OBJECTIVE:It has been confirmed that neuromodulation technology can improve the clinical symptoms of patients with Parkinson's disease,and there are differences in the efficacy of different neuromodulation stimulation methods.Herein,a network meta-analysis was used to evaluate the efficacy of different neuromodulation stimulation modalities in improving non-motor symptoms such as sleep disorders and depression and anxiety in patients with Parkinson's disease,thereby exploring the optimal neuromodulation stimulation regimen.METHODS:The Chinese Biomedical Literature Database,WanFang Database,VIP Database,CNKI Database,Web of Science,PubMed,The Cochrane Library,and EMbase databases were searched for randomized controlled trials on neuromodulation techniques to improve sleep disorders,depression and anxiety in patients with Parkinson's disease.The control group was treated with conventional treatments(drugs,conventional rehabilitation therapy,etc.)or sham stimulation,and the experimental group was supplemented with neuromodulation technology on the basis of the control group.The quality of the included studies was evaluated using the PEDro scale and the deviation risk assessment tool recommended by the Cochrane Collaboration.RevMan 5.4 and Stata 17.0 were used for network meta-analysis of the four outcomes(sleep disorders,anxiety symptoms,depressive symptoms,and quality of life).RESULTS:(1)Twenty-nine randomized controlled trials involving six neuromodulation stimulation modalities were included.These modalities were transcranial direct current stimulation,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,deep brain stimulation of the subthalamic nucleus,deep brain stimulation of the globus pallidus,multi-target deep brain stimulation.(2)The results of network meta-analysis showed that compared with conventional treatment,transcranial direct current stimulation[standardized mean difference(SMD)=-2.57,95％confidence interval(CI)=-4.52 to-0.63,P＜0.05)had the best effect in improving sleep disorders in patients with Parkinson's disease.In terms of improving depressive symptoms,deep brain stimulation of the globus pallidus(SMD=-1.00,95％CI=-1.87 to-0.14,P＜0.05)had the best effect,followed by low-frequency repetitive transcranial magnetic stimulation(SMD=-0.91,95％CI=-1.60 to-0.23,P＜0.05),deep brain stimulation of the subthalamic nucleus(SMD=-0.82,95％CI=-1.56 to-0.08,P＜0.05),and high-frequency repetitive transcranial magnetic stimulation(SMD=-0.75,95％CI=-0.97 to-0.53,P＜0.05).In terms of improving anxiety symptoms,high-frequency repetitive transcranial magnetic stimulation(SMD=-0.86,95％CI=-1.54 to-0.18,P＜0.05)had the best effect.In terms of improving the quality of life,deep brain stimulation of the globus pallidus(SMD=-0.79,95％CI=-1.55 to-0.04,P＜0.05)had the best efficacy,followed by high-frequency repetitive transcranial magnetic stimulation(SMD=-0.63,95％CI=-0.90 to-0.36,P＜0.05)and transcranial direct current stimulation(SMD=-0.50,95％CI=-0.80 to-0.19,P＜0.05).CONCLUSION:Neuromodulation technology has significant efficacy in improving non-motor symptoms in patients with Parkinson's disease.Transcranial direct current stimulation has the best efficacy in improving sleep disorders,deep electrical stimulation of the medial cerebral part of the globus pallidus has the best efficacy in improving depressive symptoms,high-frequency repetitive transcranial magnetic stimulation has the best efficacy in improving anxiety symptoms,and deep electrical stimulation of the globus pallidus has the best efficacy in improving quality of life.

OBJECTIVE:Repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown positive effects in improving gross motor function in children with cerebral palsy.A network meta-analysis was performed to analyze the clinical efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation on the improvement of lower limb motor function and gait in children with cerebral palsy.METHODS:Randomized controlled trials(RCT)about repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor function and gait in children with cerebral palsy were collected from CNKI,WanFang,VIP,SinoMed,PubMed,Web of Science,Medline.The search time limit was from the inception to October 5,2024.After screening literature,extracting data and evaluating the risk of bias of included studies,Stata 15.0 software was used for network meta-analysis,AND GRADE profiler was used for quality evaluation.RESULTS:A total of 19 studies were included,involving 4 treatment measures:conventional therapy,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation and anodic transcranial direct current stimulation.The results of network meta-analysis showed that in terms of improving gross motor function,low-frequency repetitive transcranial magnetic stimulation[mean difference(MD)=9.48,95％confidence interval(CI)(6.61,12.34),P＜0.05]was the most effective.In terms of alleviating spasticity,high-frequency repetitive transcranial magnetic stimulation[MD=-0.63,95％CI(-1.72,0.45),P＜0.05]had the best efficacy.In terms of improving ankle joint range of motion and step speed,transcranial direct current stimulation[MD=2.27,95％CI(1.37,3.17),P＜0.05;MD=0.11,95％CI(0.05,0.17),P＜0.05]was the most effective.CONCLUSION:Existing clinical evidence suggests that low-frequency repetitive transcranial magnetic stimulation has the best therapeutic effect compared with other intervention measures in terms of improving lower limb gross motor function.In terms of reducing spasticity,high-frequency repetitive transcranial magnetic stimulation has a more significant effect.In terms of improving gait,transcranial direct current stimulation has more advantages.

OBJECTIVE:Repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown positive effects in improving gross motor function in children with cerebral palsy.A network meta-analysis was performed to analyze the clinical efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation on the improvement of lower limb motor function and gait in children with cerebral palsy.METHODS:Randomized controlled trials(RCT)about repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor function and gait in children with cerebral palsy were collected from CNKI,WanFang,VIP,SinoMed,PubMed,Web of Science,Medline.The search time limit was from the inception to October 5,2024.After screening literature,extracting data and evaluating the risk of bias of included studies,Stata 15.0 software was used for network meta-analysis,AND GRADE profiler was used for quality evaluation.RESULTS:A total of 19 studies were included,involving 4 treatment measures:conventional therapy,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation and anodic transcranial direct current stimulation.The results of network meta-analysis showed that in terms of improving gross motor function,low-frequency repetitive transcranial magnetic stimulation[mean difference(MD)=9.48,95％confidence interval(CI)(6.61,12.34),P＜0.05]was the most effective.In terms of alleviating spasticity,high-frequency repetitive transcranial magnetic stimulation[MD=-0.63,95％CI(-1.72,0.45),P＜0.05]had the best efficacy.In terms of improving ankle joint range of motion and step speed,transcranial direct current stimulation[MD=2.27,95％CI(1.37,3.17),P＜0.05;MD=0.11,95％CI(0.05,0.17),P＜0.05]was the most effective.CONCLUSION:Existing clinical evidence suggests that low-frequency repetitive transcranial magnetic stimulation has the best therapeutic effect compared with other intervention measures in terms of improving lower limb gross motor function.In terms of reducing spasticity,high-frequency repetitive transcranial magnetic stimulation has a more significant effect.In terms of improving gait,transcranial direct current stimulation has more advantages.

OBJECTIVE:It has been confirmed that neuromodulation technology can improve the clinical symptoms of patients with Parkinson's disease,and there are differences in the efficacy of different neuromodulation stimulation methods.Herein,a network meta-analysis was used to evaluate the efficacy of different neuromodulation stimulation modalities in improving non-motor symptoms such as sleep disorders and depression and anxiety in patients with Parkinson's disease,thereby exploring the optimal neuromodulation stimulation regimen.METHODS:The Chinese Biomedical Literature Database,WanFang Database,VIP Database,CNKI Database,Web of Science,PubMed,The Cochrane Library,and EMbase databases were searched for randomized controlled trials on neuromodulation techniques to improve sleep disorders,depression and anxiety in patients with Parkinson's disease.The control group was treated with conventional treatments(drugs,conventional rehabilitation therapy,etc.)or sham stimulation,and the experimental group was supplemented with neuromodulation technology on the basis of the control group.The quality of the included studies was evaluated using the PEDro scale and the deviation risk assessment tool recommended by the Cochrane Collaboration.RevMan 5.4 and Stata 17.0 were used for network meta-analysis of the four outcomes(sleep disorders,anxiety symptoms,depressive symptoms,and quality of life).RESULTS:(1)Twenty-nine randomized controlled trials involving six neuromodulation stimulation modalities were included.These modalities were transcranial direct current stimulation,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,deep brain stimulation of the subthalamic nucleus,deep brain stimulation of the globus pallidus,multi-target deep brain stimulation.(2)The results of network meta-analysis showed that compared with conventional treatment,transcranial direct current stimulation[standardized mean difference(SMD)=-2.57,95％confidence interval(CI)=-4.52 to-0.63,P＜0.05)had the best effect in improving sleep disorders in patients with Parkinson's disease.In terms of improving depressive symptoms,deep brain stimulation of the globus pallidus(SMD=-1.00,95％CI=-1.87 to-0.14,P＜0.05)had the best effect,followed by low-frequency repetitive transcranial magnetic stimulation(SMD=-0.91,95％CI=-1.60 to-0.23,P＜0.05),deep brain stimulation of the subthalamic nucleus(SMD=-0.82,95％CI=-1.56 to-0.08,P＜0.05),and high-frequency repetitive transcranial magnetic stimulation(SMD=-0.75,95％CI=-0.97 to-0.53,P＜0.05).In terms of improving anxiety symptoms,high-frequency repetitive transcranial magnetic stimulation(SMD=-0.86,95％CI=-1.54 to-0.18,P＜0.05)had the best effect.In terms of improving the quality of life,deep brain stimulation of the globus pallidus(SMD=-0.79,95％CI=-1.55 to-0.04,P＜0.05)had the best efficacy,followed by high-frequency repetitive transcranial magnetic stimulation(SMD=-0.63,95％CI=-0.90 to-0.36,P＜0.05)and transcranial direct current stimulation(SMD=-0.50,95％CI=-0.80 to-0.19,P＜0.05).CONCLUSION:Neuromodulation technology has significant efficacy in improving non-motor symptoms in patients with Parkinson's disease.Transcranial direct current stimulation has the best efficacy in improving sleep disorders,deep electrical stimulation of the medial cerebral part of the globus pallidus has the best efficacy in improving depressive symptoms,high-frequency repetitive transcranial magnetic stimulation has the best efficacy in improving anxiety symptoms,and deep electrical stimulation of the globus pallidus has the best efficacy in improving quality of life.

BACKGROUND:Exercise as a form of active rehabilitation can improve the dysfunction caused by peripheral nerve injury,and different exercise modalities target different lesion sites and recovery mechanisms. OBJECTIVE:To comprehensively analyze the application and mechanisms of different exercise modalities in functional recovery from peripheral nerve injury. METHODS:A computerized search was conducted in PubMed and CNKI databases for relevant literature published before January 2024.The search terms used were"peripheral nerve injury,spinal cord,exercise,cerebral cortex,muscle atrophy,mirror therapy,blood flow restriction training"in both English and Chinese.Finally,77 articles were included for review. RESULTS AND CONCLUSION:Peripheral nerve injury can cause systemic pathological changes such as skeletal muscle atrophy,corresponding spinal cord segmental lesions,and sensorimotor cortex remodeling.Aerobic exercise can improve dysfunction by enhancing the immune response,promoting glial cell polarization,and promoting the release of nerve growth factor.Blood flow restriction exercise can regulate the secretion of muscle growth factor,promote muscle growth and enhance muscle strength.Mirror movement has a good effect in activating the cerebral cortex and reducing cortical remodeling.Different exercise modalities have potential benefits in functional recovery after peripheral nerve injury;however,there are still some problems and challenges,such as the choice of exercise modalities,the control of exercise intensity and frequency,and the detailed analysis of mechanisms.

BACKGROUND:Currently,there have been studies on three-dimensional digitalization and visualization systems for adult acupoints,but there are not many reports on the visualization of pediatric acupoints based on real pediatric digital sectional anatomical datasets. OBJECTIVE:To design and develop a digital three-dimensional visualization system for children's neck acupoints,to provide a basis for acupuncture and moxibustion,meridian and acupoint science teaching,clinical practice,acupuncture manipulation practice,and acupuncture safety research,and to provide a basis for the development of children's acupoint simulation system. METHODS:Based on a real cross-sectional anatomical dataset of pre-school boys,a three-dimensional digital virtual anatomical model of the neck region of children and internal multi-organ three-dimensional reconstruction were completed using PhotoShop 2021 and Digihuman Reconstruction System software.A database of 11 acupoints was compiled,including Fengfu and Fengchi,using the Unity database language.A three-dimensional model of children's neck anatomy,acupoint database,and writing acupuncture operation codes were integrated in Unity3D software.A three-dimensional digital visualization system for children's neck acupoints was successfully created,which integrated simulation acupoint positioning,three-dimensional acupoint anatomy,acupuncture training,clinical teaching,and acupuncture safety research. RESULTS AND CONCLUSION:(1)This study was based on real child specimens.Manual layer by layer segmentation of cross-sectional images was used to ensure the accuracy of the three-dimensional model to the greatest extent possible.The 3D software Digihuman Reconstruction System was utilized to extract and save independent segmentation data.PhotoShop 2021 software was collaborated with to complete dozens of three-dimensional reconstruction anatomical models of the outer skin of the neck and its internal bone structure,cervical spinal cord,blood vessels and nerves,muscles,and ligaments in children.The basic morphology and overall contour integrity verification of each independent structure were completed in MeshLab software.The 3-material research 13.0 software was applied for final fine tuning and anatomical position confirmation,successfully simulating and restoring the true anatomical morphology of the neck of preschool children.(2)Based on and referring to the national standards of the People's Republic of China,a database of commonly used acupoints in children's neck region was collected and organized,including their names,meridians,positioning,local anatomy,needle insertion levels,acupuncture methods,acupuncture accidents and prevention,acupoint indications,and two-dimensional anatomical sectional images.(3)Unity3D software was employed to integrate the three-dimensional model of children's neck,acupuncture simulation operation,and acupoint database,and a three-dimensional digital children's neck acupoint acupuncture visualization system was successfully constructed.The system displayed information on children's neck acupoints,two-dimensional and three-dimensional anatomical structures,and achieved two-dimensional and three-dimensional acupuncture simulation functions and acupuncture safety research functions for children's neck acupoints.Based on the ultra-thin sectional anatomical dataset of real child specimens,the first three-dimensional digital and visualization system for acupoints in the neck region of children had been constructed.Compared with previous acupoint acupuncture systems,it is more in line with the anatomical and morphological development characteristics of Asian children and has high application value in the fields of acupuncture safety research,clinical teaching,and acupuncture simulation training.

Objective To analyze the predictive value of Alberta stroke program early CT score(ASPECTS),acute stroke registry and analysis of Lausanne(ASTRAL)and totaled health risks in vascular events(THRIVE)for prognosis of intravenous thrombolysis in elderly patients with acute cerebral infarction(ACI).Methods A total of 118 elderly ACI patients receiving intravenous thrombolytic therapy in Department of Emergency Medicine of Shengli Oilfield Central Hospital from January 2021 to September 2024 were prospectively recruited.According to the score of Modified Rankin scale(mRS)at 3 months after treatment,the patients were divided into good prognosis group(73 cases)and poor prognosis group(45 cases).The scores of ASPECTS,ASTRAL and THRIVE models were compared between the two groups.ROC curve was plotted to evaluate the predictive efficiency of the three models for 3-month prognosis,and the area under the curve(AUC)was calculated.Results The poor prognosis group had significantly higher ASTRAL score and THRIVE score but obviously lower ASPECTS score when compared to the good prognosis group(P＜0.01).ROC curve analysis revealed that the AUC value of ASPECTS,ASTRAL and THRIVE models for prognosis evaluation was 0.731,0.935 and 0.799,respectively(P＜0.01),with excellent goodness of fit.Conclusion All the three models can effectively predict the prognosis of elderly ACI patients at 3 months after intravenous thrombolytic therapy.

Objective:To systematically review the progress in the method development and application of distributed learning in the estimation of epidemiological effect and provide methodological reference for multi-center studies.Methods:We conducted a literature retrieval for English papers published up to December 31, 2023 by using keywords of "health/medical big data" and "distributed/federated learning". After consulting experts, we set criteria of paper inclusion and exclusion and created a framework for data extraction. We collected information about basic study details, including method, application, and evaluation. Two researchers independently screened the papers and extracted information. We used EndNote 20 for the management of literatures and EpiData for the management of data.Results:A total of 3 444 papers were collected, and 29 papers were included in the final analysis. Most of the papers (25, 86.2%) were published in or after 2019, and the papers were mainly from the United States (21/29, 72.4%). For the estimation of epidemiological effects, 22 distributed learning methods had been developed, including methods for logistic regression (8), Cox regression (8), Poisson regression (2), and generalized linear mixed model (GLMM) (4), as well as three platforms for distributed analysis (VLP, Vantage6, AusCAT). The 29 papers described 45 applications, with 20 (44.4%) focusing on the establishment of prediction model and 25 (55.6%) on association analysis. Importantly, except for GLMM, current distributed learning methods can estimate effects with little bias in 1-3 rounds of communication. These methods show less bias compared with meta-analysis, especially in the address of data heterogeneity and rare outcomes. However, less studies examined how differences in data structure and sparse data affect results, an area that requires further research.Conclusion:While distributed learning shows promise in epidemiological effect estimation, it is still in early development, requiring further research on data heterogeneity handling and communication efficiency improvement.

Blood-bi-syndrome is primarily characterized by localized numbness and mild pain in the limbs.Records about the diagnosis and treatment of blood-bi-syndrome are scattered throughout classical medical literature.According to the theory of Yindan and Yangdan formulas in the classical prescription system,when the body's ascending function of qi movement is insufficiency,Yangdan formulas which contain Astragali Radix can be used for warming and uplifting yang qi.Conversely,when the descending function of qi movement is insufficiency,Yindan formulas which contain containing Bupleuri Radix can be used for astringing,descending,clearing and purging.This article,based on the principles of Yindan and Yangdan formulas,analyzed the fundamental pathogenesis of blood-bi-syndrome developing from the transmission of superficial syndromes,as well as its clinical manifestations during the transmission and change between taiyin disease and yangming disease.And the therapeutic strategies for blood-bi-syndrome were also summarized.It is proposed that taiyin blood-bi-syndrome arises in individuals with constitutionally deficient cold after the attack of pathogenic factors,resulting from fluid depletion,blood insufficiency,and stomach deficiency,which should be treated by Yangdan Formulas with pungent-sweet-warm properties for warming and uplifting yang qi.For the treatment of patients with taiyin blood-bi-syndrome characterized by exterior syndrome,Astragali Radix-containing classical prescriptions like Astragali Radix and Cinnamomi Ramulus Five-Component Decoction(Huangqi Guizhi Wuwu Decoction)can be chosen;for the treatment of patients with taiyin blood-bi-syndrome characterized by interior syndrome,Zingiberis Rhizoma Recens-containing classical prescriptions like Citri Reticulatae Pericarpium and Bambusae Caulis in Taenia Decoction(Jupi Zhuru Decoction)is adopted.Conversely,yangming blood-bi-syndrome occurs in individuals with constitutionally excessive heat after the attack of pathogenic factors,resulting from the internal accumulation of blood stasis and heat and the impairment of the fluid and blood,which should be treated by Yindan Formulas with pungent-sweet-cold or sour-cold properties for astringing,descending,clearing and purging.For the treatment of patients with yangming blood-bi-syndrome characterized by exterior syndrome,Puerariae Lobatae Radix-containing classical prescriptions like Phyllostachydis Henonis Folium and Puerariae Lobatae Radix Decoction(Zhuye Gegen Decoction)can be used;for the treatment of patients with yangming blood-bi-syndrome characterized by interior syndrome,Paeoniae Radix Alba-containing classical prescriptions like Rhei Radix et Rhizoma and Eupolyphaga seu Steleophaga Decoction(Dahuang Zhechong Wan)is recommended.

Objective To analyze the current status of knowledge,attitude,and behavior?(KAP)of doctors and pharmacists regarding iodine contrast agent allergic reactions in medical institutions in China and the influencing factors,to provide reference for the treatment of iodine contrast agent allergic patients.Methods A questionnaire survey on iodine contrast agent allergic reactions was conducted among doctors and pharmacists in China using a self-designed questionnaire.The questionnaire was distributed online via WeChat and the participants were anonymous and voluntary.The scores of knowledge,attitude,and behavior of medical staff of different genders,departments,and titles were statistically analyzed.Wilcoxon rank sum test and multiple linear regression analysis were used to analyze the influencing factors.Results A total of 105 doctors and pharmacists from 19 provinces,autonomous regions and municipalities participated in the survey,completing 105 valid questionnaires.The knowledge score(out of 4 points),attitude score(out of 3 points),and behavior score(out of 3 points)of doctors and pharmacists regarding contrast agent allergy reactions were 2(1,2)points,1(0,2)points,and 1(1,2)points,respectively.Multivariate linear regression analysis showed that job title is a factor affecting the knowledge score.Compared to those with primary and below titles,senior title doctors and pharmacists had higher knowledge scores(P=0.007).Educational level is a influence factor affecting the attitude score.Compared to those with undergraduate and below educational levels,doctors and pharmacists with doctoral degrees had more positive attitudes(P=0.011).Attitude score is a influence factor affecting the behavior score,the more positive the attitude,the more positive the behavior(P=0.015).Conclusion The knowledge,attitude,and practice(KAP)of doctors and pharmacists regarding contrast agent allergy reactions need to be strengthened.Training should be conducted for doctors and pharmacists,taking into account the KAP differences among individuals with different job titles and educational levels,to enhance knowledge levels and actively explore safe and effective desensitization treatment methods for patients with contrast agent allergies.The use of iodinated contrast agents should be rationalized while ensuring patient safety.