Beijing Tian Tan Hospital

High-definition transcranial alternating current stimulation (HD-tACS) is an emerging neuromodulatory intervention for major depressive disorder (MDD). Here, we evaluate the efficacy and safety of a portable, low-intensity (1.6 mA), 10 Hz HD-tACS protocol targeting the bilateral dorsolateral prefrontal cortex (DLPFC) in adults with MDD. This randomized clinical trial was conducted including 120 adult MDD participants. Participants underwent 20 sessions (5 sessions/week for 4 weeks) of either active 10 Hz HD-tACS (1.6 mA) or sham stimulation a ratio of 1:1 and were followed for an additional 4 weeks. The primary outcome was the percentage reduction in 17-item Hamilton Depression Rating Scale scores at week 4. The active group showed significantly greater improvement in depression than the sham group (48% ± 14% vs 24% ± 13%, p < 0.001), sustained through the 4-week follow-up period. Additionally, significant improvements in the active group were also found in anxiety, sleep efficiency, quality of life components of physical, vitality, social functioning, and mental health. Adverse events including two cases of new-onset hypomania occurred, but no serious adverse events were observed. Thus, this trial supported the efficacy and good tolerability of 10 Hz HD-tACS for patients with MDD. Further research requires more focus on the underlying neural mechanisms and the optimized stimulation protocols. Trial Registration: China Clinical Trial Registry Identifier: ChiCTR2500103570. ClinicalTrials.gov Identifier: NCT06891326.

Tumor location has been demonstrated to influence the risk of epilepsy in patients with low-grade gliomas (LGGs). However, existing evidence is mainly based on dichotomized analyses, without adequately accounting for seizure frequency. We present a voxel-wise lesion analysis to investigate the potential correlations between the location of tumor and the frequency of seizure occurrence in patients with LGGs. We retrospectively reviewed the clinical information and magnetic resonance images of 352 patients pathologically confirmed with LGGs. Preoperative seizure frequency during the 3 months prior to the primary surgery was classified as daily (≥1/day), weekly (≥1/week), monthly (≥1/month) and rare (<1/month). A voxel-based lesion-symptom mapping analysis was performed to identify the association between tumor location and preoperative seizure frequency. LGGs involving the left primary motor area or right insular and basal ganglia were associated with an increased risk of frequent seizures (≥1/month). A focal aware seizure was more likely to frequently occur compared with a focal to bilateral tonic-clonic seizure caused by LGGs (p < 0.001). Tumors that caused a high seizure frequency were less likely to be completely removed (p = 0.008). Furthermore, preoperative seizure frequency was a significant predictor of seizure outcomes at 6 months after surgery as determined by a univariate analysis (p = 0.002). This study utilized voxel-level neuroimaging analyses to identify the anatomical correlations of seizure frequency in patients with LGGs, providing further insight into seizure risk stratification and potential implications for surgical management.

Stimulation of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is an effective target for treating blepharospasm-oromandibular dystonia, but the individual optimal remains unclear. Thirteen patients with blepharospasm-oromandibular dystonia were enrolled. Bilateral STN and GPi electrodes were implanted and externalized, and the signal of the two targets was recorded simultaneously. The power spectrum and burst characteristics were analyzed to see how they were related to symptom severity. The 1year follow-up revealed an overall improvement rate of 76.21% ± 12.51%. Those with GPi as final targets showed higher band power and longer average burst duration in the 5.5-12Hz band in the GPi compared to the STN (P < 0.05). Conversely, those with STN as final targets showed higher band power and longer average burst duration in the 6-10Hz band in the STN compared to the GPi (P < 0.05). Exclusion of shorter low-frequency bursts led to higher correlation coefficients with BFMDRS-M scores in both the STN and GPi groups (P < 0.01). Our study suggests that low-frequency oscillatory features may be associated with therapeutic target selection for DBS in blepharospasm-oromandibular dystonia. These findings may help inform target selection strategies and warrant prospective validation for their value in supporting long-term clinical outcomes.

Accurate detection of gene subtypes with high sequence similarity is critical for pathogen diagnosis. Current CRISPR-based PCR diagnostics methods may provide improved specificity but rely on pre-amplification in a separate reaction, due to Cas protein thermal instability, increasing cross contamination. Here, we developed CRISPR-based terminal-specific amplification (CASTSA), a one-pot platform which makes use of the CRISPR-Cas12a specific recognition and cleavage, generating a single strand digested product with specific 5' termini, to serve as the template for qPCR amplification. Our assay simplifies sample preparation by eliminating the need pre-amplification, whilst simultaneously fully exploiting the high specificity of the CRISPR system and high sensitivity of PCR. CASTSA was validated in vitro and with clinical samples collected from individuals with Human Papillomavirus (HPV), demonstrating high specificity for HPV 16, whilst discriminating HPV 18, 33, 45, and 52 sub-types, using a laser-induced graphene (LIG)-based electrochemical sensor platform. The technique achieved a limit of detection of 18 copies/reaction and offers a robust and reproducible, one-pot solution for pathogen subtyping, providing excellent specificity, so advancing nucleic acid detection with an assay that is easier to implement when compared with standard clinical diagnostic workflows.

BackgroundEarly rehabilitation is vital for functional recovery in critically ill patients. Virtual reality–based early rehabilitation intervention (VR-ERI) is an emerging strategy, but evidence on its feasibility, safety, and efficacy remains inconsistent and unsynthesized.ObjectiveWe synthesized evidence from randomized controlled trials (RCTs) on the feasibility and safety of VR-ERI in adult critically ill patients and evaluated its effects on functional outcomes during intensive care unit (ICU) stay and at short-term follow-up (≤3 months post ICU).MethodsFollowing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we searched 10 databases (eg, PubMed, Web of Science, Cochrane Library, and Embase) from inception to October 5, 2025, for Chinese and English publications. We included RCTs comparing VR-ERI with control measures initiated early (within 72 h of ICU admission) in adults. FW and YW independently screened studies and extracted data; YW and YX independently conducted the revised Cochrane Risk of Bias tool assessment. Data were synthesized narratively or via meta-analysis in R Studio using a random-effects model (Hartung-Knapp-Sidik-Jonkman adjustment). Effects were expressed as standardized mean differences (SMD; with Hedges g correction) with 95% CIs and 95% prediction intervals (95% PIs). Subgroup and sensitivity analyses were performed to explore heterogeneity and assess robustness. The Grading of Recommendations Assessment, Development, and Evaluation framework was used to assess the quality of evidence.ResultsSixteen RCTs (published 2020‐2025) involving 1356 patients were included. Bias assessment found 1 study at low risk, 5 with some concerns, and 10 at high risk. Meta-analysis suggested potential trends for VR-ERI in improving ICU anxiety (SMD −0.86, 95% CI −1.85 to 0.13, 95% PI −3.75 to 2.03; very low certainty) and subjective sleep quality (SMD 3.36, 95% CI 0.77-5.94; very low certainty), with a more pronounced effect in the Richards-Campbell Sleep Questionnaire–assessed subgroup (SMD 5.12, 95% CI 0.54-9.71). At follow-up, VR-ERI showed trends toward improved balance (Berg Balance Scale: SMD 0.97, 95% CI 0.74-1.20, 95% PI 0.37-1.58; moderate certainty), limb motor function (Fugl-Meyer: SMD 1.40, 95% CI −0.23 to 3.02; low certainty), and cognitive function (SMD 0.78, 95% CI 0.16-1.39; low certainty). No significant differences were found for objective sleep measures or ICU pain (low to very low certainty). No serious adverse events were reported; only a few studies mentioned mild reactions, such as dizziness, nausea, and fatigue.ConclusionThis review indicates VR-ERI’s potential to improve anxiety, subjective sleep, balance, cognition, and motor function in early ICU rehabilitation, while its effects on pain and objective sleep remain unclear and safety protocols need refinement. Given the high risk of bias, substantial heterogeneity, and imprecision, the overall certainty of evidence is low. Thus, VR-ERI may serve as a nonpharmacological adjunct, but its clinical translation requires consideration of cost and patient suitability, and more rigorous research is needed.

KAT8 may serve as a valuable biomarker for the prognosis prediction of patients with HBV-ACLF.