BACKGROUND:In clinical application,the therapeutic effect of transcranial magnetic stimulation depends on the ability to accurately target the areas of the brain that need to be stimulated.In recent years,with the development of neuronavigation systems,mobile augmented reality technology,and the new methods of processing magnetic resonance imaging(MRI)data,the accuracy of stimulus target localization and the optimization of target selection are expected to improve further. OBJECTIVE:To review the principle of MRI-based image navigation and its application in transcranial magnetic stimulation and summarize the roles of different modal MRI data analyses in guiding the selection of target areas for transcranial magnetic stimulation. METHODS:An online computer search for relevant literature was performed in PubMed,CNKI database and WanFang database,with the keywords"transcranial magnetic stimulation,coil positioning,neuronavigation,augmented reality,magnetic resonance,theory."Finally,63 documents were included for review. RESULTS AND CONCLUSION:Among the traditional methods of positioning transcranial magnetic stimulation coils,the"5 cm rule"and the international electroencephalogram 10-20 positioning method are the most commonly used.These methods have the advantages of simplicity and economy,but they rely too much on the operator's experience and there were technical differences between operators.The neuronavigation system,which is based on stereotactic technology,is the guiding method for positioning transcranial magnetic stimulation coils with the highest visual degree and accuracy.It achieves visual positioning through MRI data acquisition,3D brain reconstruction,head model registration and stereogeometric positioning.It has high application value in clinical treatment and scientific research,but it cannot be promoted in medical institutions due to its high cost.For various medical institutions,mobile augmented reality is a cost-effective and efficient alternative to the neuronavigation system,which achieves visual positioning of brain tissue under the scalp through MRI data acquisition,2D/3D image construction,virtual image and real brain image superposition.It has the advantages of directly visualization and low cost,and is expected to be popularized and applied in primary medical units.Although the superiority of clinical efficacy of visual coil positioning over the electroencephalogram 10-20 localization strategy has not yet been fully demonstrated,with the progress of brain MRI data analysis,visual positioning is expected to further optimize the target selection strategy of transcranial magnetic stimulation therapy and to improve the response rate and individuation degree of transcranial magnetic stimulation treatment.This is a promising and challenging research direction in the future.

Objective: To explore the effects of grandparent involvement in parenting on health related behaviors among urban preschool children, so as to provide a basis for the development of interventions for unhealthy behaviors among preschool children with different parenting pattern. Methods: A total of 5 431 preschool children aged 3-6 years old in Xinbei District, Changzhou City, were selected by census method during January to October, 2022. General household characteristics and health related behaviors of children were investigated by questionnaires, and the differences in health related behaviors with different parenting pattern involving grandparents were explored by the χ 2 test. A multifactorial Logistic regression model was used to analyze the effects of grandparenting on preschool children s health behaviors. Results: About 51.2% of preschoolers were raised by both parents, 46.1 % were co parented by grandparents, and 2.7% were raised by grandparents. After multifactorial Logistic regression analysis controlling for age, gender, annual household income, and family structure, children co parented by grandparents had a reduced risk of screen exposure time>1 h/d ( OR =0.79, P <0.05), with increased risks of outdoor activity time<2 h/d ( OR =1.30, P < 0.05 ), sleep duration <10 h/d ( OR =1.31, P <0.05), sleep difficulties ( OR =1.39, P <0.05) and adverse eating behaviors ( OR =1.20， P < 0.05), compared with children parented by both parents. Children raised by grandparents were at increased risk for outdoor activity time<2 h/d ( OR =2.19) and unhealthy eating behaviors ( OR =1.39) ( P <0.05). Conclusions Compared with children raised by both parents, the incidence of unhealthy behaviors is increased in children raised by parents and grandparents and in children raised by full grandparents. Active intervention should be focused on unhealthy behaviors of preschool children with pareting involving grandparents to promote the physical and mental health of preschool children.

Objective:To analyze the mutation sites and characteristics of phospholipase CE1( PLCE1) gene in children with primary nephrotic syndrome(PNS) in Zhuang, Guangxi, China, so as to explore the expression status of PLCE1 protein in peripheral blood of PNS patients. Methods:(1)Blood samples of 154 Zhuang children with PNS and 98 healthy children of Zhuang nationality from July 2015 to September 2017 in Affiliated Hospital of Youjiang Medical College for Nationalities were collected to sequence PLCE1 gene with FastTarget target gene capture method in the combination with next generation sequencing.Based on the comparison between mutation results and information from the database, the pathogenicity, phenotype and distribution characteristics of these mutation sites were discovered and appraised.(2)The concentration of PLCE1 protein in serum samples were measured by enzyme-linked immuno sorbent assay, then the data of PNS group and healthy control group were compared and analyzed statistically with SPSS 25.0. Results:(1)A total of 18 low-frequency mutations of PLCE1 were observed, 5 of them(c.670C>T, c.578T>C, c.923G>T, c.4916C>T, and c. 5927_5929del) were found only in the PNS group, and 3 of them occurred in both PNS group and healthy control group: c.176C>T, c.389T>C, and c. 4304C>T.Five newly discovered mutations (c.923G>T, c.958T>A, c.1151C>T, c.2341A>G, and c. 3592G>C)were discovered and only c. 923 G>T is pathogenic mutation of PLCE1.(2)The concentration of PLCE1 protein in healthy control group was 414.65 (231.20, 729.81) ng/L and the level of PLCE1 in PNS group was 237.84 (116.14, 535.85) ng/L, ( Z=-3.212, P<0.001), and the value of PNS group was lower than that in the healthy control group. Conclusions:(1)As a new pathogenic mutation of PLCE1, c.923G>T was found.(2)The phenotype of PLCE1 gene mutation in Zhuang children with PNS was diverse, and they may differ by race and region.(3) PLCE1 protein of serum may act as a protective protein to guarantee various life activities of cells by participating in multiple signal transduction pathways.

Objective To investigate the dynamic changes of gene expressions in mouse jejunum after lethal dose abdomen irradiation (ABI).Methods RNA was extracted from mouse jejunum at 0 and 6 h,3.5 and 5 d after 14 Gy 137Cs γ-ray ABI and then subjected to RNA-sequence analysis.Gene with expressions changed more than 2-fold of control were identified as differentially expressed ones.The selected genes were subsequently analyzed using IPA,Funrich,GO and KEGG software.Results Gene analysis of mouse jejunum samples showed that radiation activated p53 pathway at 6 h and 3.5 d after ABI.Interaction network analysis of genes suggested that Lck,Cdkl and Fyn,genes could play an important role in jejunum damage at 3.5 d after ABI.The gene expression profiles demonstrated that ABI up-regulated DNA damage repair pathways and down-regulated cell adhesion molecules,focal adhesion and IgA production pathways.Conclusions The p53 signaling pathway and some key genes such as Lck,Cdkl,and Fyn may contribute to the radiation-induced intestinal injury.

Objective To explore Chinese character semantic processing feature and the relationship with behavioral problems in early childhood with ADHD.Methods Twenty ADHD children and twenty normal children (7-8 years old) performed a Chinese character semantic judgment task through event related potential (ERP),meanwhile Conners parent rating scale (PSQ) was completed by parents to analyze behavior problems in children.The relationship between behavioral problems and ERPs was analyzed.Results (1) ADHD group showed smaller amplitudes of P200 compared to the normal group (related (6.6±4.8) μV vs (11.6±6.4) μV;unrelated (6.7±3.7) μN vs (10.8±5.0) μV),and longer latency (related(240±30) ms vs (198±17)ms;the unrelated (232±26)ms vs (194±16)ms;psudoword (233±26)ms vs (197±15)ms),all P＜0.05).The amplitudes of N400 wave only showed a decreasing trend in ADHD group(P＞0.05),while the latency of N400 was significantly longer than that in normal children in three conditions(P＜0.05).(2) Four subscale scores of CPSQ(conduct problem,learning problem,hyperactivity-impulsion and hyperactivity index) were significantly higher in ADHD children compared with normal group.(3)The amplitudes of P200 in related condition had negative correlation with the scores of CPSQ subscale (conduct problem,psychoso matic disorder,hyperactivity-impulsion and hyperactivity index) (r=-0.51,-0.47,-0.45,-0.46,all P＜0.05.The latency of P200 in related condition had positive correlation with psychosomatic disorder scores (r =0.54,P=0.01).Conclusion Early semantic recognition disorder exists in 7～ 8 years old ADHD children.P200 can be used as an objective index to evaluate early childhood ADHD's language cognition,and P200 is related to behavior problems (such as conduct problem,impulsions).

Objective To discuss the value of magnetic resonance (MR) diffusion tensor imaging (DTI) technology in the diagnosis of the apparent diffusion coefficient (ADC) and the fraction anisotropy (FA) of neonates with hypoxic-ischemic encephalopathy (HIE) in the subacute stage.Methods Ten cases of normal full-term neonates and 34 term neonates diagnosed with HIE in the subacute stage were investigated with conventional MR and DTI.Of the 34 cases, 15 cases were mild HIE, 12 cases were moderate HIE,7 cases were severe HIE.ADC/FA values in different parts of the brain were analyzed.And the receiver operating characteristic (ROC) curve was used,the sensitivity and specificity of the FA in specific parts were also analyzed.Results (1) On convention MRI : according to the MRl scoring system,score of mild group was(2.6 ±-1.7) points, moderate group was (3.0 ± 1.5) points, severe group was (5.8 ± 1.3) points.There was significant difference between mild group and severe group, moderate and severe group (P ＜ 0.05).(2) The ADC and FA values in each group on DTI : ADC values in all of the regions of interest (ROIs) had no statistic difference between the HIE group and the controls(all P ＞ 0.05).FA values in posterior limb of internal capsule (PLIC) ,splenium had statistic difference between the HIE group and the controls.FA values in mild group were (0.317-0.018,0.339 ±0.025) ,moderate group (0.295 ±0.025,0.324 ±0.026) and severe group (0.252 ±0.039,0.253-0.036) and control group (0.455 ± 0.047,0.372 ± 0.032).(3) ROC analysis of the neonates diagnosed with HIE:the area under the ROC curve of FA values in PLIC, Splenium had statistic difference between mild group and moderate group (P ＜ 0.05).The area under the ROC curve in each group was 0.744 (P =0.032) ,0.658 (P =0.164).ROC curve was used to evaluate the diagnostic accuracy of FA values in PLIC between HIE group and control group,when FA value was lower than 0.337,0.803 was the largest area under the ROC curve, and there was significant difference between them(P ＜ 0.01).Conclusions FA values can reflect the brain white matter WM injury of HIE neonates quantitatively,and its diagnostic veracity is better than ADC value and conventional MR during the subacute phase of HIE.The diagnostic veracity of FA values in PLIC is higher than other parts.When the FA value is lower than 0.337, there is good sensitivity and specificity in diagnosis of HIE, so DTI technology can provide accurate and objective basis for clinical treatment with good sensitivity and specificity about the diagnosis of HIE in early stage.

BACKGROUNDWe evaluated the impact of the number of metastatic lymph nodes and the metastatic lymph nodes ratio (the ratio between metastatic lymph nodes and total dissected lymph nodes, MLNR) in patients with gastric adenocarcinoma following curative gastrectomy and also analyzed the relationship between the number of removed lymph nodes and prognosis in node-negative gastric cancer.

METHODSFrom January 2005 to December 2010, 1 390 patients who were diagnosed with gastric adenocarcinoma and underwent curative gastrectomy were included. In particular, lymph node metastasis was not present in 515 patients. The number of metastatic lymph nodes and the metastatic lymph nodes ratio were selected for univariate and multivariate analyses to evaluate their influences on the disease outcome. The survival curve was presented according to the number of removed lymph nodes in node-negative gastric cancer using Kaplan-Meier plots.

RESULTSThe overall 5-year survival rate was 54% in this group. Univariate analysis revealed that age category, macroscopic appearance, histological grade, tumor size, depth of primary tumor invasion, number of metastatic lymph nodes, metastatic lymph nodes ratio, tumor, nodes, metastasis-classification (TNM) stage and status of lymphovascular, and vessel invasion have significant impact on survival. The number of metastatic lymph nodes and the metastatic lymph nodes ratio both have significant impact on survival (P < 0.001). However, in multivariate analyses, only the metastatic lymph nodes ratio was identified to be an independent prognostic factor (P < 0.001). The number of removed lymph nodes in node-negative was a strong prognostic factor of survival, the more lymph nodes dissected, the better the survival.

CONCLUSIONSThe metastatic lymph nodes ratio has more significant prognostic value for survival in patients with gastric cancer following curative gastrectomy than the number of metastatic lymph nodes. The number of removed lymph nodes might be an important prognostic factor for gastric cancer without lymph node metastasis.

Adenocarcinoma ; mortality ; surgery ; Aged ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms ; mortality ; surgery

OBJECTIVETo explore the technical feasibility, safety, and short-term clinical efficacy of right-to-lateral approach in laparoscopic-assisted radical gastrectomy.

METHODSClinicopathological data of 178 gastric cancer patients undergoing laparoscopic-assisted radical gastrectomy, including 92 patients with right-to-lateral approach(R-LG group) and 86 cases with left-to-lateral approach (L-LG group), in our department from October 2010 to September 2013 were analyzed retrospectively. Short-term efficacy and complication morbidity were compared between R-LG group and L-LG group according to body mass index (BMI).

RESULTSFor those patients with BMI ≥ 24 kg/m², the R-LG group (35 cases) had shorter mean operation time, less intraoperative blood loss, shorter painkiller used time than L-LG group (31 cases)[(227 ± 17) min vs. (262 ± 23) min, (73 ± 9) ml vs. (84 ± 8) ml and (2.1 ± 0.1) d vs. (2.6 ± 0.4) d, all P<0.05]. The average time to ambulation and recovery time of peristalsis in the R-LG group were faster than those in L-LG group [(2.2 ± 0.2) d vs. (2.8 ± 0.6) d and (3.6 ± 0.3) d vs. (4.2 ± 0.5) d, all P<0.05]. The R-LG group had more dissected lymph nodes per patient (35 ± 4) than the L-LG group (30 ± 5) with significant difference (P<0.05). There were no significances in postoperative hospital stay, postoperative complication morbidity and hospitalization expenses between R-LG and L-LG group (all P>0.05). For those patients with BMI<24 kg/m², there were no significant differences in all above parameters between R-LG group (57 cases) and L-LG group (55 cases). No mortality and recurrence was observed during follow-up of 3 to 24 months.

CONCLUSIONRight-to-lateral approach in laparoscopic-assisted radical gastrectomy is a safe and feasible procedure, especially for the obesity patients, which can shorten the operation time, decrease intraoperative blood loss, lead to a faster postoperative recovery and harvest more lymph nodes as compared to L-LG procedure.

Body Mass Index ; Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Obesity ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Stomach Neoplasms ; surgery

Objective To investigate the cosmetic outcome of treatments for mentalis scars with expanded skin flaps.Methods From the experiences of past 26 cases in our department,we summarised the technique for treating the mentalis scars with expanded skin flaps.For simple mentalis scars or localized inferior facial scars,the mentalis,bottom jaw or facial skin were expanded and the expander kept superior to the neck-jaw angle.Otherwise the expander would only fill the angle and the expanding efficiency was reduced.For severe mentalis,neck or facial scars without extra normal treating skin,expanded deltopectoral flaps were chosen to cover the wound after cicatrectomy with pedicles which were cut 3 weeks later.Results All the local ordistant expanded flaps survived successfully in the 26 cases with optimistic outcomes.Conclusions Application of local or distant expanded flaps is a useful technique for mentalis scars treatment.

Objective To develop new repairing techniques for acquired inferior palpebral region defects. Methods Expanded forehead flaps were used to reconstruct the inferior palpebral defects or post-excision wound surface and the flaps were pedicled with supra-trochlea vessels or ramus frontalis arteriae temporalis superficialis. As for supra-trochlea vessels, contralateral ones were prior to the homolateral ones. The incision site located in the scalp and the major axis of the expander parallel to the forehead. Firstly, the leisions were cut and the subcutaneous tissues loosed to regain the anatomy position of inferior palpebra. Secondly, the expanded flaps were transfered onto the defects by the wound sizes with the supra-trochlea vessels as their pedicles. At last, the pedicles were cut 3 weeks later.For ramus frontalis arteriae temporalis superficialis, the flap was transfered with a subdermal pedicle and the donor site was closed directly. Results There were 10 cases in the present group, 6 for supratrochlea vessels and the 4 others for ramus frontalis arteriae temporalis superficialis. All the flaps survived successfully. 3 cases returned with optimistic outcomes 6 months later. Conclusion The expanded forehead flaps are fit for repairing the inferior palpebral defects, which can successfully avoid ectropion. This technique is very useful for reconstructing the texture of the site of defects.