ObjectiveTo explore the impact of autonomic nerve function on motor function in patients with post-stroke depression (PSD) from the perspective of regional homogeneity (ReHo). MethodsFrom January to December, 2020, a total of 60 inpatients and outpatients with cerebral infarction in the Affiliated Brain Hospital of Nanjing Medical University were divided into control group (n = 30) and PSD group (n = 30). Two groups were assessed using Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI) and Hamilton Depression Scale (HAMD). Heart rate variability (HRV) was measured. Ten patients in each group were selected randomly to undergo resting state functional magnetic resonance imaging (rs-fMRI) to calculate ReHo. ResultsAll HRV indices were lower in PSD group than in the control group (|t| > 2.092, P < 0.05). In PSD group, FMA and MBI scores showed positive correlations with 24-hour standard deviation of normal-to-normal R-R intervals (SDNN), the root mean square of successive differences between normal heartbeats over 24 hours (RMSSD), the percentage of differences between adjacent normal R-R intervals over 24 hours that were greater than 50 ms (PNN50), total power (TP), very low frequency power (VLF) and low frequency power (LF) (r > 0.394, P < 0.05), and showed negative correlations with HAMD scores (|r| > 0.919, P < 0.001). HAMD scores in PSD group were negatively correlated with SDNN, RMSSD, PNN50, TP and VLF (|r| > 0.769, P < 0.001). Compared with the control group, the ReHo increased in PSD group in the right rectus gyrus (142 voxels, t = 6.575), the left medial and paracingulate gyri (204 voxels, t = 4.925) (GRF correction, P_-Voxel < 0.005，P_-Cluster < 0.05); and reduced in the right cerebellum (191 voxels, t = -6.487), the left middle temporal gyrus (140 voxels, t = -5.516), and the left precentral gyrus (119 voxels, t = -4.764) (GRF correction, P_-Voxel < 0.005，P_-Cluster < 0.05) in PSD group. ConclusionAutonomic nerve function is related to motor dysfunction in patients with PSD. The modulation of emotional, cognitive and motor brain regions by the autonomic nervous system may play a role in influencing the motor function in patients with PSD.

Objective:To analyze hip joint movement during the swing phase of the strides of stroke survivors with hemiplegia and foot drop.Methods:Thirty stroke survivors with hemiplegia and foot drop formed the observation group, while thirty matched healthy counterparts were the control group. A three-dimensional gait analysis system was used to compare the hip and ankle joint kinematics on the hemiplegic side of the observation group members with those on the corresponding side of a matched control. Pearson correlation related the maximum plantar flexion angle of the ankle and hip joints in the observation group.Results:Compared with the control group, there was a significant increase in the maximum abduction and external rotation of the hip joint during the swing phase, but a significant decrease in the maximum extension, flexion, adduction, internal rotation. The range of motion of the hip joint in the sagittal, frontal and horizontal planes was significantly smaller, as was the maximum dorsiflexion and sagittal range of motion of the ankle joint. The maximum plantar flexion angle of the ankle was positively correlated with the hip joint′s maximum flexion, maximum external rotation and sagittal joint motion, but negatively correlated with the hip′s horizontal motion.Conclusion:In stroke survivors with hemiplegia and ptosis, significant changes are observed in the three-dimensional motion during the swing phase of a stride. The mode of hip joint compensation changes depending on the severity of the foot drop.

Based on the physiological and pathological characteristics of"spleen is often insufficient"in Children,Professor Jiang Yuren put forward the academic view of"the health of the spleen is not replenished but regulated",and took"spleen regulation meth-od"as the first choice for the treatment of spleen-stomach diseases such as anorexia,diarrhea,infantile malnutrition,iron deficiency anemia.By systematically analyzing the academic connotation,clinical practice,inheritance and development of Professor Jiang Yuren's"spleen regulation method"and combining with the current research progress,this article interprets the internal molecular mechanism of"spleen regulation method"to provide scientific basis for further promoting the clinical application and modern research of Professor Jiang Yuren's"spleen regulation method".

Objective:To explore the correlation between the initial estimated glomerular filtration rate (eGFR) and all-cause mortality in end-stage renal disease (ESRD) patients undergoing urgent-start peritoneal dialysis (USPD).Methods:The clinical data of 380 ESRD patients undergoing USPD from January 2013 to June 2023 in Affiliated Hospital of Jining Medical University were retrospective analyzed. According to the median initial eGFR of 6.25 ml/(min·1.73 m 2), the patients were divided into low eGFR group with eGFR<6.25 ml/(min·1.73 m 2) and high eGFR group with eGFR ≥6.25 ml/(min·1.73 m 2), with 190 patients in each group. The baseline characteristics and hematological indexes within 48 h before USPD were compared between the two groups. The patients were followed up until death or until June 30, 2023, and all-cause mortality was recorded. The Kaplan-Meier survival curve was used to evaluate the accumulated survival rate. Multivariate Cox regression analyses were used to identify the independent risk factors for all-cause mortality in ESRD patients undergoing USPD, with subgroup analyses based on age, gender and diabetes. Results:The median follow-up time was 40.7 (21.7, 59.0) months, 112 patients died, with a total mortality rate of 29.5% (112/380). The blood potassium, blood phosphorus, urea nitrogen, uric acid, parathyroid hormone and dialysis age in high eGFR group were significantly lower than those in low eGFR group: (4.1 ± 0.7) mmol/L vs. (4.5 ± 0.8) mmol/L, (1.6 ± 0.4) mmol/L vs. (1.9 ± 0.6) mmol/L, (21.8 ± 7.2) mmol/L vs. (29.7 ± 11.0) mmol/L, (359.8 ± 99.4) μmol/L vs. (429.4 ± 116.9) μmol/L, 242.2 (151.5, 398.3) ng/L vs. 281.7 (189.1, 487.2) ng/L and 36.1 (18.8, 54.0) months vs. 43.7 (28.8, 68.2) months, the diabetes rate, hemoglobin, platelet count, blood chloride, fasting blood glucose and mortality rate were significantly higher than those in low eGFR group: 20.0% (38/190) vs. 11.6% (22/190), (100.6 ± 18.2) g/L vs. (96.1 ± 20.0) g/L, (207.7 ± 72.6) × 10 9/L vs. (192.4 ± 65.6) × 10 9/L, (100.6 ± 4.1) mmol/L vs. (99.4 ± 4.7) mmol/L, (5.9 ± 2.3) mmol/L vs. (5.5 ± 1.9) mmol/L and 34.2% (65/190) vs. 24.7% (47/190), and there were statistical differences ( P<0.01 or< 0.05). Kaplan-Meier survival curve analysis result showed that the all-cause mortality rate in high eGFR group was significantly higher than that in low eGFR group, and there was statistical difference (log-rank χ2 = 6.64, P<0.01). After adjusting for gender, age and confounding factors, multivariate Cox regression analysis result showed that elevated eGFR, increased mean corpuscular volume and elevated fasting blood glucose were independent risk factors for all-cause mortality in ESRD patients undergoing USPD ( HR = 1.14, 1.04 and 1.15; 95% CI 1.04 to 1.26, 1.01 to 1.08 and 1.03 to 1.29; P<0.01 or<0.05), while female was an independent protective factor ( HR = 0.59, 95% CI 0.38 to 0.92, P<0.05). Subgroup analysis result showed a consistent effect of eGFR on mortality in ESRD patients undergoing USPD. Conclusions:Higher initial eGFR in ESRD patients undergoing USPD is associated with an increased risk of all-cause mortality.

Objective To observe the correlation between apparent diffusion coefficient(ADC)of sacroiliac joint and spondyloarthritis research consortium of Canada(SPARCC)score in ankylosing spondylitis(AS)patients with different grade sacroiliac joint inflammation.Methods MR examinations of sacroiliac joint were prospectively performed in 35 AS patients(AS group)and 30 healthy controls(HC group).The grade of sacroiliac joint inflammation and SPARCC score in AS group were evaluated according to MRI findings,and the patients were then further divided into bone marrow oedema(BMO)subgroup(n=19)and non-BMO subgroup(n=16)according to whether BMO presented under articular surface or not,and ADC of sacroiliac joint(ADCsacroiliac)were measured.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to evaluate the efficacy of ADCsacroiliac for assessing AS sacroiliac joint inflammation grade.Pearson correlation analysis was performed to analyze the correlation between ADCsacroiliac and SPARCC score in AS patients with different grade sacroiliac joint inflammation.Results ADCsacroiliac in BMO subgroup and non-BMO subgroup was(4.85±1.44)×10-4 and(4.30±0.64)×10-4 mm2/s,respectively,being not significantly different(P＞0.05)but both higher than that in HC group([3.32±1.36]×10-4 mm2/s,both P＜0.05).The sensitivity of ADCsacroiliac for assessing grade of sacroiliac joint inflammation in AS patients was 49.44％,51.94％,73.06％and 60.50％,with specificity of 75.00％,78.92％,83.33％and 66.67％,respectively,and AUC of 0.613,0.712,0.837 and 0.645,respectively.ADCsacroiliac was moderately-highly positively correlated with SPARCC score of AS patients with Ⅱ and Ⅲgrade sacroiliac joint inflammation(r=0.580,0.933,both P＜0.05),but no obvious correlation was detected between ADCsacroiliac and SPARCC score of AS patients with Ⅰ or Ⅳ grade sacroiliac joint inflammation(both P＞0.05).Conclusion ADCsacroiliac was positively correlated with SPARCC scores of AS patients with Ⅱ and Ⅲ grade sacroiliac joint inflammation,which could be regarded as a reliable quantitative parameter for monitoring sacroiliac joint BMO.

At present, public health education in colleges and universities has many problems, such as insufficient education and practice for infectious diseases, serious shortage of public health talents, insufficient interdisciplinary integration of public health disciplines, lack of a holistic view of public health, and insufficient flexibility and autonomy of curriculum design in colleges and universities. These problems were closely related to the cultivation of practical ability of public health talents in colleges and universities. The new era puts forward high requirements for the construction of high-level schools of public health and the training of high-level public health talents, presenting both opportunities and challenges. The School of Public Health, Sun Yat-sen University proposed the idea of "combined peacetime and wartime training" to cultivate high-level public health talents who can solve practical problems, and jointly established a demonstration base for high-level public health talents training with Guangzhou Center for Disease Control and Prevention (CDC). The core content is “one class, one team, one hospital and one center”. The experimental class of "medical, prevention and management" talents, the Sun Yat-sen University-Guangzhou Volunteer Service Team for Epidemiological Investigation, the Graduate School of Guangzhou CDC, and the Joint Research Center of for Disease Surveillance and Early Warning and Risk Assessment of Sun Yat-sen University-Guangzhou CDC has been established. Virtual simulation experiments and simulation exercises have been conducted. It is an innovated training for high-level public health talents. The linkage between universities and CDCs to promote the development of public health disciplines can provide reference for public health personnel training in universities to cultivate high-level public health talents with the ability to solve practical problems.

Objective:To investigate whether the antibacterial copper sulfide (CuS)/graphene oxide (GO) nanosheets composite film can promote angiogenesis and osteogenesis in vitro. Methods:GO and CuS/GO nanosheets were synthesized and mixed into polyvinyl alcohol (PVA)/carboxymethyl cellulose (CMC) hydrogel films. The study was conducted in 4 groups: PVA/CMC/GO, PVA/CMC/CuS/GO, PVA/CMC (only PVA/CMC-based film) and blank control (no material). The PVA/CMC, PVA/CMC/GO and PVA/CMC/CuS/GO films were characterized by electron scanning microscopy and energy dispersive spectrometer. The biocompatibility of different films (PVA/CMC/CuS/GO films with concentrations of CuS/GO nanotablets of 0, 50, 100, 200, 400, and 800 μ g/mL) was evaluated by CCK-8, live/dead cell staining, and hemolysis test. The angiogenesis was evaluated by cell migration and tube forming test in vitro. Alkaline phosphatase and alizarin red staining were used to evaluate osteogenesis in vitro, and the expression of osteogenic genes was measured by immunofluorescence staining and RT-qPCR. In addition, the bacterial plate counting method and bacteriostatic circle method were used to evaluate the antibacterial activity of films. Results:In the PVA/CMC/GO and PVA/CMC/CuS/GO groups, the surface of the PVA/CMC-based film was smooth and flat whereas the nanosheets composite films were irregularly flaky and convex. The biosafety experiments showed that the PVA/CMC-based film composited with GO or CuS/GO nanosheets at the concentration of 100 μg/mL had good biocompatibility. The results of angiogenesis in vitro showed that the migration ratio of HUVEC cells in the PVA/CMC/CuS/GO group was significantly better than those in the PVA/CMC/GO, PVA/CMC and control groups ( P<0.001). In the experiment of tube forming area and length, the PVA/CMC/CuS/GO group was significantly better than the PVA/CMC/GO, PVA/CMC and control groups ( P<0.001). The osteogenic differentiation in vitro displayed that the alkaline phosphatase and alizarin red staining of MC3T3-E1 cells in the PVA/CMC/CuS/GO group were significantly better than those in the PVA/CMC/GO, PVA/CMC and control groups ( P<0.001). In addition, the fluorescence intensity of immunofluorescence staining in alkaline phosphatase and type Ⅰcollagen on MC3T3-E1 cells, and the mRNA expression levels of osteogenic related genes including alkaline phosphatase, bone morphogenetic protein 2, osteocalcin and osteopontin in the PVA/CMC/CuS/GO group were significantly higher than those in the PVA/CMC/GO, PVA/CMC and control groups ( P<0.001). The antibacterial assay showed that the PVA/CMC/CuS/GO group had a significantly greater antibacterial activity and a significantly larger inhibition zone against Gram-positive bacteria and Gram-negative bacteria than the PVA/CMC/GO, PVA/CMC and control groups ( P< 0.001). Conclusions:PVA/CMC films composited with GO or CuS/GO nanosheets demonstrate ideal biocompatibility and antibacterial properties which promote angiogenesis and osteogenic differentiation in vitro. In particular, antibacterial PVA/CMC/CuS/GO composite films with the coupling function of angiogenesis and osteogenesis are expected to provide a new strategy for infectious bone defects.

Objective:To explore the accuracy of artificial intelligence (AI) system based on deep learning in evaluating bone age of children with abnormal growth and development.Methods:The positive X-ray films of the left wrist of children with abnormal growth and development who were treated at the Affiliated Hospital of Guizhou Medical University from January 2020 to December 2021 were collected retrospectively. A total of 717 children were collected, including 266 males and 451 females, aged 2-18 (11±3) years. Based on Tanner Whitehouse 3 (TW 3)-RUS (radius, ulna, short bone) and TW3-Carpal (carpal bone) method, bone age was measured by 3 senior radiologists, and the mean value was taken as reference standard. The bone ages were independently evaluated by the AI system (Dr.Wise bone age prediction software) and two junior radiologists (physicians 1 and 2). The accuracy within 0.5 year, the accuracy within 1 year, the mean absolute error (MAE) and the root mean square error (RMSE) between the evaluation results and the reference standard were analyzed. Paired sample t-test was used to compare MAE between AI system and junior physicians. Intraclass correlation coefficient (ICC) was used to evaluate the consistency between AI system, junior physician and reference standard. The Bland-Altman diagram was drawn and the 95% consistency limit was calculated between AI system and reference standard. Results:For TW3-RUS bone age, compared with the reference standard, the accuracy within 0.5 year of AI system, physician 1 and physician 2 was 75.3% (540/717), 62.1% (445/717) and 66.2% (475/717), respectively. The accuracy within 1 year was 96.9% (695/717), 86.3% (619/717) and 89.1% (639/717), respectively. MAE was 0.360, 0.565 and 0.496 years, and RMSE was 0.469, 0.634 and 0.572 years, respectively. For TW3-Carpal bone age, compared with the reference standard, the accuracy within 0.5 year of AI system, physician 1 and physician 2 was 80.9% (580/717), 65.1% (467/717) and 71.7% (514/717), respectively. The accuracy within 1 year was 96.0% (688/717), 87.3% (626/717) and 90.4% (648/717), respectively. MAE was 0.330, 0.527 and 0.455 years, and RMSE was 0.458, 0.612, 0.538 years, respectively. Based on TW3-RUS and TW3-Carpal bone age, the MAE of AI system were lower than those of physician 1 and physician 2, and the differences were statistically significant ( P all<0.001). The evaluation results of AI, physician 1 and physician 2 were in good agreement with the reference standard (ICC all>0.950). The Bland-Altman analysis showed that the 95% agreement limits of AI system for assessing TW3-RUS and TW3-Carpal bone age were -0.75-1.02 years and-0.86-0.91 years, respectively. Conclusion:The accuracy of AI system in evaluating the bone age of children with abnormal growth and development is close to that of senior doctors, better than that of junior doctors, and in good agreement with senior doctors.

Objective:To observe the clearance strategies of hemiplegic stroke survivors with foot drop.Methods:Thirty hemiplegic stroke survivors with foot drop formed the observation group and 30 healthy counterparts constituted the control group. A three-dimensional motion capture system was used to observe and compare the minimum toe clearance (MTC) and its variability between the two groups to draw the motion trajectory of the toe in the swing phase of their gaits. The gait parameters were correlated with the toe clearance.Results:The average MTC of the observation group subjects on both the hemiplegic and non-hemiplegic side (12.01±3.36 and 22.38±5.51mm) was significantly smaller than the control group′s averages. The variability of their MTCs on both sides was also significantly greater. Clearance on the hemiplegic side was significantly less and its variability was significantly greater. Among the observation group, MTC on the hemiplegic side was positively correlated with walking speed, step length, swing phase percentage, maximum angle of hip extension, maximum angle of knee flexion, maximum angle of ankle dorsiflexion, and the range of motion of the knee and ankle joints.Conclusions:Hemiplegic stroke survivors with foot drop walk unstably with little toe clearance. It is necessary to intervene at the hip, knee and ankle to improve their obstacle clearance.

Objective:To investigate the safety and efficacy of chemoradiotherapy compared with chemotherapy after R0 excision in pN + esophageal squamous cell carcinoma (ESCC) patients. Methods:A retrospective analysis was performed on the pathological data of 99 pN + ESCC patients who underwent radical esophagectomy with R0 resection in Renmin Hospital of Wuhan University from January 2017 to December 2020. According to postoperative adjuvant treatment methods, the patients were divided into chemo-radiotherapy group ( n=41) and chemotherapy group ( n=58). The main outcome measures were disease-free survival (DFS), overall survival (OS) and the incidences of treatment-related adverse events. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression model was used to analyze the prognostic factors. Results:The median DFS and OS of 99 patients were 20.0 months and 28.0 months respectively. The 1- and 3-year DFS rates were 60.8% and 34.5% respectively. The 1- and 3-year OS rates were 83.5% and 40.2% respectively. The median DFS was 39.0 months in the chemoradiotherapy group and 10.0 months in the chemotherapy group, and the 1- and 3-year DFS rates were 79.4% vs. 48.3% and 57.3% vs. 24.5% respectively, with a statistically significant difference ( χ2=12.27, P<0.001). The median OS in the chemoradiotherapy group was not reached, and 21.0 months in the chemotherapy group, and the 1- and 3-year OS rates of the chemoradiotherapy group and chemotherapy group were 92.1% vs. 75.9% and 60.8% vs. 27.3%, with a statistically significant difference ( χ2=11.12, P=0.001). Univariate analysis showed that pN stage ( HR=0.58, 95% CI: 0.34-0.97, P=0.038), nerve invasion ( HR=1.88, 95% CI: 1.11-3.20, P=0.020) and adjuvant therapy ( HR=0.37, 95% CI: 0.21-0.67, P<0.001) were independent influencing factors of DFS in pN + ESCC patients. Adjuvant therapy ( HR=0.33, 95% CI: 0.17-0.66, P=0.001) was an independent factor influencing OS in pN + ESCC patients. Multivariate analysis showed that pN stage ( HR=0.54, 95% CI: 0.30-0.97, P=0.038) and adjuvant therapy ( HR=0.38, 95% CI: 0.21-0.69, P=0.001) were independent prognostic factors of DFS. Adjuvant therapy ( HR=0.34, 95% CI: 0.17-0.69, P=0.003) was an independent prognostic factor for OS. During adjuvant therapy, there were statistically significant differences in the incidences of leukopenia [65.85% (27/41) vs. 31.03% (18/58), χ2=11.75, P=0.001], thrombocytopenia [29.27% (12/41) vs. 10.34% (6/58), χ2=5.78, P=0.016], radioactive esophagitis [21.95% (9/41) vs. 0 (0/58), χ2=11.48, P=0.001], and radioactive pneumonia [21.95% (9/41) vs. 0 (0/58), χ2=11.48, P=0.001] between the two groups. Conclusion:Compared with chemotherapy, chemoradiotherapy can significantly improve DFS and OS of pN + ESCC patients with R0 resection after radical surgery, and the adverse reactions can be tolerated. pN stage and adjuvant therapy are independent prognostic factors for DFS, and adjuvant therapy is an independent prognostic factor for OS.