BACKGROUND:Transcranial direct current stimulation(tDCS),as a non-invasive brain stimulation technique,can enhance human muscle strength or improve single-leg landing stability instantly,but no relevant research has demonstrated this yet. OBJECTIVE:To investigate the effect of tDCS on the stability of single-leg landings in human subjects. METHODS:Male undergraduate students from Wuhan Sports University were recruited as study participants.They were divided into two groups,A(n=6)and B(n=5),using a random number table.Group A underwent a sham stimulation session followed by a 3-day washout period,after which they received tDCS.Conversely,Group B received tDCS initially,followed by a 3-day washout period,and subsequently underwent the sham stimulation session.Following the respective stimulation sessions,an immediate single-leg landing test was administered to assess and collect biomechanical parameters.Data resulting from the tDCS intervention were aggregated and analyzed as the experimental group dataset,whereas data stemming from the sham stimulation were consolidated as the control group dataset. RESULTS AND CONCLUSION:Regarding core stability,the tDCS intervention showed a significant interaction with landing height on the maximal trunk flexion angle(P＜0.05).A paired comparison of the data showed a significant decrease in the maximum trunk flexion angle following true stimulation compared to sham stimulation at a 30-cm landing height.Additionally,the tDCS intervention had a significant main effect on the maximum trunk lateral bending angle and the mean trunk lateral bending angular velocity(P＜0.05).Following true stimulation,there was a significant decrease in the maximum trunk lateral bending angle and the mean trunk lateral bending angular velocity compared to sham stimulation.In terms of lower limb joint stability,the tDCS intervention had a significant main effect on the maximum dynamic ankle valgus angle(P＜0.05).This resulted in a significant decrease in the angle following true stimulation compared to sham stimulation.In addition,the tDCS intervention had a significant main effect on the peak muscle activation of the lateral head of the gastrocnemius lateralis(P＜0.05).This showed a significant increase after true stimulation compared to sham stimulation.An interaction between the tDCS intervention and landing height was observed for the peak muscle activation of the tibialis anterior(P＜0.05).Paired comparison analyses revealed a significant increase in muscle activation after true stimulation specifically at a 60-cm landing height.Regarding center of pressure stability,there were no significant interactions or main effects of the tDCS intervention on the mean lateral displacement,mean lateral displacement velocity,mean anterior-posterior displacement,or mean anterior-posterior displacement velocity at the center of pressure(P＞0.05).Furthermore,the tDCS intervention had no significant main effects on any of the center of pressure indicators(P＞0.05).In conclusion,tDCS can immediately improve core stability and lower limb joint stability during single-leg landing,making it an effective warm-up technique for improving single-leg landing stability and reducing the risk of lower limb injuries.

Objective:To explore the changes in the synergy mode of human lower limb muscles during the fatigue run-ning,in order to reveal the mechanism by which the central system regulates lower limb movement to adapt to fatigue accumulation. Method:Eleven male runners received constant speed running fatigue intervention,and the electromyograph-ic data of the lower limb muscles was collected during the whole intervention process.The non-negative ma-trix factorization algorithm was used to extract analysis indicators such as the number of lower limb muscle synergists,the peak activation time of muscle synergists,and the muscle relative weight at different interven-tion times. Result:A total of six types of muscle synergists were analyzed throughout the entire process of running fa-tigue intervention to dominate human lower limb joint activities,but each subject would only randomly mobi-lize four to five of them at different fatigue moments,and the number of muscle synergists participating in each fatigue moment had no significant change(P＞0.05).The peak activation time of synergy 1 decreased sig-nificantly at 33％、100％time(P＜0.05).The relative weight of semitendinosus of synergy 1 was significantly reduced at 33％、67％and 100％time(P＜0.05).The relative weight of rectus femoris of synergy 2 decreased significantly at 33％time(P＜0.05).The relative weight of biceps femoris of synergy 4 decreased significantly at 67％time(P＜0.05),but increased significantly at 100％time(P＜0.05). Conclusion:In the process of running fatigue,the human central system will regulate the muscle synergy mode of lower limbs to adapt to fatigue accumulation and reduce the risk of lower limb injury.The specific performance of this regulation process includes:stabilizing the number of lower limb muscle synergists in-volved,reducing the peak activation time of muscle synergists in the early stance stage,dynamically adjusting the relative weight of rectus femoris and semitendinosus in the early stance stage and biceps femoris in the middle swing stage.

Objective To explore the clinical characteristics and death factors of elderly male with type 2 diabetes mellitus(T2DM)complicated with coronavirus infectious disease 2019(COVID-19).Methods A total of 55 hospitalized elderly male T2DM patients with COVID-19 were enrolled in this study from December 2022 to February 2023.All the patients were divided into survival group(n=32)and death group(n=23).The clinical indicators were compared between the two groups and evaluated by multifactor analysis to clarify their clinical characteristics and death risk factors.Results Age,T2DM duration,C-RP,procalcitonin,serum creatinine,creatine kinase,myoglobin,BNP,troponin,D-dimer,FPG and HbA1c were higher(P＜0.05 or(P＜0.01),while lymphocyte count and PaO2 were lower(P＜0.05)in death group than in survival group.The advanced age,C-RP,procalcitonin,serum creatinine,troponin,BNP,D-dimer,increase of FPG and HbA1c,and the reduction of lymphocyte count and PaO2 were risk factors for death(P＜0.05).Conclusion Age,blood glucose control,cardiac renal and pulmonary functions,and risk of thrombosis in elderly male T2DM with COVID-19 have important significance inevalu-ating the prognosis.

Objective To investigate changes of muscle activation in the lower limbs during landing impact as running fatigue pro-gresses. Methods From November to December,2022,eleven male runners were recruited from Wuhan Sports University.They performed a steady-state run at 75%of their maximum heart rate and continued until Borg rating score≥17 or 90%of their maximum heart rate.Muscle activity data were collected using a Delsys wireless surface electromy-ography system,continuously recording the EMG of the quadriceps(vastus medialis,rectus femoris,vastus later-alis),hamstrings(biceps femoris,semitendinosus),gluteus maximus,lateral head of the gastrocnemius and tibia-lis anterior.The pre-activation,post-activation and co-activation characteristics of these lower limb muscles were analyzed. Results With fatigue accumulation during running,significant differences were observed in the pre-activation level of the tibialis anterior among different fatigue points(F=2.955,P=0.048),with the 100%fatigue point showing significantly higher pre-activation levels than the start(P=0.010);as well as post-activation levels of quadriceps(F=6.609,P=0.001),with higher levels at the 100%point compared to the start(P=0.011),33%(P=0.009)and 67%(P=0.043)fatigue points;co-activation ratios of ankle joint during the pre-activation phase(F=3.287,P=0.034),with a significantly higher co-activation ratio at the 100%fatigue point compared to the start(P=0.023). Conclusion As running fatigue accumulates,the central nervous system adjusts the activation levels of various lower limb muscles to modify impact posture,reducing the risk of injury from accumulated lower limb loads.

Objective:To investigate the factors contributing to frailty in very elderly patients with multimorbidity.Methods:This cross-sectional study enrolled 119 very elderly patients with multimorbidity who were hospitalized in the Department of Geriatrics of Huadong Hospital Affiliated to Fudan University from August 2022 to March 2023.The study aimed to understand the basic status of multimorbidity by collecting general information, the number and types of diseases, and frailty status.The subjects were divided into frail and non-frail groups through comprehensive geriatric assessment.Various factors including gender, age, Tinetti balance gait score, risk of sarcopenia, dementia, depression, risk of deep vein thrombosis, dysphagia, comorbidity index, medication count, Basic Activities of Daily Living(BADL)score, Instrumental Activities of Daily Living(IADL)score, Nutritional Risk Screening 2002(NRS-2002)score, Norton pressure injury risk assessment score, and Social Support Rating Scale(SSRS)score were compared.The correlation between each factor and the occurrence of frailty was analyzed using univariate analysis and multivariate Logistic regression analysis.Results:A total of 119 elderly inpatients with multimorbidity, with an average age of 90.8±5.9 years old, were included in the study.The incidence of frailty was 68.9%(82 cases).Univariate analysis revealed significant statistical differences between the frail group and the non-frail group in various factors including age( t=-3.131, P=0.002), Tinetti score( Z=-5.544, P<0.001), risk of sarcopenia( χ2=39.205, P<0.001), dysphagia( χ2=5.937, P=0.015), Charlson comorbidity index( Z=-2.565, P=0.010), medication count( Z=-3.325, P<0.001), BADL( Z=-5.871, P<0.001), IADL( Z=-5.062, P<0.001), Norton score( Z=-5.922, P<0.001), and SSRS social support( Z=-2.637, P=0.008).Multivariate logistic regression analysis showed that the Tinetti score( OR=0.843, 95% CI: 0.737-0.966, P=0.014), decreased muscle strength( OR=11.226, 95% CI: 2.157-58.432, P=0.004), sarcopenia( OR=18.084, 95% CI: 2.041-106.211, P=0.009), Norton score( OR=0.462, 95% CI: 0.254-0.838, P=0.011), and medication count( OR=1.153, 95% CI: 1.000-1.329, P=0.049)were independently associated with frailty. Conclusions:In very elderly patients with multimorbidities, the occurrence of frailty is notably increased.Frailty is linked to multiple risks including falls, muscle weakness/sarcopenia, pressure ulcer risk, and polypharmacy, and these risks are independent of other factors.

【Objective】 To screen and verify a peptide ligand specific for CD44v9. 【Methods】 A 12-mer phage peptide library was screened on CD44v9 coated on solid phase. Candidate sequences emerged after sequencing. Candidate phages were selected using enzyme-linked immunosorbent assay. The best sequence was chosen for further study. Binding of C9-3 to CD44v overexpressed HEK-293 cells was determined using immunofluorescence. Binding affinity and specificity were verified on gastric cancer tissues with immunohistochemistry. 【Results】 Phages significantly were enriched during panning process. After sequencing, nine individual sequences occurred in 30 selected clones. Among the 9 candidate sequences, C9-3 exhibited the highest frequency. Results of ELISA showed that C9-3 had the highest OD value and selectivity. Thus, C9-3 was chosen for peptide probe synthesis. C9-3 probe stained CD44v overexpressed HEK-293 cells, but not empty vector transfected HEK-293 cells. Immunohistochemistry scores of C9-3 were significantly different between gastric cancer and paracancer tissues (t=3.953, P<0.01). A linear positive correlation was observed between C9-3 binding and CD44v9 expression (r=0.823, P<0.01). 【Conclusion】 In this study, peptide ligand of CD44v9 was successfully screened. The peptide can bind to cells and cancer tissues via CD44v9. It has potential for gastric targeting probes.

Objective:To develop and examine the reliability and validity of the adolescent health literacy evaluation scale under public health emergencies (AHLES-PHE) in junior middle school students.Methods:The initial version of AHLES-PHE was formed by combining the characteristics of public health emergencies and adolescent health literacy.The expert version of AHLES-PHE was formed by two rounds of Delphi expert consultation.Totally 1 729 adolescent students from three junior middle schools in Changzhou City were tested.The formal version of AHLES-PHE was formed through item analysis and factor analysis (structural validity). The content validity of the formal version of AHLES-PHE was evaluated by specialist analysis and sensibility analysis, and its correlation validity with the everyday health information literacy (EHIL) was tested.The internal consistency reliability, parity split-half coefficient and test-retest reliability were calculated.Results:(1)Item analysis: the correlation coefficient between the scores of each item and the total score of AHLES-PHE expert version was 0.420 to 0.722 ( P<0.01), and the CR of decision value was 10.140 to 66.980 ( P<0.01). (2)Validity analysis: the formal version of AHLES-PHE with 45 items and 8 factors was obtained by exploratory factor analysis.The 8 factors could explain 61.30% of the total variation.The fitting indexes of the confirmatory factor analysis model were χ2/ df=3.325, RMSEA=0.052, GFI=0.853, CFI=0.912, TLI=0.904, NFI=0.880.Sensibility analysis of the formal version of AHLES-PHE showed the Cronbach's α ranged from 0.957 to 0.958.The correlation coefficient between the total score of AHLES-PHE formal version and the total score of EHIL was 0.340 ( P<0.01). (3)Reliability analysis: the Cronbach's α coefficient and parity split-half coefficient of the formal version of AHLES-PHE were 0.958 and 0.975, respectively.The test-retest reliability of the formal version of AHLES-PHE was 0.753 ( P<0.01). Conclusion:The formal version of AHLES-PHE developed in this study has good reliability, structural validity and content validity, and the correlation validity with EHIL is common.This scale has a certain degree of applicability to the assessment of health literacy for junior middle school students under public health emergencies.

Abstract Health literacy is closely related to the response to public health emergencies. This paper begins with health literacy evaluation tools in adults, then focuses on recent progress made in health literacy evaluation tools in adolescents from the perspective of public health emergencies. The development of adolescent health literacy evaluation tools, health education and health literacy from the perspective of public health emergencies should be greatly enhanced, helping adolescents to better respond to public health emergencies and maintain their physical and mental health.

Objective:To analyze the advantages of the impact of physical activity management under medical supervision on body components and healthy physical fitness.Methods:A total of 106 healthy adults who participated in physical activity management activities in the Health Management Center of Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital from April 1 st 2020 to May 31 th 2021 were enrolled. The subjects were equally divided into a medical supervision group and a self-supervision group with random number table. Both groups performed a 8-week physical activity intervention, followed by the model of “a combination of online home physical activity with offline team exercise, and team exercise interaction with individual physical activity guidance”, while health education was provided and wearable devices were worn to collect exercise data. The medical supervision group completed the set number of exercises under the supervision of the team, with on-site exercise guidance. They were required to participate in weekly one-to-one on-site instruction. The self-management group carried out exercises and participated in weekly one-to-one instruction in accordance according to their own will with online feedback. During the study, 6 cases withdrew, and 52 cases in the supervision group and 48 in the self-management group were obtained. The t and Wilcoxon tests were used to compare the body components and physical fitness of the two groups before and after intervention. Results:The amount of exercise in the supervision group was significantly higher than that in self-management group (1 359 vs 615), and there was no significant differences in exercise intensity (mean heart rate, maximum heart rate and exercise duration) between the two groups (all P>0.05). After the intervention, the body weight, body mass index (BMI), percent body fat, subcutaneous fat area and strength fitness of the supervision group were significantly lower than those before the intervention [(55.36±6.37) vs (56.11±6.33) kg, (21.48±2.85) vs (21.73±2.47) kg/m 2, (27.38±5.34) % vs (28.53±4.99) %, (119.56±48.45) vs (128.70±50.10) cm 2, (24.48±6.37) vs (26.07±5.29) kg], while the cardiorespiratory endurance, flexibility fitness and agility fitness were significantly higher [(33.57±5.06) vs (30.32±4.59) ml·kg -1·min -1, (14.71±7.51) vs (10.54±7.54) cm, (0.44±0.08) vs (0.48±0.05) s] (all P<0.05). After the intervention, the body weight, muscle mass and lean body mass in self-management group were all significantly higher than those before the intervention [(56.83±8.09) vs (56.45±8.22) kg, (38.28±3.19) vs (38.24±5.17) kg; (40.80±4.16) vs (40.32±4.95) kg], and agility fitness was significantly lower [(0.64±0.39) vs (0.49±0.05) s] (all P<0.05). It was also found that improvements regarding the following three indicators were more significant in the supervision group: visceral fat, balance and agility fitness (all P<0.05). Conclusions:Physical activity intervention under medical supervision can significantly improve the body components and physical fitness in healthy adults, as well as exercise compliance and validity.

Objective:To investigate the diagnosis and treatment of multicentric Castleman disease (MCD).Methods:The diagnosis and treatment of one MCD patient admitted in Hangzhou First People's Hospital in July 2020 was analyzed and related literatures were reviewed.Results:The patient was a 55-year-old male with anemia, elevated globulin levels and IgG4 > 10 g/L, and enlarged lymph nodes. He was undiagnosed for 7 years. Lymph node biopsy revealed a large number of polyclonal plasma cell hyperplasia, and the ratio of IgG4/IgG was less than 0.40; the serum interleukin (IL)-6 was more than 6 000 pg/ml and then he was eventually diagnosed as MCD (plasma cell type). Rituximab + cyclophosphamide + dexamethasone (RCD) regimen was not effective, and it was changed to anti-IL-6 receptor antibody tocilizumab for 2 courses and then the patient obtained good results.Conclusions:Castleman disease is a rare disease with a poor prognosis. It has high heterogeneity and is easy to be misdiagnosed clinically. The diagnosis requires pathological examination. IL-6 is considered to be closely related to the onset of Castleman disease and has become an effective target for treatment.