OBJECTIVE:Most of the existing studies are based on traditional Meta-analysis to study the efficacy of single stimulation protocols such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor dysfunction in stroke patients,and it is not possible to clarify which stimulation protocol is the optimal choice.This study used network meta-analysis to systematically evaluate the clinical efficacy of different regimens of non-invasive brain stimulation in the treatment of lower limb motor dysfunction after stroke.METHODS:CNKI,WanFang,VIP,CBM,PubMed,Medline and Web of Science databases were searched to collect randomized controlled trials on different regimens of non-invasive brain stimulation for lower limb motor dysfunction after stroke from inception to October 1,2024.Data extraction was performed on the included studies.RevMan 5.4.1 software was used for traditional meta-analysis and the quality of the included studies was evaluated.Stata 17.0 software was used for network meta-analysis.RESULTS:(1)A total of 39 studies involving 2 920 patients were included,involving 6 treatment methods:conventional rehabilitation training,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,intermittent theta burst stimulation,continuous theta burst stimulation,and transcranial direct current stimulation.(2)The results of network meta-analysis showed that high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,intermittent theta burst stimulation,and transcranial direct current stimulation were superior to conventional rehabilitation training in the Fugl-Meyer assessment for lower extremity motor function.(3)In terms of improving Berg balance scale score,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,and intermittent theta burst stimulation were significantly different from conventional rehabilitation training(P＜0.05),and there was a significant difference between high-frequency repetitive transcranial magnetic stimulation and intermittent theta burst stimulation(P＜0.05).(4)In improving modified Barthel index and Barthel index,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,intermittent theta burst stimulation,and transcranial direct current stimulation were superior to conventional rehabilitation training.(5)Under the cumulative ranking chart,high-frequency repetitive transcranial magnetic stimulation showed the best efficacy in Fugl-Meyer assessment for lower extremity motor function,Berg balance scale score,modified Barthel index and Barthel index,followed by low-frequency repetitive transcranial magnetic stimulation.CONCLUSION:Both high-and low-frequency repetitive transcranial magnetic stimulation can improve the lower limb motor function and balance function of patients with stroke,and can improve the activities of daily living of patients to varying degrees.Moreover,the effect of high-frequency repetitive transcranial magnetic stimulation is better than that of low-frequency repetitive transcranial magnetic stimulation.

OBJECTIVE:Most of the existing studies are based on traditional Meta-analysis to study the efficacy of single stimulation protocols such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor dysfunction in stroke patients,and it is not possible to clarify which stimulation protocol is the optimal choice.This study used network meta-analysis to systematically evaluate the clinical efficacy of different regimens of non-invasive brain stimulation in the treatment of lower limb motor dysfunction after stroke.METHODS:CNKI,WanFang,VIP,CBM,PubMed,Medline and Web of Science databases were searched to collect randomized controlled trials on different regimens of non-invasive brain stimulation for lower limb motor dysfunction after stroke from inception to October 1,2024.Data extraction was performed on the included studies.RevMan 5.4.1 software was used for traditional meta-analysis and the quality of the included studies was evaluated.Stata 17.0 software was used for network meta-analysis.RESULTS:(1)A total of 39 studies involving 2 920 patients were included,involving 6 treatment methods:conventional rehabilitation training,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,intermittent theta burst stimulation,continuous theta burst stimulation,and transcranial direct current stimulation.(2)The results of network meta-analysis showed that high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,intermittent theta burst stimulation,and transcranial direct current stimulation were superior to conventional rehabilitation training in the Fugl-Meyer assessment for lower extremity motor function.(3)In terms of improving Berg balance scale score,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,and intermittent theta burst stimulation were significantly different from conventional rehabilitation training(P＜0.05),and there was a significant difference between high-frequency repetitive transcranial magnetic stimulation and intermittent theta burst stimulation(P＜0.05).(4)In improving modified Barthel index and Barthel index,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,intermittent theta burst stimulation,and transcranial direct current stimulation were superior to conventional rehabilitation training.(5)Under the cumulative ranking chart,high-frequency repetitive transcranial magnetic stimulation showed the best efficacy in Fugl-Meyer assessment for lower extremity motor function,Berg balance scale score,modified Barthel index and Barthel index,followed by low-frequency repetitive transcranial magnetic stimulation.CONCLUSION:Both high-and low-frequency repetitive transcranial magnetic stimulation can improve the lower limb motor function and balance function of patients with stroke,and can improve the activities of daily living of patients to varying degrees.Moreover,the effect of high-frequency repetitive transcranial magnetic stimulation is better than that of low-frequency repetitive transcranial magnetic stimulation.

ObjectiveTo evaluate the effects of Tongnaoyin on the blood-brain barrier status and neurological impairment in acute ischemic stroke （AIS） patients with the syndrome of phlegm-stasis blocking collaterals by dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI）. MethodsA total of 63 patients diagnosed with AIS in the Jiangsu Province Hospital of Chinese Medicine from October 2022 to December 2023 were enrolled in this study. According to random number table method，the patients were assigned into a control group （32 cases） and an observation group （31 cases）. The control group received conventional Western medical treatment，and the observation group took 200 mL Tongnaoyin after meals，twice a day from day 2 of admission on the basis of the treatment in the control group. After 7 days of treatment，the patients were examined by DCE-MRI. The baseline data for two groups of patients before treatment were compared. The National Institute of Health Stroke Scale （NIHSS） score and modified Rankin Scale （mRS） score were recorded before treatment and after 90 days of treatment for both groups. The rKtrans，rKep，and rVe values were obtained from the region of interest （ROI） of the infarct zone/mirror area and compared between the two groups. ResultsThere was no significant difference in the NIHSS or mRS score between the two groups before treatment. After 90 days of treatment，the NIHSS and mRS scores declined in both groups，and the observation group had lower scores than the control group （P<0.05）. After treatment，the rKtrans and rVe in the observation group were lower than those in the control group （P<0.01）. ConclusionCompared with conventional Western medical treatment alone，conventional Western medical treatment combined with Tongnaoyin accelerates the repair of the blood-brain barrier in AIS patients，thereby ameliorating neurological impairment after AIS to improve the prognosis.

Objective To investigate the effects of acteoside in a rat model on of diabetic nephropathy(DN)and high-glucose-induced glomerular mesangial cells(GMCs),focusing on the role of acteoside in the silent information regulator 1(SIRT1)/nuclear factor eryth-roid 2-related factor 2(Nrf2)signaling pathway.Methods GMCs were cultured under normal glucose conditions or stimulated with high glucose.Fibrosis,oxidative stress,SIRT1 and Nrf2 protein expression,and mitochondrial structure were assessed in four groups:normal glucose,high glucose,high glucose+acteoside,and high glucose+acteoside+SIRT1 inhibitor(hsa62).DN was induced in rats via intraperitoneal streptozotocin injection,and animals were divided into control,model,and acteoside-treated groups.Pathological kidney changes,blood glucose changes,renal function indices,and protein expression of SIRT1 and Nrf2 were evaluated.Results Compared with controls,DN model rats showed significantly elevated fasting blood glucose,serum creatinine,blood urea nitrogen,and 24-h urinary protein levels of rats in the model group were significantly increased(P＜0.01).GMCs exhibited increased fibrosis,oxidative stress,and mitochondrial damage.Acteoside treatment significantly improved all measured parameters(P＜0.01);and mitigated mitochondrial injury.In vitro,acteoside reduced high-glucose-induced fibrosis and oxidative stress in GMCs,effects that were reversed by SIRT1 inhibition.Western blotting confirmed upregulation of SIRT1 and Nrf2 expression in both treated rat kidney tissues and GMCs(P＜0.01).Conclusion Acteoside alleviates glomerular fibrosis and oxidative stress in DN by activating the SIRT1/Nrf2 signaling pathway,suggesting its potential therapeutic agent for DN.

Objective To explore causal relationship between 25-hydroxyvitamin D[25(OH)D]and ankylosing spondylitis(AS).Methods Genetic data of 25(OH)D and AS were extracted from the genome-wide association study.The causal effect of 25(OH)D on AS was estimated by MR-Egger regression method,weighted median,inverse variance weighted(IVW),simple mode and weighted mode,and sensitivity analysis was conducted for verification.Results The IVW results indicated that there was a causal relationship between 25(OH)D concentration and AS(OR=0.805,95％CI:0.686-0.944,P=0.008),and the maximum likelihood ratio(OR=0.799,95％CI:0.678-0.940,P=0.007)showed consistent results.The IVW results of the reverse Mendelian randomization study showed that there was no causal relationship between the two(OR=1.019,95％CI:0.995-1.043,P=0.110).In addition,MR-Egger intercept,Cochran Q test,"leave-one-out"and MR-PRESSO analysis showed no horizontal pleipotency or heterogeneity.Conclusion There may be a genetic causal relationship between the concentration of 25(OH)D and the onset of AS.AS cannot cause changes in the concentration of 25(OH)D in the body.

Objective To investigate the effects of acteoside in a rat model on of diabetic nephropathy(DN)and high-glucose-induced glomerular mesangial cells(GMCs),focusing on the role of acteoside in the silent information regulator 1(SIRT1)/nuclear factor eryth-roid 2-related factor 2(Nrf2)signaling pathway.Methods GMCs were cultured under normal glucose conditions or stimulated with high glucose.Fibrosis,oxidative stress,SIRT1 and Nrf2 protein expression,and mitochondrial structure were assessed in four groups:normal glucose,high glucose,high glucose+acteoside,and high glucose+acteoside+SIRT1 inhibitor(hsa62).DN was induced in rats via intraperitoneal streptozotocin injection,and animals were divided into control,model,and acteoside-treated groups.Pathological kidney changes,blood glucose changes,renal function indices,and protein expression of SIRT1 and Nrf2 were evaluated.Results Compared with controls,DN model rats showed significantly elevated fasting blood glucose,serum creatinine,blood urea nitrogen,and 24-h urinary protein levels of rats in the model group were significantly increased(P＜0.01).GMCs exhibited increased fibrosis,oxidative stress,and mitochondrial damage.Acteoside treatment significantly improved all measured parameters(P＜0.01);and mitigated mitochondrial injury.In vitro,acteoside reduced high-glucose-induced fibrosis and oxidative stress in GMCs,effects that were reversed by SIRT1 inhibition.Western blotting confirmed upregulation of SIRT1 and Nrf2 expression in both treated rat kidney tissues and GMCs(P＜0.01).Conclusion Acteoside alleviates glomerular fibrosis and oxidative stress in DN by activating the SIRT1/Nrf2 signaling pathway,suggesting its potential therapeutic agent for DN.

Objectives:To analyze the 3D structural characteristics and discuss the clinical significance of pedicle-isthmus complex(PIC)through measuring the anatomical and morphological parameters of normal axis PIC.Methods:The imaging data of 100 patients without high-riding vertebral artery[57 males,43 females,56.1±1.8(18-79)years]undergone CT angiography(CTA)examinations of the cervical spine or neck and admitted to the Affiliated Hospital of Southwest Medical University between January 2022 and December 2022,and another 28 patients[15 males,13 females,55.5±14.6(18-80)years]undergone posterior C2 pedicle screw fixation and examined with CT scan of the cervical spine during the same period were collected.The original CT data were uploaded to Mimics 21.0 software,and bilateral PICs were segmented from the axis to construct a new coordinate axes with multiplanar reconstruction(MPR)technology.The upper,middle and lower faults of the PIC were cut on the new axes,and the front-most,narrowest and back-most parts of the PIC were determined.The widths of the front-most,narrowest and,back-most parts and inclination angles of the upper,middle and lower faults of PIC were measured on 3D images.Based on whether the PIC was punctured or not,the patients implanted with posterior C2 pedicle screws were divided into punctured group and non-punctured group.Using the axis pedicle screw as reference,the image parameters of screw position were measured,including the height from the screw midpoint to the PIC upper wall,the width of the screw midpoint to the PIC inner wall,and the screw inclination angle.Results:There was no statistical difference between the left and right side of PIC parameters in 100 patients.The width of PIC in males was greater than that in females at all levels,and the difference was statistically significant(P＜0.05).The results of PIC width from a coronal perspective showed that the overall width of the upper layer was 9.6±1.3mm,the overall width of the middle layer was 9.5±1.4mm,and the overall width of the lower layer was 8.0±1.1mm.There was no statistical difference between the overall width of the upper layer and the middle layer(P=0.41),while the difference between the other layers was statistically significant(P＜0.05).The overall width of the PIC from the cross-sectional perspective showed that the overall width of the front-most part was 8.8±1.4mm,the overall width of the narrowest part was 7.2±1.3mm,and the overall width of the back-most part was 11.0±1.5mm,with statistical significance among all layers(P＜0.05).The results of PIC inclination showed that the upper layer inclination was 15.1°±8.7°,the middle layer inclination was 19.5°±8.4°,and the lower layer inclination was 26.3°±9.0°,and the differences among all layers were statistically significant(P＜0.05).In the 28 patients fixed with posterior C2 pedicle screw,a total of 50 screws were inserted,with 25 screws each in the punctured group and non-punctured group.The distances from the screw midpoint to PIC upper wall[4.4(3.6-5.3)mm]and PIC inner wall[3.3(2.8-3.8)mm]in the non-punctured group was smaller than those in the punctured group[5.1(4.5-6.0)mm and 4.0(3.1-5.4)mm,P＜0.05].No statistical differences was found between the two groups in the screw inclination angles[17.6°(10.5°-21.5°)vs 16.9°(9.6°-23.1°),P=0.854].Conclusions:The normal PIC without high riding vertebral artery is wide at top and narrow at bottom in the coronal view,and wide at front and back and thin in the middle in the transverse view.The gradual increase of the internal inclination angle from top to bottom indicates that the 3D structure of PIC is distorted.Analyzing the axis PIC as a whole is helpful to better understand its anatomical morphology and change characteristics,and to guide the selection of safe strategies in implanting axial pedicle screws.

Objectives:To analyze the 3D structural characteristics and discuss the clinical significance of pedicle-isthmus complex(PIC)through measuring the anatomical and morphological parameters of normal axis PIC.Methods:The imaging data of 100 patients without high-riding vertebral artery[57 males,43 females,56.1±1.8(18-79)years]undergone CT angiography(CTA)examinations of the cervical spine or neck and admitted to the Affiliated Hospital of Southwest Medical University between January 2022 and December 2022,and another 28 patients[15 males,13 females,55.5±14.6(18-80)years]undergone posterior C2 pedicle screw fixation and examined with CT scan of the cervical spine during the same period were collected.The original CT data were uploaded to Mimics 21.0 software,and bilateral PICs were segmented from the axis to construct a new coordinate axes with multiplanar reconstruction(MPR)technology.The upper,middle and lower faults of the PIC were cut on the new axes,and the front-most,narrowest and back-most parts of the PIC were determined.The widths of the front-most,narrowest and,back-most parts and inclination angles of the upper,middle and lower faults of PIC were measured on 3D images.Based on whether the PIC was punctured or not,the patients implanted with posterior C2 pedicle screws were divided into punctured group and non-punctured group.Using the axis pedicle screw as reference,the image parameters of screw position were measured,including the height from the screw midpoint to the PIC upper wall,the width of the screw midpoint to the PIC inner wall,and the screw inclination angle.Results:There was no statistical difference between the left and right side of PIC parameters in 100 patients.The width of PIC in males was greater than that in females at all levels,and the difference was statistically significant(P＜0.05).The results of PIC width from a coronal perspective showed that the overall width of the upper layer was 9.6±1.3mm,the overall width of the middle layer was 9.5±1.4mm,and the overall width of the lower layer was 8.0±1.1mm.There was no statistical difference between the overall width of the upper layer and the middle layer(P=0.41),while the difference between the other layers was statistically significant(P＜0.05).The overall width of the PIC from the cross-sectional perspective showed that the overall width of the front-most part was 8.8±1.4mm,the overall width of the narrowest part was 7.2±1.3mm,and the overall width of the back-most part was 11.0±1.5mm,with statistical significance among all layers(P＜0.05).The results of PIC inclination showed that the upper layer inclination was 15.1°±8.7°,the middle layer inclination was 19.5°±8.4°,and the lower layer inclination was 26.3°±9.0°,and the differences among all layers were statistically significant(P＜0.05).In the 28 patients fixed with posterior C2 pedicle screw,a total of 50 screws were inserted,with 25 screws each in the punctured group and non-punctured group.The distances from the screw midpoint to PIC upper wall[4.4(3.6-5.3)mm]and PIC inner wall[3.3(2.8-3.8)mm]in the non-punctured group was smaller than those in the punctured group[5.1(4.5-6.0)mm and 4.0(3.1-5.4)mm,P＜0.05].No statistical differences was found between the two groups in the screw inclination angles[17.6°(10.5°-21.5°)vs 16.9°(9.6°-23.1°),P=0.854].Conclusions:The normal PIC without high riding vertebral artery is wide at top and narrow at bottom in the coronal view,and wide at front and back and thin in the middle in the transverse view.The gradual increase of the internal inclination angle from top to bottom indicates that the 3D structure of PIC is distorted.Analyzing the axis PIC as a whole is helpful to better understand its anatomical morphology and change characteristics,and to guide the selection of safe strategies in implanting axial pedicle screws.

Objective:To investigate the efficacy of different treatment of oral lichen planus (OLP) patients with thyroid antibody positive and its correlation with thyroid antibody, providing more targeted treatment for OLP patients with thyroid antibody positive.Methods:Patients who were admitted to Department of Oral Medicine, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine for OLP with serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) from February 2020 to June 2024 were included. Demographic and clinical data were recorded, and qualitative status and quantitative titers of TPOAb/TGAb were collected. TPOAb and/or TGAb positive patients were included into the thyroid antibody positive group, while patients with both TPOAb and TGAb negative were included into the thyroid antibody negative group. According to the treatment methods, they were divided into topical treatment group, topical treatment combined with oral immunosuppressant group, and topical treatment combined with oral immunoenhancer group. After 2 weeks and 1 month of treatment, the clinical efficacy of thyroid antibody positive group and negative group in OLP patients under different treatment methods were compared, and the correlations of different clinical efficacy with age, sex and thyroid antibody titer were analyzed.Results:A total of 116 OLP patients were included in this study, of which 38 (32.8%) were thyroid antibody positive and 78 (67.2%) were thyroid antibody negative. Compared with untreated, the modified OLP score and pain degree in thyroid antibody negative group were significantly improved after 2 weeks and 1 month of topical treatment and topical treatment combined with oral immunosuppression ( P<0.01). Although the thyroid antibody positive group also showed a remission trend, there was no statistical significance before and after treatment ( P>0.05). For topical treatment combined with oral immunoenhancer, the modified OLP score and pain degree in both groups of antibody positive and negative were statistically significant different after 2 weeks and 1 month of treatment compared with before ( P<0.01), while there was no statistically significant difference between the two groups ( P>0.05). Multivariate Logistic regression analysis showed that the treatment efficacy of OLP in topical treatment group, topical treatment combined with oral immunosuppressant group, and topical treatment combined with oral immunoenhancer group had no significant correlation with age, sex, as well as the TPOAb and TGAb titer ( P>0.05). Conclusions:Thyroid antibody TPOAb and TGAb could be reference factors for the selection of OLP treatment plan. For patients of OLP with positive thyroid antibodies, topical therapy combined with oral immunoenhancers may be preferred.

Post-stroke spasticity is a series of symptoms after stroke,such as hand and foot urgency,unflexion and extension of muscles,etc.In order to deeply understand the cognition of post-stroke spasticity of ancient Chinese physicians and comb out their therapeutic thoughts,this study took the General Catalogue of Chinese Ancient Books of Traditional Chinese Medicine as a bibliographic reference,all the ancient Chinese literature on spasms after stroke was retrieved manually and by computer,and then sorted and analyzed,and classified them by longitudinal time,and extracted the description about post-stroke spasticity,including medical classics,prescriptions,clinical evidence,medical records and so on.And this paper verified and summarized the etiology,pathogenesis,functional and indications and prescription characteristics of spasticity after stroke,in order to deeply understand systematic theories and treatment ideas of the ancient medical practitioners in the bud,development and mature stages of their understanding of spasticity after stroke,and provide the theoretical basis for the later doctors to understand this disease and the modern clinical treatment of traditional Chinese medicine.