In transcranial magnetic stimulation (TMS), the conductivity of brain tissue is obtained by using diffusion tensor imaging (DTI) data processing. However, the specific impact of different processing methods on the induced electric field in the tissue has not been thoroughly studied. In this paper, we first used magnetic resonance image (MRI) data to create a three-dimensional head model, and then estimated the conductivity of gray matter (GM) and white matter (WM) using four conductivity models, namely scalar (SC), direct mapping (DM), volume normalization (VN) and average conductivity (MC), respectively. Isotropic empirical conductivity values were used for the conductivity of other tissues such as the scalp, skull, and cerebrospinal fluid (CSF), and then the TMS simulations were performed when the coil was parallel and perpendicular to the gyrus of the target. When the coil was perpendicular to the gyrus where the target was located, it was easy to get the maximum electric field in the head model. The maximum electric field in the DM model was 45.66% higher than that in the SC model. The results showed that the conductivity component along the electric field direction of which conductivity model was smaller in TMS, the induced electric field in the corresponding domain corresponding to the conductivity model was larger. This study has guiding significance for TMS precise stimulation.
Transcranial Magnetic Stimulation ; Diffusion Tensor Imaging ; Electric Conductivity ; Electricity ; Scalp

Existing neuroregulatory techniques can achieve precise stimulation of the whole brain or cortex, but high-focus deep brain stimulation has been a technical bottleneck in this field. In this paper, based on the theory of negative permeability emerged in recent years, a simulation model of magnetic replicator is established to study the distribution of the induced electric field in the deep brain and explore the possibility of deep focusing, which is compared with the traditional magnetic stimulation method. Simulation results show that a single magnetic replicator realized remote magnetic source. Under the condition of the same position and compared with the traditional method of stimulating, the former generated smaller induced electric field which sharply reduced with distance. By superposition of the magnetic field replicator, the induced electric field intensity could be increased and the focus could be improved, reducing the number of peripheral wires while guaranteeing good focus. The magnetic replicator model established in this paper provides a new idea for precise deep brain stimulation, which can be combined with neuroregulatory techniques in the future to lay a foundation for clinical application.
Brain ; Cerebral Cortex ; Computer Simulation ; Electricity ; Magnetic Fields

Transcranial electric stimulation (TES) is a non-invasive, economical, and well-tolerated neuromodulation technique. However, traditional TES is a whole-brain stimulation with a small current, which cannot satisfy the need for effectively focused stimulation of deep brain areas in clinical treatment. With the deepening of the clinical application of TES, researchers have constantly investigated new methods for deeper, more intense, and more focused stimulation, especially multi-electrode stimulation represented by high-precision TES and temporal interference stimulation. This paper reviews the stimulation optimization schemes of TES in recent years and further analyzes the characteristics and limitations of existing stimulation methods, aiming to provide a reference for related clinical applications and guide the following research on TES. In addition, this paper proposes the viewpoint of the development direction of TES, especially the direction of optimizing TES for deep brain stimulation, aiming to provide new ideas for subsequent research and application.
Transcranial Direct Current Stimulation/methods* ; Deep Brain Stimulation ; Brain/physiology* ; Head ; Electric Stimulation/methods*

Electric field stimulation (EFS) can effectively inhibit local Ca ²⁺ influx and secondary injury after spinal cord injury (SCI). However, after the EFS, the Ca ²⁺ in the injured spinal cord restarts and subsequent biochemical reactions are stimulated, which affect the long-term effect of EFS. Polyethylene glycol (PEG) is a hydrophilic polymer material that can promote cell membrane fusion and repair damaged cell membranes. This article aims to study the combined effects of EFS and PEG on the treatment of SCI. Sprague-Dawley (SD) rats were subjected to SCI and then divided into control group (no treatment, n = 10), EFS group (EFS for 30 min, n = 10), PEG group (covered with 50% PEG gelatin sponge for 5 min, n = 10) and combination group (combined treatment of EFS and PEG, n = 10). The measurement of motor evoked potential (MEP), the motor behavior score and spinal cord section fast blue staining were performed at different times after SCI. Eight weeks after the operation, the results showed that the latency difference of MEP, the amplitude difference of MEP and the ratio of cavity area of spinal cords in the combination group were significantly lower than those of the control group, EFS group and PEG group. The motor function score and the ratio of residual nerve tissue area in the spinal cords of the combination group were significantly higher than those in the control group, EFS group and PEG group. The results suggest that the combined treatment can reduce the pathological damage and promote the recovery of motor function in rats after SCI, and the therapeutic effects are significantly better than those of EFS and PEG alone.
Animals ; Electric Stimulation ; Polyethylene Glycols/therapeutic use* ; Rats ; Rats, Sprague-Dawley ; Recovery of Function/physiology* ; Spinal Cord ; Spinal Cord Injuries/therapy*

Spinal cord stimulation (SCS) for pain is usually implanted as an open loop system using unchanged parameters. To avoid the under and over stimulation caused by lead migration, evoked compound action potentials (ECAP) is used as feedback signal to change the stimulating parameters. This study established a simulation model of ECAP recording to investigate the relationship between ECAP component and dorsal column (DC) fiber recruitment. Finite element model of SCS and multi-compartment model of sensory fiber were coupled to calculate the single fiber action potential (SFAP) caused by single fiber in different spinal cord regions. The synthetized ECAP, superimposition of SFAP, could be considered as an index of DC fiber excitation degree, because the position of crests and amplitude of ECAP corresponds to different fiber diameters. When 10% or less DC fibers were excited, the crests corresponded to fibers with large diameters. When 20% or more DC fibers were excited, ECAP showed a slow conduction crest, which corresponded to fibers with small diameters. The amplitude of this slow conduction crest increased as the stimulating intensity increased while the amplitude of the fast conduction crest almost remained unchanged. Therefore, the simulated ECAP signal in this paper could be used to evaluate the degree of excitation of DC fibers. This SCS-ECAP model may provide theoretical basis for future clinical application of close loop SCS base on ECAP.
Action Potentials ; Computer Simulation ; Electric Stimulation ; Evoked Potentials ; Spinal Cord ; Spinal Cord Stimulation

Modified electroconvulsive therapy (MECT) and magnetic seizure therapy (MST) are effective treatments for severe major depression. MECT has better efficacy in the treatment than MST, but it has cognitive and memorial side effects while MST does not. To study the causes of these different outcomes, this study contrasted the electric filed strength and spatial distribution induced by MECT and MST in a realistic human head model. Electric field strength induced by MECT and MST are simulated by the finite element method, which was based on a realistic human head model obtained by magnetic resonance imaging. The electrode configuration of MECT is standard bifrontal stimulation configuration, and the coil configuration of MST is circular. Maps of the ratio of the electric field strength to neural activation threshold are obtained to evaluate the stimulation strength and stimulation focality in brain regions. The stimulation strength induced by MECT is stronger than MST, and the activated region is wider. MECT stimulation strength in gray matter is 17.817 times of that by MST, and MECT stimulation strength in white matter is 23.312 times of that by MST. As well, MECT stimulation strength in hippocampi is 35.162 times of that by MST. More than 99.999% of the brain volume is stimulated at suprathreshold by MECT. However, MST activated only 0.700% of the brain volume. The stimulation strength induced by MECT is stronger than MST, and the activated region is wider may be the reason that MECT has better effectiveness. Nevertheless, the stronger stimulation strength in hippocampi induced by MECT may be the reason that MECT is more likely to give rise to side effects. Based on the results of this study, it is expected that a more accurate clinical quantitative treatment scheme should be studied in the future.

OBJECTIVE:To explore losses and gains (L&G) and L&G ratio induced by Essential Medicine System in a county. METHODS:By choosing a county in western China as sample area,field investigation was used to collect outpatient and inpatient visits,outpatient and inpatient income,drug income,total length of stay and medical insurance reimbursement criteria in primary medical institutions (township health centers,village health rooms) of the county during 2009-2015. By setting the year 2009 as the baseline year,the drug cost reimbursed by medical insurance was simulated and calculated when Essential Medicine System were not implemented;L&G and L&G ratio of medical insurance were calculated by comparing with actual drug cost reimbursed by medical insurance. RESULTS:The year 2012,in which the sample county fully implemented the Essential Medicine System was the turning year. Medical insurance funds lost in primary medical institutions of the county during 2010-2011(lost 437000,915000 yuan,respectively),but gained during 2012 to 2015(gained 199000,494000,858000,1290000 yuan, respectively);the L&G ratio increased from -0.67％ to 1.21％. For reimbursed outpatient drug cost and inpatient cost,L&G of medical insurance were different. For reimbursed drug cost of village health room and township health center,L&G of medical insurance were also different. CONCLUSIONS:The implementation of Essential Medicine System benefits to medical insurance within the county and Medical insurance funds can be saved.

Objective To investigate the effect of home diabetes care platform based on internet and family fixed partner on the continuous care of diabetes patients outside the hospital.Methods A total of 150 out-patients with diabetes were collected from June 2016 to November 2016,divided into family fixed partner group(group A),smart phone APP home diabetes care platform group(group B),family fixed partner combination with smart phone APP home diabetes care platform group(group C)with 50 cases each by random digits table method.The three groups received the same health education during their stay in hospital,patients in group A and group C were required to have family fixed partners,patients in group B and group C were required to receive the home diabetes care platform for smart phones APP after they left the hospital,the intervention time was six months,and the indexes of blood glucose metabolism,self-management ability of diabetes were assessed at the end of six months after intervention and before intervention.Results Fasting blood glucose and postprandial blood glucose and glycosylated hemoglobin values of the three groups after intervention were lower than those before intervention.The postprandial blood glucose and glycosylated hemoglobin values was(9.96±4.23)mmol/L,(7.16±1.47)%in group C,(13.78±3.34),(11.46±4.85)mmol/L and(8.46±2.21)%,(8.07±2.45)%in group A and B,the difference was significant(F=10.57,3.92,P＜0.05).The scores of self-management ability of diabetes of the three groups after intervention were all higher than those before intervention.The score of self-management ability of diabetes of item 1-6 was(6.45±1.65),(4.87±2.23),(6.17±2.12),(5.24±1.65),(4.67±2.13),(6.27±2.02)points in group C,(5.78±1.96),(3.63±2.14),(5.25±2.34),(4.12±1.97),(3.65±1.34),(5.26±2.21)points in group B,(5.04±1.78),(3.37±1.64),(4.63±1.87),(4.03±2.17),(3.32±1.74),(5.30±1.97)points in group A,the difference was statistically significant(F=3.82-7.94,P＜0.05).Conclusions Home diabetes care platform based on internet,combined with family fixed partner education,are more conductive to patient blood sugar control,and enhance self-management ability and account ability.

Bioartificial liver support system (BALSS) provides a new way to treat liver failure and leaves more time for patients who are waiting for liver transplantation. It has detoxification function as well as the human liver, at the same time it can provide nutrition and improve the internal environment inside human body. Bioreactors and hepatocytes with good biological activity are the cores of BALSS which determine the treatment effect. However, in the course of prolonged treatment, the function and activity of hepatocytes might be greatly changed which could influence the efficacy. Therefore, it is very important to detect the status of the hepatocytes in BALSS. This paper presents some common indicators of cell activity, detoxification and synthetic functions, and also introduces the commonly detection methods corresponding to each indicator. Finally, we summarize the application of detection methods of the hepatocyte status in BALSS and discuss its development trend.

In recent years,the occurrence of medical unsafe incidents in hospital has seriously affected the construction of a harmonious relationship between doctors and patients.In view of this,specialized research on the patient safety culture has become one of the focuses of attention.The United States is the country that carried out research on patient safety culture earlier.Through the retrieval of relevant website,case and literature about patient safety culture,this paper scientifically defined the connotation of patient safety culture,introduced the research progress of patient safety culture in United States,and had the localization research and reference to it,in order to help the research on patient safety culture in our country.