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Effect of chronic sedative-hypnotic use on sleep architecture and brain oscillations in older adults with chronic insomnia. 长期服用镇静催眠药对患有慢性失眠症的老年人的睡眠结构和大脑振荡的影响。
Pub Date : 2024-09-13 DOI: 10.1101/2024.09.12.24313583
Loic Barbaux, Aurore A. Perrault, Nathan E. Cross, Oren M. Weiner, Mehdi Es-sounni, Florence B. Pomares, Lukia Tarelli, Margaret McCarthy, Antonia Maltezos, Dylan Smith, Kirsten Gong, Jordan O Byrne, Victoria Yue, Caroline Desrosiers, Doris Clerc, Francis Andriamampionona, David Lussier, Suzanne Gilbert, Cara Tannenbaum, Jean- Philippe Gouin, Thien Thanh Dang-Vu
Rationale: High rates of insomnia in older adults lead to widespread benzodiazepine (BZD) and benzodiazepine receptor agonist (BZRA) use, even though chronic use has been shown to disrupt sleep regulation and impact cognition. Little is known about sedative-hypnotic effects on NREM slow oscillations (SO) and spindles, including their coupling, which is crucial for memory, especially in the elderly. Objectives: Our objective was to investigate the effect of chronic sedative-hypnotic use on sleep macro-architecture, EEG relative power, as well as SO and spindle characteristics and coupling. Methods: One hundred and one individuals (66.05 +/- 5.84 years, 73% female) completed a one-night study and were categorized into three groups: good sleepers (GS, n=28), individuals with insomnia (INS, n=26) or individuals with insomnia who chronically use either BZD or BZRA to manage their insomnia difficulties (MED, n=47; dose equivalent in Diazepam: 6.1 +/- 3.8 mg/week). We performed a comprehensive comparison of sleep architecture, EEG relative spectrum, and associated brain oscillatory activities, focusing on NREM brain oscillations crucial for sleep-dependent memory consolidation (i.e., SO and spindles) and their temporal coupling. Results: Chronic use of BZD/BZRA worsened sleep architecture and spectral activity compared to older adults with and without insomnia disorder. The use of BZD/BZRAs also altered the characteristics of sleep-related brain oscillations and their synchrony. An exploratory interaction model suggested that BZD use exacerbated sleep alterations compared to BZRA, and higher BZD/BZRA dosage worsened alteration in sleep micro-architecture and EEG spectrum. Conclusions: Our results suggest that chronic use of sedative-hypnotics is detrimental to sleep when compared to drug-free GS and INS. Such alteration of sleep regulation; at the macro and micro-architectural levels; may contribute to the reported association between sedative-hypnotic use and cognitive impairment in older adults. Keywords: benzodiazepine, sleep, brain oscillation, ageing
理由:老年人失眠率高,导致苯二氮卓(BZD)和苯二氮卓受体激动剂(BZRA)的广泛使用,尽管长期使用已被证明会破坏睡眠调节并影响认知能力。人们对镇静催眠药对 NREM 慢振荡(SO)和棘波的影响知之甚少,包括它们之间的耦合,这对记忆至关重要,尤其是对老年人而言。研究目的我们的目的是研究长期服用镇静催眠药对睡眠宏观结构、脑电图相对功率以及慢振荡和纺锤体特征和耦合的影响。研究方法101 人(66.05 +/- 5.84 岁,73% 为女性)完成了一夜研究,并被分为三组:睡眠良好者(GS,n=28)、失眠者(INS,n=26)或长期使用 BZD 或 BZRA 来控制失眠困难的失眠者(MED,n=47;剂量相当于地西泮:6.1 +/- 3.8 毫克/周)。我们对睡眠结构、脑电图相对频谱和相关的大脑振荡活动进行了全面比较,重点是对依赖睡眠的记忆巩固至关重要的 NREM 大脑振荡(即 SO 和棘波)及其时间耦合。研究结果与患有和未患有失眠症的老年人相比,长期服用 BZD/BZRA 会使睡眠结构和频谱活动恶化。BZD/BZRA的使用还改变了与睡眠相关的大脑振荡特征及其同步性。探索性交互作用模型表明,与 BZRA 相比,使用 BZD 会加剧睡眠改变,而 BZD/BZRA 剂量越大,睡眠微观结构和脑电图频谱的改变越严重。结论我们的研究结果表明,与不使用药物的 GS 和 INS 相比,长期使用镇静催眠药不利于睡眠。这种在宏观和微观结构层面上对睡眠调节的改变,可能是报告中镇静催眠药的使用与老年人认知障碍之间存在关联的原因之一。关键词: 苯二氮卓、睡眠、大脑振荡、老龄化
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引用次数: 0
Low-intensity focused ultrasound stimulation in stroke: An intensity escalation phase I safety and feasibility study 低强度聚焦超声刺激治疗中风:强度升级 I 期安全性和可行性研究
Pub Date : 2024-09-12 DOI: 10.1101/2024.09.12.24313472
Ziping Huang, Charalambos C Charalambous, Mengyue Chen, Taewon Kim, Estate Sokhadze, Allen Song, Sin-Ho Jung, Shashank Shekhar, Jody Feld, Xiaoning Jiang, Wuwei Feng
BACKGROUND: Low-intensity focused ultrasound stimulation (LIFUS) has recently emerged as a promising neuromodulation tool for certain neuropsychiatric diseases. However, its safety and feasibility in stroke patients remains unknown. Intensity is a critical safety parameter for LIFUS. We aimed to determine the maximum safe and tolerable intensity of LIFUS in stroke patients, and to explore its effect on upper- extremity motor learning and corticospinal excitability.METHODS: Subjects with first-ever stroke participated in this Phase I study. We adopted the classic 3+3 dose-escalation paradigm to sham/0, 1, 2, 4, 6, and 8 W/cm2 spatial-peak pulse-average intensity (ISPPA, estimated in-vivo transcranial value; LOW: sham/0, 1 and 2 W/cm2, HIGH: 4, 6 and 8 W/cm2). Stopping rules (dose limiting toxicities) were pre-defined: ≥2nd-degree scalp burn, clinical seizures, ≥20% topical apparent diffusion coefficient change, or participant discontinuation due to any reason. A 12-minute LIFUS was applied over the ipsilesional motor cortex while participants were concurrently practicing three blocks of motor sequence learning (MSL) task using the affected hand. We collected the occurrences of pre-defined adverse events, post- minus-pre improvements in MSL response time, and post-minus-pre differences in corticospinal excitability quantified by motor evoked potentials.RESULTS: ISPPA was escalated to 8 W/cm2 with eighteen stroke participants without meeting stopping rules. Compared to the LOW, the HIGH performed significantly better on the MSL (24.7±13.3% vs. 13.2±10.9%, p=0.01). Similarly, the HIGH also showed signs of increased corticospinal excitability (32.0±34.3% vs. 12.9±48.0%) but did not reach significance, p=0.53.CONCLUSIONS: Our Phase I safety study suggests that a single session of 12-minute LIFUS up to 8 W/cm2 ISPPA is safe and feasible in stroke patients. Higher LIFUS intensities can induce greater MSL retention. The next logical step is to conduct a Phase II study to further test the efficacy of LIFUS and monitor its safety profiles in stroke patients.
背景:最近,低强度聚焦超声刺激(LIFUS)已成为治疗某些神经精神疾病的一种很有前景的神经调节工具。然而,其在脑卒中患者中的安全性和可行性仍然未知。强度是 LIFUS 的关键安全参数。我们的目的是确定 LIFUS 在中风患者中的最大安全和可耐受强度,并探讨其对上肢运动学习和皮质脊髓兴奋性的影响。我们采用了经典的 3+3 剂量递增范式,即假性/0、1、2、4、6 和 8 W/cm2 空间峰值脉冲平均强度(ISPPA,体内经颅估计值;低:假性/0、1 和 2 W/cm2,高:4、6 和 8 W/cm2)。预先设定了停止规则(剂量限制毒性):≥2 度头皮灼伤、临床癫痫发作、局部表观弥散系数变化≥20% 或参与者因任何原因中止治疗。在受试者使用患手练习三个运动序列学习(MSL)任务块的同时,我们在其同侧运动皮层上进行了 12 分钟的 LIFUS 测试。我们收集了预定义不良事件的发生率、MSL 反应时间的后减前改善情况以及通过运动诱发电位量化的皮质脊髓兴奋性的后减前差异。与 LOW 相比,HIGH 在 MSL 上的表现明显更好(24.7±13.3% vs. 13.2±10.9%,P=0.01)。同样,HIGH 也显示出皮质脊髓兴奋性增加的迹象(32.0±34.3% vs. 12.9±48.0%),但未达到显著性,P=0.53:我们的 I 期安全性研究表明,对脑卒中患者进行单次 12 分钟 LIFUS(最高 8 W/cm2 ISPPA)治疗是安全可行的。更高的 LIFUS 强度可诱导更多的 MSL 保留。下一个合理的步骤是进行 II 期研究,进一步测试 LIFUS 的疗效并监测其在中风患者中的安全性。
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引用次数: 0
WearGait-PD: An Open-Access Wearables Dataset for Gait in Parkinson's Disease and Age-Matched Controls WearGait-PD:帕金森病和年龄匹配对照组步态的开放式可穿戴设备数据集
Pub Date : 2024-09-12 DOI: 10.1101/2024.09.11.24313476
Anthony J Anderson, David Eguren, Michael A Gonzalez, Naima Khan, Sophia Watkinson, Michael Caiola, Siegfried S Hirczy, Cyrus P Zabetian, Kelly Mills, Emile Moukheiber, Laureano Moro-Velazquez, Najim Dehak, Chelsie Motley, Brittney C Muir, Ankur A Butala, Kimberly L Kontson
Wearable movement sensors are powerful tools for objectively characterizing and quantifying movement. They enhance the precise characterization of gait, balance, and motor symptoms in Parkinson's disease and related disorders, facilitating in-clinic and remote assessments, disease management, and therapeutic intervention development. Access to high-quality data from these sensors can accelerate discoveries in this clinical population. The WearGait-PD open-access dataset contains raw inertial measurement unit (IMU) and sensorized insole data from individuals with PD and age-matched controls, synchronized to a gait walkway reference system. IMU data include 3-degree of freedom (DOF) acceleration, rotational velocity, magnetic field strength, and orientation for each of 13 sensors on the participant's body. Sensor insole data include absolute pressure from 16 sensors in each insole and 3-DOF acceleration and rotational velocity. Walkway data include 2D position and relative pressure for each active sensor during every footfall. Frame-by-frame annotation of participant actions during gait and balance tasks was incorporated using synchronized video cameras. All data were associated with demographic information and clinical evaluations (e.g., medications, DBS-status, MDS-UPDRS scores).
可穿戴运动传感器是客观描述和量化运动的强大工具。它们能加强对帕金森病及相关疾病的步态、平衡和运动症状的精确表征,促进诊室内和远程评估、疾病管理和治疗干预措施的开发。从这些传感器中获取高质量数据可以加速这一临床人群的发现。WearGait-PD开放存取数据集包含来自帕金森病患者和年龄匹配对照组的原始惯性测量单元(IMU)和感应鞋垫数据,这些数据与步态参考系统同步。惯性测量单元数据包括参与者身体上 13 个传感器中每个传感器的 3 自由度 (DOF) 加速度、旋转速度、磁场强度和方向。传感器鞋垫数据包括每个鞋垫中 16 个传感器的绝对压力、3-DOF 加速度和旋转速度。步行道数据包括每个有源传感器在每次落脚时的二维位置和相对压力。使用同步摄像机对参与者在步态和平衡任务中的动作进行逐帧标注。所有数据都与人口统计学信息和临床评估(如药物、DBS 状态、MDS-UPDRS 评分)相关联。
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引用次数: 0
SAHVER: Subarachnoid Hemorrhage Volumetric Expediting Resolution SAHVER:蛛网膜下腔出血容积加速分辨率
Pub Date : 2024-09-11 DOI: 10.1101/2024.09.09.24312803
saif salman, Yujia Wei, melina wirtz, bradley erickson, rohan sharma, Nicholas Brandmeir, Behnam Rezai Jahromi, david miller, nadia albaramony, rabih tawk, William David Freeman
Introduction: Subarachnoid Hemorrhage Volumetric Artificial Intelligence (SAHVAI) is a novel model that segments and quantifies Subarachnoid Hemorrhage Volume (SAHV) on non-contrast CT (NCCT) scans and generates a 3D brain volumetric map called SAHVAI-3D. It is enhanced into SAHVAI-4D when measured over time. Precise measurement of SAHV is critical to future discoveryies. For example, IRRAflow is a FDA-approved ventricular irrigation and drainage system that can expedite removal of SAH blood products.Objective: Utilize SAHVAI model to compare and quantify the course of SAHV resolution over time and generate SAHVAI-3D brain maps to help visualize significant SAHV resolution patterns and predict vasospasm. Methods: We applied SAHVAI to SAH cases with mFS(3-4) using the NCCT scans among three groups. Group A included 1 SAH patient treated with the IRRAflow system. Group B included one SAH patient presented GCS 15 two days after ictus with no requirement for EVD. Group C included 10 patients who underwent regular EVD placement per standard of care. Results: Group A showed expedited resolution of SAHV (1.87mL/day) with an mRS of 0 on discharge and minimal vasospasm (Figures 1, 2). Group B showed 16mL increase in SAHV suspected for aneurysmal rebleeding days (5-9), and the patient later died (mRS of 6) (Figure 3). Group C showed reduction of SAHV of ~ 0.5ml /day (Figure 4). Further, the resultant 3D brain maps revealed that areas with the highest density of blood concentration were correlated with the severity and location of the vasospasm in all groups (Table 1). Conclusion: SAHVAI, SAHVAI-3D and SAHVAI-4D are novel methods that reliably quantifies SAHV blood volume and changes over time including SAH blood resolution or rebleeding events. SAHVER is a model that shows how interventions such as IRRAflow can expedite SAHV resolution compared to passive EVD and non-CSF drainage groups.
简介蛛网膜下腔出血容积人工智能(SAHVAI)是一种新型模型,可对非对比 CT(NCCT)扫描中的蛛网膜下腔出血容积(SAHV)进行分割和量化,并生成名为 SAHVAI-3D 的三维脑容积图。随着时间的推移,测量结果会增强为 SAHVAI-4D。精确测量 SAHV 对未来的发现至关重要。例如,IRRAflow 是经 FDA 批准的心室灌注和引流系统,可加快 SAH 血液制品的清除:目标:利用 SAHVAI 模型比较和量化 SAHV 随时间的消退过程,并生成 SAHVAI-3D 脑图,以帮助观察显著的 SAHV 消退模式并预测血管痉挛。方法:我们将 SAHVAI 应用于三组 mFS(3-4) SAH 病例的 NCCT 扫描。A 组包括一名接受 IRRAflow 系统治疗的 SAH 患者。B 组包括一名在发病两天后出现 GCS 15 且无需 EVD 的 SAH 患者。C 组包括 10 名按照标准护理进行常规 EVD 置入的患者。结果:A 组显示 SAHV 快速消退(1.87 毫升/天),出院时 mRS 为 0,血管痉挛极小(图 1、2)。B 组的 SAHV 增加了 16 毫升,怀疑为动脉瘤再出血天数(5-9 天),患者随后死亡(mRS 为 6)(图 3)。C 组显示 SAHV 减少了约 0.5 毫升/天(图 4)。此外,三维脑图结果显示,血液浓度密度最高的区域与各组血管痉挛的严重程度和位置相关(表 1)。结论SAHVAI、SAHVAI-3D 和 SAHVAI-4D 是新颖的方法,能可靠地量化 SAHV 血容量及其随时间的变化,包括 SAH 血液缓解或再出血事件。SAHVER 是一个模型,显示了与被动 EVD 组和非脑脊液引流组相比,IRRAflow 等干预措施如何加快 SAHV 的消退。
{"title":"SAHVER: Subarachnoid Hemorrhage Volumetric Expediting Resolution","authors":"saif salman, Yujia Wei, melina wirtz, bradley erickson, rohan sharma, Nicholas Brandmeir, Behnam Rezai Jahromi, david miller, nadia albaramony, rabih tawk, William David Freeman","doi":"10.1101/2024.09.09.24312803","DOIUrl":"https://doi.org/10.1101/2024.09.09.24312803","url":null,"abstract":"Introduction: Subarachnoid Hemorrhage Volumetric Artificial Intelligence (SAHVAI) is a novel model that segments and quantifies Subarachnoid Hemorrhage Volume (SAHV) on non-contrast CT (NCCT) scans and generates a 3D brain volumetric map called SAHVAI-3D. It is enhanced into SAHVAI-4D when measured over time. Precise measurement of SAHV is critical to future discoveryies. For example, IRRAflow is a FDA-approved ventricular irrigation and drainage system that can expedite removal of SAH blood products.\u0000Objective: Utilize SAHVAI model to compare and quantify the course of SAHV resolution over time and generate SAHVAI-3D brain maps to help visualize significant SAHV resolution patterns and predict vasospasm. Methods: We applied SAHVAI to SAH cases with mFS(3-4) using the NCCT scans among three groups. Group A included 1 SAH patient treated with the IRRAflow system. Group B included one SAH patient presented GCS 15 two days after ictus with no requirement for EVD. Group C included 10 patients who underwent regular EVD placement per standard of care. Results: Group A showed expedited resolution of SAHV (1.87mL/day) with an mRS of 0 on discharge and minimal vasospasm (Figures 1, 2). Group B showed 16mL increase in SAHV suspected for aneurysmal rebleeding days (5-9), and the patient later died (mRS of 6) (Figure 3). Group C showed reduction of SAHV of ~ 0.5ml /day (Figure 4). Further, the resultant 3D brain maps revealed that areas with the highest density of blood concentration were correlated with the severity and location of the vasospasm in all groups (Table 1). Conclusion: SAHVAI, SAHVAI-3D and SAHVAI-4D are novel methods that reliably quantifies SAHV blood volume and changes over time including SAH blood resolution or rebleeding events. SAHVER is a model that shows how interventions such as IRRAflow can expedite SAHV resolution compared to passive EVD and non-CSF drainage groups.","PeriodicalId":501367,"journal":{"name":"medRxiv - Neurology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Trials for Wolfram Syndrome Neurodegeneration: Novel Design, Endpoints, and Analysis Models 沃尔夫拉姆综合征神经变性的临床试验:新颖的设计、终点和分析模型
Pub Date : 2024-09-11 DOI: 10.1101/2024.09.10.24313426
Guoqiao Wang, Zhaolong Adrian Li, Ling Chen, Heather Lugar, Tamara Hershey
ObjectiveWolfram syndrome, an ultra-rare condition, currently lacks effective treatment options. The rarity of this disease presents significant challenges in conducting clinical trials, particularly in achieving sufficient statistical power (e.g., 80%). The objective of this study is to propose a novel clinical trial design based on real-world data to reduce the sample size required for conducting clinical trials for Wolfram syndrome. MethodsWe propose a novel clinical trial design with three key features aimed at reducing sample size and improve efficiency: (i) Pooling historical/external controls from a longitudinal observational study conducted by the Washington University Wolfram Research Clinic. (ii) Utilizing run-in data to estimate model parameters. (iii) Simultaneously tracking treatment effects in two endpoints using a multivariate proportional linear mixed effects model. ResultsComprehensive simulations were conducted based on real-world data obtained through the Wolfram syndrome longitudinal observational study. Our simulations demonstrate that this proposed design can substantially reduce sample size requirements. Specifically, with a bivariate endpoint and the inclusion of run-in data, a sample size of approximately 30 per group can achieve over 80% power, assuming the placebo progression rate remains consistent during both the run-in and randomized periods. In cases where the placebo progression rate varies, the sample size increases to approximately 50 per group. ConclusionsFor rare diseases like Wolfram syndrome, leveraging existing resources such as historical/external controls and run-in data, along with evaluating comprehensive treatment effects using bivariate/multivariate endpoints, can significantly expedite the development of new drugs.
目标沃尔夫拉姆综合征是一种极为罕见的疾病,目前缺乏有效的治疗方案。这种疾病的罕见性为临床试验的开展带来了巨大挑战,尤其是在获得足够的统计功率(如 80%)方面。本研究的目的是根据真实世界的数据提出一种新的临床试验设计,以减少沃尔夫拉姆综合征临床试验所需的样本量。方法我们提出的新型临床试验设计有三个主要特点,旨在减少样本量并提高效率:(i) 汇集华盛顿大学沃尔夫拉姆研究诊所开展的纵向观察研究中的历史/外部对照。(ii) 利用运行数据估算模型参数。(iii) 使用多变量比例线性混合效应模型同时追踪两个终点的治疗效果。结果根据沃尔夫拉姆综合征纵向观察研究获得的实际数据进行了全面模拟。我们的模拟结果表明,这种拟议的设计可以大大减少对样本量的要求。具体来说,如果采用双变量终点并纳入运行期数据,假设安慰剂进展率在运行期和随机期保持一致,则每组约 30 个样本可达到 80% 以上的功率。如果安慰剂的进展率不尽相同,每组的样本量就会增加到约 50 个。结论对于沃尔夫拉姆综合征等罕见病,利用现有资源(如历史/外部对照和运行期数据)以及使用双变量/多变量终点评估综合治疗效果,可以大大加快新药的开发。
{"title":"Clinical Trials for Wolfram Syndrome Neurodegeneration: Novel Design, Endpoints, and Analysis Models","authors":"Guoqiao Wang, Zhaolong Adrian Li, Ling Chen, Heather Lugar, Tamara Hershey","doi":"10.1101/2024.09.10.24313426","DOIUrl":"https://doi.org/10.1101/2024.09.10.24313426","url":null,"abstract":"Objective\u0000Wolfram syndrome, an ultra-rare condition, currently lacks effective treatment options. The rarity of this disease presents significant challenges in conducting clinical trials, particularly in achieving sufficient statistical power (e.g., 80%). The objective of this study is to propose a novel clinical trial design based on real-world data to reduce the sample size required for conducting clinical trials for Wolfram syndrome. Methods\u0000We propose a novel clinical trial design with three key features aimed at reducing sample size and improve efficiency: (i) Pooling historical/external controls from a longitudinal observational study conducted by the Washington University Wolfram Research Clinic. (ii) Utilizing run-in data to estimate model parameters. (iii) Simultaneously tracking treatment effects in two endpoints using a multivariate proportional linear mixed effects model. Results\u0000Comprehensive simulations were conducted based on real-world data obtained through the Wolfram syndrome longitudinal observational study. Our simulations demonstrate that this proposed design can substantially reduce sample size requirements. Specifically, with a bivariate endpoint and the inclusion of run-in data, a sample size of approximately 30 per group can achieve over 80% power, assuming the placebo progression rate remains consistent during both the run-in and randomized periods. In cases where the placebo progression rate varies, the sample size increases to approximately 50 per group. Conclusions\u0000For rare diseases like Wolfram syndrome, leveraging existing resources such as historical/external controls and run-in data, along with evaluating comprehensive treatment effects using bivariate/multivariate endpoints, can significantly expedite the development of new drugs.","PeriodicalId":501367,"journal":{"name":"medRxiv - Neurology","volume":"198 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A prebiotic diet intervention can restore faecal short chain fatty acids in Parkinson's Disease yet fails to restore the gut microbiome homeostasis 益生元饮食干预可恢复帕金森病患者粪便中的短链脂肪酸,但却无法恢复肠道微生物组的平衡
Pub Date : 2024-09-11 DOI: 10.1101/2024.09.09.24313184
Janis Rebecca Bedarf, Stefano Romano, Silke Sophie Heinzmann, Anthony Duncan, Maria H Traka, Duncan Ng, Daniella Segovia-Lizano, Marie-Christine Simon, Arjan Narbad, Ullrich Wuellner, Falk Hildebrand
ABSTRACTDespite extensive research, current treatment of Parkinson's Disease (PD) remains symptomatic and disease modifying approaches are urgently required. A promising approach is to target the gut-brain-axis by modifying the intestinal microbiota and the herein produced metabolites.We decided to test this approach by modifying key metabolites of bacterial intestinal fermentation: short chain fatty acids (SCFA), known to be decreased in PD patients. A prospective, controlled pilot study was conducted in 11 couples, with one PD patient and healthy spouse as control (CO) each. Participants followed a 4-week diet rich in dietary fibre in addition to the intake of a prebiotic sirup (Lactulose). Metagenomes and metabolites of the gut microbiota, urinary metabolites and clinical characteristics were assessed. The short-term dietary intervention significantly augmented gastrointestinal SCFA production, likely associated with increased Bifidobacteria spp. PD associated gastrointestinal symptoms improved with increasing SCFA levels. The pre-existing bacterial dysbiosis associated with PD, such as depletion of genera Blautia, Dorea, and Erysipelatoclostridium in PD, persisted within the study period. Some pathobionts, i.e. Klebsiella, were reduced after the intervention. Bacterial metabolite composition (both faecal and urine metabolomes) shifted towards the composition of the healthy control in PD after the intervention. Among these brain-relevant gut metabolic functions improved in PD patients, such as S-Adenosyl methionine (SAM), 3,4-Dihydroxyphenylacetic acid (DOPAC), Glutathione (GSH), Tryptophan and inositol related changes, involved in neuroprotective and antioxidant pathways. Despite the small cohort size and short-term study period a minor dietary intervention was sufficient to improve gastrointestinal symptoms in PD and altered metabolic parameters in a presumed neuroprotective manner, warranting further investigation in larger cohorts.
摘要尽管进行了广泛的研究,但目前治疗帕金森病(PD)的方法仍然是对症治疗,因此迫切需要改变疾病的方法。我们决定通过改变细菌肠道发酵的关键代谢物--短链脂肪酸(SCFA)来测试这种方法,众所周知,帕金森病患者的短链脂肪酸会减少。我们在 11 对夫妇中进行了一项前瞻性对照试验研究,每对夫妇都有一名帕金森病患者和健康配偶作为对照(CO)。参加者除了摄入益生菌沙拉酱(乳果糖)外,还进行了为期 4 周的富含膳食纤维的饮食。对肠道微生物群的元基因组和代谢物、尿液代谢物和临床特征进行了评估。短期饮食干预明显增加了胃肠道 SCFA 的产生,这可能与双歧杆菌属的增加有关。与腹泻症相关的原有细菌失调,如腹泻症中的布劳氏菌属、多雷氏菌属和鞘氨醇菌属的减少,在研究期间依然存在。一些病原菌(如克雷伯氏菌)在干预后有所减少。干预后,帕金森病患者的细菌代谢物组成(粪便和尿液代谢组)向健康对照组转变。其中,与脑相关的肠道代谢功能在帕金森病患者中得到了改善,如 S-腺苷蛋氨酸(SAM)、3,4-二羟基苯乙酸(DOPAC)、谷胱甘肽(GSH)、色氨酸和肌醇的相关变化,这些变化参与了神经保护和抗氧化途径。尽管队列规模较小且研究时间较短,但轻微的饮食干预足以改善帕金森病患者的胃肠道症状,并以假定的神经保护方式改变代谢参数,值得在更大规模的队列中进一步研究。
{"title":"A prebiotic diet intervention can restore faecal short chain fatty acids in Parkinson's Disease yet fails to restore the gut microbiome homeostasis","authors":"Janis Rebecca Bedarf, Stefano Romano, Silke Sophie Heinzmann, Anthony Duncan, Maria H Traka, Duncan Ng, Daniella Segovia-Lizano, Marie-Christine Simon, Arjan Narbad, Ullrich Wuellner, Falk Hildebrand","doi":"10.1101/2024.09.09.24313184","DOIUrl":"https://doi.org/10.1101/2024.09.09.24313184","url":null,"abstract":"ABSTRACT\u0000Despite extensive research, current treatment of Parkinson's Disease (PD) remains symptomatic and disease modifying approaches are urgently required. A promising approach is to target the gut-brain-axis by modifying the intestinal microbiota and the herein produced metabolites.\u0000We decided to test this approach by modifying key metabolites of bacterial intestinal fermentation: short chain fatty acids (SCFA), known to be decreased in PD patients. A prospective, controlled pilot study was conducted in 11 couples, with one PD patient and healthy spouse as control (CO) each. Participants followed a 4-week diet rich in dietary fibre in addition to the intake of a prebiotic sirup (Lactulose). Metagenomes and metabolites of the gut microbiota, urinary metabolites and clinical characteristics were assessed. The short-term dietary intervention significantly augmented gastrointestinal SCFA production, likely associated with increased Bifidobacteria spp. PD associated gastrointestinal symptoms improved with increasing SCFA levels. The pre-existing bacterial dysbiosis associated with PD, such as depletion of genera Blautia, Dorea, and Erysipelatoclostridium in PD, persisted within the study period. Some pathobionts, i.e. Klebsiella, were reduced after the intervention. Bacterial metabolite composition (both faecal and urine metabolomes) shifted towards the composition of the healthy control in PD after the intervention. Among these brain-relevant gut metabolic functions improved in PD patients, such as S-Adenosyl methionine (SAM), 3,4-Dihydroxyphenylacetic acid (DOPAC), Glutathione (GSH), Tryptophan and inositol related changes, involved in neuroprotective and antioxidant pathways. Despite the small cohort size and short-term study period a minor dietary intervention was sufficient to improve gastrointestinal symptoms in PD and altered metabolic parameters in a presumed neuroprotective manner, warranting further investigation in larger cohorts.","PeriodicalId":501367,"journal":{"name":"medRxiv - Neurology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reactivation of Human Herpesvirus 6 and Epstein-Barr Virus in relapsing remitting multiple sclerosis: association with disabilities, disease progression, and inflammatory processes. 人类疱疹病毒 6 和 Epstein-Barr 病毒在复发性缓解型多发性硬化症中的再激活:与残疾、疾病进展和炎症过程的关系。
Pub Date : 2024-09-10 DOI: 10.1101/2024.09.10.24313388
Abbas F. Almulla, Aristo Vojdani, Yingqian Zhang, Elroy Vojdani, Michael F. Maes
Background: Multiple sclerosis (MS) is a chronic autoimmune disorder affecting thecentral nervous system (CNS). Reactivation of Human herpesvirus 6 (HHV-6) andEpstein-Barr virus (EBV) is observed in MS.Objectives: This study investigates immunoglobulins (Ig)G, IgM, and IgA directedagainst EBV nuclear antigen EBNA-366-406, HHV-6 and EBV deoxyuridine-triphosphatase (dUTPase), and different immune profiles in 58 patients with relapsingremitting MS (RRMS) compared to 60 healthy controls.Methods: We employed enzyme-linked immunosorbent assays (ELISA) to measure theimmunoglobulins to viral antigens. Multiplex immunoassays were used to measurecytokines, chemokines and growth factor levels that were used to compute immuneprofiles, including M1 macrophage, T helper (Th)-1, Th-17, and overall immuneactivation. We assessed disabilities using the Expanded Disability Status Scale (EDSS)and disease progression using the Multiple Sclerosis Severity Score (MSSS).Results: IgG/IgA/IgM directed to the three viral antigens were significantly higher inRRMS than in controls. RRMS was significantly discriminated from controls by usingIgG and IgM against HHV-6 dUTPase, yielding an accuracy of 91.5% (sensitivity=87.3%and specificity=95.2%). Neural network analysis showed that using IgG to EBV-dUTPase, IgM to EBV-dUTPase, and immune profiles yielded an area under the ROCcurve of 1 and a predictive accuracy of 97.1%. There were strong associations betweenIgG/IgM responses to HHV-6 and EBV-dUTPases and the EDSS/MSSS scores andaberrations in M1, Th-17, profiles, and overall immune activation.Conclusions: HHV-6 and EBV reactivation play a key role in RRMS and these effectsare mediated by activation of cytokine profiles.
背景:多发性硬化症(MS)是一种影响中枢神经系统(CNS)的慢性自身免疫性疾病。在多发性硬化症中可观察到人类疱疹病毒 6(HHV-6)和天疱疮病毒(EBV)的再活化:本研究调查了 58 例复发缓解型多发性硬化症(RRMS)患者与 60 例健康对照组相比,针对 EBV 核抗原 EBNA-366-406、HHV-6 和 EBV 脱氧尿苷三磷酸酶(dUTPase)的免疫球蛋白(Ig)G、IgM 和 IgA 以及不同的免疫特征:我们采用酶联免疫吸附试验(ELISA)来测定病毒抗原的免疫球蛋白。采用多重免疫测定法测定细胞因子、趋化因子和生长因子的水平,然后计算免疫档案,包括 M1 巨噬细胞、T 辅助细胞 (Th)-1、Th-17 和整体免疫激活。我们使用扩展残疾状况量表(EDSS)评估残疾情况,并使用多发性硬化症严重程度评分(MSSS)评估疾病进展:结果:RRMS患者针对三种病毒抗原的IgG/IgA/IgM明显高于对照组。使用针对 HHV-6 dUTPase 的 IgG 和 IgM 可以明显区分 RRMS 和对照组,准确率为 91.5%(灵敏度=87.3%,特异性=95.2%)。神经网络分析表明,使用针对EBV-dUTPase的IgG、针对EBV-dUTPase的IgM和免疫图谱得出的ROC曲线下面积为1,预测准确率为97.1%。HHV-6和EBV-dUTPase的IgG/IgM反应与EDSS/MSSS评分以及M1、Th-17、特征和总体免疫激活异常之间存在密切联系:结论:HHV-6和EBV再激活在RRMS中起着关键作用,而这些作用是通过激活细胞因子谱介导的。
{"title":"Reactivation of Human Herpesvirus 6 and Epstein-Barr Virus in relapsing remitting multiple sclerosis: association with disabilities, disease progression, and inflammatory processes.","authors":"Abbas F. Almulla, Aristo Vojdani, Yingqian Zhang, Elroy Vojdani, Michael F. Maes","doi":"10.1101/2024.09.10.24313388","DOIUrl":"https://doi.org/10.1101/2024.09.10.24313388","url":null,"abstract":"Background: Multiple sclerosis (MS) is a chronic autoimmune disorder affecting the\u0000central nervous system (CNS). Reactivation of Human herpesvirus 6 (HHV-6) and\u0000Epstein-Barr virus (EBV) is observed in MS.\u0000Objectives: This study investigates immunoglobulins (Ig)G, IgM, and IgA directed\u0000against EBV nuclear antigen EBNA-366-406, HHV-6 and EBV deoxyuridine-\u0000triphosphatase (dUTPase), and different immune profiles in 58 patients with relapsing\u0000remitting MS (RRMS) compared to 60 healthy controls.\u0000Methods: We employed enzyme-linked immunosorbent assays (ELISA) to measure the\u0000immunoglobulins to viral antigens. Multiplex immunoassays were used to measure\u0000cytokines, chemokines and growth factor levels that were used to compute immune\u0000profiles, including M1 macrophage, T helper (Th)-1, Th-17, and overall immune\u0000activation. We assessed disabilities using the Expanded Disability Status Scale (EDSS)\u0000and disease progression using the Multiple Sclerosis Severity Score (MSSS).\u0000Results: IgG/IgA/IgM directed to the three viral antigens were significantly higher in\u0000RRMS than in controls. RRMS was significantly discriminated from controls by using\u0000IgG and IgM against HHV-6 dUTPase, yielding an accuracy of 91.5% (sensitivity=87.3%\u0000and specificity=95.2%). Neural network analysis showed that using IgG to EBV-\u0000dUTPase, IgM to EBV-dUTPase, and immune profiles yielded an area under the ROC\u0000curve of 1 and a predictive accuracy of 97.1%. There were strong associations between\u0000IgG/IgM responses to HHV-6 and EBV-dUTPases and the EDSS/MSSS scores and\u0000aberrations in M1, Th-17, profiles, and overall immune activation.\u0000Conclusions: HHV-6 and EBV reactivation play a key role in RRMS and these effects\u0000are mediated by activation of cytokine profiles.","PeriodicalId":501367,"journal":{"name":"medRxiv - Neurology","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Causal Associations Between Imaging-derived Phenotypes and Risk of Alzheimer's Disease and Other Neurodegenerative Disorders:A Mendelian Randomization Study 成像表型与阿尔茨海默病和其他神经退行性疾病风险之间的因果关系:孟德尔随机研究
Pub Date : 2024-09-10 DOI: 10.1101/2024.09.10.24313402
Zhichun Chen, Jun Liu, Yong You
Background Accumulating observational studies have suggested associations between imaging-derived phenotypes (IDPs) and common neurodegenerative disorders, especially Alzheimer's disease (AD). The goal of this study is to evaluate the causal associations between structural and functional IDPs and 4 neurodegenerative disorders, including AD, Parkinson's disease (PD), Amyotrophic lateral sclerosis (ALS), and Multiple sclerosis (MS). Methods Bidirectional two-sample Mendelian randomization (MR) studies were conducted using summary statistics obtained from genome-wide association studies of 3909 IDPs from UK biobank and 4 neurodegenerative disorders.Results Forward MR analysis showed that volume of cerebral white matter in the left hemisphere was associated with increased risk of ALS (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.09-1.22, P = 3.52 x 10-6). In reverse MR analysis, we revealed genetically determined risk of AD and MS were associated with multiple IDPs (all P < 1.28 x 10-5[0.05/3909], 9 IDPs in AD and 4 IDPs in MS). For example, genetically determined risk of AD was causally associated with reduced volume of gray matter in right ventral striatum (OR = 0.95, 95% CI = 0.93-0.97, P = 4.68 x 10-7) and lower rfMRI amplitudes in several nodes (ICA25 node 9, ICA25 node 8, and ICA100 node 11). Additionally, genetically determined risk of MS was causally associated with reduced volume in left putamen (OR = 0.97, 95% CI = 0.97-0.98, P = 4.47 x 10-7) and increased orientation dispersion index in right hippocampus (OR = 1.03, 95% CI = 1.01-1.04, P = 2.02 x 10-6). Conclusions Our study suggested plausible causal associations between risk of NDDs and brain IDPs. These findings might hold promise for identifying new disease mechanisms and developing novel preventative therapies for NDDs at the brain imaging levels.
背景 越来越多的观察性研究表明,成像衍生表型(IDPs)与常见的神经退行性疾病,尤其是阿尔茨海默病(AD)之间存在关联。本研究旨在评估结构性和功能性 IDP 与 4 种神经退行性疾病(包括阿尔茨海默病、帕金森病、肌萎缩侧索硬化症和多发性硬化症)之间的因果关系。结果 正向 MR 分析表明,左半球脑白质体积与 ALS 风险增加相关(几率比 [OR] = 1.15,95% 置信区间 [CI] = 1.09-1.22,P = 3.52 x 10-6)。在反向 MR 分析中,我们发现由基因决定的 AD 和 MS 风险与多个 IDPs 相关(所有 P < 1.28 x 10-5[0.05/3909], AD 中有 9 个 IDPs,MS 中有 4 个 IDPs)。例如,由基因决定的 AD 风险与右侧腹侧纹状体灰质体积减少(OR = 0.95,95% CI = 0.93-0.97,P = 4.68 x 10-7)和几个节点(ICA25 节点 9、ICA25 节点 8 和 ICA100 节点 11)的 rfMRI 振幅降低存在因果关系。此外,由基因决定的多发性硬化症风险与左侧丘脑体积缩小(OR = 0.97,95% CI = 0.97-0.98,P = 4.47 x 10-7)和右侧海马定向弥散指数增加(OR = 1.03,95% CI = 1.01-1.04,P = 2.02 x 10-6)有因果关系。结论 我们的研究表明,NDDs 风险与大脑 IDPs 之间存在似是而非的因果关系。这些发现可能有助于在脑成像水平上确定新的疾病机制和开发新的 NDD 预防疗法。
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引用次数: 0
Rest-Activity Rhythm Phenotypes in Adults with Epilepsy and Intellectual Disability 癫痫和智障成人的静息-活动节律表型
Pub Date : 2024-09-10 DOI: 10.1101/2024.09.09.24313145
Nandani Adhyapak, Mark A Abboud, Grace E Cardenas, Vaishnav Krishnan
Objective: Sleep and rest-activity rhythms (RARs) are perturbed in many forms of neuropsychiatric illness. In this study, we applied wrist actigraphy to describe the extent of RAR perturbations in adults with epilepsy and intellectual disability (E+ID). We examined whether RAR phenotypes obtained cross-sectionally correlate with epilepsy severity, deficits in adaptive function and/or comorbid psychopathology. Methods: Primary caregivers of E+ID adults provided informed consent during routine ambulatory clinic visits and were asked to complete standardized surveys of overall epilepsy severity (GASE, Global Assessment of Severity of Epilepsy), adaptive function (ABAS-3, Adaptive Behavior Assessment System-3) and psychopathology (ABCL, Adult Behavior Checklist). Caregivers were also asked to ensure that subjects wore an Actiwatch-2 device continuously on their nondominant wrist for at least ten days. From recorded actograms, we calculated RAR amplitude, acrophase, robustness, intradaily variability (IV), interdaily stability (IS) and estimates of sleep quantity and timing. We compared these RAR metrics against those from (i) a previously published cohort of adults with epilepsy without ID (EID), and (ii) a cohort of age- and sex-matched intellectually able subjects measured within the Study of Latinos (SOL) Ancillary actigraphy study (SOL). Within E+ID subjects, we applied k-means analysis to divide subjects into three actigraphically distinct clusters. Results: 46 E+ID subjects (median age 26 [20-68], 47% female) provided a median recording duration of 11 days [range 6-27]. Surveys reflected low to extremely low levels of adaptive function (ABAS3 General Adaptive Composite score: median 50 [49-75]), and low/subclinical levels of psychopathology (ABCL total score: median 54.5 [25-67]). Compared with E-ID (n=57) and SOL (n=156) cohorts, E+ID subjects displayed significantly lower RAR amplitude, robustness and IS, with significantly higher IV and total daily sleep. K-means clustering of E+ID subjects recognized an intermediate cluster B, with RAR values indistinguishable to E-ID. Cluster A subjects displayed pronounced hypoactivity and hypersomnia with high rates of rhythm fragmentation, while cluster C subjects featured hyper-robust and high amplitude RARs. All three clusters were similar in age, body mass index, antiseizure medication (ASM) polytherapy, ABAS3 and ABCL scores. We qualitatively describe RAR examples from all three clusters. Interpretation: We show that adults with epilepsy and intellectual disability display a wide spectrum of RAR phenotypes that do not neatly correlate with measures of adaptive function or epilepsy severity. Prospective studies are necessary to determine whether continuous actigraphic monitoring can sensitively capture changes in chronobiological health that may arise with disease progression, iatrogenesis (e.g., ASM toxicity) or acute health deteriorations (e.g., seizure exacerbation, pneumonia). Similar long-term d
目的:睡眠和休息-活动节律(RAR)在多种神经精神疾病中都会受到干扰。在这项研究中,我们采用腕部活动记录仪来描述患有癫痫和智力障碍(E+ID)的成年人的 RAR 干扰程度。我们研究了横截面获得的 RAR 表型是否与癫痫严重程度、适应功能缺陷和/或合并精神病理学相关。研究方法E+ID成人的主要照护者在常规门诊就诊时提供知情同意,并被要求完成有关总体癫痫严重程度(GASE,癫痫严重程度全球评估)、适应功能(ABAS-3,适应行为评估系统-3)和精神病理学(ABCL,成人行为核对表)的标准化调查。我们还要求护理人员确保受试者在至少十天的时间里在非支配腕部持续佩戴 Actiwatch-2 设备。根据记录的动图,我们计算了 RAR 振幅、快相、稳健性、日内变异性 (IV)、日间稳定性 (IS) 以及睡眠量和睡眠时间的估计值。我们将这些 RAR 指标与 (i) 以前发表的无 ID(EID)成人癫痫患者队列和 (ii) 拉丁人研究(SOL)辅助动图研究(SOL)中测量的年龄和性别匹配的智力健全受试者队列中的指标进行了比较。在 E+ID 受试者中,我们应用 k-means 分析法将受试者分为三个不同的动图群组。结果如下46 名 E+ID 受试者(中位年龄 26 [20-68],47% 为女性)提供了 11 天 [6-27] 的中位记录时间。调查显示,受试者的适应功能处于较低至极低水平(ABAS3 一般适应综合评分:中位数 50 [49-75]),精神病理学处于较低/亚临床水平(ABCL 总分:中位数 54.5 [25-67])。与E-ID(57人)和SOL(156人)队列相比,E+ID受试者的RAR振幅、稳健性和IS显著较低,IV和每日睡眠总量显著较高。对 E+ID 受试者进行 K-means 聚类后发现了一个中间聚类 B,其 RAR 值与 E-ID 无异。A群组的受试者表现出明显的低活跃性和嗜睡症,节律破碎率高,而C群组的受试者则表现出超强和高振幅的RAR。所有三个群组在年龄、体重指数、抗癫痫药物(ASM)多重治疗、ABAS3 和 ABCL 评分方面都很相似。我们对所有三个群组的 RAR 示例进行了定性描述。解释:我们的研究表明,患有癫痫和智障的成年人显示出广泛的 RAR 表型,这些表型与适应功能或癫痫严重程度的测量结果并不完全相关。有必要进行前瞻性研究,以确定持续的动图监测能否灵敏地捕捉到随着疾病进展、先天因素(如 ASM 毒性)或急性健康恶化(如癫痫发作加重、肺炎)而可能出现的时间生物学健康变化。有必要提供类似的长期数据,以确认针对 RARs 正常化的行为干预是否会促进适应功能和治疗参与度的改善。
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引用次数: 0
Quantifying physical degradation alongside recording and stimulation performance of 980 intracortical microelectrodes chronically implanted in three humans for 956-2246 days 量化 980 个皮层内微电极的物理退化情况,以及在三个人体中长期植入 956-2246 天的记录和刺激性能
Pub Date : 2024-09-10 DOI: 10.1101/2024.09.09.24313281
D. A. Bjånes, S. Kellis, R. Nickl, B. Baker, T. Aflalo, L. Bashford, S. Chivukula, M. S. Fifer, L. E. Osborn, B. Christie, B. A. Wester, P. A. Celnik, D. Kramer, K. Pejsa, N. E. Crone, W. S. Anderson, N. Pouratian, B. Lee, C. Y. Liu, F. Tenore, L. Rieth, R. A. Andersen
Motivation The clinical success of brain-machine interfaces depends on overcoming both biological and material challenges to ensure a long-term stable connection for neural recording and stimulation. Therefore, there is a need to quantify any damage that microelectrodes sustain when they are chronically implanted in the human cortex.
动机 脑机接口的临床成功取决于克服生物和材料两方面的挑战,以确保神经记录和刺激的长期稳定连接。因此,有必要对长期植入人体皮层的微电极所遭受的任何损伤进行量化。
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引用次数: 0
期刊
medRxiv - Neurology
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