OBJECTIVE:Repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown positive effects in improving gross motor function in children with cerebral palsy.A network meta-analysis was performed to analyze the clinical efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation on the improvement of lower limb motor function and gait in children with cerebral palsy.METHODS:Randomized controlled trials(RCT)about repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor function and gait in children with cerebral palsy were collected from CNKI,WanFang,VIP,SinoMed,PubMed,Web of Science,Medline.The search time limit was from the inception to October 5,2024.After screening literature,extracting data and evaluating the risk of bias of included studies,Stata 15.0 software was used for network meta-analysis,AND GRADE profiler was used for quality evaluation.RESULTS:A total of 19 studies were included,involving 4 treatment measures:conventional therapy,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation and anodic transcranial direct current stimulation.The results of network meta-analysis showed that in terms of improving gross motor function,low-frequency repetitive transcranial magnetic stimulation[mean difference(MD)=9.48,95％confidence interval(CI)(6.61,12.34),P＜0.05]was the most effective.In terms of alleviating spasticity,high-frequency repetitive transcranial magnetic stimulation[MD=-0.63,95％CI(-1.72,0.45),P＜0.05]had the best efficacy.In terms of improving ankle joint range of motion and step speed,transcranial direct current stimulation[MD=2.27,95％CI(1.37,3.17),P＜0.05;MD=0.11,95％CI(0.05,0.17),P＜0.05]was the most effective.CONCLUSION:Existing clinical evidence suggests that low-frequency repetitive transcranial magnetic stimulation has the best therapeutic effect compared with other intervention measures in terms of improving lower limb gross motor function.In terms of reducing spasticity,high-frequency repetitive transcranial magnetic stimulation has a more significant effect.In terms of improving gait,transcranial direct current stimulation has more advantages.

OBJECTIVE:Repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown positive effects in improving gross motor function in children with cerebral palsy.A network meta-analysis was performed to analyze the clinical efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation on the improvement of lower limb motor function and gait in children with cerebral palsy.METHODS:Randomized controlled trials(RCT)about repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor function and gait in children with cerebral palsy were collected from CNKI,WanFang,VIP,SinoMed,PubMed,Web of Science,Medline.The search time limit was from the inception to October 5,2024.After screening literature,extracting data and evaluating the risk of bias of included studies,Stata 15.0 software was used for network meta-analysis,AND GRADE profiler was used for quality evaluation.RESULTS:A total of 19 studies were included,involving 4 treatment measures:conventional therapy,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation and anodic transcranial direct current stimulation.The results of network meta-analysis showed that in terms of improving gross motor function,low-frequency repetitive transcranial magnetic stimulation[mean difference(MD)=9.48,95％confidence interval(CI)(6.61,12.34),P＜0.05]was the most effective.In terms of alleviating spasticity,high-frequency repetitive transcranial magnetic stimulation[MD=-0.63,95％CI(-1.72,0.45),P＜0.05]had the best efficacy.In terms of improving ankle joint range of motion and step speed,transcranial direct current stimulation[MD=2.27,95％CI(1.37,3.17),P＜0.05;MD=0.11,95％CI(0.05,0.17),P＜0.05]was the most effective.CONCLUSION:Existing clinical evidence suggests that low-frequency repetitive transcranial magnetic stimulation has the best therapeutic effect compared with other intervention measures in terms of improving lower limb gross motor function.In terms of reducing spasticity,high-frequency repetitive transcranial magnetic stimulation has a more significant effect.In terms of improving gait,transcranial direct current stimulation has more advantages.

ObjectiveTo find out whether there is any difference in the monitoring results of mosq-ovitraps placed in different orientations in multi-storey residential areas, so as to provide a scientific basis for routine and emergency monitoring of Aedes albopictus with mosq-ovitraps in residential areas. MethodsFrom July 6th to October 26th 2023, one mosquito ovitrap was set up in each of the 4 orientations of east, south, west and north around the buildings in a multi-storey residential area in Jinhui Town, Fengxian District, Shanghai. Data was collected and recorded 72 hours after placement. The chi-square test was used to compare the mosquito ovitrap indices (MOIs) of two independent samples, and the Kruskal⁃Wallis H test was used to compare the MOIs of multiple independent samples. ResultsAfter 16 weeks of surveillance, 997 mosquito ovitraps were recovered, of which 211 were positive, with the mosquito ovitrap index (MOI) of 21.16% and the Aedes albopictus density index of 1.03 mosquitoes·ovitrap^-1. The MOIs were higher in September (24.22%) and October (23.96%), and the MOIs in the west, south and north within the two months were all above 20.00%. From July to October, the MOIs in the east, west, south and north were 20.70%, 22.20%, 25.50% and 16.20%, respectively, and the difference in MOIs among the 4 orientations was not statistically significant (χ²=6.647, P=0.084). Stratified analysis by month showed that in August, the south side of the multi-storey residential areas had the highest MOI (31.30%), the north side had the lowest MOI (1.30%), and there was a statistically significant difference in MOI in the east, west, south and north (χ²=25.986, P<0.001). In October, the MOI in the west was the highest (33.30%) and the MOI in the east was the lowest (6.30%), the difference in MOIs of the 4 orientations was statistically significant (χ²=12.007, P=0.007). The MOIs in the south side of the building in the outskirts of the residential area from the 1st week in July to the 4th week in October was lower (19.20%) than that in the south side of the inner building (31.70%), and the difference in MOI was statistically significant (χ²=5.118, P=0.024). ConclusionThe study of MOI in different orientations in a multi-storey residential area is a preliminary exploration based on field work, and the results show that there is a difference in MOIs in different orientations during the peak breeding period of mosquitoes. Further indicators such as temperature, humidity and wind speed in different orientations can be collected to explore the influencing factors of MOIs.

Objective:To observe the effect of acupuncture-synchronized exercise training on the learning and memory of rats after middle cerebral artery occlusion (MCAO), and to explore its mechanism.Methods:Among sixty 8-week-old SPF-grade Sprague-Dawley male rats, 6 were randomly chosen to form a sham group, and the rest received MCAO. After successful modeling, 18 rats were assigned at random to either the model, asynchronous or synchronous group, each of 6. The asynchronous group received 20 minutes of acupuncture followed by 20 minutes of treadmill training, while the synchronous group received the acupuncture during their treadmill training. There was no special intervention for the sham and model groups. There were 5 sessions/week for 21 days. Neurological deficit in the rats was assessed using Longa scoring 24h after the modeling and after the 21 days. The localization navigation test was performed on days 17-20 of the experiment, and the latency to escape was recorded. A space exploration experiment was performed the next day, and rats were tested for dwell time and the number of transits of the original platform quadrant. After the intervention, the morphology of hippocampal tissue was observed using HE staining. The mitochondria of the rats′ hippocampal neurons were observed using transmission electron microscopy. MDA and SOD levels were recorded. And the protein expression levels of the Parkin, PINK1, LC3-II/ LC3-Ⅰ, P62 and Beclin-1 genes were detected using western blotting.Results:The model group showed significantly higher average Longa scores than the sham group, with less time spent in the target quadrant and fewer crossings of the platform quadrant. The HE staining revealed numerous degenerating neurons, and swollen mitochondria with vacuolization and sparse cristae. There was also a significant decrease in Parkin, PINK1, LC3-II/LC3-I and Beclin-1 expression and in SOD. But there was a significant increase in P62 expression and MDA, on average. Compared with the model group, both the non-synchronous and synchronous groups showed significantly lower average Longa scores, with more time spent in the target quadrant and more platform crossings. Their neuron morphology was close to normal, with more intact cristae and autophagic bodies in the mitochondria. Those groups showed greater Parkin, PINK1, LC3-II/LC3-I and Beclin-1 expression and had higher SOD levels, on average, with significantly lower P62 expression and less MDA. But compared with the non-synchronous group, the synchronous group spent more time in the target quadrant and had significantly more platform crossings. LC3-II/LC3-I and Beclin-1 expression were higher, on average, as were SOD levels. P62 expression and MDA levels were significantly lower.Conclusions:Acupuncture synchronized with exercise improves the learning and memory of rates after MCAO. The mechanism may be related to reducing oxidative stress levels and activating mitochondrial autophagy.

Objective To explore the significance of detecting serum semaphorin 4D(Sema4D),soluble growth-stimulation expression gene 2 protein(sST2),and Omentin-1 in patients with hypertrophic cardiomyopathy(HCM)accompanied by atrial fibrillation(AF),and to provide reference for clinical diagnosis and treatment.Methods A total of 90 patients with HCM and atrial fibrillation admitted to Tsinghua University Yuquan Hospital(Tsinghua University Integrated Traditional Chinese and Western Medicine Hospital)from January 2022 to December 2023 were selected as the HCM-AF group,and another 90 patients with sinus rhythm HCM in the same stage were selected as the sinus rhythm HCM group.The serum levels of Sema4D,sST2,Omentin-1 and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)]were compared between the two groups.The correlation between serum Sema4D,sST2,Omentin-1 and cardiac function indicators,as well as the severity of atrial fibrillation in HCM was analyzed.The predictive value of three indicators for atrial fibrillation in HCM was analyzedand the predictive efficacy of percutaneous radiofrequency ablation(PRFA)for the recurrence of atrial fibrillation in HCM patients.Results The serum levels of Sema4D and sST2 in the HCM-AF group were higher than those in the sinus rhythm HCM group,while the levels of Omentin-1 and LVEF were lower than those in the sinus rhythm HCM group,with statistically significant differences(t=2.517～12.325,all P<0.05).The serum levels of Sema4D and sST2 in the persistent subgroup were higher than those in the paroxysmal subgroup,while the levels of Omentin-1 and LVEF were lower than those in the paroxysmal subgroup,the differences were statistically significant(t=2.635～15.931,all P<0.05).Spearman/Pearson correlation analysis showed that serum Sema4D and sST2 were negatively correlated with LVEF(r=-0.57,-0.609,all P<0.001),while Omentin-1 was positively correlated with LVEF(r=0.593,P<0.001).Serum Sema4D and sST2 were positively correlated with the severity of AF in HCM(r=0.625,0.631,all P<0.001),while Omentin-1 was negatively correlated with the severity of AF in HCM(r=-0.617,P<0.001).The serum levels of Sema4D and sST2 in the recurrence subgroup were higher than those in the non-recurrence subgroup,while the serum level of Omentin-1 was lower(t=12.805,7.049,13.345,all P<0.05).The receiver operator characteristic(ROC)curve results showed that the AUC(95%CI)of serum Sema4D,sST2 and Omentin-1 combined to predict atrial fibrillation in HCM was 0.916(0.865～0.952),higher than the individual predictions of the three(Z=3.621,3.657,0.318,all P<0.05).The AUC(95%CI)of serum Sema4D,sST2 and Omentin-1 combined to predict the recurrence of atrial fibrillation in patients with HCM after radiofrequency ablation was 0.931(0.857～0.973),higher than the individual predictions of the three(Z=4.115,3.657,3.853,all P<0.05).Conclusion The levels of serum Sema4D and sST2 in the serum of patients with HCM complicated with atrial fibrillation were elevated,while the level of Omentin-1 was drcreased.Detecting serum Sema4D,sST2 and Omentin-1 has high performance in predicting the occurrence of atrial fibrillation in patients with HCM and the recurrence of atrial fibrillation after radiofrequency ablation therapy.

Objective To observe the correlations of metabolite levels in medial prefrontal cortex(mPFC)and cancer-related depression(CRD)in patients with non-small cell lung cancer(NSCLC).Methods Totally 38 NSCLC patients were prospectively enrolled and divided into CRD group(n=23)and non CRD group(n=15)based on Hamilton depression scale(HAMD-17).Meanwhile,22 healthy individuals were taken as control group.1 H-MR spectroscopy was performed using Meshcher-Garwood point resolved spectroscopy sequence,then metabolite levels of mPFC were measured,and their correlations with HAMD-17 score were analyzed.Results Significant differences of gamma-aminobutyric acid(GABA)+/Water and glutamate/glutamine complex(Glx)/Water in mPFC were found among 3 groups.GABA+/Water in mPFC of CRD group was significantly lower than that of the other 2 groups(both P＜0.05),and Glx/Water in mPFC of CRD group was significantly lower than that of control group(P=0.034).In NSCLC patients,GABA+/Water in mPFC was negatively correlated with HAMD-17 score(r=-0.491,P=0.002).Conclusion GABA+/Water in mPFC was negatively correlated with HAMD-17 score in NSCLC patients.

OBJECTIVE To standardize the main processes and related technical links of the clinical comprehensive evaluation of drugs， and provide guidance and reference for improving the quality of comprehensive evaluation evidence and its transformation and application value. METHODS The construction of Guideline for the Workflow of Clinical Comprehensive Evaluation of Drugs was based on the standard guideline formulation method of the World Health Organization （WHO）， strictly followed the latest definition of guidelines by the Institute of Medicine of the National Academy of Sciences of the United States， and conformed to the six major areas of the Guideline Research and Evaluation Tool Ⅱ. Delphi method was adopted to construct the research questions； research evidence was established by applying the research methods of evidence-based medicine. The evidence quality classification system of the Chinese Evidence-Based Medicine Center was adopted for evidence classification and evaluation. The recommendation strength was determined by the recommendation strength classification standard formulated by the Oxford University Evidence-Based Medicine Center， and the recommendation opinions were formed through the expert consensus method. RESULTS & CONCLUSIONS The Guideline for the Workflow of Clinical Comprehensive Evaluation of Drugs covers 4 major categories of research questions， including topic selection， evaluation implementation， evidence evaluation， and application and transformation of results. The formulation of this guideline has standardized the technical links of the entire process of clinical comprehensive evaluation of drugs， which can effectively guide the high-quality and high-efficient development of this work， enhance the standardized output and transformation application value of evaluation evidence， and provide high-quality evidence support for the scientific decision-making of health and the rationalization of clinical medication.

OBJECTIVE To explore the effects of meropenem exposure and degradation levels on clinical efficacy in patients with purulent meningitis （PM）. METHODS A total of 131 PM patients treated with meropenem at the Affiliated Suzhou Hospital of Nanjing Medical University from January 2022 to June 2025 were prospectively included. Relevant data were collected and divided into a cured group （91 cases） and a non-cured group （40 cases） based on the efficacy. High-performance liquid chromatography-tandem mass spectrometry was used to determine the concentration of meropenem and its open-loop metabolites. Risk factors that affect efficacy were screened， and their predictive power and correlation were evaluated by univariate analysis， and multivariate Logistic regression analysis， receiver operating characteristic （ROC） curves， and correlation analysis. RESULTS Univariate analysis showed that serum creatinine， creatinine clearance rate， minimum inhibitory concentration of meropenem ≥16 μg/mL， cerebrospinal fluid red blood cell count， cerebrospinal fluid white blood cell count， cerebrospinal fluid glucose content， blood trough concentration， blood open-loop metabolite concentration/trough concentration ratio， and intrathecal injection were all correlated with efficacy （P＜0.05）. The results of multiple Logistic regression analysis showed that serum creatinine blood open-loop metabolite concentration/trough concentration ratio， intrathecal injection， and cerebrospinal fluid glucose content were influencing factors for suboptimal anti-infective ltt efficacy （P＜0.05）. ROC curve analysis showed that when the blood open-loop metabolite concentration/trough concentration ratio was greater than 2.854 （AUC＝0.647）， serum creatinine was less than 59.5 μmol/L （AUC＝0.647）， and cerebrospinal fluid glucose content was less than 3.37 mmol/L （AUC＝0.709）， the risk of treatment failure significantly increased （P＜0.05）. Correlation analysis showed that the blood trough concentration of meropenem was positively correlated with the concentration of its open-loop metabolites （R 2＝0.134 5， P＜0.000 1）. CONCLUSIONS Insufficient exposure level and rapid degradation of meropenem are key mechanisms affecting the anti-infective efficacy of PM. Elevated blood open-loop metabolite concentration/ trough concentration ratio， low serum creatinine level， lack of intrathecal injection， and low cerebrospinal fluid glucose content are independent risk factors for poor efficacy.

Aeromedical evacuation, a crucial method for casualty transport, significantly enhances survival rates by providing exceptionally rapid transfer and thus gaining valuable treatment time. However, due to the contamination risks during the transport of radioactively contaminated casualties, aeromedical evacuation has not been widely adopted for this specific scenario. This paper reviews the current status of aeromedical evacuation for radioactively contaminated casualties and identifies several challenges. These include incomplete evacuation procedures and regulatory frameworks, difficulties in rapid triage and classification, inadequate evacuation and loading equipment, and the complexity of managing specific injuries during flight. We propose corresponding strategies to address these issues, aiming to provide a reference and guidance for the advancement of aeromedical evacuation for radioactively contaminated casualties.

Objective To explore the significance of detecting serum semaphorin 4D(Sema4D),soluble growth-stimulation expression gene 2 protein(sST2),and Omentin-1 in patients with hypertrophic cardiomyopathy(HCM)accompanied by atrial fibrillation(AF),and to provide reference for clinical diagnosis and treatment.Methods A total of 90 patients with HCM and atrial fibrillation admitted to Tsinghua University Yuquan Hospital(Tsinghua University Integrated Traditional Chinese and Western Medicine Hospital)from January 2022 to December 2023 were selected as the HCM-AF group,and another 90 patients with sinus rhythm HCM in the same stage were selected as the sinus rhythm HCM group.The serum levels of Sema4D,sST2,Omentin-1 and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)]were compared between the two groups.The correlation between serum Sema4D,sST2,Omentin-1 and cardiac function indicators,as well as the severity of atrial fibrillation in HCM was analyzed.The predictive value of three indicators for atrial fibrillation in HCM was analyzedand the predictive efficacy of percutaneous radiofrequency ablation(PRFA)for the recurrence of atrial fibrillation in HCM patients.Results The serum levels of Sema4D and sST2 in the HCM-AF group were higher than those in the sinus rhythm HCM group,while the levels of Omentin-1 and LVEF were lower than those in the sinus rhythm HCM group,with statistically significant differences(t=2.517～12.325,all P<0.05).The serum levels of Sema4D and sST2 in the persistent subgroup were higher than those in the paroxysmal subgroup,while the levels of Omentin-1 and LVEF were lower than those in the paroxysmal subgroup,the differences were statistically significant(t=2.635～15.931,all P<0.05).Spearman/Pearson correlation analysis showed that serum Sema4D and sST2 were negatively correlated with LVEF(r=-0.57,-0.609,all P<0.001),while Omentin-1 was positively correlated with LVEF(r=0.593,P<0.001).Serum Sema4D and sST2 were positively correlated with the severity of AF in HCM(r=0.625,0.631,all P<0.001),while Omentin-1 was negatively correlated with the severity of AF in HCM(r=-0.617,P<0.001).The serum levels of Sema4D and sST2 in the recurrence subgroup were higher than those in the non-recurrence subgroup,while the serum level of Omentin-1 was lower(t=12.805,7.049,13.345,all P<0.05).The receiver operator characteristic(ROC)curve results showed that the AUC(95%CI)of serum Sema4D,sST2 and Omentin-1 combined to predict atrial fibrillation in HCM was 0.916(0.865～0.952),higher than the individual predictions of the three(Z=3.621,3.657,0.318,all P<0.05).The AUC(95%CI)of serum Sema4D,sST2 and Omentin-1 combined to predict the recurrence of atrial fibrillation in patients with HCM after radiofrequency ablation was 0.931(0.857～0.973),higher than the individual predictions of the three(Z=4.115,3.657,3.853,all P<0.05).Conclusion The levels of serum Sema4D and sST2 in the serum of patients with HCM complicated with atrial fibrillation were elevated,while the level of Omentin-1 was drcreased.Detecting serum Sema4D,sST2 and Omentin-1 has high performance in predicting the occurrence of atrial fibrillation in patients with HCM and the recurrence of atrial fibrillation after radiofrequency ablation therapy.