Objective To explore the effect of transcutaneous auricular vagus nerve stimulation(taVNS)combined with dual-task training(DTT)on upper limb function recovery in patients with ischemic stroke.Methods From January to October,2024,60 ischemic stroke patients with upper limb dysfunction admitted to Zhejiang Rehabilitation Medical Center were selected and randomly divided into control group(n=30)and observation group(n=30).Both groups received conventional rehabilitation training.The control group underwent sham-taVNS combined with DTT,while the observation group received active taVNS combined with DTT,for four weeks.Before and after treatment,they were assessed with Fugl-Meyer Assessment-Upper Extremities(FMA-UE),Action Research Arm Test(ARAT),modified Barthel Index(MBI)and motor-evoked potential(MEP)tests.Results The FMA-UE scores,ARAT scores,MBI scores,MEP amplitude and MEP latency improved in both groups af-ter treatment(|t|>3.670,P<0.01),and were superior in the observation group than in the control group(|t|>3.081,P<0.01).Conclusion The combination of taVNS and DTT can significantly improve upper limb function,enhance activities of daily living,and promote neurological recovery in patients with ischemic stroke.

Objective To investigate the value of MRI radiomics for the preoperative noninvasive prediction of isocitrate dehydrogenase(IDH)mutation status in glioma.Methods Totally,306 glioma patients were retrospectively selected.All patients were randomly assigned into training group(n=214)and validation group(n=92)at a ratio of 7∶3.Region of interest(ROI)was manually delineated by two radiologists independently on the fluid attenuated inversion recovery(FLAIR)and contrast enhanced(CE)MRI images for obtaining whole volume of interest(VOI)of lesion.A total of 851 radiomics features were extracted from the VOI,respectively.The least absolute shrinkage and selection operator(LASSO)method was used for features dimension reduction combing 10-fold cross validation.Three Radiomics score(Radscore)were calculated by linear combination of retained features and their corresponding coefficients.The optimal Radscore and clinical characteristics were incorporated to perform logistic regression analysis for establishing the IDH mutation status noninvasive prediction model.A nomogram was plotted for realizing the visualization of model.The receiver operating characteristic(ROC)curve was plotted to evaluate the prediction performance of model.The calibration and clinical utility of the model were evaluated by calibration curve and decision curve.Results The area under the curve(AUC)of Radscore-combined based on combination of two sequences was 0.856 in the training group,which was superior to the Radscore-CE(AUC=0.821),Radscore-FLAIR(AUC=0.766)from single sequence,with consistent result in the validation group.The addition of clinical characteristics to the model improved predictive value with AUC,sensitivity and specificity of 0.898,79.59％,90.52％in the training group.Conclusion The radiomics model based on FLAIR and CE MRI contributes to preoperative noninvasive prediction of IDH mutation status in glioma.The combination of multi-sequence and the addition of clinical characteristics can improve the prediction performance.

OBJECTIVES: This study aimed to investigate the perception of dental outpatient care quality from multiple perspectives of administrators, physicians, nurses, and patients and propose nursing care quality evaluation indices that are consistent with the clinical reality to provide reference for the construction of a scientific, systematic, and comprehensive dental outpatient care quality evaluation system. METHODS: A total of 39 interviewees, including 7 administrators, 11 doctors, 11 nurses, and 10 patients, were selected for semi-structured in-depth interviews in five regionally representative tertiary-level A stomatological specialty hospitals nationwide during January-April 2024 by using a multistage sampling method. Colaizzi 7-step analysis was used to analyze and summarize the interview data. Themes were extracted on the basis of the Structure-Process-Outcome (SPO) three-dimensional quality assessment model. RESULTS: Five main themes and 15 secondary themes were extracted from three quality dimensions: structure, process, and result. The related topics of structural quality were as follows: disinfection and isolation norms, equipment and consumable management, nursing manpower ratio and nurse education structure, and emergency capability. The related topics of process quality were as follows: pre-diagnosis risk assessment, patient triage and guidance, communication and attitude, health education, humanistic care, continuous care, specialty operation, and four-hand operation. The related topics of result quality were as follows: satisfaction, adverse event management and analysis, effective complaints and disputes. CONCLUSIONS Structure quality is the foundation, process quality is the core, and result quality is the key in the evaluation of the quality of oral outpatient care. The standardization of disinfection and isolation, equipment and consumable management, allocation of reasonable nursing manpower and post capacity, implementation of high-quality nursing services, and improvement of the quality and satisfaction of medical cooperation are necessary guarantees to ensure the quality of oral outpatient care.
Humans ; Quality of Health Care ; Ambulatory Care/standards* ; Dental Care/standards* ; Outpatients

OBJECTIVES: This study aimed to construct an evaluation index system for nursing quality management in outpatient dental clinics based on the structure-process-outcome model and provide an objective standard for the evaluation of nursing quality in outpatient dental clinics. METHODS: Through literature review, multi-subject interviews, and expert meetings, the first draft of the evaluation index for nursing quality management in outpatient dental clinics was formulated. The Delphi method was adopted to select and invite 15 experts in the fields of hospital infection management, nursing management, and specialized oral care from across the country to modify the first draft. RESULTS: The positive coefficients of the experts in the two rounds of consultation were 86.7% and 92.3%, respectively. The total authority coefficients of the experts were 0.791 and 0.717, respectively. The mean scores of the importance and feasibility of the third-level indices in the two rounds of consultation were all ≥4.333; the coefficients of variation were all ≤0.150; and the Kendall's coordination coefficients were 0.308 and 0.184 respectively, with P<0.05 for all. These results indicated that the experts were motivated to participate in this study. They recognized the importance and feasibility of the overall items in this index system, and their opinions were relatively consistent. Finally, an evaluation index system, which included 3 first-level indices, 7 second-level indices, 22 third-level indices, and 69 index connotations, for nursing quality management in outpatient dental clinics was determined. The weights of the three first-level indicators were all 0.333. Patient satisfaction (0.076, outcome dimension), hand hygiene (0.061, outcome dimension), chair care ratio (0.057, structural dimension), and turnover rate (0.057, structural dimension) were the top tertiary indicators in terms of portfolio weight. CONCLUSIONS The construction method of the evaluation index system for nursing quality management in outpatient dental clinics is scientific and reliable. It can provide a reference for the evaluation of the management level of nursing quality in outpatient dental clinics and promote the continuous improvement of nursing quality in outpatient dental clinics.
Humans ; Dental Clinics ; Delphi Technique

Increasing evidence shows that the early lesions of Parkinson's disease (PD) originate from gut, and correction of microbiota dysbiosis is a promising therapy for PD. FLZ is a neuroprotective agent on PD, which has been validated capable of alleviating microbiota dysbiosis in PD mice. However, the detailed mechanisms still need elucidated. Through metabolomics and 16S rRNA analysis, we identified glycoursodeoxycholic acid (GUDCA) was the most affected differential microbial metabolite by FLZ treatment, which was specially and negatively regulated by Clostridium innocuum, a differential microbiota with the strongest correlation to GUDCA production, through inhibiting bile salt hydrolase (BSH) enzyme. The protection of GUDCA on colon and brain were also clarified in PD models, showing that it could activate Nrf2 pathway, further validating that FLZ protected dopaminergic neurons through promoting GUDCA production. Our study uncovered that FLZ improved PD through microbiota-gut-brain axis, and also gave insights into modulation of microbial metabolites may serve as an important strategy for treating PD.

Although enteric glial cell (EGC) abnormal activation is reported to be involved in the pathogenesis of Parkinson's disease (PD), and inhibition of EGC gliosis alleviated gut and dopaminergic neuronal dysfunction was verified in our previous study, the potential role of gut microbiota on EGC function in PD still need to be addressed. In the present study, fecal microbiota transplantation revealed that EGC function was regulated by gut microbiota. By employing 16S rRNA and metabolomic analysis, we identified that 3-indolepropionic acid (IPA) was the most affected differential microbial metabolite that regulated EGC gliosis. The protective effects of IPA on PD were validated in rotenone-stimulated EGCs and rotenone (30 mg/kg i.g. for 4 weeks)-induced PD mice, as indicated by decreased inflammation, improved intestinal and brain barrier as well as dopaminergic neuronal function. Mechanistic study showed that IPA targeted pregnane X receptor (PXR) in EGCs, and inhibition of IL-13Rα1 involved cytokine-cytokine receptor interaction pathway, leading to inactivation of downstream JAK1-STAT6 pathway. Our data not only provided evidence that EGC gliosis was critical in spreading intestinal damage to brain, but also highlighted the potential role of microbial metabolite IPA in alleviating PD pathological damages through gut-brain axis.

[This corrects the article DOI: 10.1016/j.apsb.2025.02.029.].

Objective To analyze the medication rules of Chinese herbal concentrated-granule for the treatment of hypertension nationwide using data mining and knowledge graph methods,thus to provide evidence for expanding its application in treating hypertension.Methods From January 2022 to March 2023,Chinese herbal concentrated-granule prescriptions for hypertension prescribed by traditional Chinese medicine experts nationwide were collected.Microsoft Excel was used to analyze the frequency,properties and flavors,meridian tropism,and efficacy categories of the medicinals.Hierarchical clustering was applied for cluster analysis,and the Neo4j graph database was utilized to construct an information knowledge graph illustrating the relationships between regions and medicinals.Results A total of 2 600 Chinese herbal concentrated-granule prescriptions were included,involving 370 medicinals.The top six frequently-used medicinals were Poria(Fuling),Glycyrrhizae Radix et Rhizoma(Gancao),Atractylodis Macrocephalae Rhizoma(Baizhu),Citri Reticulatae Pericarpium(Chenpi),Paeoniae Radix Alba(Baishao),and Angelicae Sinensis Radix(Danggui).The properties of the medicinals were mainly warm and mild,and their flavors were usually sweet,pungent,and bitter.The medicinals frequently have the meridian tropism of the spleen,lung,and liver meridians.Hierarchical clustering yielded seven clusters.The information knowledge graph of region-medicinals relationships revealed that medicinals used in five or more regions were Baishao,Baizhu,Chenpi,Pinelliae Rhizoma(Banxia),Fuling,Gastrodiae Rhizoma(Tianma),Bupleuri Radix(Chaihu),Chuanxiong Rhizoma(Chuanxiong),Salviae Miltiorrhizae Radix et Rhizoma(Danshen),Danggui,Gancao,and Astragali Radix(Huangqi).Conclusion Chinese herbal concentrated-granule for hypertension usually consist of tonifying medicinals,with sweet and warm properties,and having the meridian tropism of the spleen meridian.And the medicinals composed of the prescriptions often have the actions of calming the liver and suppressing yang,strengthening the spleen and removing dampness,and nourishing the liver and kidney.

Objective To explore the effect of transcutaneous auricular vagus nerve stimulation(taVNS)combined with dual-task training(DTT)on upper limb function recovery in patients with ischemic stroke.Methods From January to October,2024,60 ischemic stroke patients with upper limb dysfunction admitted to Zhejiang Rehabilitation Medical Center were selected and randomly divided into control group(n=30)and observation group(n=30).Both groups received conventional rehabilitation training.The control group underwent sham-taVNS combined with DTT,while the observation group received active taVNS combined with DTT,for four weeks.Before and after treatment,they were assessed with Fugl-Meyer Assessment-Upper Extremities(FMA-UE),Action Research Arm Test(ARAT),modified Barthel Index(MBI)and motor-evoked potential(MEP)tests.Results The FMA-UE scores,ARAT scores,MBI scores,MEP amplitude and MEP latency improved in both groups af-ter treatment(|t|>3.670,P<0.01),and were superior in the observation group than in the control group(|t|>3.081,P<0.01).Conclusion The combination of taVNS and DTT can significantly improve upper limb function,enhance activities of daily living,and promote neurological recovery in patients with ischemic stroke.

Objective To investigate the value of MRI radiomics for the preoperative noninvasive prediction of isocitrate dehydrogenase(IDH)mutation status in glioma.Methods Totally,306 glioma patients were retrospectively selected.All patients were randomly assigned into training group(n=214)and validation group(n=92)at a ratio of 7∶3.Region of interest(ROI)was manually delineated by two radiologists independently on the fluid attenuated inversion recovery(FLAIR)and contrast enhanced(CE)MRI images for obtaining whole volume of interest(VOI)of lesion.A total of 851 radiomics features were extracted from the VOI,respectively.The least absolute shrinkage and selection operator(LASSO)method was used for features dimension reduction combing 10-fold cross validation.Three Radiomics score(Radscore)were calculated by linear combination of retained features and their corresponding coefficients.The optimal Radscore and clinical characteristics were incorporated to perform logistic regression analysis for establishing the IDH mutation status noninvasive prediction model.A nomogram was plotted for realizing the visualization of model.The receiver operating characteristic(ROC)curve was plotted to evaluate the prediction performance of model.The calibration and clinical utility of the model were evaluated by calibration curve and decision curve.Results The area under the curve(AUC)of Radscore-combined based on combination of two sequences was 0.856 in the training group,which was superior to the Radscore-CE(AUC=0.821),Radscore-FLAIR(AUC=0.766)from single sequence,with consistent result in the validation group.The addition of clinical characteristics to the model improved predictive value with AUC,sensitivity and specificity of 0.898,79.59％,90.52％in the training group.Conclusion The radiomics model based on FLAIR and CE MRI contributes to preoperative noninvasive prediction of IDH mutation status in glioma.The combination of multi-sequence and the addition of clinical characteristics can improve the prediction performance.