ObjectiveTo assess the effects of repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy (MT) on lower limb motor function and motor evoked potentials (MEPs) in patients with post-stroke hemiplegia.MethodsA total of 60 patients with post-stroke hemiplegia admitted to the department of rehabilitation of the First Affiliated Hospital of Bengbu Medical University from February 2024 to March 2025 were randomly assigned into MT group, rTMS group and combined group, with 20 cases in each group. All groups received conventional rehabilitation therapy. The combined group received rTMS in addition to the conventional rehabilitation therapy, followed by mirror therapy. The rTMS was delivered at a frequency of 1 Hz with stimulation intensity at 90% of the resting motor threshold (RMT), targeting the lower-limb motor hotspot of the primary motor cortex (M1) on the unaffected or affected side, totaling 600 pulses, 15 minutes per session, once daily, five days per week for four weeks. Mirror therapy was performed for 30 minutes per session, once daily, five days per week for four weeks.The rTMS group received the same rTMS protocol as the combined group, followed by sham mirror therapy where the mirror's reflective surface faced the affected limb and its back faced the unaffected limb, while all other procedures maintained consistent with the mirror therapy in the combined group. The MT group received sham rTMS with the coil positioned perpendicularly to the scalp and all other parameters consistent with the protocol of the rTMS group, followed by the same mirror therapy with that of the combined group. Before and after treatment, Fugl‑Meyer Assessment of Lower Extremity (FMA‑LE) was used to assess motor function; 10‑Meter Walking Test (10MWT) was used to assess walking function; Modified Barthel Index (MBI) was used to assess activities of daily living. A magnetic stimulator was used to record the amplitude and latency of motor evoked potentials (MEPs) in both the affected and unaffected sides for the assessment of neural plasticity and recovery.Results(1) FMA‑LE, MBI scores and 10MWT: compared with that before treatment, the FMA‑LE and MBI scores in all three groups increased significantly after treatment (P<0.05), while 10MWT decreased significantly (P<0.05). Compared with the MT group and the rTMS group, FMA‑LE and MBI scores in the combined group were significantly higher after treatment (P<0.05), and 10MWT was significantly lower after treatment (P<0.05). (2) MEP latency and amplitude: compared with that before treatment, the MEP latency on the unaffected side in all three groups was prolonged significantly after treatment (P<0.05), whereas the MEP latency on the affected side shortened significantly (P<0.05); the MEP amplitude on the unaffected side in all three groups decreased significantly (P<0.05), while the MEP amplitude on the affected side increased significantly (P<0.05). Compared with the MT group and the rTMS group, MEP latency of the unaffected side was longer and MEP amplitude of the affected side was significantly higher in the combined group (P<0.05), and MEP latency on the affected side in the combined group was significantly shorter (P<0.05).ConclusionrTMS combined with MT can effectively improve lower limb motor function, activities of daily living, and motor evoked potentials in patients with post-stroke hemiplegia.
To further optimize the talent cultivation system of Traditional Chinese Medicine Rehabilitation, literature research, case analysis, and comparative analysis were employed in this study to investigate the curriculum system and talent cultivation modes of 27 universities in China offering Traditional Chinese Medicine Rehabilitation programs. The findings have indicated several issues in the construction of Traditional Chinese Medicine Rehabilitation major, including inconsistent talent cultivation models, unclear professional course objectives, imperfect textbook systems for professional courses, and a disconnect between practical teaching systems and clinical practice. To address these problems, the following measures are recommended: strengthening ideological and political guidance to reform talent cultivation plans; promoting the integration of "high-quality Courses" and "High-quality textbooks" to build a new system of curriculum construction; adhering to practice-oriented principles to advance the "Practical Training-Innovation and Entrepreneurship Education- Professional Practice " trinity; and promoting collaborative education between medical institutions and universities to construct a faculty community. This study aims to provide theoretical reference and practical support for the connotation construction and sustainable development of Traditional Chinese Medicine Rehabilitation major.
Post-stroke cognitive impairment (PSCI) is one of the most common sequelae of stroke, which severely impairs patients' functional independence, social participation and quality of life. Hyperbaric oxygen (HBO) therapy involving the inhalation of pure oxygen or high-concentration oxygen, possesses neuroprotective properties and demonstrates efficacy in enhancing cognitive function. This study reviews the principal mechanisms, the selection of treatment regimens, combined therapy applications, and potential adverse reactions associated with HBO therapy for PSCI, aiming to offer insights for the management of post-stroke cognitive impairment. (1) Principal mechanisms: HBO therapy reduces ischemic volume by restoring oxygen supply, mitigates tight junction damage to preserve blood-brain barrier integrity, modulates the oxidation-antioxidation balance to alleviate oxidative stress, regulates the death-defense axis to prevent cell death, modulates hypoxia-inducible factor-1α and neurotrophic factors to foster neuroangiogenesis, and diminishes neuroinflammation through the action of competitive endogenous RNAs. (2) Selection of treatment regimens: standard pressures can be set at 2.5, 2, or 3 atmospheres absolute (ATA), with a single session duration of 1 to 1.5 hours. For the acute phase of ischemic stroke (IS), a regimen of 2 ATA for 1 hour per session, 60 to 70 times, may be chosen; for the chronic phase of IS, a regimen of 2 ATA for 1.5 hours per session, 40 to 60 times, may be chosen. For the acute phase of hemorrhagic stroke (HS), a regimen of 2 to 2.5 ATA for 1 hour per session, 10 to 30 times, may be chosen; for the chronic phase of HS, a regimen of 2 ATA for 1.5 hours per session, 40 to 60 times may be chosen. (3) Applications of HBO combined therapy: HBO can be combined with repetitive transcranial magnetic stimulation, transcranial direct current stimulation, acupuncture, cerebellar fastigial nucleus electrical stimulation, music therapy, computerized cognitive training, aerobic exercise, and pharmacological interventions. (4) Adverse reactions: these are associated with treatment parameters. At pressures ≤3 ATA, adverse reactions are rare. Under standard parameters, ear discomfort and dizziness may occur; pressures above 5 ATA may result in agitation or seizures.
Traditional Chinese Medicine (TCM) rehabilitation, leveraging its unique strengths, is increasingly emerging as a significant contributor to the provision of rehabilitation resources. High-quality TCM rehabilitation services, however, rely on the presence of highly skilled TCM rehabilitation professionals. At present, the mechanism for developing interdisciplinary TCM rehabilitation talents is not fully established, and the integration of TCM with modern rehabilitation curricula warrants enhancement. In response to the aforementioned challenges, this study employs the World Health Organization's International Classification of Functioning, Disability and Health (ICF) and the Rehabilitation Competency Framework (RCF) as dual theoretical frameworks to explore the construction of an undergraduate talent cultivation system for TCM rehabilitation. The ICF provides a unified framework for classifying functioning and health, thereby bridging the conceptual divide between TCM and modern rehabilitation. The RCF delineates the core competencies essential for rehabilitation professionals and offers systematic guidance for the development of interdisciplinary skills. Anchored in the ICF and RCF, the curriculum system was reverse-engineered, comprising five modules: general education courses, foundational professional courses, core professional courses, medical humanities courses, and evidence-based literacy courses. This approach ensures a dual mapping of course content to ICF components and RCF competencies. Utilizing the course "TCM Rehabilitation for Musculoskeletal System Diseases" as a case study, this paper expounds on the RCF-based curriculum development process. Furthermore, it establishes a practical teaching system that incorporates a three-tiered progression of "in-class practical training- course-based internships- clinical internships," with social practice and the cultivation of innovative capabilities integrated throughout. This system is designed to develop interdisciplinary TCM rehabilitation professionals with a global outlook, distinctive TCM knowledge, and innovative abilities, offering educational insights for the development of rehabilitation in China.
ObjectiveTo develop an early postoperative rehabilitation nursing protocol for patients with peritoneal cancer following cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), and to evaluate its effectiveness.MethodsA total of 177 patients with peritoneal cancer who underwent CRS combined with HIPEC at Beijing Tsinghua Changgung Hospital, Tsinghua University from January to October 2024 were randomly assigned to control group and observation group by random number table method, with 94 and 83 cases in each group, respectively. The control group received conventional rehabilitation nursing, including basic daily care, position management, pulmonary function rehabilitation (once every two hours, twice daily, 10-15 minutes per session), bedside activities (30 minutes per session, twice daily, seven days per week), lasting for two weeks. The observation group additionally received early postoperative rehabilitation nursing protocol, targeting the improvement of postoperative dysfunction after CRS combined with HIPEC, including aerobic exercise, resistance exercise, and balance training, 60 minutes per session, twice daily, seven days per week, lasting for two weeks. Before intervention and one day prior to discharge, the Short Physical Performance Battery (SPPB) was used to evaluate physical performance by researchers blinded to group allocation; De Morton Mobility Index (DEMMI) was used to evaluate physical activity and mobility; Borg Rating of Perceived Exertion (RPE) was used to evaluate subjective fatigue; Barthel Index (BI) was used to evaluate activities of daily living; Six-Minute Walking Test (6MWT) was used to evaluate cardiopulmonary function; a pulse oximeter was used to measure blood oxygen saturation (SpO2); and a portable spirometer was used to measure forced vital capacity (FVC). The incidence of postoperative adverse events, including atelectasis, deep vein thrombosis, intestinal obstruction, arrhythmia, and falls, as well as postoperative hospital stay duration and gastric tube retention time were compared between two groups.Results(1) SPPB, DEMMI, RPE and BI scores: compared with that before intervention, SPPB, DEMMI, and BI scores in both groups increased significantly after intervention (P<0.05), while RPE score decreased significantly (P<0.05). Compared with the control group, SPPB, DEMMI, and BI scores in the observation group were significantly higher after intervention (P<0.05), while the RPE score was significantly lower (P<0.05). (2) SpO2, 6MWT and FVC: compared with that before intervention, SpO2 and 6MWT in both groups increased significantly after intervention (P<0.05), and FVC in the observation group increased significantly after intervention (P<0.05). Compared with the control group, SpO2, 6MWT and FVC scores in the observation group were significantly higher after intervention (P<0.05). (3) Postoperative hospital stay and gastric tube retention time: compared with the control group, postoperative hospital stay and gastric tube retention time in the observation group were significantly shorter (P<0.05). (4) Incidence of adverse events: there was no statistically significant difference in the incidence of adverse events between two groups (P>0.05).ConclusionThe early postoperative rehabilitation nursing protocol can effectively facilitate physical functional recovery and improve cardiopulmonary function in patients who underwent CRS combined with HIPEC, as well as reduce hospital stay duration and gastric tube retention time.
ObjectiveTo observe the intervention effect of the five-tone figurative technique on negative emotions among medical postgraduate students and to explore its underlying mechanism in the context of the polyvagal theory.MethodsA mixed-methods approach was adopted, primarily qualitative with supplementary quantitative analysis. Using purposive sampling, medical postgraduate students from Shandong University of Traditional Chinese Medicine (January 2021 to June 2022) who exhibited negative emotions or somatization symptoms and voluntarily participated in and experienced the five-tone figurative technique were enrolled as participants, with 20 valid interview cases included. Each participant received a single 30-minute intervention of the five-tone figurative technique. Qualitative data were collected through semi-structured interviews after the intervention and thematically analyzed using Colaizzi's seven-step method. Before and after the intervention, psychological status was assessed using the Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS), and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). The root mean square of successive differences (RMSSD) between adjacent NN intervals in the resting state was recorded as a heart rate variability (HRV) index, and the natural log-transformed lnRMSSD was used as an indicator of the changes in ventral vagus nerve tone. The correlation between ΔlnRMSSD and the reduction rates of SDS and SAS scores was analyzed to explore the association between changes in vagal tone and improvement in negative emotions.ResultsQualitative analysis yielded three core themes (multidimensional changes in emotional experience, deep cognitive insights, and needs and expectations of continuous psychological education) and eight subthemes. Participants generally reported relief from negative emotions and enhanced emotional stability and self-regulation ability. Compared with those before intervention, the SDS and SAS scores decreased significantly after intervention (P0.05), while the CD-RISC-10 scores and lnRMSSD increased significantly (P0.05). Correlation analysis showed a moderate positive correlation between ΔlnRMSSD and SAS reduction rate (r=0.46, P0.05), yet there was no significant correlation with the SDS reduction rate (P0.05).ConclusionThe five-tone figurative technique can effectively alleviate negative emotions and improve psychological resilience in medical postgraduate students. Its mechanism may be associated with enhanced ventral vagal activity and improved autonomic nervous regulation.
ObjectiveTo observe the effects of transcutaneous auricular vagus nerve stimulation (taVNS) combined with respiratory muscle training on post-stroke fatigue (PSF).MethodsA total of 40 stroke patients admitted to the inpatient department of the Department of Rehabilitation Medicine at Zhejiang Provincial People's Hospital, from December 2023 to October 2025 were enrolled and randomly assigned to a control group and an observation group using a random number table, with 20 patients in each group. During the study period, 3 patients dropped out. Ultimately, 18 patients in the control group and 19 patients in the observation group were included in the final analysis. Both groups received conventional rehabilitation therapy. In addition, the control group received respiratory muscle resistance training and sham taVNS, while the observation group received respiratory muscle resistance training and active taVNS. Both groups received continuous treatment for 4 weeks. Before and after treatment, exercise tolerance was assessed using the 6-minute walk test (6MWT), dyspnea was assessed using the Modified Borg Dyspnea Scale (MBS), fatigue severity was assessed using the Fatigue Severity Scale (FSS), and respiratory muscle strength was evaluated by measuring maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP).ResultsCompared with those before treatment, the 6MWT distance increased significantly in both groups after treatment (P0.05), while the MBS scores decreased significantly (P0.05). Compared with the control group, the 6MWT distance in the observation group was longer after treatment (P0.05), and the MBS scores were lower (P0.05). Compared with those before treatment, the MIP and MEP increased significantly in both groups after treatment (P0.05). Compared with the control group, the MIP and MEP in the observation group were higher after treatment (P0.05). Compared with those before treatment, the FSS scores decreased significantly in both groups after treatment (P0.05). Compared with the control group, the FSS scores in the observation group were lower after treatment (P0.05). No obvious adverse reactions were observed in either group during the study.ConclusionThe combination of taVNS and respiratory muscle training can effectively enhance the respiratory muscle strength and respiratory function in patients with PSF, improve their exercise tolerance, and alleviate fatigue severity.
Objective Systematic review of brain-computer interface combined intervention modalities on upper limb motor function and activities of daily living in stroke patients. Methods Data were searched and retrieved from the PubMed，Embase，the Cochrane Library，Web of Science，CNKI，Wanfang Data，VIP，and CBM. The randomized controlled trials （RCTs） evaluating brain-computer interface in stroke patients，from database inception to September 30，2025. Outcome measures included Fugl-Meyer Assessment Upper Extremity （FMA-UE），Arm Movement Assessment Test （ARAT），Wolf Motor Function Test （WMFT），and Modified Barthel Index （MBI）. Two researchers independently screened the literature，extracted data，and assessed the risk of bias. Meta-analysis was performed using RevMan 5.3 and Stata 17.0 software. To address specific issues related to particular interventions for specific patients，subgroup analyses were conducted according to predefined different combination models. Results A total of 38 studies comprising 1，348 patients were included. The meta-analysis results showed：①In the FMA-UE，the experimental group showed higher scores than the control group ［MD=0.55，95%CI （0.44，0.67），P0.0001］. Subgroup analyses revealed：BCI-FES［MD=0.55，95%CI（0.34，0.76），P＜0.0001］; BCI-robotics［MD=0.52，95%CI（0.35，0.69），P＜0.0001］; the scores were all higher than those of the control group，and the difference in efficacy between the two subgroups was not statistically significant （P=0.81）; BCI-tDCS ［MD= -0.15，95%CI（-1.42，1.12），P=0.82］. ②In the ARAT，the experimental group showed higher scores than the control group. ［MD=0.71，95%CI（0.49，0.92），P0.0001］. Subgroup analyses revealed：BCI-FES［MD=1.15，95%CI（0.53，1.77），P=0.0003］; BCI-robotics［MD=0.69，95%CI（0.26，1.12），P=0.002］ ; the scores were all higher than those of the control group，and the difference in efficacy between the two subgroups was not statistically significant （P=0.23）.; BCI-tDCS ［MD=0.27，95%CI（-0.59，1.13），P=0.54］. ③ In the WMFT，the experimental group showed higher scores than the control group after BCI treatment. ［MD=0.77，95%CI（0.54，1.00），P0.0001］. Subgroup analyses revealed：BCI-FES［MD=0.95，95%CI（0.62，1.27），P0.0001］; BCI-robotics［MD=0.58，95%CI（0.25，0.92），P=0.0006］ ; the scores were all higher than those of the control group，and the difference in efficacy between the two subgroups was not statistically significant （P=0.13）. ④ In the MBI，the experimental group showed higher scores than the control group after BCI treatment. ［MD=0.75，95%CI（0.58，0.91），P0.0001］. Subgroup analyses revealed：BCI-FES［MD=1.03，95%CI（0.73，1.33），P0.0001］; BCI-robotics［MD=0.72，95%CI（0.44，1.01），P0.0001］ ; the scores were all higher than those of the control group，and the difference in efficacy between the two subgroups was not statistically significant （P=0.14）. Conclusion Both the BCI combined with FES and the BCI combined with robotic therapy significantly improved upper limb motor function and activities of daily living in stroke patients; however，the effectiveness of the BCI combined with tDCS regimen in improving the above outcomes remains unclear.
ObjectiveTo examine the psychometric properties of the Chinese version of the Survey of Activities and Fear of Falling in the Elderly (SAFE-C) in community-dwelling patients with chronic stroke using the Rasch analysis model and to generate a keyform to enhance its clinical utility.MethodsA secondary data analysis was conducted based on an original study that recruited 108 community-dwelling patients with chronic stroke in Hong Kong. Rasch analysis was performed on the 11 items of the SAFE-C using Winsteps software (version 3.72.3) to evaluate the rating scale structure, unidimensionality, item fit, reliability, local independence, matching, and differential item functioning (DIF), and to generate a key form.ResultsThe 4-level rating scale of the SAFE-C demonstrated a valid structure, and its unidimensionality was substantially supported. All items showed good fit to the Rasch model (MNSQ: 0.5-1.5). The person separation reliability was 0.81, and the person separation index was 2.06, indicating that the scale could differentiate patients into three ability strata. No substantial DIF related to age or gender was found. The key form identified a "transition zone" of fear perception, which included Item 8 (reaching for an object above the head), Item 1 (going to a store), Item 10 (walking several blocks outdoors), and Item 7 (visiting relatives or friends). Local dependence was observed for three item pairs: Item 4 (getting up) with Item 5 (walking for exercise) (r=0.44), Item 3 (bathing in a tub) with Item 5 (r=0.35), and Item 5 with Item 9 (going to crowded places) (r=0.33). The person-item map showed that the mean person ability (1.38 logits) was higher than the mean item difficulty (set at 0 logits), with a slight ceiling effect (4.63%), and the item difficulty was insufficiently distributed in the high-ability region, which restricted measurement precision for patients with better functional mobility.ConclusionThe SAFE-C demonstrates acceptable reliability, unidimensionality, and item fit in community-dwelling patients with chronic stroke, and the key form enhances its clinical translation potential. The survey presents limitations including local dependence and insufficient differentiation for high-ability patients. Future revisions may consider merging relevant items, adding more challenging activities, and bridging difficulty gaps to further optimize its measurement performance.
Brain-computer interface (BCI) technology provides objective and quantitative biological assessment methods for the rehabilitation assessment of patients with neurological dysfunction by acquiring and decoding neural activity signals, thereby overcoming the limitations of traditional assessments that rely on behavioral performance. With the rapid development of BCI technologies, their applications in the assessment of disorders of consciousness, motor dysfunction, dysphagia, cognitive impairment, speech disorders, and affective disorders have continued to expand. However, current challenges remain, including inconsistent technical standards, incomplete evaluation systems, insufficient clinical evidence, and pressing ethical and safety issues. To standardize the clinical application of BCI in rehabilitation assessment, the Professional Committee of Brain-Computer Interface and Rehabilitation of the Chinese Association of Rehabilitation Medicine convened a multidisciplinary expert panel comprising specialists in rehabilitation medicine, neuroscience, and biomedical engineering. Based on the latest national and international research advances and clinical experience, this expert consensus was developed through extensive discussion and consultation. This consensus systematically elaborates on the technical basis, principles, signal processing protocols, domain-specific assessment indicator systems, standardized operating procedures, ethical and safety guarantees, and implementation pathways for BCI rehabilitation assessment. It clearly defines the principles of technical selection (prioritizing non-invasive methods), multidisciplinary collaboration mechanisms, and talent training systems. It aims to provide scientific guidance for clinical practice, research and innovation, education and training, and industry standardization, thereby promoting the development of rehabilitation assessment toward precision, individualization, and objectivity.
ObjectiveTo investigate the effects of Yijinjing training on cardiac rehabilitation in patients with Qi-deficiency and blood-stasis syndrome following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).MethodsA total of 70 AMI patients with Qi-deficiency and blood-stasis syndrome who underwent PCI in the Department of Cardiology, Xiamen Hospital of Traditional Chinese Medicine from January to December 2024 were randomly assigned to a control group or an observation group, with 35 patients in each group. During this study, 2 patients in each group withdrew, were lost to follow-up, or had poor adherence, leaving 66 patients for final analysis. The control group received routine health education and standard secondary prevention medication for coronary heart disease, while the observation group additionally performed Yijinjing training for 12 weeks. Before and after treatment, cardiac magnetic resonance (CMR) was used to assess myocardial microcirculation parameters, including time to peak (tpeak), maximum upstroke slope (Slopemax), as well as left ventricular ejection fraction (LVEF). Serum nitric oxide (NO) was measured by enzyme-linked immunosorbent assay (ELISA). Cardiopulmonary exercise testing was performed using a symptom-limited incremental protocol on a cycle ergometer to determine maximal oxygen uptake (VO2max) and anaerobic threshold (AT). The Duke Activity Status Index (DASI) was used to assess daily physical activity capacity; the Short Form-36 (SF-36) was used to evaluate physical function, role physical, and vitality. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess psychological status. The traditional Chinese medicine (TCM) syndrome scores and clinical efficacy were evaluated, and adverse events were recorded throughout the treatment period.Results(1) Myocardial microcirculation parameters: compared with those before treatment, the tpeak decreased significantly in both groups after treatment (P0.05), while the Slopemax increased significantly (P0.05). Compared with the control group, the tpeak in the observation group was lower after treatment (P0.05), and the Slopemax was higher (P0.05). (2) LVEF and serum NO levels: compared with those before treatment, the LVEF and serum NO levels increased significantly in both groups after treatment (P0.05). Compared with the control group, the LVEF and serum NO levels in the observation group were higher after treatment (P0.05). (3) Cardiopulmonary function and exercise tolerance: compared with those before treatment, the VO2max, AT, and DASI scores increased significantly in the observation group after treatment (P0.05). Compared with the control group, the AT and DASI scores in the observation group were higher after treatment (P0.05). (4) Quality of life: compared with those before treatment, all dimensions of the SF-36 scores increased significantly in both groups after treatment (P0.05). Compared with the control group, the mental health scores in the observation group were higher after treatment (P0.05). (5) Psychological status: compared with those before treatment, the SAS and SDS scores decreased significantly in both groups after treatment (P0.05). Compared with the control group, the SAS and SDS scores in the observation group were lower after treatment (P0.05). (6) TCM syndrome scores and clinical efficacy: compared with those before treatment, the TCM syndrome scores decreased significantly in both groups after treatment (P0.05). Compared with the control group, the TCM syndrome scores in the observation group were lower after treatment (P0.05). The total effective rate of the observation group was 90.91%, higher than 60.61% of the control group (P0.05). No serious adverse events occurred in either group.ConclusionOn the basis of standardized Western medicine treatment, Yijinjing training can improve myocardial microcirculation perfusion, left ventricular systolic function, vascular endothelial function, exercise endurance, and mental state of patients with Qi-deficiency and blood-stasis syndrome after AMI-PCI, with favorable efficacy and safety.
With the progression of population aging,cognitive impairment has garnered increasing attention.It not only reduces the overall quality of life and lifespan of patients,but also imposes tremendous burdens on caregivers and the social economy.Repeti-tive transcranial magnetic stimulation(rTMS)is a neuroelectrophysiological technique used for neurological and psychiatric disor-ders,which has been proven by studies to exert ameliorative effects on multiple cognitive functions.Theta burst stimulation(TBS),as a novel rTMS treatment protocol,has been increasingly applied in the treatment of cognitive impairment.Compared with conven-tional rTMS,TBS requires lower stimulation intensity,fewer pulses and shorter application time,leading to higher patient compli-ance.By reviewing and optimizing previous research findings and clinical practice experience,this expert consensus thoroughly ana-lyzes issues pertaining to the origin,mechanism of action,efficacy and safety of TBS,and formulates clinically applicable TBS inter-vention protocols and workflows,which are expected to provide a more effective therapeutic approach for patiens with cognitive impairment.
Cardiac rehabilitation (CR) is a crucial component of cardiovascular disease management. It effectively enhances exercise tolerance and quality of life, while reducing the rates of readmission and mortality. However, its implementation remains suboptimal due to challenges such as uneven distribution of medical resources, low patient adherence, and difficulties in follow-up management. Digital healthcare offers potential solutions to overcome the limitations of traditional cardiac rehabilitation regarding feasibility, continuity, and personalization. This consensus primarily addresses the application of remote cardiac rehabilitation, including exercise prescriptions for coronary artery disease, heart failure, and valvular heart disease; nutritional prescriptions with remote dietary guidance and chatbot-based dietary monitoring; and psychological prescriptions covering screening, intervention, and feedback. It provides corresponding expert consensus recommendations and summarizes the clinical utility of digital coronary CT-derived fractional flow reserve (CT-FFR) and index of microcirculatory resistance (IMR) in CR, along with expert-endorsed opinions.This consensus aims to promote the scientific and standardized application of digital technology-based remote cardiac rehabilitation.
ObjectiveTo investigate whether electroacupuncture exerts its therapeutic effect on diabetic neuropathic pain (DNP) by regulating Nrf2-mediated antioxidative stress through lipoxin A4 (LXA4) and its receptor.MethodsIn this study, a diabetic neuralgia model was established by a single intraperitoneal injection of streptozotocin (STZ, 65 mg/kg) in male rats with SPF level SD, and rats with blood glucose levels consistently higher than 16.7 mmol/L were included in the experiment. The experiment was divided into 6 groups: control group (CON group), model group (DNP group), model + electroacupuncture group (EA group), model + intrathecal ATL group (ATL group), model + intrathecal ATL+BOC-2 group (ATL+BOC-2 group) and model + electroacupuncture + intrathecal injection BOC-2 group (EA+BOC-2 group). 6 in each group. Electroacupuncture intervention selected bilateral "Shenshu" (BL23) and "Zusanli" (ST36) acupoints, frequency 10 Hz, current 0.5 mA, 30 minutes each time, once every other day for 4 weeks. Thermal pain behavior was detected before, 2 weeks and 6 weeks after modeling, and the foot reduction latency (PWL) was recorded. After 6 weeks of modeling, the rats were sacrificed, and samples of dorsal horn tissue and sciatic nerve were collected. Transmission electron microscopy observed the ultrastructural changes of the sciatic nerve. The content of endogenous LXA4 was detected by ELISA. Western blot was used to detect the protein expressions of Nrf2, HO-1, NQO1, Akt and p-Akt. SPSS 27.0 was used for one-way ANOVA and LSD-t test, and the difference was statistically significant with P<0.05.ResultsThis study used SPF-grade SD male rats to establish a diabetic neuralgia model through a single intraperitoneal injection of streptozotocin (STZ, 65 mg/kg), and included rats with blood glucose consistently above 16.7 mmol/L. The experiment was divided into six groups: control group (CON group), model group (DNP group), electroacupuncture group (EA group), intrathecal injection of ATL group (ATL group), intrathecal injection of ATL+BOC-2 group (ATL+BOC-2 group), and electroacupuncture + intrathecal injection of BOC-2 group (EA+BOC-2 group). Each group has 6 pieces. Electroacupuncture interventions were selected at bilateral "Shenshu" (BL23) and "Zusanli" (ST36) points, with a frequency of 10 Hz and an electric current of 0.5 mA, administered 30 minutes each time, once every other day for 4 weeks. Heat pain behavior tests were performed before, 2 weeks, and 6 weeks after modeling, and foot incubation latency (PWL) was recorded. Six weeks after modeling, rats were sacrificed to collect dorsal horn tissue and sciatic nerve samples. Transmission electron microscopy observes ultrastructural changes of the sciatic nerve; LXA4 content was detected using the ELISA method; Western Blot was used to detect the expression of Nrf2, HO-1, NQO1, Akt, and p-Akt proteins. Data were analyzed using SPSS 27.0 for one-way ANOVA and LSD-t-test, with P<0.05 as statistically significant differences.
With the rising incidence of cancer in China and the substantial prolongation of survival periods for breast cancer patients, the therapeutic focus has evolved from solely disease management to enhancing overall quality of life and functional restoration, rendering the adoption of a full-cycle, multifunctional rehabilitation model an imperative trend. Among the multifunctional rehabilitation demands, sleep disorders stand out as particularly prominent and prevalent. Sleep disorders not only exacerbate psychological distress, including anxiety and depression, in breast cancer patients but may also impair immune function, affect treatment tolerance, and severely constrain quality of life and disease prognosis. This study systematically elucidates the complex etiologies and underlying mechanisms of sleep disorders at various stages of breast cancer patients' disease trajectory from diagnosis and treatment to long-term survival and end-of-life care based on the "full-cycle rehabilitation" concept. It proposes conventional rehabilitation strategies, including cognitive behavioral therapy, mindfulness and relaxation training, exercise therapy and physical therapy, sleep hygiene education, pharmacological interventions, traditional Chinese medicine, and emerging rehabilitation technologies, as well as stage-specific rehabilitation strategies. These strategies aim to provide continuous, personalized sleep support, with the goal of effective whole-cycle sleep management to comprehensively enhance the overall rehabilitation outcomes and long-term quality of life for breast cancer patients.
ObjectiveTo observe the effect of gait training with a lower limb exoskeleton robot on the balance ability and lower limb motor function in patients with subacute stroke.MethodsA total of 50 patients with subacute stroke were enrolled and randomly divided into two groups, with 25 cases in each group. The routine rehabilitation group received 80 minutes of conventional rehabilitation therapy daily; the exoskeleton training group was additionally given 40 minutes of gait training with a lower limb exoskeleton robot daily, with the intervention lasting for 4 weeks. The lower limb motor function, balance ability, gait parameters and electromyography indicators were assessed before and after the intervention.ResultsAfter the intervention, all scores of both groups were improved compared with baseline (P＜0.05). Moreover, the exoskeleton training group showed significantly greater improvements in FMA-LE scores, BBS scores, as well as some static balance parameters, gait parameters and electromyography parameters than the routine rehabilitation group (P＜0.05).ConclusionGait training with lower limb exoskeleton robots can effectively improve the FMA-LE score and BBS score of patients with subacute stroke, enhance their balance ability and motor function, and thus demonstrates favorable rehabilitation value, which is worthy of clinical promotion and application.
ObjectiveTo explore the influencing factors of pulmonary infection in patients with dysphagia after ischemic stroke, and to develop a predictive model.MethodsA retrospective cohort study was conducted. We retrospectively analyzed 125 patients with dysphagia after ischemic stroke at the Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, from August 2021 to December 2024, and the patients were divided into a pulmonary infection group (57 cases) and a non-pulmonary infection group (68 cases) based on the presence or absence of pulmonary infection. General clinical data of all subjects were colleted from the electronic medical record system of the Nanjing Drum Tower Hospital. All the included variables were analyzed using univariate logistic regression to screen for potential influencing factors. Variables with statistically significant differences (P0.05) were included in the multivariate logistic regression analysis to identify risk factors for pulmonary infection in patiens with dysphagia after ischemic stroke. Subsequently a Nomogram predictive model was constructed. The receiver operator characteristic (ROC) curve was used to assess the discriminative ability of the model, and the area under the curve (AUC), sensitivity, specificity, and Youden index were calculated to compare the discriminative ability of different models. The Akaike information criterion (AIC) and Bayesian information criterion (BIC) values were calculated to further compare the predictive performance of different models. The Delong test was utilized to compare the AUC differences among different predictive models. Finally, leave-one-out cross validation was performed for internal validation, and discriminat analysis (reporting Wilks'λ and classfication accuracy) was used to evaluate the stability of the model.ResultsUnivariate logistic regression analysis indicated that hypoproteinemia, stroke location, neutrophil-to-lymphocyte ratio (NLR), water swallowing test (WST) grade, and impaired safety on the volumeviscosity swallowing test (V-VST) were potential influencing factors for pulmonary infection in patients with dysphagia after ischemic stroke, with statistically significant differences (P0.05). Multivariate logistic regression analysis demonstrated that elevated NLR (OR=1.424, P=0.016), WST grade Ⅳ (OR=5.657, P=0.002) and impaired safety on V-VST (OR=5.488, P=0.003) were independent risk factors for pulmonary infection. A Nomogram predictive model was constructed by utilizing NLR, WST grade, and V-VST. The AUC values for the three single-indicator prediction models (NLR, WST grade, and V-VST) were 0.733, 0.774, and 0.764, respectively. The combined prediction model (NLR+WST+V-VST) attained an AUC of 0.878. Compared with the three single-indicator models, the combined model exhibited lower AIC and BIC values, suggesting a superior goodness-of-fit (P0.05). The Delong test demonstrated that the combined model had a significantly higher AUC value compared with each single-indicator model (P0.05). Leave-one-out cross-validation indicated that the combined model had a Wilks'λ value of 0.624 (P0.05), with a classification accuracy of 84.21% for the pulmonary infection group, 80.88% for the non-pulmonary infection group, and an overall classification accuracy of 82.40%.ConclusionThe NLR, WST grade, and impaired safety on V-VST can predict the incidence of pulmonary infections in patients with dysphagia after ischemic stroke, and the combined model demonstrates superior predictive value and clinical utility.
ObjectiveTo investigate the mechanism of meridian-flow intradermal needling on the intestinal transit function in rats with slow transit constipation (STC) based on the "Brain-Gut-Microbiota" axis theory.MethodsForty SPF-grade Wister rats, with an equal number of male and half female, were randomly assigned into a blank group (8 rats) and a modeling group (32 rats) using the random number table method. Rats in the modeling group were intragastrically administered 3 mg/kg loperamide hydrochloride suspension daily for 14 consecutive days to establish the STC rat model by inhibiting intestinal peristalsis. Meanwhile, the blank group received an equal volume of normal saline by gavage. Rats with successful model establisment were randomly divided into a model group, a western medicine group, the common intradermal needle group, and the meridian-flow intradermal needling group, with eight rats in each group. During the intervention period, all groups except the blank group continued to receive loperamide hydrochloride at the modeling dose to maintain a stable STC model, and the blank group was given an equal volume of normal saline simultaneously. The western medicine group was intragastrically administered prucalopride succinate at a dosage of 0.18 mg/(kg·d), with a volume of 1 mL per 100 g body weight, once daily. The common intradermal needle group received intradermal needling at bilateral Tianshu (ST25) and Dachangshu (BL25) acupoints at 10:00 AM every day. The meridian-flow intradermal needling group used the identical acupoints and procedures as the common intradermal needle group, but with time-specific intervention: Tianshu was needled at the Chen hour (08:00 AM) and Dachangshu at the Shen hour (16:00 PM) daily. Following 14 consecutive days of intervention, intestinal motility was evaluated by the number of fecal particles within 6 hours, fecal water content, and the small intestinal propulsion rate. The relative protein expression levels of 5-hydroxytryptamine (5-HT) and vasoactive intestinal peptide (VIP) in colon tissue and norepinephrine (NE) in brain tissue were detected by enzyme-linked immunosorbent assay (ELISA). Nitric oxide (NO) concentration in brain tissue was measured by the Griess chemical method. Intestinal microbiota alterations in fecal samples from the five groups were analyzed by 16S rRNA gene sequencing. The functional gene enrichment of intestinal microbiota in the meridian-flow intradermal needling group was analyzed using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database.Results1) Intestinal motility: Compared with the blank group, the model group showed fewer fecal particles within 6 hours (P0.05), a lower fecal water content (P0.05), and a lower small-intestinal propulsion rate (P0.05). Compared with the model group, the western medicine group, the common intradermal needle group, and the meridian-flow intradermal needling group exhibited a greater number of fecal particles within 6 hours (P0.05), a higher fecal water content (P0.05), and a higher small intestinal propulsion rate (P0.05). Compared with the common intradermal needle group, the western medicine group and the meridian-flow intradermal needling group exhibited a greater number of fecal particles within 6 hours (P0.05), and a higher small intestinal propulsion rate (P0.05). 2) Brain-gut peptide levels: Compared with the blank group, the model group presented a lower protein expression levels of 5-HT and VIP in colon tissue (P0.05), a higher protein expression of NE in brain tissue (P0.05), and a higher NO concentration (P0.05). Compared with the model group, the western medicine group, the common intradermal needle group, and the meridian-flow intradermal needling group showed a higher protein expressions of 5-HT and VIP in colon tissues (P0.05), a lower protein expression of NE in brain tissues (P0.05), and a lower NO concentration (P0.05). Compared with the common intradermal needle group, the western medicine group and the meridian-flow intradermal needling group had a higher protein expressions of 5-HT and VIP in colon tissue (P0.05) and a lower NO concentration in brain tissue (P0.05); the meridian-flow intradermal needling group also demonstrated a lower protein expression of NE in brain tissue (P0.05). Compared with the western medicine group, the meridian-flow intradermal needling group displayed a higher protein expressions of 5-HT and VIP in colon tissue (P0.05), a lower protein expression of NE in brain tissue (P0.05), and a lower NO concentration (P0.05). 3) Intestinal microbiota analysis: At the OTU level, the numbers of unique OTUs in the blank, model, western medicine, the common intradermal needle, and the meridian-flow intradermal needling groups were 2,738, 3,862, 4,397, 3,956, and 2,901, respectively, with 323 core OTUs shared by all five groups. α-diversity analysis revealed that compared with the blank group, the model group showed a decreasing trend in species abundance and diversity of gut microbiota (P0.05). Compared with the model group, the western medicine group, the common intradermal needle group, and the meridian-flow intradermal needling group exhibited an increasing trend in the abundance and diversity of intestinal microbiota (P0.05), with the most significant increase in the meridian-flow intradermal needling group (P0.05). The β-diversity analysis demonstrated the greatest inter-sample distance between the model group and the meridian-flow intradermal needling group. Differential species analysis indicated that the model group was characterized by high abundance of Kineothrix, whereas the meridian-flow intradermal needling group exhibited a relatively high abundance of Klebsiella and specific enrichment of Prevotella, Bacteroides H, and other genera. The functional pathways of the intestinal microbiota in the meridian-flow intradermal needling group were mainly concentrated in metabolism-related pathways. Among these, the carbohydrate metabolism had the highest relative abundance, followed by amino acid metabolism, the metabolism of cofactors and vitamins, and the metabolism of terpenoids and polyketides.ConclusionThe meridian-flow intradermal needling can promote the recovery of intestinal transit function in STC rats. Its mechanism may be related to the regulation of the "Brain-Gut-Microbiota" axis, thereby improving intestinal motility, restoring the homeostasis of brain-gut peptides, and optimizing the structure and metabolism of the microbiota.
Objective To analyze and compare the characteristics of dysphagia in patients with Parkinson's disease(PD)and stroke.Methods A total of 58 inpatients with post-stroke dysphagia or PD-related dysphagia who met the inclusion criteria in the Department of Rehabilitation Medicine,the Second Affiliated Hospital of Xi'an Jiaotong University from March to December 2019 were enrolled.There were 46 patients in the stroke group and 12 patients in the PD group.The following signs of dysphagia were screened:impaired saliva control,prolonged meal time,need for change of food texture,weight loss or malnutrition,recurrent unex-plained fever or pulmonary infection,insufficient oral hydration,dyspnea after swallowing,and repeated swallowing to clear oropha-ryngeal residue.Swallowing function was evaluated using the water swallowing test(WST)and the standardized swallowing assess-ment(SSA).Data were collected through videofluoroscopic swallowing study(VFSS).Inadequate tongue movement in oral phase,poor bolus formation,premature leakage of food into pharyngeal cavity and aspiration,leakage,epiglottic valley residue,pyriform sinus residue,pharyngeal wall residue,pharyngeal reflux and achalasia of the upper esophageal sphincter during the pharyngeal phase were selected for qualitative analysis.Oral transit time(OTT),hyoid movement time(HMT),pharyngeal transit time(PTT),swallowing reaction time(SRT),hyoid maximum displacement(HMD),and pharyngeal constriction ratio(PCR)were employed for quantitative analysis.Results Compared with the PD group,the stroke group had a higher proportion of patients who required a change in food texture during eating(x2=7.45,P<0.05),a higher incidence of recurrent unexplained fever or pulmonary infection(x2=7.33,P<0.05),and a lower proportion of patients with inadequate oral hydration(x2=10.93,P<0.05).Compared with the PD group,the stroke group had a higher WST grade(P<0.05)and higher SSA score(P<0.05).Compared with the PD group,the stroke group had a lower proportion of patients with inadequate tongue movement(x2=5.57,P<0.05)and a higher proportion of patients with pen-etration(x2=6.73,P<0.05).Compared with the PD group,the stroke group had shorter OTT and HMT(P<0.05);there were no statis-tically significant differences between the two groups in PTT,SRT,HMD or PCR(P>0.05).Conclusion The clinical manifesta-tions of dysphagia in PD and stroke are not entirely consistent.Dysphagia in PD patients is more prominently characterized by oral-phase dysfunction,whereas dysphagia in stroke patients is mainly manifested by pharyngeal-phase dysfunction.
