Objective:To observe the effect of combining transcutaneous stimulation of the auricular vagus nerve (taVNS) with modified constraint-induced movement therapy (mCIMT) on the upper limb function of hemiplegic stroke survivors.Methods:Seventy-one hemiplegic stroke survivors were randomly divided into a taVNS group of 24, an mCIMT group of 23 and a combined group of 24. In addition to conventional rehabilitation therapy, the taVNS group received taVNS therapy, the mCIMT group received mCIMT, while the combined group received both for 30 minutes a day, 5 days a week for 4 weeks. Before and after the treatment, everyone′s upper limb function was evaluated using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Action Research arm test (ARAT). Ability in the activities of daily living (ADL) was quantified using the modified Barthel index (MBI). The latency and amplitude of motor evoked potentials (MEPs) were also measured.Results:After the treatment, significant improvement was observed in the average FMA-UE, ARAT and MBI scores. MEP latency and amplitude had also improved. The averages in the mCIMT group were then significantly better than among the taVNS group.Conclusions:taVNS combined with mCIMT can significantly improve the upper limb function and ADL functioning of stroke survivors with hemiplegia. It can also promote the recovery of central nervous system function.

Objective To explore the clinical characteristics of children with bloodstream infections caused by Klebsiella pneumoniae(KP),analyze the high-risk factors for developing carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection and poor prognosis.We hope to provide clinical evidence for reducing carbapenem-resistant strains and improving prog-nosis.Methods Clinical data of children with blood cultures confirmed KP infection admitted to the Department of Pediatrics,Pediatric Surgery,PICU,and NICU of Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital from 2016 to 2022 were collected.Based on antibiotics sensitivity results and prognosis,the patients were divided into CRKP and non-CRKP infection groups,good prognosis(recovered or improved)and bad prognosis(death or withdrawing treatment)groups.Clinical characteristics,laboratory tests,and risk factors were compared between these groups.Results Among 177 blood culture samples positive for KP,97 strains(54.8％)were found to be CRKP.Logistic regression analysis suggests a histo-ry of surgery during hospitalization(OR=2.678,95％CI:1.248-5.746,P=0.011),mechanical assisted ventilation(OR=2.774,95％CI:1.235-6.229,P=0.017),hospital stay≥25 days(OR=3.467,95％CI:1.431-8.401,P=0.006),platelet count≥237 × 109/L(OR=3.005,95％CI:1.268-7.124,P=0.012),and mean platelet volume(MPV)≥12fL(OR=3.011,95％CI:1.140-7.955,P=0.026)were possible risk factors for CRKP bloodstream infection.Mechanical assisted venti-lation(OR=2.819,95％CI:1.138-6.985,P=0.025),platelet count＜149 × 109/L(OR=0.238,95％CI:0.079-0.717,P=0.011)were possible risk factors for poor prognosis in pediatric patients.Conclusion The antibiotic resistance rate of KP blood-stream infection is high and shows an increasing trend.In KP blood stream infection children,hospital stay longer than 25 days,surgery history,mechanical assisted ventilation,platelet count≥237 × 109/L and MPV≥12 fL are at high risk for CRKP in-fection.CRKP infection is not a risk factor for bad prognosis,however,KP blood stream infection children with platelet count＜149 × 109/L and mechanical assisted ventilation high-risk factors for CRKP bloodstream infection are at risk for bad progno-sis.Special attention and timely intervention should be paid to these patients.

Objective To explore the clinical characteristics of children with bloodstream infections caused by Klebsiella pneumoniae(KP),analyze the high-risk factors for developing carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection and poor prognosis.We hope to provide clinical evidence for reducing carbapenem-resistant strains and improving prog-nosis.Methods Clinical data of children with blood cultures confirmed KP infection admitted to the Department of Pediatrics,Pediatric Surgery,PICU,and NICU of Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital from 2016 to 2022 were collected.Based on antibiotics sensitivity results and prognosis,the patients were divided into CRKP and non-CRKP infection groups,good prognosis(recovered or improved)and bad prognosis(death or withdrawing treatment)groups.Clinical characteristics,laboratory tests,and risk factors were compared between these groups.Results Among 177 blood culture samples positive for KP,97 strains(54.8％)were found to be CRKP.Logistic regression analysis suggests a histo-ry of surgery during hospitalization(OR=2.678,95％CI:1.248-5.746,P=0.011),mechanical assisted ventilation(OR=2.774,95％CI:1.235-6.229,P=0.017),hospital stay≥25 days(OR=3.467,95％CI:1.431-8.401,P=0.006),platelet count≥237 × 109/L(OR=3.005,95％CI:1.268-7.124,P=0.012),and mean platelet volume(MPV)≥12fL(OR=3.011,95％CI:1.140-7.955,P=0.026)were possible risk factors for CRKP bloodstream infection.Mechanical assisted venti-lation(OR=2.819,95％CI:1.138-6.985,P=0.025),platelet count＜149 × 109/L(OR=0.238,95％CI:0.079-0.717,P=0.011)were possible risk factors for poor prognosis in pediatric patients.Conclusion The antibiotic resistance rate of KP blood-stream infection is high and shows an increasing trend.In KP blood stream infection children,hospital stay longer than 25 days,surgery history,mechanical assisted ventilation,platelet count≥237 × 109/L and MPV≥12 fL are at high risk for CRKP in-fection.CRKP infection is not a risk factor for bad prognosis,however,KP blood stream infection children with platelet count＜149 × 109/L and mechanical assisted ventilation high-risk factors for CRKP bloodstream infection are at risk for bad progno-sis.Special attention and timely intervention should be paid to these patients.

Objective:To explore the effect of combining intermittent θ pulse stimulation (iTBS) of the cerebellum with lower extremity exoskeleton robot support on the balance and walking function of stroke survivors.Methods:Seventy-five stroke survivors complicated with lower extremity dysfunction were divided into an iTBS group, an exoskeleton group and a combined group, each of 25, according to a random number table. In addition to conventional rehabilitation training, the iTBS group was given cerebellar iTBS combined with traditional walking training, the exoskeleton group received sham cerebellar iTBS combined with walking training assisted by a lower extremity exoskeleton robot. The combined group received both therapies. The schedule was once a day, 5 days a week for 3 weeks. Before and after the treatment, the 10-metre walking test (10MWT), the Berg Balance Scale (BBS) and the Fugl-Meyer lower extremity assessment (FMA-LE) were used to evaluate the subjects′ walking ability, balance and lower extremity motor ability. Gait and neuro-electrophysiological tests were also conducted in all three groups.Results:After the treatment, a significant improvement was observed in the 10MWT times, BBS scores, FMA-LE scores, stride frequency and stride speed of all three groups compared with before the treatment. On average, the results of the exoskeleton and combined groups were significantly better than those of the iTBS group, and those of the combined group were significantly better than among the exoskeleton group. Almost everyone′s MEP latency and amplitude had improved significantly compared with before the treatment, but the improvements in the exoskeleton group tended to be superior to those in the iTBS group ( P≤0.05). The latency in the combined group averaged (21.25±1.70)ms, and the amplitude averaged (184.17±6.54)μV, both significantly better than the exoskeleton group′s averages. Conclusions:Cerebellum iTBS combined with lower extremity exoskeleton walker training can significantly improve the motor functioning, balance and walking ability of stroke survivors.

Objective:To observe the effect of robot-assisted gait training (RAGT) supplemented with intermittent theta burst stimulation (iTBS) of the cerebellum in restoring lower limb function after anterior cruciate ligament reconstruction (ACLR).Methods:Eighty ACLR patients were randomly divided into a control group, a magnetic stimulation group, a robot group and a combined group, each with 20 members. The robot and magnetic stimulation groups underwent RAGT and cerebellar iTBS before conventional training, while the combined group received iTBS followed by RAGT and then conventional training. The treatments were administered once a day, three days per week for four weeks. Before and after the intervention, the peak torque ratio of the knee flexors and extensors (H/Q), peak torque of the knee extensors (PT), and knee repositioning angle difference were measured. Knee function and balance (using the Berg Balance Scale (BBS)) were also assessed.Results:The combined group demonstrated significantly better quadriceps PT and H/Q% than the other 3 groups. Knee repositioning angle difference improved significantly in all of the groups after the treatment, with the combined group showing the smallest difference (5.00±1.21)°, significantly better than the other three groups. Lysholm and BBS scores had also improved significantly in all of the groups, with the combined group′s improvements again significantly better than those of the other groups.Conclusion:Intermittent theta burst stimulation of the cerebellum combined with robot-assisted gait training can significantly improve knee function and balance after ACLR.

Objective:To explore the effect of combining repeated peripheral (rPMS) and central transcranial magnetic stimulation (rTMS) in treating upper limb motor dysfunction after a stroke.Methods:Seventy-eight patients with upper limb motor dysfunction after a stroke were randomly divided into a control group, an rTMS group and a combined magnetic stimulation group, each of 26. All three groups underwent routine rehabilitation, while the rTMS group was repeatedly given low frequency transcranial magnetic stimulation of the M1 region on the unaffected side, and the combined group also received repeated peripheral magnetic stimulation at Erb′s point on the affected upper limb. There was one treatment session a day, 5 days a week for 3 weeks. Before and after the treatment, everyone′s upper limb motor function was quantified using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Wolf motor function test (WMFT). Skill in the activities of daily living was quantified in terms of a Barthel index (BI). Motor recovery of the upper limbs and hands was assessed using Brunnstrom staging. The latency and amplitude of the motor evoked potentials (MEPs) in the subjects′ affected abductor pollicis brevis muscles were also recorded before and after the treatment. Pearson correlation coefficients quantified the correlation between the changes in FMA-UE scores and MEP amplitudes before and after the treatment in the three groups.Results:There were no significant differences among the three groups before the treatment. Afterward, however, the average FMA-UE, WMFT and BI scores, as well as the upper limb and hand Brunnstrom stages and the average MEP latencies and amplitudes of all the three groups had improved significantly. The combined group′s average results were then significantly better than the other two groups′ averages, except for the upper limb Brunnstrom stages. The increases in MEP amplitude were positively correlated with the increases in FMA-UE scores among the rTMS and the combined group, but there was no significant correlation between them in the control group.Conclusions:The combined application of rPMS and contralateral low frequency rTMS can effectively relieve motor dysfunction in the upper limbs in the early stages after a stroke.

Objective:To analyze the changing trend of cervical cancer epidemiological characteristics and disease burden in cancer registration areas of Guangxi Zhuang Autonomous Region (Guangxi) from 2010 to 2017, and to provide scientific basis for the development of cervical cancer prevention and control strategies in Guangxi.Methods:Using descriptive analysis method, based on the incidence and death data of cervical cancer in the tumor registration areas of Guangxi from 2010 to 2017, Crude morbidity, crude mortality, age-standardized morbidity and mortality (referred to as the winning rate), disability adjusted life years (DALYs) rate and the annual percentage change (APC) and average annual percentage change (AAPC) of the above indicators were calculated, and stratified analysis was conducted for urban and rural areas and different age groups.Results:From 2010 to 2017, the crude incidence rate of cervical cancer in Guangxi showed a significant upward trend, rising from 10.31/10 5 in 2010 to 19.94/10 5 in 2017, with an average annual growth rate of 7.9% ( P＜0.05). However, after age standardization, the trend of the age-standardized incidence rate of cervical cancer was not statistically significant ( P＞0.05). During the same period, the crude mortality rate of cervical cancer increased from 2.69/10 5 to 6.21/10 5, with an average annual growth rate of 13.1% ( P＜0.05), and the trend of the age-standardized mortality rate was basically consistent with that of the crude mortality rate. The analysis of urban-rural differences showed that the growth rates of the crude incidence rate and crude mortality rate of cervical cancer in rural areas were higher than those in urban areas from 2010 to 2017 (AAPC incidence rate: 21.3% vs. 2.3%; AAPC mortality rate: 20.1% vs. 8.4%). The analysis of age differences showed that the crude incidence rate and crude mortality rate of cervical cancer in all age groups increased to varying degrees, among which the growth rate of the incidence rate (AAPC=16.2%, P＜0.05) and mortality rate (AAPC=14.7%, P＜0.05) of cervical cancer in women aged 65 and above was the fastest. In addition, the DALYs rate of cervical cancer in Guangxi increased from 50.6/10 5 in 2010 to 111.0/10 5 in 2017, with an average annual increase of 11.9% ( P＜0.05). The growth rate of the DALYs rate in rural areas was higher than that in urban areas, and the growth rate of the DALYs rate in the 50-59 age group was higher than those in other age groups. Conclusions:From 2010 to 2017, the incidence rate, mortality rate and DALYs rate of cervical cancer in Guangxi showed an upward trend. Comprehensive prevention and control measures for cervical cancer, such as improving the early diagnosis and treatment system, promoting the popularization of HPV vaccination and strengthening health education, should be taken to reduce the disease burden of cervical cancer.

Objective:To analyze the changing trend of cervical cancer epidemiological characteristics and disease burden in cancer registration areas of Guangxi Zhuang Autonomous Region (Guangxi) from 2010 to 2017, and to provide scientific basis for the development of cervical cancer prevention and control strategies in Guangxi.Methods:Using descriptive analysis method, based on the incidence and death data of cervical cancer in the tumor registration areas of Guangxi from 2010 to 2017, Crude morbidity, crude mortality, age-standardized morbidity and mortality (referred to as the winning rate), disability adjusted life years (DALYs) rate and the annual percentage change (APC) and average annual percentage change (AAPC) of the above indicators were calculated, and stratified analysis was conducted for urban and rural areas and different age groups.Results:From 2010 to 2017, the crude incidence rate of cervical cancer in Guangxi showed a significant upward trend, rising from 10.31/10 5 in 2010 to 19.94/10 5 in 2017, with an average annual growth rate of 7.9% ( P＜0.05). However, after age standardization, the trend of the age-standardized incidence rate of cervical cancer was not statistically significant ( P＞0.05). During the same period, the crude mortality rate of cervical cancer increased from 2.69/10 5 to 6.21/10 5, with an average annual growth rate of 13.1% ( P＜0.05), and the trend of the age-standardized mortality rate was basically consistent with that of the crude mortality rate. The analysis of urban-rural differences showed that the growth rates of the crude incidence rate and crude mortality rate of cervical cancer in rural areas were higher than those in urban areas from 2010 to 2017 (AAPC incidence rate: 21.3% vs. 2.3%; AAPC mortality rate: 20.1% vs. 8.4%). The analysis of age differences showed that the crude incidence rate and crude mortality rate of cervical cancer in all age groups increased to varying degrees, among which the growth rate of the incidence rate (AAPC=16.2%, P＜0.05) and mortality rate (AAPC=14.7%, P＜0.05) of cervical cancer in women aged 65 and above was the fastest. In addition, the DALYs rate of cervical cancer in Guangxi increased from 50.6/10 5 in 2010 to 111.0/10 5 in 2017, with an average annual increase of 11.9% ( P＜0.05). The growth rate of the DALYs rate in rural areas was higher than that in urban areas, and the growth rate of the DALYs rate in the 50-59 age group was higher than those in other age groups. Conclusions:From 2010 to 2017, the incidence rate, mortality rate and DALYs rate of cervical cancer in Guangxi showed an upward trend. Comprehensive prevention and control measures for cervical cancer, such as improving the early diagnosis and treatment system, promoting the popularization of HPV vaccination and strengthening health education, should be taken to reduce the disease burden of cervical cancer.

Objective:To observe the effect of combining transcutaneous stimulation of the auricular vagus nerve (taVNS) with modified constraint-induced movement therapy (mCIMT) on the upper limb function of hemiplegic stroke survivors.Methods:Seventy-one hemiplegic stroke survivors were randomly divided into a taVNS group of 24, an mCIMT group of 23 and a combined group of 24. In addition to conventional rehabilitation therapy, the taVNS group received taVNS therapy, the mCIMT group received mCIMT, while the combined group received both for 30 minutes a day, 5 days a week for 4 weeks. Before and after the treatment, everyone′s upper limb function was evaluated using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Action Research arm test (ARAT). Ability in the activities of daily living (ADL) was quantified using the modified Barthel index (MBI). The latency and amplitude of motor evoked potentials (MEPs) were also measured.Results:After the treatment, significant improvement was observed in the average FMA-UE, ARAT and MBI scores. MEP latency and amplitude had also improved. The averages in the mCIMT group were then significantly better than among the taVNS group.Conclusions:taVNS combined with mCIMT can significantly improve the upper limb function and ADL functioning of stroke survivors with hemiplegia. It can also promote the recovery of central nervous system function.

Objective:To explore the effect of combining intermittent θ pulse stimulation (iTBS) of the cerebellum with lower extremity exoskeleton robot support on the balance and walking function of stroke survivors.Methods:Seventy-five stroke survivors complicated with lower extremity dysfunction were divided into an iTBS group, an exoskeleton group and a combined group, each of 25, according to a random number table. In addition to conventional rehabilitation training, the iTBS group was given cerebellar iTBS combined with traditional walking training, the exoskeleton group received sham cerebellar iTBS combined with walking training assisted by a lower extremity exoskeleton robot. The combined group received both therapies. The schedule was once a day, 5 days a week for 3 weeks. Before and after the treatment, the 10-metre walking test (10MWT), the Berg Balance Scale (BBS) and the Fugl-Meyer lower extremity assessment (FMA-LE) were used to evaluate the subjects′ walking ability, balance and lower extremity motor ability. Gait and neuro-electrophysiological tests were also conducted in all three groups.Results:After the treatment, a significant improvement was observed in the 10MWT times, BBS scores, FMA-LE scores, stride frequency and stride speed of all three groups compared with before the treatment. On average, the results of the exoskeleton and combined groups were significantly better than those of the iTBS group, and those of the combined group were significantly better than among the exoskeleton group. Almost everyone′s MEP latency and amplitude had improved significantly compared with before the treatment, but the improvements in the exoskeleton group tended to be superior to those in the iTBS group ( P≤0.05). The latency in the combined group averaged (21.25±1.70)ms, and the amplitude averaged (184.17±6.54)μV, both significantly better than the exoskeleton group′s averages. Conclusions:Cerebellum iTBS combined with lower extremity exoskeleton walker training can significantly improve the motor functioning, balance and walking ability of stroke survivors.