Early-onset Alzheimer’s disease and other dementias (EOAD) and late-onset Alzheimer’s disease and other dementias (LOAD) represent significant global disease burden challenges. However, previous studies have frequently overlooked differences in their spatial distribution, population characteristics, temporal trends, and healthcare demands. This study aims to systematically compare the burden of EOAD and LOAD at global and regional levels from 1990 to 2021, analyzing disparities in spatial patterns, demographic features, and temporal trajectories, while projecting future trends. Data were extracted from the GBD 2021 database. EOAD was defined as age-standardized cases among individuals aged 40–64 years, and LOAD as those aged ≥ 65 years. Primary outcomes included incidence, mortality, and disability-adjusted life years (DALYs). Analyses covered global, Socio-Demographic Index (SDI) regions, and 21 regions from 1990 to 2021. Bayesian age-period-cohort (BAPC) modeling projected disease burdens to 2035. In 2021, LOAD demonstrated a substantially higher global burden than EOAD: incidence cases (8,455,150 [95

Introduction Combining repetitive transcranial magnetic stimulation (rTMS) with robotic training could result in more significant improvements in motor function than either treatment alone. The efficacy of this combination may depend on the sequencing of the interventions. However, few studies have explored the possibility of interleaving or alternating between the two treatment modalities within a single session or over a shorter time frame. The objective of this study is to evaluate the efficacy of alternating rTMS and soft-hand rehabilitation robot therapy to enhance upper limb and hand function in patients with ischaemic stroke.Methods and analysis This multicentre study will be conducted as a single-blind, controlled, randomised trial, enrolling 132 post-stroke patients with a disease duration ranging from 1 week to 3 months. The study participants will be randomly assigned to group A (n=44), group B (n=44) and group C (n=44). All participants will undergo a 4-week neurological rehabilitation programme, which includes standardised physical and occupational therapy administered by experienced therapists. Group A will receive 10 Hz high-frequency rTMS (HF-rTMS) over the ipsilesional primary motor cortex (iM1) for 20 min, followed by 20 min of soft-hand rehabilitation robot training. Group B will receive 5 min of 10 Hz HF-rTMS over the iM1 followed by 5 min of soft-hand rehabilitation robot training, repeated four times. Group C will receive sham rTMS with other parameters identical to those of group A. The above treatments will be administered once daily, 5 days a week, for 4 weeks. The primary outcome measurement is the Fugl-Meyer assessment of upper extremity (FMA-UE). The secondary outcome measurements include the Hong Kong edition of Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK), the Modified Ashworth Scale (MAS), and the International Classification of Functioning, Disability and Health upper extremity entries (ICF-Upper Extremity Entries). Assessments will be conducted at baseline and after 4 weeks of treatment.Ethics and dissemination This study has been approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (2024-SR-515). The findings of this study will be spread through networks of scientists, professionals and the general public, as well as peer-reviewed scientific papers and presentations at pertinent conferences.Trial registration number ChiCTR2400089583.

Following an ischemic stroke, neuroinflammation is triggered and is often typified by microglial activation. According to recent research, increased glycolysis metabolism frequently occurs when microglia become activated in an inflammatory response. In this study, we found that the PKM2 expression of microglia was gradually increased during the activation of microglia in ischemic stroke. TEPP-46, the activator of PKM2, enhanced the M2 polarization and promoted phagocytosis of microglia both in vivo and in vitro. Meanwhile, TEPP-46 administration ameliorated neuroinflammation and neuronal injuries and reduced the infarct volume of tMCAO mice. Mechanistically, we demonstrated that TEPP-46 suppressed the nuclear translocation of PKM2 and the interaction of PKM2 and HIF-1 alpha, and inhibited glycolysis of microglia. According to our research, PKM2 modulation in microglia may be a viable therapeutic approach to lessen neuroinflammation following ischemic stroke, and TEPP-46 may be able to polarize microglia from an M1 to an M2 phenotype after ischemia/reperfusion damage.

Weight-bearing activity was the primary rehabilitation problem after knee meniscus repair, a scientific weight-bearing protocol was an important guarantee for injury healing and functional improvement. With the popularization of the concept of enhanced recovery after surgery, accelerated weight-bearing activities after knee meniscus repair surgery had gradually gained clinical promotion. However, the effectiveness and safety of accelerated weight-bearing activities were still controversial, and the appropriate weight-bearing protocol after knee meniscus repair with different injury types was still unclear. In this paper, we aimed to explore the decision-making elements of weight-bearing protocols after knee meniscus repair, and explore the effectiveness and safety of different weight-bearing protocols based on knee meniscus injury classification, providing evidences for clinical decision-making.

Purpose:This study aims to examine the predictive value of Craniocervical Flexion Test (CCFT) scores in individuals with chronic non-specific neck pain (CNNP) and to identify factors that may affect CCFT scores. Methods:This case-control study included 73 patients with CNNP and 127 healthy controls. We assessed baseline information such as demographics, duration and frequency of CNNP onset, Neck Disability Index (NDI), and Visual Analog Scale (VAS) scores. All subjects were evaluated by the same rater for CCFT, maximal muscle strength, and endurance of the deep cervical flexors. Head and neck posture was measured using two-dimensional videography, capturing sagittal head angle (SHA), forward head angle (FHA), and protracted shoulder angle (PSA). The predictive capacity of CCFT for CNNP was evaluated using the ROC curve and area under the curve (AUC). Univariate and multivariate ordered logistic regression models were employed to analyze factors influencing CCFT scores. Results:The final analysis included 70 participants in the CNNP group and 123 in the control group. The CNNP group demonstrated lower CCFT scores, reduced maximal muscle strength, and decreased endurance of the deep cervical muscles (P<0.05). Among maximum muscle strength, endurance, and CCFT scores, the latter exhibited the highest AUC. Univariate and multivariate ordered logistic regression analyses revealed that maximal muscle strength, muscle endurance, FHA, and lower NDI scores significantly increased the likelihood of higher CCFT scores (P<0.05), while SHA significantly decreased this likelihood (P<0.05). Conclusion:CCFT demonstrates good predictive value for CNNP, surpassing muscle strength and endurance. Maximal muscle strength, muscle endurance, FHA, and lower NDI scores were positive influencing factors for CCFT scores, whereas SHA was a negatively influencing factor.

目的:研究基于镜像神经元理论的动作观察疗法对轻、中度阿尔茨海默病患者语言功能的影响. 方法:采用对照试验研究,选取轻、中度阿尔茨海默病患者40例,按照随机数字表法将40例阿尔茨海默病患者随机分为试验组20例、对照组20例.两组患者均采用强化语言训练,每次30min,对照组2次/d,试验组1次/d,每周治疗6天,共8周.试验组在对照组基础上增加基于镜像神经元理论的动作观察疗法,每次30min,每周6次,共8周.于治疗前、治疗8周后采用中康汉语标准失语症检查量表(China Rehabilitation Research Center Aphasia Examina-tion,CRRCAE)、波士顿诊断性失语症测验(Boston Diagnostic Aphasia Test,BADE)、血清脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)评价治疗效果. 结果:治疗前,两组患者的语言功能、BDNF水平比较,差异无显著性意义(P＞0.05).治疗后,两组患者的语言功能、BDNF水平均较组内治疗前明显提高(P＜0.05),且治疗后试验组听理解、命名、列举、阅读、书写、BDNF水平、治疗有效率明显优于对照组(P＜0.05). 结论:基于镜像神经元理论的动作观察疗法可以改善轻、中度阿尔茨海默病患者语言功能.

Objective:To explore the effect of problem-based learning (PBL) combined with case three-dimensional training method (CTTM) for students majoring in rehabilitation therapy.Methods:Experimental control method was used in this project. From June to December 2020, 60 undergraduates majoring in rehabilitation therapy were enrolled in Kangda College of Nanjing Medical University. The students were randomly divided into experimental group and control group with 30 in each. At the end of the class, the two groups were evaluated for theoretical and practical results and questionnaire survey. χ2 test was used for comparison between counting data groups, and independent sample T test was used for comparison between measurement data groups. Results:The theoretical test scores and skill test scores of the experimental group were significantly higher than those from the control group [(82.10±5.33) vs. (73.67±7.41), (84.07±3.91) vs. (73.50±7.20)](all P<0.05). The results of the questionnaire showed that the score of improving learning interest, clinical reasoning, discussion participation and practical operation of experimental group was significantly higher than that of the control group [(13.97±4.47) vs. (10.60±4.06), (14.03±4.81) vs. (10.47±4.61), (13.93±4.39) vs. (10.10±4.99), (13.13±5.21) vs. (9.20±3.72)] (all P<0.05). Conclusions:PBL combined with CTTM improves the training outcomes of professional competence of undergraduates majoring in rehabilitation therapy, capacity building of clinical practice, clinical reasoning, and thus overcomes the barriers in traditional teaching method.

In recent years, artificial intelligence technology has been widely used in various medical fields to effectively assist physicians in patient treatment operations. In this paper, we design and implement a deep biblical network model-based orthotic design for adolescent idiopathic scoliosis to quickly and effectively assist physicians in designing orthotics for adolescent idiopathic scoliosis. A fuzzy set is used to express the knowledge of adolescent idiopathic scoliosis orthosis design, and a fuzzy reasoning based on the confidence level is implemented. Finally, the efficiency of the design of adolescent idiopathic scoliosis orthoses was improved by 50% through two cases of adolescent idiopathic scoliosis patients, and the deviation rate between the inference value and the actual operation value of the domain experts was less than 10%.

目的 探讨大腿肌群等速肌力训练对前交叉韧带(ACL)重建术后膝关节功能和姿势控制的影响.方法 选择2017年3月至2020年2月江苏省连云港市第一人民医院收治的86例ACL重建术后患者为研究对象,依照随机数字表法将其分为两组,每组各43例.对照组术后给予常规康复训练,研究组在对照组的基础上术后给予大腿肌群等速肌力训练.随访1年,比较术后3(T0)、6(T1)、12个月(T2)两组伸膝关节力矩峰值(PT)、膝关节功能及姿势控制能力.结果 两组伸膝PT、Lysholm评分、闭眼泡沫平面重心摆动速度组间比较、时间点比较及交互作用,差异均有统计学意义(P＜0.05).T1时,两组伸膝PT、Lysholm评分、闭眼泡沫平面重心摆动速度高于T0,差异有统计学意义(P＜0.05),T2时,两组伸膝PT、Lysholm评分、闭眼泡沫平面重心摆动速度高于T0、T1时,差异有统计学意义(P＜0.05).T0时,两组伸膝PT、Lysholm评分、闭眼泡沫平面重心摆动速度比较,差异无统计学意义(P＞0.05),T1、T2时,研究组伸膝PT、Lysholm评分、闭眼泡沫平面重心摆动速度高于同一时间点对照组,差异有统计学意义(P＜0.05).结论 大腿肌群等速肌力训练可改善ACL重建术后患者膝关节功能及姿势控制能力.

目的 探讨序贯应用全身振动训练(WBVT)和下肢康复机器人训练对不完全性脊髓损伤(ISCI)患者下肢功能的影响.方法 32例ISCI患者随机分为试验组和对照组,每组16例.两组患者进行相同康复训练项目.试验组患者在进行WBVT后序贯进行下肢康复机器人训练,两种训练项目之间无时间间隔;对照组进行WBVT和下肢康复机器人训练存在时间间隔.比较两组治疗前和治疗8周后评估卒中患者运动功能评估量表(MAS)评分、Berg平衡量表(BBS)评分及脊髓损伤步行指数(WISCI)Ⅱ评分.结果 治疗前,两组MAS评分、BBS评分和WISCI Ⅱ评分无统计学差异(P＞0.05);与治疗前相比,治疗后试验组和对照组患者MAS评分降低(P＜0.01),BBS评分和WISCI Ⅱ评分升高(P＜0.01),且试验组改善更明显(P＜0.01或P＜0.05).结论 序贯应用WBVT和下肢康复机器人训练能够更有效地降低ISCI患者踝关节跖屈肌群肌张力,提高平衡能力和步行能力.

This study explored the impacts of matrine on hepatocellular carcinoma (HCC) cell growth, metastasis, epithelial-mesenchymal transition (EMT), and stemness through regulating the microRNA (miR)-299-3p/phosphoglycerate mutase 1 (PGAM1) axis. The association between miR-299-3p expression with the prognosis of HCC patients was studied. miR-299-3p and PGAM1 sequences were transfected into matrine-treated HCC cells, and cell proliferation, invasion, apoptosis, and stemness were detected, as well as protein expression of EMT- and stemness-related makers. The targeting relationship between miR-299-3p and PGAM1 was identified. Matrine elevated miR-299-3p expression, repressed proliferation, invasion, and anti-apoptosis of HCC cells, and constrained EMT and stemness in vitro. PGAM1 was a target of miR-299-3p. Repression of PGAM1 rescued the effects of miR-299-3p downregulation on HCC cells. Matrine stimulates HCC cell apoptosis and represses the process of EMT and stemness through the miR-299-3p/PGAM1 axis.

目的:探究关节松动术结合改良稳定训练对颞下颌关节不可复性盘移位患者的疗效.方法:采用随机数表法将符合纳入排除标准的颞下颌关节不可复性盘移位患者随机分为观察组20例和对照组20例.两组均采用常规治疗,对照组采用关节松动术治疗,观察组采用关节松动术结合改良稳定训练.分别在治疗前和治疗6周进行最大主动开口度(MMO)、视觉模拟尺评分(VAS)和中文版颞下颌功能受损评分(MFIQ)评估,治疗结束一年后随访症状复发频率.结果:与治疗前比较,两组患者MMO较治疗前显著提高,VAS和MFIQ评分显著降低,差异具有统计学意义(P<0.05)且观察组MMO、VAS和MFIQ改善幅度均高于对照组,差异具有统计学意义(P<0.05).治疗一年后,观察组无复发和偶尔复发占比高于对照组,而经常复发和总是复发占比低于对照组.结论:关节松动术结合稳定性训练对颞下颌关节不可复位性盘移位较单纯关节松动术治疗效果更优,降低患者症状复发率.

目的:研究间歇性θ短阵脉冲经颅磁刺激联合动作观察疗法对轻、中度阿尔茨海默病患者认知功能的影响.方法:选取轻、中度阿尔茨海默病患者52例随机分为观察组和对照组各26例.2组患者均接受常规药物治疗、认知功能训练、运动训练.对照组在此基础上采用动作观察疗法,观察组在对照组基础上联合间歇性θ短阵脉冲经颅磁刺激治疗.2组疗程均为4周.采用蒙特利尔认知评估(MoCA)、简易智能精神状态检查量表(MMSE)进行认知功能评估;采用改良Barthel指数、功能活动问卷FAQ进行日常生活活动能力的评估.结果:2组治疗后MMSE评分、MoCA评分均高于治疗前,观察组MMSE评分、MoCA评分改善幅度均高于对照组,差异有统计学意义(P＜0.05).2组治疗后FAQ评分高于治疗前(P＜0.05),观察组Barthel指数评分与FAQ评分改善幅度均高于对照组,差异有统计学意义(P＜0.05).结论:间歇性θ短阵脉冲经颅磁刺激联合动作观察疗法可以改善轻、中度阿尔茨海默病患者的认知功能,提高患者的日常生活活动能力,有望在临床上推广使用.

目的 分析分阶段综合康复训练疗法对肩袖损伤术后患者康复的促进效果.方法 选择120例接受关节镜修复术治疗的肩袖损伤术后患者为研究对象,采用随机数表法分为观察组(分阶段综合康复组)与对照组(常规康复组),各60例,对照组予以早期肩关节制动及康复训练,观察组予以分阶段综合康复训练,2组均治疗16周,并于术后随访6个月.观察2组术后6个月的疗效,比较2组术前、术后3、6个月的肩关节功能、肩关节活动度及血清炎性因子水平.结果 术后6个月,观察组总有效率(96.67%,58/60)高于对照组(81.67%,49/60)(P＜0.05).术前、术后3、6个月,2组肩关节外展、肩关节后伸、肩关节前屈角度及肩关节Constant Murley score量表(CMS)评分均逐渐升高,且术后3、6个月,观察组肩关节外展、肩关节后伸、肩关节前屈角度及CMS评分均高于对照组(P＜0.05).术前、术后3、6个月,2组血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平逐渐降低,且术后3、6个月,观察组血清TNF-α、IL-6水平均低于对照组(P＜0.05).结论 分阶段综合康复训练疗法可降低肩袖损伤术后患者血清TNF-α、IL-6水平,抑制炎症反应,可缓解其肩关节疼痛程度,有效改善肩袖损伤术后患者肩关节功能和肩关节活动度,疗效显著.

目的:探究青少年特发性脊柱侧弯(AIS)动态足底压力分布特定及其与脊柱偏移程度的相关性.方法:选取符合纳入排除标准的AIS患者40例设为AIS组,门诊招募健康强少年30例设为对照组.采用Gait Aanlyzer动态足底压力测试仪评估两组人群动态足底峰值压强和动态足底平均压强,同时测量AIS患者影像学脊柱偏移相关指标.结果:AIS组凹、凸侧和正常组左、右侧足底峰值压强和足底平均压强组间存在差异(P<0.05),AIS组凹侧的足底峰值压强和足底平均压强显著高于其它组(P<0.05).凹侧足底峰值压强与CB高度相关(r=0.849,P<0.01),与AVT和cobb角中度相关(r=0.766,0.528,P<0.01);凸侧足底平均压强与CB,AVT和cobb角中度相关(r=0.709,0.661,0.560,P<0.01).其余两两间低度先关或不相关.结论:AIS患者动态足底峰值压强和平均压强较正常人群升高,且与脊柱偏移有中、高度相关性,具备临床评估AIS力学特征的潜力.

Objective To explore the effect of early cognitive training combined with aerobic exercise on quality of life (QOL) and cognitive function recovery of patients with poststroke cognitive impairment (PSCI). Methods Ninety PSCI patients treated in our hospital from April 2019 to April 2020 were selected as the subjects and were divided into the experimental group (EG) and control group (CG) according to the admission order, with 45 cases each. Patients in CG received conventional health education combined with rehabilitation training, and those in EG accepted early cognitive training combined with aerobic exercise so as to evaluate the clinical effect of different intervention modes on PSCI patients. Results Compared with CG after intervention, EG obtained an obviously higher Stroke Specific Quality of Life scale (SS-QOL) score, Montreal Cognitive Assessment (MoCA) score, Barthel Index (MBI) (BI) score and Functional Independence Measure (FIM) score (P < 0.001), and obviously shorter time for completing TMT-A and TMT-B (P < 0.001). Conclusion Performing early cognitive training combined with aerobic exercise for PSCI patients can effectively improve their QOL and promote the recovery of cognitive function. Compared with conventional health education combined with rehabilitation training, this mode presents a higher application value. Further study will be conducive to establishing a better solution for patients.

Objective:To observe the effect of paeoniflorin on motor behavior and dopamine neurons of mice with Parkinson's disease (PD) by activating autophagy.Methods:Forty C57BL/6 mice were randomly divided into normal control group, model group, paeoniflorin group and paeoniflorin+3-methyl adenine (3-MA) group ( n=10). The later 3 groups were intraperitoneally injected with 1-methyl-4-phenyl-1,2,3,6-tetmhydropyridine (MPTP) at a dosage of 30 mg/(kg·d) for a consecutive 7 d to establish subacute PD models. Meanwhile, mice in the paeoniflorin group and paeoniflorin+3-MA group were intraperitoneally injected with paeoniflorin (30 mg/[kg·d]) or paeoniflorin (30 mg/[kg·d])+3-MA (2 mg/[kg·d]), respectively. Eight d after modeling, pole test and traction test were used to evaluate the locomotor ability of mice in each group. Then, the substantia nigra of the midbrain was taken; TUNEL was used to detect the nerve cell apoptosis; immunohistochemical staining was used to detect the number of tyrosine hydroxylase (TH) positive cells and the expressions of α-synuclein (α-Syn), lysosomal associated membrane protein 2A (LAMP2A) and microtubule-associated protein 1 light chain 3-II (LC3-II); Western blotting was used to detect the LAMP2A and LC3-II protein levels. Results:As compared with model group, paeoniflorin group had significantly shortened rod climbing time, significantly higher scores in traction test, significantly decreased number of apoptotic nerve cells, significantly increased number of TH-positive cells and expressions of LAMP2A and LC3-II, significantly decreased α-Syn expression, and significantly increased protein levels of LAMP2A and LC3-II ( P<0.05). The paeoniflorin+3-MA group had significantly prolonged rod climbing time, significantly lower scores in traction test, significantly increased number of apoptotic nerve cells, significantly decreased number of TH-positive cells and expressions of LAMP2A and LC3-II, significantly increased expression of α-Syn, and significantly decreased protein levels of LAMP2A and LC3-II as compared with the paeoniflorin group ( P<0.05). Conclusion:Paeoniflorin can improve dyskinesia in PD mice by inducing autophagy to remove α-Syn and protect dopaminergic neurons.

Ankle-joint sports injuries with poor rehabilitation results can seriously affect a patient’s quality of life. Nanobamboo charcoal has a strong adsorbability and disinfection effect. It has been used in ankle guards, but the effect of nanometer-sized bamboo charcoal has not been reported thus far. In this study, 98 patients with an ankle-joint motor injury were divided into a Regular Group and Joint Group (49 cases, each) using the random number table method. The Regular Group received the conventional treatment, and the Joint Group received nano-bamboo charcoal ankle guard combined with ankle-joint rehabilitation treatment. The analysis showed that ankle function, balance function, dorsiflexion range of motion, American Orthopedic Foot Ankle Society score, and total effective rate (91.84% vs. 73.47%) in the Joint Group were all higher than those in the Regular Group, while the Visual Analog Scale and Clinical Symptom Score scores were all lower than those of the conventional group ( P < 0.05). This indicates that a nano-bamboo charcoal ankle guard combined with ankle-joint rehabilitation treatment can effectively reduce pain and improve ankle-joint balance, movement, dorsiflexion range of motion, and other functioning parameters of the patients, with a significant curative effect and high clinical application value.

神经源性膀胱(neurogenic bladder,NB)是由于神经系统病变导致膀胱和/或尿道功能障碍.脊髓损伤所致的神经源性膀胱更复杂,逼尿肌高压甚至会引起肾功能衰竭,危及患者生命. 在过去的20年中,重复功能性磁刺激(repetitive func-tional magnetic stimulation,rFMS)被逐渐应用于临床治疗.研究结果表明对S2—S4神经根进行rFMS治疗,可以有效调节逼尿肌兴奋性.Niu等[1]研究发现高频rFMS可以降低逼尿肌压力,有利于膀胱储尿[2].但高频中不同频率的rFMS对脊髓损伤后NB患者的治疗效果影响如何,目前少见临床报道.为进一步探究不同的磁刺激参数对临床疗效的影响,本研究分别采取5Hz和15Hz的rFMS对脊髓损伤后NB患者进行治疗,同时观察尿流动力学等相关指标的变化及影响.

目的 ：探讨肌肉能量技术联合磁振热治疗老年膝关节骨性关节炎患者的效果。方法 ：选取我院 2020 年 4 月～ 2021 年 4 月收治的 50 例老年膝关节骨性关节炎患者为研究对象，根据随机数字表法随机分为对照组与实验组，每组 25 例，其中对照组给以磁振热治疗，实验组在对照组的基础上加以肌肉能量技术训练（MET），共治疗 4 周，比较两组患者治疗前后膝关节疼痛评分（VAS）及膝关节功能活动情况（Lysholm 评分）的差异。结果 ：治疗后两组患者疼痛及膝关节功能活动情况较治疗前均有改善（P<0.05），且实验组比对照组改善更加明显（P<0.05）。结论 ：肌肉能量技术联合磁振热可有效减轻老年膝关节骨性关节炎患者的疼痛，改善膝关节功能，显著提高老年患者的生活质量，具有较好的临床疗效。