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 explore the presentation of T2 weighted magnetic resonance imaging(T2WI)and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)parameters in patients with prostate cancer and their correlations with prostate specific antigen(PSA)level and International Society of Urological pathology(ISUP)grading.Methods A total of 82 patients with prostate diseases who were admitted to Yixing Traditional Chinese Medicine Hospital between March 2019 and June 2023 were selected as research objects,including 52 patients with prostate cancer and 30 patients with benign prostatic hyperplasia.T2WI and DCE-MRI parameters of these patients were compared.Results The proportion of prostate cancer patients with T2WI score≥4 was 50.00%,which was higher than that of the benign prostatic hyperplasia patients(P<0.05).The peak time(Tmax)of prostate cancer patients was 70 541.44(45 035.20,90 655.41)ms,which was shorter than that of the patients with benign prostatic hyperplasia(P<0.05).The fastest enhancement rate(Rmax)of prostate cancer patients was 36.60±14.41,which was higher than that in patients with benign prostatic hyperplasia(P<0.05).The proportions of patients with T2WI score≥4 in stages Ⅲ-Ⅳ,ISUP grading≥4,and PSA≥50 ng/ml were 62.50%,75.00%and 63.16%,respectively,which were significantly higher than those in stages Ⅰ-Ⅱ,ISUP grading≤3,and PSA level<50 ng/ml(all P<0.05).The Tmax of patients in stages Ⅲ-Ⅳ was 68 405.44(43 506.43,82 204.32)ms,which was lower than that of stagesⅠ-Ⅱpatients(all P<0.05).The Rmax of patients in stages Ⅲ-Ⅳ was 39.16±9.50,which was higher than that of stages Ⅰ-Ⅱ patients(all P<0.05).The Tmax of patients with ISUP grading≥4 was 66 504.32(43 506.43,84 053.12)ms,which was lower than that of patients with ISUP grading≤3(P<0.05).The Rmax of patients with ISUP grading≥4 was 40.38±9.75,which was higher than that of patients with ISUP grading≤3(P<0.05).The Tmax of patients with PSA≥50 ng/ml was 63 044.22(45 035.20,82 204.32)ms,which was shorter than that of patients with PSA<50 ng/ml(P<0.05).The Rmax of patients with PSA≥50 ng/ml was 39.15±9.05,which was higher than that of patients with PSA<50 ng/ml(P<0.05).Tmax was negatively correlated with PSA(P<0.05),while Rmax was positively correlated with PSA(P<0.05).T2WI manifestations and Rmax were positively correlated with ISUP grading(all P<0.05),while Tmax was negatively correlated with ISUP grading(P<0.05).Conclusion T2WI and DCE-MRI parameters are correlated with clinical staging,ISUP grading,and PSA level of prostate cancer,which is worthy of further clinical research.

Background::Heterotaxy (HTX) is a thoracoabdominal organ anomaly syndrome and commonly accompanied by congenital heart disease (CHD). The aim of this study was to analyze rare copy number variations (CNVs) in a HTX/CHD cohort and to examine the potential mechanisms contributing to HTX/CHD.Methods::Chromosome microarray analysis was used to identify rare CNVs in a cohort of 120 unrelated HTX/CHD patients, and available samples from parents were used to confirm the inheritance pattern. Potential candidate genes in CNVs region were prioritized via the DECIPHER database, and PNPLA4 was identified as the leading candidate gene. To validate, we generated PNPLA4-overexpressing human induced pluripotent stem cell lines as well as pnpla4-overexpressing zebrafish model, followed by a series of transcriptomic, biochemical and cellular analyses. Results::Seventeen rare CNVs were identified in 15 of the 120 HTX/CHD patients (12.5%). Xp22.31 duplication was one of the inherited CNVs identified in this HTX/CHD cohort, and PNPLA4 in the Xp22.31 was a candidate gene associated with HTX/CHD. PNPLA4 is expressed in the lateral plate mesoderm, which is known to be critical for left/right embryonic patterning as well as cardiomyocyte differentiation, and in the neural crest cell lineage. Through a series of in vivo and in vitro analyses at the molecular and cellular levels, we revealed that the biological function of PNPLA4 is importantly involved in the primary cilia formation and function via its regulation of energy metabolism and mitochondria-mediated ATP production. Conclusions::Our findings demonstrated a significant association between CNVs and HTX/CHD. Our data strongly suggested that an increased genetic dose of PNPLA4 due to Xp22.31 duplication is a disease-causing risk factor for HTX/CHD.

BackgroundThe etiopathogenesis of major depressive disorder （MDD） is strongly associated with neuroinflammation. MDD is a highly heterogeneous psychiatric disorder， and the disease subtyping is an essential step for the identification of biological markers. The presence of psychomotor retardation seriously affects the prognosis of MDD， whereas the underlying mechanism is not yet completely clear. A potential involvement of granulocyte colony-stimulating factor （G-CSF） and macrophage colony-stimulating factor （M-CSF） in the pathogenesis of MDD with psychomotor retardation has been suggested in previous studies， but little detailed research has been completed. ObjectiveTo analyze the correlation of plasma G-CSF and M-CSF levels with psychomotor retardation in patients with MDD， and to explore the potential biological underpinnings of psychomotor retardation in MDD. MethodsA total of 50 MDD patients who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and attended the outpatient clinics of Shanghai Mental Health Center from April 2018 to April 2019 were included. The severity of symptoms was assessed using the Hamilton Depression Scale-17 item （HAMD-17）. According to the retardation factor in HAMD-17， patients with a score of ≥8 were included in retardation group （n=22）， and those with a score below 8 were included in non-retardation group （n=28）. Another 22 age- and sex-matched healthy controls were concurrently recruited. Plasma G-CSF and M-CSF levels were measured in all subjects using Luminex liquid suspension chip technology. Spearman correlation analysis was adopted to verify the correlation of retardation factor score in HAMD-17 with plasma G-CSF and M-CSF levels in MDD patients. ResultsPlasma G-CSF levels were decreased in MDD patients compared with healthy controls ［57.34（39.24， 83.15）pg/mL vs. 71.47（61.20， 79.99）pg/mL， Z=-2.098， P<0.05］. A statistical difference was found in plasma G-CSF level ［63.92（54.60， 89.43）pg/mL vs. 47.80（33.41， 74.66）pg/mL vs. 71.47（61.20， 79.99）pg/mL， H=8.247， P=0.016］ and plasma M-CSF level ［20.05（16.05， 22.23）pg/mL vs. 13.05（11.43， 17.50）pg/mL vs. 18.95（14.59， 22.88）pg/mL， H=7.620， P=0.022］ among retardation group， non-retardation group and healthy control group. The post hoc pairwise comparisons using Bonferroni correction indicated that plasma G-CSF level was lower in non-retardation group compared with healthy control group （adjusted P<0.05）， and plasma M-CSF level was higher in retardation group compared with non-retardation group （adjusted P<0.05）. The retardation factor score in HAMD-17 was positively correlated with plasma M-CSF level in MDD patients （r=0.348， P<0.05）. ConclusionThe prevalence of psychomotor retardation in MDD patients may be related to abnormally elevated plasma M-CSF level. ［Funded by Shanghai "Science and Technology Innovation Action Plan" Project in Medical Innovation Research Field （number， 21Y11905600）； Shanghai "Science and Technology Innovation Action Plan" Project in Natural Science Field （number， 21ZR1455100）； Shanghai Mental Health Center Scientific Research Project （number， 2021-YJ02）］

Background:Fibroscan is the noninvasive method widely used to evaluate quantitatively the liver fibrosis and monitor the long-term efficacy of anti-fibrosis therapy. Aims:To study the use of Fibroscan for evaluating the efficacy of combined therapy with FuFang BieJia RuanGan tablet and antiviral drugs in patients with hepatitis B virus( HBV)-related cirrhosis. Methods:A total of 90 patients with HBV-related cirrhosis from March 2013 to September 2014 at Shanghai Ren Ji Hospital were recruited,and divided into treatment group and control group. Patients in treatment group received FuFang BieJia RuanGan tablet,and patients in control group received conventional liver-protective drugs,all the patients took nucleoside antiviral drugs at the same time. The treatment courses in both groups were 6 months. Liver stiffness measurement( LSM)was detected by Fibroscan before and after treatment. Biochemical parameters,width of portal vein and clinical symptoms were recorded. Results:After treatment,LSM was significantly decreased in both groups( P <0.05). Liver function,width of portal vein and Child-Pugh score were improved in both groups(P <0. 05),and no significant differences were found between the two groups(P>0. 05). LSM was closely associated with Child-Pugh score both before and after treatment(r=0. 484,P<0. 01;r=0. 523,P<0. 01). Patients with Child-Pugh A had lower LSM than those with Child-Pugh B or Child-Pugh C(P<0. 01). Conclusions:FuFang BieJia RuanGan tablet combined with oral antiviral drugs can remarkably improve the liver function of cirrhotic patients and prevent progression of cirrhosis. Dynamic detection of LSM can be used for monitoring drug efficacy and disease progression in patients with cirrhosis.

Objective To evaluate the safety and rationality of total/near total bilateral thyroidectomy(TBT) for patients with bilateral multinodular goiter(BMG). Methods From January 2003 to December 2006,311 BMG cases were preoperatively divided into two groups, 130 cases in group A underwent TBT, and 181 cases in group B were treated with subtotal/partial bilateral thyroidectomy. Results There were 6 and 2 eases in group A and group B respectively diagnosed by intraoperative frozen biopsy as BMG, but identified as papillary carcinoma by final pathology. Hence the 6 cases in group A avoided reoporation, while the 2 cases in group B underwent a resection of the remnant gland. Transient hoarseness developed in 3 (2.42%, 3/124) and 3 (1.68%, 3/179) eases in group A and group B respectively (P =0.48). Transient hypocalcemia developed in 11 (8.87% ,11/124) and 9(5.03% ,9/179) cases in group A and group B respectively(P =0.16). There was no postoperative goiter recurrence in group A, but recurrence developed in 12 cases (6.70%,12/179) in group B(P=0.02). Conclusions Total bilateral thyroidectomy is safe and rational for the management of bilateral thyroid goiter.