The bidirectional closed-loop motor imagery brain-computer interface (MI-BCI) is an emerging method for active rehabilitation training of motor dysfunction, extensively tested in both laboratory and clinical settings. However, no standardized method for evaluating its rehabilitation efficacy has been established, and relevant literature remains limited. To facilitate the clinical translation of bidirectional closed-loop MI-BCI, this article first introduced its fundamental principles, reviewed the rehabilitation training cycle and methods for evaluating rehabilitation efficacy, and summarized approaches for evaluating system usability, user satisfaction and usage. Finally, the challenges associated with evaluating the rehabilitation efficacy of bidirectional closed-loop MI-BCI were discussed, aiming to promote its broader adoption and standardization in clinical practice.
Brain-Computer Interfaces ; Humans ; Imagination/physiology* ; Imagery, Psychotherapy/methods*

This paper realized a portable brain-computer interface (BCI) system tailored for smart healthcare. Through the decoding of steady-state visual evoked potential (SSVEP), this system can rapidly and accurately identify the intentions of subjects, thereby meeting the practical demands of daily medical scenarios. Firstly, an SSVEP stimulation interface and an electroencephalogram (EEG) signal acquisition software were designed, which enable the system to execute multi-target and multi-task operations while also incorporating data visualization functionality. Secondly, the EEG signals recorded from the occipital region were decomposed into eight sub-frequency bands using filter bank canonical correlation analysis (FBCCA). Subsequently, the similarity between each sub-band signal and the reference signals was computed to achieve efficient SSVEP decoding. Finally, 15 subjects were recruited to participate in the online evaluation of the system. The experimental results indicated that in real-world scenarios, the system achieved an average accuracy of 85.19% in identifying the intentions of the subjects, and an information transfer rate (ITR) of 37.52 bit/min. This system was awarded third prize in the Visual BCI Innovation Application Development competition at the 2024 World Robot Contest, validating its effectiveness. In conclusion, this study has developed a portable, multifunctional SSVEP online decoding system, providing an effective approach for human-computer interaction in smart healthcare.
Brain-Computer Interfaces ; Humans ; Evoked Potentials, Visual/physiology* ; Electroencephalography ; Signal Processing, Computer-Assisted ; Software ; Adult ; Male

Artificial intelligence-enhanced brain-computer interfaces (BCI) are expected to significantly improve the performance of traditional BCIs in multiple aspects, including usability, user experience, and user satisfaction, particularly in terms of intelligence. However, such AI-integrated or AI-based BCI systems may introduce new ethical issues. This paper first evaluated the potential of AI technology, especially deep learning, in enhancing the performance of BCI systems, including improving decoding accuracy, information transfer rate, real-time performance, and adaptability. Building on this, it was considered that AI-enhanced BCI systems might introduce new or more severe ethical issues compared to traditional BCI systems. These include the possibility of making users' intentions and behaviors more predictable and manipulable, as well as the increased likelihood of technological abuse. The discussion also addressed measures to mitigate the ethical risks associated with these issues. It is hoped that this paper will promote a deeper understanding and reflection on the ethical risks and corresponding regulations of AI-enhanced BCIs.
Brain-Computer Interfaces/ethics* ; Artificial Intelligence/ethics* ; Humans ; Deep Learning ; User-Computer Interface ; Electroencephalography

Objective:To investigate the efficacy of free superficial circumflex iliac artery perforator flap (SCIAPF) in reconstruction of the donor site of hallux nail flap.Methods:From December 2015 to December 2022, Section Ⅲ of Department of Hand Surgery of Hangzhou Plastic Surgery Hospital conducted thumb reconstruction surgery with free hallax nail flaps for 12 patients with traumatic defects of thumbs. Six patients had degloving injuries of thumb with intact bone scaffold and extensor-flexor tendon. Among the other 6 patients with thumb defects, 3 had grade I defect, 2 had grade II defect and 1 had grade Ⅲ defect, according to Gu Yudong's classification. Free SCIAPFs were used to reconstruct the donor sites of hallux nail flaps. Sizes of the flaps were 3.0 cm× 6.5 cm-9.0 cm ×7.0 cm. All donor sites in the abdomen were directly sutured. After surgery, functional evaluations of the reconstructed thumb were conducted through follow-ups at outpatient clinics and(or) by WeChat interviews, according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, and the functional evaluation of donor feet was conducted according to the Maryland foot function evaluation standard.Results:Successful survival of the 9 cases of flap in the donor site of hallux nail flap. One patient had venous occlusion of flap and survived after timely surgical exploration. One flap had partial necrosis at the tip of flap, and the wound was eliminated with local transfer of a flap. One patient had necrosis over most of the flap with the base of the flap survived, and the wound was repaired by a stage-II skin grafting. The donor sites at groin healed in stage-I in all of 11 patients with a linear scar. One patient who had haematoma at the donor site was cured by removal of the haematoma and a re-suture. All the patients received a 3 to 24 months of postoperative follow-up. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 10 patients were in excellent and 2 in good. All of the great toes remained with original length and recovered normal flexion and extension. No patient suffered pain while walking and running. According to the Maryland foot function evaluation standard, 10 patients were in excellent and 2 in good. All SCIAPFs were satisfactory in colour and texture. Five patients had bloated flaps and underwent Hacks in the stage-Ⅱ.Conclusion:Application of a free SCIAPF in reconstruction of the donor site for hallux nail flap can effectively preserve the appearance and function of the donor site. Meanwhile, the scar in the donor site of groin is concealed with little damage, therefore the groin meets the requirements as a donor site of a flap.

Motor imagery (MI) is an important paradigm of driving brain computer interface (BCI). However, MI is not easy to control or acquire, and the performance of MI-BCI depends heavily on the performance of the subjects' MI. Therefore, the correct execution of MI mental activities, ability evaluation and improvement methods play important and even critical roles in the improvement and application of MI-BCI system's performance. However, in the research and development of MI-BCI, the existing researches mainly focus on the decoding algorithm of MI, but do not pay enough attention to the above three aspects of MI mental activities. In this paper, these problems of MI-BCI are discussed in detail, and it is pointed out that the subjects tend to use visual motor imagery as kinesthetic motor imagery. In the future, we need to develop some objective, quantitatively visualized MI ability evaluation methods, and develop some effective and less time-consumption training methods to improve MI ability. It is also necessary to solve the differences and commonness of MI problems between and within individuals and MI-BCI illiteracy to a certain extent.
Algorithms ; Brain-Computer Interfaces ; Electroencephalography ; Humans ; Imagery, Psychotherapy ; Imagination

Objective: To explore the relationship between coronary tortuosity and coronary microvascular disease (CMVD). Methods: Patients with typical angina symptoms and without serious coronary artery stenosis by coronary angiography were enrolled from June 2014 to December 2016, and CMVD was diagnosed by single photon emission tomography (SPECT). According to the SPECT results, patients were divided to the CMVD group and non-CMVD group. The baseline clinical characteristics, results of coronary angiography were compared between the two groups. The logistic analysis was used to analyze the relationship between coronary tortuosity and CMVD. Result: A total of 117 cases were enrolled, with 69 cases in the CMVD group and 48 cases in the non-CMVD group. No differences were found in gender distribution, age, hypertension, lipid abnormality, hyperuricemia and uses of statins between the two groups (all P>0.05). Incidence of diabetes (78.26%(54/69) vs. 35.42% (17/48) , P<0.05), hs-CRP ((4.29±2.15)mmol/L vs. (2.63±1.20)mmol/L, P<0.001), LDL-C ((2.98±0.96)mmol/L vs. (2.52±0.83)mmol/L, P=0.008) and homocysteine ((13.7±5.61)mmol/L vs. (11.5±4.38)mmol/L, P=0.025) levels were higher in the CMVD group than in the non-CMVD group. The data derived from echocardiographic examination were similar between the two groups. The Corrected TIMI frame counts were higher in the CMVD group than in non-CMVD group (LAD: 31.56±4.92 vs. 27.31±3.75, LCX: 29.47±4.18 vs. 26.62±3.19, RCA: 29.09±5.05 vs. 26.24±3.28, all P<0.001). The incidences of coronary atherosclerosis (76.81% (53/69) vs. 27.08% (13/48) , P<0.001) and coronary tortuosity ( (60.87% (42/69) vs. 33.33% (16/48) , P=0.035) were also higher in the CMVD group than in non-CMVD group. Logistic analysis found that coronary tortuosity (OR=6.111, 95%CI 2.707-13.794, P<0.001), diabetes (OR=6.565, 95%CI 2.883-14.948, P<0.001) and coronary atherosclerosis (OR=8.918, 95%CI 3.822-20.808, P<0.001) were independent risk factors of CMVD. Conclusion Coronary tortuosity, diabetes and coronary atherosclerosis are related to CMVD in this patient cohort.

Objective: To explore the impact of ticagrelor on myocardial microcirculation in patients of non-ST elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI). Methods: A total of 80 NSTEMI patients treated in our hospital from 2015-03 to 2015-12 were enrolled. All patients received coronary angiography (CAG) and PCI, they were randomly divided into 2 groups: ticagrelor (TA) group and clopidogrel (CA) group, n=40 in each group. The baseline condition, PCI related parameters, plasma levels of SOD, MDA at pre- and 24h, 72h post-PCI were compared, the incidence of major adverse cardiac events (MACE) within 30 days after PCI was also compared between 2 groups. Results: The baseline condition, proportion of infarction-related vessels, average length and diameter of implanted stents were similar between 2 groups, all P>0.05. Compared with CA group, TA group had the less post-operative CTFC in LAD and RCA, P<0.05; while CTFC in LCX was similar between 2 groups, P>0.05. The ratios of acute pre-operative, post-operative TIMI grade 3 and slow flow incidence were similar between 2 groups, P>0.05. The peak values of CK-MB and cTnI in TA group were lower than CA group, P<0.05. Compared with baseline condition, MDA levels at 24h and 72h post-operation were increased in both groups, all P<0.001; compared with CA group, TA group had the lower MDA level at 24h post-operation, P=0.023, MAD was further reduced at 72h post-operation in TA group, P=0.043. Compared with baseline condition, SOD levels at 24h and 72h post-operation were decreased in both groups, all P<0.001; compared with CA group, TA group had the higher SOD level at 24h post-operation, P=0.013, SOD was elevated at 72h post-operation in both groups, the elevation was more obvious in TA group, P=0.049. The incidence of MACE was similar between 2 groups within 30 days of PCI,. Conclusion: Ticagrelor could improve myocardial microcirculation in NSTEMI patients after PCI; it was safe and without obvious adverse effects.

Objective To explore the etiology,clinical manifestations,diagnoses,treatments and prognoses of spontaneous spinal epidural and subdural hematomas.Methods Medical records of 10 patients with spontaneous spinal epidural hemorrhage and 4 patients with subdural hemorrhage,collected in our hospital from September 2013 to January 2016,were analyzed retrospectively.Evacuation of the hematoma was carried out in 12 patients and the other two patients were treated conservatively.The functions of spinal cords were assessed by American Spinal Injury Association impairment scale (ASIA) before and after the treatment.Results Spontaneous spinal epidural and subdural hematomas appeared mostly in young patients with sudden onset.Spinal epidural hematomas were much more common than subdural ones.The pathological examination showed that one suffered from arteriovenous malformation,one suffered from perimedually artriovenous fistula,and 12 had intracranial hematomas which were resulted from undefined causes.The ASIA before the operation was as follows:5 were in grade A,2 in grade B,4 in grade C and 3 in grade D.The ASIA after the operation was as follows:4 were in grade A,one in grade C,3 in grade D and 4 in grade E.The two patients received conservative treatments achieved total recovery of the neurological functions (grade E).Conclusions It should be stressed that early diagnosis and prompt surgical intervention are of great importance for prompt of spontaneous spinal epidural.The better the preoperative neurological status,the better the neurological outcome after the surgical operation.

Objective To explore the clinical characteristics and clinical treatments strategies of ependymoma in the spinal cord.Methods The clinical and follow-up data of 34 patients with ependymoma in the spinal cord,admitted to our hospital from July 2011 to September 2016,were analyzed retrospectively.All patients were operated under nerve electrophysiological monitoring,and several patients with less than 95％ tumor resection accepted adjuvant radiotherapy.Results Postoperative pathological results indicated ependymoma in all patients,including one with WHO Ⅰ,30 with WHO Ⅱ,and 3 with WHO Ⅲ.Total tumor removal was achieved in 20 patients,subtotal removal (more than 95％) in 10 and big partial removal (80％-95％) in 4.Seven patients occurred postoperative complications,including 3 with cerebrospinal fluid infection,2 with paraplegia and 2 with rectal bladder dysfunction;5 occurred in patients with total tumor removal and 2 occurred in patients with subtotal removal.Spinal cord functions were significantly improved in 20 patients,unchanged in 7 and deteriorated in 7 when they left hospital.In the follow up of (30.5±18) months,4 patients with subtotal removal were recurrent,and 4 big partial removal patients received radiotherapy after a month were without recurrence at present.Conclusions Total tumor removal with capsule or pseudocapsule by microsurgery is the most effective treatment for ependymoma in the spinal cord.For a small number of tumors whose margins are not clear,better neurological functions could be preserved and postoperative quality of life could be improved by undergoing subtotal removal and adjunctive radiotherapy.

Objective To investigate the effects of anticancer bioactive fraction AMH-T of lichen on blood routine,organ coefficient and organ morphology by canying out short-term repeated dose toxicity test in rat so as to provide evidence for the development of anticancer drugs.Methods The nude mice were randomly divided into 5 groups:DDP group,DMSO group,and three AMH-T groups with the dosage of 50mg/kg,100mg/kg,and 200 mg/kg respectively.The weights of the mice were recorded every four days.At the end of the experiment,automatic biochemical analyzer and blood cell analyzer were applied to detect the serum biochemical indicators and blood routine indexes.The mice were dissected to observe the pathological changes in main organs.Heart,liver,spleen,kidney and testicle were weighed for organ coefficient calculation.Results In short-term repeated dose toxicity test,AMH-T significantly increased blood ALT and AST levels (P＜0.01) and significant change was found in other blood biochemical indexes and blood routine indexes.AMH-T had no obvious effect on weight,development of heart,liver,spleen,kidney and testicle.Conclusion When subcutaneous injection is performed,AMH-T shows hepatotoxicity,but it shows no toxicity on bone marrow hematopoietic function.