In recent years， repetitive transcranial magnetic stimulation （rTMS） has garnered significant attention as a therapeutic approach for sleep disorders in the elderly. However， the prevailing rTMS protocols are predominantly developed based on normative neurophysiological data derived from young adults and fail to incorporate individualized parameters tailored to the brain characteristics of the elderly. To address this gap， the consensus development group synthesized the latest evidence from 2010 to 2025 and established a standardized rTMS protocol specifically for elderly patients with sleep disorders. Adhering to the Appraisal of Guidelines for Research and Evaluation II （AGREE II） framework， systematically screened randomized controlled trials （RCTs） and systematic reviews regarding rTMS in the treatment of sleep disorders across various conditions. Meanwhile， the Grading of Recommendations Assessment， Development and Evaluation （GRADE） system was employed to rigorously grade the quality of evidence and the strength of recommendations. This consensus guideline delineates precise rTMS protocols for the management of sleep disorders in the elderly， highlights the adjustment of stimulation intensity according to scalp-cortex distance recommends either MRI‑guided neuronavigation or the Beam F3/F4 heuristic approach for accurate target localization， thereby providing precise rTMS intervention protocol for sleep disorders in the elderly， aiming to enhance clinical efficacy while ensuring treatment safety. ［Funded by National Key Research and Development Program （number， 2023YFC3603200）； General Program of Shenzhen Science and Technology Innovation Commission （number， JCYJ20240813112859008， JCYJ20240813112900002）； Youth Program of Shenzhen Kangning Hospital （number， KN2023A004）； www.guidelines-registry.cn number， PREPARE-2026CN530］

Objectives: . The prognostic value of the pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in head and neck cancer (HNC) remains uncertain. This meta-analysis aimed to evaluate the predictive role of AAPR for survival outcomes in patients with HNC. Methods: . A comprehensive search of the Cochrane Library, PubMed, and Embase databases was conducted to identify relevant studies published up to July 30, 2024. We included studies on AAPR and survival outcomes in HNC patients. Results: . Eight studies comprising 1,737 HNC patients were analyzed using random-effects models. Lower AAPR values were significantly correlated with worse overall survival (hazard ratio [HR], 2.08), progression-free survival (HR, 2.00), and disease-free survival (HR, 2.18). Sensitivity analyses confirmed the robustness of these results, with no significant publication bias detected. Conclusion . Our findings suggest that pretreatment AAPR could serve as a valuable and cost-effective prognostic indicator in HNC, potentially aiding clinicians in risk stratification and treatment decision-making. However, additional validation studies are warranted to confirm its clinical applicability.

Purpose: This study aimed to evaluate the long-term efficacy of the ligation of the intersphincteric fistula tract (LIFT) procedure in treating high transsphincteric fistulas. Methods: We conducted a retrospective study to evaluate the success rate of LIFT treatment in 82 patients with high transsphincteric fistulas involving at least one-third of the external sphincter. This study was carried out across 2 centers from November 2009 to February 2023. Results: All patients underwent successful surgery with a median operative time of 48.9 minutes (range, 20–80 minutes), and no intraoperative or postoperative complications were reported. The median follow-up duration was 85.5 months (range, 4–120 months), with 5 patients (6.1%) lost to follow-up. Treatment was successful in 62 patients, whose symptoms disappeared and both the external opening and the intersphincteric incision completely healed, yielding an overall efficiency rate of 80.5%. There were 15 cases (19.5%) of treatment failure, including 6 (7.8%) that converted to intersphincteric anal fistula and 9 (11.7%) that experienced persistent or recurrent fistulas. Only 1 patient reported minor overflow during the postoperative follow-up, but no other patients reported any significant discomfort. There were no statistically significant differences between patients with surgical success and those with treatment failure in terms of fistula length, history of previous abscess or anal fistula surgery, number of external orifices or fistulas, and location of fistulas (all P>0.05). Conclusion LIFT is a safe and effective sphincter-preserving procedure that yields satisfactory healing outcomes and has minimal impact on anal function.

Purpose: This study aimed to evaluate the long-term efficacy of the ligation of the intersphincteric fistula tract (LIFT) procedure in treating high transsphincteric fistulas. Methods: We conducted a retrospective study to evaluate the success rate of LIFT treatment in 82 patients with high transsphincteric fistulas involving at least one-third of the external sphincter. This study was carried out across 2 centers from November 2009 to February 2023. Results: All patients underwent successful surgery with a median operative time of 48.9 minutes (range, 20–80 minutes), and no intraoperative or postoperative complications were reported. The median follow-up duration was 85.5 months (range, 4–120 months), with 5 patients (6.1%) lost to follow-up. Treatment was successful in 62 patients, whose symptoms disappeared and both the external opening and the intersphincteric incision completely healed, yielding an overall efficiency rate of 80.5%. There were 15 cases (19.5%) of treatment failure, including 6 (7.8%) that converted to intersphincteric anal fistula and 9 (11.7%) that experienced persistent or recurrent fistulas. Only 1 patient reported minor overflow during the postoperative follow-up, but no other patients reported any significant discomfort. There were no statistically significant differences between patients with surgical success and those with treatment failure in terms of fistula length, history of previous abscess or anal fistula surgery, number of external orifices or fistulas, and location of fistulas (all P>0.05). Conclusion LIFT is a safe and effective sphincter-preserving procedure that yields satisfactory healing outcomes and has minimal impact on anal function.

Male factors contribute to infertility at roughly the same rate as female factors,and sperm DNA methylation in ad-vanced-aged males directly affects semen parameters and significantly reduces fertility and increases the miscarriage rate of spouses.Many adverse outcomes of reproductive health are associated with advanced reproductive age of men,and few studies are reported on the influence of paternal age on the health of the offspring.The role of advanced age in human sperm DNA methylation variation and mechanism of its subsequent influence on the offspring health remain unclear.Attention should be paid to the influence of reproductive age on pregnancy outcomes in this population.This reviews focuses on the impacts of advanced male age on sperm DNA methylation and consequently on reproductive outcomes and the offspring,with elucidation of its underlying mechanisms,aiming to provide some more useful evidence for solving related clinical problems.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective:To investigate the effects of backward walking observational training combined with Soundsory cognitive training based on PASS (P: planning; A: attention; S: simultaneous; S:successive) theory on cognitive function, balance function and self-efficacy in elderly patients with post-stroke mild cognitive impairment (MCI).Methods:A randomized controlled trial was conducted. Elderly patients with post-stroke MCI admitted to the Department of Neurology, Affiliated Hospital of Jiangnan University from December 2022 to November 2023 were selected as the study objects by convenience sampling method. The patients were divided into control group and observation group by random number table. The patients in the control group implemented routine care and rehabilitation training, while the observation group were implemented backward walking observational training combined with Soundsory cognitive training based on the PASS theory. The Montreal Cognitive Assessment (MoCA), the Brunel Balance, and the Stroke Self-Efficacy Questionnaire (SSEQ) were used to evaluate the intervention effect before intervention, 2 weeks and 4 weeks of intervention, respectively.Results:A total of 116 elderly patients with post-stroke MCI were included, comprising 58 patients in the observation group (32 males and 26 females), aged (73.47 ± 7.10) years, and 58 patients in the control group (33 males and 25 females), aged (72.72 ± 8.37) years. Before intervention, there were no significant differences in the total scores of MoCA, SSEQ and Brunel Balance Scale between the 2 groups (all P>0.05). At 2 and 4 weeks of intervention, the total score of MoCA in the observation group were (20.10 ± 2.73), (22.98 ± 2.98) points, which were higher than those of the control group (18.24 ± 2.84), (20.47 ± 3.29) points, the differences were statistically significant ( t=3.61, 4.32, both P<0.05). The total score of SSEQ in the observation group were (49.97 ± 7.73), (54.98 ± 7.88) points, which were higher than those in the control group (46.50 ± 8.69), (51.59 ± 6.10) points, the differences were statistically significant ( t=2.27, 2.60, both P<0.05). At 4 weeks of intervention, the Brunel Balance Scale score in the observation group was 11(9, 11) points, which was higher than 10(8, 11) points in the control group, the difference was statistically significant ( Z=-2.00, P<0.05). Conclusions:Backward walking observational training combined with Soundsory cognitive training based on PASS theory can effectively improve cognitive and balance functions, and enhance self-efficacy in elderly patients with post-stroke MCI.

By systematically reviewing the development history of organoid technology and its application examples in Chinese med-icine,this paper summarizes the specific applications of organoids in the mechanism and translation of Chinese medicine,pathological mechanisms,diagnostic techniques,and therapeutic strategies,and evaluate their advantages and limitations through literature analysis.Organoid technology provides an in vitro model that highly simulates the function of human organs for TCM research,and can simulate the multi-target and multi-pathway mechanism of action of TCM,which significantly improves the scientificity and precision of TCM in the analysis of disease mechanisms,drug screening and personalized treatment.However,it still faces challenges in stand-ardization,ethical regulation,and clinical translation.The combination of organoid technology and TCM has a broad prospect,and it is necessary to further optimize the model construction,resolve ethical issues,and promote its wide application in TCM research and clin-ical practice through technological innovation,interdisciplinary cooperation,and international regulatory coordination in the future.

Objective In response to the prevalent issue of insufficient professional quality among nursing staff working in care homes,this study aims to conduct a foundational assessment using the"Medical and Elderly Care Integration Institution Elderly Care Staff Professional Quality Assessment Scale"based on the job competency theory,and then investigate the effective-ness of the"333"tiered training model following the initial assessment.Methods A convenience sampling method was used to select 160 caregivers from care homes in Wuxi.The caregivers were equally divided into an experimental group and a control group.A baseline assessment of professional competence was conducted using the professional quality assessment indicator system before training.The experimental group was treated with a tiered training model and training program,which were proposed using literature research and questionnaire survey methods and according to the results of baseline professional quality assessment.The control group did not undergo tiered training,but took the same training program as in the experimental group.SPSS 21.0 soft-ware was used for analysing the training outcome data.Results By comparison,the experimental group showed significantly re-duced learning time and had significantly higher assessment scores.The satisfaction degree of the elderly people and the caregiv-ers of the experimental group was significantly higher than that of the control group.The satisfaction ratings with training course design,training methods,and information-based teaching in the experimental group were significantly higher than those in the control group.Conclusion Assessing the professional quality of medical and elderly caregivers is essential for tired training.Tiered training is an effective way to improve the quality and efficiency of training,and a complete training organization system and a sound management mechanism are essential guarantees for implementing tiered training.

Objective To develop an assessment scale of oropharyngeal candidiasis risks in HIV-infected patients,and to test its reliability and validity.Methods The draft of the assessment scale was constructed by the literature analysis method,Delphi consultations and analytic hierarchy process.Totally 231 HIV-infected patients in a tertiary A hospital of Hangzhou were recruited for questionnaire survey in October 2023 to January 2024.Results The scale includes 3 dimensions,including general factors,HIV related factors and oral related factors,12 first-level items and 21 second-level items.The Cronbach's α coefficient of the scale was 0.813;the content validity index was 0.98;the correlation of each dimension was 0.574～0.733(P＜0.05).Confirmatory factor analysis showed that the 3 factor models fitted the data well.The critical value(30.5 points)of the scale was determined by ROC curve;the area under the curve was 0.909;the sensitivity of index system was 0.962,and specificity was 0.697.Conclusion The assessment scale of oropharyngeal candidiasis risks in HIV-infected patients has good reliability and validity,and it can be used as an auxiliary tool for effective identification and prediction of oropharyngeal candidiasis risk.