Objective:To analyze the clinical effect of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with neuromuscular joint facilitation(NJF)technique in improving the enhancement of muscle tone after stroke.Methods:From October 2020 to October 22,a total of 114 patients with increased muscle tone at lower limb during the recovery period of stroke who admitted to Beijing Rehabilitation hospital were selected,and they were randomly divided into the observation group(57 cases)and the control group(57 cases)according to the random number table method.The control group received routine rehabilitation treatment.The observation group added low-frequency rTMS and NJF training on the basis of the routine rehabilitation treatment.The differences of clinical efficacy and various indicators of muscle tone of lower limb before and after treatment between two groups were compared,which included modified Ashwonh score(MAS)scale,functional ambulation category(FAC)scale of the motor of lower limb,Fugl-Meyer motor function scale-Lower limbs(FMA-L),clinical spasmodic index(CSI),modified Barthel index(MBI)of activity ability of daily life,integrated electromyogram(IEMG)and root mean square(RMS)of tibialis anterior muscle of lower limb in electromyogram.Results:After intervention,29 cases appeared significant effect,and 23 cases appeared valid result,and 5 cases appeared invalid result in the observation group,and 20 cases appeared significant effect,and 20 cases appeared valid result,and 17 cases appeared invalid result in the control group.The total effective rate of the observation group was 91.23%,which was significantly higher than 70.18%of the control group,and the difference was statistically significant(x2=8.111,P<0.05).Before intervention,there was no statistically significant difference in each indicator between the two groups(P>0.05).The MAS score,CSI score,IEMG and RMS of two groups after intervention were significantly lower than those before intervention,while the FAC score,FMA-L score and MBI score were significantly higher than those before intervention,and the differences were significant(t=3.377,4.398,5.554,P<0.05),respectively.At the same time,the MAS score,CSI score,IEMG and RMS of the observation group were significantly higher than those of the control group,and the differences were statistically significant(t=11.160,9.625,16.993,8.095,P<0.05),respectively.Conclusion:The combined application of low-frequency rTMS and NJF training can significantly improve the enhancement of muscle tone after stroke,and effectively reduce the muscle tone of lower limb,and improve the motor function of lower limb and the degree of spasticity,and improve the activity ability of daily life.

Objective To explore the correlation between frontal QRS-T angle(fQRS-T)and ther-apeutic efficacy for acute pulmonary embolism(APE).Methods A total of 140 APE patients ad-mitted our department from November 2019 to February 2023 were retrospectively enrolled,and according to clinical outcome,they were divided into effective group(99 cases,recovered and im-proved)and ineffective group(41 cases,continued and deteriorated).The general clinical data,ech-ocardiographic parameters[tricuspid annular plane contraction deviation(TAPSE),right atrial transverse diameter,right atrial longitudinal diameter,pulmonary artery systolic pressure(PASP)]and electrocardiogram(ECG)were analyzed in the two groups.Logistic regression mod-el was used to analyze the related factors affecting the treatment efficacy.Results The diastolic blood pressure and TAPSE were significantly higher,while the heart rate,transverse diameter of right atrium,longitudinal diameter of right atrium,PASP and fQRS-T were notably lower in the effective group than the ineffective group(P＜0.05,P＜0.01).Logistic regression analysis showed that TAPSE(OR=1.406,95％CI:1.000-1.158,P=0.048),PASP(OR=0.909,95％CI:0.852-0.969,P=0.003)and fQRS-T(OR=0.946,95％CI:0.901-0.993,P=0.025)were influencing factors for clinical outcome in APE patients.Conclusion FQRS-T is correlated with the therapeu-tic efficacy for APE,and can be used as an indicator to evaluate the therapeutic efficacy.

Objective:To explore the application of transbronchial lung cryobiopsy guided by endobronchial ultrasound sheath (EBUS-GS-TBCB) in diagnosis of nonresolving pneumonias.Methods:Sixty patients with nonresolving pneumonias from March 2019 to July 2020 in Dalian Municipal Central Hospital were selected. The patients were divided into EBUS-GS-TBCB group (31 cases) and transbronchial forcep lung biopsy guided by endobronchial ultrasound sheath(EBUS-GS-TBLB) group (29 cases) by random digits table method.Results:The diagnostic rate of nonresolving pneumonias in EBUS-GS-TBCB group was significantly higher than that in EBUS-GS-TBLB group: 87.10% (27/31) vs. 65.52% (19/29), and there was statistical difference ( χ2 = 3.90, P = 0.048). There were no statistical difference in sensitivity, specificity, accuracy, positive predictive value and negative predictive value between 2 groups ( P>0.05). There were no statistical difference inthe shortest distance from lesions to pleura, incidence of pneumothorax and incidence of bleeding between EBUS-GS-TBCB group and EBUS-GS-TBLB group: (27.42 ± 2.88) mm vs. (27.01 ± 2.37) mm, 6.45%(2/31) vs. 3.45%(1/29) and 22.58%(7/31) vs. 13.79% (4/29), P>0.05. Among the causes of nonresolving pneumonias, infectious factors accounted for 21.67% (13/60), non infectious factors accounted for 66.67% (40/60), and uncertain causes accounted for 11.67% (7/60). Conclusions:The diagnostic rate of EBUS-GS-TBCB in nonresolving pneumonias is significantly higher than EBUS-GS-TBLB, and the complications such as bleeding and pneumothorax do not increase significantly.

BACKGROUND: Little was known about the association among time in range (TIR), time above range (TAR), time below range (TBR), and cancer mortality among patients with type 2 diabetes. We aimed to investigate the association among TIR, TAR, TBR, and the risk of cancer mortality among patients with type 2 diabetes. METHODS: A total of 6225 patients with type 2 diabetes were prospectively recruited in Shanghai, China. TIR was measured with continuous glucose monitoring at baseline and was defined as the average percentage of time in the target glucose range during a 24 h period. Cox proportion hazard regression analysis was used to determine the association between TIR and the risk of cancer mortality. RESULTS: During a mean follow-up of 7.10 years, we confirmed 237 death events related to cancer. The multivariable-adjusted hazard ratio (HR) for cancer mortality was 1.32 (95% confidence interval [CI]: 1.01-1.75) in patients with TIR ≤70% compared with those with TIR >70%. When TIR was considered as a continuous variable, the multivariable-adjusted HR for cancer mortality associated with each 10% decrease in TIR was 1.07 (95% CI: 1.02-1.14). In the site-specific analysis, a significant association between TIR as a continuous variable and the risk of hepatocellular cancer was found (HR: 1.24; 95% CI: 1.09-1.41). However, no relationship between hemoglobin A1c and cancer mortality was observed (HR: 1.04; 95% CI: 0.97-1.10). CONCLUSIONS The present study found an inverse association of TIR with the risk of cancer mortality among patients with type 2 diabetes. New evidence of TIR was added into the clinical practice that TIR may be an optimal target of glycemic control among patients with type 2 diabetes.
Blood Glucose ; Blood Glucose Self-Monitoring ; China ; Diabetes Mellitus, Type 2/complications* ; Humans ; Neoplasms ; Prospective Studies

Objective:To summarize the clinical characteristics and treatment of pituitary thyrotropin mixed secreting adenoma.Methods:The clinical data of 9 patients with pituitary thyrotropin mixed secreting adenoma from January 2008 to December 2019 in Beijing Tiantan Hospital, Capital Medical University, were retrospectively analyzed.Results:Among 9 patients, male was in 7 cases, and female in 2 cases; age was (35.7 ± 13.5) years; course of disease was (3.8 ± 3.1) years; mixed thyrotropin and growth hormone secreting adenoma was in 6 cases; most of them were accompanied with different degrees of thyrotoxicosis, 6 with acromegaly and 2 with amenorrhea and lactation. All the tumors were pituitary macroadenoma, with aggressive growth. Only 1 patient was completely relieved after operation, and most patients needed combined treatment to control the disease.Conclusions:Mixed thyrotropin and growth hormone secreting adenoma is the most common type of the disease, the clinical manifestations are complex, and the tumor is aggressive growth, surgical treatment can not be completely relieved and radiotherapy and/or combination of medicine treatment can help to improve the condition.

Driver gene mutation is one of the most important cause of non-small cell lung cancer (NSCLC), as well as the drug target of target therapy. Patients with different driver mutations have different sensitivity to target therapy drug. So it is crucial to select target drug according to respective driver mutation. Nowadays more and more driver mutation detection come into clinical use for the guidance of NSCLC target therapy as well as more detection methods and commercial reagents were developed and utilized. Clinical and laboratory staff should be more cautious to select appropriate detection targets and reagents. Therefore, the relative target driver mutation and detection reagents in target therapy of NSCLC were reviewed in this paper, according to the China National Medical Products Administration, in order to provide reference for better selection of adequate methods and reagents as well as provide advice for personalized therapy of NSCLC patients.

Objective To evaluate the effect of high-level spinal cord injury(SCI)on the expression of mitochondrial voltage-dependent anion channel 2(VDAC2)in rat cardiomyocytes.Methods Forty-eight pathogen-free healthy adult male Sprague-Dawley rats,weighing 200-250 g,were divided into 2 groups(n=24 each)using a random number table:sham operation group(group S)and high-level SCI group(group H).The animals were anesthetized with intraperitoneal chloral hydrate and subjected to SCI using the modified Allen weight-drop method in group H.The spinal cord was only exposed in group S.At 6,12,24 and 48 h after SCI(T1-4),6 rats in each group were randomly selected and sacrificed,and myocardial specimens were collected from the cardiac apex for microscopic examination of the cell morphology(with a transmission electron microscope) and for determination of cell apoptosis(by TUNEL assay),expression of Bax,Bcl-2 and VDAC2 protein and mRNA in cardiomyocytes(by Western blot and real-time polymerase chain reaction,respectively).The apoptosis rate and ratios of Bax/Bcl-2 protein and mRNA were calculated.Results Compared with group S,the apoptosis rate and ratios of Bax/Bcl-2 protein and mRNA were significantly increased at T1-4,the expression of VDAC2 protein and mRNA was significantly down-regulated at T2-4(P<0.05 or 0.01),and the pathologic changes of cardiomyocytes were aggravated in group H.Conclusion The mechanism of myocardial damage is related to down-regulation of mitochondrial VDAC2 expression in cardiomyocytes and promotion of cell apoptosis in rats with high-level SCI.

Objective To explore the impact of metabolic syndrome (MS)in bone mineral density (BMD) in elderly male type 2 diabetics (T2DM). Methods One hundred and fourty cases were divided into MS group and non-MS(NMS)group according to with or without MS. Height,weight were measured, body mass index(BMI) were calculated and the total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), glycated hemoglobin (HbA1c)were tested. The bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA). The differences among these groups were compared and the risk factors for MS were analyzed. Results The MD, BMI, TC,TG in MS group was higher than that in NMS group (P < 0.05 vs. P < 0.01),and HDL-C was lower than NMS group (P < 0.05). Correlation analysis showed that BMD was negatively correlated with age , TG , HDL-C , and was positively correlated with BMI.The results of multiple stepwise regression analysis showed that age ,HDL-C,BMI were independent risk factors for BMD. Conclusion The BMD significantly increases in T2DM with MS.Obesity and low HDL-C have positive effects in bone mass.

Objective To evaluate the clinical significance of quantitative sensory testing (QST) in screening diabetic peripheral neuropathy of the early stage. Methods One hundred patients with type 2 diabetes mellitus were examined by nerve conduction velocity (NCV) and QST examination. With the NCV positive as the gold criterion for screening diabetic peripheral neuropathy of the early stage, the sensitivity and specificity of QST was further analyzed for diagnosis of the early stage diabetic peripheral neuropathy. Results Among the 100 patients with type 2 diabetes mellitus,there were 41 cases positive and 59 cases negative in NCV examination. On the other hand,there were 74 cases positive,and 26 cases negative in QST. The sensitivity and specificity of QST for the diagnosis of early stage diabetic peripheral neuropathy was 97.56% (40/41) and 42.37% (25/59). Conclusions In the screening of early stage diabetic peripheral neuropathy,QST shows higher detection sensitivity,but lower specificity than NCV examination. Therefore, QST may be an examination for the supplement of the routine electromyography.