Objective:To explore the differences of cortical responses to unilateral upper limb training (UULT) in subacute stroke patients with different motor-evoked potentials (MEPs).Methods:A cross-sectional study was performed; 33 subacute stroke patients accepted UULT were recruited from Center of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University from August 2023 to August 2024. Transcranial magnetic stimulation was used to assess MEPs, and functional near-infrared spectroscopy (fNIRS) was used to record hemodynamic changes in bilateral primary motor cortex (M1), pre-motor cortex/supplementary motor area (PMC/SMA), and posterior parietal cortex (PPC) during the resting state and UULT task state. Wavelet coherence analysis and Granger causality analysis were used to determine the strengths of functional connectivity (FC) and effective connectivity (EC) between brain regions.Results:Among the 33 patients, 16 were assigned to an absent MEP (MEP -) group and 17 into a present MEP (MEP +) group (MEP amplitude: [310±200] μV). In the MEP - group, compared with those during the resting state, FC of ipsilesional M1 with contralesional PPC, contralesional M1, ipsilesional PPC, contralesional PMC/SMA and ipsilesional PMC/SMA during the task state (0.64±0.14 vs. 0.48±0.12, 0.63±0.14 vs. 0.45±0.10, 0.70±0.14 vs. 0.56±0.12, 0.56±0.13 vs. 0.39±0.15, 0.61±0.13 vs. 0.44±0.14), and FC between the ipsilesional PMC/SMA and ipsilesional PPC during the task state (0.71±0.12 vs. 0.61±0.09) were significantly decreased ( P<0.0033); compared with that during the resting state, EC from the ipsilesional PPC to the ipsilesional PMC/SMA during the task state (0.15±0.07 vs. 0.25±0.18) was significantly increased ( P<0.05). In the MEP + group, compared with that during the resting state, FC of the ipsilesional M1 with contralesional M1 and ipsilesional PPC during the task state (0.81±0.08 vs. 0.70±0.14, 0.78±0.08 vs. 0.68±0.13) was significantly decreased ( P<0.0033); compared with that during the resting state, EC from contralesional M1 to ipsilesional M1 during the task state (0.11±0.10 vs. 0.15±0.10) was significantly increased ( P<0.05). No significant differences were noted in changes of FC strength between resting state and UULT task state across brain regions when comparing the MEP - and MEP + groups ( P>0.0033). Conclusion:MEP - subacute stroke patients exhibit extensive bilateral cortical response during the UULT task state, whereas MEP + patients show limited cortical response, which indicate that rehabilitation training strategy in MEP + patients needs to be adjusted.

Objective To analyze the degeneration parameters of the multifidus muscle at the disjunc-tion in patients with isthmus spondylolisthesis and its correlation with the degree of spondylolisthesis.Meth-ods A retrospective analysis was conducted on the medical records and MRI imaging data of 59 patients with isthmus spondylolisthesis who visited this hospital from January 2022 to July 2024.The degeneration parame-ters of multifidus muscle were selected and assessed as cross-sectional area(CSA)and percentage of fat infil-tration area(FIA%).CSA and FIA%of the multifidus muscle at the disjunction and the previous non-sliding disconnection segment were measured and compared using Image J software.The degree of spondylolisthesis was evaluated referring to the Meyerding standard,and the correlation was analyzed between CSA,FIA%of the multifidus muscle at the disjunction and the degree of spondylolisthesis.Results Among the 59 patients,there were 2 cases of L3 spondylolisthesis,27 cases of L4 spondylolisthesis and 30 cases of L5 spondylolisthe-sis.CSA of the multifidus muscle at the disjunction and the previous non-sliding disconnection segment were(882.22±236.01)mm2 and(845.59±263.37)mm2 respectively,the difference was not statistically significant(t=0.796,P=0.428).FIA%were 37.16%(25.56%,50.78%)and 33.26%(18.65%,43.04%)respective-ly,the difference was statistically significant(Z=-2.008,P=0.045).Among the 59 patients,50 cases(84.75%)had grade Ⅰ spondylolisthesis,9 cases(15.25%)had grade Ⅱ spondylolisthesis,there were no pa-tients with grade Ⅲ or Ⅳ spondylolisthesis.The degree of spondylolisthesis was correlated with FIA%(r=0.443,P<0.001),but not correlated with CSA(r=-0.188,P=0.153).Conclusion In patients with isth-mus spondylolisthesis,FIA%of the multifidus muscle at the disjunction is significantly higher than that in the previous non-sliding disconnection segment,and it is related to the degree of spondylolisthesis.However,CSA of the multifidus muscle at the disjunction showed no significant difference from that in the previous non-slid-ing disconnection segment and was not correlated with the degree of spondylolisthesis.FIA%is more accurate in assessing the severity of multifidus muscle degeneration than CSA.

As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

Objective:To explore the differences of cortical responses to unilateral upper limb training (UULT) in subacute stroke patients with different motor-evoked potentials (MEPs).Methods:A cross-sectional study was performed; 33 subacute stroke patients accepted UULT were recruited from Center of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University from August 2023 to August 2024. Transcranial magnetic stimulation was used to assess MEPs, and functional near-infrared spectroscopy (fNIRS) was used to record hemodynamic changes in bilateral primary motor cortex (M1), pre-motor cortex/supplementary motor area (PMC/SMA), and posterior parietal cortex (PPC) during the resting state and UULT task state. Wavelet coherence analysis and Granger causality analysis were used to determine the strengths of functional connectivity (FC) and effective connectivity (EC) between brain regions.Results:Among the 33 patients, 16 were assigned to an absent MEP (MEP -) group and 17 into a present MEP (MEP +) group (MEP amplitude: [310±200] μV). In the MEP - group, compared with those during the resting state, FC of ipsilesional M1 with contralesional PPC, contralesional M1, ipsilesional PPC, contralesional PMC/SMA and ipsilesional PMC/SMA during the task state (0.64±0.14 vs. 0.48±0.12, 0.63±0.14 vs. 0.45±0.10, 0.70±0.14 vs. 0.56±0.12, 0.56±0.13 vs. 0.39±0.15, 0.61±0.13 vs. 0.44±0.14), and FC between the ipsilesional PMC/SMA and ipsilesional PPC during the task state (0.71±0.12 vs. 0.61±0.09) were significantly decreased ( P<0.0033); compared with that during the resting state, EC from the ipsilesional PPC to the ipsilesional PMC/SMA during the task state (0.15±0.07 vs. 0.25±0.18) was significantly increased ( P<0.05). In the MEP + group, compared with that during the resting state, FC of the ipsilesional M1 with contralesional M1 and ipsilesional PPC during the task state (0.81±0.08 vs. 0.70±0.14, 0.78±0.08 vs. 0.68±0.13) was significantly decreased ( P<0.0033); compared with that during the resting state, EC from contralesional M1 to ipsilesional M1 during the task state (0.11±0.10 vs. 0.15±0.10) was significantly increased ( P<0.05). No significant differences were noted in changes of FC strength between resting state and UULT task state across brain regions when comparing the MEP - and MEP + groups ( P>0.0033). Conclusion:MEP - subacute stroke patients exhibit extensive bilateral cortical response during the UULT task state, whereas MEP + patients show limited cortical response, which indicate that rehabilitation training strategy in MEP + patients needs to be adjusted.

Objective:To analysis the prevalence and characteristics of comorbid insomnia and sleep disordered breathing (SDB) in community population.Methods:This is a cross-sectional study. Cluster sampling was applied. Community residents in Shantou and Meizhou were investigated during April to May, 2021. Essential information collection, sleep related health investigation, and sleep study were conducted. Insomnia was defined as the insomnia severity index (ISI)≥8. A type Ⅳ wearable intelligent sleep monitor was applied for sleep study. Comorbid insomnia and SDB was defined as both diagnosis of insomnia and SDB. Statistical analysis was conducted by SPSS 25. Prevalence and characteristics of insomnia only, SDB only and comorbid insomnia and SDB were analyzed. Logistic regression was conducted to analyze the relationship between sleep disorders and unrestored sleep, abnormal glucose metabolism, hyperlipidemia, and cardiovascular disease.Results:There were 3 730 residents completed the investigation. The median age was 55.0 (46.0, 63.0) years. The prevalence of insomnia only, SDB only, and comorbid insomnia and SDB were 26.0%, 20.2%, and 10.4% respectively. The incidence of unrestored sleep in insomnia only and comorbid insomnia and SDB were 2.900 times and 3.777 times of that in no insomnia or SDB (both P<0.001); the risk of hyperlipidemia was elevated in insomnia only, SDB only and comorbid insomnia and SDB ( OR=1.553, 1.415, and 1.868; all P<0.05); the risk of cardiovascular disease increased 40.8% in SDB only ( P=0.001), and 42.1% in comorbid insomnia and SDB ( P=0.007), after adjusted by age, sex, body mass index (BMI), smoking, drinking, abnormal glucose metabolism, and hyperlipidemia. Stratified analysis revealed that young female (age<60 years) with normal BMI (<25 kg/m 2) and comorbid insomnia and SDB were associated with higher risk of cardiovascular disease. Female with normal body weight and insomnia only or comorbid insomnia and SDB were associated with higher risk of hyperlipidemia. Conclusions:The prevalence of comorbid insomnia and SDB is high in community population. Patients with comorbid insomnia and SDB present with more significant unrestored sleep, and are correlated with higher risk of hyperlipidemia and cardiovascular diseases.

Objective:To evaluate the efficacy and safety of nimotuzumab combined with definitive radiotherapy in the treatment of inoperable locally advanced oral and maxillofacial squamous cell carcinoma.Methods:A total of 33 patients with inoperable locally advanced oral and maxillofacial squamous cell carcinoma admitted to the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from March 2015 to December 2019 were retrospectively selected as the research objects. The treatment regimen was all targeted therapy (nimotuzumab) combined with definitive radiotherapy, with or without chemotherapy, and the efficacy and safety of the treatment were analyzed. The primary endpoints were optimal response and overall survival (OS) , and the secondary endpoints were optimal duration of response (DOR) and progression-free survival (PFS) . The survival curve was drawn using the Kaplan-Meier method, the survival rate of the patients was analyzed, and the related adverse reactions were counted.Results:Of the 33 patients, there were 20 cases of complete remission (CR) , 5 cases of partial remission (PR) , 5 cases of stable disease (SD) , 2 cases of progressive disease (PD) , and 1 case could not be evaluated. The objective response rate was 75.8% (25/33) , and the disease control rate was 90.9% (30/33) . The mean OS of all cases was 54.5 months, and the 5-year OS rate was 57.0%. The mean DOR of the overall cases was 57.2 months, and the 5-year DOR rate was 64.4%. The mean PFS of the overall cases was 54.4 months, and the 5-year PFS rate was 59.8%. The 5-year OS rates of CR, PR and SD patients were 83.6%, 20.0% and 0 ( χ2=20.07, P<0.001) , the 5-year DOR rates were 85.0%, 20.0% and 0 ( χ2=16.89, P<0.001) , and the 5-year PFS rates were 84.0%, 20.0% and 0 ( χ2=15.91, P<0.001) . The OS, DOR and PFS of patients with CR were significantly better than those of patients with PR and SD (all P<0.05) . The 5-year OS rates of patients with oropharyngeal cancer and oral cancer were 62.5% and 40.6% ( χ2=1.67, P=0.197) , the 5-year DOR rates were 73.3% and 44.0% ( χ2=1.34, P=0.247) , and the 5-year PFS rates were 68.8% and 40.9% ( χ2=1.13, P=0.289) , with no statistically significant differences, but oropharyngeal cancer patients still showed a certain advantage. Common adverse reactions included oral mucositis and hematological toxicity, most of which were grade 1-2. Two (6.1%) patients had rash, and two (6.1%) patients had nausea and vomiting, which were considered to be related to nimotuzumab. All adverse reactions were relieved after symptomatic treatments. Conclusion:For patients with locally advanced oral and maxillofacial squamous cell carcinoma who are not suitable for surgery, the choice of nimotuzumab combined with definitive radiotherapy has a relatively satisfactory efficacy and survival rate, with good safety and high clinical value.

Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.

In this paper, the micro-video teaching mode was explored in the course construction of . The micro-video teaching contents include the academic thought, experience in diagnosis and treatment, characteristic technology and clinical manipulation of famous acupuncture experts in the Henan University of CM. Each micro-video film is designed within 15-18 min, including three sections of knowledge, i.e. basic theory, technological application and clinical manipulation. Each section is designed within 5-6 min. The construction of the teaching course of is the innovation of practice mode of TCM and the new approach to the inheritance of the experience of experts. The construction of micro-video teaching course propels the reform of teaching mode, improves the learning initiative of students and clinical manipulative ability so as to improve the teaching effect and quality.
Acupuncture Therapy ; Humans ; Learning ; Moxibustion ; Students ; Teaching

Objective: To determine the prevalence and determinants of folic acid (FA) supplementation in Chinese couples planning for pregnancy and in women during early pregnancy. Methods: This was a cross-sectional study based on the Shanghai PreConception Cohort (SPCC) study. Data on FA supplementation and socio-demographic features were collected using questionnaires. Couples visiting clinics for pre-pregnancy examination and pregnant women at < 14 gestational weeks were recruited in Shanghai, China, between March 2016 and September 2018. Results: Among the pregnancy planners, 42.4% (4,710/11,099) women and 17.1% (1,377/8,045) men used FA supplements, while 93.4% (14,585/15,615) of the pregnant women used FA supplements. FA supplement use was higher in female pregnancy planners who were older ( : 1.13, 95% : 1.08-1.18), had higher education ( : 1.71, 95% : 1.53-1.92), and were residing in urban districts ( : 1.06, 95% : 1.01-1.11) of FA supplementation; female pregnancy planners with alcohol consumption ( : 0.95, 95% : 0.90-0.99) had lower odds of FA supplementation. In early pregnancy, women with higher educational level ( : 1.04, 95% : 1.03-1.06), who underwent pre-pregnancy examination ( : 1.02, 95% : 1.01-1.03) had higher odds of using an FA supplement; older aged ( : 0.99, 95% : 0.98-0.99), and multigravida ( : 0.97, 95% : 0.96-0.98) had lower odds of FA supplementation. Conclusion Although the majority of pregnant women took FA supplements, more than half of the women planning for pregnancy did not. Urgent strategies are needed to improve pre-conception FA supplementation.
Adult ; China ; Cohort Studies ; Cross-Sectional Studies ; Diet ; Dietary Supplements ; analysis ; Female ; Folic Acid ; administration & dosage ; Humans ; Male ; Pregnancy ; Surveys and Questionnaires ; Vitamin B Complex ; administration & dosage ; Young Adult