Objective To systematically evaluate robot-assisted gait training(RAGT)on motor function,ambulation and activities of daily living of patients after stroke and spinal cord injury(SCI),and to investigate the clinical value of differ-ent robotic technologies and control strategies.Methods In accordance with PRISMA guidelines,relevant randomized controlled trials(RCTs)published between 2020 and 2024 were identified from databases including Scopus,Web of Science,PubMed,Cochrane Library and CNKI.The PEDro scale was used to assess methodological quality,and a comprehensive analysis was performed on the therapeutic effects of RAGT on walking ability,balance,lower limb muscle strength and functional inde-pendence.Results Eight RCTs involving 702 participants were included,originating from countries such as China,Italy,India,Tur-key and Poland.The population consisted of adult patients with various subtypes of stroke or SCI.These studies were published in journals across geriatric neuroscience,biosciences,medicine and sports science.Interventions involved three categories of lower limb exoskeleton including treadmill-based systems(end-effector and exoskel-eton models),overground exoskeletons and specialized joint/platform-based robots.The training frequency was 20 to 45 minutes a time,once to twice a day,one to seven days a week,for a total of two to ten weeks.RAGT might significant improve gait parameters and lower limb muscle strength,though its impact on functional inde-pendence was heterogeneous.Adaptive control strategies(e.g.,assist-as-needed)proved superior to fixed-parame-ter modes.Treadmill-based systems(e.g.,Lokomat)were well-suited for early-stage rehabilitation,while over-ground exoskeletons(e.g.,EKSO-GT)better facilitated adaptation to real-world environments.Conclusion RAGT is an effective modality for improving gait and lower limb function of patients with stroke and SCI.The therapeutic outcome is contingent upon personalized setup of the exoskeleton and the implementation of adaptive control strategies.Different adaptive control modes have been developed for the three main types of lower limb exoskeleton.Rehabilitation training should consider the specific lower limb tasks with the robot's cor-responding adaptive movement and control modes.

Objective To systematically evaluate robot-assisted gait training(RAGT)on motor function,ambulation and activities of daily living of patients after stroke and spinal cord injury(SCI),and to investigate the clinical value of differ-ent robotic technologies and control strategies.Methods In accordance with PRISMA guidelines,relevant randomized controlled trials(RCTs)published between 2020 and 2024 were identified from databases including Scopus,Web of Science,PubMed,Cochrane Library and CNKI.The PEDro scale was used to assess methodological quality,and a comprehensive analysis was performed on the therapeutic effects of RAGT on walking ability,balance,lower limb muscle strength and functional inde-pendence.Results Eight RCTs involving 702 participants were included,originating from countries such as China,Italy,India,Tur-key and Poland.The population consisted of adult patients with various subtypes of stroke or SCI.These studies were published in journals across geriatric neuroscience,biosciences,medicine and sports science.Interventions involved three categories of lower limb exoskeleton including treadmill-based systems(end-effector and exoskel-eton models),overground exoskeletons and specialized joint/platform-based robots.The training frequency was 20 to 45 minutes a time,once to twice a day,one to seven days a week,for a total of two to ten weeks.RAGT might significant improve gait parameters and lower limb muscle strength,though its impact on functional inde-pendence was heterogeneous.Adaptive control strategies(e.g.,assist-as-needed)proved superior to fixed-parame-ter modes.Treadmill-based systems(e.g.,Lokomat)were well-suited for early-stage rehabilitation,while over-ground exoskeletons(e.g.,EKSO-GT)better facilitated adaptation to real-world environments.Conclusion RAGT is an effective modality for improving gait and lower limb function of patients with stroke and SCI.The therapeutic outcome is contingent upon personalized setup of the exoskeleton and the implementation of adaptive control strategies.Different adaptive control modes have been developed for the three main types of lower limb exoskeleton.Rehabilitation training should consider the specific lower limb tasks with the robot's cor-responding adaptive movement and control modes.

Objective:To explore the role of peroxisome proliferator-activated receptor (PPAR) signaling pathway in the pathogenesis of acne inversa (AI) .Methods:Skin tissue samples were obtained from 8 AI patients and 4 healthy controls from Hospital of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College from 2013 to 2019, and high-throughput sequencing was performed for tissue-specific mRNA expression profiling. Gene Ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and Gene Set Enrichment Analysis (GSEA) were carried out. Real-time fluorescence-based quantitative PCR (qPCR) and Western blot analysis were performed to verify the results of high-throughput sequencing.Results:Analysis of the specific expression profiles showed that 2 738 differentially expressed genes were screened out in the AI patients compared with the healthy controls, of which 1 328 genes were significantly up-regulated and 1 410 genes were significantly down-regulated. GO analysis demonstrated that the positive regulation of interferon γ secretion, T cell receptor complex and C-X-C chemokine receptor activity were significantly enriched in the AI lesions. KEGG analysis demonstrated that the signaling pathways associated with primary immuno‐deficiency, PPAR, and chemokine-chemokine receptor interaction were significantly enriched in the AI lesions. GSEA demonstrated that the PPAR signaling pathway was significantly weakened in the AI lesions. The mRNA expression levels of PPARA and PPARG were significantly lower in the AI patients (0.336 ± 0.120, 0.253 ± 0.078, respectively) than in the healthy group (1.000 ± 0.146, 1.000 ± 0.172, t = 3.50, 3.95, respectively, both P < 0.05), so were their protein levels. However, there was no significant difference in the PPARD mRNA expression level between the two groups ( t = 0.34, P = 0.750). The mRNA expression levels of nuclear hormone receptor 9-cis retinoid X receptor alpha (RXRA), RXRG and fatty acid-binding protein 4 were significantly lower in the AI patients than in the healthy controls ( t = 2.96, 2.96, 4.62, respectively, all P < 0.05) . Conclusion:The PPAR signaling pathway was restrained and lipid metabolism was disordered in AI patients.

Objective:To survey the child health service capacity of community health service institutions in Shenzhen city.Methods:This was a cross-sectional study. An online survey was conducted among 559 community health service centers, stations and clinics in Shenzhen from January 23, 2024 to February 3, 2024. The questionnaire contents included the development of child health management, vaccination, diagnosis and treatment of common diseases in children, management of children′s chronic diseases, appropriate technology, availability of children′s special drug dosage forms, provision of special Chinese patent medicine and appropriate technology of traditional Chinese medicine for children, referral and remote consultation in 2019 and 2023. The reasons of unavailable service items were asked in the questionnaire and the questionnaire also contained an open-ended question about the suggestions for improving the capacity of child health services.Results:A total of 559 valid questionnaires were collected, accounting for 64.48% (559/867) of the community health service centers, stations and health clinics in Shenzhen in 2023. Compared to 2019, there was a significant increase in the rate of pediatric health services provided in 2023, including the diagnosis and treatment of common diseases in children under 6 years (96.06%, 537 institutions), nebulized inhalation therapy (96.60%, 540 institutions), influenza and other respiratory pathogen detection (90.70%, 507 institutions), rotavirus and other intestinal pathogen detection (34.53%, 193 institutions), allergen detection (81.75%, 457 institutions), blood oxygen saturation monitoring (84.44%, 472 institutions), pediatric-specific formulations of Western medicine (90.52%, 506 institutions), pediatric-specific formulations of traditional Chinese medicine (89.27%, 499 institutions), appropriate Chinese medicine techniques (88.19%, 493 institutions), relatively fixed referral hospitals (95.17%, 532 institutions), and remote consultation service (19.14%, 107 institutions); and the differences were statistically significant ( P<0.01). The reasons for unavailable service items were lack of space and personnel for the basic public health services, lack of space, personnel and a deficiency in knowledge and technical capabilities for diagnostic tests, and lack of equipment and personnel for remote consultation service. Suggestions made by 394 respondent institutions (70.48%) for further improvement included: conducting and strengthening various training (44.42%, 175/394), consultation and teaching by expert visiting (18.53%, 73/394), increasing the space and equipment (9.39%, 37/394), and further study at higher-level units (98.88%, 35/394). Conclusions:The child health services have been greatly improved in community health service institutions in Shenzhen, but there are still rooms for further improvement such as the ability of child health management, vaccination, chronic disease managements and provision of remote consultation.

Objective:To investigate the differences of clinical data and pathological changes in patients with primary IgA nephropathy (IgAN) with different blood types.Methods:The clinical and pathological data of patients with primary IgAN diagnosed by renal biopsy in the People's Hospital of Ningxia Hui Autonomous Region from May 2016 to May 2021 were collected. They were divided into groups A, O, B and AB according to blood group. The clinical manifestations and pathological changes of the four groups during renal biopsy were analyzed.Results:A total of 258 patients with primary IgAN were included, including 87 cases of type A, 74 cases of type O, 72 cases of type B and 25 cases of type AB. The male to female ratio was 1.34∶1, and the median age was 36 (29, 47) years old. There was no significant difference in age, sex, blood pressure, hemoglobin and renal function among the four groups (all P>0.05). Neutrophil gelatinase-associated lipocalin (NGAL) in patients with type A and B was higher than other groups (all P<0.05). There were no significant differences in mesangial cell hyperplasia (M), capillary cell hyperplasia (E), glomerular segmental sclerosis (S), renal tubule atrophy/interstitial fibrosis (T), crescent body (C) lesions and proportion of sclerosed glomeruli among the four groups (all P>0.05). Subgroup analysis by gender showed that the hemoglobin, uric acid and creatinine of male patients were higher than those of female patients (all P<0.05), but the estimated glomerular filtration rate (eGFR) and urinary protein had no statistical significance (all P>0.05). Women with blood type A and O were heavier than men under microscope. The pathological manifestations of M, E, S and C lesions in women with type A blood were heavier than those in men, and S and T lesions in men with type B blood were heavier than those in women. There was no significant difference in the general baseline data, inflammation and kidney indexes between the four groups of men and women (all P>0.05). Pathologically, the M lesions of men with B blood group were more severe than those of other blood groups, while the S and T lesions of women with B blood group were less severe than those of other blood groups. Conclusions:The clinical and pathological manifestations of IgAN women with type A are heavier, the pathological manifestations of IgAN women with type B are lighter, but the pathological lesions of IgAN men with type B are heavier.

Objective:To investigate the effect of laparoscopic ovarian cystectomy on anti-Mullerian hormone (AMH) level, ovarian response to gonadotropin stimulation and pregnancy rate for in vitro fertilization (IVF) patients with benign ovarian cysts.Methods:Patients with benign ovarian cysts who were admitted for cystectomy and had undergone IVF treatment were enrolled in the study. There were 373 participants with ovarian cysts underwent laparoscopic ovarian cystectomy in the experimental group. According to duration of post-surgery, there were four sub-groups: 1 year post-surgery (1Y POST), 2 years post-surgery (2Y POST), 4 years post-surgery (4Y POST) and ≥5 years post-surgery (≥5Y POST) in the experimental group. According to histopathologic types of ovarian cysts, there were two sub-groups: ovarian endometriotic cysts and ovarian non-endometriotic cysts. Two hundreds and three patients with no history of ovarian cysts and ovarian surgery were in the control group. The level of AMH and basic concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P), estradiol (E 2) were measured. Antral follicle counts (AFC) were calculated. There were other study variables: total dose of gonadotropins, duration of ovarian stimulation, the number of oocyte retrieved, the number of embryo obtained, blastocyst transfer rate and pregnancy rate. Results:The control group was matched as closely as possible to the experimental group, including age, body mass index and menstrual cycle (all P>0.05). Compared to the women in control group, the women in ovarian endometriotic cystectomy sub-group had significantly higher levels of basal FSH and basal P, lower level of AMH (all P<0.05); the women in ovarian endometriotic cysts sub-group had significantly higher dose of gonadotropins (all P<0.05); the women in ovarian endometriotic cysts ≥5Y POST sub-group had significantly lower number of oocyte retrieved, lower number of embryo obtained, lower blastocyst transfer rate, and lower pregnancy rate (all P<0.05). Compared to the women in control group, the women in ovarian non-endometriotic cysts sub-group had a significantly higher level of basal FSH and basal P (all P<0.05). The women in ovarian non-endometriotic cysts sub-group had lower level of AMH, higher dose of gonadotropins, lower number of oocyte retrieved, lower number of embryo obtained, lower rate of blastocyst transfer and lower rate of pregnancy than the control group but there were no statistically significant differences among them (all P>0.05). The women with unilateral ovarian endometriotic cysts had significantly lower number of oocyte retrieved on the side of surgery than another side ( P<0.05). Conclusions:In short term laparoscopic ovarian cystectomy has no significant effect on ovarian reserve. But with long-term follow-up ovarian reserve, ovarian response to gonadotropin stimulation and pregnancy rate are decreased. The effect of laparoscopic ovarian cystectomy in benign cysts on ovarian is associated with whether or not it is the surgical side.

Objective:To construct a Bayesian network risk prediction model for delirium during recovery from general anesthesia. To explore the network relationship between awakening delirium of general anesthesia and its related factors, and to reflect the influence intensity of each factor on awakening delirium of general anesthesia through network reasoning.Methods:This is a cross-sectional study. From February to May 2022, the Chinese version of the four rapid delirium diagnosis protocols for general anesthesia patients admitted to the department of Anesthesia, the First Hospital of Shanxi Medical University were adopted as research subjects through convenience sampling method to carry out the delirium screening program during awakening, and general information and blood sample laboratory test results of the subjects were collected. The single factor analysis was used to screen the correlative factors of awakening delirium and a Bayesian network model based on the maximum minimum climb method (MMHC) was constructed.Results:A total of 480 patients were included in the study, and the delirium rate during the recovery period of general anesthesia was 12.9%(62/480). The Bayesian network of awakening delirium consisted of 11 nodes and 18 directed edges. The Bayesian network showed that age, sodium, cerebral infarction and hypoproteinemia were the direct factors related to awakening delirium, while ASA grade, hematocele and hemoglobin were the indirect factors related to awakening delirium. The area under its ROC curve was 0.80(0.78-0.83).Conclusions:Bayesian networks can well reveal the complex network connections between awakening delirium and its related factors, and then prevent and control awakening delirium accordingly.

Objective:To investigate the molecular epidemiological characteristics and antibiotic resistance of Clostridioides difficile ( Cd) in hospitalized diarrhea patients in a tertiary hospital in Shaanxi Province. Methods:This study collected 425 stool samples of hospitalized diarrhea patients from October 2018 to December 2021 for isolation and identification of Cd. Toxin genes carried by the isolates were detected. Multilocus sequence typing (MLST) was performed to analyze the phylogenetic profile. Antibiotic susceptibility was analyzed by E-test. Results:Forty-nine strains of Cd were isolated from the 425 samples, including 37 strains of toxigenic Cd (75.5%, 37/49). The detection rate of Cd was 14.0% (25/179) in diarrhea patients aged ≥65 years old and 36.4% (4/11) in Nephrology Department. In the 37 toxigenic Cd strains, A -B + CDT -Cd, A + B + CDT -Cd and A + B + CDT +Cd accounted for 18.9% (7/37), 78.4% (29/37) and 2.7% (1/37), respectively. There were 24 ST types, among which ST2, ST3 and ST54 were the predominant types, each accounting for 12.2% (6/49). All strains were sensitive to metronidazole and vancomycin, with a high resistance rate of 93.9% (46/49) to ciprofloxacin and a low resistance rate of 12.2% (6/49) and 10.2% (5/49) to rifampicin and meropenem, respectively. Conclusions:The main type of toxigenic strains was A + B + CDT -. ST2, ST3 and ST54 were the predominant types and the distribution of ST types was scattered. All isolates were sensitive to metronidazole and vancomycin and most of them were resistant to ciprofloxacin.

Objective:To evaluate the effects of a booster immunization with a candidate tetanus toxoid, reduced diphtheria toxoid and acellular pertussis combined vaccine (Tdap) in a rat model after primary vaccination with diphtheria, tetanus, acellular pertussis and Sabin strain inactivated poliovirus combined vaccine (DTacP-sIPV) or diphtheria, tetanus, acellular pertussis, inactivated poliovirus and haemophilus type b combined vaccine (DTacP-IPV/Hib) for further preclinical study.Methods:Wistar rats were randomly divided into three groups and respectively immunized with a self-developed DTacP-sIPV, a marketed DTacP-IPV/Hib and normal saline at 0, 1, and 2 months of age. Serum levels of antibody against each component in each group were detected before immunization and after each dose. A booster dose of the candidate Tdap was given 10 months after primary immunization. Serum levels of antibody against each component in each group were detected before, 1 month and 6 months after the booster immunization.Results:One month after three doses of primary immunization, the geometric mean titers (GMT, Log2) of antibodies against diphtheria toxoid (DT), tetanus toxoid (TT), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN) in the DTacP-sIPV group were 17.41, 18.34, 18.11, 19.93 and 13.91, respectively, and the seroconversion rates of these components all reached 100%. Ten months after primary immunization, the GMTs of antibodies against DT, TT, PT, FHA and PRN decreased to 15.17, 14.26, 13.60, 14.51 and 10.39, respectively, and the seroconversion rates remained above 89%. One month after booster immunization, the GMTs of antibodies against DT, TT, PT and FHA in the DTacP-sIPV and DTacP-IPV/Hib groups were 16.49/17.26, 16.80/17.63, 16.70/17.74 and 18.48/19.26, respectively, and the seroconversion rates of these components all reached 100% with no significant difference between the two groups ( P>0.05). The GMTs of anti-PRN antibody in the DTacP-sIPV and DTacP-IPV/Hib groups were 13.07 and 11.00, and the seroconversion rates were 100% and 88%, which were higher in the DTacP-sIPV group than in the DTacP-IPV/Hib group ( P<0.05). Six months after booster immunization, the GMTs of antibodies against DT, TT, PT, FHA and PRN in the DTacP-sIPV and DTacP-IPV/Hib groups decreased to 15.74/14.87, 15.07/15.14, 14.84/15.73, 16.62/16.37 and 11.44/9.96, respectively, and the seroconversion rates remained above 88%. Conclusions:Booster vaccination with the candidate Tdap vaccine induces humoral immune response following primary immunization with DTacP-sIPV or DTacP-IPV/Hib in the Wistar rat model, while the antibody titer decreases with time.

Objective:To study the epidemic and etiologic characteristics of influenza virus(Flu)and respiratory syncytial virus (RSV) infections in outpatient influenza-like illness(ILI)cases of children under 10 years of age in Gansu province in 2018 And to provide evidences for diagnosis, treatment, control and prevention of Flu and RSV infections in Gansu province.Methods:A total of 8 559 pharyngeal swab samples of ILI outpatients cases were tested with real-time fluorescent PCR to detect Flu, 3 436 of which were detected by RT-PCR for RSV.Results:Of the 8559 specimens, 934 (10.91%) samples were positive for Flu. Among them, 431 were positive for H1N1, 70 were positive for H3N2, 428 were positive for Flu B, 5 were mixed; 320 of the 3436 (9.31%, ) samples were positive for RSV. There were significant differences in the positive rates of Flu and RSV among 14 cities and prefectures ( χ2=56.99, χ2=263.34, Р< 0.01). Influenza reached its peak in January 2018 with a positive rate of 50.70%. Flu B/Yamagata strain (53.53%) and A H1N1 (39.93%) were prevalent simultaneously. The peak of RSV epidemic was from February to April, the positive rate was 13.98%. The RSV positive rate of children under 5 years of age was 10.11%, higher than that of children over 5 years of age was 6.94%. There was statistical significance ( χ2=7.67, Р<0.01). Conclusions:RSV and influenza viruses are the main pathogens in ILI cases of children under 10 years of age. There are epidemic peaks in winter and spring every year. It is suggested that the monitoring of RSV and the development and application of vaccine should be strengthened.