OBJECTIVE:To systematically evaluate the efficacy of transcranial direct current stimulation on the motor function of patients with Parkinson's disease,and to compare the efficacy of transcranial direct current stimulation at different targets on the motor function of patients with Parkinson's disease,so as to provide a theoretical basis for the target selection of transcranial direct current stimulation in clinical practice. METHODS:Cochrane Library,PubMed,Web of Science,CNKI,VIP,WanFang Data were retrieved for randomized controlled trials on the improvement of motor function in patients with Parkinson's disease by transcranial direct current stimulation published from the database inception to January 2023.The keywords were"Parkinson,transcranial direct current stimulation"in English and Chinese.The quality of the included studies was evaluated using the Cochrane 5.1.0 risk of bias assessment tool and the PEDro scale.Meta-analysis of outcome indicators was performed using RevMan 5.4 and Stata 17.0 software. RESULTS:Fifteen randomized controlled trials were finally included,and the PEDro scale showed that all were high-quality or very high-quality studies.Meta-analysis showed that transcranial direct current stimulation significantly improved Unified-Parkinson Disease Rating Scale part III score[mean difference(MD)=-2.49,95%confidence interval(CI):-4.42 to-0.55,P<0.05),step frequency score(MD=0.07,95%CI:0.03-0.11,P<0.05)and step speed score(MD=0.02,95%CI:0.00-0.05,P<0.05),but not for Berg Balance Scale scores(MD=2.57,95%CI:-0.74 to 5.87,P>0.05).Network Meta-analysis probability ranking:In terms of Unified-Parkinson Disease Rating Scale part III scores,the probability ranking results of target stimulation efficacy were dorsal lateral prefrontal cortex(52.4%)>primary motor cortex(45.8%)>central point of the brain(1.8%)>conventional rehabilitation(0%);in terms of gait frequency scores,the probability probability ranking results of target stimulation efficacy were cerebellum(50.1%)>central point of the brain(45.8%)>dorsal lateral prefrontal cortex(3.9%)>primary motor cortex(0.2%)>conventional rehabilitation(0%);in terms of gait speed scores,the probability ranking results of target stimulation efficacy were cerebellum(64.8%)>dorsal lateral prefrontal cortex(23.8%)>central point of the brain(9.4%)>primary motor cortex(1.7%)>conventional rehabilitation(0.4%);in terms of Berg Balance Scale scores,the probability ranking results of target stimulation efficacy were cerebellum(77.4%)>dorsal lateral prefrontal cortex(20.7%)>central point of the brain(0.7%)>conventional rehabilitation(0.2%). CONCLUSION:Transcranial direct current stimulation significantly improves motor function of patients with Parkinson's disease,with better motor coordination in the dorsolateral prefrontal cortex and better walking and balance in the cerebellum.

【Objective】 To investigate the effect of leukocyte-depleted suspended red blood cells (lds-RBCs) storaged for different time on blood transfusion effect of patients with hematologic diseases and malignant tumors, as well as to evaluate the storage quality of lds-RBCs in blood stations. 【Methods】 Seven hospitals (4 tertiary-A hospitals and 3 secondary-A hospitals), applying for blood from our blood center, were selected. Blood transfusion cases (medical record) and related data (indicators) of patients with blood diseases and malignant tumors in those hospitals from December 2018 to May 2019 were collected, including disease diagnosis (type) before transfusion, demographic characteristics, date of solo transfusion of lds-RBCs, units of lds-RBCs [(1~2)U/bag, 1 U=200 mL whole blood], different storage duration (1~5 weeks) (bar code), and hemoglobin (Hb) 48 h before and after transfusion. The efficacy of lds-RBCs (storaged for different time) transfusion in patients with hematologic diseases and malignant tumors was evaluated by statistical analysis. 【Results】 A total of 3 557 patients with hematologic diseases and malignant tumors were enrolled in this study. No significant changes were noticed in transfusion efficacy by blood transfusion unit, gender and previous transfusion history (P > 0.05). The effective rate of lds-RBCs in patients with blood diseases and malignant tumors, stratified by storage duration, i. e. storaged for >1~2 weeks, >2~3 weeks, >3~4 weeks and more than >4~5 weeks, was 78.77% vs 77.68% vs 75.06% vs 70.37%, and 79.32% vs 76.73% vs 72.79% vs 67.65%, respectively(P<0.05), with lds-RBCs of 4-5 storage weeks presenting the lowest transfusion efficacy in both groups of patients. 【Conclusion】 The storage time of most lds-RBCs supplied by our center is moren than 3 weeks, and the transfusion effect of lds-RBCs stored for 5 weeks needs further observation. In order to ensure and improve the efficacy of blood transfusion, evidence-based medicine and information management are needed to help the clinical gasp the advantageous time of blood products and shorten the storage-to-transfusion time of red blood cells.

Objective:To analyze the prevalence of anemia and its influencing factors in the elderly population dwelling in urban communities in Beijing.Methods:A random cluster sampling method was adopted to select the elderly people of communities in Beijing, and cross-sectional research was conducted through questionnaire surveys, field tests and blood sample collection.The criteria for diagnosing anemia were from WHO standards, and the health evaluation indicators in the questionnaire survey included demographic data and eating habits, socio-economic information, information on enjoying health services, health and physical fitness and other information.Blood samples were drawn for routine blood tests and biochemical tests.Results:A total of 1 947 elderly people aged 65 years and above were investigated, including 789 males(40.5%)and 1 158 females(59.5%). Among the 1 947 survey subjects, 288 elderly people had anemia, with the prevalence of anemia of 14.79%(288/1 947). The prevalence of anemia was 16.35%(129/789)in males and 13.73%(159/1 158)in females.There was no statistically significant difference in the prevalence of anemia between male and female( χ2=2.760, P=0.097). Logistic regression analysis was used to analyze the factors affecting anemia.The results showed that the higher age( OR=1.055, P=0.000), the higher frequency of meat-eating( OR=1.353, P=0.046), the lower frequency of fruit-eating( OR=0.759, P=0.048), the worse health status of cohabitants( OR=0.757, P=0.037), the lower BMI( OR=0.905, P=0.001)and the lower exercise frequency( OR=0.769, P=0.012)were correlated to the higher anemia risk in the elderly population dwelling in urban communities in Beijing. Conclusions:The prevalence of anemia is relatively high in the elderly in Beijing communities.According to our findings, older people should reduce the frequency of eating meat, while ensuring nutritional intake, increase the intake of fruits and take appropriate exercises to reduce the prevalence of anemia.

Objective Based on MRI m-Dixon-Quant technique to quickly quantify bone marrow fat content in the vertebral body of middle-aged and elderly patients,and provide a scientific basis for the diagnosis of osteoporosis(OP).Methods A total of 74 middle-aged and elderly patients who were admitted to our hospital from July 2016 to July 2017 were collected.The age,sex and body mass index (BMI)of the patients were collected.All subjects were evaluated for bone mineral density (BMD)and fat fraction (FF)and other indicators of measurement.According to the guidelines for bone mineral density measurement by the American College of Radiology(ACR),the subject was classified by the bone mineral density value,and receiver operating characteristic(ROC)curve was used for the diagnosis and analysis of FF.Results The average age of the subjects was (59.50±8.72)years.There was a positive correlation between MRI m-Dixon-Quant FF and age(r=0.436),which was highly negatively correlated with the average bone density(r=-0.739).By ROC analysis,the sensitivity and specificity were 74.2% and 83.3% for normal and low bone mass groups,92.0% and 88.9% for the normal and OP groups,and 72.0% and 87.1% for the low bone mass and OP groups.FF could be used for the evaluation of OP.If FF<54.60,normal bone mass was considered.If 54.60≤FF≤65.20,low bone mass was considered,if FF>65.20,OP was considered.Conclusion The MRI m-Dixon-Quant FF index can be rapidly and quantitatively used for the diagnosis of OP,which provides a new reference for the diagnosis of OP.

Background: Disruption of tight junctions between intestinal epithelial cells followed by loss of barrier function is crucial for the pathogenesis and progression of a variety of gastrointestinal disorders.Aims: To investigate the protective effect of ulinastatin on hydrogen peroxide (H2O2)-induced intestinal epithelial barrier disruption.Methods: Model of intestinal epithelial monolayer barrier was established with Caco-2 cells in vitro,and then divided into four groups: blank control group (without any intervention),H2O2 group (500 μmol/L H2O2),low-dose (500 U/mL) and high-dose (3 000 U/mL) ulinastatin groups (ulinastatin + H2O2).Level of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) were detected;transepithelial electrical resistance (TEER) and flux of sodium fluorescein were measured to assess the barrier function;expression and localization of two tight junction proteins,ZO-1 and occludin were evaluated by Western blotting and immunofluorescence;ultrastructure of tight junctions was observed by transmission electron microscopy (TEM).Results: Compared with the blank control group,treatment of Caco-2 cell monolayers with H2O2 resulted in increase in level of MDA,flux of sodium fluorescein and decrease in activity of SOD,TEER and expressions of ZO-1 and occludin (P all ＜0.05).TEM and immunofluorescence showed that the brusher border of Caco-2 cells in H2O2 group was destroyed,the cell-cell junction was vague and the localization of ZO-1 and occludin was discontinuous and the fluorescence intensity was extremely low.While in ulinastatin groups,especially the high-dose group,all the indices above-mentioned were significantly improved (P all ＜0.05).Conclusions: Ulinastatin protects intestinal epithelial monolayer barrier against H2O2-induced disruption at least partially by its antioxidant activity and modulating expression and localization of tight junction proteins.

Objective To observe the safety and efficacy of dexmedetomidine combined with butorphanol in patients with in-travenous analgesia after gynecological laparoscopic surgery.Methods Eighty patients who underwent gynecological laparoscopic sur-gery by general anesthesia were randomly divided into 2 groups, each consisting of 40 patients.With the anesthesic induction of dexme-detomidine and butorphanol, the patients in the dexmedetomidine combined with butorphanol group ( or the DB group) further received 0.5μg/kg dexmedetomidine by intravenous pumping, while the patients in the control group received the same volume of normal saline. Fifteen minutes before the end of surgery, the patients in both groups received 1.0 mg butorphanol.Patient-controlled intravenous anal-gesia(PCIA)was implemented after surgery.The patients in the control group received 0.125 mg/kg butorphanol with the highest dos-age not exceeding 10 mg, while the patients in the DB group were given butorphanol plus 0.1 μg/kg.h dexmedetomidine, with the highest dosage not exceeding 300μg.VAS and analgesia scores were observed at h 1, 2, 6,12 and 24 after surgery.The total number of button pressing of PCIA within 24 hours was observed, the number of supplementary analgesic agents was recorded, and adverse drug reactions and total rate of patient satisfaction were evaluated statistically.Results VAS scores at rest and exercise at h 1, 2, 6, 12 and 24 for the patients of the DB group were all significantly lower than those of the control group after surgery, with statistical significance ( P<0.05) .The total number of button pressing of PCIA for the patients of the DB group was less than that of the control group, and butorphanol consumption of the DB group was also significantly lower, also with statistical significance (P<0.05) .As compared with the control group, the rates of nausea and vomiting, dizziness for the patients of the DB group were all significantly lower, and statistical significance could be noted when comparisons were made between the 2 groups (P<0.05).Total rate of satisfaction with analgesia was considerably high after surgery, with statistical significance (P<0.05).Adverse drug reactions, such as bradycardia and respiratory inhibition did not occur in the patients of both groups.Conclusion Dexmedetomidine could enhance the analgesic effect of butorphanol after gynecological laparoscopic surgery, reduce the consumption of the butorphanol and decrease adverse drug reactions, and most im-portantly increase the rate of patients′satisfaction.

Objective:To observe the change of apoptosis of nucleus pulposus cells cultured in vitro under hypoxic condition and different hydrostatic pressure.Methods:The human degenerative nucleus pulposus cells were cultured in vitro and randomly divided into 2 groups according to hypoxic condition:the hypoxia group and the normal oxygen partial pressure group.While the nucleus pulposus cells were randomly divided into three groups according to different hydrostatic pressure:the control group without pressure,the 50 kPa pressure group and the 100 kPa pressure group.The change of apoptosis of nucleus pulpo-sus cells was detected by methyl thiazolyl tetrazolium(MTT)method and terminal dexynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL)assay.Results:As compared with that in normal oxygen partial pressure group,the proportion of survival nucleus pulposus cells in hypoxic group increased,while the number of apoptotic cells decreased.Under different hy-drostatic pressure,there was no statistically significant difference regarding the apoptotic positive rate of nucleus pulposus cells between the 50 kPa pressure group and the control group (P >0.05 ).However,the apoptosis positive rate in the 100 kPa pressure group increased by 3 1 .65%,compared with that in the control group,and the difference was statistically significant (P <0.01).Conclusions:Hypoxic condition,as well as low pressure condition,can reduce the occurrence of apoptosis of nu-cleus pulposus cells.

OBJECTIVETo explore the clinical characteristics and prognostic value of monosomal karyotype (MK) patients in adult acute myeloid leukemia (AML).

METHODSWe retrospectively studied 45 patients of MK⁺ in newly-diagnosed adult AML in our center from Oct 2000 to Dec 2012. Clinical characteristics, cytogenetic data and prognostic features were analyzed in the cohort of MK⁺ patients.

RESULTSMK was found in 45 patients (19.0%) of 237 newly-diagnosed adult AML with cytogenetic data available at diagnoses. Among these 45 cases, there were 28 male (62.2%) and 17 female (37.8%). Median age of MK⁺ patients at diagnose was 58(18-91) years old. The presence of -5(31.1%) and -7(17.8%) were the most common chromatid among MK⁺ AML patients. MK was much more prevalent among elderly patients. Among AML patients, the proportions of MK⁺ patients younger than 30, 30 to 59 and older than 60 years old groups were 11.5%, 17.7% and 22.4%, respectively. There was no difference between MK⁺ and MK⁻ patients in gender distribution (P=0.545). There was also no difference between MK⁺ and MK⁻ patients in the distribution of FAB castigation (P=0.239). Median survival of MK⁺ AML patients was 6.5 months. Cumulative 5-year overall survival (OS) of was 5.2%. Forty-three MK⁺ patients (43/45, 95.6%) also had a complex karyotype (CK). Two cases that did not meet the CK had not achieved complete remission (CR), and died within 6 months. There were 12 patients who were CK⁺ in 192 MK⁻ patients. The differences of OS and CR rates between MK⁺CK⁺ patients and MK⁻CK⁺ were statistically significant (P<0.05).

CONCLUSIONThe increased detection rate of MK with age was associated with lower CR and OS in AML patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chromosome Aberrations ; Female ; Humans ; Karyotyping ; Leukemia, Myeloid, Acute ; diagnosis ; genetics ; Male ; Middle Aged ; Monosomy ; Prognosis ; Remission Induction ; Retrospective Studies ; Young Adult

Objective To investigate the methylation status in the promoter region of Dickkopf-3 (Dkk3) gene in patients with myelodysplastic syndromes (MDS),and to initially explore the relationship between the methylation of this gene and survival time.Methods Methylation-specific PCR (MSP) was applied to measure the promoter methylation of Dkk3 gene in 43 bone marrow or peripheral blood samples of MDS patients.As controls,70 normal peripheral blood samples from general outpatients were examined.Results In 43 patients with MDS,7 patients (16.3 ％) showed Dkk3 gene methylation.And 5 of them were semi-methylation status,2 of them were exhaustive methylation status.In 70 controls,1 showed Dkk3 gene semi-methylation.The frequency of methylation in MDS patients was significantly higher than that of controls (x2 =8.93,P =0.005).In the Dkk3 methylation group,2/7 were from bone marrow and 5/7 were from peripheral blood.Meanwhile,2 patients were RA,1 patient was RCMD,4 patients were RAEB.There was no significant difference between the different sample source (bone marrow or peripheral blood) for the results of the methylation status (x2 =0.051,P =0.821).Either between the different sex,age,type,chromosome and WPSS score (P ＞ 0.05).The progress of disease didn't influence the methylation frequency (P ＞ 0.05).The smvival analysis showed no relationship between the methylation of this gene and smvival time.Conclusions In this MDS group,there is high level of methyl-modification in Dkk3 gene.The methylation of Dkk3 might be one of the molecular mechanisms that contribute to the progress of patients with MDS.The peripheral blood sample maybe a better substitute in detective of Dkk3 with MDS.

Objective To evaluate the effect of a modified culture method on the karyotype anomalies detection rate in elderly patients with multiple myeloma (MM),and to explore the relationship between clinical characteristics and chromosome anomalies in multiple myeloma.Methods Two culture methods were applied on the bone marrow samples which obtained from 28 MM patients.One method was used to culture cells for 24 hours with interleukin 6 (IL-6) 10 μg/L and granulocyte-macrophage colony-stimulating factor (GM-CSF) 40 μg/L,and the other for 6 days.Karyotype was analyzed by G-banding technique.Results In the 24-hour culture group,no metaphases cell was found in 4 cases (14.3 ％),karyotype anomalies were found in 6 cases in the other 24 cases,and the detection rate was 25.0％ (6/24).In the 6-day culture group,no metaphases cell was found in 1 patient (3.6％),karyotype anomalies were found in 15 cases in the other 27 patients,and the detection rate was 55.6％ (15/27).There was a significant difference in the detection rate of karyotype anomalies between the two groups (x2 =4.89,P ＜ 0.05).In 27 cases with enough metaphases in the 6-day culture group,20 cases were newly diagnosed or in progression,among whom karyotype anomalies were found in 14 cases (70.0％,14/20),and 7 cases were in stable phase,among whom karyotype anomalies were found in 1 case (14.3％,1/7).The detection rate of abnormal karyotype was higher in newly diagnosed or in progressive patients than in stable patients (P ＜0.05).Conclusions 6-day culture method can improve the detection rate of karyotype anomalies in elderly patients with multiple myeloma,which is better than 24-hour culture method.The detection rate of karyotype anomalies is higher in newly diagnosed or in progressive patients than in stable patients.