Objective:To investigate the epileptogenic networks of bilateral asymmetric tonic seizures (BATS) originating from the posterior insula using stereo-electroencephalography (SEEG).Methods:A retrospective analysis was performed. Among the epilepsy patients who underwent preoperative assessment and SEEG monitoring in the Epilepsy Department of Guangdong Sanjiu Brain Hospital from January 1, 2015 to July 1, 2024, 7 patients with insular epilepsy characterized by BATS originating from the posterior insula were selected based on anatomo-electro-clinical characteristics. The clinical characteristics, neuroimaging features, scalp EEG patterns, and SEEG recordings of the 7 patients were collected and analyzed. Via synchronously analyzing ictal semiology and electroanatomical propagation pathways shown by SEEG, the features of epileptogenic networks were elucidated. Results:Four patients had seizure onset from the dorsal-superior part of the left posterior insula, and 3 patients from the dorsal-superior part of the right posterior insula. The electroencephalographic characteristics of the seizure onset zones showed high consistency in these 7 patients: rhythmic spike or multiple spike discharges at the initial stage, and a low-amplitude rapid rhythm pattern subsequently. Totally, 3-10 seizures were recorded in each patient. Four patients experienced prodromal symptoms, including 3 patients with somatosensory symptoms (1 with chest and abdominal pain, 1 with contralateral facial numbness combined with throat constriction sensation, and 1 with contralateral limb numbness), and 1 patient with non-specific presentation (hugging family member before seizure). The seizure semiological evolution sequence was from prodrome to BATS, and then to secondary symptoms, with 3 patients exhibiting clustered spasms as secondary symptoms, and 4 patients showing eyelids and contralateral upper limb distal tonic-clonic manifestations as secondary symptoms. The epileptogenic networks followed a consistent pattern: the dorsal-superior part of the posterior insula leads to the middle-posterior part of the superior circular sulcus, to the ventral posterior insular and posterior circular sulcus, and then to the supplementary sensorimotor area (SSMA), and finally to the central sulcus, central region-vertex, and inferior parietal lobule. Only 2 patients had the anterior insular-involved epileptic brain networks, while the remaining 5 patients did not involve the anterior insular. During BATS, SEEG electrode contacts corresponding to the posterior insular, superior circular sulcus and SSMA exhibited low-amplitude rapid rhythm patterns.Conclusion:The seizures spread from the dorsal-superior part of the posterior insula to the middle-posterior part of the superior circular sulcus at the early stage of onset, and then connected with SSMA; these structures formed a epileptogenic brain network through abnormal synchronous discharge, which eventually led to BATS.

OBJECTIVE To observe the effect of electroacupuncture(EA)preconditioning at Tianshu(ST25)and Neiguan(PC6)on cardiac function and UCP1/BMP3b signaling pathway in brown adipose tissue(BAT)in mice with acute myocardial infarc-tion(AMI),so as to explore the potential mechanism of EA at different acupoints in improving myocardial infarction.METHODS Healthy adult mice and BAT excision mice were selected as the research objects,and they were divided into sham operation group,model group,PC6 group,and ST25 group.After one week of adaptive feeding,the mice in the intervention group were pretreated with bilateral EA at PC6 or ST25 for 20 minutes,respectively,and the AMI model was established by ligating the left anterior descending branch of the coronary artery.In the BAT resection group,BAT resection of the scapular region was performed before EA,and the rest of the intervention remained the same as before.Echocardiography was used to detect the changes in cardiac function.TTC staining was used to observe the myocardial infarct size.ELISA was used to detect the serum levels of cTnT and BMP3b in each group.The qPCR was used to detect the relative expression of β3-AR,UCP1 and BMP3b mRNA in mouse BAT.The protein expression of BMP3b in BAT and p-Smad1/5 in the heart were detected by Western blot.RESULTS Compared with the sham operation group,the left ven-tricular EF and FS of the model group mice were decreased(P<0.001),the white infarct area was increased(P<0.001),the cTnT level in serum was increased(P<0.001),the mRNA expression levels of β3-AR,UCP1,and BMP3b in BAT were increased(P<0.05,P<0.01),and the protein expression of BMP3b was increased(P<0.01).The BMP3b content in serum was increased(P<0.001),and the protein expression of p-Smad1/5 in the heart was increased(P<0.01).Compared with the model group,the left ventricular EF and FS of mice in the ST25 and PC6 group were increased(P<0.001),the area of white infarction was reduced(P<0.001),and the cTnT level in serum was decreased(P<0.05,P<0.01).The mRNA contents of β3-AR,UCP1,and BMP3b in BAT of the ST25 group were significantly increased(P<0.05,P<0.01,P<0.001),the protein expression of BMP3b was increased(P<0.01),and the protein expression of p-Smad1/5 in the heart was increased(P<0.01),while there was no significant change in the PC6 group.After BAT resection,compared with the model group,the left ventricular EF and FS of the mice in the PC6 group were increased(P<0.001),the area of white infarction was reduced(P<0.001),and the cTnT in serum was decreased(P<0.001),while there was no significant change in the ST25 group;there was no significant change in the protein expression of p-Smad1/5 in the heart and the BMP3b content in the serum of the PC6 and ST25 groups.CONCLUSION EA pretreatment at either ST25 or PC6 acupoints can produce myocardial protective effects.The protective effect of ST25 may be through influencing the UCP1/BMP3b signaling path-way in BAT,while PC6 does not depend on this pathway.

With the advancement of the new medical science initiative, medical laboratory science is evolving into an interdisciplinary field integrating medicine, engineering, science, and humanities. Cultivating high-level, interdisciplinary talents to meet disciplinary demands has become a core mission of medical laboratory education. As a critical phase for enhancing students′ clinical thinking and practical skills, the internship training model requires consistently innovation and improvement. This manuscript focuses on optimizing clinical internship teaching under the New Medical Science framework, exploring multidisciplinary integration, and proposing improvements in four dimensions: teaching system construction, mentorship program enhancement, teaching quality improvement, and outcome evaluation, in order to provide theoretical support for the innovative development of medical laboratory education in terms of new medical science.

OBJECTIVE To observe the effect of electroacupuncture(EA)preconditioning at Tianshu(ST25)and Neiguan(PC6)on cardiac function and UCP1/BMP3b signaling pathway in brown adipose tissue(BAT)in mice with acute myocardial infarc-tion(AMI),so as to explore the potential mechanism of EA at different acupoints in improving myocardial infarction.METHODS Healthy adult mice and BAT excision mice were selected as the research objects,and they were divided into sham operation group,model group,PC6 group,and ST25 group.After one week of adaptive feeding,the mice in the intervention group were pretreated with bilateral EA at PC6 or ST25 for 20 minutes,respectively,and the AMI model was established by ligating the left anterior descending branch of the coronary artery.In the BAT resection group,BAT resection of the scapular region was performed before EA,and the rest of the intervention remained the same as before.Echocardiography was used to detect the changes in cardiac function.TTC staining was used to observe the myocardial infarct size.ELISA was used to detect the serum levels of cTnT and BMP3b in each group.The qPCR was used to detect the relative expression of β3-AR,UCP1 and BMP3b mRNA in mouse BAT.The protein expression of BMP3b in BAT and p-Smad1/5 in the heart were detected by Western blot.RESULTS Compared with the sham operation group,the left ven-tricular EF and FS of the model group mice were decreased(P<0.001),the white infarct area was increased(P<0.001),the cTnT level in serum was increased(P<0.001),the mRNA expression levels of β3-AR,UCP1,and BMP3b in BAT were increased(P<0.05,P<0.01),and the protein expression of BMP3b was increased(P<0.01).The BMP3b content in serum was increased(P<0.001),and the protein expression of p-Smad1/5 in the heart was increased(P<0.01).Compared with the model group,the left ventricular EF and FS of mice in the ST25 and PC6 group were increased(P<0.001),the area of white infarction was reduced(P<0.001),and the cTnT level in serum was decreased(P<0.05,P<0.01).The mRNA contents of β3-AR,UCP1,and BMP3b in BAT of the ST25 group were significantly increased(P<0.05,P<0.01,P<0.001),the protein expression of BMP3b was increased(P<0.01),and the protein expression of p-Smad1/5 in the heart was increased(P<0.01),while there was no significant change in the PC6 group.After BAT resection,compared with the model group,the left ventricular EF and FS of the mice in the PC6 group were increased(P<0.001),the area of white infarction was reduced(P<0.001),and the cTnT in serum was decreased(P<0.001),while there was no significant change in the ST25 group;there was no significant change in the protein expression of p-Smad1/5 in the heart and the BMP3b content in the serum of the PC6 and ST25 groups.CONCLUSION EA pretreatment at either ST25 or PC6 acupoints can produce myocardial protective effects.The protective effect of ST25 may be through influencing the UCP1/BMP3b signaling path-way in BAT,while PC6 does not depend on this pathway.

With the advancement of the new medical science initiative, medical laboratory science is evolving into an interdisciplinary field integrating medicine, engineering, science, and humanities. Cultivating high-level, interdisciplinary talents to meet disciplinary demands has become a core mission of medical laboratory education. As a critical phase for enhancing students′ clinical thinking and practical skills, the internship training model requires consistently innovation and improvement. This manuscript focuses on optimizing clinical internship teaching under the New Medical Science framework, exploring multidisciplinary integration, and proposing improvements in four dimensions: teaching system construction, mentorship program enhancement, teaching quality improvement, and outcome evaluation, in order to provide theoretical support for the innovative development of medical laboratory education in terms of new medical science.

Objective:To investigate the epileptogenic networks of bilateral asymmetric tonic seizures (BATS) originating from the posterior insula using stereo-electroencephalography (SEEG).Methods:A retrospective analysis was performed. Among the epilepsy patients who underwent preoperative assessment and SEEG monitoring in the Epilepsy Department of Guangdong Sanjiu Brain Hospital from January 1, 2015 to July 1, 2024, 7 patients with insular epilepsy characterized by BATS originating from the posterior insula were selected based on anatomo-electro-clinical characteristics. The clinical characteristics, neuroimaging features, scalp EEG patterns, and SEEG recordings of the 7 patients were collected and analyzed. Via synchronously analyzing ictal semiology and electroanatomical propagation pathways shown by SEEG, the features of epileptogenic networks were elucidated. Results:Four patients had seizure onset from the dorsal-superior part of the left posterior insula, and 3 patients from the dorsal-superior part of the right posterior insula. The electroencephalographic characteristics of the seizure onset zones showed high consistency in these 7 patients: rhythmic spike or multiple spike discharges at the initial stage, and a low-amplitude rapid rhythm pattern subsequently. Totally, 3-10 seizures were recorded in each patient. Four patients experienced prodromal symptoms, including 3 patients with somatosensory symptoms (1 with chest and abdominal pain, 1 with contralateral facial numbness combined with throat constriction sensation, and 1 with contralateral limb numbness), and 1 patient with non-specific presentation (hugging family member before seizure). The seizure semiological evolution sequence was from prodrome to BATS, and then to secondary symptoms, with 3 patients exhibiting clustered spasms as secondary symptoms, and 4 patients showing eyelids and contralateral upper limb distal tonic-clonic manifestations as secondary symptoms. The epileptogenic networks followed a consistent pattern: the dorsal-superior part of the posterior insula leads to the middle-posterior part of the superior circular sulcus, to the ventral posterior insular and posterior circular sulcus, and then to the supplementary sensorimotor area (SSMA), and finally to the central sulcus, central region-vertex, and inferior parietal lobule. Only 2 patients had the anterior insular-involved epileptic brain networks, while the remaining 5 patients did not involve the anterior insular. During BATS, SEEG electrode contacts corresponding to the posterior insular, superior circular sulcus and SSMA exhibited low-amplitude rapid rhythm patterns.Conclusion:The seizures spread from the dorsal-superior part of the posterior insula to the middle-posterior part of the superior circular sulcus at the early stage of onset, and then connected with SSMA; these structures formed a epileptogenic brain network through abnormal synchronous discharge, which eventually led to BATS.

Objective:To summary the clinical and electrophysiological characteristics of temporal lobe epilepsy (TLE) originating from the temporal pole (TP), and to conduct brain network analysis based on stereo-electroencephalogram (SEEG) and head positron emission tomography- computed tomography (PET-CT).Methods:A retrospective analysis was conducted on patients with TLE who underwent SEEG implantation from January 1, 2019 to September 1, 2023 in Guangdong Sanjiu Brain Hospital. Based on anatomical-electrical-clinical analysis and SEEG findings, patients with seizures originating from the TP were selected. The clinical data, head magnetic resonance imaging (MRI), PET-CT, scalp electroencephalogram were reviewed, and the seizure-induced network was analyzed based on SEEG and head PET-CT.Results:A total of 108 cases of TLE were analyzed, of whom 13 cases had an epileptogenic zone located at the TP, accounting for 12% (13/108) of all TLE patients. Among them, 8 were males and 5 were females, and age of onset was (11.6±7.8) years. All of them were drug-resistant epilepsy patients, of whom 6 cases had normal cognitive function, 4 had mild cognitive abnormalities, and 3 had severe cognitive decline. A total of 59 seizures were recorded, and the occurrence rate of generalized tonic-clonic seizures (GTCS) was 42% (25/59). Seizure symptoms were classified into 3 types: the first type was hypermotor, seen in 9 patients; the second type was complex motor, seen in 2 patients; and the third type was automotor, seen in 2 patients. Head MRI showed that 9 cases had a blurring of the TP on one side, with or without hippocampal sclerosis; 2 cases had a mass at the TP without hippocampal sclerosis; 2 cases were negative on head MRI. Head PET-CT showed that 13 cases had TP hypometabolism on the lesion side, of whom 11 cases had hypometabolism involving the medial temporal lobe (mTL), posterior orbital gyrus (POG), anterior cingulate gyrus (ACG) and insular lobe at the same time, the other 2 cases combined with ipsilateral hypometabolism of the medial temporal lobe. Pathology showed that 7 cases had microcortical dysplasia of the TP; 3 had focal cortical dysplasia Ⅰ or focal cortical dysplasia Ⅱ; 2 had benign tumors. Scalp electroencephalogram showed that interictal phase was divided into 3 discharge patterns: bilateral temporal regions with prominent lesion side; bilateral anterior regions with prominent lesion side; lesion-side hemisphere with prominent temporal region. Ictal period showed 4 initial patterns: lesion-side hemispheric rhythmic spikes-slow waves or polyspikes-slow waves; lesion-side anterior region rhythmic slow waves; lesion-side anterior region low voltage fast (LVF) activities, and diffuse LVF with prominent lesion-side hemisphere. SEEG showed that 13 patients received electrode implantation with (9±2) electrodes per patient, divided into 3 seizure patterns: type 1: TP?adjacent temporal neocortex?POG, ACG and insula?mTL; type 2: TP?para hippocampal gyrus and the base of temporal lobe?ACG ,POG and insula?mTL; type 3: TP?mTL?insular lobe?POG.Conclusions:TLE originating from the TP is relatively rare, with hypermotor or complex motor as the main manifestations, and automotor being relatively less common, which is more likely to be followed by GTCS. The epileptogenic network analysis displays a tendency to spread from the TP to the frontal and insular lobes, as well as to the mTL, with the former pattern being more common. Common etiologies are cortical dysplasia and benign tumors of the TP without hippocampal sclerosis.

Objective:To explore the epileptogenic network patterns in 14 patients with mesial temporal lobe epilepsy (mTLE) originating from the amygdala.Methods:A total of 14 patients with mTLE originating from the amygdala underwent preoperative evaluation in Department of Epilepsy, Guangdong Sanjiu Brain Hospital from January 1, 2019 to December 31, 2023 were selected. A retrospective analysis was performed on the clinical data of these patients. Epileptogenic network patterns were further explored based on stereo-electroencephalogram (SEEG) and positron emission tomography-computed tomography (PET-CT).Results:Craniocerebral MRI indicated 12 patients with unilateral amygdala hypertrophy, and 2 with increased T2-FLAIR signal in the amygdala but no obvious volume change. During interictal period, scalp EEG indicated discharges in one or both temporal regions and distinguished at the lesion side. During ictal period, scalp EEG indicated that the initial side is consistent with the lesion side. Three clinical phenotypes and epileptogenic network patterns were summarized: the first type ( n=5) had clinical manifestations as aura→automotor→autonomic symptoms, with epileptic seizure starting from amygdala→hippocampus→preinsula→temporal pole (by SEEG) and low metabolism in the medial structures of the temporal lobe (by PET-CT); the second type ( n=6) had clinical manifestations as aura→hypermotor/complex motor→autonomic symptoms, with epileptic seizure starting from amygdala→hippocampus→temporal pole→frontal orbital gyrus and anterior cingulate cortex→insula (by SEEG) and low metabolism in the medial structures of the temporal lobe, temporal pole, insula, frontal-orbital gyrus, and inner frontal lobe (by PET-CT); the third type ( n=3) had clinical manifestations as aura→bilateral symmetrical dystonia→autonomic symptoms (with or without oral-alimentary automotor), with epileptic seizure starting from amygdala→hippocampus and insula→temporal pole and adjacent temporal neocortex (by SEEG) and low metabolism in the mesial structures of the temporal lobe and the insula (by PET-CT). Conclusion:The different clinical phenotypes of patients with mTLE originating from the amygdala may have equivalent epileptogenic network patterns.

BACKGROUND: Low-back pain (LBP) in nurses is a major health concern that affects their quality of life and ability to work, with consequences for their economic status. OBJECTIVE: This study evaluates the effect of low-level laser acupuncture combined with auricular acupressure (LAA) on pain intensity, pain interference and quality of life in nurses with LBP. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This randomized controlled trial recruited a convenience sample of hospital-based nurses from one teaching hospital in Taiwan, China. Participants were randomly assigned to the LAA group (n = 38) receiving low-level laser acupuncture and auricular acupressure for 4 weeks, and the control group (n = 38) receiving only sham laser acupuncture treatment without laser energy output. MAIN OUTCOME MEASURES: Data were collected for the primary pain outcome using the Short Form of the Brief Pain Inventory, while the secondary outcome, quality of life, was evaluated using the Roland-Morris Disability Questionnaire. Both primary and secondary outcomes were scored before the intervention, and after 2-week and 4-week intervention. The rate of LBP recurrence was evaluated at the 4th week and 8th week after the end of intervention. RESULTS: After controlling for prior pain, the result of linear mixed model analysis showed trends in significant between-group differences in the level of current pain occurring in week 4 (P < 0.001), worst pain in week 2 (P < 0.001) and week 4 (P < 0.001), least pain in week 2 (P = 0.032) and week 4 (P < 0.001), pain interference in week 2 (P = 0.009) and week 4 (P < 0.001), and in the life dysfunction in week 2 (P < 0.001) and week 4 (P < 0.001). Recurrence rates of LBP at the 4th and 8th weeks after the end of intervention were 0% and 36.89% in the LAA group, and 69.44% and 36.11% in the control group. CONCLUSION: This study shows that 4-week LAA intervention reduced pain intensity and pain interference, and improved quality of life for hospital-based nurses with LBP. These effects were maintained continuously for at least 4 weeks after the intervention. The nonpharmacological intervention, LAA, may be another efficacious, feasible, noninvasive, analgesic intervention for LBP. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov (registration number NCT04423445).
Humans ; Acupressure ; Quality of Life ; Treatment Outcome ; Low Back Pain/therapy* ; Acupuncture Therapy ; Nurses

At the end of 2019, COVID-19 broke out and spread rapidly in our country. Several kinds of emergency plans for epidemic prevention and control were consulted and prepared in Fifth Medical Center, PLA General Hospital. Some specialists in Department of Surgery and Operation Room also made surgery procedure, infection prevention and control measures for COVID-19 patients, including medical staff management and training, pre-surgical evaluation and preparation of patients, procedures for transferring patients, intraoperative nursing cooperation, disinfection of instruments and environmental objects after surgery. The above measures have been continuously revised in the clinical work.