Multiple gastrointestinal melanoma causing small bowel intussusception

A 61-year-old gentleman presented with small bowel intussusception from small bowel melanoma intussusceptum. He complains of intermittent abdominal distension but no history of intestinal obstruction. Apart from this, he was also symptomatic anemia which required repeated transfusion for the past few months. The contrast-enhanced computed tomography of the abdomen shows an omental mass with small bowel intussusception. He then underwent an exploratory laparotomy with segmental resection of the affected segment. Histopathological examination confirmed primary gastrointestinal melanoma. Multiple small bowel malignant melanoma is a rare disease. It remains a controversial diagnosis as it may be a primary or metastasis from an unidentified or regressed primary cutaneous melanoma. Prompt surgical intervention enables us to obtain tissue diagnosis, prevent complete intestinal obstruction and strategize the goals of treatment for the patient.

Diagnosis and management of orbital and cranial complications of pediatric acute rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.

Analysis of risk factors of radiation-induced toxicity in limited-stage small cell lung cancer treated with hypofractionated intensity-modulated radiotherapy / 中华肿瘤杂志

Objective: To compare the incidence of radiation-related toxicities between conventional and hypofractionated intensity-modulated radiation therapy (IMRT) for limited-stage small cell lung cancer (SCLC), and to explore the risk factors of hypofractionated radiotherapy-induced toxicities. Methods: Data were retrospectively collected from consecutive limited-stage SCLC patients treated with definitive concurrent chemoradiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2022. The enrolled patients were divided into two groups according to radiation fractionated regimens. Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) was used to evaluate the grade of radiation esophagus injuries and lung injuries. Logistic regression analyses were used to identify factors associated with radiation-related toxicities in the hypofractionated radiotherapy group. Results: Among 211 enrolled patients, 108 cases underwent conventional IMRT and 103 patients received hypofractionated IMRT. The cumulative incidences of acute esophagitis grade ≥2 [38.9% (42/108) vs 35.0% (36/103), P=0.895] and grade ≥ 3 [1.9% (2/108) vs 5.8% (6/103), P=0.132] were similar between conventional and hypofractionated IMRT group. Late esophagus injuries grade ≥2 occurred in one patient in either group. No differences in the cumulative incidence of acute pneumonitis grade ≥2[12.0% (13/108) vs 5.8% (6/103), P=0.172] and late lung injuries grade ≥2[5.6% (6/108) vs 10.7% (11/103), P=0.277] were observed. There was no grade ≥3 lung injuries occurred in either group. Using multiple regression analysis, mean esophageal dose ≥13 Gy (OR=3.33, 95% CI: 1.23-9.01, P=0.018) and the overlapping volume between planning target volume (PTV) and esophageal ≥8 cm(3)(OR=3.99, 95% CI: 1.24-12.79, P=0.020) were identified as the independent risk factors associated with acute esophagitis grade ≥2 in the hypofractionated radiotherapy group. Acute pneumonitis grade ≥2 was correlated with presence of chronic obstructive pulmonary disease (COPD, P=0.025). Late lung injuries grade ≥2 was correlated with tumor location(P=0.036). Conclusions: Hypofractionated IMRT are tolerated with manageable toxicities for limited-stage SCLC patients treated with IMRT. Mean esophageal dose and the overlapping volume between PTV and esophageal are independently predictive factors of acute esophagitis grade ≥2, and COPD and tumor location are valuable factors of lung injuries for limited-stage SCLC patients receiving hyofractionated radiotherapy. Prospective studies are needed to confirm these results.

Analysis on the trends of incidence and age change for global female breast cancer / 中华肿瘤杂志

Objective: To analyze the trends of incidence and age change for global female breast cancer in different regions of the world according to the database from Cancer Incidence in Five Continents Time Trends (CI5plus) published by the International Association of Cancer Registries (IACR). Methods: The recorded annual female breast cancer (ICD-10: C50) incidence data and corresponding population at-risk data (1998-2012) were extracted from CI5plus published by IACR. The annual change percentage and average annual change percentage (AAPC) were calculated to examine the trends of incidence. The age-standardized mean age at diagnosis and proportion of incidence cases by age were calculated to analyze the relationship between incidence and age. Results: For crude incidence, except in Northern America, all other regions showed an upward trend, with Asia showing the most obvious upward trend (AAPC: 4.1%, 95% CI: 3.9%, 4.3%). For age-standardized incidence, in Asia, Latin America and Europe, the rising trends had slowed down, in Oceania and Africa, the trends began to be stable, and in Northern America, the trend showed a downward trend (APPC: -0.6%; 95% CI: -1.0%, -0.1%). The mean age at diagnosis were increased from 1998 to 2012 in Asia, Latin America, Oceania and Europe, with an annual increase of 0.12 years, 0.09 years, 0.04 years and 0.03 years, respectively. But after age-standardized, only Europe still kept increasing year by year, with an annual increase of 0.02 years, while Northern America showed a decreasing trend, with an annual decrease of about 0.03 years. Conclusions: From 1998 to 2012, the trends of incidence and age change for global female breast cancer vary in different regions of the world, and the global population aging is widespread, which affects the trend of the actual age change. Prevention and control strategies should be targeted at different age groups in different regions.

Structural asymmetries in neonatal brain white matter: a diffusion tensor imaging study / 中华放射学杂志

Objective:To explore the asymmetry of neonatal brain white matter using fractional anisotropy (FA) parameter generated from diffusion tensor imaging (DTI).Methods:From January 2011 to June 2013, 88 neonates with normal cranial MRI performance, aged 1-14 (7.7±0.3) days and gestational age 31-42 (37.5±0.3) weeks, were retrospectively collected from the First Affiliated Hospital of Xi′an Jiaotong University. According to the gestational age at birth, the neonates were divided into preterm group (37 cases) and term group (51 cases). DTI was processed to generate FA parametric maps. Tract-based spatial statistics (TBSS) was used to analyze the asymmetry in neonatal white matter. Regions of interest were placed in bilaterally symmetrical white matter tracts. The white matter tracts included the bilateral anterior thalamic radiation, corticospinal tract-posterior limb of the inner capsule (CST-IC), corticospinal tract-corona radiata, cingulum hippocampus part (CGH), inferior frontal occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus (SLF), uncinate fasciculus, superior longitudinal fasciculus temporal part (SLF-temp). The FA value was measured and asymmetry index (AI) was calculated. The independent-sample t test or Mann-Whitney U test was used to compare the AI of each tract between the preterm and term groups. Partial correlation was used to analyze the effects of neonatal gestational age and birth anthropometric measures on the asymmetry of neonate at birth. Results:The results of TBSS showed that the left lateralized areas of brain white matter in the neonatal period were mainly located in the corticospinal tract, external capsule and genu of corpus callosum. The right lateralized areas of brain white matter in the neonatal period were mainly located in the optic radiation and splenium of corpus callosum. In both the preterm and term groups, the tracts related to motor (CST-IC) and language function (ILF, SLF, SLF-temp) were left asymmetry. The CGH of the preterm and the term neonates were right asymmetry, and AI was -0.086±0.114 and -0.140±0.108 respectively, with a statistically significant difference ( t=2.27, P=0.026), while the differences of AI in the remaining tracts were not statistically significant ( P>0.05). Only gestational age was correlated with the AI of ILF ( r=0.234, P=0.033), SLF ( r=0.259, P=0.018), SLF-temp ( r=0.252, P=0.022), CST-IC ( r=0.235, P=0.033). No significant correlation was found between birthweight, head circumference, body length and AI. Conclusions:The asymmetries of brain white matter already exist in neonates aged less than two weeks. The tracts associated with motor and language function are predominantly left asymmetry.

Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures (version 2023) / 中华创伤杂志

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Rapid authentication of different herbal medicines by heating online extraction electrospray ionization mass spectrometry / 药物分析学报

The rapid and accurate authentication of traditional Chinese medicines(TCMs)has always been a key scientific and technical problem in the field of pharmaceutical analysis.Herein,a novel heating online extraction electrospray ionization mass spectrometry(H-oEESI-MS)was developed for the rapid and direct analysis of extremely complex substances without the requirement for any sample pretreatment or pre-separation steps.The overall molecular profile and fragment structure features of various herbal medicines could be completely captured within 10-15 s,with minimal sample(＜0.5 mg)and solvent consumption(＜20 μL for one sample).Furthermore,a rapid differentiation and authentication strategy for TCMs based on H-oEESI-MS was proposed,including metabolic profile characterization,characteristic marker screening and identification,and multivariate statistical analysis model validation.In an analysis of 52 batches of seven types of Aconitum medicinal materials,20 and 21 key compounds were screened out as the characteristic markers of raw and processed Aconitum herbal medicines,respectively,and the possible structures of all the characteristic markers were comprehensively identified based on Com-pound Discoverer databases.Finally,multivariate statistical analysis showed that all the different types of herbal medicines were well differentiated and identified(R2X＞0.87,R2Y＞0.91,and Q2＞0.72),which further verified the feasibility and reliability of this comprehensive strategy for the rapid authentication of different TCMs based on H-oEESI-MS.In summary,this rapid authentication strategy realized the ultra-high-throughput,low-cost,and standardized detection of various complex TCMs for the first time,thereby demonstrating wide applicability and value for the development of quality standards for TCMs.

Comparison of the clinical efficacy of percutaneous vertebroplasty and biopsy by unilateral and bilateral pedicle approaches for the treatment of vertebral metastasis / 中国医师进修杂志

Objective:To retrospectively compare the clinical efficacy of percutaneous vertebroplasty and biopsy by unilateral and bilateral pedicle approaches for the treatment of vertebral metastasis.Methods:From June 2020 to July 2022, a total of 82 patients with vertebral metastasis underwent percutaneous vertebroplasty and biopsy treated in Linyi Cancer Hospital were enrolled, 39 patients with 57 vertebral bodies were performed by unilateral pedicle approach (unilateral group) and 43 patients with 52 vertebral bodies were performed by bilateral pedicle approaches (bilateral group), used bone cement filling vertebral bodies after biopsy. The clinical efficacy and the positive rate of biopsy were compared between the two groups.Results:Both groups experienced significant pain relief in the Visual Analog Scale (VAS) score and improvement in the Oswestry Disability Index (ODI) score after operation ( P<0.05), but there were no significant differences between the two groups ( P>0.05). The operative time for a single vertebra, volume of bone cement in unilateral group were less than those in the bilateral group:(44.81 ± 13.01) min vs. (31.84 ± 11.87) min, (4.87 ± 0.92) ml vs. (4.18 ± 0.90) ml, there were significant differences ( P<0.05). There were no significant differences in the incidence of bone cement leakage and the positive rate of biopsy between both groups ( P>0.05). Conclusions:Percutaneous vertebroplasty and biopsy by unilateral and bilateral pedicle approaches are significant improvement for symptoms and functions of patients with vertebral metastasis. The clinical efficacy and the positive rate of biopsy are similar. But the former has easier operation procedure, shorter operative time and less volume of bone cement.

Application of deep learning image reconstruction algorithm in low-dose abdominal CT / 西安交通大学学报(医学版)

【Objective】 To investigate the value of deep learning image reconstruction (DLIR) in improving image quality and reducing beam-hardening artifacts of low-dose abdominal CT. 【Methods】 For this study we prospectively enrolled 26 patients (14 males and 12 females, mean age of 60.35±10.89 years old) who underwent CT urography between October 2019 and June 2020. All the patients underwent conventional-dose unenhanced CT and contrast-enhanced CT in the portal venous phase (noise index of 10; volume computed tomographic dose index: 9.61 mGy) and low-dose CT in the excretory phase(noise index of 23; volume computed tomographic dose index: 2.95 mGy). CT images in the excretory phase were reconstructed using four algorithms: ASiR-V 50%, DLIR-L, DLIR-M, and DLIR-H. Repeated measures ANOVA and Kruskal-Wallis H test were used to compare the quantitative (skewness, noise, SNR, CNR) and qualitative (image quality, noise, beam-hardening artifacts) values among the four image groups. Post hoc comparisons were performed using Bonferroni test. 【Results】 In either quantitative or qualitative evaluation, the SNR, CNR, overall image quality score, and noise of DLIR images were similar or better than ASiR-V 50%. In addition, the SNR, CNR, and overall image quality scores increased as the DLIR weight increased, while the noise decreased. There was no statistically significant difference in the distortion artifacts (P=0.776) and contrast-induced beam-hardening artifacts (P=0.881) scores among these groups. 【Conclusion】 Compared with the ASiR-V 50% algorithm, DLIR algorithm, especially DLIR-M and DLIR-H, can significantly improve the image quality of low-dose abdominal CT, but has limitations in reducing contrast-induced beam-hardening artifacts.

Content comparison of assessment tools of activity and participation, and quality of life: based on ICD-11 and ICF / 中国康复理论与实践

ObjectiveTo encode and analyze the measurement items of major activity and participation function assessment tools and quality of life assessment tools using International Classification of Functioning, Disability and Health (ICF). MethodsRepresentative tools in the activity category, comprehensive activity and participation category, as well as quality of life assessment tools were selected for analysis of their measurement structures and content. Based on the ICF linking rule and content matching method, the concepts of measurement items in various tools were matched with ICF categories, analyzing the relationships between the content of measurement items and the concepts of ICF categories, and then coded in ICF and ICD-11. ResultsMeasurement tools in the activity category, such as Barthel index (BI) and Instrumental Activities of Daily Living (IADL), were primarily standardized activity assessment tools in medical, rehabilitation, and community settings. The measurement was conducted through direct observation of activity function and semi-structured interviews with individuals or their caregivers, with 25 to 60 minutes. Most measurement tools were standardized reference tools. Assessment tools related to overall functioning in the activity and participation category, such as 36-item Short-Form Health Survey (SF-36), World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), World Health Organization Quality of Life-Disability (WHOQOL-DIS) and World Health Orgnization Disability Assessment Scheme 2.0 (WHODAS 2.0) were norm-referenced assessment tools applicable in medical, rehabilitation, education, and social service contexts. The measurement was carried out by professionals through interviews and observations, or completed by the assessed individuals through self-administered questionnaires, with a measurement duration of 30 to 60 minutes. In terms of measurement content, IADL and BI mainly focus on activities of self care and functional activities, corresponding to ICF categories such as mobility (d4), self-care (d5), and domestic life (d6). SF-36 primarily covers general tasks and demands (d2), communication (d3), mobility (d4), self-care (d5), and domestic life (d6). WHOQOL-BREF and WHOQOL-DIS items related to general tasks and demands (d2), communication (d3), mobility (d4), interpersonal interactions and relationships (d7), and community, social, and civic life (d9). WHODAS 2.0 was the most comprehensive measurement tool covering all nine domains of activity and participation in the ICF. ConclusionThis study amalyzed the structures and contents of items of six assessments tools using ICF nomenclature, terminology, codes and linking rules. WHOQOL-BREF, WHOQOL-DIS and WHODAS 2.0 are comprehensive functioning evaluation tools, covering all nine ICF domains of activity and participation, as well as quality of life and well-being.

Adaptive physical activity and its health benefits for patients with spinal cord injury based on ICF: a scoping review / 中国康复理论与实践

ObjectiveTo analyze adaptive physical activity interventions and their health benefits for patients with spinal cord injury (SCI) based on International Classification of Functioning, Disability and Health (ICF). MethodsA combination of subject headings and free words was employed to search for relevant literature on physical activity in patients with SCI in PubMed, Web of Science, EBSCO and CNKI, from January, 2017 to July, 2022. A scoping review was conducted. ResultsEight English articles were included, from Australia, the United States, Estonia, Canada, Netherlands and Brazil. The study involved 150 patients with SCI and included seven randomized controlled trials and one non-randomized controlled trial. These literatures were primarily from journals in the fields of SCI, neurology, neuromuscular medicine and physical activity, with publication dates concentrated between 2017 and 2021. The included studies involved participants with complete or incomplete SCI, presenting with paraplegia, tetraplegia, and various levels of injury severity (grades A to D). The main functional disorders related to ICF included b710 mobility of joint functions, b715 stability of joint functions, b720 mobility of bone functions, b730 muscle power functions, b735 muscle tone functions, b750 motor reflex functions, b760 control of voluntary movement functions and b770 gait pattern functions; the functions involved in activities and participation included d410 changing basic body position, d415 maintaining a body position, d420 transferring oneself, d445 hand and arm use, d450 walking, d455 moving around, d570 looking after one's health, d610 acquiring a place to live, d910 community life, d920 recreation and leisure; the environmental factors involved were e1151 assistive products and technology for personal use in daily living, and e1401 assistive products and technology for culture, recreation and sport. Physical activity intervention sites mainly included home, community, medical or rehabilitation institutions. The physical activity could be classified into prevention, health promotion, treatment and rehabilitation. Patients with SCI had completed acute and subacute rehabilitation in medical and rehabilitation institutions, and returned to their families and communities, and some of them received services in medical and rehabilitation institutions from time to time. The forms of physical activity included strength training combined with routine nursing, short-term resistance training, hydrotherapy and robot treadmill activities, functional electrical stimulation and therapeutic exercise, progressive exercise training based on exoskeleton of power machine, leg bicycle assisted by electrical stimulation combined with manual bicycle, and acute exercise with different intensity. The activity frequency was twelve to 60 minutes a time, two to three times a week, lasting for three to 16 weeks, and the activity intensity was mainly medium to high. The health benefits of physical activity on patients with SCI were mainly reflected in four aspects: physical and mental health, activity and behavior health, environmental factors, quality of life and well-being. In terms of physical and mental health, it helped to improve muscle function (muscle strength, strength perception), walking function (walking speed, walking distance), respiratory and circulatory system functions (peak oxygen uptake, aerobic endurance, cardiopulmonary function, reducing the risk of cardiopulmonary diseases, etc.), immune system related functions, and improving psychosocial function (fatigue degree). In terms of activity and behavioral health, it was helpful to improve activity skills and abilities. In terms of environmental factors, the availability and effectiveness of some auxiliary equipment were confirmed. In terms of quality of life and well-being, it could improve self-living ability and quality of life. ConclusionThis study established a PICO framework for adaptive physical activity and its health effects in patients with SCI based on ICF. Physical activity for patients with SCI can be conducted in various settings, including home, community, or medical and rehabilitation institutions. The physical activities of patients with SCI are characterized by wheelchair-based adaptive physical activities, which are mainly divided into two categories: various aerobic exercises and resistance exercises based on wheelchairs, and physical activities based on auxiliary exercise equipment or intervention methods (such as robot treadmill, power machine exoskeleton, functional electrical stimulation, etc.). The frequency of physical activity in patients with SCI is twelve to 60 minutes a time, two to three times a week, lasting for three to 16 weeks, and the activity intensity is maily medium to high. Therapists and rehabilitation professionals can provide guidance and support through various means, such as online or offline supervision and one-on-one coaching, to promote the health benefits of physical activity for patients with SCI, including improved physical and psychological function, enhanced activity levels, reduced sedentary behavior, and increased self-care abilities and quality of life.

Exercise rehabilitation interventions for people with spinal cord injury and their health benefits: a systematic review of systematic reviews based on ICD-11 and ICF / 中国康复理论与实践

ObjectiveBased on the International Classification of Diseases, Eleventh Revision (ICD-11) and the International Classification of Functioning, Disability and Health (ICF), systematic reviews about the effects of different types of exercise rehabilitation and related interventions on body structure and function, activity and participation, and quality of life in people with spinal cord injury (SCI) were systematically reviewed. MethodsSystematic reviews of exercise rehabilitation and health benefits in patients with spinal cord injury were searched from PubMed, Embase, EBSCO, Web of Science and CNKI, from January, 2015 to January, 2023. ResultsEight English articles were included, from Canada, the United States, South Korea, Australia, Brazil and Netherlands, derived from the fields of physical medicine and rehabilitation, neuromedicine and rehabilitation, and exercise intervention, with the publication date mainly concentrated from 2015 to 2021. A total of 165 randomized controlled trials were involved, with 2 746 participants, aged 18 to 65 years. The diseases were mainly spinal cord injury (complete or incomplete), quadriplegia, paraplegia (thoracic, lumbar and sacral injuries), and motor neuron injury (upper and lower). There were three main types of interventions: passive intervention, using sports assistive devices, such as powered exoskeleton-assisted robots, electric bicycles, etc., and functional electrical stimulation; active interventions, such as stepping exercises; training on flat ground, outdoor walking, and activities of daily living; mixed intervention (active & passive), such as combination of exercise and functional electrical stimulation, combination of exercise and motor assistive devices. The frequency of intervention was ten to 240 minutes a time, two to 18 times a week, with the intensity of low to vigorous, for one to 456 weeks. The intervention sites mainly involved families, community health service centers and sports venues. The health impact mainly involved improving cardiovascular and increasing blood flow velocity in the legs; improving musculoskeletal structure, as well as muscle strength, tolerance and flexibility; relieving spasms and improving reflex excitability of the nervous system; increasing gait speed and walking distance; improving functional independence, such as bowel regularity; improving physical health, such as reducing spasticity and drug use (e.g., baclofen), increasing the immune response to infection, and reducing the risk of disease (vascular dementia and respiratory disease); and improving psychological condition. ConclusionBased on ICD-11 and ICF, this study constructed a research framework for active or passive exercise rehabilitation and related interventions in patients with spinal cord injury. Patients with spinal cord injury can improve their body structure and function, increase their activity and participation, and improve their quality of life and well-being through passive interventions (using motor assistive devices, functional electrical stimulation), active interventions (such as stepping exercises, outdoor walking, etc.), and mixed interventions (combining exercise and functional electrical stimulation, exercise and sports assistive devices).

Effects of Vitamin D Supplementation on Children with Autism Spectrum Disorder: A Systematic Review and Meta-analysis

The effect of vitamin D supplementation on individuals with autism spectrum disorder (ASD) is inconclusive. We aimed to conduct a meta-analysis of the available randomized controlled trials (RCTs) to explore whether vitamin D supplementation can improve core symptoms and coexisting conditions in children with ASD. Data were obtained by searching the PubMed, Embase, Web of Science, CINAHL and Cochrane Library databases up to February 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Using a random-effects model, mean differences with 95% confidence intervals (CIs) were calculated through a meta-analysis. There were eight RCTs with 266 children with ASD in the present review, among which six RCTs were included in the meta-analysis.Children who received vitamin D supplementation showed a significant improvement in stereotypical behavior scores (pooled mean difference (MD): −1.39; 95% CI: −2.7, −0.07; p = 0.04) with low heterogeneity (I2 = 34%), and there was a trend toward decreased total scores on the Social Responsiveness Scale (SRS) and Childhood Autism Rating Scale (CARS, p = 0.05); however, there were no other significant differences in the core symptoms of ASD and coexisting conditions between groups as measured by the Aberrant Behavior Checklist (ABC). Vitamin D supplementation appears to improve stereotypical behaviors but does not improve other core symptoms and coexisting conditions. Further randomized controlled trials with large sample sizes and individualized doses are needed.

Structure, content and psychometric properties of physical activity measurement/reporting tools applicable to children and adolecents with disabilities: a systematic review / 中国康复理论与实践

ObjectiveTo synthesize the structure, content and psychometric properties of physical activity measurement/reporting tools applied in children and adolescents with disabilities. MethodsLiterature on physical activity measurement/reporting tools for children with disabilities were retrieved from PubMed, Medline, EBSCO, Web of Science and CNKI, from establishment to June, 2023. The main structure and content characteristics of the tools were analyzed using the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY). The psychometric properties of the tools was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). ResultsSix tools were selected, and nine papers were finally included. Two tools were globalized standard tools, namely Global Matrix 4.0 Physical Activity Report Card for Children and Youth (Global Matrix 4.0) and the Global Matrix of Para Report Card on Physical Activity of Children and Adolescents with Disabilities (Para Report Card), measuring b455 functions of motor tolerance function, b7 neuromusculoskeletal and motor-related functions; d4 mobility, d450 walking, d470 using transportation, d820 school education, d910 community life, d920 recreation and leisure; e310 immediate family, e320 friends, e460 societal attitudes, and e575general social support services, systems and policies, etc. These tools showed a complete structure, high reliability, validity and feasibility, and could be performed in a self-reported manner or completed by the custodian or school teacher. The International Physical Activity Questionnaire (IPAQ) might measure d4 mobility, d450 walking, d640 doing housework, d820 school education, d920 recreation and leisure. IPAQ was good in terms of internal consistency, content and construct validity, and cross-cultural validity, with different test-retest reliability and hypothesis testing results reported in different applied studies. Children and Adolescents Physical Activity and Sedentary-Questionnaire (CAPAS-Q) might measure the d4 mobility, d450 walking, d470 using transportation, d820 school education, and d920 recreation and leisure. CAPAS-Q was good in internal consistency, retest reliability, content and construct validity, but hypothesis testing results and cross-cultural validity were unknown. Physical Activity Questionnaire for Older Children (PAQ-C) and Physical Activity Questionnaire for Adolescents (PAQ-A) might measure d4 mobility, d450 walking, d470 using transportation, d820 school education, and d920 recreation and leisure. PAQ-C and PAQ-A were strong in internal consistency, retest reliability, content and construct validity, and cross-cultural validity, without hypothesis testing results. ConclusionIn terms of content, Para Report Card is the most comprehensive and extended physical activity measurement/reporting tool for children and adolescents with disabilities. In terms of the psychometric properties of the instruments, the multidimensional, structured physical activity measures show high internal consistency, retest reliability, and content and construct validity, with varying retest reliability and correlational validity with objective measures across studies.

Adapted physical education programs for psychomotor development in school settings for children with intellectual and developmental disabilities: a systematic review / 中国康复理论与实践

ObjectiveTo analyze the effect of physical activity in an adaptive physical education program on the psychomotor development of children with intellectual and developmental disabilities in the school setting. MethodsLiterature related to adaptive physical education programs and psychomotor development for children with intellectual and developmental disabilities were retrieved from EBSCO, PubMed, Embase, Web of Science and CNKI, from the establishment of the library to May, 2023, and systematically reviewed. ResultsSeven English literatures of randomized controlled trials were included, from four countries, involving 236 subjects, aged six to 18 years. The main sources were journals in the fields of sport and psychomotor, developmental disorders, adapted physical education, and children's psychomotor, with publication dates centered after 2016. Physical activity components of adaptive physical education programs in school settings primarily included muscle and balance training, perceptual-motor training, walking up and down stairs, aerobic exercise using equipment (e.g., treadmills, steppers, cross-trainers, and stationary bikes), sit-ups, jumping exercises, rhythmic activities, simultaneous static and dynamic balancing activities while focusing on visual inputs, changing positions at different rhythms and moving through space, breathing and stretching exercises, adapted table tennis motor skill training, ball control exercises, and hand-eye coordination exercises, with an intervention of light-moderate intensity, 45 to 60 minutes a time, one to five times a week, for eight to 24 weeks. The health benefit maily included the enhancement of rhythmic perception as well as the improvement of integrated visual, auditory, and tactile perception; improving muscular strength and endurance, total locomotor capacity and fine-motor capacity such as fine-motor integration, running speed and agility, and balance; improving physical flexibility and coordination, such as upper limb coordination, static balance, strength and flexibility; improvement of correct response, sustained response, and theoretical level of reactivity, and motor flexibility and agility; significant improvements in self-care (eating, dressing, and self-direction), increasing in the number of sit-ups to standard, increasing success in jumping for a ball, and improving motor skill proficiency and executive functioning. ConclusionThis systematic review constructed a PICO for the psychomotor development of children with intellectual and developmental disabilities participating in physical activity in the school setting with an adaptive physical education program based on the PRISMA guidelines. The adaptive physical education program may promote psychomotor development in children with intellectual and developmental disabilities in five main areas: perception, motor control, coordination, reaction time, and movement planning and execution.

School health services and effectiveness based on World Health Organization health-promoting school framework: a scoping review / 中国康复理论与实践

ObjectiveTo review the studies related to school health services and their outcomes based on the World Health Organization health-promoting school framework, to synthesize and analyze the main research scopes and related evidence in this field. MethodsLiterature about the interventions and outcomes of implementing health-promoting school health services were retrieved from PubMed, Web of Science, EBSCO and CNKI, from the establishment to June, 2023, and a scoping review was conducted. ResultsSeven papers were eventually included, involving 76 researches, more than 20 interventions, from five countries, published mainly from 2014 to 2021. The interventions included asthma education training curriculum, oral health education, menstrual management interventions, cognitive anxiety prevention programs, physical activity curriculum, cooking and nutrition curriculum, exercise and fitness interventions, mental health education programs, health-promoting diets curriculum and health education curriculum, and health skills training curriculum. The school health services programs included health screening and monitoring, disease prevention and control, and safety and first aid training for teachers and students. The health benefits of health-promoting school for students included improving health education outcomes and grades in health services elective courses; improving health condition and qualities of learning and life at school, reducing prevalence of chronic diseases and frequency of visiting the emergency room, and alleviating asthma; improving self-esteem, communication skills and social cohesion of the group, alleviating the influence of anxiety and other negative emotion, and increasing awareness of autonomy; improving activities related to healthy living, and positively affecting behaviors, attitudes and action. The health benefits of health-promoting school for teachers included improving pedagogical abilities and skills in teaching physical activity-related curriculum content, and increasing professional support for staff such as knowledge of first aid and participation in the school health service. The health benefits of health-promoting school for schools included promoting the incorporation of health education courses into regular teaching activities and increasing the school's financial investment in the construction of health-related psychosocial environments; promoting the plan and implementation of the health service in the schools. ConclusionThe school-based health services in health-promoting school consisted of two main categories: school curriculum and school health services. The health-promoting school may improve the health conditions, health behaviors and health services for the students, teachers and schools.

School-based physical activity-related health services and their health benefits within the World Health Organization health-promoting school framework: a systematic review of systematic reviews / 中国康复理论与实践

ObjectiveTo systematically review the types of health-promoting school (HPS) curriculum and physical activity-related health services based on the WHO-HPS framework, and their impact on health of children and adolescents. MethodsThe databases of EBSCO, PubMed, Web of Science, and CNKI were searched on school-based physical activity-related services and their health benefits based on the WHO-HPS framework from 2017 to June, 2023. A systematic review of systematic reviews was conducted. ResultsA total of seven English articles were included, covering 147 studies from five countries including Switzerland, the United States, Italy, the United Kingdom and Sweden. The systematic reviews were published in the journals related to child physical education and health, HPS, and school-based physical activity. Based on the WHO-HPS framework, HPS curriculum implemented in schools primarily involved physical education classes (such as incorporating specialized sports programs like yoga and dance, increasing physical activity time) and health education programs related to physical activity. Additional activities included extracurricular programs (such as implementing children's sports, recreational and leisure programs, lunchtime enjoyment activities, and game plans, increasing physical activity time within regular school hours, creating opportunities for physical activity during breaks and after school, and providing daily physical activity plans) and integration of physical activity in other subjects. Physical activity-related health services mainly included health screening and monitoring related to physical activity, adolescent health management, and health promotion activities. The health benefits of the interventions included improvement in aerobic capacity, body mass index, cardiorespiratory function, overall physical health, and significant increases in muscle endurance and strength. They also contributed to the cessation or reduction of prolonged sedentary behavior, increased levels of all-day physical activity and moderate-to-vigorous physical activity, increased physical activity participation, significant increases in physical activity during school hours, increased proportion of moderate to vigorous physical activity during school time, increased physical activity time, improved leisure and recreational time related to physical activity, enhanced vitality, school quality of life, and energy, improved academic performance, reduced television viewing time, decreased obesity risk, reduced anxiety, improved adaptability and happiness, and promoted positive mental health. Furthermore, there was a significant improvement in students' health-related knowledge on physical activity. ConclusionImplementing HPS curriculum and physical activity-related services in schools may improve various aspects of students' health, including physical fitness, physical activity and sedentary behavior, behavioral health related to physical activity, and health literacy related to physical activity.

Psychological and behavioral benefits of adapted yoga exercise for children with autism spectrum disorder in special education schools: a systematic review / 中国康复理论与实践

ObjectiveThe psychological and behavioral health benefits participating in yoga activities for children with autism spectrum disorder (ASD) in special education schools were reviewed using the theory and methodology of the International Classification of Functioning, Disability and Health (ICF). MethodsThe literature on benefits of yoga in psychological and behavioral health for students with ASD from special education schools participating in yoga activities was searched from PubMed, Embase, Web of Science and CNKI, from January, 2010 to July, 2023, and a systematic review was conducted. ResultsSeven papers from USA, India and Australia were included, mainly from the journals related to autism, sports therapy, and health psychology, published after 2018. The study design was all randomized controlled trials, featuring a total of 207 children with ASD aged five to 15 years. Adopted yoga interventions mainly included Mandala yoga postures, traditional yoga (breathing, posture, partner posture and relaxation) activities, etc. These simple yoga activities were incorporated into the physical health curriculum of special education schools. The benefits of yoga on psychological and behavioral health of students with ASD were mainly reflected in the following aspects: in the field of cognition, it significantly improved working memory, task monitoring, planning/organization and other aspects in reactive joint attention function and executive function; in the field of emotional development and control, it enhanced the ability of emotions/expressing emotions, empathy for others, and awareness of emotional control, and reduced in anxiety states, irritability that occurred in social, emotional, behavioral aspects, and hyperactivity and aggressive behavior; in the field of social and team activities, it improved speech/communication skills, social skills, and teamwork; in the field of psychomotor, it improved overall motor and imitation skills, exercise-related health behaviors, and sedentary behaviors. Yoga activities also relieved sleep problems. The frequency of intervention ranged from twelve to 60 minutes, one to six times a week for eight to 45 weeks. ConclusionIn the context of special education schools, the health benefits of adapted yoga activities are primarily reflected in improving the psychological health, motor function, and social skills of children with ASD.

Mental health services for children with intellectual and developmental disabilities: a WHO-FICs-based study / 中国康复理论与实践

ObjectiveTo systematically analyze the typical mental health conditions and psychological disorders of children with intellectual and developmental disabilities (IDD), to construct a mental health service system and psychological interventions to these mental health conditions of children with IDD . MethodsBased on the framework of the World Health Organization Family International Classifications (WHO-FICs), the mental health conditions and related functioning were analyzed, and the mental health service framework and proposed mental health interventions were constructed.There were six main categories of mental health conditions for children with IDDConclusionThis study systematically analyzed the typical mental health status and related psychological functional impairments of children with IDD. Based on the World Health Organization health service system, a mental health service framework for children with IDD was constructed. Referring to the WHO's continuum of health services, a system of psychological intervention methods for children with IDD was established. Furthermore, the WHO-FICs were used to describe and code the functions of children with IDD, and the ICHI-β3 was applied to code and analyze the related psychological interventions. Resultsmood disorders (anxiety and depression), behavioral disorders (disruptive disorders and challenging behaviors, aggressive behaviors), traumatic disorders (post-traumatic stress disorder), mental disorders (schizophrenia), suicide and self-harm, and learning disabilities (developmental learning disabilities, attention deficit hyperactivity disorder). Mental health services for children with IDD involved in six dimensions: leadership and governance, fundraising, human resources, service delivery, mental health technologies, and information and research. Mental health services went through the continuum of health services from prevention, treatment, rehabilitation to health promotion. We delivered mental health services for children with IDD in three aspects: identifying and diagnosing mental health problems or conditions, analyzing the main factors caused mental health problems, and analyzing the environmental factors. Mental health service interventions mainly covered five categories: antidepressants, psychotherapy, stress management training, physical exercise training, healthy lifestyle education, consultation and support. Children with IDD may obtain the mental health services in hospitals, rehabilitation institutions, community and school settings.

Structured physical activity programs for children with autism spectrum disorders and their health benefits: a systematic review / 中国康复理论与实践

ObjectiveTo systematically analyze the content and health benefits of structured physical activity programs for children with autism spectrum disorders (ASD). MethodsPublished literature related to structured physical activity for children with ASD and its health benefits were searched in Wanfang database, CNKI, Embase, EBSCO and PubMed from January, 2013 to July, 2023. A systematic review was conducted using the PRISMA guidelines. ResultsSeven literatures were finally included, from China, USA, Germany, Italy and Turkey. The publication dates concentrated after 2019. The study designs were all randomised controlled trials with 193 children with ASD, aged three to 14 years. Structured physical activity intervention sites included community sports halls, special education schools, rehabilitation wards of children's hospitals, and rehabilitation centers for children with disabilities. The intervention attributes were generally treatment, rehabilitation and health promotion. The content of physical activity mainly included motor skill-based activities (e.g., running, jumping, kicking, hitting, throwing), traditional yoga activities (e.g., breathing, mimicking postures and relaxation, as well as appropriate socialization activities such as encouragement of greeting/farewell songs, touch/contact games and expressive games), and a combination of multiple types of exercises integrated with school-based curricula such as aerobic exercises (walking), endurance exercises (jumping) and neuromuscular exercises (throwing paper airplanes), mindfulness for emotions and body, and judo. The frequency of the intervention ranged from 40 to 90 minutes, one to four times a week; the intensity ranged from mild to vigorous; and the duration ranged from eight to 40 weeks. The physical and behavioral health benefits were reflected in three aspects. In terms of body composition, it could reduce fat and body mass, increase muscle strength, and improve cardiorespiratory function. In terms of function, it could improve children's language and communication function, cognitive and executive function, and motor function. In terms of physical activity-related health behaviors, it could enhance children's motivation to exercise, reduce sedentary behavior, increase social and interactive behavior, improve emotional regulation, and reduce the risk of problematic behaviors. ConclusionThe physical and behavioral health benefits of structured physical activity for children with ASD can be reflected in the areas of body composition, function, and physical activity-related health behaviors.