Transcranial direct current stimulation is one of the non-invasive brain-stimulation techniques. Based on the introduction of the origin and development, this article gave an overview of the mechanisms emphatically, the current view is that the transcranial direct current stimulation may exert effect on neuromodulation by changing cortical excitability, increasing synaptic plasticity, impacting cortical excitation/ inhibition balance, altering regional cerebral blood flow, modulating the activity within and between different cortical networks. In this review, clinical studies and analysis findings were compared, and then 2 problems should be discussed for ideal effects: choice of stimulating parameters and timing of the stimulation in relation to task performance.

Poststroke fatigue is not a single etiology disorder.As a kind of central fatigue,the basal ganglia,thalamencephalon,limbic system and the high grade cortical area man be involved,but none of them can be identified as the fatigue area.Some literature suggest the interrelationship between the proinflammatory cytokines,such as IL-1,TNF-α,IL-6,and fatigue.Since the pathologic process of stroke involving cytokines,the researchers proposed that poststroke fatigue may be related to sickness behavior promoted by proinflammatory cytokines ultimately.The physical fatigue may be associated with the proinflammatory cytokines's activation to hypothalamic-pituitary-adrenal axis,and the psychological fatigue may involve that proinflammatory cytokines decreased the clearance of extracellular glutamate by astroglia.

Objective To explore the correlation between fatigue and depression after cerebral infarction. Methods 112 cases were assessed with Zung Self-rating Depression Scale (SDS), depression dimension of Symptom Checklist 90 (SCL-90d) and Checklist Individual Strength (CIS). The data were analyzed with Spearman correlation analysis. Results The correlation coefficient between SDS and SCL-90d was 0.822 (P<0.01), and were 0.671 (P<0.01) and 0.640 (P<0.01) between CIS and SDS, CIS and SCL-90d, respectively. Conclusion The fatigue and depression after cerebral infarction is correlated.

Objective To evaluate the effect of short-wave ultraviolet combined with millimeter-wave irradiation on pressure ulcers.Methods Fifty-three patients with 87 pressure ulcer wounds were randomly divided into 3 groups.Group A consisted of 17 patients with 28 pressure ulcers,group B had 18 patients with 29 ulcers and group C had 18 patients with 29 pressure ulcers.All the patients in the 3 groups accepted routine care.Group B was treated with short-wave ultraviolet radiation in addition,and group C received millimeter-wave combined with short-wave ultraviolet radiation.Braden's scale was used to evaluate the integrity of the patients' skin before treatment,and the pressure sore status tool (PSST) was used to evaluate exudation and skin recovery before and after treatment.Results Before treatment the patients demographics and pressure sores of the three groups had no significant differences.In group A there was no significant difference in the average PSST-5 score between before and after treatment.Compared with the scores before therapy,the average scores of groups B and C decreased significantly.They were also significantly lower than in group A after treatment.The effect in group C was better than in group B.With regard to improvement rate,the improvement percentages of groups B and C were significantly higher than that of group A,while there was no statistically significant difference between groups B and C.The rate of excellent recovery of group C was better than that of group A or B,but there was no significant difference between groups A and B.Conclusions Combining short-wave ultraviolet irradiation with millimeter-wave irradiation has remarkable effects on exudation from and the recovery of pressure ulcers.

Objective To evaluate effects of simultaneous inhibition of mammalian target of rapamycin complex 1(mTORC1)kinase and glycogen synthase kinase-3β(GSK-3β)on phosphorylation of 4E-binding protein-1(4EBP1), cap-dependent translation, as well as survival and apoptosis of melanoma cells. Methods Cultured A375 cells were classified into several groups to be treated with dimethyl sulfoxide (DMSO group), the mTORC1 kinase inhibitor everolimus at a concentration of 5 nmol/L (everolimus group), the GSK-3β kinase inhibitor AR-A014418 at a concentration of 10 μmol/L (AR-A014418 group), or 5 nmol/L everolimus and 10 μmol/L AR-A014418(combined treatment group). After additional culture, Western-blot analysis was performed to measure protein expressions of phosphorylated 4EBP1 (p4EBP1)and survivin in A375 cells, m7GTP pull down assay to estimate interaction between eukaryotic initiation factor-4E (eIF4E)and eIF4G, cell counting kit 8 (CCK8)assay to evaluate cell proliferation, and flow cytometry to detect cell apoptosis. Results Both everolimus and AR-A014418 had inhibitory effects on 4EBP1 phosphorylation and survivin expression. The expressions of p4EBP1-65 and survivin were both significantly decreased in the everolimus group (0.74 ± 0.05 and 0.71 ± 0.06 respectively), AR-A014418 group (0.62 ± 0.06 and 0.58 ± 0.07 respectively)and combined treatment group (0.14 ± 0.04 and 0.09 ± 0.05 respectively)compared with the DMSO group (1.00 ± 0.07 and 1.00 ± 0.06, respectively, all P < 0.001), with the most significant decrease observed in the combined treatment group. As m7GTP pull-down assay showed, the everolimus group, AR-A014418 group and combined treatment group all showed significantly lower relative expression levels of eIF4G(0.72 ± 0.04, 0.67 ± 0.05 and 0.12 ± 0.05 vs. 1.00 ± 0.06, all P < 0.001), but significantly higher relative expression levels of 4EBP1 (1.98 ± 0.16, 2.32 ± 0.17 and 7.58 ± 0.25 vs. 1.00 ± 0.08, all P < 0.001)than the DMSO group, and the combined treatment group showed the lowest eIF4G expression but highest 4EBP1 expression. After 24-hour culture, the proliferation of A375 cells was inhibited by 18.5% ± 1.3% in the everolimus group, 19.8% ± 1.8% in the AR-A014418 group, and 61.2% ± 2.1% in the combined treatment group compared with the DMSO group, with the strongest inhibition noted in the combined treatment group. The inhibitory effects of everolimus and AR-A014418 on cell proliferation increased over time, and showed the same trend at 48 hours. Flow cytometry showed that the apoptosis of A375 cells was accelerated by the 24-hour treatments with everolimus and AR-A014418 alone or in combination, with the apoptosis rate being 14.28% ± 2.18%, 14.57% ± 2.35% and 55.18% ± 6.27% in the everolimus group, AR-A014418 group and combined treatment group respectively, and the combined treatment showed the strongest accelerating effect. Conclusion The combined treatment with everolimus and AR-A014418 can evidently inhibit 4EBP1 phosphorylation and eIF4F complex formation in A375 cells, which then suppress cap-dependent translation and promote apoptosis of melanoma cells.

Objective To introduce Checklist Individual Strength(CIS)into China,and evaluate its reliability and validity.Methods CIS was translated into Chinese language and the reverse translation was done by several experts.Validity and reliability were implemented in 214 cases with cerebral infarction.Results 4 components were extracted in factor analysis,and the total cumulative contribution was 78.984%.By correlation analysis,the twenty items were divided into 4 domains:subjective feeling of fatigue,concentration,motivation and physical activity,it was same as in the English version.Cronbach α of four domains were 0.9256,0.9072,0.7598,and 0.9157,respectively.Conclusion Psychometric properties(reliabilities and validities)of CIS Chinese version is met with satisfaction and seems to be adaptable to Chinese cerebral infarction patients.

Objective To analyze the instruments for post stroke fatigue, Fatigue Severity Scale (FSS)，Checklist Individual Strength (CIS) and Fatigue Impact Scale (FIS). Methods The FSS，CIS and FIS were applied in 214 cases with cerebral infarction. They were combined together at the (sub)scale level, and evaluated with Mokken Scale Analysis for Polytomous Items, for validity and reliability. Results and Conclusion Three scales were and The combined scale proved to be acceptable (H>0.5). 3 components were extracted in factor analysis, and the their total cumulative contribution was 77.504%, with reliability (α) of 0.8097，0.7094 and 0.8019 respectively. FSS put emphasis on the fatigue experiences of stroke patients, CIS on the influence of fatigue on, and FIS on the social function.

Objective To summarize the common types and clinical characteristics of ureter disease;which can increase manipulation difficulties and adverse events during rigid ureteroscopic procedures. Methods From Jan 2001 to Dec 2010,our team performed 317 rigid ureteroscopic Drocedures for ureteroscopic examination or treatment;including 60 difficult procedures(34 male and 26 female).The mean age of the patients was 37 years (range,18 to 71).The ureteral diseases were classifted into five types according to the pathological characteristics:Type Ⅰ calculous stenosis,Type Ⅱ neoplastic stenosis;Type Ⅲ non-congenital stenosis,Type Ⅳ congenital stenosis,Type Ⅴ expansion of tortuous ureters.The operative time,complications,and conversion to open surgery were evaluated,and the therapeutic methods were analyzed. Results Of the 60 difficuhly-manipulated procedures,the mean manipulated time was 75 min (range,31 to 200).Intra-operative complications occurred in 9 procedures,including 4 cases of mucosal bleeding,2 cases of submucosaI false passage and 3 cases of ureteral perforation.Eleven procedures were converted to open surgery. In five procedures only a double J tube was inserted for drainage due to the difficulty of entering the ureter.Fiftyfive patients were followed up for 17 months (range,3 to 110);48 patients were cured,5 patients improved and 2 patients were unchanged. Conclusions The five types of ureteral disease can increase operative difficulties and risks of rigid ureteroscopic procedures.We should be cautious during surgery and should stop manipulation or convert to other surgeries if necessary.

ObjectiveTo evaluate gallbladder conserving gallstone removal and polyps resection using combination laparoscopy,hard gallbladder endoscopy and soft choledochoscopy.MethodsClinical data of 122 patients with cholecystolithiasis or polyps undergoing removal of calculus (polyps) and preservation of gallbladder were analyzed retrospectively.ResultsGallstones in 56 patients and polyps in 24 cases was removed or resected successfully by laparoscopy and hard gallbladder endoscopy; In the remaining 34 cases stones were completely removed by combination soft choledochoscopy; 8 cases were converted to laparoscopic cholecystectomy.Romoved stone was single in 25 cases and multiple in 65 cases,with the number ranging from 1to 52,the diameter of stone ranged from 0.2 cm to 3.2 cm.In the 24 gallbladder polyps,7 cases were single,17 cases were multiple,the diameter of polyp ranged from 0.8cm to 1.2 cm.The operation time was 40-125 (78) min. The mean hospitalization was 4 days. No intraoperative and postoperative complications occurred.All patients were followed up for 1year.Gallstones recurred in 3 cases,and the recurrence rate was 3.06％. ConclusionsLaparoscopy combined with hard gallbladder endoscopy and soft choledochoscopy for removing calculi (polyp) and conserving gallbladder is safe and feasible.

Gallstone ileus is a rare mechanical ileus,which was caused by discharge of giant gall bladder stone to the intestine.Understanding the causes of ileus is the key factor for treatment,and surgical treatment is the treatment of choice.An old patient with gallstone ileus was admitted to the Second Affiliated Hospital of Soochow University in April 2013.Preoperative X ray detection and computed tomography showed gallbladder wall thickening,formation of a sinus tract between the gall bladder and the duodenum,and intestinal ileus in the left iliac region (the diameter of the stone was about 4 cm).The patient received medical treatment for 3 days and then exploratory laparotomy + lithotomy.Gall bladder stones were not detected during the operation,so the gall bladder was preserved.The patient was followed up till December 2013,the sinus tract was disappeared under B sonography,and the cholecystitis was cured.