Objective To compare the application value of contrast enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance angiography ( CEMRA ) in the diagnosis of carotid plaque characteristics . Methods Fourty-six patients ( 48 carotid plaques) were performed with carotid CEUS and CEMRA examination prior to carotid endarterectomy . The following characteristics of plaque including the surface of the plaque ,the presence of calcification ,the internal composition and the diameter stenosis were observed and measured ,which were compared with pathologic and digital subtraction angiography ( DSA ) results . Results There were 42 vulnerable plaques and 6 stable plaques in the 48 plaques . Fourty-seven carotid plaques had been correctly diagnosed by CEUS and CEMRA ,and one plaque had been misdiagnosed . The sensitivity ,specificity and accuracy between CEUS and CEMRA had no obvious differences in terms of the overall evaluation of plaque vulnerability ( P > 0 .05) ;CEUS and CEMRA in the diagnosion of the plaque surface situation had no statistical difference in terms of sensitivity ,specificity and accuracy compared with pathological results( P > 0 .05) ;There was no significant difference in diagnostic accuracy rate between two modalities ( P < 0 .05) ;In the diagnosis of plaque internal composition ,they had statistically differences in terms of specificity and accuracy ( P < 0 .05) ,while sensitivity had no obvious difference ( P > 0 .05) . With DSA examination results as the gold standard ,the accuracy of CEUS in the diagnosis of the diameter stenosis was 97 .92% (47/48) ,CEMRA was 100% (48/48) ,they had no significant difference between two groups ( P > 0 .05 ) . Conclusions CEUS and CEMRA in carotid plaques characteristic evaluation have respective advantages ,are highly complementary ,and combining two methods can systematically evaluate for plaque characteristics .

Objective To compare the effects of repetitive transcranial magnetic stimulation (rTMS) at various low frequencies on upper limb function after cerebral infarction.Methods Fifty patients were randomly assigned to a control group (10 cases),a sham rTMS group (10 cases) or an rTMS group which had three sub-groups treated at 0.25 Hz,0.5 Hz and 0.75 Hz with 10 cases in each.All of the patients were treated with conventional medical treatment and rehabilitation training.The sham and true rTMS groups received rTMS applied over the M1 area of the unaffected hemisphere,5 days per week for 4 weeks.Motor evoked potential (MEP) cortical latency,and central motor conduction time (CMCT) were measured and the Fugl-Meyer assessment (FMA),motricity index (MI) and a Hong Kong functional test for the hemiplegic upper extremity (FTHUE-HK) were evaluated beforehand and at Post 1 after 2 weeks of treatment and Post 2 after 4 weeks of treatment.Results The average CMCT and FMA scores of the control and sham rTMS groups both had improved significantly at Post 2.There was no significant difference in any of the indices between those 2 groups at any time point.At Post 1,the average MEP cortical latencies of the 0.25 Hz and 0.5 Hz subgroups had improved to be significantly better than those of the control and sham rTMS groups.The average CMCTs of the 0.25 Hz and 0.5 Hz rTMS subgroups were significantly shorter after treatment,and significantly better than those of the control and sham rTMS groups.At Post 2,the average MEP cortical latency of all groups except the control group showed significant improvement compared with pre-treatment.The 2 indices of the 0.25 Hz and 0.5 Hz subgroups were again significantly shorter than those of the control and sham rTMS groups,and the average CMCTs were significantly better than that of 0.75 Hz subgroup.At Post 1 the average FMA and MI scores of the rTMS subgroups had all improved significantly.In the 0.25 Hz and 0.5 Hz subgroups the average MI scores were significantly higher than those of the control and sham rTMS groups.The FTHUE-HK scores of those 2 subgroups had also improved significantly.At Post 2,the average FMA and MI scores of all groups and the FTHUE-HK scores of rTMS group had improved significantly.In the 0.25 Hz and 0.5 Hz subgroups,all of the indices were significantly better than in the control and sham rTMS groups.The average FTHUE-HK score of the 0.25 Hz subgroup was significantly superior to that of the 0.75 Hz subgroup.In the 0.75 Hz subgroup the average MI score was significantly higher than in the control and sham rTMS groups.Conclusions rTMS at either 0.25 Hz or 0.5 Hz applied to the unaffected hemisphere provides effective treatment for enhancing the excitability of the motor cortex and the motor function of a paretic upper limb after stroke.Compared with others,the total number of stimulus pulse in 0.25 Hz subgroup was the least,and priority consideration should be given to the frequency of 0.25 Hz when using rTMS in clinical treatment of cerebral infarction.

Objective To investigate the effects of low frequency repetitive transcranial magnetic stimulation (rTMS) on non-fluent aphasia in patients after stroke.Methods Forty stroke patients displaying non-fluent aphasia were randomly assigned to an rTMS group and a control group using a random number table.Both groups were treated with conventional language therapy,while the rTMS group was additionally given 0.5 Hz rTMS over the Broca's homologues of the unaffected hemisphere 5 days a week for 3 weeks.The patients were stimulated at 90％ of the motor threshold (MT),with 16 second trains and intervals of 3 seconds 48 times (384 pulses) in a session.Before and after the 3 weeks of treatment,the Western Aphasia Battery (WAB) and the Communicative Abilities in Daily Living (CADL) test were conducted in both groups to evaluate their language function and communication ability.Results Only spontaneous speech improved significantly (P＜0.05) in the control group after 3 weeks of treatment.In the rTMS group,the spontaneous speech,auditory comprehension,repetition,naming and aphasia quotient (AQ) had all improved significantly (P＜0.05).Moreover,after the treatment,the average score of the auditory comprehension (153.90± 31.79),repetition (82.65± 15.14),naming(81.28±22.12) and AQ (63.66± 13.64) of the rTMS group were significantly higher than those of the control group (P＜0.05).Conclusion rTMS applied to the Broca's homologues of the unaffected hemisphere can significantly improve language function in those exhibiting non-fluent aphasia after stroke.

Objective To study the application of contrast-enhanced ultrasonography (CEUS) in the evaluation of the stability of carotid atherosclerotic plaque (CAP).Methods 162 patients with CAP were selected as study group.Meanwhile,34 patients with carotid artery strong echo plaques were selected as control group.The color doppler ultrasound was used to observe the CAP.Results The proportions of lipid type,fiber type,calcification and ulcer plaque in the study group were 21.60%,33.33%,34.57% and 10.37%,which were higher than those of the control group (5.88%,2.94%,2.94% and 2.94%),the differences were statistically significant (χ2=4.537,12.859,13.629 and 3.855,all P<0.05).There were 75 patients of soft plaques,36 patients with mixed plaques,51 patients with hard plaque in 162 patients.The new blood vessels classification in soft plaque group (36.00%,45.33% and 10.33%) were higher than the mixed plaque (30.56%,41.67% and 8.33%) and hard plaque group (31.37%,13.72% and 7.84%).The peak intensity (-86.41±7.81) %,tmax (8.34±1.62)s,mean transit time (24.18±8.67)s in the soft plaque group were significantly lower than the mixed plaque [(-100.73±6.52)%,(9.79±2.14)s and (28.93±9.11)s] and hard plaque patients [(-104.14±6.15)%,(10.23±2.33)s and (30.07±9.48)s],the differences were statistically significant (t=9.518,6.966,2.658,13.592,5.374 and 3.064,all P<0.05),but there were no statistically significant differences between mixed plaque and hard plaque (all P>0.05).The plaque diameter (4.13±0.75)mm diagnosed by CEUS was significantly larger than that of conventional ultrasound [(3.62±1.14)mm],the difference was statistically significant (t=4.757,P=0.000).Conclusion The CEUS can qualitatively detect the atherosclerotic plaque angiogenesis,can quantitatively assess plaque,evaluate the stability of the plaques,and the sensitivity is high.

Objective:To explore the effect of repetitive high-frequency magnetic stimulation (H-F rTMS) of the dorsolateral part of the prefrontal cortex (DLPFC) combined with smoking-related cues on nicotine addicts′ cigarette craving, the concentration of exhaled CO and sleep quality.Methods:Sixty nicotine addicts were randomly divided into groups A, B and C, each of 20. All were given H-F rTMS five times a week for two weeks, while those in groups A and B watched smoking and non-smoking pictures for ten minutes, respectively. Before and after the intervention, all of the subjects self-reported their cigarette cravings using a visual analogue scale. Exhaled CO (CO ppm) was measured and the Pittsburgh sleep quality index (PSQI) was evaluated. Results:After the intervention the average craving score, CO ppm and PSQI score had improved significantly in all three groups. The average craving score and CO ppm of group A were both significantly better than in the other two groups. Conclusions:rTMS can significantly improve cigarette craving, CO ppm and sleep quality of cigarette adicts. Viewing smoking-related pictures as an addition to rTMS can even better the effects of rTMS.

BACKGROUND:The correlation between blood stasis syndrome and non-blood stasis syndrome of lumbar intervertebral disc protrusion remains unclear.
OBJECTIVE:To construct serum protein pattern model for diagnosing blood stasis syndrome of lumbar intervertebral disc protrusion.
METHODS:A total of 180 cases were included in this study and divided into treatment group (120 patients with lumbar intervertebral disc protrusion) and control group (60 healthy cases from physical examination). Furthermore treatment group was equal y assigned into blood stasis syndrome subgroup and non-blood stasis syndrome subgroup, with 60 cases in each subgroup. The involved cases were wel matched in nations, genders and ages. Serum samples of peripheral blood from the 180 cases were col ected. Surface-enhanced laser desorption/inionation time of flight mass spectrometry and ProteinChip technology were employed to detect and plot protein mass spectrum. The protein peak values were identified using Biomarker Wizard software. Then serum diagnosis model of blood stasis syndrome of lumbar intervertebral disc protrusion was established. The obtained models were verified through double blind method. The differential proteins were searched by ExPASy data.
RESULTS AND CONCLUSION:We detected that peak values of eleven proteins had statistical significance (P<0.05) from the involved 180 cases. Among them, two proteins were highly expressed while the other nine proteins were lowly expressed. Serum protein pattern model for diagnosing blood stasis syndrome of lumbar intervertebral disc protrusion was established through Biomarker Patterns software, and the sensibility was 86.667%, the specificity was 94.167%, the positive predictive value was 88.136%. There are a variety of abnormal y expressed proteins in the serum of the patients with blood stasis syndrome of lumbar intervertebral disc protrusion. The serum protein pattern model involved eleven different proteins can be used to diagnose blood stasis syndrome of lumbar intervertebral disc protrusion.

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) combined with the mirror therapy (MT) on the recovery of upper limb function recovery 3 to 6 months after a stroke.Methods Forty-five male patients were randomly assigned to an MT (A) group,an rTMS+MT (B) group or an MT +rTMS group (C),each of 15.All received conventional medical treatment and stroke rehabilitation.In addition,group A received 60 min of MT daily,5 days a week for 4 weeks.Group B received 10 min of rTMS over the M1 area of the affected hemisphere followed by 50 min of MT treatment,and group C received 50 min of MT treatment followed by 10 min of rTMS.rTMS was delivered at a frequency of 10 Hz and an intensity of 90％ resting motor threshold.The latency of motor evoked potential (MEP) for the affected abductor pollicis brevis muscle and its central motor conduction time (CMCT) were observed before and after the treatment.The upper extremity portion of the Fugl-Meyer assessment (FMA) was performed along with a functional test for the hemiplegic upper extremity (FTHUE).The motricity index (MI) was also quantified.Results Average MEP latency and CMCT had decreased significantly in all three groups after the treatments.The average MEP latency of group B was significantly shorter than that of group A,and CMCT was also significantly shorter than for groups A and C.Moreover,after the intervention,all of the groups had significantly improved their average FMA,MI and FTHUE scores,with the average FMA score of group B significantly better than those of groups A and C.The average FTHUE score of group B was also significantly better than that of group A.Conclusions MT either alone or in combination with rTMS can improve cerebral motor cortex excitability and motor recovery after a stroke.Ten minute rTMS sessions followed by 50 min of MT have the best effect.

Objective:To analyze the correlation between chronic obstructive pulmonary disease (COPD) and cognitive dysfunction.Methods:This is a case-control study. From February 2022 to October 2022, 32 COPD patients (inpatient and outpatient) from the Department of Respiratory and Critical Care Medicine and Rehabilitation Medical Center of the First Affiliated Hospital of Nanjing Medical University and 32 healthy subjects were recruited. All participants underwent a thorough evaluation, which included Montreal Assessment of Cognitive Function (MoCA), visuospatial n-back task included accuracy (ACC) and mean response time (RT), the pulmonary functions including forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), one-second rate (FEV 1/FVC) and maximum volume per minute (MVV), Health Survey Short Form (SF-36), and St. George′s Respiratory Questionnaire (SGRQ). The correlation between cognitive dysfunction and lung function, SF-36 and SGRQ in COPD patients were analyzed. Results:The prevalence of smoking, hypertension and cardiovascular disease in the two groups were significantly different (all P<0.05). MoCA score, 1-back ACC and 2-back ACC in COPD group were significantly lower than those in healthy control group [(23.86±4.50) vs (27.55±1.29) points, (76.82%±16.60%) vs (90.61%±7.40%), (67.93%±10.10%) vs (78.74%±10.38%), all P<0.001]; 2-back RT was significantly higher than that of healthy group [(316.43±108.17) vs (254.09±101.62) ms, P<0.05]; and the Physiological function (PF), physiological function (RP), emotional function (RE), energy (VT), social function (SF), physical pain (BP) in SF-36 were significantly worse than the healthy control group (all P<0.05). The MoCA score of COPD group was positively correlated with FEV 1/FVC ( r=0.501, P=0.018). The 1-back ACC was positively correlated with FEV 1 and FEV 1/FVC ( r=0.568, 0.634; both P<0.05). The 1-back RT was negatively correlated with FEV 1/FVC and MVV ( r=-0.452, -0.534; both P<0.05). The 2-back ACC was positively correlated with FEV 1/FVC ( r=0.426, P=0.048). The 2-back RT was negatively correlated with MVV ( r=-0.571, P=0.006). In COPD group, MoCA score was negatively correlated with activity, influence and total score in SGRQ ( r=-0.533, -0.466, -0.521; all P<0.05). The 1-back ACC was negatively correlated with activity, influence and total score ( r=-0.552, -0.517, -0.584; all P<0.05). The 1-back RT was positively correlated with activity, influence and total score ( r=0.430, 0.379, 0.417; all P<0.05). The 2-back ACC was negatively correlated with impact and total score ( r=-0.398, -0.412; both P<0.05). Conclusion:COPD patients have impaired cognitive function, which is mainly manifested by the decline of working memory and executive function, and is correlated with the lung function, general health condition and quality of life.

BACKGROUND:Anterior subtotal corpectomy,decompression and fusion is a conventional method to treat cervical degenerative diseases.A titanium cage is an important implant to maintain the stability of the cervical spine after subtotal corpectomy.In recent years,many patients have complications such as titanium cage sinking,which are highly controversial. OBJECTIVE:To investigate the internal biomechanical relationship between the tilt angle of the titanium cage and postoperative titanium cage subsidence after anterior subtotal cervical corpectomy,decompression and fusion. METHODS:A three-dimensional finite element model of the C4-C6 segment was established by CT images of a normal human cervical spine,in which the anterior subtotal resection,decompression and fusion of the C5 vertebral body were simulated,and titanium cages with different tilt angles(-6° to-1° negative angle,that is,the front edge of titanium cage is shorter than the rear edge of titanium cage;1° to 6° positive angle,that is,the front edge of titanium cage is longer than the rear edge of titanium cage)were placed.After setting the boundary conditions,preloads of 50,100 and 150 N were applied respectively on the C4 vertebral body.The stress value of each contact point between the titanium cage and C4 lower-end plate and C6 lower-end plate(seven stress contact points on the contact surface of titanium mesh)was recorded and statistical analysis was conducted. RESULTS AND CONCLUSION:(1)The tilt angles of the titanium cage of the positive angle group and negative angle group under 50,100 and 150 N stress respectively were found by Mann Whitn test,with P<0.05,which was statistically significant.The dispersion coefficients of the positive angle group were smaller than those of the negative angle group under 50,100 and 150 N stress conditions.(2)Under 50,100 and 150 N stress conditions,the Wilcoxon sign rank test in the positive angle group of titanium cage tilt angle found that when the angle was set to 1° to 5°,the difference was not statistically significant(P>0.05).However,when the tilt angle of the titanium cage was set to 6°,the difference was statistically significant(P<0.05).(3)Under 50,100 and 150 N stress conditions,the Wilcoxon sign rank test in the negative angle group of titanium cage tilt angle found that when the tilt angle was set to-1° to-6°,the difference was not statistically significant(P>0.05).(4)It is concluded that in the sagittal position,the titanium cage with a positive tilt angle is more stable than with a negative tilt angle,which is more suitable for clinical use.The tilt angle of the titanium cage is relatively stable in the range of 1° to 5°.When the tilt angle is 6°,the stability starts to decline,which is easy to cause complications of titanium cage sinking after surgery.It is more suitable to select the titanium cage with a tilt angle of 1° to 5° according to the clinical situation during surgery to improve the efficacy.

Objective:To investigate anye effect of magnetic stimulation of the sacral nerve (SMS) on acontractile detrusor disorder.Methods:Thirty spinal cord injury patients with neurogenic bladder dysfunction were randomly divided into a stimulation group and a sham group, each of 15. In a first experiment the stimulation group was treated with SMS (over S3) with a bladder volume of 100ml on the 1st day, 200ml on the 2nd day, and 300ml on the 3rd day. Each SMS session involved a total of 1500 pulses at 15Hz in 10-second bursts with 30-second intervals. For the sham group the treatment was ostensibly identical, but the coil was rotated 90 degrees. Maximum detrusor pressure was assessed before and immediately after each SMS session. In a second experiment the bladder volumes were adjusted to 200-300ml ultrasonically before treatment. Both groups were treated twice a day, 5 days a week for 4 weeks. Maximum detrusor pressures were detected at the bladder volumes of 0ml, 100ml, 200ml and 300ml before and after the 4 weeks of treatment.Results:The stimulation group′s average pressures at 200ml and 300ml had increased significantly immediately after SMS and were then significantly higher than the sham group′s averages. After 4 weeks of treatment the stimulation group′s maximum pressures were significantly higher than before treatment at all of the bladder volumes tested, and were significantly better than those of the sham group.Conclusions:SMS can significantly improve detrusor functioning, but the effect is related to bladder volume.