ObjectiveTo investigate the effect of cerebellar intermittent theta-burst stimulation (iTBS) on postural control and fall risk in stroke patients. MethodsFrom October, 2024 to August, 2025, 45 stroke patients were recruited from Huadong Hospital Affiliated to Fudan University. They were randomly divided into control group (n = 15), group A (n = 15) and group B (n = 15). All the groups received conventional medication and rehabilitation. Group A was additionally administered iTBS over the ipsilesional primary motor cortex (M1), while group B received iTBS over the contralesional cerebellum, for three weeks. Before and after intervention, postural stability indexes (eyes open/closed), limits of stability, directional control score and reaction time were measured using Biodex Balance System, and they were assessed with Berg Balance Scale (BBS), Timed Up & Go Test (TUGT) and 10-meter walk test (10MWT). ResultsAfter intervention, significant group-time interaction effects were observed for eyes open/closed postural stability indexes, limits of stability, directional control score, reaction time, BBS score, TUGT and 10MWT (F > 23.487, P < 0.001). All the groups improved in all the indexes after intervention (P < 0.01). The eyes open/closed postural stability indexes, limits of stability, directional control score and reaction time were the best in group B, followed by group A, and the worst in the control group (P < 0.05), while BBS, TUGT and 10MWT were better in groups A and B than in the control group (P < 0.05). ConclusionCerebellar iTBS can effectively improve postural control disorders and reduce fall risk in stroke patients, and may be superior to M1 iTBS.

ObjectiveTo systematically evaluate the effect of intermittent theta burst stimulation (iTBS) on lower extremity motor function and balance function in patients with stroke. MethodsA systematic literature search was conducted in the Cochrane Library, Embase, PubMed, Web of Science, CNKI, SinoMed, Wanfang data and VIP from inception to February 19, 2025. Randomized controlled trials comparing iTBS with conventional rehabilitation or sham iTBS in patients with post-stroke lower extremity motor and balance dysfunction were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Tool. Meta-analysis was performed using RevMan 5.4 and Stata 14.0. ResultsA total of 16 articles involving 647 patients were included. Meta-analysis showed that iTBS improved the Fugl-Meyer Assessment-Lower Extremities score (MD = 2.58, 95%CI 1.61 to 3.55, P < 0.001), Berg Balance Scale score (MD = 4.11, 95%CI 2.43 to 5.79, P < 0.001), Barthel Index score (MD = 4.95, 95%CI 0.97 to 8.92, P = 0.010) and motor-evoked potential (MEP) latency (MD = -1.42, 95%CI -2.54 to -0.30, P = 0.010). Subgroup analyses suggested that at subacute stage, cerebellar iTBS, more than ten treatment sessions, and 1 200 pulses per day may be more effective. ConclusioniTBS may improve lower extremity motor function and activities of daily living in patients with stroke, and shorten MEP latency, and it may also confer potential benefits in improving balance function in these patients.

Objective:To investigate the expression and clinical relevance of MicroRNA(miRNA)-21 and miRNA-22 in urine exosomes of patients diagnosed with contrast-induced nephropathy(CIN).Methods:A total of 258 patients who underwent coronary intervention at our hospital's Department of Cardiology between July 2020 and July 2023 were retrospectively selected.These patients were divided into a CIN group( n=68)and a non-CIN group( n=190)based on the occurrence of contrast-induced nephropathy(CIN)post-coronary intervention.Clinical data from both groups were collected and compared, and levels of miRNA-21 and miRNA-22 in urinary exosomes were detected using polymerase chain reaction.Binary logistic regression was then utilized to analyze the risk factors associated with CIN.Furthermore, the diagnostic accuracy of urine exosomal miRNA-21 and miRNA-22 in detecting CIN was assessed through a receiver operating characteristic(ROC)curve. Results:Various risk factors were identified for contrast-induced nephropathy(CIN)in the study, including age(≥70 years old, 48.5%), diabetes(52.9%), myocardial infarction(11.8%), hypotension(17.7%), reduced glomerular filtration rate(GFR)[≤60 ml·min -1·1.73(m -1) 2, 32.4%], decreased left ventricular ejection fraction(LVEF)(≤0.45, 16.2%), high contrast agent dosage(>200 ml, 17.7%), elevated serum creatinine(Scr)levels 24 hours post-coronary intervention in the CIN group[(76.5±4.5)μmol/L], as well as higher levels of urine exosomal miRNA-21(0.9±0.2)and miRNA-22(5.9±1.1)between CIN group and non-CIN group[32.6%, 32.1%, 2.6%, 5.8%, 18.9%, 5.8%, 5.3%, (68.4±3.3)mol/L, (0.8±0.2), (3.1±0.90]( t=5.441, 9.266, 8.730, 8.671, 5.164, 6.927, 9.846, 8.707, 3.040, 11.233, all P<0.05).Logistic regression analysis showed that age ≥70 years( OR: 3.611, 95% CI: 1.235-10.561), diabetes( OR: 5.886, 95% CI: 1.601-21.641), myocardial infarction( OR: 3.600, 95% CI: 1.204-10.763), hypertension( OR: 6.672, 95% CI: 1.761-25.281), GFR≤60 ml·min -1·1.73(m -1) 2( OR: 3.413, 95% CI: 1.086-10.732), LVEF≤0.45( OR: 5.008, 95% CI: 1.380-18.178), dosage of contrast agent >200mL( OR: 3.389, 95% CI: 1.016-11.299), elevated Scr 24 hours after operation( OR: 0.597, 95% CI: 0.478-0.746)and high expression of miRNA-21( OR: 0.014, 95% CI: 0.001-0.292)and miRNA-22( OR: 0.017, 95% CI: 0.001-0.294)in urine exosomes were the risk factors for CIN(all P<0.05).The AUC of urinary exocrine miRNA-21 and miRNA-22 in the diagnosis of CIN were 0.694 and 0.950, respectively, and the AUC of combined diagnosis was 0.967. Conclusions:The expression levels of miRNA-21 and miRNA-22 in urinary exosomes of patients with contrast-induced nephropathy(CIN)are significantly elevated, indicating their potential clinical relevance in predicting CIN.Simultaneous assessment of both miRNAs can enhance the precision of CIN identification.

ObjectiveTo elucidate the critical role of rehabilitation medical records (including electronic records) in rehabilitation medicine's clinical practice and management, comprehensively analyzed the structure, core content and data standards of rehabilitation medical records, to develop a standardized medical record data architecture and core dataset suitable for rehabilitation medicine and to explore the application of rehabilitation data in performance evaluation and payment. MethodsBased on the regulatory documents Basic Specifications for Medical Record Writing and Basic Specifications for Electronic Medical Records (Trial) issued by National Health Commission of China, and referencing the World Health Organization (WHO) Family of International Classifications (WHO-FICs) classifications, International Classification of Diseases (ICD-10/ICD-11), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI Beta-3), this study constructed the data architecture, core content and data standards for rehabilitation medical records. Furthermore, it explored the application of rehabilitation record summary sheets (home page) data in rehabilitation medical statistics and payment methods, including Diagnosis-related Groups (DRG), Diagnosis-Intervention Packet (DIP) and Case Mix Index. ResultsThis study proposed a systematic standard framework for rehabilitation medical records, covering key components such as patient demographics, rehabilitation diagnosis, functional assessment, rehabilitation treatment prescriptions, progress evaluations and discharge summaries. The research analyzed the systematic application methods and data standards of ICD-10/ICD-11, ICF and ICHI Beta-3 in the fields of medical record terminology, coding and assessment. Constructing a standardized data structure and data standards for rehabilitation medical records can significantly improve the quality of data reporting based on the medical record summary sheet, thereby enhancing the quality control of rehabilitation services, effectively supporting the optimization of rehabilitation medical insurance payment mechanisms, and contributing to the establishment of rehabilitation medical performance evaluation and payment based on DRG and DIP. ConclusionStructured rehabilitation records and data standardization are crucial tools for quality control in rehabilitation. Systematically applying the three reference classifications of the WHO-FICs, and aligning with national medical record and electronic health record specifications, facilitate the development of a standardized rehabilitation record architecture and core dataset. Standardizing rehabilitation care pathways based on the ICF methodology, and developing ICF- and ICD-11-based rehabilitation assessment tools, auxiliary diagnostic and therapeutic systems, and supporting terminology and coding systems, can effectively enhance the quality of rehabilitation records and enable interoperability and sharing of rehabilitation data with other medical data, ultimately improving the quality and safety of rehabilitation services.

ObjectiveTo analyze the data structure and standards of rehabilitation outpatient medical records, to provide data support for improving the quality of rehabilitation outpatient care and developing medical insurance payment policies. MethodsBased on the normative documents issued by the National Health Commission, Basic Standards for Medical Record Writing and Standards for Electronic Medical Record Sharing Documents, in accordance with the Quality Management Regulations for Outpatient (Emergency) Diagnosis and Treatment Information Pages (Trial), reference to the framework of the World Health Organization Family of International Classifications (WHO-FICs), the data framework and content of rehabilitation outpatient medical records were determined, and the data standards were discussed. ResultsThis study constructed a data framework for rehabilitation outpatient medical records, including four main components: patient basic information, visit process information, diagnosis and treatment information, and cost information. Three major reference classifications of WHO-FICs, International Classification of Diseases, International Classification of Functioning, Disability and Health, and International Classification of Health Interventions,were used to establish diagnostic standards and standardized terminology, as well as coding disease diagnosis, functional description, functional assessment, and rehabilitation interventions, to improve the quality of data reporting, and level of quality control in rehabilitation. ConclusionThe structuring and standardization of rehabilitation outpatient medical records are the foundation for sharing of rehabilitation data. The using of the three major classifications of WHO-FICs is valuable for the terminology and coding of disease diagnosis, functional description and assessment, and intervention in rehabilitation outpatient medical records, which is significant for sharing and interconnectivity of rehabilitation outpatient data, as well as for optimizing the quality and safety of rehabilitation medical services.

ObjectiveTo explore the standardization of inpatient rehabilitation medical record summary sheet, encompassing its structure, content and data standards, to enhance the standardization level of inpatient rehabilitation medical record summary sheet, improve data reporting quality, and provide accurate data support for medical insurance payment, hospital performance evaluation, and rehabilitation discipline evaluation. MethodsBased on the relevant specifications of the National Health Commission's Basic Norms for Medical Record Writing, Specifications for Sharing Documents of Electronic Medical Records, and Quality Management and Control Indicators for Inpatient Medical Record Summary Sheet (2016 Edition), this study analyzed the structure and content of the inpatient rehabilitation medical record summary sheet. The study systematically applied the three major reference classifications of the World Health Organization Family of International Classifications, International Classification of Diseases (ICD-10/ICD-11, ICD-9-CM-3), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI Beta-3), for disease diagnosis, functional description and assessment, and rehabilitation intervention, forming a standardized terminology system and coding methods. ResultsThe inpatient rehabilitation medical record summary sheet covered four major sections: inpatient information, hospitalization information, diagnosis and treatment information, and cost information. ICD-10/ICD-11 were the standards and coding tools for admission and discharge diagnoses in the inpatient rehabilitation medical record summary sheet. The three functional assessment tools recommended by ICD-11, the 36-item version of World Health Organization Disability Assessment Schedule 2.0, Brief Model Disability Survey and Generic Functioning domains, as well as ICF, were used for rehabilitation functioning assessment and the coding of outcomes. ICHI Beta-3 and ICD-9-CM-3 were used for coding surgical procedures and operations in the medical record summary sheet, and also for coding rehabilitation intervention items. ConclusionThe inpatient rehabilitation medical record summary sheet is a summary of the relevant content of the rehabilitation medical record and a tool for reporting inpatient rehabilitation data. It needs to be refined and optimized according to the characteristics of rehabilitation, with necessary data supplemented. The application of ICD-11/ICD-10, ICF and ICHI Beta-3/ICD-9-CM-3 classification standards would comprehensively promote the accuracy of inpatient diagnosis of diseases and functions. Based on ICD-11 and ICF, relevant functional assessment result data would be added, and ICHI Beta-3/ICD-9-CM-3 should be used to code rehabilitation interventions. Improving the quality of rehabilitation medical records and inpatient rehabilitation medical record summary sheet is an important part of rehabilitation quality control, and also lays an evidence-based data foundation for the analysis and application of inpatient rehabilitation medical record summary sheet.

Aging is an inevitable, physiological process of the human body, leading to deterioration in bodily function and increased susceptibility to various diseases. Effective endogenous therapeutic strategies for anti-aging and related diseases remain limited. Exercise confers multifaceted benefits to physical health by augmenting osteogenic and myogenic processes, enhancing cardiovascular and nervous system function, and attenuating chronic inflammation. Angiogenesis and lymphangiogenesis play pivotal roles in anti-aging, tissue repair, and immune response modulation, underscoring their potential as therapeutic targets for age-related diseases. Modulating angiogenic and lymphangiogenic pathways may provide a promising strategy for mitigating vascular decline and immune system dysfunction associated with aging. Exercise-induced endogenous angiogenesis and lymphangiogenesis can exert beneficial effects on physiological function, thereby representing a potential therapeutic paradigm for combating age-related decline and diseases. This review offers a thorough summary of the present knowledge regarding angiogenesis and lymphangiogenesis induced by exercise, encompassing the underlying mechanisms and the effects in different organs. In addition, it explores the potential of physical activity as a non-pharmacological intervention for anti-aging strategies and disease management, offering novel insights into the intersection of physical activity, aging, and disease progression.
Humans ; Lymphangiogenesis/physiology* ; Aging/physiology* ; Exercise/physiology* ; Animals ; Neovascularization, Physiologic/physiology* ; Angiogenesis

Objective:To investigate the expression and clinical relevance of MicroRNA(miRNA)-21 and miRNA-22 in urine exosomes of patients diagnosed with contrast-induced nephropathy(CIN).Methods:A total of 258 patients who underwent coronary intervention at our hospital's Department of Cardiology between July 2020 and July 2023 were retrospectively selected.These patients were divided into a CIN group( n=68)and a non-CIN group( n=190)based on the occurrence of contrast-induced nephropathy(CIN)post-coronary intervention.Clinical data from both groups were collected and compared, and levels of miRNA-21 and miRNA-22 in urinary exosomes were detected using polymerase chain reaction.Binary logistic regression was then utilized to analyze the risk factors associated with CIN.Furthermore, the diagnostic accuracy of urine exosomal miRNA-21 and miRNA-22 in detecting CIN was assessed through a receiver operating characteristic(ROC)curve. Results:Various risk factors were identified for contrast-induced nephropathy(CIN)in the study, including age(≥70 years old, 48.5%), diabetes(52.9%), myocardial infarction(11.8%), hypotension(17.7%), reduced glomerular filtration rate(GFR)[≤60 ml·min -1·1.73(m -1) 2, 32.4%], decreased left ventricular ejection fraction(LVEF)(≤0.45, 16.2%), high contrast agent dosage(>200 ml, 17.7%), elevated serum creatinine(Scr)levels 24 hours post-coronary intervention in the CIN group[(76.5±4.5)μmol/L], as well as higher levels of urine exosomal miRNA-21(0.9±0.2)and miRNA-22(5.9±1.1)between CIN group and non-CIN group[32.6%, 32.1%, 2.6%, 5.8%, 18.9%, 5.8%, 5.3%, (68.4±3.3)mol/L, (0.8±0.2), (3.1±0.90]( t=5.441, 9.266, 8.730, 8.671, 5.164, 6.927, 9.846, 8.707, 3.040, 11.233, all P<0.05).Logistic regression analysis showed that age ≥70 years( OR: 3.611, 95% CI: 1.235-10.561), diabetes( OR: 5.886, 95% CI: 1.601-21.641), myocardial infarction( OR: 3.600, 95% CI: 1.204-10.763), hypertension( OR: 6.672, 95% CI: 1.761-25.281), GFR≤60 ml·min -1·1.73(m -1) 2( OR: 3.413, 95% CI: 1.086-10.732), LVEF≤0.45( OR: 5.008, 95% CI: 1.380-18.178), dosage of contrast agent >200mL( OR: 3.389, 95% CI: 1.016-11.299), elevated Scr 24 hours after operation( OR: 0.597, 95% CI: 0.478-0.746)and high expression of miRNA-21( OR: 0.014, 95% CI: 0.001-0.292)and miRNA-22( OR: 0.017, 95% CI: 0.001-0.294)in urine exosomes were the risk factors for CIN(all P<0.05).The AUC of urinary exocrine miRNA-21 and miRNA-22 in the diagnosis of CIN were 0.694 and 0.950, respectively, and the AUC of combined diagnosis was 0.967. Conclusions:The expression levels of miRNA-21 and miRNA-22 in urinary exosomes of patients with contrast-induced nephropathy(CIN)are significantly elevated, indicating their potential clinical relevance in predicting CIN.Simultaneous assessment of both miRNAs can enhance the precision of CIN identification.

Background Shoemaking industry workers are prone to work-related musculoskeletal disorders (WMSDs) due to long-term awkward postures during the work process. There is little research on the prevalence and influencing factors of WMSDs in the knee region of this industry, and it should be taken seriously. Objective To estimate the prevalence of work-related knee pain among shoemaking workers and analyze the related influencing factors. Methods A total of 6982 shoemaking workers were selected from 26 shoemaking factories in Guangdong, Hubei, Fujian, Chongqing, Shandong, Zhejiang, and Jingxi by convenience sampling. Prevalence of work-related knee pain in past year, demographic characteristics, occupational related factors, and work posture were collected by a cross-sectional survey using the electronic version of Musculoskeletal Disorder Questionnaire. Logistic regression analysis was used to analyze the influencing factors that may lead to work-related knee pain. Results This survey collected 6982 valid questionnaires with a recovery rate of 98.3%. The prevalence of work-related knee pain of shoemaking workers in the past 12 months was 13.0% (908/6982). According to the results of logistic regression analysis, compared with workers with less than 5 years of service, workers with 5-10 years of service (OR=1.21, 95%CI: 1.02, 1.45) and more than 10 years (1.53, 95%CI: 1.27, 1.83) showed a higher risk of knee WMSDs; sometimes, often and very frequent (reference : rarely or never) long-term standing (OR=1.33, 95%CI: 1.08, 1.64; OR=2.67, 95%CI: 2.10, 3.39; OR=2.75, 95%CI: 2.08, 3.63) and sometimes, often and very frequent (reference: rarely or never) long-term squatting or kneeling (OR=1.80, 95%CI: 1.47, 2.21; OR=2.43, 95%CI: 1.58, 3.75; OR=3.22, 95%CI: 1.66, 6.24) increased the risk of knee pain: long-term bending (OR=1.59, 95%CI: 1.34, 1.89) and often repeated movement of lower limbs and ankles (OR=1.48, 95%CI: 1.25, 1.75) were also risk factors for knee WMSDs among shoemaking industry workers (P<0.05). Adequate rest time (OR=0.58, 95%CI: 0.49, 0.68) and able to stretch or change leg posture (OR=0.75, 95%CI: 0.64, 0.88) reduced the risk of knee WMSDs (P<0.05). Conclusion In the shoemaking industry, length of service and awkward postures are risk factors for knee pain. The shoemaking enterprises should ensure that workers have sufficient rest time, reduce long-term standing, squatting, kneeling, and bending postures, as well as lower limbs repetition in order to reduce the occurrence of knee WMSDs of workers.

Objective:To explore the relationship between thyroid function status and related indicators of muscle and bone metabolism, as well as serum levels of chemerin and 25-hydroxyvitamin D [25 (OH) D] in elderly patients with type 2 diabetes mellitus (T2DM) .Methods:A total of 158 elderly T2DM patients admitted to Department of Gerontology, Second Affiliated Hospital of Xi’an Jiaotong University from Mar. 2022 to Mar. 2024 were selected as the study subjects. According to whether they had osteoporosis (OP), they were included in the concurrent group (61 cases) and the non-concurrent group (97 cases). The baseline data, muscle (grip strength, muscle content), bone metabolism [osteocalcin, bone-specific alkaline phosphatase (BAP) ] related indicators, and serum Chemerin and 25 (OH) D levels were compared between the two groups. The partial correlation coefficient was used to analyze the partial correlation between the above indicators and the concurrent OP in elderly patients with T2DM. The levels of muscle, bone metabolism-related indicators and serum indicators were compared among patients with different thyroid function status, and the interaction coefficient γ was used to analyze the interactive effects of abnormal thyroid function status on muscle, bone metabolism-related indicators and serum indicators.Results:There were significant differences in the duration of T2DM, thyroid function status, glycosylated hemoglobin (HbA1c), muscle content, osteocalcin, 25 (OH) D, BAP, and Chemerin levels between the two groups ( t/ χ 2=4.564, 7.900, 8.184, -2.028, -7.708, -6.927, 3.167, 14.298, P<0.05). Partial correlation analysis showed that thyroid function status (hyperthyroidism, hypothyroidism), muscle content, osteocalcin, BAP, Chemerin, and 25 (OH) D were significantly associated with the occurrence of OP in elderly T2DM patients (partial correlation coefficients = 0.814, 0.827, -0.675, -0.759, 0.732, 0.848, -0.702, P<0.05). The levels of osteocalcin, BAP, and Chemerin were higher in elderly T2DM patients with hyperthyroidism than in those with hypothyroidism and normal thyroid function, and those with hypothyroidism were higher than those with normal thyroid function, showing significant differences ( F=118.845, 7.444, 54.253, P<0.05). Interaction analysis revealed that both hypothyroidism and hyperthyroidism had multiplicative and additive interactions with osteocalcin and Chemerin, and the synergistic effect could be several times higher than the sum of the effects of the two, increasing the risk of OP ( RERI=8.216, 15.472, SI=1.414, 2.053, P<0.001) . Conclusions:The thyroid function status is closely related to the muscle and bone metabolism-related indicators, as well as serum levels of Chemerin and 25 (OH) D in elderly patients with T2DM complicated by OP. The concurrent exposure of thyroid dysfunction to osteocalcin and Chemerin can synergistically increase the risk of elderly T2DM complicated by OP. The combined application can serve as a novel auxiliary scheme for clinical prediction of OP and has certain guiding significance for clinical prevention and treatment.