Simulation of transcranial magnetic stimulation in head model with morphologically-realistic cortical neurons

BackgroundTranscranial magnetic stimulation (TMS) enables non-invasive modulation of brain activity with both clinical and research applications, but fundamental questions remain about the neural types and elements TMS activates and how stimulation parameters affect the neural response.ObjectiveTo develop a multi-scale computational model to quantify the effect of TMS parameters on the direct response of individual neurons.MethodsWe integrated morphologically-realistic neuronal models with TMS-induced electric fields computed in a finite element model of a human head to quantify the cortical response to TMS with several combinations of pulse waveforms and current directions.ResultsTMS activated with lowest intensity intracortical axonal terminations in the superficial gyral crown and lip regions. Layer 5 pyramidal cells had the lowest thresholds, but layer 2/3 pyramidal cells and inhibitory basket cells were also activated at most intensities. Direct activation of layers 1 and 6 was unlikely. Neural activation was largely driven by the field magnitude, rather than the field component normal to the cortical surface. Varying the induced current direction caused a waveform-dependent shift in the activation site and provided a potential mechanism for experimentally observed differences in thresholds and latencies of muscle responses.ConclusionsThis biophysically-based simulation provides a novel method to elucidate mechanisms and inform parameter selection of TMS and other cortical stimulation modalities. It also serves as a foundation for more detailed network models of the response to TMS, which may include endogenous activity, synaptic connectivity, inputs from intrinsic and extrinsic axonal projections, and corticofugal axons in white matter.     

金刚丸调节Hippo信号通路mRNA表达防治OVX大鼠骨质疏松作用机制

摘要：目的 基于Hippo信号通路核心基因mRNA表达，探索具有补肾填精壮骨之效的金刚丸治疗去卵巢（ovariectomized,OVX）大鼠骨质疏松症的疗效机制。方法 通过OVX法建立绝经后骨质疏松症（postmenopausal osteoporosis,PMOP）大鼠模型，分正常组、假手术组、模型组、金刚丸高剂量组、金刚丸中剂量组、金刚丸低剂量组、仙灵骨葆对照组、骨化三醇对照组。灌胃12周后，通过X射线骨密度仪检测骨密度、镜下观察股骨头显微形态结构、ELISA法检测血清ALP、实时定量RT-PCR检测骨组织Mst2、Lats1、Taz mRNA表达。结果 ①与正常组比较，模型组股骨骨密度显著降低（P＜0.01）、骨微结构显著破坏、血清ALP显著降低（P＜0.01）、骨组织Mst2、Lats1 mRNA表达显著升高（P＜0.01）、Taz mRNA表达显著降低（P＜0.01）；②与模型组比较，除金刚丸低剂量组外，各给药组的骨密度均显著升高（P＜0.01），各给药组骨微结构破坏均得到改善、血清ALP均显著升高（P＜0.01）、骨组织Mst2、Lats1 mRNA表达均显著降低（P＜0.01）、Taz mRNA表达均显著升高（P＜0.01），均以金刚丸高剂量组最为显著。结论 骨组织Hippo信号通路核心基因Mst2、Lats1 mRNA表达上调，Taz mRNA表达下调可能是PMOP的发病机制之一；金刚丸可能通过下调骨组织Hippo信号通路核心基因Mst2、Lats1 mRNA表达、上调Taz mRNA表达的机制，有效防治PMOP。     

Differentiating autoimmune pancreatitis from pancreatic ductal adenocarcinoma with CT radiomics features

PurposeThe purpose of this study was to determine whether computed tomography (CT)-based machine learning of radiomics features could help distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC).Materials and MethodsEighty-nine patients with AIP (65 men, 24 women; mean age, 59.7 ± 13.9 [SD] years; range: 21–83 years) and 93 patients with PDAC (68 men, 25 women; mean age, 60.1 ± 12.3 [SD] years; range: 36–86 years) were retrospectively included. All patients had dedicated dual-phase pancreatic protocol CT between 2004 and 2018. Thin-slice images (0.75/0.5 mm thickness/increment) were compared with thick-slices images (3 or 5 mm thickness/increment). Pancreatic regions involved by PDAC or AIP (areas of enlargement, altered enhancement, effacement of pancreatic duct) as well as uninvolved parenchyma were segmented as three-dimensional volumes. Four hundred and thirty-one radiomics features were extracted and a random forest was used to distinguish AIP from PDAC. CT data of 60 AIP and 60 PDAC patients were used for training and those of 29 AIP and 33 PDAC independent patients were used for testing.ResultsThe pancreas was diffusely involved in 37 (37/89; 41.6%) patients with AIP and not diffusely in 52 (52/89; 58.4%) patients. Using machine learning, 95.2% (59/62; 95% confidence interval [CI]: 89.8–100%), 83.9% (52:67; 95% CI: 74.7–93.0%) and 77.4% (48/62; 95% CI: 67.0–87.8%) of the 62 test patients were correctly classified as either having PDAC or AIP with thin-slice venous phase, thin-slice arterial phase, and thick-slice venous phase CT, respectively. Three of the 29 patients with AIP (3/29; 10.3%) were incorrectly classified as having PDAC but all 33 patients with PDAC (33/33; 100%) were correctly classified with thin-slice venous phase with 89.7% sensitivity (26/29; 95% CI: 78.6–100%) and 100% specificity (33/33; 95% CI: 93–100%) for the diagnosis of AIP, 95.2% accuracy (59/62; 95% CI: 89.8–100%) and area under the curve of 0.975 (95% CI: 0.936–1.0).ConclusionsRadiomic features help differentiate AIP from PDAC with an overall accuracy of 95.2%.     

PBL教学法在中医急诊学教学中的运用分析

目的分析PBL教学法在中医急诊学教学中的运用效果。方法2018年3月-2018年6月选取本校2016级针推专升本学生68名进行调查,采用随机数字表法将其分为2组,各34名,观察组采取PBL教学法,对照组采取传统讲授法,对比2组学生的理论、实践考核成绩,并通过调查问卷评价学生对教学方法的认可程度。结果实施教学后,观察组学生理论、实践考核成绩较对照组学生明显提高(P<0.05)。相比于对照组,观察组学生在培养学习兴趣、提升学习技巧、增强合作能力、创新思维方式的层面上对教学方法的认可程度普遍较高(P<0.05)。结论采取PBL法实施中医急诊学教学有助于提升临床教学效果和质量。     

康复护理教学中应用Seminar教学法的分析

目的 探讨康复护理教学中应用Seminar教学法的效果.方法 选择医院2018年6月—2019年6月在肿瘤科实习的80名护理学生作为本次研究入组对象,根据随机数字表随机分为研究组和对照组,每组40名学生.对照组采用传统护理教学方法 ,研究组采用Seminar教学法,分析对比两组护理学生的教学效果.结果 研究组护理学生理论考试、技能考试、综合成绩高于对照组护理学生成绩(P<0.05).研究组护理学生自主学习情况由于对照组护理学生(P<0.05).结论 康复护理教学中应用Seminar教学法的效果好,有利于激发学生学习兴趣,巩固学生护理基本知识技能,提高护理思维能力,从而提高护理教学质量.     

Analysis of jump load during a volleyball season in terms of player role

ObjectivesThe aim of this study was to analyze the jump load performed by top-level volleyball players during an entire training season in terms of the player role, training period, type of daily training, and quality of opposition in the subsequent match.DesignLongitudinal panel observational study.MethodsThe total number of jumps performed by players was recorded through 174 training days distributed in 32 weeks during the 2016/2017 season (pre-season, 5 weeks; in-season, 27 weeks). The players role were classified as middle-blocker, outside-hitter, opposite and setter (the libero was omitted). A generalized mixed linear model was performed (with Bonferroni post hoc test at p < 0.05) to assess the effect of training variables and the repeated-measures data of players’ jumps along various training days. Additionally, the effect sizes at 95% confidence intervals were calculated to compare the jump load between players’ role and training variables.ResultsThe results showed a significant and moderate higher amount of jumps performed by middle-blockers regardless the type of macro- or micro-cycle, the micro-cycle phase, the type of training and the quality of match opposition. Contrarily, the setter performs the least jump load in all variables analyzed. Only the players’ role, macro-cycle and micro-cycle phase had significant effects on the player's jump load variation along the season.ConclusionsThis information could be useful to guide the monitoring and preparation process for coaches and physical trainers. These values allow differentiating between players’ role and could be used as references values in order to avoid injuries whereas performance increase along the season.     

品管圈活动在喜疗妥联合新鲜马铃薯外敷治疗小儿输液外渗中的应用效果分析

目的探讨品管圈活动在喜疗妥联合新鲜马铃薯外敷治疗小儿输液外渗中的应用效果。方法选取我院2016年8月至2018年12月收治的输液外渗患儿100例,随机分为两组各50例。对照组给予50%硫酸镁湿敷治疗与常规护理,干预组采用喜疗妥联合新鲜马铃薯外敷,进行品管圈活动。对比两组的临床疗效、损伤痊愈时间和完全消肿时间。结果干预组的总有效率为90.00%,高于对照组的74.00%(P <0.05)。干预组的损伤痊愈时间和完全消肿时间短于对照组(P <0.05)。结论品管圈活动在喜疗妥联合新鲜马铃薯外敷治疗小儿输液外渗中的效果较好,可缩短临床症状消失时间,加快康复进程。     

An analysis of underlying factors for seasonal variation in gonorrhoea in India: A 6-year statistical assessment

Purpose: A statistical assessment of a disease is often necessary before resources can be allocated to any control programme. No literature on seasonal trends of gonorrhoea is available from India. Objectives: The objectives were (1) to determine, if any, seasonal trends were present in India (2) to describe factors contributing to seasonality of gonorrhoea (3) to formulate approaches for gonorrhoea control at the national level. Materials and Methods: Seasonal indices for gonorrhoea were calculated quarterly in terms of a seasonal index between 2005 and 2010. Ratio-to-moving average method was used to determine the seasonal variation. The original data values in the time-series were expressed as percentages of moving averages. Results were also analyzed by second statistical method i.e. seasonal subseries plot. Results: The seasonally adjusted average for culture-positive gonorrhoea cases was highest in the second quarter (128.61%) followed by third quarter (108.48%) while a trough was observed in the first (96.05%) and last quarter (64.85%). The second quarter peak was representative of summer vacations in schools and colleges. Moreover, April is the harvesting month followed by celebrations and social gatherings. Both these factors are associated with increased sexual activity and partner change. A trough in first and last quarter was indicative of festival season and winter leading to less patients reporting to the hospital. Conclusion: The findings highlight the immediate need to strengthen sexual health education among young people in schools and colleges and education on risk-reduction practices especially at crucial points in the calendar year for effective gonorrhoea control.     

案例教学法在消化内科见习课的应用效果评价

目的探讨案例教学法在消化内科见习课的教学效果和体会。方法选取2017年10月—2017年12月在消化内科进行见习课的2015级39-40班护理本科学生44例(全部为女生),抓阄分成对照组(22人)和试验组(22人),对照组给予传统的带教方法,试验组给予案例教学法教学,比较两组护生在理论、技能、综合能力和对带教满意度方面有无差异。两组学生在性别、年龄、专业前的课程成绩比较,差异无统计学意义(均P>0.05)。结果观察组在理论考核成绩、操作考核成绩、教学满意度等方面均高于对照组。结论案例教学法能提高护理教学的教学效果,增加学生的理论、操作能力,提高护理临床思维能力,提升学生的学习主动性和积极性。