Objective To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS)on post-stroke depression(PSD)patients and changes in cerebral white matter fiber tracts based on diffusion tensor imaging.Methods Thirty patients with PSD were randomly divided into rTMS group(n=15)and sham stimulation group(n=15).Based on conventional treatment for cerebrovascular diseases,the rTMS group was given continuous high-frequency(10 Hz)rTMS for 20 sessions,while the sham stimulation group was given sham stimulation for 20 sessions.The NIHSS score,Hamilton depression scale(HAMD)score,Pittsburgh sleep quality index(PSQI)score,Barthel index(BI),and fractional anisotropy(FA)values of various fiber tracts were compared between the two groups before and after treatment.Fifteen non-depressed patients after stroke who visited during the same period were selected as the control group,and the differences in relevant scale scores and imaging indicators between them and PSD patients were compared.Results There were significant differences in left cortical spinal tract(CST),cingulum and cingulate gyrus(CC)and inferior fronto-occipital fasciculus(IFO)FA values among rTMS group,sham stimulation group and control group before treatment(all P＜0.05).There was no significant difference in the FA value of each fiber bundle between rTMS group and sham stimulation group before treatment(all P＞0.05).After treatment,the FA values of left CST,IFO and uncinate fasciculus(Unc)in the rTMS group were significantly higher than those in the sham stimulation group(all P＜0.05).Compared with those before treatment,the HAMD score,PSQI score,NIHSS score after treatment in the rTMS group and the PSQI score,NIHSS score in the sham stimulation group were significantly decreased,and the BI score in the rTMS group and the sham stimulation group was significantly increased(all P＜0.05).Compared with those in the sham stimulation group,the HAMD score and PSQI score were significantly decreased,and the BI score was significantly increased in the rTMS group after treatment(all P＜0.05).The FA values of left CST,CC and IFO in PSD patients were negatively correlated with HAMD score(r=-0.7211,r=-0.6500,r=-0.7265).Conclusions The microstructure damage of left CST,CC and IFO may be involved in the occurrence of PSD.rTMS can repair the microstructure damage of white matter fiber bundles,thus effectively improving the depression of PSD patients.

Objective To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS)on post-stroke depression(PSD)patients and changes in cerebral white matter fiber tracts based on diffusion tensor imaging.Methods Thirty patients with PSD were randomly divided into rTMS group(n=15)and sham stimulation group(n=15).Based on conventional treatment for cerebrovascular diseases,the rTMS group was given continuous high-frequency(10 Hz)rTMS for 20 sessions,while the sham stimulation group was given sham stimulation for 20 sessions.The NIHSS score,Hamilton depression scale(HAMD)score,Pittsburgh sleep quality index(PSQI)score,Barthel index(BI),and fractional anisotropy(FA)values of various fiber tracts were compared between the two groups before and after treatment.Fifteen non-depressed patients after stroke who visited during the same period were selected as the control group,and the differences in relevant scale scores and imaging indicators between them and PSD patients were compared.Results There were significant differences in left cortical spinal tract(CST),cingulum and cingulate gyrus(CC)and inferior fronto-occipital fasciculus(IFO)FA values among rTMS group,sham stimulation group and control group before treatment(all P＜0.05).There was no significant difference in the FA value of each fiber bundle between rTMS group and sham stimulation group before treatment(all P＞0.05).After treatment,the FA values of left CST,IFO and uncinate fasciculus(Unc)in the rTMS group were significantly higher than those in the sham stimulation group(all P＜0.05).Compared with those before treatment,the HAMD score,PSQI score,NIHSS score after treatment in the rTMS group and the PSQI score,NIHSS score in the sham stimulation group were significantly decreased,and the BI score in the rTMS group and the sham stimulation group was significantly increased(all P＜0.05).Compared with those in the sham stimulation group,the HAMD score and PSQI score were significantly decreased,and the BI score was significantly increased in the rTMS group after treatment(all P＜0.05).The FA values of left CST,CC and IFO in PSD patients were negatively correlated with HAMD score(r=-0.7211,r=-0.6500,r=-0.7265).Conclusions The microstructure damage of left CST,CC and IFO may be involved in the occurrence of PSD.rTMS can repair the microstructure damage of white matter fiber bundles,thus effectively improving the depression of PSD patients.

Objective:To analyze the efficacy and safety of nalbuphine for analgesia in patients with non-mechanical ventilation in intensive care unit (ICU).Methods:From December 2018 to August 2021, a multicenter randomized controlled clinical study was conducted to select non-mechanical ventilation patients with analgesic needs admitted to ICU of four hospitals in Henan Province and Guizhou Province. Patients were randomly assigned to nalbuphine group and fentanyl group. The nalbuphine group was given continuous infusion of nalbuphine [0.05~0.20 mg/(kg·h)], and the fentanyl group was given continuous infusion of fentanyl [0.5~2.0 μg/(kg·h)]. The analgesic target was critical-care pain observation tool (CPOT) score<2. The observation time was 48 hours. The primary endpoint was CPOT score, the secondary endpoints were Richmond agitation-sedation score (RASS), ICU length of stay, adverse events, and proportion of mechanical ventilation. The quantitative data of the two groups were compared by t test or Mann-Whitney U test. The enumeration data were compared by chi square test or Fisher exact probability method. The data at different time points between groups were compared by repeated measures analysis of variance. Results:A total of 210 patients were enrolled, including 105 patients in the nalbuphine group and 105 patients in the fentanyl group. There was no significant difference in baseline data between the two groups (all P>0.05). There was no significant difference in CPOT score between nalbuphine group and fentanyl group at each time point after medication ( P>0.05), the CPOT score of both groups at each time point after medication was significantly lower than that before medication, and the analgesic target could be achieved and maintained 2 hours after medication. There was no significant difference in RASS between the two groups at each time point after medication ( P>0.05), which was significantly lower than that before medication, and the target sedative effect was achieved 2 hours after medication. There was no significant difference in ICU length of stay between nalbuphine group and fentanyl group [5.0(4.0,7.5) d vs. 5.0(4.0,8.0) d, P=0.504]. The incidence of delirium, nausea and vomiting, abdominal distension, pruritus, vertigo and other adverse events in the nalbuphine group was lower than that in the fentanyl group (all P<0.05). There was no significant difference in the incidence of other adverse events such as deep sedation, hypotension and bradycardia between the two groups (all P>0.05). The incidence of respiratory depression in nalbuphine group was not significantly different from that in fentanyl group ( P>0.05), but the proportion of mechanical ventilation was significantly lower than that in the fentanyl group [1.9% (2/105) vs. 8.6%(9/105), P=0.030]. Conclusions:Nalbuphine could be used for analgesia in ICU patients with non-mechanical ventilation. The target analgesic effect could be achieved within 2 hours, and it had a certain sedative effect with a low incidence of adverse reactions.

The depth of invasion is a new index in the 8th edition of TNM classification and staging of oral cancer. Currently, there is no standardized evaluation method for the diagnosis of bone invasion and depth of invasion in lower gingival squamous cell carcinoma (LGSCC). The evaluation of LGSCC bone invasion depth not only provides a reference for surgical margin, but also determines the choice of surgical method, and is an independent prognostic factor for predicting cervical lymphatic metastasis. At present, the main evaluation methods of LGSCC bone invasion and invasion depth include X-ray, MRI, CT, positron emission tomography(PET)/CT, PET/MRI, singlephoton emission CT(SPECT)/CT and pathological examination. In this paper, the evaluation methods and effects of LGSCC bone invasion and invasion depth are summarized, and its advantages and disadvantages are analyzed in order to provide reference for clinical application.

Objective:To investigate the application value of reactive oxygen species (ROS) and adiponectin (ADPN) in the judgment of liver inflammation in chronic hepatitis B virus infection combined with nonalcoholic fatty liver disease (NAFLD).Methods:A total of 159 cases with NAFLD (21 cases), chronic hepatitis B virus infection (57 cases), and chronic hepatitis B virus infection combined with NAFLD (81 cases) were collected between June 2016 to December 2018, and the visited patients diagnosis were confirmed by histopathological examination of the liver. ROS and ADPN level retained in serum was determined by enzyme-linked immunosorbent assay. Histopathological examination of liver tissue was used as the gold standard to discuss the diagnostic value of the serum in patients with chronic hepatitis B virus infection combined with NAFLD for the occurrence of nonalcoholic steatohepatitis. One-way analysis of variance was used for the comparison among multiple groups, and LSD-t test was used for pairwise comparison between groups. Measurement data for non-normal distributions were expressed as M (P25, P75). Comparisons between groups were performed using the Mann-Whitney U or Kruskal-Wallis H test. Chi-square test was used to compare the count data between groups. Correlation analysis was performed using Spearman correlation analysis. Histopathological grouping of liver tissue was used as the gold standard, and the area under the receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the regression formula.Results:(1) In patients with chronic hepatitis B virus infection combined with NAFLD, the levels of ROS in the non-hepatic steatosis group and the mild hepatic steatosis group were significantly lower than those in the moderate and severe hepatic steatosis group, while the ADPN level in the non-hepatic steatosis group was significantly higher than liver steatosis group, P < 0.05. (2) The results of correlation analysis showed that ROS was significantly correlated with NAS score, change in the degree of fatty liver and lobular inflammation (all P < 0.05).There was a significant negative correlation between ADPN and the change in the degree of fatty liver ( P < 0.05). (3) Logistic regression analysis results showed that the diagnostic formula for chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis was 0.02 × controlled attenuation index + 0.584 × white blood cells/10 9 + 0.587 × ROS-10.982. The area under receiver operating characteristic curve of the subject was = 0.896. The sensitivity, specificity, positive and negative predictive value were 97.1%, 71.2%, 64.2%, and 97.9%. Conclusion:ADPN and ROS have certain reference value in differentiating the change in the degree of fatty liver and inflammation in chronic hepatitis B virus infection combined with NAFLD and the diagnostic formula has higher application value in the diagnosis and exclusion of chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis.

Objective: To detect the levels of D-dimer (D-D) and fibrinogen (Fbg) in plasma of patients with malignant tumors, and to evaluate the diagnostic value of combined detection of D-D and Fbg. Methods: The clinical data of 99 patients with malignant tumors were retrospectively analyzed, including 47 patients in DVT group and 52 patients in control group. DVT diagnosis was based on color Doppler or venography. The ROC curve was used to evaluate the diagnostic value of D-D, Fbg and the combination of D-D and Fbg for the malignant tumor patients with DVT. Results: The D-D levels in the DVT group and the control group were 7.17 μg/ml and 4.25 μg/ml, respectively, and the Fbg levels were 4.01 mg/ml and 2.02 mg/ml, respectively, and the differences were statistically significant (all P<0.01). For the area under the ROC curve (AUC), specificity and sensitivity for diagnosing malignant tumors with DVT, D-D were 0.728, 62.50%, and 72.50%, respectively, and Fbg was 0.642, 65.50%, and 58.80%, respectively, and D-D+Fbg was 0.764, 83.30% and 59.00% respectively. Conclusions D-D and Fbg has a significantly high level in malignant tumor patients with DVT. The combined detection of D-D and Fbg has potential application value in the early diagnosis, early intervention and better prognosis for the malignant tumors patients with DVT.

AIM:To investigate the molecular mechanism of Xijiao Dihuang decoction combined with Yinqiao powder (XDY) in treating viral pneumonia, and the effects of XDY on TNF-α-induced permeability in pulmonary microvascular endothelial cells (PMVEC) and the role of PKC-SSeCKS pathway involved.METHODS:The electric conductivity method was used to detect transendothelial electrical resistance (TER) of primarily cultured PMVEC on Transwell chamber at different time points to determine the permeability of PMVEC.After pretreatment for 24 h, the activity of PKC, TER, and the expression of SSeCKS at mRNA and protein levels were detected.Laser scanning confocal microscopy was used to observe the location of SSeCKS and construction of F-actin in PMVEC.RESULTS:The permeability of PMVECs induced by TNF-α reached the peak at 24 h.Compared with control group, the TER in TNF-α group was decreased, and the activity of PKC was increased.Compared with TNF-α group, the activity of PKC in TNF-α with PKC inhibitor group and TNF-α with XDY group was decreased, while the TER was increased, without difference from control group.Compared with control group, the mRNA expression of SSeCKS and phospho-SSeCKS was increased in PMVEC of TNF-α group, but decreased in TNF-α with XDY group compared with TNF-α group.In control group, F-actin was mainly located around the nucleus and at cytoplasmic borders of PMVEC, forming the dense peripheral bundle, and SSeCKS was evenly scattered in the cell.In TNF-α group, the dense peripheral bundle of F-actin surrounding the cells almost disappeared, and SSeCKS was concentrated around the nucleus.Compared with TNF-α group, the distribution and the structure of F-actin and SSeCKS nearly returned to normal in TNF-α with XDY group.CONCLUSION:XDY inhibits the activation of PKC signaling pathway in PMVEC caused by TNF-α to reduce the mRNA expression of SSeCKS and the phosphorylation of SSeCKS, thus preventing the deformation of endothelial cells and reducing the permeability of PMVEC.

Purpose To explore the application of single index,double exponential and tensile density index model diffusion weighted imaging and other parameters on endometrial carcinoma diagnosis to offer new ideas for it.Materials and Methods Intravoxel incoherent motion imaging data of 28 endometrial carcinoma patients and 24 patients of normal endometrium were analyzed retrospectively.Single index,double exponential and DWI parameter of endometrial carcinoma tissue and normal endometrial tissue were measured respectively,including standard apparent diffusion coefficient (ADC-stand),slow apparent diffusion coefficient (ADC-slow),fast apparent diffusion coefficient (ADC-fast,perfusion fraction (f),distributed diffusion coefficient (DDC) and a.Receiver operator characteristic (ROC) curve was adopted to assess threshold value and diagnostic efficiency of each parameter,and analyzed difference among each parameter in two groups and relativity of each parameter in the same group.Results ADC-stand,ADC-slow,f,DDC and a in endometrial carcinoma group were all lower than those in normal endometrium group.The difference was statistically significant (P＜0.05).The difference of ADC-fast was not statistically significant (P＞0.05).Areas of ADC-stand and ADC-slow on ROC curve were 0.949 and 0.911 respectively,and threshold values were 1.245×10-3 mm2/s and 0.998× 10-3 mm2/s.ADC-stand in endometrial carcinoma group was positive correlated with ADC-slow and DDC value (r=0.787 and 0.880,P＜0.05).ADC-slow was significantly lower than ADC-stand (P＜0.05).Conclusion The differences in single index,double exponential and DWI can provide new ideas for endometrial carcinoma diagnosis.

Objective:To investigate the association of the rsl801133 polymorphisms of the methylenetetrahydrofolate reductase (MTHFR)gene and rs2236225 polymorphisms of the methylenetetrahydrofolate dehydrogenase(MTHFD1)gene with non-syndromic cleft lip with or without cleft palate (NSCL/P)in Chinese population of Shanxi Province.Methods:The rsl801133 polymorphism of MTHFR gene and rs2236225 polymorphism of MTHFD1 gene were examined by PCR-RFLP in 265 patients with NSCL/P and 276 healthy controls.Data were statistically analysed.Results:The genotypic distribution of rsl801133 and rs2236225 was not deviated from the Hardy-Weinberg equilibrium.There was no significant difference in allele frequencies of rsl801133 and rs2236225 variants between patients with NSCL/P and healthy individuals(P <0.05).Conclusion:The polymorphism of MTHFR gene and MTHFD1 gene was not associated with NSCL/P in Chinese population of Shanxi Province.

Objective To observe the migration ofmesenchymal stem cells (MSCs) transfected with recombinant lentiviral vectors carried brain derived neurotrophic factor (BDNF) gene from lateral ventricle to intracerebral hemorrhage stove in rats and to discuss the protective effect of BDNF on MSCs.Methods Intracerebral hemorrhagic models were constructed in 60 SD rats and randomly divided into 4 groups:phosphate buffer solution (PBS) group,BMSCs group,BMSCs-enhanced green fluorescent protein (EGFP) group and BMSCs-EGFP-BDNF group (n=15); PBS,BMSCs,lentiviral vector (LV)carried EGFP and LV carried BDNF-EGFP were,respectively,injected into the lateral cerebral ventricle of each group; 7,14 and 21 d after the injection,BDNF protein expression in the BMSCs of each group was detected by Western blotting and immunofluorescence; the migration of BMSCs from lateral ventricle to intracerebral hemorrhage stove was observed by signal labeling immunofluorescent staining.Results Western blotting and immunofluorescence showed that the BDNF protein expression in the MSCs-EGFP-BDNF group was significantly higher than that in the MSCs group and MSCs-EGFP group (P＜0.05); signal labeling immunofluorescent staining of brain tissue section indicated that the MSCs-EGFP-BDNF group had significantly larger number of BMSCs-positive cells which migrated to the surrounding issues of intracerebral hemorrhage stove than MSCs group and MSCs-EGFP group (P＜0.05),while there were no significant differences between the latter two except on the 7th d of establishment of models.Conclusion BMSCs modified with recombinant LV carried BDNF gene have high expression level of BDNF,indicating that BDNF performs a protective effect on BMSCs.