Objective:To observe the effect of cognitive-motor dual-task training on patients with subacute stroke and to analyze the mechanism of improvement in brain functional connectivity by functional near-infrared spectroscopy(fNIRS).Method:Forty patients with subacute stroke were randomly divided into a control group(n=20)and an obser-vation group(n=20).All patients were given conventional comprehensive rehabilitation treatment.The control group was given walking and cognitive function training separately,while the observation group was given cog-nitive-motor dual-task training.The cognition,motor function and activities of daily living were evaluated by mini-mental state examination(MMSE),functional ambulation category scale(FAC)and modified Barthel in-dex(MBI)before and after 6 weeks of treatment.fNIRS was used to compare the functional activity of the primary motor cortex(M1),supplementary motor area(SMA),prefrontal cortex(PFC)and the functional connectivity of each brain region under task states.Result:A total of 37 patients were included in the final statistics,and there was no difference in baseline lev-el between the two groups before treatment(P>0.05).After intervention,the MMSE,FAC and MBI of the two groups were better than those before treatment,and the observation group was better than the control group.The differences were statistically significant(P<0.05).At the same time,fNIRS observation showed that after treatment,except the right M1 and right PFC,the functional intensity of M1,SMA and PFC in the two groups were higher than those before treatment.The functional intensity of SMA in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Af-ter treatment,the functional connection intensity of brain regions on the injured side in the two groups were higher than those before treatment,and the functional connection intensity between bilateral SMA,M1 and PFC,SMA and PFC in the observation group were higher than those in the control group,and the differenc-es were statistically significant(P<0.05).Conclusion:Compared with conventional motor and cognitive function training,cognitive-motor dual-task training can more significantly improve cognitive,motor function and independence in patients with subacute stroke.The mechanism may be related to the fact that dual-task training can effectively improve the brain func-tional intensity of the SMA area,the functional connection intensity between M1 and PFC as well as SMA and PFC.

Objective:To explore the effect of different swallowing tasks on cortex activation and functional connectivity in stroke survivors with dysphagia using functional near-infrared spectroscopy (fNIRS).Methods:Thirty stroke survivors with dysphagia performed three different swallowing tasks: swallowing action observation (SO), swallowing action execution (SE), and swallowing action imagination (SI). During each task, fNIRS was used to document the brain concentrations of oxyhemoglobin and deoxyhemoglobin. Cortex activation (β value) and brain functional connectivity were assessed.Results:Compared with the resting state, the areas activated during the SO task included the left primary sensory cortex and the right prefrontal cortex. During the SE and SI tasks the left prefrontal cortex and the left motor cortex were activated as well. Compared with hemorrhagic stroke survivors, ischemic stroke survivors showed significantly greater activation of the right primary sensory cortex, the right motor cortex, and the left primary sensory cortex during the SE task. Functional connectivity during the SO, SE and SI tasks was significantly greater than in the resting state, with the average connectivity values during the SE task significantly higher than during the SI task.Conclusions:Stroke survivors with dysphagia exhibit increased activation in the prefrontal cortex and primary sensory cortex during different swallowing tasks. Such tasks can improve their brain functional connectivity.

Objective:To explore the effect of different swallowing tasks on cortex activation and functional connectivity in stroke survivors with dysphagia using functional near-infrared spectroscopy (fNIRS).Methods:Thirty stroke survivors with dysphagia performed three different swallowing tasks: swallowing action observation (SO), swallowing action execution (SE), and swallowing action imagination (SI). During each task, fNIRS was used to document the brain concentrations of oxyhemoglobin and deoxyhemoglobin. Cortex activation (β value) and brain functional connectivity were assessed.Results:Compared with the resting state, the areas activated during the SO task included the left primary sensory cortex and the right prefrontal cortex. During the SE and SI tasks the left prefrontal cortex and the left motor cortex were activated as well. Compared with hemorrhagic stroke survivors, ischemic stroke survivors showed significantly greater activation of the right primary sensory cortex, the right motor cortex, and the left primary sensory cortex during the SE task. Functional connectivity during the SO, SE and SI tasks was significantly greater than in the resting state, with the average connectivity values during the SE task significantly higher than during the SI task.Conclusions:Stroke survivors with dysphagia exhibit increased activation in the prefrontal cortex and primary sensory cortex during different swallowing tasks. Such tasks can improve their brain functional connectivity.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

The Healthy China 2030 Plan set the goal of reducing premature deaths from diabetes by 30% by 2030. However, there has been a lack of assessment of premature mortality for diabetes since the action plan was issued. This study used data from the Global Burden of Disease Study 2021, calculated the premature deaths for diabetes by sex, provinces, and subtypes from 1990 to 2021. We explored the temporal trend of premature mortality using the average annual percent change (AAPC) for different sexes, provinces, and subtypes from 1990 to 2021. Furthermore, we predicted premature mortality for diabetes through 2030 for China and its provinces according to the average annual change rate from 2010 to 2021. There was a first slow upward trend in premature mortality for diabetes from 0.5% in 1990 to 0.6% in 2004, and then a decline until 2021 with premature mortality of 0.4%. By 2030, only Fujian (30.3%) will achieve the desired level of reduction, with only seven provinces meeting the target for females and none for males. There is a large range in the degree of decline between inland and coastal regions, showing obvious geographic differences, and there should be a focus on balancing medical resources.
Humans ; China/epidemiology* ; Female ; Male ; Mortality, Premature/trends* ; Diabetes Mellitus/mortality* ; Goals ; Middle Aged ; Adult

Objective:To explore the diagnostic value of multiparametric magnetic resonance imaging (mp-MRI) combined with computed tomography (CT) for brucellar spondylitis (BS).Methods:From March 2019 to March 2024, patients with suspected BS admitted to Yili Kazakh Autonomous Prefecture Friendship Hospital were selected as study subjects. Their clinical characteristics, laboratory tests, and imaging findings (mp-MRI and CT) were analyzed.Results:A total of 60 suspected BS patients were enrolled, including 43 males and 17 females. Among them, 39 cases (65.00%) were diagnosed with BS, while 21 cases (35.00%) were non-BS. CT examination was performed in 48 patients, mp-MRI in 40 patients, and both examinations in 28 patients. Among CT-examined patients, there were 28 BS cases, 1 case had cervical spine involvement, 3 case had thoracic spine involvement, 3 case had thoracolumbar spine involvement, and 21 case had lumbosacral spine involvement. There were 16 cases involved 2 vertebrae, 3 cases involved 3 vertebrae, and 9 cases involved > 3 vertebrae.There were 15 cases had vertebral osteophyte formation, 28 cases had vertebral bone destruction, 22 cases had intervertebral space stenosis, 25 cases had uneven intervertebral disc density, 28 cases had thickening of soft tissues around the vertebrae, 19 cases had paravertebral abscesses, and 6 cases had spinal canal stenosis. In the mp-MRI examination of patients, there were 30 BS patients, among whom 1 case had cervical spine involvement, 2 case had thoracic spine involvement, 4 case had thoracolumbar spine involvement, and 23 case had lumbosacral spine involvement. There were 16 cases involved 2 vertebrae, 3 cases involved 3 vertebrae, and 11 cases involved > 3 vertebrae, 24 cases had intervertebral space stenosis, 27 cases had intervertebral disc destruction. There were 27 cases had swelling and thickening of soft tissues around the vertebrae, and 21 cases had paravertebral, psoas major muscle, and/or spinal canal abscesses. The BS group showed lower fractional anisotropy value and higher apparent diffusion coefficient value compared to the non-BS group, with statistically significant differences ( t = 5.26, 5.63, P < 0.001). The mp-MRI combined with CT showed higher sensitivity (86.36%, 19/22) and specificity (5/6) for BS diagnosis compared to mp-MRI alone (78.57%, 11/14; 80.77%, 21/26) and CT alone (56.25%, 9/16; 71.88%, 23/32). Conclusions:BS patients present diverse imaging manifestations. The combination of mp-MRI and CT demonstrates better diagnostic efficacy for BS than single examinations alone, showing good diagnostic value.

Objective:To observe the effect of cognitive-motor dual-task training on patients with subacute stroke and to analyze the mechanism of improvement in brain functional connectivity by functional near-infrared spectroscopy(fNIRS).Method:Forty patients with subacute stroke were randomly divided into a control group(n=20)and an obser-vation group(n=20).All patients were given conventional comprehensive rehabilitation treatment.The control group was given walking and cognitive function training separately,while the observation group was given cog-nitive-motor dual-task training.The cognition,motor function and activities of daily living were evaluated by mini-mental state examination(MMSE),functional ambulation category scale(FAC)and modified Barthel in-dex(MBI)before and after 6 weeks of treatment.fNIRS was used to compare the functional activity of the primary motor cortex(M1),supplementary motor area(SMA),prefrontal cortex(PFC)and the functional connectivity of each brain region under task states.Result:A total of 37 patients were included in the final statistics,and there was no difference in baseline lev-el between the two groups before treatment(P>0.05).After intervention,the MMSE,FAC and MBI of the two groups were better than those before treatment,and the observation group was better than the control group.The differences were statistically significant(P<0.05).At the same time,fNIRS observation showed that after treatment,except the right M1 and right PFC,the functional intensity of M1,SMA and PFC in the two groups were higher than those before treatment.The functional intensity of SMA in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Af-ter treatment,the functional connection intensity of brain regions on the injured side in the two groups were higher than those before treatment,and the functional connection intensity between bilateral SMA,M1 and PFC,SMA and PFC in the observation group were higher than those in the control group,and the differenc-es were statistically significant(P<0.05).Conclusion:Compared with conventional motor and cognitive function training,cognitive-motor dual-task training can more significantly improve cognitive,motor function and independence in patients with subacute stroke.The mechanism may be related to the fact that dual-task training can effectively improve the brain func-tional intensity of the SMA area,the functional connection intensity between M1 and PFC as well as SMA and PFC.

Objective:To explore the diagnostic value of multiparametric magnetic resonance imaging (mp-MRI) combined with computed tomography (CT) for brucellar spondylitis (BS).Methods:From March 2019 to March 2024, patients with suspected BS admitted to Yili Kazakh Autonomous Prefecture Friendship Hospital were selected as study subjects. Their clinical characteristics, laboratory tests, and imaging findings (mp-MRI and CT) were analyzed.Results:A total of 60 suspected BS patients were enrolled, including 43 males and 17 females. Among them, 39 cases (65.00%) were diagnosed with BS, while 21 cases (35.00%) were non-BS. CT examination was performed in 48 patients, mp-MRI in 40 patients, and both examinations in 28 patients. Among CT-examined patients, there were 28 BS cases, 1 case had cervical spine involvement, 3 case had thoracic spine involvement, 3 case had thoracolumbar spine involvement, and 21 case had lumbosacral spine involvement. There were 16 cases involved 2 vertebrae, 3 cases involved 3 vertebrae, and 9 cases involved > 3 vertebrae.There were 15 cases had vertebral osteophyte formation, 28 cases had vertebral bone destruction, 22 cases had intervertebral space stenosis, 25 cases had uneven intervertebral disc density, 28 cases had thickening of soft tissues around the vertebrae, 19 cases had paravertebral abscesses, and 6 cases had spinal canal stenosis. In the mp-MRI examination of patients, there were 30 BS patients, among whom 1 case had cervical spine involvement, 2 case had thoracic spine involvement, 4 case had thoracolumbar spine involvement, and 23 case had lumbosacral spine involvement. There were 16 cases involved 2 vertebrae, 3 cases involved 3 vertebrae, and 11 cases involved > 3 vertebrae, 24 cases had intervertebral space stenosis, 27 cases had intervertebral disc destruction. There were 27 cases had swelling and thickening of soft tissues around the vertebrae, and 21 cases had paravertebral, psoas major muscle, and/or spinal canal abscesses. The BS group showed lower fractional anisotropy value and higher apparent diffusion coefficient value compared to the non-BS group, with statistically significant differences ( t = 5.26, 5.63, P < 0.001). The mp-MRI combined with CT showed higher sensitivity (86.36%, 19/22) and specificity (5/6) for BS diagnosis compared to mp-MRI alone (78.57%, 11/14; 80.77%, 21/26) and CT alone (56.25%, 9/16; 71.88%, 23/32). Conclusions:BS patients present diverse imaging manifestations. The combination of mp-MRI and CT demonstrates better diagnostic efficacy for BS than single examinations alone, showing good diagnostic value.

Objective:To construct an evaluation indicator system for the efficiency of nursing human resources in integrated medical and elderly care institutions using Data Envelopment Analysis (DEA) and subsequently evaluate its effectiveness.Methods:This cross-sectional survey utilized literature review and investigative methods to initially establish a library of evaluation indicators for nursing human resource efficiency. The Delphi method was employed in two rounds of consultations with 17 experts from various fields, including nursing management, elderly care institution management, integrated medical and elderly care institution management, health economics management, and public health. The reliability of the indicator system was assessed based on factors such as expert enthusiasm, authority, concentration of opinions, and coordination. Adjustments, modifications, and improvements were made to the indicators based on expert opinions to establish the final indicator system. From August to December 2022, the DEA model was applied to evaluate the efficiency of 12 integrated medical and elderly care institutions in Haikou city based on this indicator system.Results:The constructed evaluation indicator system comprised 68 items divided into three levels: 9 primary indicators, 19 secondary indicators, and 40 tertiary indicators. The positive coefficients of the two rounds of expert consultations were 100% and 94.1%, with authority coefficients of 0.88 and 0.92, Kendall harmony coefficients of 0.471 and 0.348, and mean coefficients of variation of 0.16 and 0.12 ( P<0.001). DEA evaluation results for the 12 integrated medical and elderly care institutions showed that 5 were DEA effective institutions with comprehensive efficiency (OE), technical efficiency (TE), and scale efficiency (SE) values all equal to 1.000, while 7 were non-DEA effective institutions, including 4 with SE <1.000 but TE=1.000 and 3 with both SE and TE<1.000. Conclusions:The constructed evaluation indicator system demonstrates high enthusiasm, authority coefficients, and coordination in expert consultations, indicating high acceptability and comprehensive content with distinct levels and strong specialty characteristics. The DEA model′s evaluation results objectively and effectively reflect the efficiency of nursing human resources in integrated medical and elderly care institutions, demonstrating practical utility.