The role of TT virus (TTV) as a human pathogen is unclear, as is the mode of TTV transmission. To determine the prevalence of TTV infection and the possible fecal-oral route of transmission, we analyzed fecal specimens from 67 healthy, nontransfused children for TTV DNA sequences by heminested PCR, using the NG and T primer sets. The overall prevalence of TTV fecal excretion was 22.4% (15 of 67), with the T primer set (19.4%) being more sensitive than the NG primer set (10.4%). TTV prevalence based on gender or ethnicity showed no significant differences. None of seven children in the 0-to 6-month age group had detectable TTV in feces. Of three sets of siblings, two unrelated sets of twins, ages 33 and 37 months, were negative for fecal TTV DNA, while the third set of siblings, ages 99 and 35 months, was positive. The absence of TTV in the feces of children younger than 6 months and the high prevalence (40%) in children 7 to 12 months of age is consistent with age-specific acquisition of TTV infection by the nonparenteral route. TTV genotypes 1, 3, 4, and 5 were represented in our study population. TTV-positive siblings had TTV genotypes 1 and 4, suggesting unrelated environmental sources of TTV infection. This observation suggests a possible time frame for TTV acquisition in children which coincides with increased interaction with their environment and increased susceptibility to infectious agents.Recent molecular studies have demonstrated that TT virus (TTV), the first known human circovirus, is a single-stranded, nonenveloped DNA virus with an approximately 3.8-kb circular viral genome (12, 13). TTV has been suggested as an etiologic agent of non-A to -E hepatitis, but its role in liver disease is still unclear (14,25). TTV is widespread in the general population, with a reported prevalence of 1.9% in Scotland (22), 10% in the United States (2), 12% in Japan (17), 74% in Papua New Guinea, and 83% in Gambia (18).We and others have previously demonstrated a lack of association between parenteral and sexual routes of TTV transmission (8,10,15). Recent detection of TTV DNA in nonblood products, such as saliva, breast milk, and feces, suggests nonparenteral routes of transmission (11,16,19,21). Transmission by close physical contact would support the high prevalence of TTV infection observed in the general population. Moreover, the relatively common occurrence of TTV among children, ranging from 5.1% in Japan (3) to 54% in the Democratic Republic of Congo (1), suggests its early acquisition and endemicity in various geographic areas. To investigate the prevalence and possible fecal-oral route of TTV transmission, we analyzed fecal specimens from 67 healthy, nontransfused children. The high prevalence of TTV in the feces of such children suggests a fecal-oral route of TTV transmission. MATERIALS AND METHODSIn this study approved by the committees on human subjects of the Kapiolani Medical Center and the University of Hawaii at Manoa, 67 children (33 males and 34 females; age range, 1 to 133 months; median age, 21 m...

Background: Although increasing evidence suggests that repetitive transcranial magnetic stimulation may help improve cognitive impairment after stroke, its clinical efficacy is still limited. This limitation may be due to the fact that the left dorsolateral prefrontal cortex (DLPFC) is only one of several brain areas involved in post stroke cognitive impairment (PSCI). The aim of the present study is to reveal whether dual-target stimulation is superior to single-target stimulation in the treatment of PSCI. Methods: A single-center, double-blind, randomized controlled trial will be conducted, and fifty-seven PSCI patients will be recruited and randomly assigned to one of three groups based on the stimulating site. The primary outcome is cognitive function, measured using montreal cognitive assessment Beijing Version (MoCA-BJ) and mini-mental status examination (MMSE). The secondary outcomes are modified barthel index (MBI), trail-making test (TMT), digital span test (DST). Futhermore, changes in brain activity are assessed using transcranial Doppler sonography (TCD) examination and serum levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) closely related to nerve and vascular repair after brain injury. All outcomes will be measured at baseline and post-treatment. Discussion: If dual-target rTMS in significant improvements on cognitive function, this method could be considered as a first-line clinical treatment for PSCI. This proposed study has the potential to identify a new, evidence-based intervention that can enhance cognition and independent living in patients with cognitive impairment after stroke. Trial registration:Chinese Clinical Trial Registry ChiCTR2200066184. It was registered on 26 November 2022.

Background Although increasing evidence suggests that repetitive transcranial magnetic stimulation may help improve cognitive impairment after stroke, its clinical efficacy is still limited. This limitation may be due to the fact that the left dorsolateral prefrontal cortex (DLPFC) is only one of several brain areas involved in post-stroke cognitive impairment (PSCI). The aim of the present study is to reveal whether dual-target stimulation is superior to single-target stimulation and usual care in the treatment of PSCI. Methods A single-center, single-blind, randomized controlled trial will be conducted, and fifty-seven PSCI patients will be recruited and randomly assigned to one of three groups based on the stimulating site. The primary outcome is cognitive function, measured using the Montreal Cognitive Assessment Beijing Version (MoCA-BJ) and Mini-Mental Status Examination (MMSE). The secondary outcomes are the modified Barthel Index (MBI), Trail-Making Test (TMT), and digital span test (DST). Furthermore, changes in brain activity are assessed using transcranial Doppler sonography (TCD) examination and serum levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) closely related to nerve and vascular repair after brain injury. All outcomes will be measured at baseline and 4 weeks after treatment. Discussion If dual-target rTMS in significant improvements in cognitive function, this method could be considered as a first-line clinical treatment for PSCI. This proposed study has the potential to identify a new, evidence-based intervention that can enhance cognition and independent living in patients with cognitive impairment after stroke. Trial registration Chinese Clinical Trial Registry ChiCTR2200066184. It was registered on 26 November 2022.