Priming transcranial direct current stimulation for improving hemiparetic upper limb in patients with subacute stroke: study protocol for a randomised controlled trial.

INTRODUCTION: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that modulates brain states by applying a weak electrical current to the brain cortex. Several studies have shown that anodal stimulation of the ipsilesional primary motor cortex (M1) may promote motor recovery of the affected upper limb in patients with stroke; however, a high-level clinical recommendation cannot be drawn in view of inconsistent findings. A priming brain stimulation protocol has been proposed to induce stable modulatory effects, in which an inhibitory stimulation is applied prior to excitatory stimulation to a brain area. Our recent work showed that priming theta burst magnetic stimulation demonstrated superior effects in improving upper limb motor function and neurophysiological outcomes. However, it remains unknown whether pairing a session of cathodal tDCS with a session of anodal tDCS will also capitalise on its therapeutic effects. METHODS AND ANALYSIS: This will be a two-arm double-blind randomised controlled trial involving 134 patients 1-6 months after stroke onset. Eligible participants will be randomly allocated to receive 10 sessions of priming tDCS+robotic training, or 10 sessions of non-priming tDCS+robotic training for 2 weeks. The primary outcome is the Fugl-Meyer Assessment-upper extremity, and the secondary outcomes are the Wolf Motor Function Test and Modified Barthel Index. The motor-evoked potentials, regional oxyhaemoglobin level and resting-state functional connectivity between the bilateral M1 will be acquired and analysed to investigate the effects of priming tDCS on neuroplasticity. ETHICS AND DISSEMINATION: The study has been approved by the Research Ethics Committee of the Shanghai Yangzhi Rehabilitation Center (reference number: Yangzhi2023-022) and will be conducted in accordance with the Declaration of Helsinki of 1964, as revised in 2013. TRIAL REGISTRATION NUMBER: ChiCTR2300074681.

Excellent Nonlinear Optical M[M4 Cl][Ga11 S20 ] (M = A/Ba, A = K, Rb) Achieved by Unusual Cationic Substitution Strategy.

The typical chalcopyrite AgGaQ2 (Q = S, Se) are commercial infrared (IR) second-order nonlinear optical (NLO) materials; however, they suffer from unexpected laser-induced damage thresholds (LIDTs) primairy due to their narrow band gaps. Herein, what sets this apart from previously reported chemical substitutions is the utilization of an unusual cationic substitution strategy, represented by [[SZn4 ]S12 + [S4 Zn13 ]S24 + 11ZnS4 ⇒ MS12 + [M4 Cl]S24 + 11GaS4 ], in which the covalent Sx Zny units in the diamond-like sphalerite ZnS are synergistically replaced by cationic Mx Cly units, resulting in two novel salt-inclusion sulfides, M[M4 Cl][Ga11 S20 ] (M = A/Ba, A = K, 1; Rb, 2). As expected, the introduction of mixed cations in the GaS4 anionic frameworks of 1 and 2 leads to wide band gaps (3.04 and 3.01 eV), which exceeds the value of AgGaS2 , facilitating the improvement of high LIDTs (9.4 and 10.3 × AgGaS2 @1.06 µm, respectively). Furthermore, compounds 1 and 2 exhibit moderate second-harmonic generation intensities (0.84 and 0.78 × AgGaS2 @2.9 µm, respectively), mainly originating from the orderly packing tetrahedral GaS4 units. Importantly, this study demonstrates the successful application of the cationic substitution strategy based on diamond-like structures to provide a feasible chemical design insight for constructing high-performance NLO materials.

Considerable effects of lateralization and aging in intracortical excitation and inhibition.

Introduction: Findings based on the use of transcranial magnetic stimulation and electromyography (TMS-EMG) to determine the effects of motor lateralization and aging on intracortical excitation and inhibition in the primary motor cortex (M1) are inconsistent in the literature. TMS and electroencephalography (TMS-EEG) measures the excitability of excitatory and inhibitory circuits in the brain cortex without contamination from the spine and muscles. This study aimed to investigate the effects of motor lateralization (dominant and non-dominant hemispheres) and aging (young and older) and their interaction effects on intracortical excitation and inhibition within the M1 in healthy adults, measured using TMS-EMG and TMS-EEG. Methods: This study included 21 young (mean age = 28.1 ± 3.2 years) and 21 older healthy adults (mean age = 62.8 ± 4.2 years). A battery of TMS-EMG measurements and single-pulse TMS-EEG were recorded for the bilateral M1. Results: Two-way repeated-measures analysis of variance was used to investigate lateralization and aging and the lateralization-by-aging interaction effect on neurophysiological outcomes. The non-dominant M1 presented a longer cortical silent period and larger amplitudes of P60, N100, and P180. Corticospinal excitability in older participants was significantly reduced, as supported by a larger resting motor threshold and lower motor-evoked potential amplitudes. N100 amplitudes were significantly reduced in older participants, and the N100 and P180 latencies were significantly later than those in young participants. There was no significant lateralization-by-aging interaction effect in any outcome. Conclusion: Lateralization and aging have independent and significant effects on intracortical excitation and inhibition in healthy adults. The functional decline of excitatory and inhibitory circuits in the M1 is associated with aging.

Open honeycomb frameworks of sulphides AHg4Ga5S12 (A = Rb, Cs) exhibiting infrared nonlinear optical properties.

A crystal structure with a diamond-like anionic framework belongs to a non-centrosymmetric macrostructure due to the aligned arrangement of tetrahedral units, meeting the premise of second-order nonlinear optical (NLO) materials. Herein, two new Hg-based sulphides, namely RbHg4Ga5S12 (1) and CsHg4Ga5S12 (2), which are isostructural and crystallise in the trigonal space group R3, are successfully isolated in sealed silica tubes by a solid-state reaction. The features of their three-dimensional open honeycomb frameworks are attributed to the parallel alignment of tetrahedral MS4 (M is disordered by 0.444 Hg and 0.555 Ga) building motifs, accompanied by Rb+ (or Cs+) reseating in the cavities. Notably, although the band gap values of 1 and 2 are 2.30 and 2.36 eV, separately, their thermal expansion anisotropies (0.15 and 0.41, respectively) are favourable for achieving laser-induced damage thresholds (5.6 and 5.8 times that of AgGaS2 for 1 and 2, respectively). In addition, the strong polarisability of tetrahedral MS4 building motifs in the diamond-like anionic structures is responsible for the promising second-harmonic generation (SHG) intensities (1.1 and 1.8 times that of AgGaS2 for 1 and 2, respectively) in the particle size range of 50-75 µm with non-phase-matchable behaviour at 1910 nm. Furthermore, theoretical investigation elaborates that electron transitions in compounds 1 and 2 mainly occur from valence band S-3p to conduction band Hg-6s and Ga-4s states, demonstrating that the linear and nonlinear optical properties originate primarily from the synergy of tetrahedral MS4 units.

Conjugated Microporous Poly(aniline) Enabled Hierarchical Porous Carbons for Hg(II) Adsorption.

Hierarchical porous carbons equipped with heteroatoms and diffusion pores have a wide application prospect in adsorption. Herein, we report N-autodoped porous carbons (PTPACs), which were derived from rigid N-rich conjugated microporous poly(aniline)s (CMPAs) and show their all-around applicability in heavy metal adsorption. Their molecular structure could be delicately tuned from 3D organic networks to graphitic carbons through simply adjusting the pyrolysis temperature, affording unique hybrid features of hierarchical micro-meso-macroporosity and amount-tunable nitrogen defects, as validated by the enhanced CO2 adsorption capacities reaching 5.0 mmol g-1, a 230% increase compared to the precursor (2.15 mmol g-1). They therefore show promising a Langmuir adsorption capacity of 434.8 mg g-1 toward mercury ions, which could be rapidly achieved within a short 20 min. Based on the comprehensive experimental, characterization, and DFT calculation studies, we rationally reveal these impressive adsorptions arise from the hybrid function of chemisorption contributed by populated nitrogen defects and physical adsorption achieved by synergistic functions in the diffusion and storage pores. Outcomes mark the high merits of PTPACs in addressing recent global challenges in environmental engineering.

Porosity Design on Conjugated Microporous Poly(Aniline)S for Exceptional Mercury(II) Removal.

The use of conjugated microporous polymers (CMPs) in practical wastewater treatment demands further design on the pore structure, otherwise their adsorption capacities toward heavy-metal ions were moderate. Here, we report a rational design approach, which produces hybrid molecular pores in conjugated microporous poly(aniline)s (CMPAs) for mercury removal. It is achieved through a delicate interval introduction of linkers with differential molecular lengths during polymerization, acquiring both diffusion channels and storage pores for radical enhancement of mass transfer and adsorption storage. The resulting CMPA-M featured a large adsorption capacity of 975 mg g-1 and rapid kinetics that could remove 94.8% of 50 mg g-1 of mercury(II) within a very short contact time of 48 s, with a promising initial adsorption rate h as high as 113 mg g-1 min-1, which was 2.54-fold larger in the adsorption capacity and 45.2-fold faster in the adsorption efficiency compared with the undeveloped CMPAs. More importantly, our CMPA-M-2, with robust stability and easy reusability, was able to scavenge over 99.9% of mercury(II) from the actual wastewater in a harsh condition with a very low pH of 0.77, extremely high salinity of 53,157 mg L-1, and complex impurities, featuring exceptional selectivity that allows us to extract and recycle a high purity of 99.1% of mercury from the wastewater. These outcomes demonstrate the unprecedented potential of CMPs for environmental remediation and real-world mercury extraction and present benchmarks for CMP-based mercury adsorbents.

The effectiveness of an emergency department nursing intervention on psychological symptoms and self-care capacities: A randomized controlled study protocol.

BACKGROUND: We carried out a randomized trial of an emergency department (ED)-based nursing intervention to evaluate the impact of an ED nursing intervention on ED revisits, patient perceptions of continuity of care, illness perceptions, self-care capacities and psychological symptoms. METHOD: We conducted a randomized controlled trial to compare the ED-based intervention with usual care. The protocol was reviewed and approved by the Research Ethics Board of the Huzhou Central Hospital & Affiliated Central Hospital Huzhou University (K901923-021), each participant signed a written consent before participating, and SPIRIT guidelines were followed throughout. To be eligible, patients ready for discharge from the ED had to be at risk for ED return based on 2 criteria: at least one ED visit during the year prior to the initial visit, and current treatment with at least 6 medications. Exclusion criteria included cognitive problems (e.g., dementia) that would preclude provision of informed consent either noted in the medical chart or identified based on the clinical judgment of the project nurse. To avoid multiple interveners for the same patient, we also excluded patients already receiving other regular follow-up (e.g., at a specialized clinic in the hospital or from external resources). The major outcomes were assessed with the Heart Continuity of Care Questionnaire, the Illness Perception Questionnaire-Revised, the Therapeutic Self-Care Tool, the Hospital Anxiety and Depression Scale, and the Self-Reported Medication-Taking Scale. RESULTS: Two hundred patients who met the inclusion criteria were included in our study, Table 1 showed the effects of nursing intervention on measures of clinical outcomes. DISCUSSION: The ED is a major entry point into the health care system of many countries. Unnecessary ED revisits may result in overcrowding, increased waiting time, and failure to provide appropriate emergency care. The ED-based interventions literature focuses primarily on service use and ways to reduce ED revisits, with very little focus on impacting secondary outcomes. Because of their potential link with health service utilization, secondary outcomes such as perceived continuity of care, illness perceptions, self-care capacities, psychological symptoms and medication adherence might influence ED revisits. Future research was needed to better understand the complex relationship between ED utilization and a variety of intermediary factors in order to develop interventions that will optimize ED utilization.

Preoperative fluid management in traumatic shock: A retrospective study for identifying optimal therapy of fluid resuscitation for aged patients.

Fluid resuscitation was used on aged patients with traumatic shock in their early postoperative recovery. The present study aimed to assess whether different fluid resuscitation strategies had an influence on aged patients with traumatic shock.A total of 219 patients with traumatic shock were recruited retrospectively. Lactated Ringer and hydroxyethyl starch solution were transfused for fluid resuscitation before definite hemorrhagic surgery. Subjects were divided into 3 groups: group A: 72 patients were given aggressive fluid infusion at 20 to 30 mL/min to restore normal mean arterial pressure (MAP) of 65 to 75 mm Hg. Group B: 72 patients were slowly given restrictive hypotensive fluid infusion at 4 to 5 mL/min to maintain MAP of 50 to 65 mm Hg. Group C: 75 patients were given personalized infusion to achieve MAP of 75 to 85 mm Hg. Preoperative infusion volume, preoperative MAP, optimal initial points for surgery, postoperative shock time and mortality rates at 6 and 24 hours after surgery were determined.No significant difference in clinical characteristics was found among the 3 groups. Amount of preoperative infusion was considerably lower in the restrictive group (P < .01, compared with group A). A significant difference in preoperative infusion volume was found between the personalized and other 2 groups (P < .01, compared with groups A and B). Patients in the personalized resuscitation group achieved a higher preoperative MAP (P < .01 compared with Group B; P < .05, compared with group A) and required less prepared time for surgery (P < .01 compared with groups A and B). In addition, a lower mortality rate at 6 and 24 hours after operation was observed in the subjects with personalized therapy (P < .05, compared with group B).Personalized management of fluid resuscitation in traumatized aged patients with appropriate volume and speed of fluid transfusion, suggesting increased survival rate and less prepared time for surgery.

Therapeutic effect and mechanism of breviscapine on cisplatin-induced nephrotoxicity in mice.

OBJECTIVE: To observe the protective effect of breviscapine on mice with cisplatin-induced nephrotoxicity. METHODS: Mice were given a single injection of cisplatin (8 mg/kg, i.p.); then, breviscapine was given to mice at 25 mg/kg and 50 mg/kg doses, respectively, once a day for seven days. Renal tissue structure was observed after animals were sacrificed. Blood urea nitrogen (BUN), serum creatinine (Scr), lipid peroxide (MDA) and superoxide dismutase (SOD) serum levels were detected; and MDA, glutathione peroxidase, and SOD levels in the renal cortex were detected. RESULTS: Compared with the blank control group (BCG), the kidney pathological damage of mice in the model control group (MCG) was more severe. After applying different doses of breviscapine, different degrees of renal injury improvement appeared. Compared with the BCG, the serum levels of Scr and BUN in the MCG increased to (89.92 ± 6.78) µmoL/Land (15.32 ± 4.53) mmoL/L. The differences were statistical significant (P < 0.01). Compared with the MCG, the serum levels of Scr and BUN in the Bre low-dose groups and Bre high-dose groups decreased significantly (P < 0.05). Compared with the BCG, the MDA levels in serum and in the renal cortex in the MCG significantly increased, while the SOD levels significantly decreased. Both the differences were statistically significant (P < 0.01). In the Bre low-dose groups and Bre high-dose groups, MDA levels in serum and in the renal cortex significantly decreased, while SOD and glutathione peroxidase levels in the renal cortex significantly increased, compared with the MCG; and the differences were statistically significant (P < 0.05). CONCLUSIONS: Breviscapine can reduce cisplatin-induced renal toxicity in mice and it's possible through inhibition of renal tubule cell lipid peroxidation and reduces the nephrotoxicity of cisplatin.