Post-stroke cognitive impairment (PSCI) is a common complication after stroke, which has high disability rate and mortality rate, and can affect the patient′s daily living ability and quality of life. Non-invasive brain stimulation (NIBS) has the advantages of non-invasiveness, safety, and ease of operation, and is easily accepted by patients. NIBS has a good application prospect in the treatment of PSCI, especially the representative treatment repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) such as have good clinical application effects. At present, there is no standardized treatment plan for NIBS, and there are large individual differences in therapeutic effects. This study reviewed the mechanism and clinical application of NIBS in the treatment of PSCI, and discussed the future application direction of NIBS.

Objective:To quantify any correlation between serum levels of omega-3 polyunsaturated fatty acids (ω3-PUFAs) and post-stroke cognitive impairment (PSCI).Methods:The clinical data of 77 patients hospitalized after a first stroke were analyzed. The Minimum Mental State Examination (MMSE) was used to divide them into impaired (PSCI) and unimpaired (non-PSCI) cohorts. The serum levels of ω3-PUFAs, α-linolenic acid (ALA), eieosapentaenoic acid (EPA) and dueosahexenoie acid (DHA) were compared between the two groups and correlated with the individuals′ MMSE scores.Results:The average ALA, EPA, DHA and total ω3-PUFAs levels of PSCI group were in most cases significantly lower than those of the non-PSCI group. Spearman correlation analysis showed that serum DHA level was a weak positive predictor of the MMSE scores (R=0.32, P≤0.05). Logistic regression analysis indicated that low serum DHA level was an independent risk factor for PSCI ( P≤0.01). Conclusions:Cognitively impaired stroke survivors tend to have lower serum ω3-PUFAs levels than those without cognitive impairment. There is a weak positive correlation between serum DHA levels and MMSE scores. Low serum DHA level is an independent risk factor for PSCI. The serum level of ω3-PUFAs is of high value in the auxiliary diagnosis and evaluation of PSCI.

Objective To investigate the development of rehabilitation medical resources in Jiangsu during Thirteenth Five-year Plan.Methods The electronic questionnaire was issued uniformly to the medical and health institutions in 13 prefecture-level cities in Jiangsu Province through the Health Commission system, to survey the rehabilitation medical resources data from 2015 to 2019.Results Compared with those in 2015, the secondary and above general hospitals with rehabilitation medicine departments increased 3.42 percentage points and community-level medical and healthcare institutions providing rehabilitation medical services increased 5.67 percentage points at the end of 2019; while, the authorized beds increased 127 and actual beds increased 142 in the rehabilitation department per million population; the early rehabilitation intervention increased 4 326 person-times per million population; there were 91 more rehabilitation professionals per million population, including 25 rehabilitation physicians, 31 rehabilitation therapists, 29 rehabilitation nurses and six other rehabilitation practitioners; the practitioners with associate senior titles and above increased 1.65 percentage points, and those with master-degree or above increased 1.27 percentage points.Conclusion The allocation of various rehabilitation resources has been improved in Jiangsu province during Thirteenth Five-year Plan.

Objective Broth dilution method was used as a reference method to observe the capability of Kirby-Bauer disc diffusion assay(K-B)for correcting automated ampicillin susceptibility detection of He-mophilus influenzae(HI).Methods A total of 228 HI strains isolated were collected,broth dilution assay,K-B and automated microdilution broth test(ATB)were used to determine the susceptibility of HI to ampicillin. Analyze the essential agreements of the three methods and the correction of K-B to the errors of A TB. Results The essential agreement of K-B or ATB with broth dilution method were 77.19%,70.18% respec-tively,combination of K-B and ATB could make the essential agreement increase up to 86.0%,which was sig-nificantly higher than ATB(χ2=16.600,P=0.000).Major error of ATB(42.0%)was higher than that of K-B(10.0%)(χ2=13.306,P=0.001),but very major error and minor error showed no significant difference be-tween the two methods(χ2=1.208,P=0.272;χ2=1.182,P=0.227),meanwhile,76.19% of major error of ATB could be corrected by K-B.For the very major error of ATB,53.57% could be corrected by K-B.Howev-er,the corrective capability of K-B to minor error of ATB was relative low.Conclusion K-B test could correct some errors generated by ATB.For the β-lactamase negative strains which were judged as ampicillin resistance by A TB,K-B test should be used to correct the errors by ATB.Moreover,it is necessary to apply K-B to confirm am-picillin sensitivity of the β-lactamase positive strains which were judged as ampicillin susceptible by ATB.

Objective To analyze the initial experience of total laparoscopic radical resection for patients with Bismuth type Ⅲa hilar cholangiocarcinoma.Methods A retrospective study was conducted to analyze the clinical data of three patients with Bismuth type Ⅲa hilar cholangiocarcinomatotal who underwent laparoscopic radical resection in Zhejiang Provincial People's Hospital from February to May in 2017.Results The three patients all underwent the operations successfully.The operation time ranged from 490.0 to 580.0 min.The intraoperative blood loss ranged from 300.0 ml to 1 200.0 ml.There was no severe perioperatire complication or death.One patient developed biliary leakage which responded to drainage without reoperation.Another patient developed pleural effusion treated with minimal invasive drainage.The length of postoperative hospital stay ranged from 10.0 to 18.0 days.Histopathology showed two patients with well-differentiated adenocarcinomas and one patient with poorly differentiated adenocarcinoma.The number of lymph nodes harvested ranged from 8 ～ 13.Two patients had no regional lymph node metastasis and one patient had regional lymph node metastasis (1/13).The hilar bile duct resection margins of the three patients were all negative.There was no evidence of tumor recurrence on following up for 7 ～ 10 months.Conclusions It was safe and feasible to carry out total laparoscopic radical resection in selected patients with Bismuth type Ⅲa hilar cholangiocarcinoma.More patients and longer follow-up are required to study the long term oncological results.

Objective To observe the effects of immune acupuncture and moxibustion on the infection in hospital and the outcome of re-habilitation after stroke. Methods From January, 2014 to January, 2016, 100 patients following acute stroke were randomly divided into ob-servation group (n=50) and control group (n=50). The control group accepted routine medications, rehabilitation and acupuncture, while the observation group accepted acupuncture and moxibustion on Guanyuan (RN4), Qihai (RN6) and Zusanli (ST36) in addition. The nosocomi-al infection rate was recorded 90 days after treatment, and the T lymphocyte subsets, scores of Fugl-Meyer Assessment (FMA) and modified Barthel index (MBI) were measured before and after treatment. Results The nosocomial infection rate was 20% in the observation group, less than 42% in the control group (χ2=5.657, P<0.05). The contribution of CD3+ and CD4+ T lymphocytes, and the scores of FMA and MBI increased after treatment in both groups (t>2.463, P<0.05), and increased more in the observation group than in the control group (t>2.225, P<0.05). Conclusion Immune acupuncture and moxibustion therapy can reduce the incidence of nosocomial infection, and promote the func-tion of the immune system and outcome in patients after acute stroke.

Objective To investigate the epidemic strains of biological type, drug resistance, and the basic clinical characteristics of haemophilus influenzae(Hi)isolated from hospitalized adults with lower respiratory tract infection in Chengdu area.Methods A prospective cross-sectional study was conducted to analyze the biological typing,capsular genes detected by PCR technique,and drug resistance tested by drug sensitive test of Hi epidemic strains isolated from the sputum of adults aged above 18 years who were hospitalized in two tertiary hospitals of west Sichuan in China.Results The positive rate of pathogenic bacteria in adults aged above 18 years who were hospitalized in the two hospitals was 46.71%(15 447/33 069)between November 2013 and October 2014.The positive rate of Hi isolated from the sputum of 100 adults with lower respiratory tract infection was 0.31%(101/33 069).The constituent ratio of Hi in lower respiratory tract infection pathogens was 0.65%(101/15 447).The Hi were all undifferentiated type detected by PCR,and the biological typing of Hi were typeⅠ(42.57%),Ⅳ(29.7%),Ⅱ(15.84%),Ⅲ(9.9%),Ⅶ(1.98%), and Ⅵ(0.9%).The diseases of Hi positive were acute phase of chronic obstructive pulmonary disease(59%), pneumonia(35%), and bronchitis(6%), in which community acquired infection was 55%.The rate of β-lactamase enzyme production was 38.61%.The frequencice of β-lactamase -nonproducing-ampicillin-resistant(BLNAR)strains was 2.97%,and of intermediary strains was 4.95%(5/101).The drug resistance rate of amoxicillin and clavulafiate was 2.97%.The drug resistance rate of cefuroxime was 12.87%, and intermediary rate was 12.87%.The drug resistance rate of cefaclor was 29.7%,and intermediary rate was 8.91%.The drug resistance rate of cefotaxime and ofloxacin was 6.93%and 1.99%.There were no obvious statistical differences between the drug resistance rates of the two hospitals.Conclusions The Hi epidemic strains isolated from the sputum of adults with lower respiratory tract infection were all undifferentiated type,and the common biological types were Ⅰ,Ⅳ,Ⅱ, andⅢ in west Sichuan in China.It should pay attention to the BLNAR strains and ofloxacin-resistant strains.

Objective To evaluate the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) on recurrence after hepatectomy for AFP negative hepatocellular carcinoma (HCC).Methods Clinical data of 68 AFP negative HCC patients undergoing radical hepatectomy from September 2010 to January 2013 were analyzed retrospectively.According to preoperative NLR,patients were divided into low NLR group (NLR ＜ 2.78) and high NLR group (NLR ≥ 2.78),respectively.Univariate analysis was performed to assess for a significant difference in clinicopathological characteristics influencing disease-free suvival after hepatectomy.A multivariate analysis was performed by Cox regression for variables significant on univariate analysis.Kaplan-Meier method was used to assess disease-free survival rate.Results The overall 1,2,and 3-year disease-free survival rate was 79.7％,37.5％,and 18.2％ respectively.The disease-free survival of high NLR group was significantly lower than the low NLR group (1,2,and 3-year overall survival were 70.3％,35.1％,and 13.5％ vs 85.2％,40.7％,and 18.5％,respectively,P =0.042).Preoperative NLR ≥2.78,tumor size (＞ 5 cm),microvascular invasion and liver cirrhosis were risk factors of poor disease-free survival.Cox regression analysis revealed that all of these four factors were independent predictors of poorer disease-free survival.Conclusions Preoperative NLR≥2.78 was one of independent adverse predictors for disease-free survival in AFP negative HCC patients after hepatectomy.

Objective To study the changes of posterior corneal elevation with one-year follow-up by using Allegro Oculyzer anterior segment diagnostic system in patients who had undergone laser in situ keratomileusis with femtosecond laser (FS-LASIK) for myopia. Methods Ninety eyes of forty-five patients who had undergone FS-LASIK for myopia were included in our study . The spherical equivalent of ametropia was-10.63D to -1.63D. The preoperative and postoperative corneal tomography (including 1, 3, 6 and 12 month after operation ) were collected by Allegro Oculyzer in the posterior corneal elevation and the thickness at central corneal thinnest point of each eye were measured , and the differences of the posterior corneal elevation were calculated. The data were analyzed with ANOVA and Pearson correlation analysis. Results There were no statistically significant differences in the changes of posterior corneal elevation from the preoperative time to the any postoperative follow-up time (F = 1.50, P > 0.05). There were no statistically significant changes of the posterior corneal elevation from the 1st month to 12th month postoperatively (F = 1.47, P > 0.05). There were statistically significant differences in the changes of thickness at central corneal thinnest point from the preoperative to the 12th month postoperative (F = 369.10, P <0.01). At postoperative time, the posterior corneal elevation was not correlated with several factors including spherical equivalent , ablation depth , residual bed thickness, ablation percentage per total corneal thickness and (corneal flap thickness + ablation depth) /thinnest point preoperative corneal thickness (P > 0.05). Conclusion After strictly followed surgical indications in FS-LASIK, the posterior corneal elevation can keep good stability and has no significant change. Thickness of central cornea thinnest point increases gradually and tends to stablity at the 3th months after surgery.

Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) targeted treatment has been a standard therapy for advanced non-small cell lung cancer (NSCLC), but it is not tolerated well by all patients. In China, some studies have reported that traditional Chinese medicinal herbs (TCMHs) may increase efficacy and reduce toxicity when combined with EGFR-TKI, but outside of China few studies of this kind have been attempted.