OBJECTIVE: To observe the effects of electroacupuncture (EA) on improving motor function and regulating microglial activation based on Notch receptor 1 (Notch1)/Hes family bHLH transcription factor 1 (Hes1) pathway in mice with Parkinson's disease (PD). METHODS: Thirty-six male C57BL/6 mice were randomly divided into a control group, a model group and an EA group, 12 mice in each group. PD model was established by intraperitoneal injection of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) for 7 consecutive days in the model group and the EA group. From the 1st day of modeling, EA was applied at "Baihui" (GV20) and bilateral "Shenshu" (BL23) in the EA group, with continuous wave, in frequency of 2 Hz and current of 2 mA, 15 min a time, once a day for 14 days continuously. The behavioral performance was evaluated by gait test, pole climbing test and hanging test, the number of positive cells of tyrosine hydroxylase (TH) and the co-expression positive cells of Notch1/ionized calcium binding adaptor molecule 1 (Iba-1) in the substantia nigra of midbrain was assessed by immunofluorescence, the protein expression of TH, α-synuclein (α-syn), Notch1, Hes1, Iba-1, inducible nitric oxide synthase (iNOS), Arginase-1 (ARG1), tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and IL-10 was detected by Western blot, the mRNA expression of Notch1 and Hes1 was detected by real-time PCR. RESULTS: Compared with the control group, in the model group, the stride frequency was accelerated (P<0.001) and the stride length was shortened (P<0.001) for the four limbs, the pole climbing test time was prolonged (P<0.01) and the grip level was reduced (P<0.01); in the substantia nigra of midbrain, the number of positive cells of TH was decreased (P<0.001), the number of co-expression positive cells of Notch1/Iba-1 was increased (P<0.001), the protein expression of α-syn, Notch1, Hes1, Iba-1, iNOS, TNF-α, IL-1βand IL-6 was increased (P<0.01, P<0.05, P<0.001), the protein expression of TH, ARG1 and IL-10 was decreased (P<0.01, P<0.001), the mRNA expression of Notch1 and Hes1 was increased (P<0.01). Compared with the model group, in the EA group, the stride frequency was decelerated (P<0.001) and the stride length was increased (P<0.05, P<0.01, P<0.001) for the four limbs, the pole climbing test time was shortened (P<0.05) and the grip level was increased (P<0.05); in the substantia nigra of midbrain, the number of positive cells of TH was increased (P<0.01), the number of co-expression positive cells of Notch1/Iba-1 was decreased (P<0.001), the protein expression of α-syn, Notch1, Hes1, Iba-1, iNOS, TNF-α, IL-6 and IL-1β was decreased (P<0.05, P<0.01), the protein expression of TH, ARG1 and IL-10 was increased (P<0.05, P<0.001, P<0.01), the mRNA expression of Notch1 and Hes1 was decreased (P<0.05). CONCLUSION EA can improve the behavioral performance and protect the dopaminergic neurons in PD mice, its mechanism may relate to the inhibition of Notch1/Hes1-mediated neuroinflammation, thus inhibiting the microglial activation.
Animals ; Electroacupuncture ; Microglia/metabolism* ; Male ; Receptor, Notch1/metabolism* ; Parkinson Disease/physiopathology* ; Transcription Factor HES-1/metabolism* ; Mice ; Mice, Inbred C57BL ; Humans ; Signal Transduction

Objective:To construct the user personas of the patients who practice self-management home rehabilitation after lower limb bone transport by exploring their self-management experiences and needs in rehabilitation at home so as to provide targeted countermeasures for related medical staff.Methods:A purposive sampling method was employed to select the 21 patients who had undergone home rehabilitation after lower limb bone transport at Department of Orthopedic Trauma, Nanfang Hospital from September to December 2024. The cohort included 12 males and 9 females, with an age of (39.8±15.1) years. The phenomenological research method was used to conduct semi-structured interviews with this cohort. After the data from interviews were explored by the Colaizzi 7-step analysis to extract the factual labels, role dimension models were built, covering 3 dimensions: description, characteristics (basic, cognitive, behavioral, social support, and psychological adjustment characteristics) and needs.Results:All patients were interviewed. Four user personas were constructed, including self-awareness growth type (5 cases), emotional dependency-driven type (4 cases), risk-aversion procrastination type (7 cases), and management motivation-impaired type (5 cases). The patients of self-awareness growth type were 21 to 36 years old and received high school or university education, characterized by high self-efficacy, active measures to improve and maintain their state of rehabilitation, good management of negative emotions, and a low sense of stigma. The patients of emotional low-driven type were 42 to 74 years old and received their education in a primary school or junior high school, characterized by lack of independence, dependence on others for rehabilitation management, common management of negative emotions, low self-efficacy, and a strong sense of stigma. The patients of risk-aversion procrastination type were 33 to 56 years old and received their education in a junior or senior high school, characterized by a willingness to cooperate but insufficient motivation for rehabilitation management, an awareness of rehabilitation which was vulnerable to external factors, common management of negative emotions, low self-efficacy, and a strong sense of stigma. The patients of management motivation-impaired type were 51 to 61 years old, received primary school education or lower, characterized by insufficient knowledge and poor self-management behavior, constant failure to follow the prescribed rehabilitation exercises, poor management of negative emotions, low self-efficacy, and a low sense of stigma.Conclusion:The user personas we have constructed for the patients who practice self-management home rehabilitation after lower limb bone transport can help healthcare professionals with specific targeted interventions to enhance self-management efficacy to facilitate the rehabilitation process for the patients.

BACKGROUND:Increasing evidence has indicated that early reinforcement of correct posture is particularly important for improving abnormal gait in stroke patients.Wearable exoskeleton-assisted training can improve patients'walking function in a short period of time,and can also assist the coordinated movement of muscles around the pelvis,hip,knee,and ankle joints,control the walking trajectory of the lower limbs,and improve walking ability in patients with stroke.OBJECTIVE:To explore the improvement of abnormal gait in stroke patients by a wearable exoskeleton with posture feedback,and to explore the rehabilitation mechanism.METHODS:A total of 52 patients in the recovery period of stroke admitted to the Affiliated Hospital of Jining Medical College from January 2023 to January 2024 were included in this study and randomly divided into an experimental group(n=26)and a control group(n=26)using a random number table method.Based on conventional rehabilitation training,the patients in the experimental group participated in training using a wearable exoskeleton with posture feedback(15 minutes per day,6 times per week),while those in the control group were given conventional gait therapy(15 minutes per day,6 times per week).Training in each group lasted for 4 weeks.Before and after training,the lower limb motor function scores,gait parameters(step length,step speed,step width)and gait symmetry were compared between the two groups,and the brain functional connectivity values of the prefrontal motor area,the primary motor cortex and the sensorimotor area were detected using portable near-infrared spectroscopy.RESULTS AND CONCLUSION:After training,lower limb motor function scores,gait parameters and gait symmetry were significantly improved in the two groups(P＜0.05).Meanwhile,the experimental group was superior to the control group in terms of gait parameters and gait symmetry(P＜0.05).Brain functional connectivity values of the right sensorimotor area-left prefrontal motor area and right sensorimotor area-right prefrontal motor area were significantly increased in the two groups after training(P＜0.05).The functional connectivity values of the left sensorimotor area-right primary motor cortex and left sensorimotor area-left primary motor cortex in the experimental group were increased after training(P＜0.05).Compared with the control group,the functional connectivity values of the left sensorimotor area-right primary motor cortex and left sensorimotor area-left primary motor cortex were increased in the experimental group after training(P＜0.05).To conclude,based on conventional rehabilitation training,a wearable exoskeleton with posture feedback can not only effectively improve the abnormal gait of stroke patients,but also activate the functional sensorimotor areas of the brain associated with abnormal gait.

Objective:To implement cross-cultural adaptation after translating the Integral Nursing Leadership Scale(INLS), and to test the validity of the Chinese version of INLS.Methods:In April 2024, the translation method adopted was direct translation and back translation, cross-cultural adaptation was carried out using the expert consultation method, a pre-survey was conducted and the Chinese version of INLS was modified accordingly. From May to June 2024, a convenience sampling method was used to select the participants from Southern Medical University Southern Hospital to test the reliability and validity of the Chinese version of INLS.Results:The effective recovery rate was 95.30% (669/702). Among 669 clinical nurses, there were 635 females and 34 males, aged (35.01 ± 7.54) years old. The Chinese version of the INLS consisted of 4 dimensions and 30 entries. The CR value of the entry threshold was between 12.742 and 20.157 (all P<0.01). The correlation coefficient of the score of 30 items was between 0.692 and 0.819 (all P<0.01). The average scale-level and item-level content validity index were all 1. The index of fit: χ2/ df = 2.860, root mean square error of approximation was 0.071, incremental fit index was 0.921, Tucker- Lewis index was 0.914, comparative fit index was 0.921. The Cronbach α coefficient of the scale and each dimension was>0.90 ( P<0.01). The test-retest reliability was 0.947( P<0.01). Conclusions:The Chinese version of INLS has good reliability and validity, and can be used as an effective tool to evaluate the comprehensive leadership of nursing managers in China.

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.

Objective:To implement cross-cultural adaptation after translating the Integral Nursing Leadership Scale(INLS), and to test the validity of the Chinese version of INLS.Methods:In April 2024, the translation method adopted was direct translation and back translation, cross-cultural adaptation was carried out using the expert consultation method, a pre-survey was conducted and the Chinese version of INLS was modified accordingly. From May to June 2024, a convenience sampling method was used to select the participants from Southern Medical University Southern Hospital to test the reliability and validity of the Chinese version of INLS.Results:The effective recovery rate was 95.30% (669/702). Among 669 clinical nurses, there were 635 females and 34 males, aged (35.01 ± 7.54) years old. The Chinese version of the INLS consisted of 4 dimensions and 30 entries. The CR value of the entry threshold was between 12.742 and 20.157 (all P<0.01). The correlation coefficient of the score of 30 items was between 0.692 and 0.819 (all P<0.01). The average scale-level and item-level content validity index were all 1. The index of fit: χ2/ df = 2.860, root mean square error of approximation was 0.071, incremental fit index was 0.921, Tucker- Lewis index was 0.914, comparative fit index was 0.921. The Cronbach α coefficient of the scale and each dimension was>0.90 ( P<0.01). The test-retest reliability was 0.947( P<0.01). Conclusions:The Chinese version of INLS has good reliability and validity, and can be used as an effective tool to evaluate the comprehensive leadership of nursing managers in China.

BACKGROUND:Increasing evidence has indicated that early reinforcement of correct posture is particularly important for improving abnormal gait in stroke patients.Wearable exoskeleton-assisted training can improve patients'walking function in a short period of time,and can also assist the coordinated movement of muscles around the pelvis,hip,knee,and ankle joints,control the walking trajectory of the lower limbs,and improve walking ability in patients with stroke.OBJECTIVE:To explore the improvement of abnormal gait in stroke patients by a wearable exoskeleton with posture feedback,and to explore the rehabilitation mechanism.METHODS:A total of 52 patients in the recovery period of stroke admitted to the Affiliated Hospital of Jining Medical College from January 2023 to January 2024 were included in this study and randomly divided into an experimental group(n=26)and a control group(n=26)using a random number table method.Based on conventional rehabilitation training,the patients in the experimental group participated in training using a wearable exoskeleton with posture feedback(15 minutes per day,6 times per week),while those in the control group were given conventional gait therapy(15 minutes per day,6 times per week).Training in each group lasted for 4 weeks.Before and after training,the lower limb motor function scores,gait parameters(step length,step speed,step width)and gait symmetry were compared between the two groups,and the brain functional connectivity values of the prefrontal motor area,the primary motor cortex and the sensorimotor area were detected using portable near-infrared spectroscopy.RESULTS AND CONCLUSION:After training,lower limb motor function scores,gait parameters and gait symmetry were significantly improved in the two groups(P＜0.05).Meanwhile,the experimental group was superior to the control group in terms of gait parameters and gait symmetry(P＜0.05).Brain functional connectivity values of the right sensorimotor area-left prefrontal motor area and right sensorimotor area-right prefrontal motor area were significantly increased in the two groups after training(P＜0.05).The functional connectivity values of the left sensorimotor area-right primary motor cortex and left sensorimotor area-left primary motor cortex in the experimental group were increased after training(P＜0.05).Compared with the control group,the functional connectivity values of the left sensorimotor area-right primary motor cortex and left sensorimotor area-left primary motor cortex were increased in the experimental group after training(P＜0.05).To conclude,based on conventional rehabilitation training,a wearable exoskeleton with posture feedback can not only effectively improve the abnormal gait of stroke patients,but also activate the functional sensorimotor areas of the brain associated with abnormal gait.

Objective:To construct the user personas of the patients who practice self-management home rehabilitation after lower limb bone transport by exploring their self-management experiences and needs in rehabilitation at home so as to provide targeted countermeasures for related medical staff.Methods:A purposive sampling method was employed to select the 21 patients who had undergone home rehabilitation after lower limb bone transport at Department of Orthopedic Trauma, Nanfang Hospital from September to December 2024. The cohort included 12 males and 9 females, with an age of (39.8±15.1) years. The phenomenological research method was used to conduct semi-structured interviews with this cohort. After the data from interviews were explored by the Colaizzi 7-step analysis to extract the factual labels, role dimension models were built, covering 3 dimensions: description, characteristics (basic, cognitive, behavioral, social support, and psychological adjustment characteristics) and needs.Results:All patients were interviewed. Four user personas were constructed, including self-awareness growth type (5 cases), emotional dependency-driven type (4 cases), risk-aversion procrastination type (7 cases), and management motivation-impaired type (5 cases). The patients of self-awareness growth type were 21 to 36 years old and received high school or university education, characterized by high self-efficacy, active measures to improve and maintain their state of rehabilitation, good management of negative emotions, and a low sense of stigma. The patients of emotional low-driven type were 42 to 74 years old and received their education in a primary school or junior high school, characterized by lack of independence, dependence on others for rehabilitation management, common management of negative emotions, low self-efficacy, and a strong sense of stigma. The patients of risk-aversion procrastination type were 33 to 56 years old and received their education in a junior or senior high school, characterized by a willingness to cooperate but insufficient motivation for rehabilitation management, an awareness of rehabilitation which was vulnerable to external factors, common management of negative emotions, low self-efficacy, and a strong sense of stigma. The patients of management motivation-impaired type were 51 to 61 years old, received primary school education or lower, characterized by insufficient knowledge and poor self-management behavior, constant failure to follow the prescribed rehabilitation exercises, poor management of negative emotions, low self-efficacy, and a low sense of stigma.Conclusion:The user personas we have constructed for the patients who practice self-management home rehabilitation after lower limb bone transport can help healthcare professionals with specific targeted interventions to enhance self-management efficacy to facilitate the rehabilitation process for the patients.

Objective:To explore any effect of repeated transcranial magnetic stimulation (rTMS) on the upper limb motor function and cerebral cortex activation of stroke survivors.Methods:Sixty stroke survivors were randomly divided into an intervention group and a control group, each of 30. In addition to routine rehabilitation training (including drug therapy, comprehensive hemiplegic limb training and physical factor therapy), the intervention group received 15 minutes of rTMS daily, five days a week for 4 weeks while the control group was given false rTMS. Upper limb motor function was evaluated before and after the treatment using the Fugl Meyer upper limb motor function rating scale (FMA-UE). Functional near-infrared spectroscopy was used to detect and compare the activation (β values) of the prefrontal cortex, the motor cortex and the primary somatosensory cortex in the 2 groups. The correlation between the FMA-UE scores and the β values was quantified.Results:①There was no significant difference in the average FMA-UE scores between the two groups before the treatment. Afterward, though both groups′ average scores had increased significantly, there was significantly greater improvement in the treatment group. ②There was also no significant difference in average β value between the two groups before the experiment, but afterward the average βs of channels 27 and 13 in the intervention group were significantly higher than in the control group. Moreover, in patients with lesion in the left brain, the β-values of CH27 and CH13 were also significantly higher than the control group ( P<0.05). ③The FMA-UE scores of the intervention group were moderately correlated with the CH27 and CH13 β values, but those of the control group were only weakly correlated with the β values of CH27. Conclusion:Transcranial magnetic stimulation activates a lesioned left brain region, improving upper limb motor function. The improvement is correlated with the activation of the left prefrontal cortex and the left primary somatosensory cortex.