A Dynamic Prediction Model for Renal Progression in Primary Membranous Nephropathy.

Objective: This study aimed to build and validate a practical web-based dynamic prediction model for predicting renal progression in patients with primary membranous nephropathy (PMN). Method: A total of 359 PMN patients from The First Affiliated Hospital of Fujian Medical University and 102 patients with PMN from The Second Hospital of Longyan between January 2018 to December 2023 were included in the derivation and validation cohorts, respectively. Renal progression was delineated as a decrease in eGFR of 30% or more from the baseline measurement at biopsy or the onset of End-Stage Renal Disease (ESRD). Multivariable Cox regression analysis was employed to identify independent prognostic factors. A web-based dynamic prediction model for renal progression was built and validated, and the performance was assessed using. An analysis of the receiver operating characteristic and the decision curve analysis. Results: In the derivation cohort, 66 (18.3%) patients experienced renal progression during the follow-up period (37.60 ± 7.95 months). The final prediction rule for renal progression included hyperuricemia (HR=2.20, 95%CI 1.26 to 3.86), proteinuria (HR=2.16, 95%CI 1.47 to 3.18), significantly lower serum albumin (HR=2.34, 95%CI 1.51 to 3.68) and eGFR (HR=1.96, 95%CI 1.47 to 2.61), older age (HR=1.85, 95%CI 1.28 to 2.61), and higher sPLA2R-ab levels (HR=2.08, 95%CI 1.43 to 3.18). Scores for each variable were calculated using the regression coefficients in the Cox model. The developed web-based dynamic prediction model, available online at http://imnpredictmodel1.shinyapps.io/dynnomapp, showed good discrimination (C-statistic = 0.72) and calibration (Brier score, P = 0.155) in the validation cohort. Conclusion: We developed a web-based dynamic prediction model that can predict renal progression in patients with PMN. It may serve as a helpful tool for clinicians to identify high-risk PMN patients and tailor appropriate treatment and surveillance strategies.

High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on global cognitive function of elderly in mild to moderate Alzheimer's disease: a systematic review and meta-analysis.

OBJECTIVE: High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) is a non-invasive brain stimulation technique used to improve cognitive deficits in patients with Alzheimer's disease (AD). This systematic review and meta-analysis aimed to evaluate the efficacy of HF-rTMS in improving global cognitive function rehabilitation in elderly patients with mild to moderate AD. METHODS: A detailed literature search of publications using ten databases (Chinese: Wanfang, VIP Periodical, SinoMed, the Chinese National Knowledge Infrastructure; English: PubMed, Embase, OVID, Web of Science, Cochrane Library, and EBSCOhost) was performed to identify English and Chinese language articles published up to December 2022. We only included randomized controlled trials (RCTs) that evaluate the effect of HF-rTMS on elderly patients with mild to moderate AD. The retrieved studies were carefully reviewed, extracted data, and assessed quality. RESULTS: Seventeen studies, including 1161 elderly patients with mild to moderate AD, were included in this meta-analysis. Compared to the control group, HF-rTMS could increase MMSE (mean difference [MD] = 3.64; 95%CI 1.86-5.42; P < 0.0001), MoCA (MD = 3.69; 95%CI 1.84-5.54; P < 0.0001), P300 amplitude (MD = 1.09; 95%CI 0.45-1.72; P = 0.0008), and total effective rate scores (MD = 3.64; 95% CI 2.14-6.18; P < 0.00001) while decreasing ADAS-Cog (MD = - 3.53; 95%CI - 4.91- - 2.15; P < 0.00001) and P300 latency scores (MD = - 38.32; 95%CI - 72.40- - 4.24; P = 0.03). Our study showed that HF-rTMS could improve the global cognitive function of elderly patients with mild to moderate AD. CONCLUSION: HF-rTMS can improve global cognitive function in elderly patients with mild to moderate AD, which is an effective and safe rehabilitation treatment tool for AD patients.

High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) impacts activities of daily living of patients with post-stroke cognitive impairment: a systematic review and meta-analysis.

OBJECTIVE: To systematically evaluate the impact of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on activities of daily living (ADLs) of patients with post-stroke cognitive impairment (PSCI). DATA SOURCES: Relevant studies published as of November 2022 (English and Chinese) were searched in Web of Science, PubMed, Embase, Cochrane Library, OVID, China Science and Technology Journal Database (VIP), Wanfang, Chinese National Knowledge Infrastructure (CNKI), and SinoMed databases. REVIEW METHODS: Randomized controlled trials (RCTs) that used HF-rTMS for the treatment of ADLs in patients with PSCI were included in this meta-analysis. Two reviewers independently screened literature, extracted the data, evaluated the risk of bias using the Cochrane Risk of Bias Tool, and cross-checked. RESULTS: Forty-one RCTs involving 2855 patients with PSCI were included. In 30 RCTs, the experimental group received HF-rTMS in addition to the interventions used in the control group. In 11 RCTs, the experimental group received HF-rTMS while the control group received sham-rTMS. Barthel Index (BI), Modified Barthel Index (MBI), and Functional Independence Measure (FIM) were higher in the HF-rTMS group than in the control group, whereas scores of Blessed Behavior Scale was lower in the HF-rTMS group than in the control group. All P < 0.05. In 36 studies, the stimulation sites were on the dorsolateral prefrontal cortex (DLPFC). CONCLUSION: HF-rTMS can ameliorate ADLs of patients with PSCI and has a better rehabilitation effect on PSCI.

High-Frequency Repetitive Transcranial Magnetic Stimulation on Overall Cognition in Patients With Poststroke Cognitive Impairment: A Systematic Review and Meta-analysis.

OBJECTIVE: The aim of the study is to comprehensively assess the recovery effects of high-frequency repetitive transcranial magnetic stimulation in patients with poststroke cognitive impairment. METHODS: Six English and four Chinese databases were searched for relevant studies published up to January 2022. Randomized controlled trials of patients with poststroke cognitive impairment treated with high-frequency repetitive transcranial magnetic stimulation were included. Included studies were assessed for the risk of bias through the Cochrane Intervention Systematic Review Manual 5.1.0. The meta-analysis was performed using RevMan 5.4 software. The PRISMA 2020 guidelines were followed. RESULTS: Sixty-one randomized controlled trials (4012 patients) were included. Montreal Cognitive Assessment Score, Mini-Mental State Examination score, event-related potential P300 (P300) amplitude, Loewenstein Occupational Therapy Cognitive Assessment score, and total effective rate of cognitive function were higher in the high-frequency repetitive transcranial magnetic stimulation group than in the control group at the end of the treatment period, and scores of Alzheimer Disease Assessment Scale-Cognitive Subscale and P300 latency were lower in the high-frequency repetitive transcranial magnetic stimulation group than in the control group. Fifty studies had selected the dorsolateral prefrontal cortex as the stimulation site for high-frequency repetitive transcranial magnetic stimulation. CONCLUSIONS: Compared with nonrepetitive transcranial magnetic stimulation or sham repetitive transcranial magnetic stimulation, high-frequency repetitive transcranial magnetic stimulation not only improves the overall cognitive function of poststroke cognitive impairment patients but also has better rehabilitation results.

Transcranial Direct Current Stimulation for Global Cognitive Functioning and Ability in Daily Life Activities in Poststroke Cognitive Impairment: A Systematic Review and Meta-analysis.

OBJECTIVE: The aim of the study is to determine the efficacy of transcranial direct current stimulation on global cognition and ability in daily life activities of patients with poststroke cognitive impairment. DESIGN: Nine electronic databases were searched from their respective inceptions through January 2022. We included the randomized controlled trials that used transcranial direct current stimulation for poststroke cognitive impairment and included at least one global cognitive function or ability in daily life activities outcome indicators. Two reviewers appraised the risks of bias through the Cochrane Collaboration's tool and performed the meta-analysis. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. RESULTS: Twenty-two studies (1198 participants) were included. Most studies had no significant bias in the quality of the methodology. Meta-analyses found that compared with the control group, transcranial direct current stimulation increased Montreal cognitive assessment, Mini-mental state examination, Loewenstein occupational therapy cognitive assessment, total effective rate of cognition, modified Barthel Index, and decreased P300 latency (all P < 0.05). These results showed transcranial direct current stimulation can improve cognitive function and ability in daily life activities in poststroke cognitive impairment. CONCLUSIONS: The transcranial direct current stimulation may have a significant rehabilitation effect on global cognitive functioning and ability in daily life activities of patients with poststroke cognitive impairment.

Assessment of the Second Mesiobuccal Root Canal in Maxillary First Molars: A Cone-beam Computed Tomographic Study.

INTRODUCTION: The purpose of this study was to investigate the incidence and location of the second mesiobuccal (MB2) root canal of the maxillary first molar and the relationship between the presence of an MB2 canal and the distribution of canal orifices on the pulpal floor with the aid of cone-beam computed tomographic (CBCT) technology. METHODS: A total of 1008 maxillary first molars (548 patients) were randomly selected and analyzed through CBCT imaging. The association between the incidence of MB2 canals and potential impacting factors including sex, side, age, and the distribution of the main root canal orifices on the pulpal floor was explored. The interorifice distances (ie, the length of a line between the center point of any 2 orifices) at the pulpal floor level were measured using Mimics 10.01 software (ImageWorks, Materialise, Belgium). RESULTS: The majority of 3-rooted maxillary first molars showed 2 root canals (85.4%) in the mesiobuccal root. The incidence of MB2 canals had no statistically significant difference between the left and right sides (P > .05) but had a significant association with the patients' sex and age (P < .05). Receiver operating characteristic curve analysis showed a high diagnostic accuracy (the area under the receiver operating characteristic curve = 0.92) of using the distance ratio of the interorifice distance between the main mesiobuccal and the palatal root canal orifices to the interorifice distance between the distobuccal and the palatal root canal orifices to predict the presence of an MB2 canal. A larger distance ratio (>1.26) indicated a highly probable existence of an MB2 canal. In this study, no molar presented an MB2 canal with a distance ratio of less than 1.16, whereas all molars with a ratio greater than 1.37 presented an MB2 canal without exception. A Bland-Altman scatterplot showed great agreement between the distances of the main mesiobuccal and the distobuccal canal orifices and the second mesiobuccal and the distobuccal canal orifices. CONCLUSIONS: Understanding the incidence of MB2 canals and the distribution pattern of canal orifices on the pulpal floor may help clinicians to quickly identify and locate MB2 canals.