OBJECTIVE:Repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown positive effects in improving gross motor function in children with cerebral palsy.A network meta-analysis was performed to analyze the clinical efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation on the improvement of lower limb motor function and gait in children with cerebral palsy.METHODS:Randomized controlled trials(RCT)about repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor function and gait in children with cerebral palsy were collected from CNKI,WanFang,VIP,SinoMed,PubMed,Web of Science,Medline.The search time limit was from the inception to October 5,2024.After screening literature,extracting data and evaluating the risk of bias of included studies,Stata 15.0 software was used for network meta-analysis,AND GRADE profiler was used for quality evaluation.RESULTS:A total of 19 studies were included,involving 4 treatment measures:conventional therapy,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation and anodic transcranial direct current stimulation.The results of network meta-analysis showed that in terms of improving gross motor function,low-frequency repetitive transcranial magnetic stimulation[mean difference(MD)=9.48,95％confidence interval(CI)(6.61,12.34),P＜0.05]was the most effective.In terms of alleviating spasticity,high-frequency repetitive transcranial magnetic stimulation[MD=-0.63,95％CI(-1.72,0.45),P＜0.05]had the best efficacy.In terms of improving ankle joint range of motion and step speed,transcranial direct current stimulation[MD=2.27,95％CI(1.37,3.17),P＜0.05;MD=0.11,95％CI(0.05,0.17),P＜0.05]was the most effective.CONCLUSION:Existing clinical evidence suggests that low-frequency repetitive transcranial magnetic stimulation has the best therapeutic effect compared with other intervention measures in terms of improving lower limb gross motor function.In terms of reducing spasticity,high-frequency repetitive transcranial magnetic stimulation has a more significant effect.In terms of improving gait,transcranial direct current stimulation has more advantages.

OBJECTIVE:Repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown positive effects in improving gross motor function in children with cerebral palsy.A network meta-analysis was performed to analyze the clinical efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation on the improvement of lower limb motor function and gait in children with cerebral palsy.METHODS:Randomized controlled trials(RCT)about repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor function and gait in children with cerebral palsy were collected from CNKI,WanFang,VIP,SinoMed,PubMed,Web of Science,Medline.The search time limit was from the inception to October 5,2024.After screening literature,extracting data and evaluating the risk of bias of included studies,Stata 15.0 software was used for network meta-analysis,AND GRADE profiler was used for quality evaluation.RESULTS:A total of 19 studies were included,involving 4 treatment measures:conventional therapy,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation and anodic transcranial direct current stimulation.The results of network meta-analysis showed that in terms of improving gross motor function,low-frequency repetitive transcranial magnetic stimulation[mean difference(MD)=9.48,95％confidence interval(CI)(6.61,12.34),P＜0.05]was the most effective.In terms of alleviating spasticity,high-frequency repetitive transcranial magnetic stimulation[MD=-0.63,95％CI(-1.72,0.45),P＜0.05]had the best efficacy.In terms of improving ankle joint range of motion and step speed,transcranial direct current stimulation[MD=2.27,95％CI(1.37,3.17),P＜0.05;MD=0.11,95％CI(0.05,0.17),P＜0.05]was the most effective.CONCLUSION:Existing clinical evidence suggests that low-frequency repetitive transcranial magnetic stimulation has the best therapeutic effect compared with other intervention measures in terms of improving lower limb gross motor function.In terms of reducing spasticity,high-frequency repetitive transcranial magnetic stimulation has a more significant effect.In terms of improving gait,transcranial direct current stimulation has more advantages.

BACKGROUND:Metal-organic framework is an emerging porous material composed of metal nodes and organic ligands.Metal-organic frameworks can be both intrinsic photodynamic or photothermal and modified by photothermal agents or photosensitizers.Upon light irradiation,phototherapy effects are exerted through production of reactive oxygen species or rise in temperature,which is widely applied to antitumor and antibacterial treatments.When metal-organic frameworks possess both of above phototherapeutic effects,they can exert a synergistic therapeutic effect to compensate for the shortcomings of using a single phototherapy method.OBJECTIVE:To summarize recent proposed photodynamic-thermal synergistic strategies according to different structures of metal-organic frameworks,to provide new insights into the structural design,functionalization,and clinical scenarios of combined therapy metal-organic frameworks.METHODS:Using"metal-organic frameworks,photodynamic therapy,photothermal therapy"as Chinese search terms and"metal-organic frameworks,photodynamic therapy,photothermal therapy,phototherapy"as English search terms,articles were searched on PubMed,Web of Science,ScienceDirect,CNKI,and WanFang databases.Finally,76 articles were included for review.RESULTS AND CONCLUSION:(1)The combination of photothermal and photodynamic therapy has been shown to exert a synergistic effect.(2)Current strategies for combined photothermal and photodynamic therapy predominantly involve the modifying of metal-organic frameworks to impart photothermal and photodynamic properties,encapsulating phototherapeutic agents within metal-organic frameworks,forming core-shell structures with phototherapeutic agents and metal-organic frameworks,in-situ reduction of phototherapeutic agents within metal-organic frameworks,adhering phototherapeutic agents to metal-organic framework surfaces,and unique modification methods like pyrolyzing metal-organic frameworks to form metal-organic frameworks-derived carbon materials.(3)To construct metal-organic framework structures for specific phototherapy,it is essential to comprehensively consider the type,size,and binding of the phototherapeutic agents and metal-organic frameworks,and select different synthesis strategies accordingly.Encapsulation is a straightforward synthesis approach but is only suitable for small-sized phototherapeutic agents.Core-shell structures are stable,but their synthesis process is relatively complex.In situ reduction does not impose special restrictions on the size of phototherapeutic agents,but it is challenging to precisely control the growth of the phototherapeutic agents within the metal-organic frameworks.Surface attachment offers a simple synthesis step,but it cannot prevent the early aggregation and quenching of phototherapeutic agents.Surface attachment requires stringent conditions and can only be implemented with specific metal-organic frameworks.(4)The existing photothermal and photodynamic combined therapy approaches have been primarily applied in antimicrobial and antitumor treatments,demonstrating remarkable efficacy.The specific applications are related to the properties of the phototherapeutic agents and metal-organic frameworks.A minority of applications extend to rheumatoid arthritis and anticoagulation thrombolysis treatments,indicating a broad potential application scope.(5)The clinical translation of photothermal and photosensitizing agents is currently in its nascent stage,facing key challenges that include the evaluation of biocompatibility and biosafety,optimization of laser irradiation parameters,and the development of efficient methods for large-scale synthesis.

Objective To analyze the current status of knowledge,attitude,and behavior?(KAP)of doctors and pharmacists regarding iodine contrast agent allergic reactions in medical institutions in China and the influencing factors,to provide reference for the treatment of iodine contrast agent allergic patients.Methods A questionnaire survey on iodine contrast agent allergic reactions was conducted among doctors and pharmacists in China using a self-designed questionnaire.The questionnaire was distributed online via WeChat and the participants were anonymous and voluntary.The scores of knowledge,attitude,and behavior of medical staff of different genders,departments,and titles were statistically analyzed.Wilcoxon rank sum test and multiple linear regression analysis were used to analyze the influencing factors.Results A total of 105 doctors and pharmacists from 19 provinces,autonomous regions and municipalities participated in the survey,completing 105 valid questionnaires.The knowledge score(out of 4 points),attitude score(out of 3 points),and behavior score(out of 3 points)of doctors and pharmacists regarding contrast agent allergy reactions were 2(1,2)points,1(0,2)points,and 1(1,2)points,respectively.Multivariate linear regression analysis showed that job title is a factor affecting the knowledge score.Compared to those with primary and below titles,senior title doctors and pharmacists had higher knowledge scores(P=0.007).Educational level is a influence factor affecting the attitude score.Compared to those with undergraduate and below educational levels,doctors and pharmacists with doctoral degrees had more positive attitudes(P=0.011).Attitude score is a influence factor affecting the behavior score,the more positive the attitude,the more positive the behavior(P=0.015).Conclusion The knowledge,attitude,and practice(KAP)of doctors and pharmacists regarding contrast agent allergy reactions need to be strengthened.Training should be conducted for doctors and pharmacists,taking into account the KAP differences among individuals with different job titles and educational levels,to enhance knowledge levels and actively explore safe and effective desensitization treatment methods for patients with contrast agent allergies.The use of iodinated contrast agents should be rationalized while ensuring patient safety.

Objective To analyze the current status of knowledge,attitude,and behavior?(KAP)of doctors and pharmacists regarding iodine contrast agent allergic reactions in medical institutions in China and the influencing factors,to provide reference for the treatment of iodine contrast agent allergic patients.Methods A questionnaire survey on iodine contrast agent allergic reactions was conducted among doctors and pharmacists in China using a self-designed questionnaire.The questionnaire was distributed online via WeChat and the participants were anonymous and voluntary.The scores of knowledge,attitude,and behavior of medical staff of different genders,departments,and titles were statistically analyzed.Wilcoxon rank sum test and multiple linear regression analysis were used to analyze the influencing factors.Results A total of 105 doctors and pharmacists from 19 provinces,autonomous regions and municipalities participated in the survey,completing 105 valid questionnaires.The knowledge score(out of 4 points),attitude score(out of 3 points),and behavior score(out of 3 points)of doctors and pharmacists regarding contrast agent allergy reactions were 2(1,2)points,1(0,2)points,and 1(1,2)points,respectively.Multivariate linear regression analysis showed that job title is a factor affecting the knowledge score.Compared to those with primary and below titles,senior title doctors and pharmacists had higher knowledge scores(P=0.007).Educational level is a influence factor affecting the attitude score.Compared to those with undergraduate and below educational levels,doctors and pharmacists with doctoral degrees had more positive attitudes(P=0.011).Attitude score is a influence factor affecting the behavior score,the more positive the attitude,the more positive the behavior(P=0.015).Conclusion The knowledge,attitude,and practice(KAP)of doctors and pharmacists regarding contrast agent allergy reactions need to be strengthened.Training should be conducted for doctors and pharmacists,taking into account the KAP differences among individuals with different job titles and educational levels,to enhance knowledge levels and actively explore safe and effective desensitization treatment methods for patients with contrast agent allergies.The use of iodinated contrast agents should be rationalized while ensuring patient safety.

BACKGROUND:Metal-organic framework is an emerging porous material composed of metal nodes and organic ligands.Metal-organic frameworks can be both intrinsic photodynamic or photothermal and modified by photothermal agents or photosensitizers.Upon light irradiation,phototherapy effects are exerted through production of reactive oxygen species or rise in temperature,which is widely applied to antitumor and antibacterial treatments.When metal-organic frameworks possess both of above phototherapeutic effects,they can exert a synergistic therapeutic effect to compensate for the shortcomings of using a single phototherapy method.OBJECTIVE:To summarize recent proposed photodynamic-thermal synergistic strategies according to different structures of metal-organic frameworks,to provide new insights into the structural design,functionalization,and clinical scenarios of combined therapy metal-organic frameworks.METHODS:Using"metal-organic frameworks,photodynamic therapy,photothermal therapy"as Chinese search terms and"metal-organic frameworks,photodynamic therapy,photothermal therapy,phototherapy"as English search terms,articles were searched on PubMed,Web of Science,ScienceDirect,CNKI,and WanFang databases.Finally,76 articles were included for review.RESULTS AND CONCLUSION:(1)The combination of photothermal and photodynamic therapy has been shown to exert a synergistic effect.(2)Current strategies for combined photothermal and photodynamic therapy predominantly involve the modifying of metal-organic frameworks to impart photothermal and photodynamic properties,encapsulating phototherapeutic agents within metal-organic frameworks,forming core-shell structures with phototherapeutic agents and metal-organic frameworks,in-situ reduction of phototherapeutic agents within metal-organic frameworks,adhering phototherapeutic agents to metal-organic framework surfaces,and unique modification methods like pyrolyzing metal-organic frameworks to form metal-organic frameworks-derived carbon materials.(3)To construct metal-organic framework structures for specific phototherapy,it is essential to comprehensively consider the type,size,and binding of the phototherapeutic agents and metal-organic frameworks,and select different synthesis strategies accordingly.Encapsulation is a straightforward synthesis approach but is only suitable for small-sized phototherapeutic agents.Core-shell structures are stable,but their synthesis process is relatively complex.In situ reduction does not impose special restrictions on the size of phototherapeutic agents,but it is challenging to precisely control the growth of the phototherapeutic agents within the metal-organic frameworks.Surface attachment offers a simple synthesis step,but it cannot prevent the early aggregation and quenching of phototherapeutic agents.Surface attachment requires stringent conditions and can only be implemented with specific metal-organic frameworks.(4)The existing photothermal and photodynamic combined therapy approaches have been primarily applied in antimicrobial and antitumor treatments,demonstrating remarkable efficacy.The specific applications are related to the properties of the phototherapeutic agents and metal-organic frameworks.A minority of applications extend to rheumatoid arthritis and anticoagulation thrombolysis treatments,indicating a broad potential application scope.(5)The clinical translation of photothermal and photosensitizing agents is currently in its nascent stage,facing key challenges that include the evaluation of biocompatibility and biosafety,optimization of laser irradiation parameters,and the development of efficient methods for large-scale synthesis.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a chronic immune-mediated disease with uncertain causes. Malnutrition in IBD patients, attributed to factors such as inadequate intake, increased consumption, poor absorption, and bacterial overgrowth in the small intestine, poses a prevalence of 23%–50%, elevating the risk of readmission and mortality while diminishing quality of life. Therefore, urgent implementation of personalized dietary interventions is crucial for enhancing adherence and rectifying malnutrition in IBD patients.

Objective:To explore the dynamic change trajectory and influencing factors of postoperative fatigue (POF) in patients with early digestive tract cancer undergoing endoscopic submucosal dissection (ESD), so as to provide theoretical basis for individualized management of such patients.Methods:Using cross-sectional survey and convenient sampling method, the patients who underwent ESD for early cancer of digestive tract in the endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to June 2024 were selected as the research objects. The questionnaires were conducted at 30 min, 24 h, 3 days, 5 days, 7 days after ESD with Christensen's postoperative fatigue score. Spearman test was used to analyze the correlation between pain, insomnia and POF. The latent variable growth model was used to identify the potential categories of POF trajectory, and the influencing factors were analyzed by Logistic regression.Results:A total of 232 patients were finally induded, with ages of 19-94(59.53 ± 13.29) years, including 120 males and 112 femalss. The POF level of patients with early cancer of digestive tract showed a downward trend one week after operation. Three postoperative fatigue trajectories were fitted, 9.05% in moderate or severe fatigue low-speed smooth descent group (C1 group); 32.76% in moderate fatigue first decreased quickly and then slowly group (C2 group) and 58.19% in mild fatigue continuous decline group (C3 group). The result of Logistic regression analysis showed that, compared with C1 group, people without religious beliefs were morelikely to enter C2 group [ β = 1.572, OR = 4.818(1.033 - 22.465), P<0.05]; compared with C3 group, patients with high pain level and severe insomnia degree were likely to enter C1 [ β = 2.621, 0.663, OR were 13.754(2.692 - 70.283) and 1.942(1.429 - 2.638), both P<0.05] and C2 [ β = 2.010, 0.491, OR were 7.464(1.890 - 29.482) and 1.634(1.348 - 1.982), both P<0.05] group. Conclusions:There were three potential types of POF in patients with early digestive tract cancer ESD. Medical staff should pay attention to patients with severe insomnia, intense pain and religious beliefs, and give staged fatigue assessment and individualized intervention, so as to reduce the level of POF and promote rapid recovery.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a chronic immune-mediated disease with uncertain causes. Malnutrition in IBD patients, attributed to factors such as inadequate intake, increased consumption, poor absorption, and bacterial overgrowth in the small intestine, poses a prevalence of 23%–50%, elevating the risk of readmission and mortality while diminishing quality of life. Therefore, urgent implementation of personalized dietary interventions is crucial for enhancing adherence and rectifying malnutrition in IBD patients.

Objective:To assess the fall risk of hospitalized patients with cardiovascular diseases, analyze the related influencing factors, and construct a prediction model based on machine learning technology, so as to provide a basis for the fall management of hospitalized patients with cardiovascular diseases.Methods:This study was a retrospective cohort study. A total of 450 patients admitted to the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University from June 2017 to June 2024 were selected as the research objects by convenience sampling method. By reviewing electronic medical records, trained nurses extracted the patients' general information and Activities of Daily Living Scale (ADL) scores during hospitalization. Lasso regression was used to screen risk factors, and machine learning libraries were used to construct support vector machine (SVM), decision tree, XGBoost, and neural network models. Bootstrap resampling method and area under the curve (AUC) were used to verify the model performance.Results:Among the 450 patients, there were 261 males and 189 females, with a mean age of (66.0 ± 8.4) years. Among them, 90 patients fell during hospitalization and 360 patients did not fall. The results of Lasso regression showed that ADL score ≤60 points, use of hypnotics, hypokalemia, nighttime toilet visits≥2 times, use of antihypertensive drugs, no caregiver, and history of atrial fibrillation were all risk factors for falls in hospitalized patients with cardiovascular diseases (regression coefficients ranging from 0.61 to 1.20, all P<0.01). Among the machine learning models, XGBoost had the best comprehensive performance (AUC=0.98), which was better than decision tree (AUC=0.66), SVM (AUC=0.95), and neural network (AUC=0.87). Conclusions:The fall risk of hospitalized patients with cardiovascular diseases is jointly affected by physiological, medication and behavioral factors, and the XGBoost model can effectively identify high-risk groups. In actual clinical work, nursing strategies can be optimized in combination with risk factors, and the application of intelligent fall prediction and assessment tools can be promoted.