ObjectiveTo analyze the research hotspots and development trends in the field of spinal cord stimulation (SCS) for spinal cord injury (SCI). MethodsLiterature about SCS for SCI was retrieve from the Web of Science (WOS) Core Collection database, with a time range from January, 1999 to July, 2025. VOSviewer 1.6.20 and CiteSpace 6.4.R2 were used to analyze the annual publication volume, countries, authors, institutions, journals and keywords. ResultsA total of 636 literatures were included. From 1999 to 2025, the overall publication trend in this field showed an upward trajectory, with recent years fluctuating but tending to stabilize. The country with the most publications was the United States (429 papers), followed by Russia (98 papers) and China (70 papers). The institution with the highest number of publications was the University of California, Los Angeles (76 papers), the author with the most publications was V. Reggie Edgerton (70 papers), and the journal with the most publications was Journal of Clinical Medicine (31 papers). The most frequently cited study focused on exploring the combination of epidural spinal cord stimulation with task-specific training to restore motor function in patients with complete SCI. Keyword analysis showed that the research hotspots in this field were mainly focused on neuroregulation mechanisms, recovery of motor and autonomic nervous dysfunction, artificial intelligence, closed-loop stimulation and brain-computer interface technology innovations. In recent years, the research focus gradually shifted from basic mechanisms to personalized and precise multifunctional rehabilitation strategies. ConclusionThe field of SCS for SCI has undergone phases of basic mechanism exploration and clinical application expansion. Current research hotspots and future trends focus primarily on the development of new stimulation paradigms and combined innovative technologies.

Objective: Traumatic brain injury (TBI) patients often experience massive bleeding and require blood transfusion. However, the storage duration of the transfused blood may affect the prognosis of these patients. This study explored the influence of exosomes derived from fresh and aged blood on the prognosis of rats with TBI, so as to provide theoretical support for the blood transfusion management of TBI patients. Methods: Exosomes were isolated from red blood cell (RBC) suspensions stored for 1 week and 5 weeks using ultracentrifugation method. The size, morphology and surface markers of the exosomes were identified by nanoparticle flow cytometry, transmission electron microscopy and Western blotting, respectively. A rat model of TBI was constructed using a mechanical impactor for brain injury. After the successful establishment of the model, exosomes from RBC suspensions stored for 1 week and 5 weeks were injected into the extracellular space of rat brain cells using a stereotactic syringe. Cerebral edema at day 1, 3, 7 and 14 were recorded through cranial magnetic resonance imaging (MRI) scans. Magnetic tracing technology (the tracer was Gd-DTPA solution) was used to evaluate the drug metabolism level in the extracellular space of brain cells of TBI rats. The cranial magnetic resonance imaging was scanned every 15 or 30 minutes, and the recording lasted for a total of 240 minutes. The magnetic images were imported into the 3D-Slicer software in Dicom data format for analysis. Mass spectrometry technology was used to analyze the differential proteins of exosomes from RBC suspensions stored for 1 week and 5 weeks, and functional prediction was carried out to explore the possible mechanisms by which exosomes affect the prognosis of TBI. Results: After injection of exosomes into TBI rats, the areas of cerebral edema on the day 1, 3, 7, and 14 were all significantly higher in the rats treated with exosomes from 5-week-stored RBC suspensions, with peak cerebral edema occurring at day 3. The diffusion volume of the tracer was significantly higher in TBI rats than in normal rats, which implied there was a disorder in the structure of the traumatic brain tissue in TBI rats. Compared with the rats injected with exosomes from 1-week-stored RBC suspensions, those treated with exosomes from 5-week-stored RBC suspensions showed increased tracer diffusion volume within 120 minutes. Mass spectrometry analysis identified 81 differentially expressed proteins between exosomes from RBC suspensions stored for 5 weeks vs 1 week. Among them, 93.83% (76/81) proteins had increased expression levels. The neurodegeneration-related pathways were among the most enriched pathways for upregulated proteins. Conclusion: The exosomes from aged RBC suspensions can lead to exacerbated cerebral edema, disrupted extracellular space, and suppressed metabolic rate in TBI rats, suggesting that transfusion of aged RBC suspensions may have adverse effects on TBI patients.

OBJECTIVE To observe the in vitro induced drug resistance mechanisms of polymyxin B-resistant Acin-etobacter baumannii and explore the in vitro antimicrobial activity of polymyxin B combined with melatonin.METHODS Totally 10 strains of polymyxin B-sensitive A.baumannii were clinically isolated from the Affiliated Li Huili Hospital of Ningbo university between Jan.2021 to Dec.2021 and were induced to the polymyxin B-resistant strains by means of in vitro induction method.The drug resistance mechanisms of the polymyxin B-resistant A.baumannii strains were explored by polymerase chain reaction(PCR)combined with sequencing analysis.The minimum inhibitory concentrations(MICs)of the single and joint use of polymyxin B and melatonin were detected by using broth microdilution checkerboard.The antibacterial effect of polymyxin combined with melatonin was e-valuated by calculating fractional inhibitory concentration index(FICI).The strains that showed the remarkable synergistic effect for the antimicrobial activity were chosen to determine the time-kill curves.RESULTS Among the polymyxin B-induced drug-resistant A.baumannii strains,there were gene mutations at various loci of polymyxin resistance genes pmrB,lpxA and lpxD.The MIC of polymyxin B against A.baumannii strains declined after the combined use of polymyxin B and melatonin.The combined use of the two drugs that showed synergistic effect for antimicrobial activity accounted for 80.00％(8/10),the additive effect 20.00％(2/10).The time-kill curve showed that the combined use of polymyxin B and melatonin showed remarkable antibacterial effect at the 24th hour.CONCLUSIONS The drug resistance gene mutations that are mediated by chromosomes are the major drug resist-ance mechanisms of the A.baumannii strains to polymyxin B.The combined use of polymyxin B and melatonin may reverse the drug resistance of the A.baumannii to polymyxin B.

Objective:To gain insight into the multidimensional needs of adults with moderate-to-severe psoriasis at different stages of disease progression diagnostic and treatment dynamics based on patient journey maps, providing a basis for developing precise intervention strategies and optimizing care throughout the journey.Methods:From September to October 2024, 14 adult patients with moderate-to-severe psoriasis admitted to the Department of Dermatology of the First Hospital of Shanxi Medical University were selected by purposive sampling method for semi-structured interviews. Content analysis was used to analyze the data, drawing on theory of "timing it right" to depict a patient journey map that was reviewed and improved by the research team and patients.Results:Patient journey map was developed and condensed into four themes of experiences and challenges from pre-diagnosis to adaptation, complex emotional experiences, experiential pain points at each stage of the diagnosis and treatment, and opportunity points to improve the experience and quality of the diagnosis and treatment.Conclusions:At different stages of disease progression, the diagnosis and treatment needs of adults with moderate-to-severe psoriasis are characterized by dynamic evolution and multidimensional integration. The journey map can accurately identify patients' differentiated experiences and needs, and can provide a reference for healthcare professionals and policy makers to optimize patients' diagnostic and treatment experiences and focus on patients' health management.

Objective To develop a risk prediction model for moderate-to-severe catheter-related bladder discomfort(CRBD)after non-transurethral surgery based on various machine-learning algorithms and to compare the performance of the models,so as to provide a reference for accurately identification and prevention of the postoperative moderate-to-severe CRBD.Methods A convenience sampling method was employed to recruit 719 patients as study subjects.The patients received non-transurethral surgery and intraoperative urinary catheterisation in a Tier-ⅢA hospital in Shanxi Province between January and May 2024.The clinical data were collected,with 70％of the randomly selected data was assigned to a training dataset(n=503)for the model building and the rest of 30％of data was used as the testing dataset(n=216)for internal model validation.Predictors were determined using least absolute shrinkage and selection operators(LASSO).Seven machine learning methods of logistic regression,K-nearest neighbours,random forest,artificial neural network,decision tree,light gradient boosting machine(LightGBM)and elastic net were employed to establish the risk prediction models.Performance of the models was evaluated based on the area under receiver operating characteristic curve(AUR-ROC),accuracy,precision,recall and F1 score.Results A total of 719 patients who underwent non-transurethral surgery were included in the study.It was found that 154(21.4％)patients presented with moderate to severe CRBD and 565(78.6％)patients were without or only with a mild CRBD.The predictors were deduced to six variables:gender,abdominal surgery,type of surgery,administration of dexmedetomidine before surgery,intraoperative administration of flurbiprofenate,and use of tramadol by the completion of surgery.It was found that the LightGBM model demonstrated a high stability,with 0.793 in AUC-ROC,0.763 in accuracy,0.879 in precision,0.747 in recall and 0.808 in F1.Conclusion The risk prediction model established through LightGBM for moderate-to-severe CRBD after a non-transurethral surgery exhibits a high stability.It offers a reference for medical practitioners to identify the patients with high-risk of moderate-to-severe CRBD and prepares for relevant interventions.

BACKGROUND:Cervical disc herniation can cause pain in the neck and shoulder area,as well as radiating pain in the upper limbs.The incidence rate is increasing year by year and tends to affect younger individuals.Fully understanding the biomechanical characteristics of the cervical spine in adolescents is of great significance for preventing and delaying the onset of cervical disc herniation in this age group. OBJECTIVE:To reconstruct cervical spine models for both healthy adolescents and adolescent patients with cervical disc herniation utilizing finite element analysis techniques,to analyze the motion range of the C1-T1 cervical vertebrae as well as the biomechanical characteristics of the annulus fibrosus,nucleus pulposus,endplates,and the cartilage of the small joints. METHODS:A normal adolescent's cervical spine and an adolescent patient with cervical disc herniation were selected in this study.The continuous scan cervical spine CT raw image data were imported into Mimics 21.0 in DICOM format.The C1-T1 vertebrae were reconstructed separately.Subsequently,the established models were imported into the 3-Matic software for disc reconstruction.The perfected models were then imported into Hypermesh software for meshing of the vertebrae,nucleus pulposus,annulus fibrosus,and ligaments,creating valid geometric models.After assigning material properties,the final models were imported into ABAQUS software to observe the joint motion range of the C1-C7 cervical vertebrae segments under different conditions,and to analyze the biomechanical characteristics of the annulus fibrosus,nucleus pulposus,endplates,and small joint cartilage of each cervical spine segment. RESULTS AND CONCLUSION:(1)In six different conditions,the joint motion range of the C1 vertebra in the cervical spine models of both normal adolescent and adolescent patient with cervical disc herniation was higher than that of the other vertebrae.Additionally,the joint motion range of each cervical spine segment in normal adolescent was greater than that in adolescent patient with cervical disc herniation.(2)In the cervical spine model of normal adolescent,the maximum stress values in the annulus fibrosus and nucleus pulposus were found on the left side during C2-3 flexion conditions(0.43 MPa and 0.17 MPa,respectively).In the cervical spine model of adolescent patient with cervical disc herniation,the maximum stress values were found on the left side during C7-T1 flexion conditions(0.54 MPa and 0.18 MPa,respectively).(3)In the cervical spine model of normal adolescent,the maximum stress value on the endplate was found on the left side of the upper endplate of C3 during flexion conditions(1.46 MPa).In the model of adolescent patient with cervical disc herniation,the maximum stress value on the endplate was found on the left side of the lower endplate of C7 during flexion conditions(1.32 MPa).(4)In the cervical spine model of normal adolescent,the maximum stress value in the small joint cartilage was found in the C2-3 left rotation conditions(0.98 MPa).In adolescent patient with cervical disc herniation,the stress in the small joint cartilage significantly increased under different conditions,especially in C1-2,with the maximum stress found during left flexion(3.50 MPa).(5)It is concluded that compared to normal adolescent,adolescent patient with cervical disc herniation exhibits altered cervical curvature and a decrease in overall joint motion range in the cervical spine.In adolescent with cervical disc herniation,there is a significant increase in stress on the annulus fibrosus,nucleus pulposus,and endplates in the C7-T1 segment.The stress on the left articular cartilage of the C1-2 is notable.Abnormal cervical curvature may be the primary factor causing these stress changes.

BACKGROUND: Epidemiological data on chronic diarrhea in the Chinese population are lacking, and the association between obesity and chronic diarrhea in East Asian populations remains inconclusive. This study aimed to investigate the prevalence of chronic diarrhea and its association with obesity in a representative community-dwelling Chinese population. METHODS: This cross-sectional study was based on a multistage, randomized cluster sampling involving 3503 residents aged 20-69 years from representative urban and rural communities in Beijing. Chronic diarrhea was assessed using the Bristol Stool Form Scale (BSFS), and obesity was determined based on body mass index (BMI). Logistic regression analysis and restricted cubic splines were used to evaluate the relationship between obesity and chronic diarrhea. RESULTS: The standardized prevalence of chronic diarrhea in the study population was 12.88%. The average BMI was 24.67 kg/m 2 . Of all the participants, 35.17% (1232/3503) of participants were classified as overweight and 16.13% (565/3503) as obese. After adjustment for potential confounders, individuals with obesity had an increased risk of chronic diarrhea as compared to normal weight individuals (odds ratio = 1.58, 95% confidence interval: 1.20-2.06). A nonlinear association between BMI and the risk of chronic diarrhea was observed in community residents of males and the overall participant group ( P  = 0.026 and 0.017, respectively). CONCLUSIONS This study presents initial findings on the prevalence of chronic diarrhea among residents of Chinese communities while offering substantiated evidence regarding the significant association between obesity and chronic diarrhea. These findings offer a novel perspective on gastrointestinal health management.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Body Mass Index ; China/epidemiology* ; Chronic Disease/epidemiology* ; Cross-Sectional Studies ; Diarrhea/epidemiology* ; Obesity/complications* ; Prevalence ; East Asian People/statistics & numerical data*

Background::Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China.Methods::Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran’s I analysis. Results::The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603) of total cases and cirrhosis cases accounted for 11.23% (180/1603). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (Moran’s I <0) and percentage of urban population (Moran’s I <0), and positively correlated with the number of pediatric beds per million population (Moran’s I >0). Conclusion::The number of severe hepatitis B cases is low in areas with high gross domestic product levels and high urban population ratios, and health care costs have been declining over the years.

OBJECTIVE To observe the in vitro induced drug resistance mechanisms of polymyxin B-resistant Acin-etobacter baumannii and explore the in vitro antimicrobial activity of polymyxin B combined with melatonin.METHODS Totally 10 strains of polymyxin B-sensitive A.baumannii were clinically isolated from the Affiliated Li Huili Hospital of Ningbo university between Jan.2021 to Dec.2021 and were induced to the polymyxin B-resistant strains by means of in vitro induction method.The drug resistance mechanisms of the polymyxin B-resistant A.baumannii strains were explored by polymerase chain reaction(PCR)combined with sequencing analysis.The minimum inhibitory concentrations(MICs)of the single and joint use of polymyxin B and melatonin were detected by using broth microdilution checkerboard.The antibacterial effect of polymyxin combined with melatonin was e-valuated by calculating fractional inhibitory concentration index(FICI).The strains that showed the remarkable synergistic effect for the antimicrobial activity were chosen to determine the time-kill curves.RESULTS Among the polymyxin B-induced drug-resistant A.baumannii strains,there were gene mutations at various loci of polymyxin resistance genes pmrB,lpxA and lpxD.The MIC of polymyxin B against A.baumannii strains declined after the combined use of polymyxin B and melatonin.The combined use of the two drugs that showed synergistic effect for antimicrobial activity accounted for 80.00％(8/10),the additive effect 20.00％(2/10).The time-kill curve showed that the combined use of polymyxin B and melatonin showed remarkable antibacterial effect at the 24th hour.CONCLUSIONS The drug resistance gene mutations that are mediated by chromosomes are the major drug resist-ance mechanisms of the A.baumannii strains to polymyxin B.The combined use of polymyxin B and melatonin may reverse the drug resistance of the A.baumannii to polymyxin B.

Objective:To investigate the efficacy and toxicity of blinatumomab in the first-line and second-line treatment of pediatric B-cell acute lymphoblastic leukemia (B-ALL).Methods:A multi-center retrospective cohort study was conducted to analyze clinical data from 323 pediatric B-ALL patients treated with blinatumomab across 14 hospitals in China from May 2021 to July 2023. Patients were divided into four groups based on the treatment phase and disease status when blinatumomab was used: relapsed/refractory group, post-consolidation minimal residual disease (MRD)-positive group, early MRD-positive group, and MRD-negative group. Blinatumomab for the relapsed/refractory group was considered as second-line treatment, while the other 3 groups as first-line treatment. The MRD negativity rate after treatment, the survival rates and the incidence of severe adverse events were compared across these groups. Patients who received blinatumomab for more than 7 days were included in the efficacy analysis. Survival analysis was performed using the Kaplan-Meier method, and Log-Rank test was used to compare the survival rates among groups.Results:Among the 323 patients, 191 (59.1%) were male, with the age of 6.2 (3.9, 10.5) years. There were 117 patients in the relapsed/refractory group, 62 cases in the post-consolidation MRD-positive group, 43 cases in the early MRD-positive group, and 101 cases in the MRD negative group. In the relapsed/refractory group, the complete remission rate and MRD negativity rate after one course of blinatumomab were 71.4% (35/49) and 81.5% (75/92) for the 49 children without complete remission and the 92 children with flow cytometry-positive MRD, respectively. In the post-consolidation MRD-positive group, the MRD negativity rates after one course of blinatumomab were 100.0% (27/27), 12/16 and 9/19 for patients with MRD positivity detected by flow cytometry, polymerase chain reaction and next-generation sequencing, respectively. In the early MRD-positive group, the MRD negativity rates were 96.7% (29/30) and 9/9 for flow cytometry and next-generation sequencing, respectively. The 2-year overall survival rate and event-free survival rate for the 319 children evaluable for efficacy were (90.6±1.7)% and (87.6±1.9)%, respectively, with the relapsed/refractory group showing significantly lower overall survival rates and event-free survival rate compared to the other groups ( χ2=21.40, 26.21,both P<0.001). Grade 3 or higher adverse events occurred in 128 cases (39.6%), with hematological toxicity observed in 101 cases, while cytokine release syndrome (CRS), infection, and neurotoxicity occurred in 11, 26 and 8 cases, respectively. In addition, there were statistically significant differences in the grade 3 or higher CRS among the four groups ( χ2=8.03, P<0.05). Conclusion:Blinatumomab can clear MRD more effectively and achieve superior survival outcomes when used as first-line treatment for pediatric B-ALL, with less CRS.