Epidural spinal cord stimulation (eSCS) represents an emerging neuromodulation technology that ameliorates motor dysfunction in patients with spinal cord injury, Parkinson's disease, and stroke by activating sensory afferent fibers, enhancing spinal cord neural network integration, optimizing brain-spinal cord information transmission, and inducing neural plasticity. This article reviews the mechanism, electrode implantation, and stimulation parameter of eSCS, and application of eSCS in spinal cord injury, Parkinson's disease, and stroke, aiming to provide valuable insight for its clinical implementation.

Objective:Based on the process theory of stress effect, the mediating effect of health literacy and perceived social support between perceived control and fatigue symptom of asthmatic patients was analyzed, which provide the evidence for the formulation of intervention programs to relieve fatigue in patients.Methods:Adopting a cross-sectional survey design, from January 2019 to November 2023, asthmatic patients at The First Affiliated Hospital of Anhui Medical University (Feidong County People′s Hospital) were selected by convenience sampling method and investigated by the General Information Questionnaire, Fatigue Severity Scale, Perceived Control of Asthma Questionnaire, Health Literacy Management Scale, and Perceived Social Support Scale. Pearson correlation analysis was used to investigate the correlation between fatigue symptom, perceived control, health literacy, and perceived social support in asthma patients. A structural equation model was constructed using AMOS24.0 software and conduct mediation analysis.Results:A total of 260 questionnaires were distributed, and 241 valid questionnaires were collected. There were 110 males and 131 females aged (55.48 ± 15.03) years old. The scores of Fatigue Severity Scale, Perceived Control of Asthma Questionnaire, Health Literacy Management Scale, and Perceived Social Support Scale were (4.27 ± 1.68), (31.72 ± 8.51), (85.71 ± 19.36), (46.97 ± 11.79) points, respectively. Pearson correlation analysis showed that fatigue symptom was negatively correlated with perceived control, health literacy, and perceived social support ( r=-0.719, -0.716, -0.767, all P<0.01). The mediating model showed that perceived control had a significant direct effect on fatigue symptom ( β=-0.204, 95% CI-0.252--0.169). Moreover, perceived control also indirectly affected fatigue symptom through the independent mediating effect of health literacy ( β=-0.378, 95% CI-0.405--0.202), the independent mediating effect of perceived social support ( β=-0.227, 95% CI-0.381--0.203), and the chain mediating effect of health literacy and perceived social support ( β=-0.089, 95% CI-0.142--0.025), which accounting for 77.3% of the total effect. Conclusions:Health literacy and perceived social support play a mediating role in the correlation between perceived control and fatigue symptom, which can promote health literacy and perceived social support and thus alleviate fatigue symptom in asthmatic patients.

Objective:Based on the process theory of stress effect, the mediating effect of health literacy and perceived social support between perceived control and fatigue symptom of asthmatic patients was analyzed, which provide the evidence for the formulation of intervention programs to relieve fatigue in patients.Methods:Adopting a cross-sectional survey design, from January 2019 to November 2023, asthmatic patients at The First Affiliated Hospital of Anhui Medical University (Feidong County People′s Hospital) were selected by convenience sampling method and investigated by the General Information Questionnaire, Fatigue Severity Scale, Perceived Control of Asthma Questionnaire, Health Literacy Management Scale, and Perceived Social Support Scale. Pearson correlation analysis was used to investigate the correlation between fatigue symptom, perceived control, health literacy, and perceived social support in asthma patients. A structural equation model was constructed using AMOS24.0 software and conduct mediation analysis.Results:A total of 260 questionnaires were distributed, and 241 valid questionnaires were collected. There were 110 males and 131 females aged (55.48 ± 15.03) years old. The scores of Fatigue Severity Scale, Perceived Control of Asthma Questionnaire, Health Literacy Management Scale, and Perceived Social Support Scale were (4.27 ± 1.68), (31.72 ± 8.51), (85.71 ± 19.36), (46.97 ± 11.79) points, respectively. Pearson correlation analysis showed that fatigue symptom was negatively correlated with perceived control, health literacy, and perceived social support ( r=-0.719, -0.716, -0.767, all P<0.01). The mediating model showed that perceived control had a significant direct effect on fatigue symptom ( β=-0.204, 95% CI-0.252--0.169). Moreover, perceived control also indirectly affected fatigue symptom through the independent mediating effect of health literacy ( β=-0.378, 95% CI-0.405--0.202), the independent mediating effect of perceived social support ( β=-0.227, 95% CI-0.381--0.203), and the chain mediating effect of health literacy and perceived social support ( β=-0.089, 95% CI-0.142--0.025), which accounting for 77.3% of the total effect. Conclusions:Health literacy and perceived social support play a mediating role in the correlation between perceived control and fatigue symptom, which can promote health literacy and perceived social support and thus alleviate fatigue symptom in asthmatic patients.

Epidural spinal cord stimulation (eSCS) represents an emerging neuromodulation technology that ameliorates motor dysfunction in patients with spinal cord injury, Parkinson's disease, and stroke by activating sensory afferent fibers, enhancing spinal cord neural network integration, optimizing brain-spinal cord information transmission, and inducing neural plasticity. This article reviews the mechanism, electrode implantation, and stimulation parameter of eSCS, and application of eSCS in spinal cord injury, Parkinson's disease, and stroke, aiming to provide valuable insight for its clinical implementation.

Objective To investigate the immediate brain effect of acupuncture at Fengchi using amplitude of low-frequency fluctuation(ALFF)and functional connectivity by the resting-state functional magnetic resonance imaging(rs-fMRI)in patients with posterior circulation ischemia vertigo(PCIV).Methods Twenty patients with PCIV were enrolled.The dizziness handicap inventory(DHI)was used to evaluate the severity of vertigo.The patients were randomly divided into acupuncture group and sham acupoint acupuncture group.Rs-fMRI scan was performed before and after acupuncture.MATLAB-based DPABI 6.1 software was used to analyze rs-fMRI data.Correlation analysis was used between the altered ALFF values and DHI scores.The regions of altered ALFF were taken as seeds to analyze functional connectivity.Results Compared with the sham acupoint acupuncture group,the increased ALFF values were mainly located on the left precuneus,left superior frontal gyrus and left caudate nucleus after acupuncture in the acupuncture group;the decreased ALFF values were mainly located on the left cerebellum and right inferior occipital gyrus.The ALFF value of the left superior frontal gyrus was negatively correlated with the DHI score(P=0.04).The increased functional connectivity was mainly found between left precuneus and the right middle frontal gyrus,the right superior frontal gyrus,the decreased functional connectivity was mainly found between left precuneus and the bilateral paracentral lobule and right cerebellum.Conclusion The ALFF value and functional connectivity are different before and after acupuncture,indicating that the vestibular network,visual and motor brain regions functional activities are changed after needling at Fengchi,which may be the brain functional basis of Fengchi for vertigo in PCIV.

Objective:To develop a recombinant protein vaccine based on KPC-2, a drug resistance target in Klebsiella pneumoniae, and evaluate its immunogenicity, protective efficacy and mechanism in a mouse model of pneumonia. Methods:KPC-2 was expressed in Escherichia coli and purified using GST affinity chromatography. A recombinant protein vaccine was prepared with KPC-2 and used to immunize New Zealand rabbits through subcutaneous injection. Serum samples were isolated from cardiac blood and Protein G chromatography was used to purify polyclonal antibodies against KPC-2. Opsonophagocytic killing assay was used to assess the bactericidal activity of the polyclonal antibodies in vitro. Female BALB/c mice were immunized three times with the recombinant protein vaccine, and the titers of specific IgG antibodies in serum were measured by indirect ELISA. One week after the last vaccination, the mice were infected with Klebsiella pneumoniae strain SRT through tracheal intubation, and received a single intravenous dose of meropenem (0.1 mg) 1 h later. The protective efficacy of the KPC-2 recombinant protein vaccine was evaluated by comparing the survival rates, bacterial colonization and histopathological changes between vaccine group and adjuvant group as well as the survival rates between meropenem group and normal saline group. Moreover, the protective efficacy of polyclonal antibodies against KPC-2 was evaluated through passive immunization. Results:The level of specific IgG antibodies in serum was significantly higher in the vaccine group than in the adjuvant group ( t=4.325, P<0.05). The survival rate in the vaccine group was also higher than that of the adjuvant group [70% (7/10) vs 10% (1/10), P<0.05]. Furthermore, lung inflammation was less severe and bacterial burden was reduced in the vaccine group as compared with those of the control group ( t=3.127, P<0.05). Both active and passive vaccination strategies demonstrated strong protective efficacy against Klebsiella pneumoniae infection, and had a synergistic effect when used in combination with antibiotic therapy. The polyclonal antibodies against KPC-2 had bactericidal activity in vitro ( t=5.427, P<0.05). Conclusions:The prepared KPC-2 vaccine has better immunogenicity and protective efficacy. It can induce strong humoral immune responses. This study suggest that drug resistance target may be used as a candidate antigen for future vaccine development.

Following the principles of evidence-based medicine,in accordance with the structure and drafting rules of standardized documents,based on literature research,according to the characteristics of chronic cough in children and issues that need to form a consensus,the TCM Guidelines for Diagnosis and Treatment of Chronic Cough in Children was formulated based on the Delphi method,expert discussion meetings,and public solicitation of opinions.The guideline includes scope of application,terms and definitions,eti-ology and diagnosis,auxiliary examination,treatment,prevention and care.The aim is to clarify the optimal treatment plan of Chinese medicine in the diagnosis and treatment of this disease,and to provide guidance for improving the clinical diagnosis and treatment of chronic cough in children with Chinese medicine.

Objective To investigate the value of human papilloma virus(HPV)DNA,HPV E6/E7 protein and thin-prep cytology test(TCT)in cervical intraepithelial neoplasia(CIN)and cervical cancer screening.Methods A total of 190 adult women who received early cervical cancer screening in Department of Gynecology,Zhuji People's Hospital from July 2021 to June 2022 were selected as the study objects.HPV DNA,HPV E6/E7 protein and TCT were detected,respectively,and further colposcopic biopsy was performed.The diagnostic efficacy of HPV DNA,HPV E6/E7 protein and TCT in patients with different lesions were compared.Results The positive rates of HPV DNA,HPV E6/E7 protein,TCT and combined detection in CIN3 and cervical cancer patients were significantly higher than those in cervicitis patients(P<0.05).The positive rates of HPV DNA,HPV E6/E7 protein,TCT and combined detection in cervical cancer patients were significantly higher than those in CIN1 patients(P<0.05).The positive rates of HPV DNA,HPV E6/E7 protein,TCT and combined detection in CIN2+ patients were significantly higher than those in CIN1-patients.The sensitivity,specificity,positive predictive value and negative predictive value of HPV DNA,HPV E6/E7 protein and TCT in the diagnosis of high-grade lesions were 90.80%,30.10%,52.32%and 79.48%,respectively.Conclusion HPV DNA,HPV E6/E7 protein and TCT can be used as screening methods for cervical cancer and precancerous lesions,with the combination of the three being the most sensitive.

Objective:To explore the effects of “Internet plus” management based on attention-interest-search-action-share (AISAS) mode on health-promoting lifestyles in young and middle-aged patients with hypertension.Methods:A prospective randomized controlled trial was used by this study, 212 young and middle-aged patients with hypertension from Cardiovascular Medicine Department of the First Affiliated Hospital of Nanchang University were divided into"Internet plus"management group and routine management group according to the random number table method between January 2021 and January 2023, 106 cases in each group. The regular management group were given regular management intervention, and the “Internet plus” management group were used the “Internet plus” management model intervention based on the AISAS model, each lasting 12 months. All patients were intervened for 12 months. At 1d before discharge, 6 months and 12 months after discharge, health-promoting lifestyles were evaluated by Chinese version of Health Promotion Lifestyle Scale (HPLP-IIC), quality of life were evaluated by the 36-item shot-form health status survey (SF-36), and treatment compliance were evaluated by therapeutic adherence scare for hypertensive patients (TASHP).Results:With discharge time, scores of HPLP-IIC, SF-36 and TASHP were significantly increased in both groups (all P<0.05). At 6 and 12 months after discharge, the scores of HPLP-IIC [(117.58±16.43) and (134.37±20.25) points], SF-36 [(79.58±5.43) and (84.37±3.25) points] and TASHP [(101.84±6.32) and (115.37±4.25) points] in “Internet plus” management group were significantly higher than those in routine management group [HPLP-IIC: (96.25±13.74) and (108.05±14.73) points, SF-36: (61.25±5.09) and (78.05±4.37) points, TASHP: (81.05±5.37) and (94.68±3.37) points] (all P<0.001), while systolic blood pressure (SBP) [(128.52±4.02) and (126.81±2.34) mmHg (1 mmHg=0.133 kPa)] and diastolic blood pressure (DBP) [(81.84±6.32) and (79.37±4.25) mmHg] were significantly lower than those in routine management group [SBP: (133.09±5.16) and (133.35±2.57) mmHg, DBP: (85.68±7.15) and (86.05±5.37) mmHg](all P<0.001). And, decrease of SBP [6 months: (-4.43±1.19) and (-6.14±2.01) mmHg] and DBP [6 months: (-3.75±1.71) and (-6.22±2.38) mmHg] in “Internet plus” management group were significantly higher than those in routine management group [SBP: (-1.28±0.75) and (-1.02±0.26) mmHg; DBP: (-1.05±0.62) and (-0.68±0.29) mmHg](all P<0.001). Conclusion:The “Internet plus” management based on AISAS mode can control blood pressure by improving the lifestyle, compliance and quality of life of young and middle-aged hypertensive patients.

Objective:To evaluate risk factors for local recurrence and prognosis in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy combined with lymph node dissection (LND).Methods:The data of 237 patients who were diagnosed with UTUC in Peking University First Hospital and received radical nephroureterectomy combined with LND during January 2010 and March 2022 were retrospectively reviewed. Clinicopathologic characteristics and oncological outcomes were compared according to lymph node metastasis. There were 122 males and 115 females. The tumors of 122 cases were located on the left, while 115 cases were on the right. The tumors of 102 cases were in the renal pelvic, 124 cases in the ureter and 11 cases in both sites. The mean age was (65.52±10.14) years old. The overall survival (OS), cancer-specific survival (CSS), local recurrence-free survival (LRFS) of all patients were valued using Kaplan-Meier method, and the survival curves with statistical significance between two groups were analyzed by log-rank test. Univariate and multivariate Cox proportional hazards regressions were performed to identify the independent risk factors for CSS and LRFS.Results:There were 122 males and 115 females. According to the lymph node metastasis, the patients were divided into lymph node negative group ( n=180, 75.9%) and lymph node positive group ( n=57, 24.1%). Lymph node positive group had a higher percentage in renal tumor [57.9%(33/57) vs. 38.1% (69/180)], stage T 3-4 [84.2%(48/57) vs. 32.8%(59/180)], G 3 [91.2%(52/57) vs. 55.6%(100/180)], glandular differentiation [17.5%(10/57) vs. 4.4%(8/180)], sarcomatoid differentiation [22.8%(13/57) vs. 9.4%(17/180)], necrosis [47.4%(27/57) vs. 16.1%(29/180)], lymphovascular invasion [40.4%(23/57) vs. 12.2%(22/180)] and the number of lymph node dissection [ 4(1, 10) vs. 2(1, 5)]. There were significant differences between the two groups ( P<0.05). Of 237 patients, 42 lost of follow up. The median follow-up time was 46(22, 79) months. Among the 195 patients, 52 patients died, and 42 died due to the tumor. Of all patients, 58(29.7%) had local recurrence, 34 had local recurrence alone, and 24 had concurrent distant metastasis. The 5-year OS and CSS were 67.4% and 71.3%, respectively. The 5-year OS and CSS were 70.5% and 75.1% respectively in the lymph node negative group, 57.5% and 59.4% respectively in the lymph node positive group ( P < 0.05). The 3-year LRFS was 68.0% for all the patients. The 3-year LRFS was 75.6% in the lymph node negative group and 44.5% in the lymph node positive group ( P<0.05). Multivariate analysis showed that tumor stage T 3-4( HR =3.924, 95% CI 2.045-7.529, P<0.001) and G 3( HR=2.871, 95% CI 1.193-6.909, P =0.019) were independent risk factors for LRFS. Multivariate analysis showed that age ≥70 years ( HR = 3.578, 95% CI 1.917-6.678, P<0.001) and pathological stage T 3-4 ( HR =2.366, 95% CI 1.278-4.381, P =0.006) were independent risk factors for CSS. Multivariate analysis showed that age ≥70 years ( HR = 3.874, 95% CI 2.190-6.853, P<0.001) and pathological stage T 3-4 ( HR = 2.757, 95% CI 1.565-4.857, P<0.001) were independent risk factors for OS. Conclusions:Patients with high T stage, high grade, as well as glandular differentiation, sarcomatoid differentiation, necrosis, lymphovascular invasion are more likely to have positive lymph node detection. Age ≥70 years and stage T 3-4 were independent risk factors for CSS and OS. Stage T 3-4 and G 3were independent risk factors for LRFS.