Objective:To explore the effect of combining repeated peripheral (rPMS) and central transcranial magnetic stimulation (rTMS) in treating upper limb motor dysfunction after a stroke.Methods:Seventy-eight patients with upper limb motor dysfunction after a stroke were randomly divided into a control group, an rTMS group and a combined magnetic stimulation group, each of 26. All three groups underwent routine rehabilitation, while the rTMS group was repeatedly given low frequency transcranial magnetic stimulation of the M1 region on the unaffected side, and the combined group also received repeated peripheral magnetic stimulation at Erb′s point on the affected upper limb. There was one treatment session a day, 5 days a week for 3 weeks. Before and after the treatment, everyone′s upper limb motor function was quantified using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Wolf motor function test (WMFT). Skill in the activities of daily living was quantified in terms of a Barthel index (BI). Motor recovery of the upper limbs and hands was assessed using Brunnstrom staging. The latency and amplitude of the motor evoked potentials (MEPs) in the subjects′ affected abductor pollicis brevis muscles were also recorded before and after the treatment. Pearson correlation coefficients quantified the correlation between the changes in FMA-UE scores and MEP amplitudes before and after the treatment in the three groups.Results:There were no significant differences among the three groups before the treatment. Afterward, however, the average FMA-UE, WMFT and BI scores, as well as the upper limb and hand Brunnstrom stages and the average MEP latencies and amplitudes of all the three groups had improved significantly. The combined group′s average results were then significantly better than the other two groups′ averages, except for the upper limb Brunnstrom stages. The increases in MEP amplitude were positively correlated with the increases in FMA-UE scores among the rTMS and the combined group, but there was no significant correlation between them in the control group.Conclusions:The combined application of rPMS and contralateral low frequency rTMS can effectively relieve motor dysfunction in the upper limbs in the early stages after a stroke.

BACKGROUND: Pulmonary arterial hypertension (PAH) presents a significant health burden in Asia and remains a critical challenge. This study aims to delineate the PAH burden in Asia from 1990 to 2021. METHODS: Using the latest data from the Global Burden of Disease 2021, we evaluated and analyzed the distributions and patterns of PAH disease burden among various age groups, sexes, regions, and countries in Asia. Additionally, we examined the associations between PAH disease burden and key health system indicators, including the socio-demographic index (SDI) and the universal health coverage (UHC) index. RESULTS: In 2021, there were 25,989 new PAH cases, 103,382 existing cases, 13,909 PAH-associated deaths, and 385,755 DALYs attributed to PAH in Asia, which accounted for approximately 60% of global PAH cases. The age-standardized rates (ASRs) for prevalence and deaths were 2.05 (95% uncertainty interval [UI]: 1.66-2.52) per 100,000 population and 0.31 (95% UI: 0.23-0.38) per 100,000 population, respectively. From 1990 to 2021, Asia reported the lowest ASRs for PAH prevalence but the highest ASRs for deaths compared to other continents. While the ASRs for prevalence increased slightly, ASRs for mortality and DALYs decreased over time. This increasing burden of PAH was primarily driven by population growth and aging. The burden was especially pronounced among individuals aged ≥60 years and <9 years, who collectively accounted for the majority of deaths and DALYs. Moreover, higher SDI and UHC levels were linked to reduced incidence, but higher prevalence rates. CONCLUSIONS Although progress has been made in reducing PAH-related mortality and DALYs, the disease continues to impose a substantial burden in Asia, particularly among older adults and young children. Region-specific health policies should focus on improving early diagnosis, expanding access to treatment, and effectively addressing the growing PAH burden in the region.
Humans ; Global Burden of Disease ; Male ; Female ; Middle Aged ; Adult ; Asia/epidemiology* ; Prevalence ; Aged ; Pulmonary Arterial Hypertension/mortality* ; Adolescent ; Young Adult ; Child ; Child, Preschool ; Infant ; Hypertension, Pulmonary/epidemiology*

Objective To explore the clinical characteristics of children with bloodstream infections caused by Klebsiella pneumoniae(KP),analyze the high-risk factors for developing carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection and poor prognosis.We hope to provide clinical evidence for reducing carbapenem-resistant strains and improving prog-nosis.Methods Clinical data of children with blood cultures confirmed KP infection admitted to the Department of Pediatrics,Pediatric Surgery,PICU,and NICU of Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital from 2016 to 2022 were collected.Based on antibiotics sensitivity results and prognosis,the patients were divided into CRKP and non-CRKP infection groups,good prognosis(recovered or improved)and bad prognosis(death or withdrawing treatment)groups.Clinical characteristics,laboratory tests,and risk factors were compared between these groups.Results Among 177 blood culture samples positive for KP,97 strains(54.8％)were found to be CRKP.Logistic regression analysis suggests a histo-ry of surgery during hospitalization(OR=2.678,95％CI:1.248-5.746,P=0.011),mechanical assisted ventilation(OR=2.774,95％CI:1.235-6.229,P=0.017),hospital stay≥25 days(OR=3.467,95％CI:1.431-8.401,P=0.006),platelet count≥237 × 109/L(OR=3.005,95％CI:1.268-7.124,P=0.012),and mean platelet volume(MPV)≥12fL(OR=3.011,95％CI:1.140-7.955,P=0.026)were possible risk factors for CRKP bloodstream infection.Mechanical assisted venti-lation(OR=2.819,95％CI:1.138-6.985,P=0.025),platelet count＜149 × 109/L(OR=0.238,95％CI:0.079-0.717,P=0.011)were possible risk factors for poor prognosis in pediatric patients.Conclusion The antibiotic resistance rate of KP blood-stream infection is high and shows an increasing trend.In KP blood stream infection children,hospital stay longer than 25 days,surgery history,mechanical assisted ventilation,platelet count≥237 × 109/L and MPV≥12 fL are at high risk for CRKP in-fection.CRKP infection is not a risk factor for bad prognosis,however,KP blood stream infection children with platelet count＜149 × 109/L and mechanical assisted ventilation high-risk factors for CRKP bloodstream infection are at risk for bad progno-sis.Special attention and timely intervention should be paid to these patients.

Objective To explore the clinical characteristics of children with bloodstream infections caused by Klebsiella pneumoniae(KP),analyze the high-risk factors for developing carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection and poor prognosis.We hope to provide clinical evidence for reducing carbapenem-resistant strains and improving prog-nosis.Methods Clinical data of children with blood cultures confirmed KP infection admitted to the Department of Pediatrics,Pediatric Surgery,PICU,and NICU of Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital from 2016 to 2022 were collected.Based on antibiotics sensitivity results and prognosis,the patients were divided into CRKP and non-CRKP infection groups,good prognosis(recovered or improved)and bad prognosis(death or withdrawing treatment)groups.Clinical characteristics,laboratory tests,and risk factors were compared between these groups.Results Among 177 blood culture samples positive for KP,97 strains(54.8％)were found to be CRKP.Logistic regression analysis suggests a histo-ry of surgery during hospitalization(OR=2.678,95％CI:1.248-5.746,P=0.011),mechanical assisted ventilation(OR=2.774,95％CI:1.235-6.229,P=0.017),hospital stay≥25 days(OR=3.467,95％CI:1.431-8.401,P=0.006),platelet count≥237 × 109/L(OR=3.005,95％CI:1.268-7.124,P=0.012),and mean platelet volume(MPV)≥12fL(OR=3.011,95％CI:1.140-7.955,P=0.026)were possible risk factors for CRKP bloodstream infection.Mechanical assisted venti-lation(OR=2.819,95％CI:1.138-6.985,P=0.025),platelet count＜149 × 109/L(OR=0.238,95％CI:0.079-0.717,P=0.011)were possible risk factors for poor prognosis in pediatric patients.Conclusion The antibiotic resistance rate of KP blood-stream infection is high and shows an increasing trend.In KP blood stream infection children,hospital stay longer than 25 days,surgery history,mechanical assisted ventilation,platelet count≥237 × 109/L and MPV≥12 fL are at high risk for CRKP in-fection.CRKP infection is not a risk factor for bad prognosis,however,KP blood stream infection children with platelet count＜149 × 109/L and mechanical assisted ventilation high-risk factors for CRKP bloodstream infection are at risk for bad progno-sis.Special attention and timely intervention should be paid to these patients.

Objective:To explore the effect of combining repeated peripheral (rPMS) and central transcranial magnetic stimulation (rTMS) in treating upper limb motor dysfunction after a stroke.Methods:Seventy-eight patients with upper limb motor dysfunction after a stroke were randomly divided into a control group, an rTMS group and a combined magnetic stimulation group, each of 26. All three groups underwent routine rehabilitation, while the rTMS group was repeatedly given low frequency transcranial magnetic stimulation of the M1 region on the unaffected side, and the combined group also received repeated peripheral magnetic stimulation at Erb′s point on the affected upper limb. There was one treatment session a day, 5 days a week for 3 weeks. Before and after the treatment, everyone′s upper limb motor function was quantified using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Wolf motor function test (WMFT). Skill in the activities of daily living was quantified in terms of a Barthel index (BI). Motor recovery of the upper limbs and hands was assessed using Brunnstrom staging. The latency and amplitude of the motor evoked potentials (MEPs) in the subjects′ affected abductor pollicis brevis muscles were also recorded before and after the treatment. Pearson correlation coefficients quantified the correlation between the changes in FMA-UE scores and MEP amplitudes before and after the treatment in the three groups.Results:There were no significant differences among the three groups before the treatment. Afterward, however, the average FMA-UE, WMFT and BI scores, as well as the upper limb and hand Brunnstrom stages and the average MEP latencies and amplitudes of all the three groups had improved significantly. The combined group′s average results were then significantly better than the other two groups′ averages, except for the upper limb Brunnstrom stages. The increases in MEP amplitude were positively correlated with the increases in FMA-UE scores among the rTMS and the combined group, but there was no significant correlation between them in the control group.Conclusions:The combined application of rPMS and contralateral low frequency rTMS can effectively relieve motor dysfunction in the upper limbs in the early stages after a stroke.

Objective:To evaluate the clinical efficacy of intermittent theta burst stimulation (iTBS) of the bilateral cerebellum in treating post-stroke dysphagia.Methods:Forty patients with dysphagia after a cerebral infarction were randomly divided into a control group and an iTBS group, with 20 cases in each group. In addition to routine swallowing rehabilitation training and nutritional guidance, the iTBS group underwent daily bilateral cerebellar iTBS 6 times a week for 3 weeks, while the control group was given sham stimulation. Before and after the treatment, both groups were evaluated by using the water-swallowing test and the standardized swallowing assessment (SSA), and the latency and amplitude of the mylohyoid muscle′s motor evoked potential (MEP) were also recorded. The SSA scores and MEP amplitudes of the mylohyoid muscle after treatment were tested for any correlation.Results:The treatment improved the water-swallowing test results in both groups, with that of the iTBS group significantly better than that of the control group. The clinical efficacy in the iTBS group was 95%, significantly higher than the control group′s 80%. The SSA scores decreased significantly in both groups after the treatment, with the iTBS group′s average score then significantly lower than that of the control group. The average latency and amplitude of the mylohyoid muscle′s MEP was also significantly better in the iTBS group after the treatment. In the control group only the average amplitude was significantly greater than before the treatment. Pearson correlation analysis showed that the SSA scores and the MEP amplitudes of the mylohyoid muscle after treatment were uncorrelated in both groups.Conclusions:Bilateral intermittent theta burst stimulation can effectively improve the swallowing of patients with post-stroke dysphagia.

Gastric cancer(GC)is one of the most common gastrointestinal tumors.As a newly discovered type of non-coding RNAs,transfer RNA(tRNA)-derived small RNAs(tsRNAs)play a dual biological role in cancer.Our previous studies have demonstrated the potential of tRF-23-Q99P9P9NDD as a diagnostic and prognostic biomarker for GC.In this work,we confirmed for the first time that tRF-23-Q99P9P9NDD can promote the proliferation,migration,and invasion of GC cells in vitro.The dual luciferase reporter gene assay confirmed that tRF-23-Q99P9P9NDD could bind to the 3'untranslated region(UTR)site of acyl-coenzyme A dehydrogenase short/branched chain(ACADSB).In addition,ACADSB could rescue the effect of tRF-23-Q99P9P9NDD on GC cells.Next,we used Gene Ontology(GO),the Kyoto Encyclopedia of Genes and Genomes(KEGG),and Gene Set Enrichment Analysis(GSEA)to find that downregulated ACADSB in GC may promote lipid accumulation by inhibiting fatty acid catabolism and ferroptosis.Finally,we verified the correlation between ACADSB and 12 ferroptosis genes at the transcriptional level,as well as the changes in reactive oxygen species(ROS)levels by flow cytometry.In summary,this study proposes that tRF-23-Q99P9P9NDD may affect GC lipid metabolism and ferroptosis by targeting ACADSB,thereby promoting GC progression.It provides a theoretical basis for the diagnostic and prognostic monitoring value of GC and opens up new possibilities for treatment.

Objective:To seek any differential effect of combining repeated transcranial magnetic stimulation (rTMS) with a modified version of constraint-induced movement therapy (mCIMT) on the walking ability of stroke survivors.Methods:Seventy-five stroke survivors were randomly divided into a sham rTMS group, an rTMS group and a combined group, each of 25. In addition to 40 minutes of routine rehabilitation daily, including balance training, transfer training, muscle strength training, and proprioceptive training five times a week for 4 weeks, the sham rTMS group and rTMS group received sham or genuine rTMS. The combined group received 20 minutes of rTMS followed by mCIMT training 30 minutes later. The treatment was performed once a day, 5 days a week for 4 weeks. Before and after the treatment, all groups were evaluated using the Fugl-Meyer lower extremity assessment, the Berg balance scale, a 10-metre walk test and the modified Barthel index.Results:Significant improvement was observed in the average scores of all three groups in all of the assessments. The combined group′s averages were, however, significantly better than those of the other two groups.Conclusion:Supplementing mCIMT with rTMS can better improve the walking and other abilities in the activities of daily living of stroke survivors.

Objective:To investigate the effect and influencing factors of anti-retroviral therapy (ART) in human immunodeficiency virus (HIV)-positive female commercial sex workers (CSW) in Guangxi Zhuang Autonomous Region.Methods:A retrospective cohort study was used in this study. A total of 661 HIV-positive CSW receiving ART from the Guangxi Zhuang Autonomous Region′s municipal and county-level Centers for Disease Control and Prevention (CDC) reported to Guangxi Zhuang Autonomous Region CDC from January 1, 2009 to December 31, 2018 were included.The demographic information of the patients, marital status, past medical history, acquired immunodeficiency syndrome (AIDS)-related diseases after six to 12 months of ART, medications, CD4 + T lymphocytes, virological and immunological effects after receiving ART for six to 12 months were collected. Logistic regression model was used to analyze the influencing factors of virological failure and immunological failure of HIV-positive CSW after six to 12 months of ART. Results:Among 661 HIV-positive CSW, 50(7.6%) cases experienced virological failure, 80(12.1%) cases experienced immunological failure, and 13(2.0%) had both virological failure and immunological failure.There were 85 cases (12.9%) who had a history of sexually transmitted diseases. Multivariate logistic regression analysis showed that unmarried (adjusted odds ratio (a OR)=3.298, 95% confidence interval ( CI) 1.285 to 8.461), AIDS-related diseases after six to 12 months of ART (a OR=4.391, 95% CI 1.555 to 12.402) and missed medications in the last seven days (a OR=3.731, 95% CI 1.942 to 7.166) were risk factors for virological failure. Compared with CD4 + T lymphocytes<200.00/μL at baseline, 350.00≤CD4 + T lymphocytes <500.00/μL (a OR=3.543, 95% CI 1.631 to 7.701) and CD4 + T lymphocytes≥500.00/μL (a OR=2.358, 95% CI 1.002 to 5.547) were risk factors for immunological failure. Conclusions:HIV-positive CSW in Guangxi Zhuang Autonomous Region have a better treatment effect, with low rates of virological failure and immunological failure. Marital status, baseline CD4 + T lymphocyte counts, AIDS-related diseases after six to 12 months of ART, and missed medication in the last seven days are factors influencing the effect of six to 12 months of ART.

Objective To develop a quality evaluation indicator system of midwifery care in line with the modern service concept in Shanghai area under the background of over-medicalization trend of midwifery services, and to guide the improvement direction of midwifery quality. Methods Guided by the evidence-based framework of midwifery quality and indicator selection principles, the indicators for evaluating midwifery quality were preliminarily selected by literature review and theoretical analysis. Two rounds of Delphi survey among 53 experts from Shanghai were conducted to decide the final quality evaluation indicator system of midwifery care. Analytic hierarchy process ( AHP) and the importance′ sum average method were adopted to calculate weights coefficients of the indicators. Results 45 indicators for evaluating midwifery quality were preliminarily selected. The response rate of two rounds of Delphi survey were 76% and 100% , the authority coefficients were 0.90 and 0.89, expert opinion coordinate coefficients were 0.190 and 0.257, respectively. The final version of the indicator system consists of 11 structure quality indicators, 13 process quality indicators and 19 outcome quality indicators. The weight values of the three first-level indicators were 0.195 8, 0.310 8 and 0.493 4 respectively. The weight values of the 43 second-level indicators ranged from 0. 016 1 to 0. 028 6. Conclusions The quality evaluation indicator system of midwifery care developed fits evidence-based midwifery philosophy. It provides a scientific tool for midwifery quality evaluation in Shanghai, which can guide the improvement of midwifery quality.