Objective:To explore the effect of exercise on glycemic control and physical indicators among community-dwelling persons with type 2 diabetes mellitus (T2DM).Methods:A total of 42 T2DM patients undergoing regular follow-up at a community health center were divided into a control group and an exercise group. To minimize confounding factors, 1∶1 propensity score matching was performed, resulting in 21 patients in each group. Both groups received standardized diabetes management, including medication, dietary guidance and diabetes health education. The exercise group additionally performed exercises which integrated sports and medical care models. The experiment lasted 8 weeks. Before and after the intervention, glycosylated hemoglobin A1c (HbA1c) levels, body weight, body mass index (BMI), fat mass, visceral fat area (VFA), fat mass index (FMI) and appendicular skeletal muscle mass index (ASMI) were recorded and compared between the two groups. Moreover, the actual exercise compliance of the exercise group was observed, along with any adverse events such as hypoglycemia or exercise-related injuries, as well as changes in antidiabetic medication dosage.Results:After the intervention, significant improvement was observed in both groups in all of the measurements, but with the average HbA1c, BMI, fat mass, VFA and FMI values of the exercise group then significantly better than the control group′s averages. The average compliance rate in the exercise group was 60%. No cases of hypoglycemia or exercise-related injuries were reported during the intervention, and there were no changes in the use of anti-diabetes medications.Conclusions:Exercise effectively improves glycemic control and physical indicators among community-dwelling T2DM patients. However, exercise compliance needs improving.

Objective:To observe any effect of oscillating positive expiratory pressure training on the airway clearing ability of postoperative esophageal cancer patients after neoadjuvant chemotherapy.Methods:Forty postoperative esophageal cancer patients undergoing neoadjuvant chemotherapy were enrolled and randomized into a control group and an experimental group, each of 20. Both groups received conventional postoperative rehabilitation starting on the first postoperative day, while the experimental group additionally underwent oscillating positive expiratory pressure training (3 sets/day, 30 breaths/set) for five consecutive days. Peak cough flow was measured using a peak flow meter before and 1, 3 and 5 days after the operation. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) were also measured on the 5th day after the operation using spirometry. Any postoperative pulmonary complications were recorded.Results:On the 1st day after the operation, peak cough flow had decreased significantly in both groups compared to preoperative levels. However, it had increased significantly on days 3 and 5 in both groups, with the average increase in the experimental group significantly greater than in the control group. On day 5 the average FEV1, forced vital capacity and PEF in both groups were significantly lower than the preoperative values, while the experimental group demonstrated significantly higher average FEV1s (2.22±0.51L) and PEFs (5.09±1.26L/s) compared to the control group.Conclusions:Early postoperative oscillating positive expiratory pressure training can improve the peak cough flow and airway clearing ability of esophageal cancer patients after neoadjuvant chemotherapy, promoting the recovery of their lung function.

Objective:To investigate the effect of aerobic exercise with acupuncture needles on the learning and memory ability in rats subjected to middle cerebral artery occlusion/reperfusion(MCAO/R)and to explore the underly-ing mechanisms.Method:Male SD rats were randomly divided into four groups:sham,model,aerobic exercise with acupunc-ture needles,and inhibitor groups(n=12 per group).In the sham group,only the left common carotid artery,in-ternal carotid ar tery,and external carotid artery were exposed without inducing ischemia,while the other three groups underwent MCAO/R modeling.To establish an MCAO/R model with reduced NLRP3 expression,rats in the inhibitor group received an intraperitoneal injection of MCC950 60 minutes before modeling.On the first day of post-modeling,the Zea-Longa score and T2 WI were used to screen the MCAO/R rats.From the second day,rats in the aerobic exercise with acupuncture needles and the inhibitor groups were underwent a 14-day intervention.The acupoints were selected for"Shenting"(GV 24)and"Baihui"(GV 20),with sparse waveform at a frequency 2/10Hz and a current intensity of 1-3mA.Simultaneously,the rats performed tread-mill exercise,with speeds of 4m/min(day 1-3),6m/min(day 4-7),and 8m/min(day 8-14)for 30min/day.Afterthe intervention,neurological function was reassessed,and the new object recognition test was used to measure the learning and memory ability,and the pathological changes of the hippocampus were observed by HE staining.The protein expressions of NLRP 3,GSDMD,and Caspase-1 were detected by Western Blot and immunofluorescence,ELISA detected the contents of ILL-1β and IL-18,the expression and localization of IBA 1 and NLRP 3 were detected by double immunofluorescent staining.Result:The hippocampal neurons in the ischemic side of the rats were loosely and disorderly arranged in the model group.Compared to the sham group,the model group showed significantly impaired neurological func-tion and novel object recognition ability(P＜0.01),with significant increased expression of NLRP 3,GSDMD,and Caspase-1(P＜0.01),and elevated ILL-lβ and IL-18 contents(P＜0.01).In addition,IBA 1 and NLRP 3 fluo-rescence expression were enhanced(P＜0.01),and many IBA 1+/NLRP 3+double-positive cells were observed un-der the microscope(P＜0.01).Compared with the model group,the aerobic exercise with acupuncture needles group showed significant improvements in neurological function and the new object recognition index(P＜0.05,P＜0.01),reduced hippocampal pathological injury,decreased expression of NLRP 3,GSDMD,and Caspase-1 d(P＜0.01)and lower IL-lβ and IL-18 levels(P＜0.05);the activation of microglia and the expression of IBA 1,NL-RP 3 and the number of IBA 1+/NLRP 3+double-positive cells decreased(P＜0.01).The inhibitor group demon-strated even greater improvements in neural function and new object recognition performance than the aerobic exercise with acupuncture needles group(P＜0.05,P＜0.01),with further reductions in NLRP 3,GSDMD,Caspase-1 protein expression(P＜0.01)and lower level of IL-1β,IL-18(P＜0.01,P＜0.05);the microglia activation level,the number,arrangement and morphology of nerve cells were closely resembled those in the sham group,and there was minimal NLRP 3 microglia observed under the microscope(P＜0.01).Conclusion:Aerobic exercise with acupuncture needles at"Shenting"(GV 24)and"Baihui"(GV 20)points could improve the learning and memory function in MACO/R rats by inhibiting microglia pyroptosis and activa-tion,thereby reducing neuroinflammation.

Objective:To elucidate the temporal characteristics of dysphagia following infratentorial stroke and its associa-tion with penetration/aspiration.Method:A total of 51 patients with infratentorial stroke and 26 healthy controls were recruited.All partici-pants underwent videofluoroscopic swallowing studies(VFSS),during which they swallowed 5ml of thin liquid in two separate trials.Swallowing parameters analyzed included oral transit time(OTT),velopharyngeal clo-sure duration(VCD),hyoid movement duration(HMD),laryngeal vestibule closure duration(LCD),upper esophageal sphincter(UES)opening duration(UOD),and stage transition duration(STD).The temporal coor-dination and sequential order of four swallowing actions and the intervals namely T1-T4 were also assessed.Inter-rater variability was evaluated using intraclass correlation coefficients(ICCs)for 20％of the results.Result:In the patient group,40.2％exhibited failed opening in UES,39.3％had penetration,and 20.5％ex-perienced aspiration.Compared to the control group,patients showed significantly prolonged OTT,VCD,and STD(P＜0.01),while UOD was significantly shorter(P＜0.01).The conformity rates of temporal sequences 3 and 4 were significantly lower in the patient group compared to controls(P＜0.001),and intervals Tl,T2,and T3 were significantly longer(P＜0.01).Significant negative correlations were found between VCD and PAS,UOD and PAS,and T2(P＜0.01).All measured parameters demonstrated good reliability.Conclusion:Patients with infratentorial stroke experience abnormal swallowing sequence,which is associated with the severity of penetration and aspiration.These findings may help in developing more targeted interven-tions to prevent aspiration.

Objective:To analyze the risk factors for aspiration pneumonia m patients with post-stroke dysphagia based on quantitative analysis of videofluoroscopic swallowing study(VFSS),and to construct a prediction model and validate it in order to standardize the management of high-risk patients with post-stroke dysphagia complicating aspiration pneumonia.Method:A total of 556 patients with post-stroke dysphagia admitted to Xiamen Hospital of Beijing University of Traditional Chinese Medicine from July 2021 to June 2023 were selected for the study and divided into a modeling group(n=436)and an external validation group(n=120).The model group was divided into pneumo-nia group(n=113,25.9％)and non-pneumonia group(n=323,74.1％)according to the occurrence of aspiration pneumonia.Clinical data and VFSS results were collected for all participants.Logistic regression identified the risk factors for aspiration pneumonia,and a nomogram predictive model was constructed.Model perfonnance was evaluated using receiver operating characteristic(ROC)curves,the area under the ROC curve(AUC),and the Hosmer-Lemeshow goodness-of-fit test.External validation was conducted to assess the sensitivity,spec-ificity and consistency of the model.Result:Logistic regression analysis showed that advanced age,poor oral hygiene,tracheotomy,Penetration-As-piration Scale(PAS)grade≥5,pharyngeal residue and prolonged pharyngeal transport time were risk factors for aspiration pneumonia,and active cough and eating instruction were protective factors(P＜0.05 for both).The predictive risk index(C-index)of the nomogram prediction model was 0.957,AUC=0.957,sensitivity was 93.8％,specificity was 86.4％,and the Hosmer-Lemeshow goodness of fit test showed P=0.6.Conclusion:The predictive model can be used to predict the occurrence of aspiration pneumonia in stroke pa-tients with dysphagia.Its use in clinical practice allows for the development of targeted and individualized inter-ventions according to patient risk levels,thereby improving the quality of nursing.

Objective:To evaluate the the effect of inductive electrical stimulation combined with swallowing function tram-ing on patients with oral dysphagia in the oral phase of stroke patients using quantitative analysis based on vid-eo fluoroscopy swallowing study(VFSS).Method:A total of 40 patients with oral dysphagia during stroke who were hospitalized in Shijiazhuang Peo-ple's Hospital from February 2023 to February 2024 were randomly divided into experimental group(n=20)and control group(n=20).Both groups were treated with swallowing function training,while the experimental group additionally underwent induction electrical stimulation.Before the intervention and 3 weeks after the inter-vention,the functional oral feeding scale(FOIS),oral function score and VFSS were used to evaluate the swallowing function.The VFSS results were quantitatively analyzed using a digital acquisition and quantitative analysis software system,recording the oral transit time(OTT),soft palate elevation time(SET)and hyoid-bone movement time(HMT)of the patients were recorded.Result:After 3 weeks of treatment,FOIS ratings and oral function score were increased in both groups(P＜0.05),and the OTT,SET and HMT were shortened(P＜0.05).However,the experimental group exhibited sig-nificantly greater improvements in FOIS ratings,oral function scores,OTT,SET,and HMT compared to the control group(P＜0.05).Conclusion:Based on the quantitative analysis of VFSS,induced electrical stimulation combined with swallow-ing function training can effectively improve the swallowing function of patients with oral dysphagia after stroke.

Objective:To investigate the effects of low-frequency repetitive transcranial magnetic stimulation(rTMS)com-bined with repetitive peripheral magnetic stimulation(rPMS)on upper limb function and cortical excitability of stroke.Method:Thirty-five patients with upper limb dysfunction in stroke admitted to the Department of Rehabilita-tion Medicine of the Third Affiliated Hospital of Sun Yat-sen University from November 2021 to November 2022 were selected.They were randomly divided into experimental group(n=17)and control group(n=17).Both groups received conventional rehabilitation therapy and low-frequency rTMS.The experimental group re-ceived additional rPMS for the affected upper extremity extensors,while the control group received sham rPMS.Both groups received Fugl-Meyer assessment of the upper extremity(FMA-UE),modified Ashworth scale(MAS),modified Barthel index(MBI),rest motor threshold(rMT)assessments.23 patients underwent fNIRS to detect changes in oxyhemoglobin concentration(HbO2)in bilateral premotor and supplementary mo-tor cortex(PMC-SMA)and sensorimotor cortex(SMC)before and after treatment.Result:FMA-UE and MBI were significantly improved in both groups(P＜0.05),and the improvement of FMA-UE and the rMT of unaffected Ml were significantly higher in the experimental group than in the con-trol group after treatment(P＜0.05);the MAS grade of the flexor elbow group and Δ HbO2 of the affected SMC were significantly improved in the experimental group(P＜0.05),and the improvement of FMA-UE was correlated with the increase of the rMT of unaffected Ml and ΔHbO2 of the affected SMC(P＜0.05).There was no statistically significant difference for the MAS grade of elbow extension and wrist flexion muscle groups,ΔHbO2 of bilateral PMC-SMA area,and ΔHbO2 of unaffected SMC area(P＞0.05).Conclusion:The combination of rTMS and rPMS improved upper limb function and activities of daily living and modulated cortical excitability in stroke patients,This combination was more effective than rTMS alone,likely due to the reduced excitability of the unaffected Ml and the activation of the affected SMC.

Objective:To compare the effects of scalp acupuncture combined with rehabilitation therapy and rehabilitation therapy alone on the brain functional connectivity(FC)in patients with post-stroke motor dysfunction.Method:Forty patients with post-stroke motor dysfunction were randomly divided into a treatment group and a control group,with 20 patients in each group.Both groups received routine rehabilitation therapy,with the treatment group receiving additionally scalp acupuncture therapy.Functional magnetic resonance imaging(fMRI)scans were performed on all patients before and after treatment,with the affected side primary motor cortex(M1)as the region of interest(ROI)to observe the FC between the Ml and other brain regions.Result:In the treatment group,FC was enhanced between the orbital inferior frontal gyrus,orbital middle frontal gyrus,right middle frontal gyrus,bilateral medial superior frontal gyri,and Ml;conversely,FC be-tween the right inferior temporal gyrus and Ml was reduced(FWE corrected,P＜0.05,cluster size＞59).In the control group,FC between the left triangular part of the inferior frontal gyrus and Ml was enhanced.Af-ter treatment,both groups showed a significant increase in Fugl-Meyer scores compared to pre-treatment,with the treatment group scoring higher than the control group(P＜0.01).In the treatment group,changes in FC be-fore and after treatment were moderately and significantly correlated with improvements in Fugl-Meyer scores(P＜0.05).Additionally,changes in FC of the bilateral medial superior frontal gyri before and after treatment were significantly positively correlated with changes in upper limb Fugl-Meyer scores(P＜0.05)in the treatment group.Conclusion:Scalp acupuncture combined with rehabilitation therapy can enhance the functional connectivity be-tween the frontal lobe and the affected side Ml,and the functional connectivity of the bilateral medial superi-or frontal gyri is associated with the recovery of upper limb function in patients with post-stroke motor dys-function.

Objective:To explore cortical activation during the obstacle avoidance task in convalescent stroke patients,and examine the effect of obstacle avoidance difficulty on brain activation.Method:A total of 20 convalescent stroke patients were recruited to perform various motor tasks,including walking,simple obstacle avoidance,difficult obstacle avoidance,and motor imagery.Functional near-infrared spectroscopy(fNIRS)was used to detect the oxygenated hemoglobin concentration in the prefrontal cortex(PFC),premotor cortex(PMC)and supplementary motor area(SMA)of the patients.Additional relevant sec-ondary indicators were evaluated and collected.Statistical analysis was performed without grouping and with grouping.Result:The activation levels of bilateral PFC,PMC and SMA during the dynamic task were significantly dif-ferent from those during the static tasks(P＜0.05),with the highest activation observed in the PFC.There were significant differences between simple and difficult obstacle avoidance tasks in the unaffected-side SMA(P＜0.05).In addition,there was a linear positive correlation between the peak activation level of PMC on the unaffected side and Tinetti score(P＜0.05).Conclusion:Bilateral PFC,PMC and SMA are involved in limb movement in convalescent stroke patients,with PFC showing the highest level of activation.In addition,SMA on the unaffected side may contribute to regulating the difficulty of obstacle avoidance.Moreover,the peak activation level of PMC on the unaffected side is associated with balance and walking function.

Objective:To compare the effects of tele-rehabilitation delivered via a WeChat mim-program with traditional outpatient-home combined rehabilitation for non-specific neck pain patients.Method:Individuals with non-specific neck pain were recruited from the Rehabilitation Medicine Department of West China Hospital between January 2021 and August 2021,were randomly assigned to either tele-rehabili-tation treatment group(TRG)or outpatient-home combined rehabilitation group.Both groups received compre-hensive exercise therapy at home or in the clinic for 4 weeks.Assessments were conducted at baseline,4 weeks,and 8 weeks post-intervention,using the Neck Disability Index(NDI),Numeric Pain Rating Scale(NPRS),and Pain Self-efficacy Questionnaire(PSEQ).Result:A total of 60 patients completed the intervention,with 30 in each group.There were no significant de-mographic differences between groups.At the 4-week mark,both groups showed significant improvements in NDI,NPRS and PSEQ scores compared to baseline,but no significant differences were found between groups.By the 8th week,the tele-rehabilitation group showed further improvements in all three metrics,with NDI and NPRS scores significantly better than those of the outpatient-home combined rehabilitation group.Conclusion:Both remote and outpatient-home combined comprehensive exercise therapies demonstrate short-term effects on non-specific neck pain.However,tele-rehabilitation exhibited more sustained improvements,sug-gesting that it holds promise for further clinical application.