Efficacy of repetitive transcranial magnetic stimulation on post-stroke cognitive impairment: A systematic and a network meta-analysis.

OBJECTIVES: This study aimed to evaluate the efficacy of different repetitive transcranial magnetic stimulation (rTMS) modes in stroke patients with cognitive impairment, and to rank the best option according to the outcome measures. METHODS: Literature was searched in PubMed, Cochrane Library, Web of Science, Embase, SinoMed, China National Knowledge Infrastructure, Wanfang Database, and VIP Database, from database inception to September 2023. We included randomized controlled trials (RCTs) investigating the efficacy of all rTMS modes for post-stroke cognitive impairment. The selected studies assessed at least one of the following outcome measures: Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), P300 latency and amplitude, and modified Barthel Index (MBI) or BI. Two researchers independently conducted data extraction. Quality assessment was performed using RevMan 5.3 software based on the Cochrane Collaboration's tool, and statistical analysis was conducted by GeMTC 0.14.3 software and Stata 17.0 software. RESULTS: The network meta-analysis included 74 RCTs with a total of 5478 patients. The best probability ranking indicated that intermittent theta burst stimulation (iTBS) was the most effective in enhancing MoCA, MMSE and MBI scores (85%, 54%, 42%, respectively), followed by 10 Hz rTMS (79%, 50%, 39%, respectively), for P300 amplitude, ≤1 Hz rTMS was ranked first (52%). CONCLUSIONS: The current limited evidence suggests that iTBS may be the optimal approach for improving cognitive and daily life abilities of stroke patients, followed by 10 Hz rTMS, ≤1 Hz rTMS may be the preferred option for enhancing P300 amplitude. TRAIL REGISTRATION: PROSPERO 2023 CRD42023424771 available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=424771.

Properties of Spherically Symmetric Black Holes in the Generalized Brans-Dicke Modified Gravitational Theory.

The many problems faced by the theory of general relativity (GR) have always motivated us to explore the modified theory of GR. Considering the importance of studying the black hole (BH) entropy and its correction in gravity physics, we study the correction of thermodynamic entropy for a kind of spherically symmetric black hole under the generalized Brans-Dicke (GBD) theory of modified gravity. We derive and calculate the entropy and heat capacity. It is found that when the value of event horizon radius r+ is small, the effect of the entropy-correction term on the entropy is very obvious, while for larger values r+, the contribution of the correction term on entropy can be almost ignored. In addition, we can observe that as the radius of the event horizon increases, the heat capacity of BH in GBD theory will change from a negative value to a positive value, indicating that there is a phase transition in black holes. Given that studying the structure of geodesic lines is important for exploring the physical characteristics of a strong gravitational field, we also investigate the stability of particles' circular orbits in static spherically symmetric BHs within the framework of GBD theory. Concretely, we analyze the dependence of the innermost stable circular orbit on model parameters. In addition, the geodesic deviation equation is also applied to investigate the stable circular orbit of particles in GBD theory. The conditions for the stability of the BH solution and the limited range of radial coordinates required to achieve stable circular orbit motion are given. Finally, we show the locations of stable circular orbits, and obtain the angular velocity, specific energy, and angular momentum of the particles which move in circular orbits.

[Case-control study on two osteotomy techniques for the treatment of distal radial malunion].

OBJECTIVE: Radial corrective osteotomy is an established but challenging treatment for distal radial malunion. There is an ongoing discussion about whether an opening or closing-wedge osteotomy between should employed. The purpose of the present study was to retrospectively compare the clinical and radio graphic results between conventional opening-wedge osteotomy and closing-wedge technique. METHODS: From January 2004 and December 2012,42 patients with extra-articular distal radial malunion were managed with corrective osteotomy and were followed for a minimum of one year. Twenty-two patients (5 males and 17 females, ranging in age from 25 to 75 years old) were managed with radial opening-wedge osteotomy and implanting of interpositional bone graft or bone-graft substitute, and twenty patients (4 males and 16 females, ranging in age from 19 to 79 years) were managed with simultaneous radial closing-wedge and ulnar shortening osteotomy without bone graft. The selection of the surgical procedure was determined by the surgeon. Each patient was evaluated on the basis of objective radio graphic measurements, and functional outcomes were determined on the basis of clinical examinations, including range of wrist motion, grip strength, pain-rating score, Mayo wrist score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: The mean duration of follow-up was 36 months (ranged, 12 to 101 months) for the opening-wedge cohort and 28 months (ranged, 12 to 87 months) for the closing-wedge cohort. The two techniques were comparable in terms of complications. Post-operative volar tilt and ulnar variance were improved significantly in each cohort. The ulnar variance was more frequently restored to within defined criteria (22.5 to 0.5 mm) in the closing-wedge cohort than that in the opening-wedge cohort. The post-operative mean extension-flexion are of the wrist and Mayo wrist score were significantly better in the closing-wedge cohort. Differences in the pronation-supination arc, grip strength, pain-rating score, and DASH scores between these two cohorts were not significant. CONCLUSION: The closing wedge osteotomy technique is an effective reconstructive procedure for the treatment of extra-articular distal radial malunion. It is significantly better than the opening-wedge osteotomy technique in terms of the restoration of ulnar variance, the extension-flexion arc of wrist motion, and the Mayo wrist score.