Objective To explore the effects of repetitive transcraninal magnetic stimulation (rTMS) on depression,sleep disorder and activities of daily life (ADL) in post-stroke depression (PSD) patients.Methods A total of 90 PSD patients were divided into a control group,a treatment group and a combined treatment group according to a random number table,30 cases in each group.All patients were given basic treatment and comprehensive rehabilitation training.Moreover,the control group was additionally received escitalopram treatment,the treatment group rTMS treatment,the combined treatment group the above both,lasting 8 weeks.Before and after the treatment,the Hamilton depression (HAMD) scale,the Pittsburgh sleep quality index (PQSI),the Chinese stroke scale (CSS) and the modified Barthel index (MBI) were employed to evaluate depression,quality of sleep,neurological impairment and the activities of daily living (ADL) of patients in three groups.Results Before treatment,there was no significant difference in the HAMD,CSS,PSQI and MBI score among the 3 groups.After 8 weeks' treatment,the HAMD,PSQI and CSS scores of three groups had significantly decreased,but their MBI scores had significantly increased.Compared with the control group,no significant differences were observed in HAMD,CSS,PSQI and MBI scores of the treatment group and the combined treatment group (P ＞ 0.05).After treatment,there was no significant difference in the above four values between the combined treatment group,and the treatment group.Conclusion The rTMS can significantly improve PSD patient's depressive symptoms,relieve sleep disorders and neurological deficit situation,and effectively improve their ADL.

Objective To evaluate the value of CT and bronchoscopy in diagnosis of solitary pulmonary nodules.Methods The CT,FOB and histologic data of 60 patients with solitary pulmonary nodules were analysed retrospectively.Results 60 pulmonary lesions were all detected by CT scan,the detected rate was 100%.The detected rate by endoscopy was 67%(40/60).Conclusion CT can be used as the routine method in evaluating pulmonary nodules and guiding biopsy by fibroptic bronchoscopy.

The development of society raises demands for high-level talents,which requires high level post graduate education.The model of post graduate education is changing from research centered to professional skill centered.The research centered program has a long history and has gained consensus,while the professional skill program is still new.To address the social and economic needs,we explored the professional skill centered post graduate program and report our experience here.

Objective To investigate the effects of peroral catheter balloon dilatation on patients with dysphagia caused by cricopharyngeal achalasia after stroke.Methods Thirty-two stroke survivors with cricopharyngeal achalasia were randomly divided into a control group and a treatment group,each of 16.Both groups were given routine dysphagia rehabilitation training,but the treatment group was additionally given peroral balloon dilatation therapy six times a week for 2 weeks.Both groups were given swallowing function evaluations and videofluoroscopic swallowing examinations (VFSS) before and after the treatment.Results After the treatment,14 of the 16 patients in the treatment group demonstrated improved swallowing,significantly better than the control group,where only 9 patients had improved.The VFSS showed dysphagia to have been relieved in both groups,but significantly more in the treatment group.Transit duration in the pharnx was significantly shortened from 0.28 s to 0.16 s in the treatment group,but no significant difference was tound in the control group.Conclusion Peroral catheter balloon dilatation is effective for relieving cricopharyngeal achalasia after stroke.

Objective To investigate the effects of a training program based on virtual reality on static and dynamic balance perfor-mance in patients with Parkinson's disease (PD). Methods From June, 2014 to June, 2016, 46 patients with PD were randomly divided into control group (n=23) and experimental group (n=23). The control group received routine balance training, while the experimental group re-ceived balance training of virtual reality, for six weeks. They were assessed with Unified Parkinson's Disease Rating Scale part 3 (UP-DRS3), Berg Balance Scale (BBS), TimedUp and GoTest (TUGT) and Hamilton Depression Scale (HAMD) before and after training. The envelope area, anteroposterior standard deviation (AP-SD), mediolateral standard deviation (ML-SD) of centre of pressure (COP) were also measured with posturography. Results The scores of BBS, TUGT and HAMD improved in both groups after training (t>2.657, P<0.05), and improved more in the experimental group than in the control group (t>2.426, P<0.05). The score of UPDRS3 and the parameters of pos-turography improved in the experimental group (t>2.626, P<0.05), and improved more than that in the control group (t>2.112, P<0.05). Con-clusion Virtual reality rehabilitation is more effective than routine balance training on the static and dynamic balance function in patients with PD, and may release their depression.

Objective:To investigate the preoperative endocrinological characteristics of pituitary apoplexy of infarcted type.Methods:Twenty-six patients with pituitary apoplexy of infarcted type, confirmed by pathological pathology in our hospital from January 2010 to October 2019, were chosen. All patients were performed pituitary adenoma stroke scale before surgery, and endocrine examinations were performed on three pituitary target gland axes, namely the pituitary-thyroid axis, pituitary-gonadal axis and pituitary-adrenal axis, to evaluate the pituitary function and functions of three target gland axes.Results:Preoperative pituitary adenoma stroke scale scores were (1.92±1.78), ranged from 2 to 8. Twenty-five patients (96%) were with impaired pituitary function, including 13 patients (50%) with panhypopituitarism and 12 patients (46%) with partial hypopituitarism; in these 12 patients with partial hypopituitarism, 9 patients were noted to be involved two target gland axes, and 3 patients were noted to be involved one target gland axis. There were 22 patients (85%) with hypophysia-gonadal axis hypopituitarism, 14 (54%) with hypophysia-thyroid axis hypopituitarism, and 13 (50%) with hypophysia-adrenal axis hypopituitarism. Preoperative levels of prolactin in 26 patients (100%), testosterone in 26 patients (100%), luteinizing hormone in 18 patients (75%), progestational hormone in 18 patients (75%), thyroid stimulating hormone in 18 patients (69%), free triiodothyronine in 17 patients (65%), free thyroxine in 14 patients (54%), estradiol in 13 patients (54%), cortisol in 13 patients (52%), follicle stimulating hormone in 9 patients (38%), adrenocorticotrophic hormone in 9 patients (35%), growth hormone in 3 patients (15%) were lower as compared with baseline levels.Conclusion:Hypophysia-gonadal axis hypopituitarism is most common in pituitary apoplexy of infarcted type, and the endocrinological features are the sharp decrease of prolactin and testosterone levels.

Objective To investigate the factors affecting the prognosis of posterior communicating artery aneurysm (PCoA) to provide theoretical foundation for treatment of PCoA.Methods The clinical data of 308 patients with PCoA,admitted to our hospital from January 1997 to June 2013,were studied retrospectively.With the therapeutic effect as the dependent variable,Logistic regression analysis was performed to examine 13 factors those potentially affected the outcomes of the patients.Results The patient's gender,side and size of PCoA,position and pointing of PCoA,timing of surgery and rupture or not during operation did not affect the outcomes of the patients (patient's age,gender,times of subarachnoid hemorrhage (SAH),Hunt-Hess grade,preoperative condition of consciousness,side and size of PCoA,position and pointing of PCoA,timing of surgery,rupture or not during operation,degrees of SAH and postoperative complications).But univariate analysis showed that the patient's age (P=0.003),times of SAH (P=0.005),Hunt-Hess grade (P=0.000),preoperative consciousness situation (P=0.003),degree of SAH (P=0.001) and postoperative complications (P=0.000) were the independent risk factors affecting the postoperative outcomes; whereas the Hunt-Hess grade and postoperative complications are fundamental risk factors that affected the postoperative effects (OR=14.330,P=0.000,95％CI:2.005-102.396; OR=19.445,P=0.004,95％CI:2.513-150.442).Conclusion Preoperative Hunt-Hess grade and postoperative complications are independent risk factors affecting the prognosis of patients; through analysis of these factors,the prognosis of patients can be broadly determined,thus the treatment of PCoA can be further guided and level of clinical treatment can be improved.

Objective:To explore the evaluation value of abnormal muscle response (AMR) monitoring in efficacy of microvascular decompression in primary hemifacial spasm.Methods:A retrospective study was performed. Sixty-four patients with primary hemifacial spasm, admitted to our hospital from April 2019 to December 2020, were chosen. All patients underwent intraoperative AMR monitoring and were divided into AMR complete-disappeared group, AMR significant-changed group and AMR not significant-changed group according to the monitoring results. The relief of spasticity symptoms among the three groups was observed one week and one year after surgery. The specificity and sensitivity of AMR monitoring in evaluating the efficacy, the relations between intraoperative AMR changes and postoperative efficacy after microvascular decompression were analyzed.Results:The specificity and sensitivity of AMR monitoring in predicting spasmodic relief after microvascular decompression were 89.7% and 66.7%, respectively, at one week, and 86.7% and 50.0%, respectively, at one year. There were statistical differences in clinical remission rate one week after microvascular decompression among AMR complete-disappeared group ( n=46), AMR significant-changed group ( n=8) and AMR not significant-changed group ( n=10, P<0.05); there were no significant differences in clinical remission rate one year after microvascular decompression among the three groups ( P>0.05). There was no significant difference in clinical remission rate one week and one year after microvascular decompression between patients having AMR complete disappearance before Teflon and patients having AMR complete disappearance after Teflon ( P>0.05). Conclusion:AMR monitoring has high specificity but modest sensitivity in predicting spasmodic relief after microvascular decompression; intraoperative AMR disappearance is associated with short-term efficacy, but it is not a reliable indicator for long-term efficacy; the time of disappearance of intraoperative AMR has no guiding significance in judging the efficacy of patients with primary hemifacial spasm.