Objective:To develop and validate a predictive nomogram for 28-day mortality among very older patients with sepsis, to identify high-risk patients early and improve prognosis.Methods:This study was conducted from January 1, 2022, to November 30, 2022. Very older patients aged≥80 years with sepsis admitted to the emergency department of Beijing Chao-Yang Hospital, Capital Medical University were consecutively recruited. Their clinical data within 24 h of admission and 28-day mortality was recorded. The participants were divided into training (70%) and validation cohort (30%) (random number). In the training cohort, the risk factors of 28-day mortality were selected via least absolute shrinkage and selection operator (LASSO) regression analysis and multivariable Cox proportional hazard model, and a nomogram was developed. The prediction model was verified in validation cohort.Results:In total, 507 very older patients with sepsis were included, among which the mortality rate was 31.2%. In training cohort, the independent risk factors for 28-day mortality were identified: increased age [hazard ratio ( HR)=1.059, 95% confidence interval (95% CI)=1.017-1.103, P=0.005], cognitive impairment ( HR=2.100, 95% CI=1.322-3.336, P=0.002), frailty ( HR=2.561, 95% CI=1.183-5.545, P=0.017), decreased mean arterial pressure ( HR=0.987, 95% CI=0.976-0.998, P=0.017), decreased prealbumin ( HR=0.997, 95% CI=0.994-1.000, P=0.040), increased blood urea nitrogen ( HR=1.028, 95% CI=1.010-1.045, P=0.001), increased procalcitonin ( HR=1.008, 95% CI=1.001-1.016, P=0.019) via LASSO regression analysis and multivariable Cox regression analysis. The nomogram was developed using these seven predictors. In the training and validation cohorts, the calibration curves, time-dependent AUC curves, and decision curve analysis showed that the nomogram had good calibration degree, discrimination and clinical net benefits. Conclusions:Increased age, cognitive impairment, frailty, decreased mean arterial pressure, decreased prealbumin, increased blood urea nitrogen, and increased procalcitonin are independent risk factors for 28-day mortality in very older patients with sepsis. The nomogram, which included the seven predictors, have good predictive performance, and might be helpful for prognosis assessment.

Objective:To investigate the effect of combining repeated high-frequency transcranial magnetic stimulation (rTMS) with escitalopram in treating the neurological functioning and post-stroke depression of stroke survivors.Methods:Eighty persons with post-stroke depression were randomly divided into an observation group and a control group, each of 40. The control group was treated with oral escitalopram, while the observation group also received transcranial magnetic stimulation at 5Hz. The magnetic stimulation intensity was 80% of each person′s resting motion threshold. The rTMS was administered once a day, 5 days a week for 8 weeks. Neurological functioning and depression were evaluated using National Institutes of Health stroke scoring (NIHSS) and the Hamilton depression scale before and after the 8 weeks of treatment. The levels of tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2) and interleukin-6 (IL-6) in serum samples from the two groups were detected using enzyme-linked immunosorbent assays.Results:After treatment, the NIHSS and Hamilton scores and TNF-α, IL-2 and IL-6 levels in both groups had improved significantly, but in each case they were significantly better in the treated group, on average.Conclusion:Supplementing escitalopram with high-frequency transcranial magnetic stimulation more effectively improves depression and neurological functioning after a stroke.

Objective:To compare the effects of repetitive transcranial magnetic stimulation (TMS) at three different relatively high frequencies on neuropathic pain so as to find the best frequency.Methods:One hundred Sprague-Dawley rats were randomly divided into a sham operation group, a model group, a TMS group and a control stimulation group. The TMS group was further divided into a 5Hz group, a 10Hz group, and a 20Hz group. The rats in the model, control stimulation and TMS groups received constriction injury of the sciatic nerve, while the rats in the sham group were given a sham version of the operation. On the third day after the operation the rats in the TMS group and the control stimulation group began to receive TMS treatment. Neuropatic pain was evaluated on the day before the operation, and on the 3rd, 5th, 7th, 10th and 12th days after the operation. The evaluations included the paw withdrawal thermal latency (PWTL) and the paw withdrawal mechanical threshold (PWMT).Results:The average PWTLs and PWMTs in all of the TMS groups increased with the TMS treatment. Those of the 10Hz and 20Hz groups were significantly higher than the 5Hz group′s average, while there were no significant differences between the 10Hz group and 20Hz group.Conclusions:High-frequency TMS at different frequencies has different effects on neuropathic pain, at least in rats. The treatment efficacy at 10 and 20Hz is superior to that at 5Hz.

Objective:To investigate the effect of paired associative stimulation (PAS) on the recovery of neurological function after cerebral infarction, and to explore whether any such effect is associated with autophagy in the ischemic penumbra.Methods:Sixty adult male Sprague-Dawley rats were randomly divided into a sham operation group ( n=20) and an experimental group ( n=40). The rats of the experimental group underwent 90 minutes of right middle cerebral artery occlusion (MCAO), while the sham group received a sham operation. The experimental group was subsequently divided into a model group ( n=20) and a PAS group ( n=20). The PAS group received 14 days of paired associative stimulation (PAS) beginning 24 hours after the operation. Neurological dysfunction was evaluated with a modified neurological severity scale (mNSS) and the elevated body swing test (EBST) on the 1st, 7th and 14th day after the MCAO. The rats were then euthanized and the expression of LC3Ⅰ, LC3Ⅱ, Beclin1, and Cathepsin B in the ischemic penumbra were detected using Western blotting, while the distribution of LC3 in neurons was detected using double immunofluorescent staining. Results:Compared with the sham group, the average mNSS scores and EBST values of the model and PAS groups were both higher on the 7th and 14th day after the MCAO, with those of the PAS group significantly lower than those of the model group on those days. The average mNSS score on the 14th day was significantly lower than on the 7th day. Compared with the sham group, the average LC3Ⅱ/Ⅰ values, Beclin 1 and Cathepsin B levels of both the model group and the PAS group were significantly higher on the 7th and 14th day after the MCAO, with the LC3Ⅱ/Ⅰ values of the PAS group significantly lower than those of the model group at both time points. The PAS group also had significantly lower Beclin1 and Cathepsin B levels on day 14. On the 7th and 14th days after the MCAO, the average number of LC3-positive cells and the ratio of LC3-positive neurons to total neurons in the model and PAS groups were significantly greater than the those of sham group, with the PAS group′s values significantly lower than those of the model group at each time point.Conclusion:PAS can significantly promote neurological recovery after stroke. The beneficial effects may involve inhibition of neuronal autophagy in the ischemic penumbra.

Objective: To observe the effects of paired associative stimulation (PAS) on synaptic ultrastructure, neuron apoptosis and BDNF in rats with cerebral infarct, and explore the possible underlying mechanisms. Methods: Forty-five male Sprague-Dawley rats were randomly divided into three groups: a sham operation group, a model group and a PAS group, with 15 rats in each. All the rats underwent a surgical operation for transient middle cerebral artery occlusion (MCAO) on the right side to model focal cerebral ischemia, with those in the sham operation group left without real occlusion. PAS treatment was given to rats in the PAS group 24h after MCAO model was successfully established, while no special intervention was given to those in the sham operation group and model group. After 28 days of treatment, transmission electron microscopy was used to investigate the ultrastructure of the ischemic penumbra, TUNEL was used to observe the apoptosis of cortex neurons, and real time-PCR to investigate BDNF mRNA expression. Results: It was found that after 28 days treatment: ①The synaptic curvature, the synapse length and the post-synaptic density (PSD) decreased significantly in the rats of model group in contrast to those of the sham control group (P<0.05). And compare to model group, the synaptic curvature, the synapse length and the PSD increased significantly in the rats of PAS group (P<0.05). ②Compare to sham control group, the apoptosis rate of model group and PAS group increased significantly (P<0.05). And the apoptosis rate of PAS group decreased significantly in contrast to those of model group (P<0.05). ③Compare to sham control group, BDNF mRNA expression of the PAS group increased significantly(P<0.05), while BDNF mRNA expression of the model group decreased significantly(P<0.05). BDNF mRNA expression of the PAS group increased significantly in contrast to those of model group (P<0.05). Conclusion PAS promotes neural plasticity and inhibits apoptosis of cortex neurons of the ischemic penumbra in rats with ischemic cerebral infarction. One of the underlying mechanisms might be related to the up-regulation of BDNF mRNA expression.

Objective To observe the effect of paired associative stimulation ( PAS) on the recovery of sensorimotor function and to explore the mechanism in terms of neural plasticity. Methods Ninety male adult Sprague-Dawley rats were randomly divided into a sham operation group (Sham group), a model group (Model group) and a paired associative stimulation group ( PAS group) , each of 30. Each group was then subdivided into 7-, 14-and 28-day subgroups with 10 rats in each. A model of focal cerebral ischemia and reperfusion was estab-lished using the Longa suture method in the Model and PAS groups. The rats in the Sham group underwent the same surgical procedure except for the occlusion of the middle cerebral artery. The rats received 30 minutes of paired pe-ripheral nerve stimulation and transcranial magnetic stimulation comprising 90 pairs at 0.05 Hz beginning 24 h after the occlusion. The impulse wave width of the peripheral nerve stimulation was 200 μs and the intensity was 6 mA. The intensity of the transcranial magnetic stimulation was 120％ of the resting motor threshold. The other two groups weren't given any intervention. Neurological function was tested using Garcia scores on the 1st, 7th, 14th and 28th day after surgery. The rats were then sacrificed and the expression of MAP-2 and GAP-43 in the ischemic penumbra were detected using western blotting and immunohistochemistry. Results No neurological dysfunction was ob-served in the Sham group at any time. Compared with the Sham group at the same time points, the average Garcia scores of the Model and PAS groups were significantly lower (P≤0.05). However, the average Garcia scores on the 7th, 14th and 28th day were significantly higher in the PAS group compared with the Model group at the same time points ( P≤0.05) . The average Garcia scores of the Model and PAS groups on the 28th day after surgery were significantly higher than those on the 1st day (P≤0.05), but only the PAS group's average Garcia score on the 28th day was significantly higher than that on the 7th day. Compared with the Sham group at the same time points, the expression of MAP-2 and GAP-43 protein in the Model and PAS groups was significantly higher, but with that of the Model group significantly lower than that of the PAS group ( all P≤0.05) . The protein expression of MAP-2 and GAP-43 protein in the PAS group on the 14th day was significantly higher than on the 7th and 28th day ( P≤0.05 for both) . Conclusions PAS can promote the recovery of sensorimotor function after cerebral thrombosis, at least in rats. That may be due to its promoting the expression of the neuroplasticity-associated proteins MAP-2 and GAP-43 in the ischemic penumbra.

Objective To explore the effects and the underlying mechanisms by which paired associative stimulation ( PAS) of tibial nerve electrostimulation and M1 cortex transcranial magnetic stimulation ( TMS) in pro-moting the recovery of forelimb dysfunction in rats with cerebral ischemic stroke. Methods Resting motor thresholds of left extensor carpi radialis muscle ( ECR) were determined 5 min before and 5 min, 30 min, 60 min after PAS,respectively, in 8 male Sprague-Dawley ( SD) rats. Then 48 male SD rats were divided into a sham group ( n=16) subject to sham surgery, an experimental group (n=32) which was further divided into a MCAO group (n=16) and a PAS group (n=16) after cerebral ischemic stroke model was established successfully by occluding the right middle cerebral artery. 24 hours after surgery, PAS consisting of left tibial nerve stimulation and right M1 cortex area TMS was applied to PAS group once daily for 7 consecutive days. The corner tests and grip strength tests were per-formed before and after 7 days of PAS treatment in each group. The RMTs of left ECR were determined, metabolites of the left area tissue of cervical spinal cord were measured by nuclear magnetic resonance spectrum, and expressions of Bcl-2 and Bax of left and right area tissue of cervical spinal cord enlargement were detected by Western Blot tech-nique after 7 days of intervention. Results The average RMTs of left ECR at 5 min, 30 min, 60 min after PAS were significantly lower than those at 5 min before PAS ( P<0.05) . All rats in experimental group showed significant higher turning scores and lower grip strength when compared with sham group (P<0.001 or P<0.01). After PAS interven-tion, PAS group demonstrated lower turning scores, higher grip strength and lower RMT of left ECR as compared with MCAO group ( P<0.05 or P<0.01) . The expression of GABA of left cervical enlargment was significantly decreased in MCAO group when compared with the sham group ( P<0.05) , and there was no significant difference between MCAO group and PAS group. Meanwhile, other metabolites showed no significant difference among the three groups. The av-erage expression level of Bcl-2 and Bax proteins in both sides of cervical spinal cord enlargment showed no significant difference among three groups either. Conclusions Tibial nerve-M1 cortex area PAS may increase the excitability of motor cortical representation of forelimbs in rats, by which PAS promotes the recovery of forelimb dysfunction in rats with cerebral ischemic stroke.

Objective To investigate the effect of a pulsed electromagnetic field ( PEMFS) on bone mineral density and bone metabolism in males with osteoporosis after a stroke. Methods Fifty male stroke survivors with os-teoporosis were randomly divided into a control group and a treatment group, both of 25. Both groups were treated with routine rehabilitation, oral calcium carbonate and vitamin D3 tablets, while the treatment group was additionally pro-vided with PEMFS treatment. The subjects′bone mineral density ( BMD) and their blood levels of bone-specific alka-line phosphatase (B-ALP), type I procollagen amino-terminal peptide (PINP) and type β-I collagen cross-linked carboxy-terminal peptide (β-CTx) were measured before and after the 12 weeks of treatment. Results After the treatment the BMD values of the lumbar spine, femoral neck, trochanter and Ward′s triangle had increased signifi-cantly in both groups, but the average BMD values of the lumbar spine and femoral neck in the treatment group were significantly higher than those of the control group. After the treatment, the average B-ALP, PINP andβ-CTx levels of both groups had also improved significantly compared with before the treatment, but the average improvement in all three among the treatment group was significantly greater than among the controls. Conclusion PEMFS treatment supplementing routine rehabilitation, oral calcium carbonate and vitamin D3 tablets can improve bone formation, re-duce bone resorption and increase bone mineral density in men after a stroke.

Objective To observe the effects of repeated low and high-frequency transcranial magnetic stimulation (rTMS) on neuropathic pain and the expression of specific activation markers of astrocytes and glial fibrillary acidic protein (GFAP) in the lumbar spinal cord.Methods Twenty-eight male Sprague-Dawley rats were randomly divided into a sham-operated group,a sham-rTMS group,a 1 Hz group and a 20 Hz group,with 7 in each group.The rats in the sham-operated group had their sciatic nerve exposed without ligation,while the other groups underwent sciatic nerve ligation to induce neuropathic pain.Three days after the operation,rTMS was applied to the primary motor cortex (M1) contralateral to the pain once a day for 10 consecutive days.Pain-related behavior and thermal pain response were tested before the operation and before and after the course of rTMS therapy.The expression of GFAP in the lumbar spinal cord was examined.Results All of the rats which underwent sciatic nerve ligation showed pain-related behavior and significantly decreasing thermal pain latency compared with the sham-operated group.After the rTMS therapy the thermal hyperalgia was significantly attenuated in the 20 Hz group but not in the 1 Hz group compared with the sham-rTMS group.The expression of GFAP in the dorsal horn of the lumbar spinal cord ipsilateral to the neuropathic pain was significantly increased in the sham-rTMS group and the 1 Hz group compared with the sham-operated group.Compared with the sham-rTMS group,GFAP levels were significantly lower in the 20 Hz group but not in the 1 Hz group.The pain relief in the 20 Hz group was negatively related to the expression of GFAP.Conclusions Neuropathic pain induced by peripheral nerve injury is associated with increased activity and proliferation of astrocytes in the dorsal horns of the spinal cord.High-frequency rTMS can relieve neuropathic pain through inhibiting the activity and proliferation of astrocytes in the dorsal horns,but low-frequency rTMS has no clinically significant effect.

Objective To generate data on the current medical rehabilitation resources in Hubei province so as to improve the management of rehabilitation quality.Methods Medical institutions on the second level and above were investigated using a questionnaire which covered installations,personnel,equipment and field of operations.Results A total of 176 questionnaires were recovered.Among them,166 (94.3％) of the hospitals had established a department of rehabilitation medicine,and 122 (69.3％) had set up an independent rehabilitation ward,accounting for a total of 3,359 beds.Altogether,there were 1,260 rehabilitation physicians (36.7％ of the assigned personnel),904 therapists (26.3％) and 1,272 nurses (37％).Senior physicians,therapists and nurses were 26％,3.1％ and 28.3％ of the respective totals.Conclusion Rehabilitation medicine in Hubei Province remains relatively poorly developed.It is weak in terms of building the discipline,management and devices,especially in a serious lack of professionals and rehabilitation therapists.