrolled in the non-depression group. The general data, blood routine examination, high-sensitivity C-reactive protein (hs-CRP), blood electrolytes, blood lipids, clinical symptoms (gastroesophageal reflux, sleep disturbance, appetite, etc.) and depression score were compared between the depression group and the non-depression group. Independent sample t-test and Mann-Whitney U test were used for statistical analysis. Multiple logistic regression model was performed to analyze the independent risk factors of postoperative depression in patients with esophageal cancer, and a risk warning model was constructed. The Hosmer-Lemeshow test and receiver operating characteristic curve (ROC) were used to evaluate the fitting degree and predictive efficiency of the model, and the cross-validation method was used to verify the effectiveness of the model. Results:The incidence of postoperative depression in patients with esophageal cancer was 71.0% (191/269). The total white blood cell count, hs-CRP, blood phosphorus β 2 microglobulin and the proportion of sleep disorders of the depression group were higher than those of the non-depression group (1.3 (1.1, 5.4) ×10 9/L vs. 0.9 (0.3, 1.1) ×10 9/L, 75.8 (54.8, 102.1) mg/L vs. 60.8 (3.6, 61.5) mg/L, (1.33±0.32) mmol/L vs. (1.02±0.19) mmol/L, (2.17±0.72) mg/L vs.(2.12±0.49) mg/L, 84.3% (161/191) vs. 33.3% (26/78), and the differences were statistically significant ( Z=9.24, 7.88, t=9.24, χ2=67.87 t=1.98; all P<0.001); hemoglobin, total platelet count, high-density lipoprotein (HDL) and the proportion of poor appetite were lower than those of the non-depression group ((119.91±24.51) g/L vs. (122.09±22.97) g/L, (203.43±58.45)×10 9/L vs. (311.55±83.54)×10 9/L, (1.04±0.30) mmol/L vs. (1.43±0.23) mmol/L, 73.3% (140/191) vs. 84.6% (66/78)), and the differences were statistically significant ( t=-2.00, -8.42 and -8.48, χ2=3.96; P=0.047, <0.001, <0.001, =0.047). The results of multifactorial logistic regression model analysis showed that sleep disorder ( OR=3.976, 95% confidence interval (95% CI 1.601 to 9.872)), loss of appetite ( OR=0.271, 95% CI 0.092 to 0.791), white blood cell count ( OR=31.808, 95% CI 2.879 to 351.401), hs-CRP ( OR=1.031, 95% CI 1.017 to 1.044), platelet count ( OR=0.990, 95% CI 0.982 to 0.997), and HDL ( OR=0.017, 95% CI 0.001 to 0.242) were independent influencing factors of postoperative depression in patients with esophageal cancer. The formula of risk warning model was probability of depression=1-1/{1+ exp[1.544+ 1.380×sleep disturbance (yes=1, no=0)-1.307×loss of appetite (yes=1, no=0)-0.010×platelet count (×10 9/L)-4.063×HDL (mmol/L)+ 0.030×hs-CRP (mg/L)+ 3.460×white blood cell count (×10 9/L)]}. The results of Hosmer-Lemeshow test showed that the model has a good fit ( χ2=2.01, P=0.981), with an area under the ROC of 0.949, a sensitivity of 0.874, and a specificity of 0.872. The cross-validation of the external validation set showed that the accuracy of the risk warning model was 67.9%. Conclusion:This study is a preliminary study on the risk warning model of postoperative depression in patients with esophageal cancer, which provides a novel approach for screening depression in patients with esophageal cancer after surgery.

Objective:To explore the role and mechanism of nuclear factor erythroid 2-related factor 2 (NRF2) in lung injury in mice with Staphylococcus aureus-induced sepsis. Methods:A sepsis mouse model with Staphylococcus aureus infection was created using wild-type C57BL/6 male mice and NRF2 -/- male mice aged six to eight weeks. The mice were divided into four groups with five in each group. In WT control group and NRF2 -/- control group, the wild type mice and NRF2 -/- mice were intraperitoneally injected with 100 μL phosphate buffered saline (PBS) respectively. In WT model group and NRF2 -/- model group, the wild type mice and NRF2 -/- mice were intraperitoneally injected with 100 μL PBS containing Staphylococcus aureus (3×10 8 colony forming unit (CFU)/mL) respectively. The lung samples were taken under anesthesia six hours after injection, and hematoxylin and eosin staining was performed to observe tissuse lesions. The survival of the mice was evaluated. The protein concentrations and cell counts in the bronchoalveolar lavage fluid (BALF), the mRNA relative expressions of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 beta (IL-1β) in lung tissues, and the serum levels of myeloperoxidase (MPO), malondialdehyde (MDA), and superoxide dismutase (SOD) were compared among the four groups. Independent samples t test was used for statistical comparison. Results:After six days of observation, no mice died in WT control group and NRF2 -/- control group, three mice died in WT model group on day 3, and four mice died in NRF2 -/- model group on day 4. The pathological staining showed that macrophage infiltration and alveolar structure damage occurred in the lung tissuse of WT model group, and the damage were more significant in NRF2 -/- model group. The protein concentrations and cell counts in BALF of mice in WT control group were (342±23) μg/mL and (5.78±2.67)×10 5/mL, respectively, those in WT model group were (657±39) μg/mL and (10.78±5.57)×10 5/mL, respectively, those in NRF2 -/- control group were (312±45) μg/mL and (5.67±1.46)×10 5/mL, respectively, and those in NRF2 -/- model group were (957±85) μg/mL and (13.85±3.72)×10 5/mL, respectively. The protein concentrations and cell counts in WT model group were higher than those in WT control group ( t=6.56, P<0.001 and t=8.21, P<0.001, respectively), while lower than NRF2 -/- model group ( t=2.32, P=0.001 and t=3.11, P=0.002, respectively). The differences were all statistically significant. Compared with the WT model group, the mRNA relative expressions of TNF-α (4.345±1.131 vs 12.375±4.534), IL-1β (5.395±2.112 vs 6.865±2.185), IL-6 (2.964±0.945 vs 5.467±1.855) in the lung tissues of NRF2 -/- model group increased, and the serum levels of MPO (2.956±1.211 vs 4.745±1.945) and MDA (4.333±1.652 vs 8.234±3.734) increased, while the level of SOD (17.121±8.183 vs 11.967±8.122) decreased, with statistically differences ( t=1.77, 4.67, 2.99, 7.99, 10.45 and 8.45, respectively, all P<0.05). Conclusions:The absence of NRF2 gene can exacerbate the inflammatory response and oxidative stress in mice with Staphylococcus aureus-induced sepsis, leading to more severe lung tissue damage.

Objective:To explore the role and mechanism of nuclear factor erythroid 2-related factor 2 (NRF2) in lung injury in mice with Staphylococcus aureus-induced sepsis. Methods:A sepsis mouse model with Staphylococcus aureus infection was created using wild-type C57BL/6 male mice and NRF2 -/- male mice aged six to eight weeks. The mice were divided into four groups with five in each group. In WT control group and NRF2 -/- control group, the wild type mice and NRF2 -/- mice were intraperitoneally injected with 100 μL phosphate buffered saline (PBS) respectively. In WT model group and NRF2 -/- model group, the wild type mice and NRF2 -/- mice were intraperitoneally injected with 100 μL PBS containing Staphylococcus aureus (3×10 8 colony forming unit (CFU)/mL) respectively. The lung samples were taken under anesthesia six hours after injection, and hematoxylin and eosin staining was performed to observe tissuse lesions. The survival of the mice was evaluated. The protein concentrations and cell counts in the bronchoalveolar lavage fluid (BALF), the mRNA relative expressions of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 beta (IL-1β) in lung tissues, and the serum levels of myeloperoxidase (MPO), malondialdehyde (MDA), and superoxide dismutase (SOD) were compared among the four groups. Independent samples t test was used for statistical comparison. Results:After six days of observation, no mice died in WT control group and NRF2 -/- control group, three mice died in WT model group on day 3, and four mice died in NRF2 -/- model group on day 4. The pathological staining showed that macrophage infiltration and alveolar structure damage occurred in the lung tissuse of WT model group, and the damage were more significant in NRF2 -/- model group. The protein concentrations and cell counts in BALF of mice in WT control group were (342±23) μg/mL and (5.78±2.67)×10 5/mL, respectively, those in WT model group were (657±39) μg/mL and (10.78±5.57)×10 5/mL, respectively, those in NRF2 -/- control group were (312±45) μg/mL and (5.67±1.46)×10 5/mL, respectively, and those in NRF2 -/- model group were (957±85) μg/mL and (13.85±3.72)×10 5/mL, respectively. The protein concentrations and cell counts in WT model group were higher than those in WT control group ( t=6.56, P<0.001 and t=8.21, P<0.001, respectively), while lower than NRF2 -/- model group ( t=2.32, P=0.001 and t=3.11, P=0.002, respectively). The differences were all statistically significant. Compared with the WT model group, the mRNA relative expressions of TNF-α (4.345±1.131 vs 12.375±4.534), IL-1β (5.395±2.112 vs 6.865±2.185), IL-6 (2.964±0.945 vs 5.467±1.855) in the lung tissues of NRF2 -/- model group increased, and the serum levels of MPO (2.956±1.211 vs 4.745±1.945) and MDA (4.333±1.652 vs 8.234±3.734) increased, while the level of SOD (17.121±8.183 vs 11.967±8.122) decreased, with statistically differences ( t=1.77, 4.67, 2.99, 7.99, 10.45 and 8.45, respectively, all P<0.05). Conclusions:The absence of NRF2 gene can exacerbate the inflammatory response and oxidative stress in mice with Staphylococcus aureus-induced sepsis, leading to more severe lung tissue damage.

Objective:To investigate the risk factors of acute lung injury (ALI) caused by Staphylococcus aureus infection, and to construct a risk warning model. Methods:Patients with Staphylococcus aureus infection confirmed by sputum or blood culture admitted to the Affiliated Hospital of Jiangnan University from January 1, 2020 to May 10, 2022 were enrolled and divided into ALI group and non-ALI group. The age, smoking status, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), albumin, oxygenation index and other clinical data were compared between the two groups. Univariate analysis was performed by using independent sample t test and chi-square test. Binary logistic regression analysis was used to screen the independent risk factors of ALI caused by Staphylococcus aureus infection, and a risk warning model was constructed. The receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of the model. Results:There were 96 cases of Staphylococcus aureus infection, including 68 cases (70.8%) in ALI group, of which 41 cases (60.3%) were positive in sputum culture and 27 cases (39.7%) were positive in blood culture. Compared with the non-ALI group, the proportion of patients aged ≥60 years in ALI group was lower (58.8%(40/68) vs 64.3%(18/28)), the proportion of smoking was higher (58.8%(40/68) vs 35.7%(10/28)), and the differences were both statistically significant ( χ2=0.76 and 0.03, respectively, both P<0.05). The levels of CRP, PCT and NLR in the ALI group were all higher than those in non-ALI group, while oxygenation index and albumin level were both lower, and the differences were all statistically significant ( t=-5.28, -3.46, -9.87, 12.83 and 3.08, respectively, all P<0.05). Binary logistic regression analysis showed that CRP (odds ratio ( OR)=1.973, 95% confidence interval (95% CI) 0.956 to 2.989), PCT ( OR=3.734, 95% CI 1.014 to 13.746), NLR ( OR=1.152, 95% CI 1.058 to 2.254) and albumin ( OR=1.527, 95% CI 1.110 to 2.102) were independent risk factors for ALI caused by Staphylococcus aureus infection. The areas under the ROC curve of CRP, PCT, NLR, albumin and the risk warning model constructed from the combination of four risk factors were 0.69, 0.81, 0.83, 0.78 and 0.93, respectively. The sensitivities were 65.14%, 89.91%, 84.40%, 56.88% and 98.17%, respectively. The specificities were 62.37%, 60.22%, 65.59%, 80.64% and 93.55%, respectively. The accuracy of the effectiveness test of the risk warning model was 84.97%. Conclusions:CRP, PCT, NLR and albumin are the independent risk factors for ALI caused by Staphylococcus aureus infection. The risk warning model based on the above factors has a good early warning effect on ALI caused by Staphylococcus aureus infection.