Objective To observe the effects of extracorporeal shock wave therapy (ESWT) combined with kinesio taping (KT) on chronic non-specific low back pain (CNLBP). Methods CNLBP patients who visited the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Nantong University between January 2021 and January 2022 were selected. The included patients were divided into ESWT group, KT group, and combined treatment group using a random number table method. All patients received conventional rehabilitation. The ESWT group was treated with ESWT, the KT group was given KT therapy, and the combined treatment group were treated with ESWT and KT with the same treatment frequency as before. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), MOS 36-item Short form Health Survey (SF-36) and Self-rating Anxiety Scale (SAS) were used to evaluate pain severity, lumbar spine function, quality of life, and anxiety status in all groups before and 4 weeks after treatment, respectively. Results A total of 85 patients were included. Among them, there were 29 cases in the ESWT group, 28 cases in the KT group, and 28 cases in the combined treatment group. There was no adverse event in any group. The intra-group comparison results showed that the VAS, ODI, and SAS scores of the three groups after 4 weeks of treatment were lower than those before treatment (P<0.05), while the SF-36 scores in all dimensions were higher than those before treatment (P<0.05). Before treatment, there was no statistically significant difference in VAS, ODI, SAS, or SF-36 scores among the three groups (P>0.05). After 4 weeks of treatment, there were statistically significant differences in VAS, ODI, SAS, and SF-36 scores among the three groups (P<0.05). The results of multiple comparisons between groups showed that the VAS scores of the ESWT group and the combination therapy group were lower than those of the KT group (P<0.05); the ODI scores of the combination therapy group were lower than those of the ESWT group and the KT group (P<0.05); the SAS scores of the combination therapy group were lower than those of the KT group (P<0.05); the SF-36 scores of each dimension were compared in pairs among the three groups, and the differences were statistically significant (P<0.05); there was no statistically significant difference in pairwise comparison of other indicators between groups (P>0.05). Conclusion ESWT combined with KT can more effectively improve the pain and lumbar spine function of patients with CNLBP, and improve the quality of life of patients.
Objective To systematically evaluate the consistency between large language models (LLMs) and human raters in the assessment of medical students’ knowledge examinations, clinical documentation, and behavioral performance. Methods PubMed, Web of Science, Embase, ERIC, China National Knowledge Infrastructure, and WanFang Data were searched for original research articles published between January 2020 and March 2026 regarding the agreement between LLMs and human scoring in medical student assessments. Meta-analysis was performed using R 5.3.0 software. Results A total of 16 studies were included, yielding 39 independent effect sizes, comprising 17 intraclass correlation coefficients (ICC) and 22 Cohen’s Kappa data points. The assessment tasks spanned three categories: knowledge examinations, clinical documentation, and behavioral assessment, involving various mainstream LLMs such as GPT-4. Meta-analysis revealed a pooled ICC of 0.74 [95% confidence interval (CI) (0.51, 0.87), P<0.001] and a pooled Cohen’s Kappa of 0.52 [95%CI (0.38, 0.64), P<0.001], indicating overall moderate-to-high consistency. Significant heterogeneity was observed among the included studies, primarily driven by task types and task difficulty. Conclusions Constrained by factors such as task difficulty, LLMs currently serve only as adjunctive tools to human evaluation, despite demonstrating a potential for consistency comparable to human scoring in medical education assessments. The future intelligent transformation of medical education evaluation must operate within a clinician-in-the-loop framework to achieve a balance between assessment efficiency and the rigor of medical logic.
Objective To report the clinical characteristics and treatment analysis of 3 cases of congenital ulnar collateral flexor contracture of the forearm and take a reference for clinic. Methods A total of 3 patients with congenital ulnar collateral flexor contracture of the forearm were admitted between February 2019 and August 2021. Two patients were male and 1 was female, and their ages were 16, 20, and 16 years, respectively. The disease durations were 8, 20, and 15 years, respectively. They all presented with flexion deformity of the proximal and distal interphalangeal joints of the middle, ring, and little fingers in the neutral or extended wrist position, and the deformity worsened in the extended wrist position. The total action motion (TAM) scores of 3 patients were 1 and the gradings were poor. The Carroll’s hand function evaluation scores were 48, 55, and 57, and the grip strength indexes were 72.8, 78.4, and 30.5. Preoperative CT of case 2 showed a bony protrusion of the flexor digitorum profundus tendon at the proximal end of the ulna; and MRI of case 3 showed that the ulnar flexor digitorum profundus presented as a uniform cord. After diagnosis, all patients were treated with operation to release the denatured tendon, and functional exercise was started early after operation. Results The incisions of 3 patients healed by first intention. Three patients were followed up for 12, 35, and 12 months, respectively. The hand function and the movement range of the joints significantly improved, but the grip strength did not significantly improve. At last follow-up, TAM scores were 3, 4, and 4, respectively, among which 2 cases were excellent and 1 case was good. Carroll’s hand function evaluation scores were 95, 90, and 94, and the grip strength indexes were 73.5, 81.3, and 34.2, respectively. ConclusionCongenital ulnar collateral flexor contracture is a rare clinical disease that should be distinguished from ischemic muscle contracture. The location of the contracture should be identified and appropriate surgical timing should be selected for surgical release. Active postoperative rehabilitation and functional exercise can achieve good hand function.
ObjectiveUsing the whole genome association study (GWAS) data, Mendel randomization (MR) method was used to find the causal relationship between oral flora and type 2 diabetes (T2D) and myocardial infarction (MI). MethodsGenetic association data of oral microbiota were selected from the Chinese 4D-SZ cohort GWAS dataset, and T2D and MI outcome data were obtained from a large-scale cohort study in BioBank Japan. Four methods, including inverse variance weighting (IVW), were used to analyze the causal relationship between exposure and outcomes. Sensitivity analysis was conducted on significant MR results to further validate the robustness of the results. ResultsThe results showed a total of 24 species of dorsal tongue flora and 13 species of salivary flora with a potential causal relationship with T2D. There were 12 species each of dorsal tongue and salivary flora with a potential causal relationship with MI. A total of 8 oral flora were found on the dorsum of the tongue and saliva that could affect both T2D and MI, namely Saccharimonadaceae, Treponemataceae, Prevotella, Haemophilus, Lachnoanaerobaculum, Campylobacter_A, Neisseria, and Streptococcus. ConclusionWe identified 8 oral flora causally associated with both T2D and MI, suggesting that T2D may play a role in promoting the progression of MI by affecting the above oral flora.
ObjectiveTo observe the effects of upper limb rehabilitation robot-assisted training combined with mirror therapy on unilateral spatial neglect (USN) in stroke patients.MethodsA total of 40 patients with USN admitted to the Department of Rehabilitation Medicine of the Second Affiliated Hospital of Nantong University from January 2017 to December 2018 were selected and randomly divided into the trial group and the control group, with 20 cases in each group. The trial group used upper limb rehabilitation robot-assisted training combined with mirror therapy and USN comprehensive rehabilitation treatment. The control group patients only received USN comprehensive rehabilitation treatment. All patients continued treatment for 4 weeks. Before treatment and after 4 weeks of treatment, the modified Barthel index (MBI) was used to assess the activities of daily living, the Fugl-Meyer assessment (FMA) was used to assess motor function, and the Catherine-Bergego scale was used to assess the degree of USN.ResultsThere was no statistically significant difference in general information between the two groups of patients (P>0.05). There was no significant difference in MBI, FMA or USN degree scores between the two groups before treatment (P>0.05). After 4 weeks of treatment, the MBI, FMA and USN degree scores of the two groups were improved compared with those before treatment (P<0.05). The improvements in MBI, FMA and USN degree scores of the trial group were 14.75±1.97, 17.05±3.93 and 5.25±2.29, respectively, and those of the control group were 9.75±4.44, 8.30±2.06 and 3.10±0.72, respectively, and the differences were statistically significant (P<0.05).ConclusionsUpper limb rehabilitation robot-assisted training combined with mirror therapy can effectively improve the spatial neglect of USN patients, and improve the ability of daily living and motor functions.
ObjectiveTo investigate the effect of virtual scene simulation training combined with midium frequency impulse electrotherapy on upper limb function and daily living ability of hemiplegia patients.MethodsFrom March to October 2019, 50 hemiplegic patients were recruited and randomly assigned to the trial group and the control group, with 25 patients in each group. The control group was given routine rehabilitation training, while the trial group was given virtual scene simulation training and medium frequency impulse electrotherapy on the basis of routine rehabilitation training. The Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Simple Test for Evaluating Hand Function (STEF), and Modified Barthel Index (MBI) were used to assess patients’ upper limb function and daily living ability before treatment and after 8 weeks of treatment.ResultsBefore treatment, the FMA-UE, STEF, and MBI scores of the trial group vs. the control group were 22.88±5.18 vs. 23.44±6.26, 40.12±4.82 vs. 41.44±4.54, and 51.40±7.29 vs. 48.60±7.00, respectively, and none of the between-group differences was statistically significant (P>0.05); after 8 weeks of treatment, the FMA-UE, STEF, and MBI scores of the two groups were 39.48±6.35 vs. 33.52±6.53, 59.08±7.54 vs. 52.52±5.83, and 71.00±8.78 vs. 62.40±9.37, respectively, and all of the between-group differences were statistically significant (P<0.05). After 8 weeks of treatment, the FMA-UE, STEF and MBI scores of the two groups of patients were significantly improved compared with those before treatment (P<0.05), and the improvement of each score of the trial group was significantlybetter than that of the control group (P<0.05). No stroke recurrence, electric burn, or other adverse reactions occurred in the two groups after treatment. ConclusionVirtual scene simulation training combined with midium frequency impulse electrotherapy can effectively improve the upper limb function of patients with hemiplegia and improve their quality of life.
ObjectiveTo evaluate the quality of randomized controlled trials (RCTs) of Chinese medicine (TCM) formulated granules published in core journals in China. MethodsComputerized searches were conducted in CNKI, VIP, WanFang Data and CBM databases. The publicly published RCTs of TCM formulated granules were collected, with sources from Peking University Core, CSSCI and EI. The following information was extracted: including title, the first author, the journals name, type of disease, year of publication, and source of drug. The included studies were evaluated using the CONSORT extension for CHM formulas (CONSORT-CHM formulas 2017), which included 25 items from title, abstract and keywords, introduction, research methods, steps, results, discussion, and other information. ResultsA total of 125 papers were included, which mainly included digestive system diseases (n=25), respiratory system diseases (n=17), and circulatory system diseases (n=17). The results showed that the overall reporting quality of RCTs of TCM formulated granules was poor. After the publication of the CONSORT-CHM formulas 2017, the reporting quality of RCTs of TCM formulated granules had no significant changes, while some items were still reported with poor quality. For example, 42.2% of RCTs did not adequately report how to generate allocation sequence, 93.3% of RCTs did not adequately report allocation concealment, and 62.2% of RCTs did not adequately report how to solve the missing data. ConclusionThe quality of RCTs reports on TCM formula granules published in Chinese journals still needs to be improved. It is recommended that researchers, journals and reviewers attach importance to the application of CONSORT-CHM formula throughout the whole process of paper writing. In the future, more scientific and detailed requirements should be put forward for trial design and reporting standards in line with the characteristics of clinical trials of TCM formula granules.
Sample size re-estimation (SSR) refers to the recalculation of the sample size using the existing trial data as original planned to ensure that the final statistical test achieved the pre-defined goals. SSR can enhance research efficiency, save trial costs, and accelerate the research process. Depending on whether the group assignment of the patients is known, SSR is divided into blinded sample size re-estimation and unblinded sample size re-estimation. Blinded sample size re-estimation can estimate the variance of the primary evaluation index through the EM algorithm or single sample variance re-estimation method, and then calculate the sample size. Unblinded sample size re-estimation can calculate the sample size by estimating the overall variance or therapeutic effect difference, but it needs to control the family wise type I error (FWER) rate. Cui-Hung-Wang method, conditional rejection probability method, P-value combination method, conditional error function, and promising zone are common methods used to control FWER. Currently, there are application examples of SSR methods. With the maturation of related theories and the popularization of methods, it is expected to be widely applied in clinical trials, especially in traditional Chinese medicine clinical trials in the future.
ObjectiveTo investigate the annual publication volume, paper type distribution, journal quartile distribution, and citation status of SCI journal papers published by West China Hospital, Sichuan University, to provide a reference for optimizing the publication-based research evaluation system. MethodsA cross-sectional study was conducted. The Web of Science Core Collection was electronically searched to retrieve all papers affiliated with West China Hospital, Sichuan University. After screening, SCI journal papers up to December 31, 2024, in which the first author’s first affiliation was West China Hospital, Sichuan University published were included. Citation information as of December 31, 2024 was further obtained from the Web of Science Core Collection. R 4.2.2 software was used to analyze the annual quantity, journal quartile, paper type and citation distribution of SCI papers. ResultsA total of 38 005 papers were included. Original articles accounted for the highest proportion (62.06%), followed by reviews (17.66%), meeting abstracts (10.16%), letters (6.17%), and editorials (3.95%). Overall, 55.11% of the papers were published in JCR Q1 journals, and the proportion of Q1 papers showed a trend of initial decline followed by a rise over time. By the end of 2024, the total number of citations all included papers was 534 338, with an average number of citations of 14.06 per paper. The proportion of papers that received no citations within 2 years of publication was 29.65%. The 2-year average citation frequency ranked reviews (11.18) > original articles (5.99) > editorials (1.78) > letters (1.23) > meeting abstracts (0.23), and ranked as Q1 (7.61) > Q2 (4.28) > Q3 (3.18) > Q4 (1.56) when classified by JCR quartile. However, the 2-year citation rate was Q2 (75.67%) > Q3 (71.00%) > Q1 (68.78%) > Q4 (53.98%). ConclusionThe annual publication volume, the proportion of high-level Q1 journal papers, and the citation rate and average citation frequency of West China Hospital all showed an increasing trend. Nevertheless, structural problems such as a high proportion of uncited papers and a lack of high-impact papers remain.
Response-adaptive randomization (RAR) dynamically adjusts the probability of assigning patients to different groups, optimizing treatment efficacy and participant welfare. It is particularly suitable for clinical studies involving multiple interventions or dose-finding and seamless phase II/III trials. This paper systematically introduces the concept, principles, and types of RAR, as well as its application in clinical trials (including traditional Chinese medicine research). It also provides R implementation code, offering researchers practical tools aimed at promoting the adoption of RAR in clinical practice.