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Resting-State fMRI Whole Brain Network Function Plasticity Analysis in Attention Deficit Hyperactivity Disorder. 注意缺陷多动障碍静息态fMRI全脑网络功能可塑性分析。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-09-26 eCollection Date: 2022-01-01 DOI: 10.1155/2022/4714763
Yi Tang, Shuxing Zheng, Yin Tian

Attention deficit hyperactivity disorder (ADHD) is a common mental disorder in children, which is related to inattention and hyperactivity. These symptoms are associated with abnormal interactions of brain networks. We used resting-state functional magnetic resonance imaging (rs-fMRI) based on the graph theory to explore the topology property changes of brain networks between an ADHD group and a normal group. The more refined AAL_1024 atlas was used to construct the functional networks with high nodal resolution, for detecting more subtle changes in brain regions and differences among groups. We compared altered topology properties of brain network between the groups from multilevel, mainly including modularity at mesolevel. Specifically, we analyzed the similarities and differences of module compositions between the two groups. The results found that the ADHD group showed stronger economic small-world network property, while the clustering coefficient was significantly lower than the normal group; the frontal and occipital lobes showed smaller node degree and global efficiency between disease statuses. The modularity results also showed that the module number of the ADHD group decreased, and the ADHD group had short-range overconnectivity within module and long-range underconnectivity between modules. Moreover, modules containing long-range connections between the frontal and occipital lobes disappeared, indicating that there was lack of top-down control information between the executive control region and the visual processing region in the ADHD group. Our results suggested that these abnormal regions were related to executive control and attention deficit of ADHD patients. These findings helped to better understand how brain function correlates with the ADHD symptoms and complement the fewer modularity elaboration of ADHD research.

注意缺陷多动障碍(ADHD)是儿童中一种常见的精神障碍,与注意力不集中和多动有关。这些症状与大脑网络的异常相互作用有关。采用基于图论的静息状态功能磁共振成像(rs-fMRI)技术探讨ADHD组与正常组脑网络拓扑特性的变化。更精细的AAL_1024图谱用于构建具有高节点分辨率的功能网络,以检测大脑区域更细微的变化和组间差异。我们从多个层面比较了两组大脑网络拓扑结构的变化,主要包括中水平的模块化。具体来说,我们分析了两组模块组成的异同。结果发现,ADHD组表现出较强的经济小世界网络属性,但聚类系数显著低于正常组;额叶和枕叶在不同疾病状态下的结度和整体效率较小。模块化结果还显示ADHD组模块数量减少,且ADHD组模块内存在短距离过连通性,模块间存在远距离欠连通性。此外,包含额叶和枕叶之间远程连接的模块消失,表明ADHD组的执行控制区和视觉加工区之间缺乏自上而下的控制信息。我们的结果表明,这些异常区域与ADHD患者的执行控制和注意缺陷有关。这些发现有助于更好地理解大脑功能与多动症症状之间的关系,并补充了多动症研究中较少的模块化阐述。
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引用次数: 1
Effects of Meaningful Action Observation Therapy on Occupational Performance, Upper Limb Function, and Corticospinal Excitability Poststroke: A Double-Blind Randomized Control Trial. 有意义的动作观察疗法对脑卒中后职业表现、上肢功能和皮质脊髓兴奋性的影响:双盲随机对照试验》。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-09-16 eCollection Date: 2022-01-01 DOI: 10.1155/2022/5284044
Aryan Shamili, Afsoon Hassani Mehraban, Akram Azad, Gholam Reza Raissi, Mohsen Shati

Introduction: Action observation therapy (AOT) is a mirror neuron-based approach that has been recently used in poststroke rehabilitation. The main goal of this study was to investigate the effectiveness of AOT of occupations and tasks that are meaningful for chronic stroke patients on occupational performance, upper-extremity function, and corticospinal changes.

Method: A randomized control trial was designed to compare between experimental (n = 13) and control groups (n = 14). In both groups, the execution of meaningful tasks was practiced, but the videos of those tasks were just shown to the experiment group. Instead, patients in the control group watched nature videos as a placebo. Clinical outcomes were evaluated using the Canadian Occupational Performance Measure (COPM), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box-Block Test (BBT) on 3 occasions: baseline, post (at 4 weeks), and follow-up (at 8 weeks). The assessments of central motor conduction time (CMCT) for abductor policis brevis (APB) and extensor indicis (EI) were only recorded at baseline and posttreatment. Both assessors of clinical and neurophysiological outcomes were blinded to the allocation of subjects.

Result: Finally, the results of outcomes in 24 patients who completed the study were analyzed. In both groups, significant improvements after treatment were seen for most outcomes (p ≤ 0.05). These changes were persistent until follow-up. There were significant differences in COPM performance (p = 0.03) and satisfaction (p = 0.001) between the experimental and control groups. In contrast, other clinical assessments such as FMA, ARAT, and BBT did not show significant differences between the two treatments (p ≥ 0.05). The results of CMCT related to APB showed a more significant change in the experiment group compared to the control group (p = 0.022). There was no difference in change detected between the two groups for CMCT related to EI after treatments.

Conclusion: Observation and execution of meaningful activities can enhance the effects of simply practicing those activities on occupational performance/satisfaction and corticospinal excitability poststroke.

简介行动观察疗法(AOT)是一种基于镜像神经元的方法,最近被用于脑卒中后康复。本研究的主要目的是调查对慢性中风患者有意义的职业和任务的行动观察疗法对职业表现、上肢功能和皮质脊髓变化的有效性:设计了一项随机对照试验,比较实验组(n = 13)和对照组(n = 14)。两组患者都进行了有意义任务的执行练习,但实验组只播放了这些任务的视频。而对照组的患者则观看自然视频作为安慰剂。临床结果通过加拿大职业表现测量法(COPM)、福格尔-迈耶评估法(FMA)、行动研究手臂测试法(ARAT)和箱形块测试法(BBT)进行评估,评估分三次进行:基线、后期(4 周)和随访(8 周)。外展肌(APB)和内收肌(EI)的中枢运动传导时间(CMCT)评估仅在基线和治疗后进行记录。临床和神经电生理结果的评估人员对受试者的分配均为盲人:最后,对完成研究的 24 名患者的结果进行了分析。在两组患者中,大多数结果在治疗后都有明显改善(P ≤ 0.05)。这些变化一直持续到随访。实验组和对照组在 COPM 表现(p = 0.03)和满意度(p = 0.001)方面存在明显差异。相比之下,其他临床评估如 FMA、ARAT 和 BBT 在两种治疗方法之间没有显示出显著差异(p ≥ 0.05)。与 APB 相关的 CMCT 结果显示,实验组与对照组相比变化更显著(p = 0.022)。结论:结论:观察和执行有意义的活动可以增强简单练习这些活动对脑卒中后职业表现/满意度和皮质脊髓兴奋性的影响。
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引用次数: 0
Combined-Acupoint Electroacupuncture Induces Better Analgesia via Activating the Endocannabinoid System in the Spinal Cord. 联合穴位电针通过激活脊髓内源性大麻素系统诱导更好的镇痛。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-09-15 eCollection Date: 2022-01-01 DOI: 10.1155/2022/7670629
Zhenhua Jiang, Yuheng Li, Qun Wang, Zongping Fang, Jiao Deng, Xinxin Zhang, Bowen Shen, Zhixin Wu, Qianzi Yang, Lize Xiong

Electroacupuncture (EA) therapy has been widely reported to alleviate neuropathic pain with few side effects in both clinical practice and animal studies worldwide. However, little is known about the comparison of the therapeutic efficacy among the diverse EA schemes used for neuropathic pain. The present study is aimed at investigating the therapeutic efficacy discrepancy between the single and combined-acupoint EA and to reveal the difference of mechanisms behind them. Electroacupuncture was given at both Zusanli (ST36) and Huantiao (GB30) in the combined group or ST36 alone in the single group. Paw withdrawal mechanical threshold (PWMT) was measured to determine the pain level. Electrophysiology was performed to detect the effects of EA on synaptic transmission in the spinal dorsal horn of the vGlut2-tdTomato mice. Spinal contents of endogenous opioids, endocannabinoids, and their receptors were examined. Inhibitors of CBR (cannabinoid receptor) and opioid receptors were used to study the roles of opioid and endocannabinoid system (ECS) in EA analgesia. We found that combined-acupoint acupuncture provide stronger analgesia than the single group did, and the former inhibited the synaptic transmission at the spinal level to a greater extent than later. Besides, the high-intensity stimulation at ST36 or normal stimulation at two sham acupoints did not mimic the similar efficacy of analgesia in the combined group. Acupuncture stimulation in single and combined groups both activated the endogenous opioid system. The ECS was only activated in the combined group. Naloxone totally blocked the analgesic effect of single-acupoint EA; however, it did not attenuate that of combined-acupoint EA unless coadministered with CBR antagonists. Hence, in the CCI-induced neuropathic pain model, combined-acupoint EA at ST36 and GB30 is more effective in analgesia than the single-acupoint EA at ST36. EA stimulation at GB30 alone neither provided a superior analgesic effect to EA treatment at ST36 nor altered the content of AEA, 2-AG, CB1 receptor, or CB2 receptor compared with the CCI group. Activation of the ECS is the main contributor of the better analgesia by the combined acupoint stimulation than that induced by single acupoint stimulation.

电针治疗在临床上和动物实验中都被广泛报道能减轻神经性疼痛,而且副作用小。然而,对于不同EA方案治疗神经性疼痛的疗效比较了解甚少。本研究旨在探讨单穴电疗与联合穴电疗的疗效差异,并揭示其背后的机制差异。联合组同时电针足三里(ST36)和环条(GB30),单独组电针ST36。测量足爪退缩机械阈值(PWMT)以确定疼痛程度。电生理观察EA对vGlut2-tdTomato小鼠脊髓背角突触传递的影响。检测脊髓内源性阿片样物质、内源性大麻素及其受体的含量。采用CBR (cannabinoid receptor)和阿片受体抑制剂研究阿片和内源性大麻素系统(endocannabinoid system, ECS)在EA镇痛中的作用。我们发现联合穴位针刺的镇痛作用强于单独针刺组,且联合穴位针刺对脊髓水平突触传递的抑制作用强于单独针刺组。此外,在ST36处进行高强度刺激或在两个假穴位进行正常刺激均无法模仿联合组镇痛的相似效果。针刺刺激单独组和联合组均能激活内源性阿片系统。ECS仅在联合用药组被激活。纳洛酮完全阻断单穴EA的镇痛作用;然而,除非与CBR拮抗剂共同使用,否则它不会减弱联合穴位EA的作用。因此,在cci诱导的神经性疼痛模型中,ST36和GB30的联合穴位EA比ST36的单穴位EA更有效。与CCI组相比,单独在GB30处进行EA刺激既没有提供优于ST36处的EA治疗的镇痛效果,也没有改变AEA、2-AG、CB1受体或CB2受体的含量。联合穴位刺激的镇痛效果优于单一穴位刺激的镇痛效果,其主要作用是激活ECS。
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引用次数: 4
Translocator Protein 18 kDa (TSPO) as a Novel Therapeutic Target for Chronic Pain. 转运蛋白18kda (TSPO)作为慢性疼痛的新治疗靶点。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-08-29 eCollection Date: 2022-01-01 DOI: 10.1155/2022/8057854
Jie Liu, Jingyao Huang, Zhenjiang Zhang, Rui Zhang, Zhihao Zhang, Yongxin Liu, Baoyu Ma

Chronic pain is an enormous modern public health problem, with significant numbers of people debilitated by chronic pain from a variety of etiologies. Translocator protein 18 kDa (TSPO) was discovered in 1977 as a peripheral benzodiazepine receptor. It is a five transmembrane domain protein, mainly localized in the outer mitochondrial membrane. Recent and increasing studies have found changes in TSPO and its ligands in various chronic pain models. Reversing their expressions has been shown to alleviate chronic pain in these models, illustrating the effects of TSPO and its ligands. Herein, we review recent evidence and the mechanisms of TSPO in the development of chronic pain associated with peripheral nerve injury, spinal cord injury, cancer, and inflammatory responses. The cumulative evidence indicates that TSPO-based therapy may become an alternative strategy for treating chronic pain.

慢性疼痛是一个巨大的现代公共卫生问题,大量的人因各种病因的慢性疼痛而衰弱。转运蛋白18kda (TSPO)作为外周苯二氮卓类受体于1977年被发现。它是一种五跨膜结构域蛋白,主要定位于线粒体外膜。最近越来越多的研究发现,在各种慢性疼痛模型中,TSPO及其配体发生了变化。在这些模型中,逆转它们的表达已被证明可以减轻慢性疼痛,这说明了TSPO及其配体的作用。在此,我们回顾了最近的证据和TSPO在周围神经损伤、脊髓损伤、癌症和炎症反应相关的慢性疼痛发展中的机制。越来越多的证据表明,以tspo为基础的治疗可能成为治疗慢性疼痛的一种替代策略。
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引用次数: 2
Altered Brain Activity and Effective Connectivity within the Nonsensory Cortex during Stimulation of a Latent Myofascial Trigger Point. 在潜在肌筋膜触发点的刺激下,大脑活动的改变和非感觉皮层内的有效连接。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-08-12 eCollection Date: 2022-01-01 DOI: 10.1155/2022/4416672
Xinglou Li, Meiling Luo, Yan Gong, Ning Xu, Congcong Huo, Hui Xie, Shouwei Yue, Zengyong Li, Yonghui Wang

Myofascial trigger point (MTrP), an iconic characteristic of myofascial pain syndrome (MPS), can induce cerebral cortex changes including altered cortical excitability and connectivity. The corresponding characteristically reactive cortex is still ambiguous. Seventeen participants with latent MTrPs underwent functional near-infrared spectroscopy (fNIRS) to collect cerebral oxygenation hemoglobin (Δ[oxy-Hb]) signals. The Δ[oxy-Hb] signals of the left/right prefrontal cortex (L/R PFC), left/right motor cortex (L/R MC), and left/right occipital lobe (L/R OL) of the subjects were measured using functional near-infrared spectroscopy (fNIRS) in the resting state, nonmyofascial trigger point (NMTrP), state and MTrP state. The data investigated the latent MTrP-induced changes in brain activity and effective connectivity (EC) within the nonsensory cortex. The parameter wavelet amplitude (WA) was used to describe cortical activation, EC to show brain network connectivity, and main coupling direction (mCD) to exhibit the dominant connectivity direction in different frequency bands. An increasing trend of WA and a decreasing trend of EC values were observed in the PFC. The interregional mCD was primarily shifted from a unidirectional to bidirectional connection, especially from PFC to MC or OL, when responding to manual stimulation during the MTrP state compared with resting state and NMTrP state in the intervals III, IV, and V. This study demonstrates that the nonsensory cortex PFC, MC, and OL can participate in the cortical reactions induced by stimulation of a latent MTrP. Additionally, the PFC shows nonnegligible higher activation and weakened regulation than other brain regions. Thus, the PFC may be responsible for the central cortical regulation of a latent MTrP. This trial is registered with ChiCTR2100048433.

肌筋膜触发点(MTrP)是肌筋膜疼痛综合征(MPS)的一个标志性特征,它可以引起大脑皮层的变化,包括皮层兴奋性和连通性的改变。相应的特征反应皮层仍然是模糊的。17名潜在MTrPs患者接受功能性近红外光谱(fNIRS)采集脑氧合血红蛋白(Δ[oxy-Hb])信号。采用功能近红外光谱(fNIRS)测量被试在静息状态、非肌膜触发点(NMTrP)、状态和MTrP状态下左/右前额叶皮层(L/R PFC)、左/右运动皮层(L/R MC)和左/右枕叶(L/R OL)的Δ[oxy-Hb]信号。这些数据调查了mtrp诱导的大脑活动和非感觉皮层内有效连接(EC)的潜在变化。用小波振幅(WA)参数描述皮层的激活,用小波振幅(EC)参数描述脑网络的连通性,用主耦合方向(mCD)参数描述不同频段的主要连通性方向。与静息状态和NMTrP状态相比,MTrP状态下响应手动刺激时,区域间mCD主要由单向连接转向双向连接,尤其是PFC与MC或OL之间的连接。研究表明,PFC、MC、和OL可以参与潜在MTrP刺激引起的皮层反应。此外,PFC比其他脑区表现出不可忽视的高激活和弱调节。因此,PFC可能负责中枢皮质对潜在MTrP的调节。该试验注册号为ChiCTR2100048433。
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引用次数: 1
High-Frequency Cerebellar rTMS Improves the Swallowing Function of Patients with Dysphagia after Brainstem Stroke. 高频小脑rTMS改善脑干卒中后吞咽困难患者的吞咽功能。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-08-11 eCollection Date: 2022-01-01 DOI: 10.1155/2022/6259693
Ling-Hui Dong, Xiaona Pan, Yuyang Wang, Guangtao Bai, Chao Han, Qiang Wang, Pingping Meng

Objective: To explore the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) of the swallowing motor area of the cerebellum in patients with dysphagia after brainstem stroke.

Methods: A total of 36 patients with dysphagia after brainstem stroke were recruited and divided into 3 groups. Before stimulation, single-pulse transcranial magnetic stimulation (TMS) was used to determine the swallowing dominant cerebellar hemisphere and the representation of the mylohyoid muscle. The three groups of patients received bilateral cerebellar sham stimulation, dominant cerebellar rTMS + contralateral sham stimulation, or bilateral cerebellar rTMS. The stimulus plan for each side was 10 Hz, 80% resting movement threshold (rMT), 250 pulses, 1 s per stimulus, and 9 s intervals. Sham rTMS was performed with the coil held at 90° to the scalp. The changes in the motor evoked potential (MEP) amplitude and the clinical swallowing function scales of the patients after stimulation were compared among the three groups.

Results: 34 patients were finally included for statistical analysis. The scores of penetration aspiration scale (PAS) and functional dysphagia scale (FDS) of the patients after 2 weeks of rTMS in the unilateral stimulation group and bilateral stimulation group were better than that in the sham stimulation group, and there was no significant difference between the two groups. The increase in the MEP amplitude of the cerebral hemisphere in the bilateral stimulation group was higher than that in the other two groups, and the increase in the MEP amplitude in the unilateral stimulation group was higher than that in sham stimulation group. There was no correlation between the improvement in patients' clinical swallowing function (PAS scores and FDS scores) and the increase in MEP amplitude in either the unilateral stimulation group or the bilateral stimulation group.

Conclusion: High-frequency rTMS in the cerebellum can improve swallowing function in PSD patients and increase the excitability of the representation of swallowing in the bilateral cerebral hemispheres. Compared with unilateral cerebellar rTMS, bilateral stimulation increased the excitability of the cerebral swallowing cortex more significantly, but there was no significant difference in clinical swallowing function.

目的:探讨高频重复经颅磁刺激(rTMS)对脑干卒中后吞咽困难患者小脑吞咽运动区的治疗效果。方法:选取脑干卒中后吞咽困难患者36例,分为3组。刺激前采用单脉冲经颅磁刺激(TMS)测定吞咽优势小脑半球和下颌舌骨肌的表征。三组患者分别接受双侧小脑假性刺激、优势小脑rTMS +对侧假性刺激、双侧小脑rTMS。每侧刺激方案为10 Hz, 80%静息运动阈值(rMT), 250次脉冲,每次刺激1 s,间隔9 s。假rTMS在线圈与头皮保持90°时进行。比较三组患者刺激后运动诱发电位(MEP)振幅变化及临床吞咽功能量表的变化。结果:最终纳入34例患者进行统计分析。rTMS治疗2周后,单侧刺激组和双侧刺激组患者穿刺吸吸量表(PAS)和功能性吞咽困难量表(FDS)评分均优于假刺激组,两组间差异无统计学意义。双侧刺激组大脑半球MEP振幅的增加幅度高于其他两组,单侧刺激组MEP振幅的增加幅度高于假刺激组。无论是单侧刺激组还是双侧刺激组,患者临床吞咽功能的改善(PAS评分和FDS评分)与MEP振幅的增加均无相关性。结论:小脑高频rTMS可改善PSD患者的吞咽功能,增加双侧大脑半球吞咽表征的兴奋性。与单侧小脑rTMS相比,双侧刺激使大脑吞咽皮层兴奋性升高更为显著,但临床吞咽功能无显著差异。
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引用次数: 3
Varied Response of EEG Rhythm to Different tDCS Protocols and Lesion Hemispheres in Stroke Subjects with Upper Limb Dysfunction. 脑卒中上肢功能障碍患者脑电节律对不同tDCS方案和损伤半球的不同反应。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-07-30 eCollection Date: 2022-01-01 DOI: 10.1155/2022/7790730
Chunfang Wang, Yuanyuan Chen, Peiqing Song, Hongli Yu, Jingang Du, Ying Zhang, Changcheng Sun

Transcranial direct current stimulation (tDCS) provides a way to modulate the cortical activity and promote motor rehabilitation following stroke. However, evidence indicates that the response to tDCS is highly variable. This study was aimed at exploring rhythmic response of Electroencephalography (EEG) to three tDCS protocols in stroke subjects. We hypothesize that tDCS protocols may interact with stoke characteristics, and electrode placement may affect cortical activity which could be reflected by the EEG rhythm. 32 subjects with unilateral stroke were recruited to a single-blinded, randomized, and controlled crossover experiment. All of the subjects underwent four tDCS protocols (anodal (atDCS), cathodal (ctDCS), and bilateral tDCS (bi-tDCS) and sham) with an interval of at least 1 week. Resting-state EEG was acquired before and after the stimulation. We tested the change of EEG spectral power after tDCS and the difference of change among four protocols using the paired-sample t-test and repeated measures analysis of variance. Then, we investigated the clinical factors affecting the above changes using the linear and quadratic regression model. According to the results, EEG responded to atDCS and bi-tDCS protocols on alpha and beta rhythm and subjects with a left lesion had higher response than those with the right lesion. Besides that, the change of alpha and beta power after atDCS and of beta power after bi-tDCS showed association with clinical characteristics only in subjects with the left lesion. In conclusion, the study found varied EEG response with different protocols, lesion hemispheres, and other clinical characteristics supporting the individualized cortical oscillatory effect induced by tDCS.

经颅直流电刺激(tDCS)提供了一种调节脑卒中后皮层活动和促进运动康复的方法。然而,证据表明,对tDCS的反应是高度可变的。本研究旨在探讨脑卒中患者在三种tDCS方案下的脑电图节律性反应。我们假设tDCS方案可能与脑卒中特征相互作用,电极放置可能影响皮层活动,这可以通过脑电图节律反映出来。本研究招募了32例单侧脑卒中患者进行单盲、随机、对照交叉试验。所有受试者接受四种tDCS方案(阳极(atDCS),阴极(ctDCS),双侧tDCS (bi-tDCS)和假手术),间隔至少1周。获得刺激前后静息状态脑电图。采用配对样本t检验和重复测量方差分析,检验tDCS后脑电谱功率的变化以及四种方案的变化差异。然后,我们采用线性和二次回归模型探讨影响上述变化的临床因素。结果表明,脑电对atDCS和双tdcs方案的α和β节律有响应,且左脑损伤组的响应高于右脑损伤组。此外,仅在左侧病变的受试者中,atDCS后α和β功率的变化以及双tdcs后β功率的变化与临床特征相关。综上所述,研究发现不同方案、病变半球和其他临床特征的脑电图反应不同,支持tDCS诱导的个体化皮质振荡效应。
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引用次数: 3
Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain and Neuropsychiatric Symptoms in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. 重复经颅磁刺激治疗创伤性脑损伤的神经性疼痛和神经精神症状:系统回顾和荟萃分析。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-07-30 eCollection Date: 2022-01-01 DOI: 10.1155/2022/2036736
Xin Li, Tijiang Lu, Hong Yu, Jie Shen, Zhengquan Chen, Xiaoyan Yang, Zefan Huang, Yuqi Yang, Yufei Feng, Xuan Zhou, Qing Du

Neuropathic pain and neuropsychiatric symptoms are common complications reported by the traumatic brain injury (TBI) population. Although a growing body of research has indicated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for the management of neurological and psychiatric disorders, little evidence has been presented to support the effects of rTMS on neuropathic pain and neuropsychiatric symptoms in patients with TBI in all age groups. In addition, a better understanding of the potential factors that might influence the therapeutic effect of rTMS is necessary. The objective of this preregistered systematic review and meta-analysis was to quantify the effects of rTMS on physical and psychological symptoms in individuals with TBI. We systematically searched six databases for randomized controlled trials (RCTs) of rTMS in TBI patients reporting pain and neuropsychiatric outcomes published until March 20, 2022. The mean difference (MD) with 95% confidence intervals (CIs) was estimated separately for outcomes to understand the mean effect size. Twelve RCTs with 276 TBI patients were ultimately selected from 1605 records for systematic review, and 11 of the studies were included in the meta-analysis. Overall, five of the included studies showed a low risk of bias. The effects of rTMS on neuropathic pain were statistically significant (MD = -1.00, 95% CI -1.76 to -0.25, P = 0.009), with high heterogeneity (I 2 = 76%). A significant advantage of 1 Hz rTMS over the right dorsolateral prefrontal cortex (DLPFC) in improving depression (MD = -6.52, 95% CI -11.58 to -1.46, P = 0.01) was shown, and a significant improvement was noted in the Rivermead Post-Concussion Symptoms Questionnaire-13 (RPQ-13) scores of mild TBI patients after rTMS (MD = -5.87, 95% CI -10.63 to -1.11, P = 0.02). However, no significance was found in cognition measurement. No major adverse events related to rTMS were reported. Moderate evidence suggests that rTMS can effectively and safely improve neuropathic pain, while its effectiveness on depression, postconcussion symptoms, and cognition is limited. More trials with a larger number of participants are needed to draw firm conclusions. This trial is registered with PROSPERO (PROSPERO registration number: CRD42021242364.

神经性疼痛和神经精神症状是创伤性脑损伤(TBI)人群中常见的并发症。尽管越来越多的研究表明重复性经颅磁刺激(rTMS)对神经和精神疾病的治疗有效,但几乎没有证据支持rTMS对所有年龄组TBI患者的神经性疼痛和神经精神症状的影响。此外,更好地了解可能影响rTMS治疗效果的潜在因素是必要的。这项预登记的系统评价和荟萃分析的目的是量化rTMS对TBI患者身体和心理症状的影响。我们系统地检索了6个数据库,检索了截至2022年3月20日发表的rTMS在报告疼痛和神经精神预后的TBI患者中的随机对照试验(rct)。分别估计结果的95%置信区间(ci)的平均差异(MD),以了解平均效应大小。最终从1605份记录中选择了12项随机对照试验,共276例TBI患者进行系统评价,其中11项研究纳入meta分析。总体而言,纳入的研究中有5项显示偏倚风险较低。rTMS对神经性疼痛的影响有统计学意义(MD = -1.00, 95% CI -1.76 ~ -0.25, P = 0.009),异质性高(I 2 = 76%)。1 Hz rTMS比右背外侧前额叶皮质(DLPFC)在改善抑郁方面有显著优势(MD = -6.52, 95% CI -11.58 ~ -1.46, P = 0.01),轻度TBI患者rTMS后Rivermead脑震荡后症状问卷-13 (RPQ-13)评分显著改善(MD = -5.87, 95% CI -10.63 ~ -1.11, P = 0.02)。然而,在认知测量中没有发现显著性。未发现与rTMS相关的重大不良事件。中度证据表明,rTMS可以有效、安全地改善神经性疼痛,但其对抑郁、脑震荡后症状和认知的效果有限。要得出确切的结论,还需要更多参与者参与的试验。该试验在普洛斯彼罗注册(普洛斯彼罗注册号:CRD42021242364)。
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引用次数: 5
Low-Intensity Focused Ultrasound Alleviates Chronic Neuropathic Pain-Induced Allodynia by Inhibiting Neuroplasticity in the Anterior Cingulate Cortex. 低强度聚焦超声通过抑制前扣带皮层的神经可塑性减轻慢性神经性疼痛引起的异常痛。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-07-23 eCollection Date: 2022-01-01 DOI: 10.1155/2022/6472475
Bin Wang, Mo-Xian Chen, Shao-Chun Chen, Xiang-Jun Feng, Ye-Hui Liao, Yun-Xin Zhao, Jin-Shan Tie, Yao Liu, Li-Juan Ao

Low-intensity focused ultrasound (LIFU) is a potential noninvasive method to alleviate allodynia by modulating the central nervous system. However, the underlying analgesic mechanisms remain unexplored. Here, we assessed how LIFU at the anterior cingulate cortex (ACC) affects behavior response and central plasticity resulting from chronic constrictive injury (CCI). The safety of LIFU stimulation was assessed by hematoxylin and eosin (H&E) and Fluoro-Jade C (FJC) staining. A 21-day ultrasound exposure therapy was conducted from day 91 after CCI surgery in mice. We assessed the 50% mechanical withdrawal threshold (MWT50) using Von Frey filaments (VFFs). The expression levels of microtubule-associated protein 2 (MAP2), growth-associated protein 43 (GAP43), and tau were determined via western blotting (WB) and immunofluorescence (IF) staining to evaluate the central plasticity in ACC. The regions of ACC were activated effectively and safely by LIFU stimulation, which significantly increased the number of c-fos-positive cells (P < 0.05) with no bleeding, coagulative necrosis, and neuronal loss. Under chronic neuropathic pain- (CNP-) induced allodynia, MWT50 decreased significantly (P < 0.05), and overexpression of MAP2, GAP43, and tau was also observed. After 3 weeks of treatment, significant increases in MWT50 were found in the CCI+LIFU group compared with the CCI group (P < 0.05). WB and IF staining both demonstrated a significant reduction in the expression levels of MAP2, GAP43, and tau (P < 0.05). LIFU treatment on ACC can effectively attenuate CNP-evoked mechanical sensitivity to pain and reverse aberrant central plasticity.

低强度聚焦超声(LIFU)是一种通过调节中枢神经系统来缓解异常性疼痛的潜在无创方法。然而,潜在的镇痛机制仍未被探索。在这里,我们评估了前扣带皮层(ACC)的LIFU如何影响慢性收缩性损伤(CCI)导致的行为反应和中枢可塑性。采用苏木精伊红(H&E)染色和氟玉C (FJC)染色评价LIFU刺激的安全性。小鼠CCI术后第91天开始进行21天超声暴露治疗。我们使用Von Frey细丝(VFFs)评估50%机械退出阈值(MWT50)。通过western blotting (WB)和免疫荧光(IF)染色检测ACC组织中微管相关蛋白2 (MAP2)、生长相关蛋白43 (GAP43)和tau蛋白的表达水平,评价ACC组织的中枢可塑性。LIFU刺激可有效、安全地激活ACC区域,显著增加c-fos阳性细胞数量(P < 0.05),无出血、凝固性坏死和神经元丢失。慢性神经性疼痛(CNP-)诱导的异常性疼痛时,MWT50显著降低(P < 0.05), MAP2、GAP43、tau蛋白也过表达。治疗3周后,CCI+LIFU组MWT50较CCI组显著升高(P < 0.05)。WB和IF染色均显示MAP2、GAP43和tau的表达水平显著降低(P < 0.05)。LIFU治疗ACC可有效减弱cnp诱发的疼痛机械敏感性,逆转中枢可塑性异常。
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引用次数: 0
Aerobic Exercise and Human Visual Cortex Neuroplasticity: A Narrative Review. 有氧运动与人类视觉皮层神经可塑性:叙述性综述。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2022-07-23 eCollection Date: 2022-01-01 DOI: 10.1155/2022/6771999
Dania Abuleil, Benjamin Thompson, Kristine Dalton

There is compelling evidence from animal models that physical exercise can enhance visual cortex neuroplasticity. In this narrative review, we explored whether exercise has the same effect in humans. We found that while some studies report evidence consistent with exercise-induced enhancement of human visual cortex neuroplasticity, others report no effect or even reduced neuroplasticity following exercise. Differences in study methodology may partially explain these varying results. Because the prospect of exercise increasing human visual cortex neuroplasticity has important implications for vision rehabilitation, additional research is required to resolve this discrepancy in the literature.

来自动物模型的令人信服的证据表明,体育锻炼可以增强视觉皮层的神经可塑性。在这篇叙述性综述中,我们探讨了运动是否对人类有同样的作用。我们发现,一些研究报告显示,运动可增强人类视觉皮层的神经可塑性,而另一些研究报告则显示,运动后视觉皮层的神经可塑性没有任何影响,甚至有所减弱。研究方法的不同可能是造成这些不同结果的部分原因。由于运动增强人类视觉皮层神经可塑性的前景对视力康复具有重要意义,因此需要更多的研究来解决文献中的这一差异。
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引用次数: 0
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Neural Plasticity
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