BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking rec...BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking recovery.OBJECTIVE:To determine whether early suspension-protected training with a personal assistant machine for stroke patients enhances walking ability and prevents muscle spasms.METHODS:Thirty-two early-stage stroke patients from Shenzhen University General Hospital and the China Rehabilitation Research Center were randomly assigned to the experimental group(n=16)and the control group(n=16).Both groups underwent 4 weeks of gait training under the suspension protection system for 30 minutes daily,5 days a week.The experimental group used the personal assistant machine during training.Three-dimensional gait analysis(using the Cortex motion capture system),Brunnstrom staging,Fugl-Meyer Assessment for lower limb motor function,Fugl-Meyer balance function,and the modified Ashworth Scale were evaluated within 1 week before the intervention and after 4 weeks of intervention.RESULTS AND CONCLUSION:After the 4-week intervention,all outcome measures showed significant changes in each group.The experimental group had a small but significant increase in the modified Ashworth Scale score(P<0.05,d=|0.15|),while the control group had a large significant increase(P<0.05,d=|1.48|).The experimental group demonstrated greater improvements in walking speed(16.5 to 38.44 cm/s,P<0.05,d=|4.01|),step frequency(46.44 to 64.94 steps/min,P<0.05,d=|2.32|),stride length(15.50 to 29.81 cm,P<0.05,d=|3.44|),and peak hip and knee flexion(d=|1.82|to|2.17|).After treatment,the experimental group showed significantly greater improvements than the control group in walking speed(38.44 vs.26.63 cm/s,P<0.05,d=|2.75|),stride length,peak hip and knee flexion(d=|1.31|to|1.45|),step frequency(64.94 vs.59.38 steps/min,P<0.05,d=|0.85|),and a reduced support phase(bilateral:24.31%vs.28.38%,P<0.05,d=|0.88|;non-paretic:66.19%vs.70.13%,P<0.05,d=|0.94|).For early hemiplegia,personal assistant machine-assisted gait training under the suspension protection system helps establish a correct gait pattern,prevents muscle spasms,and improves motor function.展开更多
This article reviews research advances in the application of early enteral nutrition(EEN)in elderly patients with severe acute pancreatitis(SAP).Elderly SAP patients are associated with higher mor tality rates due to ...This article reviews research advances in the application of early enteral nutrition(EEN)in elderly patients with severe acute pancreatitis(SAP).Elderly SAP patients are associated with higher mor tality rates due to age-related immune dysfunction,whereas EEN has been demonstrated to improve clinical prognosis,reduce infection and complication rates,and shor ten hospital stays.However,ongoing debates exist regarding the optimal timing,route selection,and complication management of EEN.Through a systematic review of the literature,this study synthesizes current evidence on EEN in elderly SAP populations,critically examines unresolved clinical controversies,and proposes future research priorities to inform evidence-based practice.展开更多
The increasing global prevalence of mild cognitive impairment(MCI)necessitates a paradigm shift in early detection strategies.Conventional neuropsychological assessment methods,predominantly paper-and-pencil tests suc...The increasing global prevalence of mild cognitive impairment(MCI)necessitates a paradigm shift in early detection strategies.Conventional neuropsychological assessment methods,predominantly paper-and-pencil tests such as the Mini-Mental State Examination and the Montreal Cognitive Assessment,exhibit inherent limitations with respect to accessibility,administration burden,and sensitivity to subtle cognitive decline,particularly among diverse populations.This commentary critically examines a recent study that champions a novel approach:The integration of gait and handwriting kinematic parameters analyzed via machine learning for MCI screening.The present study positions itself within the broader landscape of MCI detection,with a view to comparing its advantages against established neuropsychological batteries,advanced neuroimaging(e.g.,positron emission tomography,magnetic resonance imaging),and emerging fluid biomarkers(e.g.,cerebrospinal fluid,blood-based assays).While the study demonstrates promising accuracy(74.44%area under the curve 0.74 with gait and graphic handwriting)and addresses key unmet needs in accessibility and objectivity,we highlight its cross-sectional nature,limited sample diversity,and lack of dual-task assessment as areas for future refinement.This commentary posits that kinematic biomarkers offer a distinctive,scalable,and ecologically valid approach to widespread MCI screening,thereby complementing existing methods by providing real-world functional insights.Future research should prioritize longitudinal validation,expansion to diverse cohorts,integration with multimodal data including dual-tasking,and the development of highly portable,artificial intelligence-driven solutions to achieve the democratization of early MCI detection and enable timely interventions.展开更多
BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate se...BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.展开更多
Objective:To analyze the improvement effect of early postoperative rehabilitation training on balance ability and quality of life in elderly patients with hip fracture.Methods:A total of 50 elderly patients with hip f...Objective:To analyze the improvement effect of early postoperative rehabilitation training on balance ability and quality of life in elderly patients with hip fracture.Methods:A total of 50 elderly patients with hip fracture admitted to our hospital from January 2023 to January 2024 were selected and divided into the observation group(25 cases)and the control group(25 cases)by random number table method.The control group received routine nursing,while the observation group received early rehabilitation training on the basis of routine nursing.The balance ability(Berg Balance Scale,BBS)and quality of life(SF-36)of the two groups were compared.Results:The BBS scores of the observation group at all postoperative time points were significantly higher than those of the control group(p<0.05),and the quality-of-life scores of the observation group were also significantly higher than those of the control group(p<0.05).Conclusion:Early postoperative rehabilitation training for elderly patients with hip fracture can improve their balance ability,enhance their quality of life,and reduce the incidence of postoperative complications,which is worthy of clinical promotion.展开更多
Long-span bridges are usually constructed over waterways that involve substantial ship traffic,resulting in a risk of collisions between the bridge girders and over-height ships.The consequences of this can be severe ...Long-span bridges are usually constructed over waterways that involve substantial ship traffic,resulting in a risk of collisions between the bridge girders and over-height ships.The consequences of this can be severe structural damage or even collapse.Accurate measurement of ship dimensions is an effective way to monitor approaching over-height ships and avoid collisions.However,the performance of current techniques for estimating the size of moving objects can be undermined by large sensor-to-object distance,limiting their applicability.In this study,we propose a digital twin-assisted ship size measurement framework that can overcome such limitations through a predictive model and virtual-to-real-world transfer learning.Specifically,a 3D synthetic environment is first established to generate a synthetic dataset,which includes ship images,positions,and dimensions.Then the pixel information and spatial coordinates of ships are adopted as regressors,and ship dimensions are selected as the output variables to pre-train deep learning models using the generated dataset.Coordinate system transformations are applied to address dataset bias between the simulated world and real-world,as well as improve the model’s generalization.The pre-trained models are compared using supervised virtual-to-real-world transfer learning to select the version with optimal real-world performance.The mean absolute percentage error is only 3.74%across varying camera-to-ship distances,which demonstrates that the proposed method is effective for over-limit ship monitoring.展开更多
Distribution transformers play a vital role in power distribution systems,and their reliable operation is crucial for grid stability.This study presents a simulation-based framework for active fault diagnosis and earl...Distribution transformers play a vital role in power distribution systems,and their reliable operation is crucial for grid stability.This study presents a simulation-based framework for active fault diagnosis and early warning of distribution transformers,integrating Sample Ensemble Learning(SEL)with a Self-Optimizing Support Vector Machine(SO-SVM).The SEL technique enhances data diversity and mitigates class imbalance,while SO-SVM adaptively tunes its hyperparameters to improve classification accuracy.A comprehensive transformer model was developed in MATLAB/Simulink to simulate diverse fault scenarios,including inter-turn winding faults,core saturation,and thermal aging.Feature vectors were extracted from voltage,current,and temperature measurements to train and validate the proposed hybrid model.Quantitative analysis shows that the SEL–SO-SVM framework achieves a classification accuracy of 97.8%,a precision of 96.5%,and an F1-score of 97.2%.Beyond classification,the model effectively identified incipient faults,providing an early warning lead time of up to 2.5 s before significant deviations in operational parameters.This predictive capability underscores its potential for preventing catastrophic transformer failures and enabling timely maintenance actions.The proposed approach demonstrates strong applicability for enhancing the reliability and operational safety of distribution transformers in simulated environments,offering a promising foundation for future real-time and field-level implementations.展开更多
Early life stress correlates with a higher prevalence of neurological disorders,including autism,attention-deficit/hyperactivity disorder,schizophrenia,depression,and Parkinson's disease.These conditions,primarily...Early life stress correlates with a higher prevalence of neurological disorders,including autism,attention-deficit/hyperactivity disorder,schizophrenia,depression,and Parkinson's disease.These conditions,primarily involving abnormal development and damage of the dopaminergic system,pose significant public health challenges.Microglia,as the primary immune cells in the brain,are crucial in regulating neuronal circuit development and survival.From the embryonic stage to adulthood,microglia exhibit stage-specific gene expression profiles,transcriptome characteristics,and functional phenotypes,enhancing the susceptibility to early life stress.However,the role of microglia in mediating dopaminergic system disorders under early life stress conditions remains poorly understood.This review presents an up-to-date overview of preclinical studies elucidating the impact of early life stress on microglia,leading to dopaminergic system disorders,along with the underlying mechanisms and therapeutic potential for neurodegenerative and neurodevelopmental conditions.Impaired microglial activity damages dopaminergic neurons by diminishing neurotrophic support(e.g.,insulin-like growth factor-1)and hinders dopaminergic axon growth through defective phagocytosis and synaptic pruning.Furthermore,blunted microglial immunoreactivity suppresses striatal dopaminergic circuit development and reduces neuronal transmission.Furthermore,inflammation and oxidative stress induced by activated microglia can directly damage dopaminergic neurons,inhibiting dopamine synthesis,reuptake,and receptor activity.Enhanced microglial phagocytosis inhibits dopamine axon extension.These long-lasting effects of microglial perturbations may be driven by early life stress–induced epigenetic reprogramming of microglia.Indirectly,early life stress may influence microglial function through various pathways,such as astrocytic activation,the hypothalamic–pituitary–adrenal axis,the gut–brain axis,and maternal immune signaling.Finally,various therapeutic strategies and molecular mechanisms for targeting microglia to restore the dopaminergic system were summarized and discussed.These strategies include classical antidepressants and antipsychotics,antibiotics and anti-inflammatory agents,and herbal-derived medicine.Further investigations combining pharmacological interventions and genetic strategies are essential to elucidate the causal role of microglial phenotypic and functional perturbations in the dopaminergic system disrupted by early life stress.展开更多
Background:Health benefits have been reported for many physical activity(PA)interventions for improving fundamental movement skills(FMS)and cognitive function(CF),but the most effective type of PA interventions for em...Background:Health benefits have been reported for many physical activity(PA)interventions for improving fundamental movement skills(FMS)and cognitive function(CF),but the most effective type of PA interventions for emhancing FMS and CF in early childhood remain unknown.Thus,the study aimed to determine the effects of PA interventions in enhancing FMS and CF among young children and to establish the optimal types of PA interventions.Methods:Six electronic databases(PubMed,OVID,SPORTDiscus,Scopus,Web of Science,and Cochrane)were searched for studies from inception to March 17,2024.Randomized controlled trials(RCTs)were included in this study if they reported outcomes related to FMS,CF,or both associated with PA interventions.Effect sizes were calculated and performed as Hedges'g.The hierarchy of competing interventions was established using the surface under the cumulative ranking curve(SUCRA).Risk of bias was independently assessed using the Cochrane Riskof-Bias 2.Results:This analysis included 38 studies with 5237 young children,with sample sizes ranging from 32 to 897 participants.The types of PA interventions analyzed included active play/free play/unstructured PA(AP),general structured PA(GSPA),FMS-targeted PA programs(FMSprograms),cognitively-engaging PA programs(CPA),multilevel PA interventions(MPA),and exergaming.PA interventions had a large,pooled effect size for total FMS(g=0.96;95%CI:0.45-1.46;p<0.01;I^(2)=94%).For CF,a small-to-moderate pooled effect size was found(g=0.39;95%CI:0.18-0.60;p<0.01;I^(2)=88%).PA interventions longer than 3 months showed fewer benefits for FMS(p<0.01).The network meta-analysis showed that FMS-programs(standardized mean difference((SMD)=1.55,95%CI:0.98-2.11,SUCRA=98.3%)and GSPA(SMD=0.94,95%CI:0.05-1.85,SUCRA=69.8%)significantly improved total FMS compared to AP.For locomotor skills(LMS),exergaming ranked highest(SUCRA=79.3%),followed by FMS-programs(75.9%)and GSPA(61.6%).However,despite its top ranking,exergaming's effect estimate was not statistically significant(SMD=1.38,95%CI:-0.08 to 2.85).For object control skills(OCS),exergaming again ranked highest(SUCRA=91.9%)and showed the largest significant effect(SMD=2.38,95%CI:0.96-3.80),followed by FMS-programs(SUCRA=78.5%)and GSPA(SUCRA=53.7%).FMS-programs,GSPA,MPA,and UC also significantly improved OCS compared to AP.While no significant differences were observed across PA interventions for most CF domains,exergaming had a significant positive effect on working memory(SMD=1.41,95%CI:0.07-2.75).The certainty of evidence varied from low to moderate.Conclusion:These findings emphasize the importance of PA interventions in improving FMS and CF in early childhood.FMS-programs and GSPA appear to be the most effective approaches for enhancing total FMS,while exergaming showed the highest ranking for LMS and OCS,with a significant impact on OCS but uncertainty in LMS improvements.Additionally,exergaming had a positive effect on working memory,suggesting its potential cognitive benefits.展开更多
Background:Early Hearing Detection and Intervention(EHDI)plays a critical role in improving language,cognitive,and socio-emotional outcomes for infants with hearing loss.In Nigeria,however,EHDI implementation remains ...Background:Early Hearing Detection and Intervention(EHDI)plays a critical role in improving language,cognitive,and socio-emotional outcomes for infants with hearing loss.In Nigeria,however,EHDI implementation remains limited by fragmented service delivery,uneven technological capacity,and sociocultural factors that delay timely diagnosis.This study explored the perspectives of paediatric audiologists and parents to provide a comprehensive understanding of the opportunities and challenges influencing early hearing care across diverse Nigerian settings.Methods:A mixed-methods design was employed across audiology facilities selected systematically from four Nigerian geopolitical zones.Twenty-five paediatric audiologists and twenty-three parents of children with congenital hearing loss participated.Quantitative data were collected using a structured questionnaire assessing awareness,diagnostic access,and intervention experiences.Qualitative data were obtained through semi-structured interviews and two focus group discussions.Thematic analysis followed Braun and Clarke's six-step framework,with dual coding,external auditing,and member validation to enhance credibility.Results:Quantitative findings demonstrated broad agreement on the diagnostic value of otoacoustic emissions(OAEs)and automated auditory brainstem responses(AABRs),the developmental benefits of early intervention,and the importance of active parental involvement.However,respondents identified persistent barriers including high costs of screening and therapy,poor public awareness of early hearing loss symptoms,and a critical shortage of trained personnel,and unequal distribution of diagnostic tools,particularly in rural and northern regions.Thematic analysis further underscored disparities in diagnostic capacity,sociocultural interpretations of deafness that delay clinical consultation,and economic constraints that hinder continuity of care.While families who accessed early intervention reported improved communication,social engagement,and learning readiness in their children,systemic gaps continue to limit widespread success.Conclusions:Despite growing technological capacity and awareness of EHDI benefits,significant structural,financial,and sociocultural challenges continue to impede timely diagnosis and intervention in Nigeria.Strengthening national policies,ensuring equitable distribution of diagnostic tools,expanding professional training,subsidising services,implementing culturally sensitive awareness campaigns and integration of Universal Newborn Hearing Screening into routine postnatal care are essential to improving outcomes for deaf infants.展开更多
Parkinson’s disease remains a major clinical issue in terms of early detection,especially during its prodromal stage when symptoms are not evident or not distinct.To address this problem,we proposed a new deep learni...Parkinson’s disease remains a major clinical issue in terms of early detection,especially during its prodromal stage when symptoms are not evident or not distinct.To address this problem,we proposed a new deep learning 2-based approach for detecting Parkinson’s disease before any of the overt symptoms develop during their prodromal stage.We used 5 publicly accessible datasets,including UCI Parkinson’s Voice,Spiral Drawings,PaHaW,NewHandPD,and PPMI,and implemented a dual stream CNN–BiLSTM architecture with Fisher-weighted feature merging and SHAP-based explanation.The findings reveal that the model’s performance was superior and achieved 98.2%,a F1-score of 0.981,and AUC of 0.991 on the UCI Voice dataset.The model’s performance on the remaining datasets was also comparable,with up to a 2–7 percent betterment in accuracy compared to existing strong models such as CNN–RNN–MLP,ILN–GNet,and CASENet.Across the evidence,the findings back the diagnostic promise of micro-tremor assessment and demonstrate that combining temporal and spatial features with a scatter-based segment for a multi-modal approach can be an effective and scalable platform for an“early,”interpretable PD screening system.展开更多
Vitamin D deficiency(VDD)represents a significant nutritional concern among children and adolescents.The estimated prevalence of VDD in China is 46.8%in this population^([1]).VDD during childhood and adolescence has b...Vitamin D deficiency(VDD)represents a significant nutritional concern among children and adolescents.The estimated prevalence of VDD in China is 46.8%in this population^([1]).VDD during childhood and adolescence has been associated with the onset of various conditions,including acute respiratory infections,asthma,atopic dermatitis,and food allergies^([2]).Multiple factors,including age,sun exposure,adiposity,and genetics,influence vitamin D levels^([2,3]).Increasing attention has been directed toward understanding the environmental determinants that may influence vitamin D status.Given the potential of metallic pollutants to disrupt endocrine function and their ubiquity in the environment,investigating the effects of metal exposure on human vitamin D status,particularly in vulnerable populations,is imperative.展开更多
In the era of artificial intelligence(AI),healthcare and medical sciences are inseparable from different AI technologies[1].ChatGPT once shocked the medical field,but the latest AI model DeepSeek has recently taken th...In the era of artificial intelligence(AI),healthcare and medical sciences are inseparable from different AI technologies[1].ChatGPT once shocked the medical field,but the latest AI model DeepSeek has recently taken the lead[2].PubMed indexed publications on DeepSeek are evolving[3],but limited to editorials and news articles.In this Letter,we explore the use of DeepSeek in early symptoms recognition for stroke care.To the best of our knowledge,this is the first DeepSeek-related writing on stroke.展开更多
Osteoarthritis(OA)is one of the most common degenerative joint diseases in the elderly,increasing in prevalence and posing a substantial socioeconomic challenge,while no disease-modifying treatments available.Better u...Osteoarthritis(OA)is one of the most common degenerative joint diseases in the elderly,increasing in prevalence and posing a substantial socioeconomic challenge,while no disease-modifying treatments available.Better understanding of the early molecular events will benefit the early-stage diagnosis and clinical therapy.Here,we observed the nucleus accumulation of ZBTB20,a member of ZBTB-protein family,in the chondrocytes of early-stage OA.Chondrocytes-specific depletion of Zbtb20 in adult mice attenuated DMM-induced OA progress,restored the balance of extracellular matrix anabolism and catabolism.The NF-κB signaling mediated disturbance of ECM maintenance by ZBTB20 requires its suppression of Pten and consequent PI3K-Akt signaling activation.Furthermore,the subcellular localization of ZBTB20 was modulated by the kinase LATS1.Independent approaches to modulating ZBTB20 via utilizing TRULI and DAPA can restore ECM homeostasis,improving the abnormal behavior and moderating cartilage degeneration.The compounds TRULI and DAPA modulating ZBTB20 may serve as anti-OA drugs.展开更多
BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with ...BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis(IVT).AIM To investigate the predictive value of glycemic indicators for early neurological outcomes(ENOs)in patients with AIS treated with IVT.METHODS We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology,Second Affiliated Hospital of Xuzhou Medical University,between January 2017 and June 2022.ENO included early neurological improvement(ENI)and early neurological deterioration(END),defined as a decrease or increase in the National Institutes of Health Stroke Scale(NIHSS)score between baseline and 24 hours after IVT.We analyzed the associations between glycemic indicators[including admission hyperglycemia(AH),fasting blood glucose(FBG),and SH ratio(SHR)]and ENO in all patients and in subgroups stratified by diabetes mellitus(DM).RESULTS A total of 819 patients with AIS treated with IVT were included.Among these,AH was observed in 329 patients(40.2%).Compared with patients without AH,those with AH were more likely to have a higher prevalence of DM(P<0.001)and hypertension(P=0.031)and presented with higher admission NIHSS scores(P<0.001).During the first 24 hours after IVT,END occurred in 208 patients(25.4%)and ENI occurred in 156 patients(19.0%).Multivariate mixed logistic regression analyses indicated that END was independently associated with AH[odds ratio(OR):1.744,95%confidence interval(CI):1.236-2.463;P=0.002].Subjects were classified into four groups representing quartiles.Compared with Q1,patients in the higher quartiles of SHR(Q2:OR:2.306,95%CI:1.342-3.960;P=0.002)(Q3:OR:2.284,95%CI:1.346-3.876;P=0.002)(Q4:OR:3.486,95%CI:2.088-5.820;P=0.001)and FBG(Q3:OR:1.746,95%CI:1.045-2.917;P=0.033)(Q4:OR:2.436,95%CI:1.476-4.022;P=0.001)had a significantly higher risk of END in the overall population.However,none of the glycemic indicators were found to be associated with ENI in patients with or without DM.CONCLUSION Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.展开更多
Early diagnosis of rapidly progressive osteoarthritis of the hip(RPOH)remains clinically challenging due to the lack of unified guidelines and standardized diagnostic criteria.Current diagnostic criteria(chondrolysis&...Early diagnosis of rapidly progressive osteoarthritis of the hip(RPOH)remains clinically challenging due to the lack of unified guidelines and standardized diagnostic criteria.Current diagnostic criteria(chondrolysis>2 mm/year)require follow-up for at least 12 months.This review characterizes two types of earlystage RPOH progression:Chondrolysis with or without subsequent femoral head destruction within 12 months of onset.Based on their association with early disease progression in RPOH,elevated serum matrix metalloproteinase-3 levels and spinopelvic malalignment may serve as predictive factors for subsequent bone destruction when only joint space narrowing is observed.This review also proposes potential mechanisms of pathogenesis and intervention strategies for RPOH at its initial stage.Cartilage matrix fragments generated by stress concentrations on the hip joint,resulting from spinopelvic malalignment,may trigger inflammatory pathways involving proinflammatory cytokines and inflammasome activation,ultimately leading to joint destruction in the initial phase of RPOH.Suppression of these early pathological events may prevent joint destruction caused by RPOH.However,further elucidation of the cellular and molecular pathways involved in rapid joint destruction is necessary to identify specific biomarkers for early diagnosis and to facilitate the development of targeted therapies in the initial phase of RPOH.展开更多
BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilizatio...BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.展开更多
Breast cancer represents a significant and growing public health challenge in China,marked by a rising incidence and distinct variations across age groups and geographical regions.This review synthesizes recent eviden...Breast cancer represents a significant and growing public health challenge in China,marked by a rising incidence and distinct variations across age groups and geographical regions.This review synthesizes recent evidence regarding the epidemiology,early detection,and early treatment in the Chinese context.We outline current patterns of disease burden and the spectrum of risk factors—both modifiable and non-modifiable.We note ongoing shifts linked to reproductive trends,lifestyle changes,and an aging population.Screening practices are increasingly evolving towards stratified,risk-adapted pathways.These approaches often combine mammography with adjunct imaging modalities such as ultrasound,digital breast tomosynthesis,or magnetic resonance imaging for selected populations,while artificial intelligence is under active investigation to enhance image interpretation and streamline workflow.Contemporary early management strategies emphasize breast-conserving surgery and selective axillary surgery,alongside the expanded application of hypofractionated and precision-targeted radiotherapy.Systemic therapy is increasingly guided by tumor subtype.In the adjuvant setting,molecular profiling and multigene assays are now routinely utilized to tailor treatment intensity to individual tumor biology,facilitating both treatment escalation or de-escalation where appropriate.Concurrently,in the neoadjuvant setting,research efforts within China and globally are focused on evaluating novel therapeutic regimens and biomarker-driven strategies to improve pathologic complete response rates and inform subsequent postoperative care.A consolidated understanding of these evolving themes is crucial for shaping effective clinical practice and health policies,ultimately supporting the goals of earlier diagnosis and improved patient outcomes in China.展开更多
BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno...BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno-arterial ECMO(VA-ECMO)are considered very-high risk patients to participate in any type of physical therapy(PT)or mobilization.However,cumulative evidence suggests that early mobilization of critically ill patients is feasible,safe,and efficient under certain circumstances.AIM To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.METHODS This is a scoping review that used systematic electronic literature searches(from inception until January 2025)on MEDLINE(PubMed),PEDro,DynaMed,CINAHL,Scopus,Science direct and Hellenic Academic Libraries.Snowball searching method was also applied.Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT,published in English and utilized any primary evidence study design.Studies on children,animals and patients placed on any other ECMO,secondary evidence,and‘grey’literature were excluded.RESULTS A total of 316 articles were retrieved and 13 were included in the study.Of those,1 study was a randomized control trial,4 retrospective studies,4 retrospective cohort studies,1 case series and 3 case reports.The sample size of the included studies ranged from 1 to 104 VA-ECMO patients,who were ambulated or received PT inter-ventions,and mobilization frequency ranged from 2 per day to 4 per week.Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position.PT and early mobilization were associated with better weaning from mechanical ventilation,gradual reduction of inotropes and functional capacity improvement after ECMO discharge.CONCLUSION Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times.High quality research on early mobilization in VA-ECMO patients is warranted.展开更多
文摘BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking recovery.OBJECTIVE:To determine whether early suspension-protected training with a personal assistant machine for stroke patients enhances walking ability and prevents muscle spasms.METHODS:Thirty-two early-stage stroke patients from Shenzhen University General Hospital and the China Rehabilitation Research Center were randomly assigned to the experimental group(n=16)and the control group(n=16).Both groups underwent 4 weeks of gait training under the suspension protection system for 30 minutes daily,5 days a week.The experimental group used the personal assistant machine during training.Three-dimensional gait analysis(using the Cortex motion capture system),Brunnstrom staging,Fugl-Meyer Assessment for lower limb motor function,Fugl-Meyer balance function,and the modified Ashworth Scale were evaluated within 1 week before the intervention and after 4 weeks of intervention.RESULTS AND CONCLUSION:After the 4-week intervention,all outcome measures showed significant changes in each group.The experimental group had a small but significant increase in the modified Ashworth Scale score(P<0.05,d=|0.15|),while the control group had a large significant increase(P<0.05,d=|1.48|).The experimental group demonstrated greater improvements in walking speed(16.5 to 38.44 cm/s,P<0.05,d=|4.01|),step frequency(46.44 to 64.94 steps/min,P<0.05,d=|2.32|),stride length(15.50 to 29.81 cm,P<0.05,d=|3.44|),and peak hip and knee flexion(d=|1.82|to|2.17|).After treatment,the experimental group showed significantly greater improvements than the control group in walking speed(38.44 vs.26.63 cm/s,P<0.05,d=|2.75|),stride length,peak hip and knee flexion(d=|1.31|to|1.45|),step frequency(64.94 vs.59.38 steps/min,P<0.05,d=|0.85|),and a reduced support phase(bilateral:24.31%vs.28.38%,P<0.05,d=|0.88|;non-paretic:66.19%vs.70.13%,P<0.05,d=|0.94|).For early hemiplegia,personal assistant machine-assisted gait training under the suspension protection system helps establish a correct gait pattern,prevents muscle spasms,and improves motor function.
基金supported by the Scientific Research Project of the Health Commission of Shanxi Province(No.2024003)。
文摘This article reviews research advances in the application of early enteral nutrition(EEN)in elderly patients with severe acute pancreatitis(SAP).Elderly SAP patients are associated with higher mor tality rates due to age-related immune dysfunction,whereas EEN has been demonstrated to improve clinical prognosis,reduce infection and complication rates,and shor ten hospital stays.However,ongoing debates exist regarding the optimal timing,route selection,and complication management of EEN.Through a systematic review of the literature,this study synthesizes current evidence on EEN in elderly SAP populations,critically examines unresolved clinical controversies,and proposes future research priorities to inform evidence-based practice.
文摘The increasing global prevalence of mild cognitive impairment(MCI)necessitates a paradigm shift in early detection strategies.Conventional neuropsychological assessment methods,predominantly paper-and-pencil tests such as the Mini-Mental State Examination and the Montreal Cognitive Assessment,exhibit inherent limitations with respect to accessibility,administration burden,and sensitivity to subtle cognitive decline,particularly among diverse populations.This commentary critically examines a recent study that champions a novel approach:The integration of gait and handwriting kinematic parameters analyzed via machine learning for MCI screening.The present study positions itself within the broader landscape of MCI detection,with a view to comparing its advantages against established neuropsychological batteries,advanced neuroimaging(e.g.,positron emission tomography,magnetic resonance imaging),and emerging fluid biomarkers(e.g.,cerebrospinal fluid,blood-based assays).While the study demonstrates promising accuracy(74.44%area under the curve 0.74 with gait and graphic handwriting)and addresses key unmet needs in accessibility and objectivity,we highlight its cross-sectional nature,limited sample diversity,and lack of dual-task assessment as areas for future refinement.This commentary posits that kinematic biomarkers offer a distinctive,scalable,and ecologically valid approach to widespread MCI screening,thereby complementing existing methods by providing real-world functional insights.Future research should prioritize longitudinal validation,expansion to diverse cohorts,integration with multimodal data including dual-tasking,and the development of highly portable,artificial intelligence-driven solutions to achieve the democratization of early MCI detection and enable timely interventions.
基金Supported by China Health&Medical Development Foundation,No.M2021551.
文摘BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.
基金Chongqing Education Science Planning Project.Project Name:Research on Talent Training of Community Rehabilitation Major in Higher Vocational Colleges Based on OBE Concept(Project No.:K23ZG3420222)。
文摘Objective:To analyze the improvement effect of early postoperative rehabilitation training on balance ability and quality of life in elderly patients with hip fracture.Methods:A total of 50 elderly patients with hip fracture admitted to our hospital from January 2023 to January 2024 were selected and divided into the observation group(25 cases)and the control group(25 cases)by random number table method.The control group received routine nursing,while the observation group received early rehabilitation training on the basis of routine nursing.The balance ability(Berg Balance Scale,BBS)and quality of life(SF-36)of the two groups were compared.Results:The BBS scores of the observation group at all postoperative time points were significantly higher than those of the control group(p<0.05),and the quality-of-life scores of the observation group were also significantly higher than those of the control group(p<0.05).Conclusion:Early postoperative rehabilitation training for elderly patients with hip fracture can improve their balance ability,enhance their quality of life,and reduce the incidence of postoperative complications,which is worthy of clinical promotion.
基金supported by the National Natural Science Foundation of China(Nos.52338011 and 52108274)the Start-up Research Fund of Southeast University(No.RF1028624058),Chinasupport from the SEU Innovation Capability Enhancement Plan for Doctoral Students(No.CXJH_SEU 26112),China.
文摘Long-span bridges are usually constructed over waterways that involve substantial ship traffic,resulting in a risk of collisions between the bridge girders and over-height ships.The consequences of this can be severe structural damage or even collapse.Accurate measurement of ship dimensions is an effective way to monitor approaching over-height ships and avoid collisions.However,the performance of current techniques for estimating the size of moving objects can be undermined by large sensor-to-object distance,limiting their applicability.In this study,we propose a digital twin-assisted ship size measurement framework that can overcome such limitations through a predictive model and virtual-to-real-world transfer learning.Specifically,a 3D synthetic environment is first established to generate a synthetic dataset,which includes ship images,positions,and dimensions.Then the pixel information and spatial coordinates of ships are adopted as regressors,and ship dimensions are selected as the output variables to pre-train deep learning models using the generated dataset.Coordinate system transformations are applied to address dataset bias between the simulated world and real-world,as well as improve the model’s generalization.The pre-trained models are compared using supervised virtual-to-real-world transfer learning to select the version with optimal real-world performance.The mean absolute percentage error is only 3.74%across varying camera-to-ship distances,which demonstrates that the proposed method is effective for over-limit ship monitoring.
文摘Distribution transformers play a vital role in power distribution systems,and their reliable operation is crucial for grid stability.This study presents a simulation-based framework for active fault diagnosis and early warning of distribution transformers,integrating Sample Ensemble Learning(SEL)with a Self-Optimizing Support Vector Machine(SO-SVM).The SEL technique enhances data diversity and mitigates class imbalance,while SO-SVM adaptively tunes its hyperparameters to improve classification accuracy.A comprehensive transformer model was developed in MATLAB/Simulink to simulate diverse fault scenarios,including inter-turn winding faults,core saturation,and thermal aging.Feature vectors were extracted from voltage,current,and temperature measurements to train and validate the proposed hybrid model.Quantitative analysis shows that the SEL–SO-SVM framework achieves a classification accuracy of 97.8%,a precision of 96.5%,and an F1-score of 97.2%.Beyond classification,the model effectively identified incipient faults,providing an early warning lead time of up to 2.5 s before significant deviations in operational parameters.This predictive capability underscores its potential for preventing catastrophic transformer failures and enabling timely maintenance actions.The proposed approach demonstrates strong applicability for enhancing the reliability and operational safety of distribution transformers in simulated environments,offering a promising foundation for future real-time and field-level implementations.
基金supported by the National Natural Science Foundation of China,Nos.82304990(to NY),81973748(to JC),82174278(to JC)the National Key R&D Program of China,No.2023YFE0209500(to JC)+4 种基金China Postdoctoral Science Foundation,No.2023M732380(to NY)Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine,No.202102010014(to JC)Huang Zhendong Research Fund for Traditional Chinese Medicine of Jinan University,No.201911(to JC)National Innovation and Entrepreneurship Training Program for Undergraduates in China,No.202310559128(to NY and QM)Innovation and Entrepreneurship Training Program for Undergraduates at Jinan University,Nos.CX24380,CX24381(both to NY and QM)。
文摘Early life stress correlates with a higher prevalence of neurological disorders,including autism,attention-deficit/hyperactivity disorder,schizophrenia,depression,and Parkinson's disease.These conditions,primarily involving abnormal development and damage of the dopaminergic system,pose significant public health challenges.Microglia,as the primary immune cells in the brain,are crucial in regulating neuronal circuit development and survival.From the embryonic stage to adulthood,microglia exhibit stage-specific gene expression profiles,transcriptome characteristics,and functional phenotypes,enhancing the susceptibility to early life stress.However,the role of microglia in mediating dopaminergic system disorders under early life stress conditions remains poorly understood.This review presents an up-to-date overview of preclinical studies elucidating the impact of early life stress on microglia,leading to dopaminergic system disorders,along with the underlying mechanisms and therapeutic potential for neurodegenerative and neurodevelopmental conditions.Impaired microglial activity damages dopaminergic neurons by diminishing neurotrophic support(e.g.,insulin-like growth factor-1)and hinders dopaminergic axon growth through defective phagocytosis and synaptic pruning.Furthermore,blunted microglial immunoreactivity suppresses striatal dopaminergic circuit development and reduces neuronal transmission.Furthermore,inflammation and oxidative stress induced by activated microglia can directly damage dopaminergic neurons,inhibiting dopamine synthesis,reuptake,and receptor activity.Enhanced microglial phagocytosis inhibits dopamine axon extension.These long-lasting effects of microglial perturbations may be driven by early life stress–induced epigenetic reprogramming of microglia.Indirectly,early life stress may influence microglial function through various pathways,such as astrocytic activation,the hypothalamic–pituitary–adrenal axis,the gut–brain axis,and maternal immune signaling.Finally,various therapeutic strategies and molecular mechanisms for targeting microglia to restore the dopaminergic system were summarized and discussed.These strategies include classical antidepressants and antipsychotics,antibiotics and anti-inflammatory agents,and herbal-derived medicine.Further investigations combining pharmacological interventions and genetic strategies are essential to elucidate the causal role of microglial phenotypic and functional perturbations in the dopaminergic system disrupted by early life stress.
文摘Background:Health benefits have been reported for many physical activity(PA)interventions for improving fundamental movement skills(FMS)and cognitive function(CF),but the most effective type of PA interventions for emhancing FMS and CF in early childhood remain unknown.Thus,the study aimed to determine the effects of PA interventions in enhancing FMS and CF among young children and to establish the optimal types of PA interventions.Methods:Six electronic databases(PubMed,OVID,SPORTDiscus,Scopus,Web of Science,and Cochrane)were searched for studies from inception to March 17,2024.Randomized controlled trials(RCTs)were included in this study if they reported outcomes related to FMS,CF,or both associated with PA interventions.Effect sizes were calculated and performed as Hedges'g.The hierarchy of competing interventions was established using the surface under the cumulative ranking curve(SUCRA).Risk of bias was independently assessed using the Cochrane Riskof-Bias 2.Results:This analysis included 38 studies with 5237 young children,with sample sizes ranging from 32 to 897 participants.The types of PA interventions analyzed included active play/free play/unstructured PA(AP),general structured PA(GSPA),FMS-targeted PA programs(FMSprograms),cognitively-engaging PA programs(CPA),multilevel PA interventions(MPA),and exergaming.PA interventions had a large,pooled effect size for total FMS(g=0.96;95%CI:0.45-1.46;p<0.01;I^(2)=94%).For CF,a small-to-moderate pooled effect size was found(g=0.39;95%CI:0.18-0.60;p<0.01;I^(2)=88%).PA interventions longer than 3 months showed fewer benefits for FMS(p<0.01).The network meta-analysis showed that FMS-programs(standardized mean difference((SMD)=1.55,95%CI:0.98-2.11,SUCRA=98.3%)and GSPA(SMD=0.94,95%CI:0.05-1.85,SUCRA=69.8%)significantly improved total FMS compared to AP.For locomotor skills(LMS),exergaming ranked highest(SUCRA=79.3%),followed by FMS-programs(75.9%)and GSPA(61.6%).However,despite its top ranking,exergaming's effect estimate was not statistically significant(SMD=1.38,95%CI:-0.08 to 2.85).For object control skills(OCS),exergaming again ranked highest(SUCRA=91.9%)and showed the largest significant effect(SMD=2.38,95%CI:0.96-3.80),followed by FMS-programs(SUCRA=78.5%)and GSPA(SUCRA=53.7%).FMS-programs,GSPA,MPA,and UC also significantly improved OCS compared to AP.While no significant differences were observed across PA interventions for most CF domains,exergaming had a significant positive effect on working memory(SMD=1.41,95%CI:0.07-2.75).The certainty of evidence varied from low to moderate.Conclusion:These findings emphasize the importance of PA interventions in improving FMS and CF in early childhood.FMS-programs and GSPA appear to be the most effective approaches for enhancing total FMS,while exergaming showed the highest ranking for LMS and OCS,with a significant impact on OCS but uncertainty in LMS improvements.Additionally,exergaming had a positive effect on working memory,suggesting its potential cognitive benefits.
文摘Background:Early Hearing Detection and Intervention(EHDI)plays a critical role in improving language,cognitive,and socio-emotional outcomes for infants with hearing loss.In Nigeria,however,EHDI implementation remains limited by fragmented service delivery,uneven technological capacity,and sociocultural factors that delay timely diagnosis.This study explored the perspectives of paediatric audiologists and parents to provide a comprehensive understanding of the opportunities and challenges influencing early hearing care across diverse Nigerian settings.Methods:A mixed-methods design was employed across audiology facilities selected systematically from four Nigerian geopolitical zones.Twenty-five paediatric audiologists and twenty-three parents of children with congenital hearing loss participated.Quantitative data were collected using a structured questionnaire assessing awareness,diagnostic access,and intervention experiences.Qualitative data were obtained through semi-structured interviews and two focus group discussions.Thematic analysis followed Braun and Clarke's six-step framework,with dual coding,external auditing,and member validation to enhance credibility.Results:Quantitative findings demonstrated broad agreement on the diagnostic value of otoacoustic emissions(OAEs)and automated auditory brainstem responses(AABRs),the developmental benefits of early intervention,and the importance of active parental involvement.However,respondents identified persistent barriers including high costs of screening and therapy,poor public awareness of early hearing loss symptoms,and a critical shortage of trained personnel,and unequal distribution of diagnostic tools,particularly in rural and northern regions.Thematic analysis further underscored disparities in diagnostic capacity,sociocultural interpretations of deafness that delay clinical consultation,and economic constraints that hinder continuity of care.While families who accessed early intervention reported improved communication,social engagement,and learning readiness in their children,systemic gaps continue to limit widespread success.Conclusions:Despite growing technological capacity and awareness of EHDI benefits,significant structural,financial,and sociocultural challenges continue to impede timely diagnosis and intervention in Nigeria.Strengthening national policies,ensuring equitable distribution of diagnostic tools,expanding professional training,subsidising services,implementing culturally sensitive awareness campaigns and integration of Universal Newborn Hearing Screening into routine postnatal care are essential to improving outcomes for deaf infants.
基金supported via funding from Prince Sattam bin Abdulaziz University project number(PSAU/2025/03/32440).
文摘Parkinson’s disease remains a major clinical issue in terms of early detection,especially during its prodromal stage when symptoms are not evident or not distinct.To address this problem,we proposed a new deep learning 2-based approach for detecting Parkinson’s disease before any of the overt symptoms develop during their prodromal stage.We used 5 publicly accessible datasets,including UCI Parkinson’s Voice,Spiral Drawings,PaHaW,NewHandPD,and PPMI,and implemented a dual stream CNN–BiLSTM architecture with Fisher-weighted feature merging and SHAP-based explanation.The findings reveal that the model’s performance was superior and achieved 98.2%,a F1-score of 0.981,and AUC of 0.991 on the UCI Voice dataset.The model’s performance on the remaining datasets was also comparable,with up to a 2–7 percent betterment in accuracy compared to existing strong models such as CNN–RNN–MLP,ILN–GNet,and CASENet.Across the evidence,the findings back the diagnostic promise of micro-tremor assessment and demonstrate that combining temporal and spatial features with a scatter-based segment for a multi-modal approach can be an effective and scalable platform for an“early,”interpretable PD screening system.
基金supported by grants from the National Natural Science Foundation of China(G.F.Wang,grant number 82204071)(P.Y.Su,grant numbers 81874268 and 82473655)the Research Funds of the Center for Big Data and Population Health of IHM(P.Y.Su,No.JKS2023016)Anhui Provincial Health Commission Scientific Research Project(Y.Zhou,No.AHWJ2023A30027)。
文摘Vitamin D deficiency(VDD)represents a significant nutritional concern among children and adolescents.The estimated prevalence of VDD in China is 46.8%in this population^([1]).VDD during childhood and adolescence has been associated with the onset of various conditions,including acute respiratory infections,asthma,atopic dermatitis,and food allergies^([2]).Multiple factors,including age,sun exposure,adiposity,and genetics,influence vitamin D levels^([2,3]).Increasing attention has been directed toward understanding the environmental determinants that may influence vitamin D status.Given the potential of metallic pollutants to disrupt endocrine function and their ubiquity in the environment,investigating the effects of metal exposure on human vitamin D status,particularly in vulnerable populations,is imperative.
文摘In the era of artificial intelligence(AI),healthcare and medical sciences are inseparable from different AI technologies[1].ChatGPT once shocked the medical field,but the latest AI model DeepSeek has recently taken the lead[2].PubMed indexed publications on DeepSeek are evolving[3],but limited to editorials and news articles.In this Letter,we explore the use of DeepSeek in early symptoms recognition for stroke care.To the best of our knowledge,this is the first DeepSeek-related writing on stroke.
基金supported by grants from the National Natural Science Foundation of China(82002351,82394442,82130070,82272442)funded by the Innovation Capability Support Program of Shaanxi Province(2024SF-LCZX-16)+2 种基金the Shaanxi Province Health Scientific Research Innovation Ability Promotion Plan(2024PT-12)the Independent Exploration and Innovation Project of Xi’an Jiaotong University(xzy012023121)the project of Xi’an Postdoctoral Innovation Base.
文摘Osteoarthritis(OA)is one of the most common degenerative joint diseases in the elderly,increasing in prevalence and posing a substantial socioeconomic challenge,while no disease-modifying treatments available.Better understanding of the early molecular events will benefit the early-stage diagnosis and clinical therapy.Here,we observed the nucleus accumulation of ZBTB20,a member of ZBTB-protein family,in the chondrocytes of early-stage OA.Chondrocytes-specific depletion of Zbtb20 in adult mice attenuated DMM-induced OA progress,restored the balance of extracellular matrix anabolism and catabolism.The NF-κB signaling mediated disturbance of ECM maintenance by ZBTB20 requires its suppression of Pten and consequent PI3K-Akt signaling activation.Furthermore,the subcellular localization of ZBTB20 was modulated by the kinase LATS1.Independent approaches to modulating ZBTB20 via utilizing TRULI and DAPA can restore ECM homeostasis,improving the abnormal behavior and moderating cartilage degeneration.The compounds TRULI and DAPA modulating ZBTB20 may serve as anti-OA drugs.
基金Supported by the Foundation of Jiangsu Provincial Commission of Health and Family Planning,No.QNRC2016353the Commission of Health and Family Planning Xuzhou,No.KC22206.
文摘BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis(IVT).AIM To investigate the predictive value of glycemic indicators for early neurological outcomes(ENOs)in patients with AIS treated with IVT.METHODS We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology,Second Affiliated Hospital of Xuzhou Medical University,between January 2017 and June 2022.ENO included early neurological improvement(ENI)and early neurological deterioration(END),defined as a decrease or increase in the National Institutes of Health Stroke Scale(NIHSS)score between baseline and 24 hours after IVT.We analyzed the associations between glycemic indicators[including admission hyperglycemia(AH),fasting blood glucose(FBG),and SH ratio(SHR)]and ENO in all patients and in subgroups stratified by diabetes mellitus(DM).RESULTS A total of 819 patients with AIS treated with IVT were included.Among these,AH was observed in 329 patients(40.2%).Compared with patients without AH,those with AH were more likely to have a higher prevalence of DM(P<0.001)and hypertension(P=0.031)and presented with higher admission NIHSS scores(P<0.001).During the first 24 hours after IVT,END occurred in 208 patients(25.4%)and ENI occurred in 156 patients(19.0%).Multivariate mixed logistic regression analyses indicated that END was independently associated with AH[odds ratio(OR):1.744,95%confidence interval(CI):1.236-2.463;P=0.002].Subjects were classified into four groups representing quartiles.Compared with Q1,patients in the higher quartiles of SHR(Q2:OR:2.306,95%CI:1.342-3.960;P=0.002)(Q3:OR:2.284,95%CI:1.346-3.876;P=0.002)(Q4:OR:3.486,95%CI:2.088-5.820;P=0.001)and FBG(Q3:OR:1.746,95%CI:1.045-2.917;P=0.033)(Q4:OR:2.436,95%CI:1.476-4.022;P=0.001)had a significantly higher risk of END in the overall population.However,none of the glycemic indicators were found to be associated with ENI in patients with or without DM.CONCLUSION Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.
文摘Early diagnosis of rapidly progressive osteoarthritis of the hip(RPOH)remains clinically challenging due to the lack of unified guidelines and standardized diagnostic criteria.Current diagnostic criteria(chondrolysis>2 mm/year)require follow-up for at least 12 months.This review characterizes two types of earlystage RPOH progression:Chondrolysis with or without subsequent femoral head destruction within 12 months of onset.Based on their association with early disease progression in RPOH,elevated serum matrix metalloproteinase-3 levels and spinopelvic malalignment may serve as predictive factors for subsequent bone destruction when only joint space narrowing is observed.This review also proposes potential mechanisms of pathogenesis and intervention strategies for RPOH at its initial stage.Cartilage matrix fragments generated by stress concentrations on the hip joint,resulting from spinopelvic malalignment,may trigger inflammatory pathways involving proinflammatory cytokines and inflammasome activation,ultimately leading to joint destruction in the initial phase of RPOH.Suppression of these early pathological events may prevent joint destruction caused by RPOH.However,further elucidation of the cellular and molecular pathways involved in rapid joint destruction is necessary to identify specific biomarkers for early diagnosis and to facilitate the development of targeted therapies in the initial phase of RPOH.
文摘BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2021-I2M-1-014 and No.2022-I2M-2-002)National High Level Hospital Clinical Research Funding(2025-LYZX-D-A02)。
文摘Breast cancer represents a significant and growing public health challenge in China,marked by a rising incidence and distinct variations across age groups and geographical regions.This review synthesizes recent evidence regarding the epidemiology,early detection,and early treatment in the Chinese context.We outline current patterns of disease burden and the spectrum of risk factors—both modifiable and non-modifiable.We note ongoing shifts linked to reproductive trends,lifestyle changes,and an aging population.Screening practices are increasingly evolving towards stratified,risk-adapted pathways.These approaches often combine mammography with adjunct imaging modalities such as ultrasound,digital breast tomosynthesis,or magnetic resonance imaging for selected populations,while artificial intelligence is under active investigation to enhance image interpretation and streamline workflow.Contemporary early management strategies emphasize breast-conserving surgery and selective axillary surgery,alongside the expanded application of hypofractionated and precision-targeted radiotherapy.Systemic therapy is increasingly guided by tumor subtype.In the adjuvant setting,molecular profiling and multigene assays are now routinely utilized to tailor treatment intensity to individual tumor biology,facilitating both treatment escalation or de-escalation where appropriate.Concurrently,in the neoadjuvant setting,research efforts within China and globally are focused on evaluating novel therapeutic regimens and biomarker-driven strategies to improve pathologic complete response rates and inform subsequent postoperative care.A consolidated understanding of these evolving themes is crucial for shaping effective clinical practice and health policies,ultimately supporting the goals of earlier diagnosis and improved patient outcomes in China.
文摘BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno-arterial ECMO(VA-ECMO)are considered very-high risk patients to participate in any type of physical therapy(PT)or mobilization.However,cumulative evidence suggests that early mobilization of critically ill patients is feasible,safe,and efficient under certain circumstances.AIM To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.METHODS This is a scoping review that used systematic electronic literature searches(from inception until January 2025)on MEDLINE(PubMed),PEDro,DynaMed,CINAHL,Scopus,Science direct and Hellenic Academic Libraries.Snowball searching method was also applied.Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT,published in English and utilized any primary evidence study design.Studies on children,animals and patients placed on any other ECMO,secondary evidence,and‘grey’literature were excluded.RESULTS A total of 316 articles were retrieved and 13 were included in the study.Of those,1 study was a randomized control trial,4 retrospective studies,4 retrospective cohort studies,1 case series and 3 case reports.The sample size of the included studies ranged from 1 to 104 VA-ECMO patients,who were ambulated or received PT inter-ventions,and mobilization frequency ranged from 2 per day to 4 per week.Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position.PT and early mobilization were associated with better weaning from mechanical ventilation,gradual reduction of inotropes and functional capacity improvement after ECMO discharge.CONCLUSION Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times.High quality research on early mobilization in VA-ECMO patients is warranted.
