Objective To identify the effective therapeutic targets of multiple system atrophy-parkinsonian type （MSA-P） based on clinical and electrophysiological assessment indices， and to investigate the clinical efficacy of low-frequency versus high-frequency repetitive transcranial magnetic stimulation （rTMS） applied to the primary motor cortex （M1 region） of the brain in patients with MSA-P. Methods A total of 40 patients with MSA-P who were diagnosed and treated in Jilin People’s Hospital from January 2023 to December 2024 were enrolled， and according to the frequency of rTMS， they were divided into low-frequency group with 20 patients and high-frequency group with 20 patients. The patients in the low-frequency group received 1 Hz rTMS over the M1 region， while those in the high-frequency group received 5 Hz rTMS over the M1 region， and clinical and electrophysiological assessments were performed for both groups at 1 week， 2 weeks， 4 weeks， and 3 months after intervention. Results After low-frequency or high-frequency rTMS was applied to the M1 region of MSA-P patients， there were no significant improvements in clinical and electrophysiological assessment indices in the low-frequency group， while the high-frequency group had significant improvements in clinical and electrophysiological assessment indices. Conclusion The primary motor cortex （M1 region） of the brain is an effective therapeutic target for MSA-P. Excitatory stimulation of the M1 region significantly improves the clinical and electrophysiological assessment indices of MSA-P， while inhibitory stimulation of the M1 region fails to achieve such improvements. This study shows that rTMS is an effective therapeutic modality for MSA-P and thus holds promise for clinical application. High-frequency rTMS over the M1 region can improve the symptoms of MSA-P and correct abnormal rhythmic activity within the cortex and related subcortical brain regions， thereby achieving a sustained therapeutic effect.

Objective To investigate the impact of steatosis on liver stiffness (LS) detected by transient elastography (Fibroscan) in patients with chronic hepatitis B (CHB).Methods 303 cases of CHB who underwent liver pathology and Fibroscan from January 2010 to May 2013 were retrospectively analysed.Biochemical parameters were collected.LS values in patients of CHB with and without steatosis were compared.LS values in patients of the same stage of liver fibrosis combined with different degrees of steatosis were compared using ANOVA.Cut-off values were obtained by Receiver Operating Characteristic (ROC curve) analysis.Results 273 cases were included when excluding BMI ＞ 28 kg/m2 and ALT ＞200U/ml.Steatosis was present in 75 (31.6％) cases,steatosis was absent in 162 (68.4％) cases.In every stage of fibrosis,combining with steatosis has no significant impact on LS values.LS(kPa) were 5.3 ±1.4vs5.9±1.9,9.5±4.2 vs8.7 ±3.0,18.4 ±7.5 vs 15.0 ±6.6,21.4 ±7.5 vs27.6±5.9 kPa,respectively.(P ＞ 0.05).While in the degree of F2,LS values in patients combined with the steatosis (S2) were higher than those in patients without steatosis (S0) (P ＜ 0.05) and with mild steatosis (S1) (P ＜0.05).LS values(kPa) were 11.28 ±5.54,8.68 ±2.95,8.12 ±2.44,respectively.Conclusions LS values have no significant difference in patients of CHB with steatosis and without steatosis with different degree of liver fibrosis.In patients with fibrosis stage of F2,LS values in those combined with moderate steatosis (S2) were higher than those without steatosis and with mild steatosis.

Objective To investigate a new strategy of bone marrow transplantation (BMT) for donor-specific tolerance induction after heart transplantation. Methods Donor bone marrow cells (BMCs)were harvested simultaneously with donor cardiac graft using modified perfusion method (PM) ,then stored in a -80 ℃ refrigerator after filtration and centrifugation. Whole BMCs (IBM-BMT) (monocytes 1.2 ×107/kg,CD34+ cells 2.38× 105/kg) in host iliac bones were injected into the bone marrow cavity 40 days after heart transplantation. Preconditoning regimens that consisted of fludarabine, antithymoctye globin and total lymphoid irradiation were performed 3 days before BMT. Tacrolimus (Tac) was administrated intravenously after BMT or orally in conjunction with mycophenolate mofetil (MMF) 3 weeks later.Cyclosporine and MMF were orally administrated 6 weeks later. Donor chimerism was detected using short tandem repeats-polymerase chain reaction in monocytes from peripheral blood at the 2nd,4th, 8th or 12th week after BMT or BMCs at the 4th, 8th or 12th week after BMT. Intramyocardium electrocardiography examination or endomyocardial biopsy was performed weekly or monthly respectively. Mixed lymphocyte reactions (MLR) were performed 3 months after BMT. Results Donor chimerism in monocytes in peripheral blood or BMCs in iliac bones measured at the 1 st,2nd and 3rd month after BMT was 26.3%, 19.1%,4.8% ,and 46.3%, 24.4%, 7.6%, respectively. After 3-month follow-up, there was no rejection confirmed by endomyocardial biopsy or intramyocardium electrocardiography. Echocardiography revealed that the diastolic and systolic function of the cardiac graft was maintained well 3 months after BMT. MLR revealed donor-specific hyporesponsiveness while immunocompetence was preserved to third-party antigens. Conclusion These findings indicate that the two-stage BMT strategy is a safe and feasible method for the induction of donor-specific tolerance via stable mixed chimerism and needs to be further confirmed after a long-term observation.