We thank Professor Hans-Leo Teulings from Neuroscript LLD for the digital technology support.
This study was supported by the Wu Jieping Foundation (Grant No.: 320.6750.18456).

Our study was approved by the Academic Ethics Committee of the Biological Sciences Division of the Chinese PLA General Hospital in Beijing, China.
1. General aspects of method development
<ol>
	<li>Use a USB digitizer (e.g., Wacom Cintiq Pro 16) and a handheld stylus pen for the handwriting movements. The detailed specifications of the digitizer are as follows: external dimensions (width x depth x height) 410 x 265 x 17.5 mm, spatial resolution 3840 x 2160 dots, pixel size 0.090 x 0.090 mm, temporal resolution 30 ms, and a pressure level of 8,192.</li>
	<li>Connect a laptop PC to the digitizer to collect and exhibit the handwriting traces.</li>
	<li>Use a software (e.g., Neuroscript MovAlyzeR) for data recording, processing, and analyzing.</li>
	<li>Patient inclusion/exclusion criteria
	<ol>
		<li>Recruit MCI participants who present with a memory complaint, an objectively impaired memory function, intact activities of daily living, and the absence of dementia21. Besides, they should have the educational level of more than 2 years of preliminary school in mainland China, otherwise, they might have difficulty in writing Chinese characters.</li>
		<li>Exclude participants who have obvious visual and upper limb disability.</li>
	</ol>
	</li>
</ol>
2. Handwriting task
<ol>
	<li>Run the software and a non-inking stylus pen.</li>
	<li>Create an example of Chinese characters on the writing area of the digitizer (see Figure 1).</li>
	<li>Allow the subjects to position the writing area into a comfortable position.</li>
	<li>Allow the subjects to write on the writing area and accommodate the pen and the surface of the writing area.</li>
	<li>Set the sampling rate in the software at 200 Hz.</li>
	<li>Instruct the subjects to write his/her name in Chinese with the dominant hand. 
	NOTE: A signature in either cursive or a printed version is acceptable, as the subject wished.</li>
	<li>Instruct the subjects to write the Chinese character &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; (pronounced &#8220;Zheng&#8221;) with the dominant hand. 
	NOTE: The Chinese character &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; in a printed version is acceptable.
	<ol>
		<li>Remind the subjects to write in a printed version prior to beginning handwriting. 
		NOTE: Ensure that the subject sits and writes in an upright position.</li>
	</ol>
	</li>
	<li>Keep instructions visible during each trial.
	<ol>
		<li>Repeat the handwriting trial three times.</li>
		<li>If the character &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; was in written in the wrong stroke order, stop the trial and trace and show the subject how to write the character in the correct stroke order.</li>
		<li>If any hesitation was derived from a lack of knowledge, stop the trial and show the subject how to write the character correctly.</li>
	</ol>
	</li>
</ol>
3. Data analysis
<ol>
	<li>Run the software; right click on Experiment and select Properties.</li>
	<li>Select Processing, and then select Segmentation.</li>
	<li>Click on Add first segmentation at any rate, Add last segmentation at any rate, and Move segmentation point to nearest pendown if on a penlift in Segmentation Flags.</li>
	<li>Click on At pendown trajectories in Segmentation Methods. 
	NOTE: All of these adjustments for the default mode were done to improve the analysis of the Chinese handwriting.</li>
</ol>
4. Parameter calculation
<ol>
	<li>Run the software, select the subjects in &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221;, and click on Handwriting Trials.</li>
	<li>Use the tracing system and trace the handwriting process and stroke order of &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; step by step.</li>
	<li>Find the segmentation of stroke #3 of &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; and read out the &#8220;Average Absolute Velocity&#8221; in &#8220;extracted data&#8221;. 
	NOTE: The handwriting analysis software will automatically calculate the &#8220;Average Absolute Velocity&#8221; of each segmentation. 
	CAUTION: Stroke #3 of &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; is a horizonal movement (from left to right) of the pen tip that is shorter than Character 1 and Character 5 (Figure 1A).</li>
	<li>Find the segmentation of stroke #4 of &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; and read out of the &#8220;Average Absolute Velocity&#8221; in the &#8220;extracted data&#8221;. 
	CAUTION: Stroke #4 of &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; is a vertical movement (from up to down) of the pen tip that is shorter than Character 2 (Figure 1).</li>
	<li>Read out the &#8220;Pen Pressure&#8221; of each segmentation in the &#8220;extracted data&#8221; and obtain an &#8220;Average Pen Pressure&#8221; of &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221;. 
	NOTE: The handwriting analysis software will automatically calculate the &#8220;Average Pen Pressure&#8221; of each segmentation.</li>
	<li>Run the software, select the subjects in &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221;, and click on Handwriting Trials.</li>
	<li>Using the tracing system, trace the handwriting process and stroke order of the signature step by step.</li>
	<li>Find the segmentation of the stroke between the characters and read out the &#8220;Absolute Size&#8221; and &#8220;Road Length&#8221; in the &#8220;extracted data&#8221;.</li>
	<li>Obtain the in-air length tortuosity in the segmentation between characters according to the equation. 
	NOTE: The segmentation of the stroke between characters was an in-air segmentation (Figure 2).
	<ol>
		<li>Calculate the in-air length tortuosity: 1-Absolute Size/Road Length %. 
		NOTE: Tortuosity, defined by the ratio of the arc length to the Euclidean distance between end points, is a measure of curvature, and therefore indexes the smoothness of a specific writing output20. A highly tortuous curve has several bends or curves, whereas a low tortuous curve is one with relatively wide loops/curves and more straightness. 
		CAUTION: Most Chinese names are composed of two or three characters. If the signature has two characters, there is only one segmentation of stroke between characters. If the signature has three characters, there are two stroke segmentations between characters. In-air length tortuosity in the segmentation between characters would be an average value.</li>
	</ol>
	</li>
</ol>
5. Statistical analysis
<ol>
	<li>Evaluate group differences using a Student&#8217;s t-test. A P value less than 0.05 was considered statistically significant. Conduct all statistical analyses using the SPSS 22.0 statistical software package.</li>
</ol>

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The authors have nothing to disclose.

The critical steps in the protocol confirm the legibility of &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221;. In detail, within an entire character, the #3 stroke needs to be shorter than the other horizonal strokes, and the #4 stroke needs to be shorter than the #2 stroke. More specifically, more attentional resources are needed during the writing of the #3 stroke and #4 stroke6,<sup class="xref"...

Mild cognitive impairment (MCI) is considered as a transitional but progressively degenerative cognitive phase that precedes the onset of Alzheimer&#8217;s disease (AD)1. It has been reported that the AD progression rate per year is 15% while nearly 75% of moderate and severe MCI cases might remain undiagnosed2. Recent studies have reported that patients with MCI have difficulty in some aspects of fine motor tasks3, and those patients who showed motor disorders, such as slow gait, had a high risk of dementia4.
Handwriting is a complex human activity that entails an intricate blend of cognitive, kinesthetic, and perceptual-motor components including visual and kinesthetic perception, motor planning, eye-hand coordination, visual-motor integration, dexterity, and manual skills1. Handwriting analysis has been utilized to detect cognitive and motor dysfunctions in many types of neurodegenerative diseases, such as AD and Parkinson&#8217;s disease (PD)5. In addition, some aspects of handwriting problems have been reported to be an indicator for MCI and related to disease progression6. As a majority of the population uses language, studies that investigate handwriting analysis in Chinese speakers (especially simplified Chinese characters) are still lacking.
There have been several articles that have investigated handwriting abnormalities or &#8220;agraphia&#8221; in individuals with MCI. For example, by utilizing the traditional pencil&#8211;paper methods, Zhou and colleagues tried to unveil the distinct writing abilities between patients with MCI and individuals without MCI. The differences between the groups were not obvious, with the exception of writing errors7. Kawa et al. found handwriting features in patients with MCI using a smart pen, which could dynamically analyze the stroke and pen speed during writing2. WACOM hardware and MovAlyzeR software can detect more real-time information compared with traditional pencil and paper methods and smartpen paper methods. Therefore, dynamic handwriting data, such as pen-down pressure, velocity, acceleration, and jerk, have been found to be a new focus of handwriting analysis relative to static data, such as letter size and space between words2.
However, another phenomenon that cannot be overlooked is the cross-cultural effect of handwriting. The writing systems of different nations are not always the same (e.g., English letters are written from left to right while Hebrew letters are written from right to left)8. In this issue, even reviews have confirmed the effectiveness of handwriting analysis9,10 in alphabetic languages, and the wide gap between Chinese characters and western letters has hindered the interchange capability of handwriting analysis in the methods and results11 of these studies.
There exist several major dissimilarities between western languages (e.g., English) and Chinese. First, there are many more horizonal movements of the pen tip during Chinese character writing compared with letter writing12. Second, unlike the alphabet language, which is associated with phonemes, Chinese is considered to be logographic7. As a result, most Chinese characters have their own unique stroke order, and the width and height of strokes need to be strictly limited. Otherwise, unlimited widths and heights might cause increased illegibility11 (&#8220;<img alt="Equation 1" src="/files/ftp_upload/61841/61841equ01.jpg" />&#8221; and &#8220;<img alt="Equation 2" src="/files/ftp_upload/61841/61841equ02.jpg" />&#8221; are completely different Chinese characters. Also, &#8220;<img alt="Equation 3" src="/files/ftp_upload/61841/61841equ03.jpg" />&#8221;, &#8220;<img alt="Equation 4" src="/files/ftp_upload/61841/61841equ04.jpg" />&#8221;, and &#8220;<img alt="Equation 5" src="/files/ftp_upload/61841/61841equ05.jpg" />&#8221; are different Chinese characters).
&#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; (pronounced &#8220;Zheng&#8221;) is a typical, simple, and commonly used Chinese character that nearly every Chinese speaker with a two-year educational level can read and write. It has been selected as a writing task in previous Chinese handwriting analysis studies6,12. Researchers decided to use &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221; as the writing task because it is &#8220;square-like&#8221; and composed of five strokes, all of which are horizonal (#1, #3, #5 stroke, from left to right) or vertical (#2, #4 stroke, from up to down) (Figure 1). According to many fine motor studies, fulfilling the #3 stroke (horizonal) and the #4 stroke (vertical) requires pure wrist and finger movements, respectively6,12,13. As a result, the stroke velocity of both strokes could be a proper manifestation14.
In addition, pen pressure during handwriting is a handwriting feature that has been shown to outperform other kinematic features in reflecting motor control5,15. However, there are no relevant studies in Chinese patients, though positive results have been confirmed by research groups from the Czech Republic, Spain, Israel, and other countries8,16,17.
The signature has been commonly used as a handwriting task in numerous studies5. In general, a signature requires little thinking or in-air time18. &#8220;In-air&#8221; is defined as when the pressure of the pen tip to the screen is 0 during the handwriting, and &#8220;in-air time&#8221; is the sum of the time &#8220;in-air&#8221; during the handwriting. Individuals who suffer from many neuropsychiatric disorders might have deficits in psychomotor control, and thus they exhibit increased in-air time of the signature. For example, Rosenblum et al. found that Israeli patients with depression and Parkinson&#8217;s disease showed longer in-air time compared with healthy controls during writing their own name in Hebrew8,19. As Chinese characters have their own shape, in this study, it was decided to use the in-air length tortuosity in segmentation between characters during writing the name as a potential indicative parameter. Tortuosity, defined by the ratio of the arc length to the Euclidean distance between end points, is a measure of curvature, and therefore indexes the smoothness of a specific writing output20.

<table>
	<tbody>
		<tr>
			<td></td>
			<td>Microsoft</td>
			<td>Surface Pro 2</td>
			<td>computer</td>
		</tr>
		<tr>
			<td></td>
			<td>MovAlyeR</td>
			<td>3.4</td>
			<td>software</td>
		</tr>
		<tr>
			<td></td>
			<td>WACOM</td>
			<td>Cintiq</td>
			<td>digitizer</td>
		</tr>
	</tbody>
</table>

digital handwriting analysis of characters in chinese patients with mild cognitive impairment

An increasing amount of evidence shows that cognitive deficits and movement dysfunctions are not separated. Patients with mild cognitive impairment (MCI) can manifest fine motor disorders of the upper extremities. Handwriting is a complex and unique human activity involving both motor and cognitive coordination. Researchers from western countries have discovered that patients with MCI have abnormal handwriting features. However, no relevant studies have been conducted in the Chinese population. Owing to the cross-culture phenomenon of handwriting, the aim of this study is to find new handwriting tasks to demonstrate the differences in handwriting features between elderly patients with MCI and age-matched healthy individuals.

The demographic data of the subjects demonstrated that all the groups matched well in age, gender, educational level, dominant hand, and other parameters.
As shown in Table 1, during the writing of the Chinese character &#8220;<img alt="Equation 6" src="/files/ftp_upload/61841/61841equ06.jpg" />&#8221;, elderly subjects with MCI exhibited a lower average absolute velocity of the #3 (2.46 &#177; 0.40 vs 1.82 &#177; 0.55, P = 0.001) and #4 stroke (2.61 &#17...

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Digital Handwriting Analysis of Characters in Chinese Patients with Mild Cognitive Impairment

This study proposed a digital handwriting analysis of characters in individuals with mild cognitive impairment to find more information than is revealed by traditional pencil&#8211;paper handwriting analysis.

An increasing amount of evidence shows that cognitive deficits and movement dysfunctions are not separated. Patients with mild cognitive impairment (MCI) ...

digital-handwriting-analysis-characters-chinese-patients-with-mild

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4.4K Views.  Chinese PLA General Hospital. This study proposed a digital handwriting analysis of characters in individuals with mild cognitive impairment to find more information than is revealed by traditional pencil–paper handwriting analysis.

Video: Digital Handwriting Analysis of Characters in Chinese Patients with Mild Cognitive Impairment

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations over time in the blood-oxygenation level dependent signal. rs-fcMRI has been applied extensively to identify abnormalities in brain connectivity in different neurologic and psychiatric diseases. However, the relationship among rs-fcMRI connectivity abnormalities, brain electrophysiology and disease state is unknown, in part because the causal significance of alterations in functional connectivity in disease pathophysiology has not been established. Transcranial Magnetic Stimulation (TMS) is a technique that uses electromagnetic induction to noninvasively produce focal changes in cortical activity. When combined with electroencephalography (EEG), TMS can be used to assess the brain's response to external perturbations. Here we provide a protocol for combining rs-fcMRI, TMS and EEG to assess the physiologic significance of alterations in functional connectivity in patients with neuropsychiatric disease. We provide representative results from a previously published study in which rs-fcMRI was used to identify regions with abnormal connectivity in patients with epilepsy due to a malformation of cortical development, periventricular nodular heterotopia (PNH). Stimulation in patients with epilepsy resulted in abnormal TMS-evoked EEG activity relative to stimulation of the same sites in matched healthy control patients, with an abnormal increase in the late component of the TMS-evoked potential, consistent with cortical hyperexcitability. This abnormality was specific to regions with abnormal resting-state functional connectivity. Electrical source analysis in a subject with previously recorded seizures demonstrated that the origin of the abnormal TMS-evoked activity co-localized with the seizure-onset zone, suggesting the presence of an epileptogenic circuit. These results demonstrate how rs-fcMRI, TMS and EEG can be utilized together to identify and understand the physiological significance of abnormal brain connectivity in human diseases.

Resting-state functional-connectivity MRI has identified abnormalities in patients with a wide range of neuropsychiatric disorders, including epilepsy due to malformations of cortical development. Transcranial Magnetic Stimulation in combination with EEG can demonstrate that patients with epilepsy have cortical hyperexcitability in regions with abnormal connectivity.

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations ...

Application of Granger Causality Analysis of the Directed Functional Connection in Alzheimer's Disease and Mild Cognitive Impairment

Impaired functional connectivity in the Default Mode Network (DMN) may be involved in the progression of Alzheimer&#39;s Disease (AD). The Posterior Cingulate Cortex (PCC) is a potential imaging marker for monitoring the progression of AD. Previous studies did not focus on the functional connectivity between the PCC and nodes in regions outside the DMN, but our study is an effort to explore these overlooked functional connections. For collecting data, we used functional Magnetic Resonance Imaging (fMRI) and Granger Causality Analysis (GCA). fMRI provides a non-invasive method for studying the dynamic interactions between the different brain regions. GCA is a statistical hypothesis test for determining whether one-time series is useful in forecasting another. In simple terms, it is judged by comparing the &#34;Known all the information on the last moment, the distribution of the probability of X at this time&#34; and the &#34;Known all the information on the last moment except Y, the distribution of the probability of X at this time&#34;, to determine whether there is a causal relationship between Y and X. This definition is based on the complete information source and stationary chronological sequence. The main step of this analysis is to use X and Y to establish the regression equation and draw a causal relationship by a hypothetical test. Since GCA can measure causal effects, we used it to investigate the anisotropy of the functional connectivity and explore the hub function of the PCC. Here, we screened 116 participants for MRI scanning, and after preprocessing the data obtained from neuroimaging, we used GCA to derive the causal relationship of each node. Finally, we concluded that the directed connection is significantly different between the Mild Cognitive Impairment (MCI) and AD groups, both from the PCC to the whole brain and from the whole brain to the PCC.

Application of Granger Causality Analysis of the Directed Functional Connection in Alzheimer&#039;s Disease and Mild Cognitive Impairment

Based on resting-state functional magnetic resonance imaging with Granger causality analysis, we investigated the alterations in the directed functional connectivity between the posterior cingulate cortex and whole brain in patients with Alzheimer&#39;s Disease (AD), patients with Mild Cognitive Impairment (MCI), and healthy controls.

Impaired functional connectivity in the Default Mode Network (DMN) may be involved in the progression of Alzheimer&#39;s Disease (AD). The Posterior ...

Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis

Severe acute pancreatitis (SAP) is characterized by high mortality rates, numerous complications, and extreme difficulties in treatment. A traditional Chinese medicine (TCM) enema has been widely utilized in clinical and experimental studies of SAP. It has been demonstrated to have beneficial effects in protecting pancreatic function and delaying disease progression. The procedure of TCM enema is to perfuse the Chinese medicinal liquid of raw rhubarb (Rheum officinale Baill. DaHuang) from the anus into the rectum and colon. Basic steps of the procedure include boiling the herbal solution in advance, using a disposable enema kit to assist patients in taking a left lying position, raising the patient's hip 10 cm, and carefully inserting the enema 30-35 cm into the anus, with a drip speed of 60-80 drops/min. The medicine liquid temperature should be equivalent to the patient's body temperature, typically between 37-39 &#176;C. The end of the enema operation should be slow, and Tui na (massage therapy) should be administered before extubation. The medication liquid should be kept in the rectum for more than 1 h. After issuing an enema, it is essential to observe the patient's feces and abdomen, and to evaluate the remission of abdominal signs and symptoms.

An enema is a type of traditional Chinese medicine (TCM) therapy used to treat severe acute pancreatitis (SAP). The therapy involves instilling a TCM liquid into the rectum and colon through the anus to keep the liquid in the intestine, absorbing through the intestinal mucosa. This study aims to standardize the enema procedure for SAP patients.

Severe acute pancreatitis (SAP) is characterized by high mortality rates, numerous complications, and extreme difficulties in treatment. A traditional ...

Tai Chi with Mindfulness Training to Manage Diabetic Peripheral Neuropathy

Effects of Mindfulness Training Combined with Tai Chi in Patients with Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. One of its crucial therapy approaches is mind-body exercise. Recently, various exercise modalities, including stepping, resistance, aerobics, balance, and whole-body vibration, were investigated to construct the most suitable form of exercise for patients with DPN. The purpose of this study is to describe a standard protocol for mindfulness training combined with Tai Chi. The convenience sampling method was used to select 90 patients with DPN who met the inclusion and exclusion criteria from three communities. The three communities were randomly divided into the control group (CG), the Tai Chi group (TCG), and the mindfulness training combined with the Tai Chi group (MTCG). The CG was given routine health education guidance once a month, a total of three times. Based on the CG, the TCG practiced Tai Chi three times; the MTCG received mindfulness training combined with Tai Chi exercise a week for a total of 12 weeks. Before the intervention and 12 weeks after the intervention, the clinical symptoms, neurological function, attention awareness level, pain, and quality of life of the subjects were evaluated by Toronto Clinical Scoring System (TCSS), Mindful Attention Awareness Scale (MAAS), Visual analog scale (VAS), Diabetes Specificity Quality of life Scale (DSQL) and tumor necrosis factor-&#945;. Overall, the addition of mindfulness training to Tai Chi effectively enhances the exercise effects of Tai Chi. Therefore, mindfulness training combined with Tai Chi is worthy of promotion and application.

Author Spotlight: Integrating Tai Chi with Mindfulness Training to Achieve an Effective Mind-Body Exercise 

When studying exercise for treating diabetic peripheral neuropathy (DPN), achieving mind-body exercise is essential. This study proposes a protocol for mindfulness training combined with Tai Chi to achieve mind-body exercise.

Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. One of its crucial therapy approaches is mind-body ...

Establishment of the KOA Model in Rabbits Using the Modified Videman Method

Application of Acupotomy in a Knee Osteoarthritis Model in Rabbit

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department, which seriously reduces the quality of life of people with KOA. Among several pathogenic factors, the biomechanical imbalance of the knee joint is one of the main causes of KOA. Acupotomology believes that restoring the mechanical balance of the knee joint is the key to treating KOA. Clinical studies have shown that acupotomy can effectively reduce pain and improve knee mobility by reducing adhesion, contracture of soft tissues, and stress concentration points in muscles and tendons around the knee joint. 
In this protocol, we used the modified Videman method to establish a KOA model by immobilizing the left hindlimb in a straight position. We have outlined the method of operation and the precautions related to acupotomy in detail and evaluated the efficacy of acupotomy in conjunction with the theory of "Modulating Muscles and Tendons to Treat Bone Disorders" through the detection of the mechanical properties of quadriceps femoris and tendon, as well as cartilage mechanics and morphology. The results show that acupotomy has a protective effect on cartilage by adjusting the mechanical properties of the soft tissues around the knee joint, improving the cartilage stress environment, and delaying cartilage degeneration.

Author Spotlight: Investigating the Mechanism of Action of Acupotomy in Treating Knee Osteoarthritis

In this protocol, a knee osteoarthritis model was prepared using the modified Videman method, and the operation procedures and precautions of acupotomy are detailed. The effectiveness of acupotomy has been demonstrated by testing the mechanical properties of quadriceps femoris and tendon and the mechanical and morphological properties of cartilage.

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department, which seriously reduces the quality of life of ...

Enhancing Stroke Rehabilitation with Virtual Reality-Based Occupational Training

Cognitive Function and Upper Limb Rehabilitation Training Post-Stroke Using a Digital Occupational Training System

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the potential to meet these demands by providing engaging and motivating therapy options. The digital occupational training system is a VR application that utilizes cutting-edge technologies, including multi-touch screens, virtual reality, and human-computer interaction, to offer diverse training techniques for advanced cognitive capacity and hand-eye coordination abilities. The objective of this study was to assess the effectiveness of this program in enhancing cognitive function and upper extremity rehabilitation in stroke patients. The training and assessment consist of five cognitive modules covering perception, attention, memory, logical reasoning, and calculation, along with hand-eye coordination training. This research indicates that after eight weeks of training, the digital occupational training system can significantly improve cognitive function, daily living skills, attention, and self-care abilities in stroke patients. This software can be employed as a time-saving and clinically effective rehabilitation aid to complement traditional one-on-one occupational therapy sessions. In summary, the digital occupational training system shows promise and offers potential financial benefits as a tool to support the functional recovery of stroke patients.

Author Spotlight: Rehabilitation of Stroke Patients With a Digital Occupational Training System

The current protocol outlines how the VR-based digital occupational training system enhances the rehabilitation of patients with cognitive impairment and upper limb dysfunction following a stroke.

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the ...

Diagnosis and Strain Identification of pSS-Related Oral Candida

Examination of Oral Candida Infection in Primary Sj&#246;gren&#39;s Syndrome Patients

Primary Sj&#246;gren's syndrome (pSS) is an autoimmune disease characterized by symptoms such as dry mouth, dry eyes, and other systematic symptoms. Due to the hyposalivation experienced by pSS patients, oral dysbacteriosis often occurs. A common complication of pSS is the oral Candida infection. In this article, the authors describe systematic methods that can effectively diagnose oral Candida infection and identify the Candida strains using saliva, oral mucosal swabs, or mouthwash from pSS patients. The Sabouraud's Dextrose Agar (SDA), hyphal formation assay, potassium hydroxide (KOH) smear test, and calcofluor white (CFW) staining assay are used for the diagnosis of oral Candida infection. A Candida diagnostic agar is used for the identification of Candida strains. Finally, antifungal susceptibility testing is used to determine appropriate antifungal drug treatment. This standardized method can enhance the diagnosis, treatment, and future research of pSS-related oral Candida infections. Early diagnosis, using this method, can also prevent any complications arising due to delay in receiving appropriate treatment.

Author Spotlight: Oral Candida Diagnosis to Advance Clinical Treatment Regimen for pSS Patients

Here, we present a protocol for the examination of oral Candida infection in patients with primary Sj&#246;gren's syndrome, which can be used for timely treatment and, thereafter, avoiding related complications.

Primary Sj&#246;gren's syndrome (pSS) is an autoimmune disease characterized by symptoms such as dry mouth, dry eyes, and other systematic symptoms. Due ...

Standardizing Press Needle Treatment for Myopia with Dry Eye

Press Needle: A Traditional Chinese Medicine Therapy for Myopia Patients with Dry Eye

Most patients with myopia have dry eye, which has been shown to adversely affect ocular symptoms, myopia progression, and quality of life in patients with myopia. Needle prickling has been shown to be effective in providing symptom relief in patients with myopia and dry eye. Press needle is a long-lasting, easy-to-operate, and inexpensive traditional Chinese medicine treatment. The standard practice of needle insertion is very important for the treatment of myopia and dry eye. The specific steps include selecting the appropriate acupoints, piercing them with appropriate needles, and fixing them in the skin or subcutaneously at the acupoints, burying them for 2 days, resting for 1 day; the course of treatment lasts for 2 weeks. Specifically, the following indicators were assessed: uncorrected visual acuity and the ocular surface disease index. This article will explain how to standardize the operation of a press needle in the treatment of myopia and dry eye.

Author Spotlight: Exploring Press Needle Efficacy and Underlying Molecular Pathways

Here, we present a protocol to standardize the operation of acupuncture in the treatment of myopia with dry eye.

Most patients with myopia have dry eye, which has been shown to adversely affect ocular symptoms, myopia progression, and quality of life in patients with ...

Assessing Sleep Quality and Cognitive Function in Patients with Major Depressive Disorder

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

Cognitive symptoms and sleep disturbance (SD) are common non-mood-related symptoms of major depressive disorder (MDD). In clinical practice, both cognitive symptoms and SD are related to MDD progression. However, there are only a few studies investigating the connection between cognitive symptoms and SD in patients with MDD, and only preliminary evidence suggests a significant association between cognitive symptoms and SD in patients with mood disorders. This study investigates the relationship between cognitive symptoms and sleep quality in patients with major depressive disorder. Patients (n = 20) with MDD were enrolled; their mean Hamilton Depression Scale-17 score was 21.95 (&plusmn;2.76). Gold standard polysomnography (PSG) was used to assess sleep quality, and the validated THINC-integrated tool (the cognitive screening tool) was used to evaluate cognitive function in MDD patients. Overall, the results showed significant correlations between the cognitive screening tool's total score and sleep latency, wake-after-sleep onset, and sleep efficiency. These findings indicate that cognitive symptoms are associated with poor sleep quality among patients with MDD.

Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression

Here, we present a protocol that investigates the relationship between cognitive symptoms and sleep quality in patients with major depressive disorder. The THINC-integrated tool and polysomnography were used to evaluate cognitive symptoms and sleep quality.

Cognitive symptoms and sleep disturbance (SD) are common non-mood-related symptoms of major depressive disorder (MDD). In clinical practice, both ...

MOGHE and Epilepsy: Outcomes of Frontal Disconnection Surgery 

Frontal Disconnection for Treating Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia in Epilepsy (MOGHE) in the Frontal Lobe

Malformation of cortical development is an important cause of drug-resistant epilepsy in young children. Mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE) has been added to the last focal cortical dysplasia (FCD) classification and commonly involves the frontal lobe. The semiology at the onset of epilepsy is dominated by non-lateralizing infantile spasm; the boundaries of the malformation are usually difficult to determine by magnetic resonance imaging (MRI) and positron emission tomography (PET), and electroencephalography (EEG) findings are often widespread. Therefore, the traditional concept and strategy of preoperative evaluation to determine the extent of the epileptogenic zone by comprehensive anatomo-electro-clinical methods are difficult to implement. 
Frontal disconnection is an effective surgical method for the treatment of epilepsy, but there are few related reports. A total of 8 children with histo-pathologically confirmed MOGHE were retrospectively studied. MOGHE was located in the frontal lobe in all patients, and frontal disconnection was performed. The periinsular approach was used in the disconnective procedures, divided into several surgical steps: the partial inferior frontal gyrus resection, the frontobasal and intrafrontal disconnection, and the anterior corpus callosotomy. 
One patient presented with a short-term postoperative speech disorder, while another patient exhibited transient postoperative limb weakness. No long-term postoperative complications were observed. At 2 years after surgery, 75% of patients were seizure-free, with cognitive improvement in half of them. This finding suggested that frontal disconnection is an effective and safe surgical procedure for the treatment of MOGHE instead of extensive resection in the frontal lobe.

Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE

Here, we present a protocol to describe the epilepsy outcome and complications of 8 patients with mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE) in the frontal lobe after frontal disconnection. The procedure is characterized by its simplicity, user-friendliness, and fewer postoperative complications.

Malformation of cortical development is an important cause of drug-resistant epilepsy in young children. Mild malformation of cortical development with ...