To develop a milestone-based evaluation system for the core "knowledge and skills" competency of neurology residents that is tailored to China's medical context, so as to provide precise guidance for their training and assessment.

This study aimed to investigate the effect of saltwater stir-fried Plantaginis Semen(SPS) on renal fibrosis in rats and decipher the underlying mechanism. Thirty-six Sprague-Dawley rats were randomly assigned into control, model, losartan potassium, and low-, medium-, and high-dose(15, 30, and 60 g·kg~(-1), respectively) SPS groups. Rats in other groups except the control group were subjected to unilateral ureteral obstruction(UUO) to induce renal fibrosis, and the modeling and gavage lasted for 14 days. After 14 consecutive days of treatment, the levels of serum creatinine(Scr) and blood urea nitrogen(BUN) in rats of each group were determined by an automatic biochemical analyzer. Hematoxylin-eosin(HE) and Masson staining were used to evaluate pathological changes in the renal tissue. Western blot and immunofluorescence assay were conducted to determine the protein levels of fibronectin(FN), collagen Ⅰ, vimentin, and α-smooth muscle actin(α-SMA) in the renal tissue. The mRNA levels of epithelial-mesenchymal transition(EMT)-associated transcription factors including twist family bHLH transcription factor 1(TWIST1), snail family transcriptional repressor 1(SNAI1), and zinc finger E-box binding homeobox 1(ZEB1), as well as inflammatory cytokines such as interleukin-1β(IL-1β), interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α), were determined by RT-qPCR. Human renal proximal tubular epithelial(HK2) cells exposed to transforming growth factor-β(TGF-β) for the modeling of renal fibrosis were used to investigate the inhibitory effect of SPS on EMT. Network pharmacology and Western blot were employed to explore the molecular mechanism of SPS in alleviating renal fibrosis. The results showed that SPS significantly reduced Scr and BUN levels and alleviated renal injury and collagen deposition in UUO rats. Moreover, SPS notably down-regulated the protein levels of FN, collagen Ⅰ, vimentin, and α-SMA as well as the mRNA levels of SNAI1, ZEB1, TWIST1, IL-1β, IL-6, and TNF-α in the kidneys of UUO rats and TGF-β-treated HK-2 cells. In addition, compared with Plantaginis Semen without stir-frying with saltwater, SPS showed increased content of specific compounds, which were mainly enriched in the mitogen-activated protein kinase(MAPK) signaling pathway. SPS significantly inhibited the phosphorylation of extracellular signal-regulated kinase(ERK) and p38 MAPK in the kidneys of UUO rats and TGF-β-treated HK2 cells. In conclusion, SPS can alleviate renal fibrosis by attenuating EMT through inhibition of the MAPK signaling pathway.
Animals ; Epithelial-Mesenchymal Transition/drug effects* ; Rats, Sprague-Dawley ; Male ; Rats ; Fibrosis/genetics* ; Drugs, Chinese Herbal/administration & dosage* ; Kidney Diseases/pathology* ; Kidney Tubules/pathology* ; Humans

The tumor microenvironment is a crucial factor in tumor occurrence and progression. The hypoxic microenvironment is widely present in tumor tissue and is a key endogenous factor accelerating tumor deterioration. The "blood stasis toxin" theory, as an emerging perspective in tumor research, is regarded as the unique "soil" in tumor progression from the perspective of traditional Chinese medicine(TCM) due to its dynamic evolution mechanism, which closely resembles the formation of the hypoxic microenvironment. Scientifically integrating TCM theories with the biological characteristics of tumors and exploring precise syndrome differentiation and treatment strategies are key to achieving comprehensive tumor prevention and control. This article focused on the hypoxic microenvironment of the tumor, elucidating its formation mechanisms and evolutionary processes and carefully analyzing the internal relationship between the "blood stasis toxin" theory and the hypoxic microenvironment. Additionally, it explored the interaction among blood stasis, toxic pathogens, and hypoxic environment and proposed micro-level prevention and treatment strategies targeting the hypoxic microenvironment based on the "blood stasis toxin" theory, aiming to provide TCM-based theoretical support and therapeutic approaches for precise regulation of the hypoxic microenvironment.
Humans ; Tumor Microenvironment/drug effects* ; Neoplasms/therapy* ; Animals ; Medicine, Chinese Traditional ; Disease Progression ; Drugs, Chinese Herbal

Objective:To evaluate the safety, effectiveness, and long-term efficacy of the Jinling procedure for management of refractory mixed constipation.Methods:We prospectively collected clinical data of patients with refractory mixed constipation treated by the Jinling procedure in the Institute of General Surgery of our hospital from January 2007 to August 2023. Perioperative complications, effectiveness within 1 year of surgery (as assessed by the Wexner constipation score, gastrointestinal quality of life index, frequency of spontaneous defecation, rate of satisfactory defecation, body composition, serological indicators, defecography, anorectal manometry) and 10 years after surgery (as assessed by the Wexner constipation score, patient assessment of constipation symptom, SF-36 quality of life score, and questionnaire concerning satisfaction with defecation).Results:The study cohort comprised 3310 patients of mean age 44±15 years, including 653 men and 2657 women. The duration of constipation was 141±114 months. The 1-month, 3-month, 6-month, and 12-month follow-up rates were 98.07% (3246/3310), 95.11% (3148/3310), 93.38% (3091/3310), and 92.81% (3072/3310), respectively. Overall, 1100 patients had undergone surgery at least 10 years previously, 683 of whom completed the questionnaire, making the 10-year follow-up rate 62.09%. The overall incidence of postoperative complications was 21.99% (728/3310), mortality 0.45% (15/3310), and duration of postoperative hospital stay 12.5±5.4 days. Compared with preoperative values, Wexner scores decreased significantly from 1 to 12 months after surgery, whereas the gastrointestinal quality of life index scores had gradually increased by 3 months after surgery; both changes were statistically significant (both P < 0.001). The frequency of spontaneous defecation increased significantly to > five times/day 1 month after surgery, following which it decreased gradually with time, falling to two to five times/day by 6 months after surgery. All nutritional indicators returned to preoperative levels within 1 year except for that of inorganic salt, which did not change significantly. By 6–12 months after surgery, the proportions of rectocele, mucosal prolapse, internal rectal intussusception, visceral ptosis, perineal descent, pelvic floor spasm, and puborectalis syndrome assessed by defecography were all significantly lower than before surgery (all P < 0.05). By 3 months after surgery, the anal resting pressure, anal maximum systolic pressure, and anorectal depression had all returned to preoperative levels. Twelve months after surgery, the rectoanal inhibition reflex was stronger than that before surgery, whereas anal relaxation was less pronounced than that before surgery; these differences are statistically significant (both P < 0.05). The Wexner scores (7±2 vs. 21±6) and patient assessment of constipation symptoms scores (13±5 vs. 39±5) were significantly lower 10 years after the Jinling procedure than they had been before surgery. The eight dimensions of the SF-36 quality of life scores for physical functioning (90±5 vs. 78±8), role limitations in physical functioning (89±12 vs. 50±24), bodily pain (67±18 vs. 33±22), emotional well-being (63±23 vs. 48±30), vitality (71±11 vs. 31±13), mental health (71±10 vs. 30±10), social functioning (69±17 vs. 26±15) and general health (79±9 vs. 35±12) had all improved significantly (all P < 0.001). The total rates of satisfaction with defecation were 95.02% (2919/3072) and 87.56% (598/683) 1 year and 10 years after surgery, respectively. Conclusion:The Jinling procedure is a safe and effective means of treating refractory mixed constipation, achieving improvement in long-term defecation function and gastrointestinal quality of life.

Objective:To explore the impact of different six-character qigong training modes on respiratory muscle function early after a stroke.Methods:Sixty-six stroke survivors in the early stage of recovery were randomly divided into a control group, a modified training group, and an ancient training group, each of 22. In addition to routine rehabilitation training, the control group received conventional respiratory training. The modified training and ancient training groups were trained in modified six-character qigong or ancient six-character qigong, respectively, for two weeks. Before the treatment, after the two weeks and one month later, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), forced expiratory volume in one second, forced vital capacity, peak expiratory flow, maximum mid-expiratory flow, and peak inspiratory flow were measured. Diaphragm mobility during quiet inspiration and maximum inspiration were also quantified.Results:After 2 weeks of treatment and at 1 and 3 months after the end of the treatment, all three groups showed significant improvement in MIP, MEP and the pulmonary ventilation indicators, but the average improvement in the modified training group was significantly greater than in the other two groups. Their average diaphragm mobility was also significantly greater.Conclusion:Modified six-character qigong respiratory training is more effective than its ancient counterpart in improving respiratory muscle function, pulmonary ventilation, and diaphragm mobility early after a stroke, with effects which persist for at least one month.

Objective To make an epidemiological investigation on traditional Chinese medicine(TCM)dampness syndrome manifestations in the population at risk of cerebrovascular diseases in Guangdong area.Methods A cross-sectional study was conducted to analyze the clinical data related to the risk of cerebrovascular diseases in 330 Guangdong permanent residents.The diagnosis of dampness syndrome,quantitative scoring of dampness syndrome and rating of the risk of stroke were performed for the investigation of the distribution pattern of dampness syndrome and its influencing factors.Results(1)A total of 306(92.73%)study subjects were diagnosed as dampness syndrome.The percentage of dampness syndrome in the risk group was 93.82%(258/275),which was slightly higher than that of the healthy group(48/55,87.27%),but the difference was not statistically significant(χ2 = 2.91,P = 0.112).The quantitative score of dampness syndrome in the risk group was higher than that of the healthy group,and the difference was statistically significance(Z =-2.24,P = 0.025).(2)Among the study subjects at risk of cerebrovascular disease,evaluation time(χ2 = 26.11,P = 0.001),stroke risk grading(χ2= 8.85,P = 0.031),and history of stroke or transient ischemic attack(TIA)(χ2 = 9.28,P = 0.015)were the factors influencing the grading of dampness syndrome in the population at risk of cerebrovascular disease.Conclusion Dampness syndrome is the common TCM syndrome in the population of Guangdong area.The manifestations of dampness syndrome are more obvious in the population with risk factors of cerebrovascular disease,especially in the population at high risk of stroke,and in the population with a history of stroke or TIA.The assessment and intervention of dampness syndrome should be taken into account for future project of stroke prevention in Guangdong.

In recent years, clinicians have paid more attention to the biological and esthetic effects of the 2 mm keratinized mucosa width (KMW) around dental implant. How to increase the keratinized mucosa is the focus of clinicians. While the free gingival graft (FGG) is still the gold standard of keratinized mucosa augmentation, alveolar ridge preservation (ARP), connective tissue graft (CTG) and apically positioned flap (APF) can also be used to obtain more than 2 mm keratinized mucosa width when they are used before implantation, with implantation, within the implant-healing phase, with second stage of implantation or after rehabilitation according to different indications. This article comprehensively summarizes the influencing factors of timing and surgical procedures for keratinized mucosa augmentation, providing guidance for clinicians to treat peri-implant keratinized mucosa deficiencies.

Objective:To evaluate the safety, effectiveness, and long-term efficacy of the Jinling procedure for management of refractory mixed constipation.Methods:We prospectively collected clinical data of patients with refractory mixed constipation treated by the Jinling procedure in the Institute of General Surgery of our hospital from January 2007 to August 2023. Perioperative complications, effectiveness within 1 year of surgery (as assessed by the Wexner constipation score, gastrointestinal quality of life index, frequency of spontaneous defecation, rate of satisfactory defecation, body composition, serological indicators, defecography, anorectal manometry) and 10 years after surgery (as assessed by the Wexner constipation score, patient assessment of constipation symptom, SF-36 quality of life score, and questionnaire concerning satisfaction with defecation).Results:The study cohort comprised 3310 patients of mean age 44±15 years, including 653 men and 2657 women. The duration of constipation was 141±114 months. The 1-month, 3-month, 6-month, and 12-month follow-up rates were 98.07% (3246/3310), 95.11% (3148/3310), 93.38% (3091/3310), and 92.81% (3072/3310), respectively. Overall, 1100 patients had undergone surgery at least 10 years previously, 683 of whom completed the questionnaire, making the 10-year follow-up rate 62.09%. The overall incidence of postoperative complications was 21.99% (728/3310), mortality 0.45% (15/3310), and duration of postoperative hospital stay 12.5±5.4 days. Compared with preoperative values, Wexner scores decreased significantly from 1 to 12 months after surgery, whereas the gastrointestinal quality of life index scores had gradually increased by 3 months after surgery; both changes were statistically significant (both P < 0.001). The frequency of spontaneous defecation increased significantly to > five times/day 1 month after surgery, following which it decreased gradually with time, falling to two to five times/day by 6 months after surgery. All nutritional indicators returned to preoperative levels within 1 year except for that of inorganic salt, which did not change significantly. By 6–12 months after surgery, the proportions of rectocele, mucosal prolapse, internal rectal intussusception, visceral ptosis, perineal descent, pelvic floor spasm, and puborectalis syndrome assessed by defecography were all significantly lower than before surgery (all P < 0.05). By 3 months after surgery, the anal resting pressure, anal maximum systolic pressure, and anorectal depression had all returned to preoperative levels. Twelve months after surgery, the rectoanal inhibition reflex was stronger than that before surgery, whereas anal relaxation was less pronounced than that before surgery; these differences are statistically significant (both P < 0.05). The Wexner scores (7±2 vs. 21±6) and patient assessment of constipation symptoms scores (13±5 vs. 39±5) were significantly lower 10 years after the Jinling procedure than they had been before surgery. The eight dimensions of the SF-36 quality of life scores for physical functioning (90±5 vs. 78±8), role limitations in physical functioning (89±12 vs. 50±24), bodily pain (67±18 vs. 33±22), emotional well-being (63±23 vs. 48±30), vitality (71±11 vs. 31±13), mental health (71±10 vs. 30±10), social functioning (69±17 vs. 26±15) and general health (79±9 vs. 35±12) had all improved significantly (all P < 0.001). The total rates of satisfaction with defecation were 95.02% (2919/3072) and 87.56% (598/683) 1 year and 10 years after surgery, respectively. Conclusion:The Jinling procedure is a safe and effective means of treating refractory mixed constipation, achieving improvement in long-term defecation function and gastrointestinal quality of life.

EMG-TRIGGERED NEUROMUSCULAR ELECTRICAL STIMULATION FOR MUSCULOSKELETAL REHABILITATION OF STROKE A decline in stroke-related mortality has led to an increased prevalence of post-stroke complications, globally. One of the most significant clinical effects of stroke are musculoskeletal problems. Musculoskeletal issues are typically induced by hemiplegia and they occur on the affected side. They also may not appear for weeks or months after a stroke. The most frequent musculoskeletal complications of stroke include motor loss, spasticity, shoulder discomfort, and wrist flexion contracture. Neuromuscular electrical stimulation (NMES) is a rehabilitation technique advised for stroke patients. NMES contracts muscles innervated by an external electrical stimulus, with or without patient participation (active or passive). There is evidence that NMES can strengthen muscles, reduce spasticity, increase corticospinal neural circuit excitability, and improve neuroplasticity. Electromyogram (EMG)-triggered NMES is a device that identifies subtle electrical EMG signals that remain discernible in paralyzed muscles after a stroke and utilizes these signals to trigger electrical stimulation impulses to the same paralyzed muscles, resulting in muscle movement. A study found that EMG-triggered NMES was superior to cyclic-NMES for increasing wrist extension and grip strength following the intervention.

We aimed to study radiomics approach based on biparametric magnetic resonance imaging (MRI) for determining significant residual cancer after androgen deprivation therapy (ADT). Ninety-two post-ADT prostate cancer patients underwent MRI before prostatectomy (62 with significant residual disease and 30 with complete response or minimum residual disease [CR/MRD]). Totally, 100 significant residual, 52 CR/MRD lesions, and 70 benign tissues were selected according to pathology. First, 381 radiomics features were extracted from T2-weighted imaging, diffusion-weighted imaging, and apparent diffusion coefficient (ADC) maps. Optimal features were selected using a support vector machine with a recursive feature elimination algorithm (SVM-RFE). Then, ADC values of significant residual, CR/MRD lesions, and benign tissues were compared by one-way analysis of variance. Logistic regression was used to construct models with SVM features to differentiate between each pair of tissues. Third, the efficiencies of ADC value and radiomics models for differentiating the three tissues were assessed by area under receiver operating characteristic curve (AUC). The ADC value (mean ± standard deviation [s.d.]) of significant residual lesions ([1.10 ± 0.02] × 10^-3 mm² s^-1) was significantly lower than that of CR/MRD ([1.17 ± 0.02] × 10^-3 mm² s^-1), which was significantly lower than that of benign tissues ([1.30 ± 0.02] × 10^-3 mm² s^-1; both P < 0.05). The SVM feature models were comparable to ADC value in distinguishing CR/MRD from benign tissue (AUC: 0.766 vs 0.792) and distinguishing residual from benign tissue (AUC: 0.825 vs 0.835) (both P > 0.05), but superior to ADC value in differentiating significant residual from CR/MRD (AUC: 0.748 vs 0.558; P = 0.041). Radiomics approach with biparametric MRI could promote the detection of significant residual prostate cancer after ADT.
Male ; Humans ; Prostatic Neoplasms/drug therapy* ; Androgen Antagonists/therapeutic use* ; Androgens ; Neoplasm, Residual ; Retrospective Studies ; Magnetic Resonance Imaging/methods* ; Diffusion Magnetic Resonance Imaging/methods*