Objective:To explore the clinical efficacy, safety and possible neuroimaging mechanism of deep transcranial magnetic stimulation (dTMS) and repetitive transcranial magnetic stimulation (rTMS) in the treatment of refractory migraine.Methods:Thirty patients with refractory migraine were selected from the Department of Neurology, Affiliated Hospital of North Sichuan Medical College from October 2022 to August 2023. The patients were randomly divided into dTMS group ( n=10), rTMS group ( n=10) and sham stimulation group ( n=10). The dTMS group was treated with H7 coil and the rTMS group with "8" coil, and the sham stimulation group was treated with sham stimulation rTMS with the frequency of 10 Hz. The stimulation site was the contralateral primary motor cortex (M1) of headache, which was treated for 2 weeks (3 600 pulses per time, 5 times per week, 10 times in total). Visual Analogue Scale (VAS) and Headache Impact Test-6 (HIT-6) evaluations were performed before treatment, on the first day after treatment, and 1, 3 and 6 months after treatment. The resting-state functional magnetic resonance images of the 3 groups of patients before and after treatment were collected and analyzed by MATLAB2018b, SPM12 and RESTPLUS softwares, and the brain regions with different regional homogeneity (ReHo) before and after treatment were obtained. The general clinical data and scale scoring data were analyzed and processed by SPSS 26.0 version software. Results:There were significant differences in VAS scores among the dTMS group (before treatment 6.70±0.68, the first day after treatment 5.60±0.70, 1 month after treatment 5.00±0.82, 3 months after treatment 3.50±0.85, 6 months after treatment 3.90±1.45), the rTMS group (before treatment 6.90±0.74, the first day after treatment 5.90±0.74, 1 month after treatment 5.30±0.82, 3 months after treatment 5.30±0.82, 6 months after treatment 6.80±0.63) and the sham stimulation group (before treatment 6.60±0.97, the first day after treatment 6.70±0.95, 1 month after treatment 6.90±1.10, 3 months after treatment 6.70±0.68, 6 months after treatment 7.10±0.88; F=16.054, P<0.001), VAS scores among different time points ( F=34.292, P<0.001), and the interaction between groups and time ( F=24.136, P<0.001). Compared with those before treatment, VAS scores in the dTMS group and the rTMS group decreased on the first day after treatment, 1 month and 3 months after treatment (all P<0.05); VAS scores decreased in the dTMS group 6 months after treatment ( P<0.05). Compared with the sham stimulation group, the VAS scores of the dTMS group were lower at the same time points after treatment (all P<0.05), and the VAS scores of the rTMS group were lower on the first day after treatment, 1 month and 3 months after treatment (all P<0.05). Compared with the rTMS group, VAS scores were lower at 3 and 6 months after dTMS treatment (both P<0.05). There were significant differences in HIT-6 scores among groups ( F=13.173, P<0.001), HIT-6 scores among different time points ( F=60.788, P<0.001), and interaction between groups and time ( F=35.576, P<0.001). Compared with those before treatment, the HIT-6 scores in the dTMS group decreased on the first day after treatment ( P<0.05); the HIT-6 scores in the dTMS group and the rTMS group decreased 1 month and 3 months after treatment (both P<0.05); the HIT-6 scores decreased in the dTMS group 6 months after treatment ( P<0.05). Compared with the sham stimulation group, the HIT-6 scores were lower in the dTMS group at the same time points after treatment (all P<0.05), and the HIT-6 scores were lower in the rTMS group at 1 and 3 months after treatment (both P<0.05). Compared with the rTMS group, HIT-6 scores were lower at 3 and 6 months after dTMS treatment (both P<0.05). Analysis of ReHo results: compared with those before treatment, the ReHo values of the right cerebellar angle area 1 increased in the dTMS group and the sham stimulation group, decreased in the rTMS group. The ReHo values of the right middle occipital gyrus, left dorsolateral superior frontal gyrus and right cerebellar area 8 increased in the dTMS group, but decreased in the rTMS group and the sham stimulation group. The ReHo values of the left precentral gyrus and left superior temporal gyrus decreased in the dTMS group, while those in the rTMS group and the sham stimulation group increased. There were no obvious adverse reactions in the 3 groups during the treatment and follow-up period. Conclusions:dTMS and rTMS may help to improve the headache degree and quality of life of patients with refractory migraine, and they are safe, which may be related to the changes of brain network in the right cerebellar angle area 1, right middle occipital gyrus, left dorsolateral superior frontal gyrus, left precentral gyrus, left superior temporal gyrus and right cerebellar area 8.

Objective:To explore the clinical efficacy, safety and possible neuroimaging mechanism of deep transcranial magnetic stimulation (dTMS) and repetitive transcranial magnetic stimulation (rTMS) in the treatment of refractory migraine.Methods:Thirty patients with refractory migraine were selected from the Department of Neurology, Affiliated Hospital of North Sichuan Medical College from October 2022 to August 2023. The patients were randomly divided into dTMS group ( n=10), rTMS group ( n=10) and sham stimulation group ( n=10). The dTMS group was treated with H7 coil and the rTMS group with "8" coil, and the sham stimulation group was treated with sham stimulation rTMS with the frequency of 10 Hz. The stimulation site was the contralateral primary motor cortex (M1) of headache, which was treated for 2 weeks (3 600 pulses per time, 5 times per week, 10 times in total). Visual Analogue Scale (VAS) and Headache Impact Test-6 (HIT-6) evaluations were performed before treatment, on the first day after treatment, and 1, 3 and 6 months after treatment. The resting-state functional magnetic resonance images of the 3 groups of patients before and after treatment were collected and analyzed by MATLAB2018b, SPM12 and RESTPLUS softwares, and the brain regions with different regional homogeneity (ReHo) before and after treatment were obtained. The general clinical data and scale scoring data were analyzed and processed by SPSS 26.0 version software. Results:There were significant differences in VAS scores among the dTMS group (before treatment 6.70±0.68, the first day after treatment 5.60±0.70, 1 month after treatment 5.00±0.82, 3 months after treatment 3.50±0.85, 6 months after treatment 3.90±1.45), the rTMS group (before treatment 6.90±0.74, the first day after treatment 5.90±0.74, 1 month after treatment 5.30±0.82, 3 months after treatment 5.30±0.82, 6 months after treatment 6.80±0.63) and the sham stimulation group (before treatment 6.60±0.97, the first day after treatment 6.70±0.95, 1 month after treatment 6.90±1.10, 3 months after treatment 6.70±0.68, 6 months after treatment 7.10±0.88; F=16.054, P<0.001), VAS scores among different time points ( F=34.292, P<0.001), and the interaction between groups and time ( F=24.136, P<0.001). Compared with those before treatment, VAS scores in the dTMS group and the rTMS group decreased on the first day after treatment, 1 month and 3 months after treatment (all P<0.05); VAS scores decreased in the dTMS group 6 months after treatment ( P<0.05). Compared with the sham stimulation group, the VAS scores of the dTMS group were lower at the same time points after treatment (all P<0.05), and the VAS scores of the rTMS group were lower on the first day after treatment, 1 month and 3 months after treatment (all P<0.05). Compared with the rTMS group, VAS scores were lower at 3 and 6 months after dTMS treatment (both P<0.05). There were significant differences in HIT-6 scores among groups ( F=13.173, P<0.001), HIT-6 scores among different time points ( F=60.788, P<0.001), and interaction between groups and time ( F=35.576, P<0.001). Compared with those before treatment, the HIT-6 scores in the dTMS group decreased on the first day after treatment ( P<0.05); the HIT-6 scores in the dTMS group and the rTMS group decreased 1 month and 3 months after treatment (both P<0.05); the HIT-6 scores decreased in the dTMS group 6 months after treatment ( P<0.05). Compared with the sham stimulation group, the HIT-6 scores were lower in the dTMS group at the same time points after treatment (all P<0.05), and the HIT-6 scores were lower in the rTMS group at 1 and 3 months after treatment (both P<0.05). Compared with the rTMS group, HIT-6 scores were lower at 3 and 6 months after dTMS treatment (both P<0.05). Analysis of ReHo results: compared with those before treatment, the ReHo values of the right cerebellar angle area 1 increased in the dTMS group and the sham stimulation group, decreased in the rTMS group. The ReHo values of the right middle occipital gyrus, left dorsolateral superior frontal gyrus and right cerebellar area 8 increased in the dTMS group, but decreased in the rTMS group and the sham stimulation group. The ReHo values of the left precentral gyrus and left superior temporal gyrus decreased in the dTMS group, while those in the rTMS group and the sham stimulation group increased. There were no obvious adverse reactions in the 3 groups during the treatment and follow-up period. Conclusions:dTMS and rTMS may help to improve the headache degree and quality of life of patients with refractory migraine, and they are safe, which may be related to the changes of brain network in the right cerebellar angle area 1, right middle occipital gyrus, left dorsolateral superior frontal gyrus, left precentral gyrus, left superior temporal gyrus and right cerebellar area 8.

Objective To explore the research status,hot topics and trends in the construction of integrity in public hos-pitals in China,provide references for the research on integrity construction in public hospitals and promote their high-quality de-velopment.Methods The relevant literature on the construction of integrity in public hospitals from 2009 to 2022 was collected from the China National Knowledge Infrastructure(CNKI)database.CiteSpace software was used to analyze the selected litera-ture in terms of publication timeline,author co-citation,institution co-citation,keyword co-occurrence,keyword clustering and keyword burst analysis,and visualize the knowledge graph.Results The research on the construction of integrity in public hos-pitals in China showed an upward trend from 2009 to 2022.The hot topics in the research mainly focused on incorruptible medical practices,integrity risks and integrity culture.The keyword burst analysis revealed that discipline inspection and supervision,in-formation platforms and institutional development were the future research directions.Conclusion The research on the construc-tion of integrity in public hospitals in China has a clear policy orientation,and various subfields are being explored.Internal inde-pendent research is predominant,while collaboration among multiple scholars and institutions needs to be strengthened.The con-struction of integrity in public hospitals in China mainly focuses on three areas.

Objective:To compare the differences of brain activation in patients with neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) under contact heat stimulation (CHS), and to explore the characteristics of pain-related brain networks in NMOSD and MS patients.Methods:Fourteen NMOSD patients (NMOSD group) and 12 MS patients (MS group) admitted to Affiliated Hospital of North Sichuan Medical College from September 2022 to December 2022 who met the diagnostic criteria were collected. Twelve healthy individuals (HC group) matched with gender and age were recruited during the same period. Visual Analogue Scale (VAS) score was used to evaluate the pain of the subjects, CHS painful stimuli were given, and task-state functional magnetic resonance imaging (fMRI) scans were performed at the same time, and the differences in brain activation among the 3 groups were analyzed and compared.Results:(1) Compared with the HC group, the NMOSD group had a stronger activation degree than the HC group in the brain regions including the cortex around the left distance fissure, bilateral medial superior frontal gyrus; the activation degree of the NMOSD group was weaker than that of the HC group in the brain areas including the left medial and paracingulate gyrus, right superior parietal gyrus, left postcentral gyrus, and right supplementary motor area (all P<0.05). (2) Compared with the HC group, the brain regions whose activation degree was weaker in the MS group included the left caudate nucleus, left medial and paracingulate gyrus, left paracentral lobule, right superior parietal gyrus, left postcentral gyrus, left precuneus, right supplementary motor area, right superior temporal gyrus and right thalamus, and there was no brain area in the MS group whose activation degree was stronger than that of the HC group (all P<0.05). (3) Compared with the MS group, the brain regions with stronger activation degree in the NMOSD group included the left perifissure cortex and right thalamus, but no brain regions with weaker activation degree were found in the NMOSD group (all P<0.05). (4) There was a correlation between somatic pain VAS scores and activation of the medial superior frontal gyrus in the NMOSD group ( r=0.66, P<0.05). Conclusions:The results of CHS-fMRI in the NMOSD group, MS group and HC group showed that multiple brain regions were activated, indicating that multiple brain regions were involved in the generation and processing of pain, and there was a pain-related brain network. Pain-related brain networks were altered in NMOSD patients and MS patients, and there were differences in pain-related brain networks between the two diseases.

Objective To make rehabilitation nursing signs and apply them in positioning of unaffected extremities among patients with hemiplegia.Methods Totally 49 stroke patients with hemiplegia were recruited in the control group from July 2013 to November 2014,and 52 stroke patients with hemiplegia were recruited in the experimental group from January 2015 to September 2015.Same treatment and rehabilitation nursing were provided to patients in two groups.For the experimental group,rehabilitation nursing signs were applied together with regular guidance and demonstration of positioning of unaffected extremities.For the control group,only regular guidance and demonstration of positioning of unaffected extremities were provided.Results For the experimental group,the compliance was 86.03％(4 026 of 4 680 times),the accuracy was 72.73％(2 928 of 4 026 times);for the control group,the compliance and accuracy were 58.10％ (2 562 of 4 410 times)and 50.94％ (1 305 of 2 562 times),respectively.In the experimental group,no new complication occurred,no existing complication deteriorated,10 cases of complications were alleviated.However,in the control group,two cases developed complications,two cases of existing complication deteriorated,and only four cases of complications were alleviated.Subjective attention from patients and their family members in the experimental group was higher than that in the control group,and the difference was statistically significant.Conclusion For patients with hemiplegia,the rehabilitation nursing signs can significantly increase the compliance and accuracy of unaffected extremities positioning,and increase the attention from patients and their family members regarding unaffected extremities positioning in daily life.