Objective To observe the effect of robot-assisted upper limb training on the recovery of upper limb motor function after stroke.Methods One hundred patients within one month of suffering a stroke were randomly divided into a control group (50 cases) and a therapy group (50 cases).Both groups were given conventional drug therapy and rehabilitation training,while the therapy group also received robot-assisted training once a day,5 days per week for 12 weeks.The Fugl-Meyer assessment for the upper extremities (FMA-UE),the modified Ashworth scale (MAS) and the modified Barthel index (MBI) were used to evaluate the subjects before the experiment and after 4,8 and 12 weeks of treatment.Results During the treatment,the average FMA-UE scores and the average MBI of both groups increased gradually.The treatment group's averages were significantly better than those of the control group at each time point,except that there was no significant difference in elbow and wrist MAS scores.Conclusion Upper limb robots can be used with acute stroke patients in a clinical setting,and they may be beneficial for improving upper limb function and ability in the activities of daily living.

Objective To investigate the relationship between Klotho and autophagy in sepsisinduced acute kidney injury mice model.Methods The male healthy Balb/c mice were used to establish the model of sepsis-induced acute kidney injury by using cecal ligation and puncture (CLP).Mice were sacrificed at 3 h,6 h,12 h,1 d,2 d,3 d,and 5 d after CLP (n =12 for each interval) and on 1 d 6 mice in sham group as well as 6 mice in normal group were sacrificed at the same time.Scr and BUN in the blood serum were detected.The HE and PAS staining were employed for observation on the histopathological changes in kidney tissues under light microscope.The autophagosomes were observed under transmission electron microscope (TEM).The renal protein of Klotho,LC3 and P62 were detected by using Western blot and Immunohistochemistry.Statistical analyses were performed using Student's t-test by SPSS 23.0.software.Results Scr and BUN increased significantly after CLP,especially on 1 d,respectively (165.64 ± 20.56) μmol/L and (45.51 ± 4.05) mmol/L.HE and PAS staining showed renal tissue was damaged obviously 1 d after CLP,as indicated by desquamation of the brush border of proximal tubular epithelial cells,appearance of bare basement membrane,and interstitial inflammatory cell infiltration.Under TEM,autophagosomes and phagocytosis were observed.Compared with sham group,the expression of Klotho protein decreased gradually from 3 h to 1 d and dropped to the trough at 1 d (t =51.851,P ＜0.01),then resumed gradually from 2 d to 5 d.On the contrary,the activation of autophagy increased as indicated by the expression of LC3-Ⅱ/L3-Ⅰ and p62.Autophagy was induced gradually from 3 h to 1 d and reached peak at 1 d,then declined gradually from 2 d to 5 d (P ＜ 0.01).The protein of Klotho and LC3-Ⅱ mainly distributed in renal tubular cytoplasm,and Klotho was reduced significantly (t =-8.371,P ＜ 0.01) and LC3-Ⅱ appeared in high density remarkably (t =4.995,P =0.001) on 1 d after CLP.Conclusions Klotho protein reduction and autophagy protein increase were observed in sepsis-induced acute kidney injury,and the expressions of Klotho and autophagy acted out in certain extent of time dependence.

Helicobacter pylori (H.pylori) infection is one of the most common chronic infectious diseases in humans. It is the leading cause of chronic gastritis and peptic ulcer, and also the most important risk factor for gastric cancer. H. pylori lipopolysaccharide has unique chemical structures that are critical to the persistent infection and pathogenesis of H. pylori in human gastric mucosa. Recent studies have elucidated the H. pylori lipid A constitutive modification pathway, redefined the core-oligosaccharide and O-antigen domains, discovered that the heptan commonly present in the lipopolysaccharide structure of European strains is absent in East Asian strains and more importantly, the identification of ADP-heptose (the donor of heptose residues in lipopolysaccharide structure) as the newly discovered pathogen-associated molecular pattern, which is dependent on the type Ⅳ secretion system of H. pylori to induce inflammatory responses in host cells. This paper reviewed the resent research progress in the structure and biological functions of H. pylori lipopolysaccharide.

Objective To explore the effect of different blood glucose monitoring frequency on blood glucose fluctuation and control in type 2 diabetes mellitus patients with intensive insulin therapy .Methods One hundred and twenty type 2 diabetes mellitus patients with intensive insulin therapy were chosen and randomly divided into three groups .The three times group received 3 times monitoring including fasting , after breakfast and bedtime , and the five times group received 5 times monitoring including fasting , after breakfast , before supper , bedtime and before dawn , and the eight times group received the 8 times monitoring including before and after every meal , bedtime and before dawn , and the changes of the hemoglobin A 1 c ( HbA1 c) were observed for 4 weeks before and after the treatment .Results The average levels of HbA 1 c in the three groups were decreased 4 weeks after treatment in the three groups , and the difference was not statistically significant ( F=0.301, P>0.05).No difference was found in the fasting blood glucose and blood glucose before supper in the three groups (F=1.450, t=1.760;P>0.05).The levels of blood glucose after breakfast were respectively (8.78 ±0.90), (9.08 ±0.63), (7.49 ±1.01) mmol/L in the three groups, and the level of blood glucose in the eight times group was better than those of the three and five times groups , and the difference was statistically significant (F=23.340,P<0.05).The levels of bedtime blood glucose were respectively (8.07 ±0.59), (8.32 ±0.75), (7.28 ±0.54) mmol/L in the three groups, and the blood glucose fluctuation range in the eight times group was lowest, and the difference was statistically significant (F=32.880, P<0.05).The level of blood glucose before dawn in the eight times group was (6.68 ±0.59) mmol/L, and was better than (7.75 ±0.77) mmol/L in the five times group, and the difference was statistically significant (t=4.170, P<0.01).The average levels of 24 h blood glucose in the three groups were respectively (8.33 ±1.20), (8.26 ± 0.97), (7.84 ±1.15) mmol/L, and the blood glucose control in the eight times group was best , and the difference was statistically significant (F=22.36, P<0.05), and the detection rate of hypoglycemia was 33.3%in the small hours.Conclusions The blood glucose fluctuation range in the eight times group is minimum.The many times blood glucose monitoring in type 2 diabetic patients with intensive insulin therapy , at least 3 times daily, can reduce and prevent the incidence of hypoglycemia .

Objective:To evaluate the effect of using a walking support band on the gait of stroke survivors.Methods:Sixty stroke survivors were randomly divided into a walking support band group ( n=20), an ankle foot orthosis (AFO) group ( n=20) and a conventional rehabilitation group ( n=20). All three groups received conventional rehabilitation therapy, while the AFO group members were additionally provided with an ankle-foot orthosis and the walking support band group members received training wearing a walking support band. Before and after 4 weeks of treatment, all three groups were evaluated using three-dimensional gait analysis. Results:A total of 57 patients finished the study. After the interventions, the average step speed, frequency and step length of the three groups had all increased significantly, while the average stride width, the percentage of double stance phase, unaffected and affected side stance phase, and the ratio between unaffected and affected side stance phase had all decreased significantly. After the intervention, the average step speed, frequency and length of the AFO and walking support band groups had increased significantly compared with the conventional rehabilitation group, while the average stride width of the AFO group, and the stride width, the percentage of double stance phase and unaffected side stance phase of the walking support band group had decreased significantly. After the treatment, the average percentages of double stance phase and unaffected side stance phase of the walking support band group had decreased significantly more than in the AFO group.Conclusions:A walking support band can significantly improve the abnormal gait of stroke survivors and is superior to an ankle-foot orthosis when combined with conventional rehabilitation therapy.

Objective:To study the expression of miRNA-29c in type 1 diabetic patients with early nephropathy and its diagnostic value for early nephropathy.Methods:168 patients with type 1 diabetes who were treated in our hospital from Jan. 2019 to Mar. 2022 were retrospectively selected as the research subjects. According to the occurrence of nephropathy, they were divided into simple diabetes group (122 cases) and diabetic nephropathy group (46 cases). Serum miRNA-29c levels were detected by RT-PCR. The gender, age, course of disease, and serum miRNA-29c levels were compared between the two groups. Logistic regression was used to analyze the influencing factors of early nephropathy in patients with type 1 diabetes. The ROC curve was used to analyze the diagnostic value of miRNA-29c for early nephropathy in type 1 diabetes.Results:The course of disease, blood pressure (systolic blood pressure, diastolic blood pressure), HbA1c, TC and blood uric acid in early nephropathy group were higher than those in simple diabetes group, while albumin, total bilirubin and miRNA-29c were lower than those in simple diabetes group, and the difference was statistically significant ( P<0.05). Multivariate Logistic analysis showed: long disease duration ( OR=2.061, 95% CI=1.090-3.896), systolic blood pressure ( OR=1.143, 95% CI=1.023-1.279), diastolic blood pressure ( OR=1.151, 95% CI=1.022) -1.298), high HbA1c ( OR=1.317, 95% CI=1.049~1.653), high blood uric acid ( OR=1.306, 95% CI=1.028-1.659), low miRNA-29c ( OR=0.845,95% CI= 0.730-0.979) were the risk factors for early nephropathy in patients with type 1 diabetes ( P<0.05). ROC curve analysis showed that the cut-off value of miRNA-29c for the diagnosis of early renal disease was 0.952, the area under the curve (AUC) was 0.863 (95% CI: 0.801-0.925), and the sensitivity and specificity were 84.78% and 80.33%, respectively. Conclusion:Serum miRNA-29c in patients with early stage nephropathy of type 1 diabetes is in a low expression state, which is an influencing factor for early stage nephropathy in patients with type 1 diabetes, and has a good diagnostic value for early stage nephropathy.

Objective To compare artificial intelligence-assisted diagnostic system and conventional manual CT image interpretation for detection of positive pulmonary nodules and differential diagnosis of benign and malignant pulmonary nodules, and to provide a reference for the application of artificial intelligence in clinical screening for lung cancer. Methods Patients who underwent chest CT scans for pulmonary nodules from March 2019 to December 2023 were enrolled. The CT images were subjected to artificial intelligence-based and conventional manual CT image interpretation. The pathological examination results of pulmonary lesions served as a gold standard for comparison of artificial intelligence-based and conventional manual CT image interpretation in detection rate of positive pulmonary nodules and differential diagnosis of benign and malignant pulmonary nodules. Results A total of 327 positive pulmonary nodules were identified in 207 patients. The detection rate of positive pulmonary nodules was significantly higher with artificial intelligence-based CT image interpretation than with conventional manual CT image interpretation (95.72% vs. 86.85%; χ²=16.16, P < 0.01). Moreover, artificial intelligence-based CT image interpretation showed significantly higher detection rates for solid (χ²=7.71, P < 0.01) and ground-glass pulmonary nodules (χ²=5.80, P < 0.05) than conventional manual CT image interpretation. The detection rates for pulmonary nodules with < 1 cm (χ²=4.97, P < 0.05), 1 to < 2 cm (χ²=7.04, P < 0.01), and 2 to < 3 cm (χ²=4.91, P < 0.05) diameters were significantly higher with artificial intelligence-based CT image interpretation than with conventional manual CT image interpretation. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for differential diagnosis of benign and malignant pulmonary nodules were 98.08%, 91.53%, 95.33%, 96.43%, and 95.71% with artificial intelligence-based CT image interpretation and 91.34%, 77.97%, 87.96%, 32.62%, and 86.50% with conventional CT image interpretation. The sensitivity (χ²=4.70, P < 0.05), specificity (χ²=4.20, P < 0.05), negative predictive value (χ²=65.28, P < 0.01), and accuracy (χ²=8.52, P < 0.01) were significantly higher with artificial intelligence-based CT image interpretation than with conventional manual CT image interpretation. However, there was no significant difference in the positive predictive value (χ²=3.80, P > 0.05). Conclusion Compared with conventional manual CT image interpretation, artificial intelligence-assisted diagnostic system for CT image interpretation can significantly increase the detection rate of positive pulmonary nodules and improve the efficiency of differential diagnosis of benign and malignant pulmonary nodules, so it deserves widespread applications in physical examination and early screening for lung cancer.

Objective To compare artificial intelligence-assisted diagnostic system and conventional manual CT image interpretation for detection of positive pulmonary nodules and differential diagnosis of benign and malignant pulmonary nodules, and to provide a reference for the application of artificial intelligence in clinical screening for lung cancer. Methods Patients who underwent chest CT scans for pulmonary nodules from March 2019 to December 2023 were enrolled. The CT images were subjected to artificial intelligence-based and conventional manual CT image interpretation. The pathological examination results of pulmonary lesions served as a gold standard for comparison of artificial intelligence-based and conventional manual CT image interpretation in detection rate of positive pulmonary nodules and differential diagnosis of benign and malignant pulmonary nodules. Results A total of 327 positive pulmonary nodules were identified in 207 patients. The detection rate of positive pulmonary nodules was significantly higher with artificial intelligence-based CT image interpretation than with conventional manual CT image interpretation (95.72% vs. 86.85%; χ²=16.16, P < 0.01). Moreover, artificial intelligence-based CT image interpretation showed significantly higher detection rates for solid (χ²=7.71, P < 0.01) and ground-glass pulmonary nodules (χ²=5.80, P < 0.05) than conventional manual CT image interpretation. The detection rates for pulmonary nodules with < 1 cm (χ²=4.97, P < 0.05), 1 to < 2 cm (χ²=7.04, P < 0.01), and 2 to < 3 cm (χ²=4.91, P < 0.05) diameters were significantly higher with artificial intelligence-based CT image interpretation than with conventional manual CT image interpretation. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for differential diagnosis of benign and malignant pulmonary nodules were 98.08%, 91.53%, 95.33%, 96.43%, and 95.71% with artificial intelligence-based CT image interpretation and 91.34%, 77.97%, 87.96%, 32.62%, and 86.50% with conventional CT image interpretation. The sensitivity (χ²=4.70, P < 0.05), specificity (χ²=4.20, P < 0.05), negative predictive value (χ²=65.28, P < 0.01), and accuracy (χ²=8.52, P < 0.01) were significantly higher with artificial intelligence-based CT image interpretation than with conventional manual CT image interpretation. However, there was no significant difference in the positive predictive value (χ²=3.80, P > 0.05). Conclusion Compared with conventional manual CT image interpretation, artificial intelligence-assisted diagnostic system for CT image interpretation can significantly increase the detection rate of positive pulmonary nodules and improve the efficiency of differential diagnosis of benign and malignant pulmonary nodules, so it deserves widespread applications in physical examination and early screening for lung cancer.

Objective:To explore the effect of setting up an internal-cross disciplinary team (ICDT) in the intensive care unit (ICU) on a new model of overall treatment for patients with chronic critical illness (CCI).Methods:A 60-year-old male patient with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to ICU in the Second Affiliated Hospital of Fujian Medical University was introduced. The role of ICDT composed of physicians, nurses, respiratory therapists, physiotherapists, clinical dietitians and patients' family members in ventilator withdrawal and super-early rehabilitation was analyzed in this case.Results:The patient was diagnosed as AECOPD, type Ⅱ aspiration penumonia respiratory failure, septic shock. The ICDT in ICU carried out early rehabilitation treatment for the patient on the basis of traditional infection control and supportive treatment. Under the care of the ICDT, peripheral blood white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), arterial partial pressure of carbon dioxide (PaCO 2), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), right excursion of diaphragm, sputum viscosity, tidal volume (VT) and respiratory rate (RR) were improved. Subsequently, the ventilator mode was gradually changed and the ventilator parameters were down-regulated. The ventilator was successfully weaned on the 10th day of treatment. After weaning, the patient's bedside pulmonary function indicators improved, and he was transferred out of ICU on the 15th day of treatment and discharged on the 20th day. The mental state of the patients was good and the quality of life was greatly improved in CCI outpatient follow-up. Conclusions:ICDT cooperation is very important for monitoring and treatment of CCI patients, which is beneficial to the super-early rehabilitation and prognosis improvement of critically ill patients.