Objective:To develop a virtual reality (VR) exercise rehabilitation system for home-based patients with spinal cord injury, and test patients' acceptance and experience.Methods:The VR exercise rehabilitation system for home-based patients with spinal cord injury was developed by a multidisciplinary team based on the home rehabilitation needs, evidence, and clinical experience of spinal cord injury patients, and further improved after recommendations from experts and patients. From February to July 2024, convenience sampling was used to select 148 patients with spinal cord injuries admitted to the Department of Spinal Cord and Neurological Function Reconstruction at the China Rehabilitation Research Center. Acceptance Questionnaire was used to investigate patients' acceptance of the system. Thirteen patients with spinal cord injuries were selected for semi-structured interviews to explore the themes of their experiences using VR exercise rehabilitation system for home-based patients with spinal cord injury.Results:A VR exercise rehabilitation system for home-based patients with spinal cord injury was developed, which includes four aspects of personal profile, personal assessment, training selection, and care knowledge. The total acceptance score of this system among 148 patients was (87.69±1.59). Through semi-structured interviews, three themes were identified involving excellent experience, expectation of rehabilitation effects, satisfaction with functionality and hope for continuous system updates.Conclusions:The design of VR exercise rehabilitation system for home-based patients with spinal cord injury is scientifically reasonable, which can further verify the rehabilitation effect of the system.

Objective:To establish and verify a nomogram model for predicting the risk of non-alcoholic fatty liver disease (NAFLD) in helicopter flying personnel.Methods:The helicopter flying personnel who recuperated at Air Force Healthcare Center for Special Services Hangzhou were selected as the study subjects. They were divided into the training group (75%) and the verification group (25%) by using the cluster random sampling method for internal verification. Multivariate Logistic regression analysis was used to analyze the factors influencing NAFLD of helicopter flying personnel, and the nomogram model was constructed by R4.2.1 software and rms package. The H-L goodness-of-fit test and receiver operating characteristic (ROC) curve were used to assess the discrimination and calibration of the prediction model, and decision curve analysis (DCA) was used to evaluate the clinical practicality of the model.Results:A total of 2 195 helicopter flying personnel were included, with 1 648 in the training group and 547 in the verification group. Seven variables, including age, BMI, hyperuricemia, hypertriglyceridemia, abnormal high-density lipoprotein, daily intakes of milk and/or its products and years of smoking were used as the predictors of the nomogram model for the risk prediction of NAFLD in helicopter flying personnel. The H-L goodness-of-fit tests of training group and verification group were χ2=8.54, 11.03, P=0.382, 0.200, respectively, indicating a good predictive accuracy. The area under the ROC curve of the 2 groups was 0.840 and 0.860, respectively, indicating a certain degree of discrimination. The incidence risk probability of DCA curve in 2 groups was about 10%-30%, and the net return rate was above 0, suggesting that it had a certain clinical applicability. Increased age ( OR=1.18, P=0.010), overweight and obesity ( OR=3.67, P<0.001), hyperuricemia ( OR=2.12, P<0.001), hypertriglyceridemia ( OR=2.96, P<0.001), abnormal high-density lipoprotein cholesterol ( OR=1.83, P=0.010), and increased years of smoking ( OR=1.20, P=0.010) were the risk factors for NAFLD in helicopter flying personnel, while increased daily intakes of milk and/or its products ( OR=0.76, P=0.020) were identified as a protective factor. Conclusions:The nomogram model based on the aforementioned factors can effectively evaluate the incidence risk of NAFLD in helicopter flying personnel, and has certain clinical practicality.

Objective:To summarize the clinical features, diagnosis, treatment, and outcomes of necrotizing pneumonia(NP)in children, so as to improve the understanding of NP.Methods:Children with NP admitted to the Children′s Medical Center of Hunan Provincial People′s Hospital from December 2012 to June 2020 were selected and divided into respiratory support group(nine cases) and non-respiratory support group(27 cases) according to whether they received respiratory support; and they were also divided into pleural effusion group(28 cases) and non-pleural effusion group(eight cases) according to whether combined with pleural effusion.The clinical data of all children were collected, and the differences between different groups were compared.Results:There were thirty-six children with NP, included 14 boys and 22 girls, with a median age of 30(12, 49) months, and the disease duration was 34(25, 42)days.All children had cough, 34 cases had fever, and the fever peak was 39.5(39.1, 40.0) ℃.Laboratory tests(all peaks) showed that blood white blood cell count was 20.77(15.65, 28.35)×10 9/L, neutrophil count was 15.11(8.52, 20.65)×10 9/L, C-reactive protein(CRP) was 104.00(23.45, 146.50)mg/L, D-dimer was 5.12(1.88, 8.04)mg/L, and lactate dehydrogenase(LDH) was 347.95(284.68, 447.81)U/L.The detection rate of pathogens was 58.33%(21/36), and the most common was Staphylococcus aureus(28.57%, 6/21). Eight cases underwent surgical treatment, including five cases of thoracoscopic surgery and three cases of thoracotomy.All patients improved and were discharged from hospital.The differences in hospital stay, white blood cell count, CRP, procalcitonin and LDH levels between respiratory support group and non-respiratory support group were statistically significant, and the median age, white blood cell count, CRP, D-dimer and LDH between pleural effusion group and non-pleural effusion group were statistically significant(all P<0.05). Further multivariate Logistic regression analysis showed that LDH was a risk factor for NP children receiving respiratory support( P<0.05), the area under the ROC curve of LDH was 0.802, whose the cut-off value was 471.21 U/L.There were no statistically significant differences in the indexes between effusion group and non-pleural effusion group. Conclusion:Children with NP are prone to repeated high fever, high inflammatory markers, and a long course of disease.Staphylococcus aureus is the most common pathogen.Serum LDH≥471.21 U/L is an early independent predictor of respiratory support for NP.

Objective: To investigate the trends in incidence of stroke in Jindong District, Jinhua City, Zhejiang Province from 2016 to 2022, so as to provide to the evidence for improving the stroke control strategy. Methods: The incidence of stroke in Jindong District from 2016 to 2022 was collected through the Zhejiang Chronic Disease Monitoring Information System, and standardized by the data of the Chinese National Population Census in 2010. The gender-, age- and subtype-specific incidence of stroke was calculated, and the trends in stroke incidence were investigated with average annual percent change (AAPC). Results: A total of 9 159 stroke cases were reported in Jindong District from 2016 to 2022, with crude incidence of 386.52/105 and standardized incidence of 276.75/105. The crude incidence of stroke appeared a tendency towards a rise (AAPC=3.704%, 95%CI: 0.792%-6.700%, P<0.05), while the standardized incidence showed no significant changing patterns (P>0.05). The crude incidence of stroke was significantly higher among men than among women (438.69/105 vs. 334.66/105; χ2=14.028, P<0.05), and the standardized incidence of stroke was significantly higher among men than among women (316.58/105 vs. 237.31/105; χ2=6.985, P<0.05). The crude incidence of stroke appeared a tendency towards a rise with age（χ2=5 290.180, P<0.05), and the crude incidence of stroke appeared a tendency towards a decline with age among residents at ages of 45 to 64 years (AAPC=-9.135%, 95%CI: -15.003% to -2.861%, P<0.05), while no significant changing patterns were found in the crude incidence of stroke among residents at other age groups (P>0.05). The crude incidence of ischemic stroke was significantly higher than that of hemorrhagic stroke (306.08/105 vs. 76.89/105; χ2=137.184, P<0.05). Conclusions The incidence of stroke appeared a tendency towards a rise in Jindong District from 2016 to 2022, with ischemic stroke as the predominant subtype. Male and middle-aged and elderly populations should be given a high priority for stroke control.

Objective:To establish and verify a nomogram model for predicting the risk of non-alcoholic fatty liver disease (NAFLD) in helicopter flying personnel.Methods:The helicopter flying personnel who recuperated at Air Force Healthcare Center for Special Services Hangzhou were selected as the study subjects. They were divided into the training group (75%) and the verification group (25%) by using the cluster random sampling method for internal verification. Multivariate Logistic regression analysis was used to analyze the factors influencing NAFLD of helicopter flying personnel, and the nomogram model was constructed by R4.2.1 software and rms package. The H-L goodness-of-fit test and receiver operating characteristic (ROC) curve were used to assess the discrimination and calibration of the prediction model, and decision curve analysis (DCA) was used to evaluate the clinical practicality of the model.Results:A total of 2 195 helicopter flying personnel were included, with 1 648 in the training group and 547 in the verification group. Seven variables, including age, BMI, hyperuricemia, hypertriglyceridemia, abnormal high-density lipoprotein, daily intakes of milk and/or its products and years of smoking were used as the predictors of the nomogram model for the risk prediction of NAFLD in helicopter flying personnel. The H-L goodness-of-fit tests of training group and verification group were χ2=8.54, 11.03, P=0.382, 0.200, respectively, indicating a good predictive accuracy. The area under the ROC curve of the 2 groups was 0.840 and 0.860, respectively, indicating a certain degree of discrimination. The incidence risk probability of DCA curve in 2 groups was about 10%-30%, and the net return rate was above 0, suggesting that it had a certain clinical applicability. Increased age ( OR=1.18, P=0.010), overweight and obesity ( OR=3.67, P<0.001), hyperuricemia ( OR=2.12, P<0.001), hypertriglyceridemia ( OR=2.96, P<0.001), abnormal high-density lipoprotein cholesterol ( OR=1.83, P=0.010), and increased years of smoking ( OR=1.20, P=0.010) were the risk factors for NAFLD in helicopter flying personnel, while increased daily intakes of milk and/or its products ( OR=0.76, P=0.020) were identified as a protective factor. Conclusions:The nomogram model based on the aforementioned factors can effectively evaluate the incidence risk of NAFLD in helicopter flying personnel, and has certain clinical practicality.

Objective: To create a model for early prediction of essential hypertension (EH) based on the TreeNet algorithm, so as to provide a tool for early monitoring of EH. Methods: The health examination data were collected from individuals receiving health examinations in Hangzhou Haiqin Health Examination Center or Shanghai Yibao Health Management Co., Ltd from 2014 to 2016, and a predictive model for EH was created based on the TreeNet algorithm. The effectiveness of the model for early prediction of EH was evaluated using root mean square error (RMSE), mean absolute deviation (MAD), coefficient of determination (R2) and receiver operating characteristic (ROC) curve. Results: A total of 12 variables were included in the model, and the highest contributing variable was body mass index (BMI), followed by BMI difference, two-year BMI difference, two-year triglyceride (TG) difference, two-year total cholesterol (TC) difference, high-density lipoprotein cholesterol (HDL-C) in 2014, TG in 2014, low-density lipoprotein cholesterol (LDL-C) in 2014, body weight in 2015, fasting blood glucose in 2015, TG in 2015, urea nitrogen difference and platelet in 2015. The highest predictive accuracy was 100.00%, and the lowest was 56.89%. The risk of EH significantly increased among individuals with BMI in 2015 of >25 kg/m2, two-year BMI difference of >0.5 kg/m2, two-year TG difference ranging from 1.3 to 3.3 mmol/L, TC in 2015 of 2.0 to 2.4 mmol/L and HDL-C in 2014 of <0.52 mmol/L. The model presented RMSE of 0.082, MAD of 0.064, R2 of 0.811, area under the ROC curve of 0.788 (95%CI: 0.741-0.815), sensitivity of 69.05% and specificity of 66.21% for prediction of EH Conclusion The TreeNet algorithm-based model is effective for early monitoring of high-risk individuals for EH.

Objective:To summarize the clinical characteristics of children with Mycoplasma pneumoniae pneumonia(MPP) complicated with pleural effusion, and explore the effect of mixed adenovirus infection on children with MPP complicated with pleural effusion.Methods:The clinical data of children with MPP complicated with pleural effusion diagnosed in Children′s Medical Center at the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People′s Hospital) from January 2013 to December 2019 were collected.MPP cases were divided into single infection group and mixed infection group according to whether mixing adenovirus infection.The clinical characteristics were compared between two groups.Results:A total of 180 children with MPP complicated with pleural effusion were included, the male to female ratio was 1.22∶1 (99/81), the age was 66.13 (44.35, 83.98) months, and the most common cases were children over 5 years old (55.56%). The length of hospitalization was 9.00 (7.00, 12.00) days.Fever (93.33%) and cough (98.33%) were the most common clinical manifestations, and mild increases in C-reactive protein, erythrocyte sedimentation rate and D-dimer were the most common laboratory results.Among included children, right pleural effusion was the most common (54.44%), bilateral pleural effusion accounted for 26.67%, and left pleural effusion accounted for 18.89%.Compared with single infection group, the mixed infection group had a longer hospital stay, a higher proportion of oxygen intake, a higher proportion of gamma globulin use, and a higher value of lactate dehydrogenase and aspartate aminotransferase.The results of multivariate Logistic regression analysis showed that compared with single infection group, although the mixed infection group had a higher proportion of gamma globulin use (36.54% vs.10.93%, P<0.05), the length of hospital stay, clinical manifestations, laboratory examination, chest CT and fiberoptic bronchoscopy showed no statistically significant difference between two groups. Conclusion:MPP complicated with pleural effusion is more common in children over 5 years old, especially in the right side.Mild increases of C-reactive protein, erythrocyte sedimentation rate, and D-dimer are more common.The clinical features of MPP complicated with pleural effusion are similar between mixed adenovirus infection group and single infection group.

Rapid detection and response to visual threats are critical for survival in animals. The amygdala (AMY) is hypothesized to be involved in this process, but how it interacts with the visual system to do this remains unclear. By recording flash-evoked potentials simultaneously from the superior colliculus (SC), lateral posterior nucleus of the thalamus, AMY, lateral geniculate nucleus (LGN) and visual cortex, which belong to the cortical and subcortical pathways for visual fear processing, we investigated the temporal relationship between these regions in visual processing in rats. A quick flash-evoked potential (FEP) component was identified in the AMY. This emerged as early as in the LGN and was approximately 25 ms prior to the earliest component recorded in the SC, which was assumed to be an important area in visual fear. This quick P1 component in the AMY was not affected by restraint stress or corticosterone injection, but was diminished by RU38486, a glucocorticoid receptor blocker. By injecting a monosynaptic retrograde AAV tracer into the AMY, we found that it received a direct projection from the retina. These results confirm the existence of a direct connection from the retina to the AMY, that the latency in the AMY to flashes is equivalent to that in the sensory thalamus, and that the response is modulated by glucocorticoids.

Objective:To investigate the current status of prevention and treatment of esophagogastric variceal bleeding (EVB) in cirrhotic portal hypertension patients in Ningxia region.Methods:The retrospective and descriptive study was conducted. The clinical data of 820 cirrhotic portal hypertension patients who were admitted to 21 medical centers in Niangxia region from January 2018 to December 2020 were collected, including 85 cases in Ningxia Hui Autonomous Region People′s Hospital, 73 cases in the Fifth People′s Hospital of Ningxia Hui Autonomous Region, 59 cases in the Wuzhong People′s Hospital, 52 cases in the Qingtongxia People′s Hospital, 50 cases in the Guyuan People′s Hospital, 47 cases in the Yuanzhou District People′s Hospital of Guyuan City, 47 cases in the Yinchuan Second People′s Hospital, 40 cases in the General Hospital of Ningxia Medical University, 40 cases in the Tongxin People′s Hospital, 35 cases in the Yinchuan First People′s Hospital, 34 cases in the Third People′s Hospital of Ningxia Hui Autonomous Region, 32 cases in the Zhongwei People′s Hospital, 30 cases in the Lingwu People′s Hospital, 30 cases in the Wuzhong New District Hospital, 30 cases in the Yanchi People′s Hospital, 29 cases in the Ningxia Hui Autonomous Region Academy of Traditional Chinese Medicine, 28 cases in the Shizuishan Second People′s Hospital, 25 cases in the Shizuishan First People′s Hospital, 21 cases in the Haiyuan People′s Hospital, 20 cases in the Pengyang People′s Hospital, 13 cases in the Longde People′s Hospital. There were 538 males and 282 females, aged (56±13)years. Observation indicators: (1) clinical charac-teristics of cirrhotic portal hypertension patients; (2) overall prevention and treatment of EVB in cirrhotic portal hypertension patients; (3) prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Clinical characteristics of cirrhotic portal hypertension patients: of 820 cirrhotic portal hypertension patients, 271 cases were in compensated stage and 549 cases were in decompensated stage. Of the 271 cases in compensated stage, there were 183 maels and 88 females, aged (53±12)years. There were 185 Han people, 85 Hui people and 1 case of other ethic group. The etiological data of liver cirrhosis showed 211 cases of viral hepatitis B, 4 cases of alcoholic liver disease, 8 cases of viral hepatitis C, and 48 cases of other etiology. There were 235 cases of Child-Pugh grade A and 36 cases lack of data. Of the 549 cases in decompensated stage, there were 355 males and 194 females, aged (57±14) years. There were 373 Han people, 174 Hui people and 2 cases of other ethic group. The etiological data of liver cirrhosis showed 392 cases of viral hepatitis B, 33 cases of alcoholic liver disease, 10 cases of viral hepatitis C, and 114 cases of other etiology. There were 80 cases of Child-Pugh grade A, 289 cases of grade B, 170 cases of grade C and 10 cases lack of data. (2) Overall prevention and treatment of EVB in cirrhotic portal hypertension patients: of 271 patients in compensated stage, 38 cases received non-selective β-blocker (NSBB) therapy, 16 cases received endoscopic treatment, 6 cases received interventional therapy. Of 549 patients in decompensated stage, 68 cases received NSBB therapy, 46 cases received endoscopic treatment, 28 cases received interventional therapy. (3) Prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals: of 271 patients in compensated stage, 181 cases came from tertiary hospitals, of which 28 cases received NSBB therapy, 15 cases received endoscopic treatment, 6 cases received interventional therapy. Ninety cases came from secondary hospitals, of which 10 cases received NSBB therapy, 1 cases received endoscopic treatment. There was no significant difference in NSBB for prevention of EVB between tertiary and secondary hospitals ( χ2=0.947, P>0.05), while there was a significant difference in endoscopic treatment for prevention of EVB between tertiary and secondary hospitals ( χ2=5.572, P<0.05). Of 549 patients in decompensated stage, 309 cases came from tertiary hospitals, of which 22 cases received NSBB therapy, 29 cases received endoscopic treatment, 22 cases received interventional therapy. Two hundreds and fourty cases came from secondary hospitals, of which 46 cases received NSBB therapy, 17 cases received endoscopic treatment, 6 cases received interven-tional therapy. There were significant differences in NSBB and interventional therapy for prevention of EVB between tertiary and secondary hospitals ( χ2=18.065, 5.956, P<0.05). Conclusions:The proportion of receiving EUB prevention in cirrhotic portal hypertension in Ningxia is relatively low. For patients with compensated liver cirrhosis, the proportion of NSBB therapy and endoscopic treatment in the secondary hospitals was lower than that in tertiary hospitals. For patients with decompensated liver cirrhosis, the proportion of interventional treatment in secondary hospitals is lower than that of tertiary hospitals, but the proportion of NSBB in secondary hospitals taking is higher than that of tertiary hospitals.

Objective:To explore the correlation between the body fat, blood lipid levels, and the vital capacity/body mass index of the special duty personnel in a sanatorium, and to provide guidance on effectively optimize the cardiopulmonary endurance of the special duty personnel, so as to improve the combat effectiveness of the armed forces.Methods:The subjects were the special duty personnel who were examined in a sanatorium from January 2015 to April 2019. Their body fat, blood lipid, and vital capacity/body mass index were measured. The influence of body fat and blood lipid on the vital capacity body/mass index were analyzed by multiple linear regression.Results:The prevalence rate of dyslipidemia (20.4%) was significantly lower in the special duty personnel than that in Chinese male adults (47.0%), while the body fat level of the special duty personnel was similar to the average body fat level of Chinese male adults. Their body fat percentage, waist to hip ratio, blood lipid level (TG, TC, LDL-C), and the prevalence rate of dyslipidemia were all negatively correlated with the vital capacity/body mass index ( P<0.05). Conclusion:The body fat and blood lipid levels of the special duty personnel are the main factors affecting their vital capacity/body mass index. Therefore, the body fat and blood lipid levels of the special duty personnel should be optimized by active training and dietary adjustment, so as to improve their physical fitness and promote the combat effectiveness.