BackgroundHemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem.MethodsThis study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score.DiscussionUltrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function.Trial registrationChinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722.

AbstractBackgroundHypertension increases the risk of cognitive impairment and related dementia, causing impaired executive function and unusual gait parameters. However, the mechanism of neural function illustrating this is unclear. Our research aimed to explore the differences of cerebral cortex activation, gait parameters, and working memory performance between healthy older adults (HA) and older hypertensive (HT) patients when performing cognitive and walking tasks.MethodA total of 36 subjects, including 12 healthy older adults and 24 older hypertensive patients were asked to perform series conditions including single cognitive task (SC), single walking task (SW), and dual‐task (DT), wearing functional near‐infrared spectroscopy (fNIRS) equipment and Intelligent Device for Energy Expenditure and Activity equipment to record cortical hemodynamic reactions and various gait parameters.ResultsThe left somatosensory cortex (L‐S1) and bilateral supplementary motor area (SMA) showed higher cortical activation (p < .05) than HA when HT performed DT. The intragroup comparison showed that HT had higher cortical activation (p < .05) when performing DT as SW. The cognitive performance of HT was significantly worse (p < .05) than HA when executing SC. The activation of the L‐S1, L‐M1, and bilateral SMA in HT were significantly higher during SW (p < .05).ConclusionHypertension can lead to cognitive impairment in the elderly, including executive function and walking function decline. As a result of these functional declines, elderly patients with hypertension are unable to efficiently allocate brain resources to support more difficult cognitive interference tasks and need to meet more complex task demands by activating more brain regions.

Pre-frailty is a transitional stage between health and frailty. Previous studies have demonstrated that individuals with pre-frailty experience declines in cognitive and gait performances compared with healthy individuals. However, the basic neural mechanism underlying this needs to be clarified. In this cross-sectional study, twenty-one healthy older adults and fifteen with pre-frailty underwent three conditions, including a single cognitive task (SC), single walking task (SW), and dual-task (DT), while cortical hemodynamic reactions were measured using functional near-infrared spectroscopy (fNIRS). The prefrail group (PG) showed a significantly lower activation of the left dorsolateral prefrontal cortex (L-DLPFC) than the healthy group (HG) when performing SC (p < 0.05). The PG showed a significantly lower Timed Up and Go test and step speed than the HG during SW (p < 0.05). The coefficient of variation (CV) of the step length of the PG was significantly higher than that of the HG when performing DT (p < 0.05). No significant correlation in cerebral cortex activation and gait parameters in the HG when performing SW and DT was noted (p > 0.05). Participants of the PG with a higher oxygenated area in the left anterior prefrontal cortex (L-APFC) had a lower step frequency during SW (r = −0.533, p = 0.041), and so did the following indicators of the PG during DT: L-APFC and step speed (r = −0.557, p = 0.031); right anterior prefrontal cortex and step speed (r = −0.610, p = 0.016); left motor cortex and step speed (r = −0.674, p = 0.006); step frequency (r = −0.656, p = 0.008); and step length (r = −0.535, p = 0.040). The negative correlations between the cerebral cortex and gait parameters of the PG indicated a neural compensatory effect of pre-frailty. Therefore, older adults with pre-frailty promote prefrontal activation to compensate for the impaired sensorimotor systems.

With the development of Internet of things, the healthcare service is getting intelligent and wearable devices have become the focus of healthcare. In the field of healthcare, wearable devices are mainly applied in health monitoring, motion sensing, big health analysis, and so on. All these applications make wearable devices a good tool to achieve the ultimate goal of rehabilitation medicine, which is function recovery and health promotion, thus wearable devices are meant to play an important role in rehabilitation medicine. The users will have a high demand for the comforts and designs of the wearable devices because the wearable devices need to be worn for a long period in the skin; however, traditional devices are unable to satisfy the demand so that novel materials are needed. Nowadays, the wearable devices sold in the market such as smart watches and smart glasses are made of rigid materials, which have poor ductility and high density, thus they are difficult to satisfy the demand of users for comforts and convenience. Flexible materials are novel materials with good portability, high ductility, and could keep stable physicochemical properties even if in the process of extension. The wearable devices made of flexible materials inherit the advantages of flexible materials so that they might make up for the shortcomings of traditional wearable devices and then be widely applied in the field of rehabilitation medicine. As is shown in the domestic and foreign literature, flexible wearable devices have the potential for clinical application. Compared with traditional devices, flexible wearable devices not only improve user experience but also offer more powerful functions to meet a variety of clinical demands. In this review, we briefly introduce the principle and classification of flexible wearable devices and review the research progress of the application of flexible wearable devices in the field of rehabilitation medicine from six aspects: health monitoring, motion monitoring, swallow-speech monitoring, home rehabilitation, fall warning, and intelligent rehabilitation. Finally, we summarize current challenges and recent development trends of flexible wearable devices to provide a theoretical basis for future clinical applications

Background: Previous studies show that the high-mobility group box protein 1 (HMGB1) and the toll-like receptor 4 (TLR4) participate in systemic lupus erythematosus (SLE). The two molecules contribute to the (xxurrence and persistence of seizures in various disease conditions, such as epilepsy. Since seizures are one of the most severe complications associated with neuropsychiatric SLE (NPSLE), the current study aimed at investigating whether HMGB1 and TLR4 play any role in NPSLE related seizures. Methods: Data from 291 SLE patients and 100 healthy controls (HC) were prospectively collected from 2013 to 2018. The ELISA test was used to determine serum levels of HMGB1 for all patients and HC and cerebrospinal fluid (CSF) levels of NPSLE patients. The expression levels of TLR4 by the peripheral blood monocytes (PBMCs) were determined by real-time PCR of TLR4 mRNA. Binary logistic regression and ROC curve analysis were used to predict NPSLE. Results: Among the 291 SLE patients, 188 had active disease and were grouped into two, NPSLE (N=86) and Non-NPSLE (N=102) groups. Among the NPSLE patients, 21 had seizure disorders. Serum HMGB1 levels were increased in NPSLE (8.73=0.29 ng/mL) and were associated with disease activity (r=0.6527, P=0.000). Both serum and CSF HMGB1 levels in NPSLE patients with seizure disorders (9.59 +/- 0.63 and 2.90 +/- 2.29 ng/mL, respectively) were higher than in patients with other neuropsychiatric symptoms (8.45 +/- 0.33 and 2.56 +/- 1.70 ng/mL, respectively), though without significance. The gene expression of mRNA TLR4 in PBMCs was similar to serum HMGB1 in the investigated groups. Independent predictors of NPSLE were SLEDAI-2k (OR 1.25; 95% CI: 1.155-1.353), serum HMGB1 (OR 1.659; 95% CI: 1.266-2.175), and antiRib-P Ab (OR 3.296; 95% CI: 1.013-10.725). ROC curves for the above predictors had a large AUC (95% CI) of 0.936 (0.900-0.971), indicating a good prediction of NPSLE occurrence. Conclusions: The expression of HMGB1 and TLR4 was increased in NPSLE, but HMGB1 and TLR4 had minimal effect on NPSLE related seizures. The serum levels of HMGB1 were positively correlated with disease activity, and could, therefore, be a potential biomarker of NPSLE for use in future clinical practice.

系统性红斑狼疮(SLE)是一种病因未明的慢性多系统自身免疫性疾病,遗传、激素和某些环境因素均与SLE的发病有关. SLE复发和缓解交替出现,病程复杂,目前的药物治疗可减少或延缓疾病的进展和器官损害,尚无法治愈.巨噬细胞移动抑制因子(MIF)是一种具有广泛免疫调节特性的多功能蛋白质,能够通过激活巨噬细胞功能、活化淋巴细胞、促进某些细胞因子的分泌和表达等途径参与SLE的发生和发展.因此,MIF可能成为自身免疫性疾病的治疗靶点,在临床应用上具有很大的潜力,但未来仍需要更深入的研究来证实其安全性和有效性.

目的 探讨神经精神性狼疮(NPSLE)患者血清抗N-甲基-D-天[门]冬氨酸受体亚单位2A抗体(抗NR2 A抗体)水平及其临床意义.方法 将73例活动期系统性红斑狼疮(SLE)患者分为NPSLE组36例和非NPSLE组37例.比较两组自身抗体及补体水平.评估NPSLE患者抗NR2 A抗体水平与SLE疾病活动指数2000(SLEDAI-2000)评分、抗双链脱氧核糖核酸(dsDNA)抗体及补体水平的相关性.结果 NPSLE组患者的SLEDAI-2000评分、抗NR2 A抗体及抗dsDNA抗体水平均高于非NPSLE组(均P<0.05),但认知障碍与无认知障碍NPSLE患者间抗NR2 A抗体水平差异无统计学意义(P>0.05).NPSLE组中,抗NR2 A抗体水平与SLEDAI-2000评分、抗dsDNA抗体水平呈正相关,与C3、C4水平呈负相关(P<0.05).抗核糖体P蛋白抗体(ARPPA)阳性的SLE患者抗NR2A抗体水平高于ARPPA阴性SLE患者(P<0.05).结论 抗NR2A抗体在NPSLE的发病过程中起重要作用,且与疾病活动度有关,但可能与认知障碍无关.

目的 探讨干燥综合征合并视神经脊髓炎谱系疾病(NMOSD-SS)的临床特点及复发影响因素.方法 将2011年1月至2016年12月南方医科大学南方医院确诊的179例视神经脊髓炎谱系疾病(NMOSD)患者,分为NMOSD-SS组及NMOSD-非SS组,收集两组患者的一般情况、检查结果、治疗及复发情况等临床资料,分析两组患者的临床特点及复发影响因素.结果 (1) NMOSD-SS组较NMOSD-非SS组女性比例高(93.9％ vs.76.7％,P＜0.05)、治疗前扩展功能障碍状态量表(EDSS)评分高[(5.15±2.54)分 vs.(3.81±2.71)分,P＜0.05];(2)NMOSD-SS组患者岛叶(3.0％ vs 0,P＜0.05)及胸髓(63.6％ vs.41.1％,P＜0.05)受累率更高;(3) NMOSD-SS组复发率更高(45.5％ vs.24.7％,P＜0.05),治疗前EDSS评分(OR=2.574,P＜0.05)、应用免疫抑制剂治疗(OR=0.345,P＜0.05)为NMOSD-SS复发的独立影响因素.结论 NMOSD-SS较NMOSD-非SS女性发病率高、病情严重,且更容易复发,使用免疫抑制剂可有效降低NMOSD-SS的复发率.

目的 探索体验式教学模式在风湿病学全英文教学中的应用及其效果.方法 将体验式教学模式应用于风湿病学全英文教学,并通过问卷调查方式,了解学生对体验式教学的评价.结果 85.0％的学生认为体验式教学有利于提高自身素质,87.5％的学生认为体验式教学有利于提高其学习兴趣,80.0％的学生认为体验式教学有利于提高知识掌握程度,90.0％的学生认为体验式教学效果比传统授课效果好.结论 将体验式教学模式应用于风湿病学全英文教学中,能提高临床医学专业学生个人素质、学习兴趣、临床思维能力和教学质量.

基于问题的学习模式(Problem-based learning,PBL)、模块化教学法均是近年来备受推崇的新兴教学方法,可有效增强学生的学习主动性和学习效果,已在我国各学科的教学中取得了一定的成绩.本文从风湿病教学入手,在紧密结合临床的基础上,将PBL教学法与模块化教学法融合应用,激发了学生学习兴趣,提高了其学习效率和思考能力,为如何培养高素质风湿病学人才进行了有效尝试与探索.