AIM: To investigate the influence of pterygium thickness and area on corneal refractive status.METHODS: Prospective longitudinal study. A total of 60 cases(60 eyes)of pterygium patients admitted to our hospital from January 2024 to September 2024 were randomly selected. All patients underwent pterygium excision combined with pedicle conjunctival flap transplantation for treatment. Optical coherence tomography(OCT)was used to measure the preoperative thickness of patient's pterygium, and a digital slit lamp microscope was used to measure the area of pterygium. The corneal refractive status(degree of corneal astigmatism and average curvature)and changes in uncorrected visual acuity of patients before surgery, 1 d, 1, and 3 mo after surgery were compared. The relationship between preoperative thickness and area of pterygium in patients and corneal refractive status indicators at different postoperative time points were analyzed, and Logistic regression was used to analyze the impact of pterygium thickness and area on postoperative visual improvement in patients.RESULTS: All patients completed follow-up after surgery for 3 mo. At 3 mo after surgery, visual acuity improved in 21 eyes(35%). The results of bivariate Pearson correlation analysis showed that the thickness and area of pterygium positively correlated with the degree of corneal astigmatism and uncorrected visual acuity before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05), and negatively correlated with the average corneal curvature before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05). Logistic regression analysis showed that the thickness and area of pterygium before surgery, high degree of corneal astigmatism, and low uncorrected visual acuity(large LogMAR value)were all risk factors for poor postoperative visual improvement in patients(OR>1, P<0.05). The large average corneal curvature before surgery was a protective factor for poor postoperative visual improvement in patients(OR<1, P<0.05).CONCLUSION: The increase in thickness and area of pterygium can, to some extent, improve corneal astigmatism, reduce the average curvature of the cornea, and affect postoperative visual recovery.

Objective: To investigate the effect of auricular therapy on sleep improvement and the GABAergic system pathway in a rat model of insomnia and to explore its possible mechanism. Methods: According to the random number table, 60 male SD rats were randomly divided into blank control, model, auricular point sticking, auricular bloodletting, and auricular bloodletting combined with sticking groups, with 12 rats per group. Insomnia was induced by intraperitoneal injection of p-chlorophenylalanine. After establishing the insomnia model, 36 rats were treated once a day with auricular point sticking or bloodletting for 5 consecutive days. After the intervention, the general condition and body weight of rats were observed; the righting reflex test was used to detect the sleep latency and duration; HE staining was used to observe the morphology of hypothalamic neuron cells; and an enzyme-linked immunosorbent assay was used to detect the GABA and glutamate content in rat serum. Immunohistochemistry(IHC) and real-time fluorescence quantitative PCR were used to detect GABA ARα1 and GABA ARγ2 protein and mRNA expression in the hypothalamus of rats, and Western blotting(WB) was used to detect GABA ARα1, GABA ARγ2, GAD65/67, GAT-1, and GABA-T protein expression in the hypothalamus of rats. Results: Compared with the blank control group, the model group had a lower body weight, a significantly shorter sleep duration (P<0.05), severe damage to the morphological structure of hypothalamic neurons with disordered cell arrangement, larger intercellular gaps, enlarged cell bodies, and a vacuolated appearance. All the intervention groups had significantly higher body weight and longer sleep duration than the model group (P<0.05). Compared with the other intervention groups, the auricular point sticking group had a longer sleep duration (P<0.05), and the hypothalamic neuron cells in all intervention groups improved, with the auricular point sticking group showing more apparent improvement. The model group had a lower GABA and higher glutamate contents, and GABA ARα1, GABA ARγ2, and GAD65/67 protein expression in the hypothalamus were lower than in the blank control group. In contrast, GAT-1 and GABA-T protein expression was higher, and GABA ARα1 and GABA ARγ2 mRNA expression was lower (P<0.05). The serum GABA content in the auricular point sticking and auricular bloodletting groups was higher, and the serum glutamate content in the auricular point sticking and auricular bloodletting combined sticking groups was lower than in the model group. GABA ARα1 mRNA expression in the hypothalamus of each intervention group was significantly increased, and GABA ARγ2 mRNA expression in the hypothalamus of the auricular point sticking and auricular bloodletting combined sticking groups increased. GABA ARα1(IHC, WB), GABA ARγ2(WB), and GAD65/67 protein expression in the hypothalamus of the auricular point sticking group increased, whereas GAT-1 and GABA-T protein expression decreased. GABA ARα1 and GABA ARγ2 protein expression(IHC, WB) in the hypothalamus of the auricular bloodletting group increased, whereas GABA-T protein expression decreased. GABA ARγ1(IHC) and GABA ARγ2(WB) protein expression in the hypothalamus of the auricular bloodletting combined sticking group increased, whereas GAT-1 and GABA-T protein expression decreased (P<0.05). Compared with in the inventation groups, the serum GABA content in the auricular point sticking group increased, the serum glutamate content decreased, GABA ARα1 and GABA ARγ2 mRNA expression in the hypothalamus increased, and GABA ARα1(IHC), GAD65/67 protein expression increased. In contrast, GABA-T protein expression decreased (P<0.05), and GABA ARγ2 protein expression(IHC) in the hypothalamus of the auricular bloodletting group increased (P<0.05). Conclusion Auricular therapy, particularly auricular point sticking, may have modulated the GABAergic system pathway by upregulating hypothalamic GABA ARα1, GABA ARγ2, and GAD65/67 protein expression while downregulating GAT-1 and GABA-T protein expression to alleviate symptoms in an insomnia rat model.

Objective: To investigate the availability and use of child safety seats among children aged 0-3 years, so as to provide the basis for improving riding safety for children. Methods: Parents of children aged 0-3 years in Huangpu District, Shanghai Municipality, were recruited using the stratified multistage random sampling method from May to July 2024. Demographic information, family travel patterns, the use of child safety seat and related health beliefs were collected using questionnaire surveys. Factors affecting the use of child safety seats were identified using a multivariable logistic regression model. Results: Totally 514 valid questionnaires were recovered, with an effective rate of 96.98%. The respondents included 122 fathers (23.74%) and 392 mothers (76.26%), with a median age of 34.00 (interquartile range, 5.00) years. There were 446 families equipping with child safety seats, accounting for 86.77%; and 169 families using child safety seats, accounting for 32.88%. Multivariable logistic regression analysis showed that the parents who had children aged >1-2 years (OR=0.597, 95%CI: 0.366-0.973), travelled 2-4 times per month (OR=0.359, 95%CI: 0.213-0.607) or once per month or less (OR=0.384, 95%CI: 0.202-0.729), and scored high in perceived barrier (OR=0.634, 95%CI: 0.486-0.827) were less likely to use child safety seats; the parents who had children with local household registration (OR=2.506, 95%CI: 1.356-4.633), travelled 5-<10 km (OR=1.887, 95%CI: 1.148-3.101) or ≥10 km (OR=2.319, 95%CI: 1.355-3.967), always wore seat belts (OR=2.342, 95%CI: 1.212-4.524), scored high in perceived susceptibility (OR=1.392, 95%CI: 1.091-1.778) and self-efficacy (OR=1.413, 95%CI: 1.156-1.727) were more likely to use child safety seats. Conclusions Equipping family cars with child safety seats and using them can prevent and reduce traffic injuries among children aged 0-3 years. It is recommended to strengthen publicity to promote the use of child safety seats.

Objective:To investigate variation of peripheral blood monocyte subtypes in patients with rheumatoid arthritis(RA),to study variation of surface antigen expression intensity and plasma related cytokine content of monocytes of each subtype,and to discuss their clinical application value.Methods:Percentage of monocyte subtypes and mean fluorescence intensity(MFI)of monocyte surface markers(HLA-DR,CD64,CD11b)in peripheral blood of 38 patients with RA were detected by multi-parameter flow cytometry,and differences were statistically analyzed compared with 40 healthy controls(HV group).Plasma levels of five cyto-kines(IL-2,IL-6,IL-10,TNF-α and IFN-γ)were detected by flow fluorescence microsphere technology.Linear correlation analysis was performed to determine correlation between percentage of monocyte subtypes and MFI of their surface markers and expression of related cytokines in RA patients.Disease activity 28(DAS28)score was performed in RA patients to study its association with percent-age of monocyte subtypes and plasma cytokines.Results:Compared with control group,percentage of classical monocytes in RA pa-tients decreased significantly(P<0.05),while percentage of intermediate monocytes and non-classical monocytes increased signifi-cantly(P<0.01).HLA-DR expression(MFI)on monocyte subsets in RA group was significantly higher than HV group(P<0.05 or P<0.01).CD64 expression(MFI)on intermediate monocytes and non-classical monocytes in RA group was significantly higher than HV group(P<0.01 or P<0.001).CD11b expression(MFI)on intermediate monocytes in RA group was significantly higher than HV group(P<0.001).In RA group,percentage of intermediate monocytes was positively correlated with contents of IL-6,TNF-α and IFN-γ(P<0.01).HLA-DR expression(MFI)on intermediate monocytes was positively correlated with TNF-α content(P<0.05);CD64 expres-sion(MFI)on non-classical monocytes was positively correlated with contents of IL-2 and IL-10(P<0.05).In RA group,percentage of intermediate monocytes was positively correlated with DAS28(P<0.001);plasma IL-6 and TNF-α levels were positively correlated with DAS28(P<0.01).Conclusion:Characteristic expression of intermediate monocytes and their surface antigens are closely related to occurrence of RA,and related inflammation is triggered by secretion of related cytokines.Monocyte subtype detection can be a new experimental diagnostic index for RA.Dynamic monitoring of peripheral blood monocyte subtypes and plasma IL-6 and TNF-α in RA patients during treatment is helpful to guide clinical treatment of RA.

Objective To explore the predictive value of umbilical artery ultrasound blood flow parameters combined with the levels of serum miR-148a and miR-424-5p in pregnant women with preeclampsia for perinatal outcomes.Methods A total of 95 pregnant women with preeclampsia admitted from June 2020 to July 2023 were enrolled as the research group and divided into the poor outcome group(n=37)and the good outcome group(n=58)according to the perinatal outcomes.In addition,152 healthy pregnant women who underwent prenatal examinations during the same period were included as the control group.Color Doppler ultrasound examination was performed to determine umbilical artery blood flow parameters:resistance index(RI),pulpability index(PI),and the ratio of maximum systolic blood flow velocity to diastolic blood flow velocity(S/D).The relative expression levels of serum miR-148a and miR-424-5p were detected by real-time fluorescence quantitative PCR(RT-qPCR).Multivariate logistic regression was used to analyze the influencing factors of poor perinatal outcomes in pregnant women with preeclampsia.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of umbilical artery RI,PI,S/D and serum miR-148a and miR-424-5p for perinatal outcomes in pregnant women with preeclampsia.Results Compared with the control group,the expression levels of umbilical artery RI,PI,S/D and serum miR-424-5p in the research group all increased,while the expression level of serum miR148a decreased(P＜0.01).The proportions of perinatal infants with preterm birth,asphyxia,intrauterine growth restriction,low birth weight and the incidence of poor outcomes in the research group were all higher than those in the control group(P＜0.05).Compared with the good outcome group,the expression levels of umbilical artery RI,PI,S/D and serum miR-424-5p in the poor outcome group all increased,while the expression level of serum miR-148a decreased(P＜0.01).Umbilical artery RI,PI,S/D and serum miR-424-5p were all risk factors for poor perinatal outcomes,while serum miR-148a was a protective factor(P＜0.01).The area under the curve(AUC)of umbilical artery RI,PI,S/D combined with serum miR-148a and miR-424-5p for predicting poor perinatal outcomes in pregnant women with preeclampsia was significantly greater than that of RI(Z=3.489,P＜0.001),PI(Z=3.089,P＜0.001),and S/D(Z=3.296,P=0.001),miR-148a(Z=3.542,P＜0.001)and miR424-5p(Z=2.916,P=0.004)for prediction alone,and was also greater than that predicted by the combination of ultrasound blood flow parameters(RI,PI,S/D)(Z=2.457,P=0.014),and by the combination of serum miR-148a and miR-424-5p(Z=2.214,P=0.027).Conclusion The expression levels of umbilical artery RI,PI,S/D and serum miR-424-5p in pregnant women with preeclampsia are all increased,while the expression level of serum miR-148a is decreased,which is associated with poor perinatal outcomes.The combination of the above indicators has certain evaluation value for the perinatal outcomes of pregnant women with preeclampsia.

Objective To explore the predictive value of umbilical artery ultrasound blood flow parameters combined with the levels of serum miR-148a and miR-424-5p in pregnant women with preeclampsia for perinatal outcomes.Methods A total of 95 pregnant women with preeclampsia admitted from June 2020 to July 2023 were enrolled as the research group and divided into the poor outcome group(n=37)and the good outcome group(n=58)according to the perinatal outcomes.In addition,152 healthy pregnant women who underwent prenatal examinations during the same period were included as the control group.Color Doppler ultrasound examination was performed to determine umbilical artery blood flow parameters:resistance index(RI),pulpability index(PI),and the ratio of maximum systolic blood flow velocity to diastolic blood flow velocity(S/D).The relative expression levels of serum miR-148a and miR-424-5p were detected by real-time fluorescence quantitative PCR(RT-qPCR).Multivariate logistic regression was used to analyze the influencing factors of poor perinatal outcomes in pregnant women with preeclampsia.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of umbilical artery RI,PI,S/D and serum miR-148a and miR-424-5p for perinatal outcomes in pregnant women with preeclampsia.Results Compared with the control group,the expression levels of umbilical artery RI,PI,S/D and serum miR-424-5p in the research group all increased,while the expression level of serum miR148a decreased(P＜0.01).The proportions of perinatal infants with preterm birth,asphyxia,intrauterine growth restriction,low birth weight and the incidence of poor outcomes in the research group were all higher than those in the control group(P＜0.05).Compared with the good outcome group,the expression levels of umbilical artery RI,PI,S/D and serum miR-424-5p in the poor outcome group all increased,while the expression level of serum miR-148a decreased(P＜0.01).Umbilical artery RI,PI,S/D and serum miR-424-5p were all risk factors for poor perinatal outcomes,while serum miR-148a was a protective factor(P＜0.01).The area under the curve(AUC)of umbilical artery RI,PI,S/D combined with serum miR-148a and miR-424-5p for predicting poor perinatal outcomes in pregnant women with preeclampsia was significantly greater than that of RI(Z=3.489,P＜0.001),PI(Z=3.089,P＜0.001),and S/D(Z=3.296,P=0.001),miR-148a(Z=3.542,P＜0.001)and miR424-5p(Z=2.916,P=0.004)for prediction alone,and was also greater than that predicted by the combination of ultrasound blood flow parameters(RI,PI,S/D)(Z=2.457,P=0.014),and by the combination of serum miR-148a and miR-424-5p(Z=2.214,P=0.027).Conclusion The expression levels of umbilical artery RI,PI,S/D and serum miR-424-5p in pregnant women with preeclampsia are all increased,while the expression level of serum miR-148a is decreased,which is associated with poor perinatal outcomes.The combination of the above indicators has certain evaluation value for the perinatal outcomes of pregnant women with preeclampsia.

Objective:To investigate variation of peripheral blood monocyte subtypes in patients with rheumatoid arthritis(RA),to study variation of surface antigen expression intensity and plasma related cytokine content of monocytes of each subtype,and to discuss their clinical application value.Methods:Percentage of monocyte subtypes and mean fluorescence intensity(MFI)of monocyte surface markers(HLA-DR,CD64,CD11b)in peripheral blood of 38 patients with RA were detected by multi-parameter flow cytometry,and differences were statistically analyzed compared with 40 healthy controls(HV group).Plasma levels of five cyto-kines(IL-2,IL-6,IL-10,TNF-α and IFN-γ)were detected by flow fluorescence microsphere technology.Linear correlation analysis was performed to determine correlation between percentage of monocyte subtypes and MFI of their surface markers and expression of related cytokines in RA patients.Disease activity 28(DAS28)score was performed in RA patients to study its association with percent-age of monocyte subtypes and plasma cytokines.Results:Compared with control group,percentage of classical monocytes in RA pa-tients decreased significantly(P<0.05),while percentage of intermediate monocytes and non-classical monocytes increased signifi-cantly(P<0.01).HLA-DR expression(MFI)on monocyte subsets in RA group was significantly higher than HV group(P<0.05 or P<0.01).CD64 expression(MFI)on intermediate monocytes and non-classical monocytes in RA group was significantly higher than HV group(P<0.01 or P<0.001).CD11b expression(MFI)on intermediate monocytes in RA group was significantly higher than HV group(P<0.001).In RA group,percentage of intermediate monocytes was positively correlated with contents of IL-6,TNF-α and IFN-γ(P<0.01).HLA-DR expression(MFI)on intermediate monocytes was positively correlated with TNF-α content(P<0.05);CD64 expres-sion(MFI)on non-classical monocytes was positively correlated with contents of IL-2 and IL-10(P<0.05).In RA group,percentage of intermediate monocytes was positively correlated with DAS28(P<0.001);plasma IL-6 and TNF-α levels were positively correlated with DAS28(P<0.01).Conclusion:Characteristic expression of intermediate monocytes and their surface antigens are closely related to occurrence of RA,and related inflammation is triggered by secretion of related cytokines.Monocyte subtype detection can be a new experimental diagnostic index for RA.Dynamic monitoring of peripheral blood monocyte subtypes and plasma IL-6 and TNF-α in RA patients during treatment is helpful to guide clinical treatment of RA.

BACKGROUND:Pro-kin balance system guidance has a relatively excellent rehabilitation effect on lower extremity proprioception and trunk control in stroke patients,but its effect on knee proprioception and balance function in patients after anterior cruciate ligament reconstruction has been less reported. OBJECTIVE:To investigate the effect of rehabilitation training guided by Pro-kin balance system on proprioception and balance function of the affected knee after anterior cruciate ligament reconstruction. METHODS:A total of 84 patients who underwent anterior cruciate ligament rupture reconstruction surgery were randomly divided into observation group and control group,with 42 patients in each group.The patients in the control group received routine rehabilitation intervention after surgery,and those in the observation group were given rehabilitation training based on the guidance of Pro-kin balance system.The training in each group lasted for 8 weeks.Lysholm score and International Knee Documentation Committee score were used to evaluate the change of knee joint function before and after the intervention.Average weight-bearing strength difference,trajectory error,swing value and 30°,45° and 60° passive angulation errors of the affected knee joint were used to evaluate the changes in the proprioception of the affected knee.The area and length of motion trajectory under open and closed eyes were used to evaluate the change of balance function.The satisfaction of patients in both groups with this rehabilitation training was investigated. RESULTS AND CONCLUSION:After training,Lysholm score and International Knee Documentation Committee score of patients in both groups were significantly higher than those before training(P<0.01),and the above scores in the observation group were significantly higher than those in the control group(P<0.01).After training,the average weight-bearing strength difference,trajectory error and swing value of the two groups were significantly lower than those before training(P<0.01),and the above scores in the observation group were significantly lower than those in the control group(P<0.01).After training,the passive angulation errors of 30°,45° and 60° of the affected knee joints in both groups were significantly lower than those before training(P<0.01),and those in the observation group were significantly lower than those in the control group(P<0.05,P<0.01).After training,the area and length of motion trajectory in both groups with eyes open were significantly smaller than those before training(P<0.01),and the above indicators in the observation group were significantly smaller than those in the control group(P<0.05,P<0.01).After training,the area and length of the movement track of the patients in both groups with eyes closed were significantly smaller than those before training(P<0.01),and the above indicators in the observation group were significantly smaller than those in the control group(P<0.01).The satisfaction of patients in the observation group was 95,which was significantly higher than 81%in the control group(P<0.05).To conclude,compared with the conventional rehabilitation training,the rehabilitation training based on Pro-kin balance system is more effective in improving the function,proprioception and balance function of the affected knee joints of patients undergoing anterior cruciate ligament rupture reconstruction,and the patients'satisfaction is higher.

Objective To explore the effect of case-based learning(CBL)combined with PICOS(population,interventions,compari-sons,outcomes,study design)framework in undergraduate occupational therapy(OT)education. Methods A total of 43 junior students majoring in OT from School of Rehabilitation Medicine,Nanjing Medical Univer-sity,were taught the core courses of OT using CBL combined with PICOS framework,from February,2023 to June,2024.The Evidence-based Practice Competency Assessment Scale was used to investigate the students at the beginning and the end of the semester,respectively. Results At the end of the semester,students'self-assessments improved in areas such as the quality evaluation of litera-ture,identifying the best scientific evidence,evaluating the quality of papers,conducting practical analysis of re-search,applying PICOS to formulate clinical questions,assessing the primary association measurement methods of research results,understanding different levels of evidence,and familiarity with commonly used evidence-based practice databases(χ2>4.778,P<0.05).Self-assessment regarding uncertainty about the decision-making process or the different recommendation strengths for health interventions(χ2=7.938,P<0.01)was lower.Atti-tudes toward evidence-based practice,skill levels,and knowledge all improved. Conclusion The combined application of CBL and PICOS framework could improve the effect of undergraduate OT ed-ucation and enhance the evidence-based practice ability of OT students.

ObjectiveTo analyze the current status, research hotspots, and development trends of transcranial ultrasound stimulation (TUS) in neurorehabilitation. MethodsRelevant literature on the application of TUS in neurological rehabilitation was retrieved from CNKI, Wanfang data, and Web of Science Core Collection, covering publications from inception to December 31, 2023. VOSviewer 1.6.20 and CiteSpace 6.2.R1 were used for visualized analysis. ResultsA total of 247 articles were included, with 124 in Chinese and 123 in English, showing an increasing trend in annual publications. The major contributors to English literature were China, the United States, Canada, France and South Korea. High-frequency Chinese keywords included transcranial ultrasound, neuromodulation, Parkinson's disease, stroke and clinical efficacy. The keyword clusters were transcranial ultrasound, neuromodulation, upper limb function and Parkinson's disease. Bursting keywords included rehabilitation, neural function, ultrasound therapy, closed-loop control and low intensity. High-frequency English keywords included focused ultrasound, deep brain stimulation, transcranial magnetic stimulation, blood-brain barrier and thalamotomy. Keyword clusters covered tissue plasminogen activator, ultrasonic imaging, transcranial magnetic stimulation, thalamotomy and ultrasound. Bursting keywords featured essential tremor, neurostimulation, direct current stimulation and transcranial ultrasound stimulation. ConclusionResearch on the application of TUS in neurorehabilitation is on the rise, focusing on its efficacy and safety in Parkinson's disease, essential tremor, and ischemic stroke. Future research needs to explore the mechanisms of TUS, optimize treatment plans, and promote the development of individualized therapies.