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A New Classification System for Postinterventional Cerebral Hyperdensity: The Influence on Hemorrhagic Transformation and Clinical Prognosis in Acute Stroke. 介入后脑高密度新分类系统:对急性脑卒中出血转化及临床预后的影响。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-11-23 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6144304
Yuan Shao, Yuyun Xu, Yumei Li, Xuehua Wen, Xiaodong He

Background: Postinterventional cerebral hyperdensity (PCHD) is commonly seen in acute ischemic patients after mechanical thrombectomy. We propose a new classification of PCHD to investigate its correlation with hemorrhagic transformation (HT). The clinical prognosis of PCHD was further studied.

Methods: Data from 189 acute stroke patients were analyzed retrospectively. According to the European Cooperative Acute Stroke Study criteria (ECASS), HT was classified as hemorrhagic infarction (HI-1 and HI-2) and parenchymal hematoma (pH-1 and pH-2). Referring to the classification of HT, PCHD was classified as PCHD-1, PCHD-2, PCHD-3, and PCHD-4. The prognosis included early neurological deterioration (END) and the modified Rankin Scale (mRS) score at 3 months.

Results: The incidence of HT was 14.8% (12/81) in the no-PCHD group and 77.8% (84/108) in the PCHD group. PCHD was highly correlated with HT (r = 0.751, p < 0.01). After stepwise regression analysis, PCHD and the National Institutes of Health Stroke Scale (NIHSS) score at admission were found to be independent factors for END (p < 0.001, p = 0.015, respectively). The area of curves (AUC) of PCHD, the NIHSS at admission, and the combined model were 0.810, 0.667, and 0.832, respectively. The optimal diagnostic cutoff of PCHD for END was PCHD > 2. PCHD, the NIHSS score at admission, and good vascular recanalization (VR) were independently associated with 3-month mRS (all p < 0.05). The AUC of PCHD, the NIHSS at admission, good VR, and the combined model were 0.779, 0.733, 0.565, and 0.867, respectively. And the best cutoff of PCHD for the mRS was PCHD > 1.

Conclusion: The relationship of PCHD and HT suggested PCHD was an early risk indicator for HT. The occurrence of PCHD-3 and PCHD-4 was a strong predictor for END. PCHD-1 is considered to be relatively benign in relation to the 3-month mRS.

背景:介入后脑高密度(PCHD)常见于机械取栓术后急性缺血性患者。我们提出一种新的PCHD分类,以探讨其与出血性转化(HT)的关系。进一步研究PCHD的临床预后。方法:回顾性分析189例急性脑卒中患者的资料。根据欧洲急性卒中合作研究标准(ECASS), HT分为出血性梗死(HI-1和HI-2)和实质血肿(pH-1和pH-2)。参照HT的分类,将PCHD分为PCHD-1、PCHD-2、PCHD-3、PCHD-4。预后包括早期神经功能恶化(END)和3个月时的改良Rankin量表(mRS)评分。结果:无PCHD组HT发生率为14.8% (12/81),PCHD组为77.8%(84/108)。PCHD与HT高度相关(r = 0.751, p < 0.01)。逐步回归分析发现入院时PCHD和NIHSS评分是影响END的独立因素(p < 0.001, p = 0.015)。入院时PCHD、NIHSS曲线面积(AUC)和联合模型分别为0.810、0.667和0.832。PCHD诊断END的最佳临界值为PCHD > 2。PCHD、入院时NIHSS评分、良好血管再通(VR)与3个月mRS独立相关(均p < 0.05)。PCHD、入院时NIHSS、良好VR和综合模型的AUC分别为0.779、0.733、0.565和0.867。PCHD的最佳临界值为PCHD > 1。结论:PCHD与HT的关系提示PCHD是HT的早期危险指标。PCHD-3和PCHD-4的出现是END的重要预测因子。与3个月的mRS相比,PCHD-1被认为是相对良性的。
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引用次数: 0
Changes in Gait Characteristics of Stroke Patients with Foot Drop after the Combination Treatment of Foot Drop Stimulator and Moving Treadmill Training. 足下垂刺激器联合运动跑步机训练对脑卒中足下垂患者步态特征的影响。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-11-22 eCollection Date: 2021-01-01 DOI: 10.1155/2021/9480957
Chen Peishun, Zhou Haiwang, Li Taotao, Guan Hongli, Min Yu, Zhang Wanrong

Objective: To study the changes in gait characteristics of stroke patients with foot drop after the combination treatment of foot drop stimulator and moving treadmill training and thus provide a basis for the improvement in a foot drop gait after stroke.

Methods: Sixty patients with hemiplegia and foot drop caused by stroke were randomly divided into two groups of 30: the test group and the control group. Both groups received basic rehabilitation training. On this basis, the test group received the combination treatment of foot drop stimulator and moving treadmill training. The control group received foot drop stimulator training. Both groups received consecutive treatment for 3 weeks, five times a week, and every single time lasted for 30 minutes. Before and after the treatment, a gait watch three-dimensional gait analysis system was used to measure and record the maximum angles of flexion of the affected side's hip, knee, and ankle; the pace; the step length asymmetry; the iEMG of the tibialis anterior muscle; the functional ambulation category; and Ashworth's modified spasticity classification of the gastrocnemius.

Results: After treatment, in the two groups, the maximum angles of flexion of the affected side's hip, knee, and ankle improved, the pace increased, the step length asymmetry decreased, the iEMG of the tibialis anterior muscle increased, the functional ambulation category improved, and Ashworth's modified spasticity classification of the gastrocnemius decreased, but the above changes in the test group were better than those in the control group. The difference is statistically significant (p < 0.05).

Conclusions: The combination treatment of the foot drop stimulator and moving treadmill can significantly improve stroke patients' foot gait and promote the normalization of hip flexion, knee flexion, and ankle flexion. It can increase the pace, significantly reduce the step length asymmetry, reduce the muscle tone of the gastrocnemius, and improve walking function.

目的:研究落脚刺激器与运动跑步机训练联合治疗卒中后落脚患者步态特征的变化,为卒中后落脚步态的改善提供依据。方法:将60例脑卒中所致偏瘫及足下垂患者随机分为两组,每组30人,分别为试验组和对照组。两组均接受基础康复训练。在此基础上,试验组给予足部刺激器与运动跑步机训练的联合治疗。对照组接受足部刺激器训练。两组均连续治疗3周,每周5次,每次30分钟。治疗前后采用步态腕表三维步态分析系统测量并记录患侧髋关节、膝关节、踝关节的最大屈曲角度;速度;步长不对称;胫骨前肌的肌电图;功能性步行类;以及Ashworth改良的腓肠肌痉挛分类。结果:两组患者治疗后患侧髋关节、膝关节、踝关节最大屈曲角度改善,步速加快,步长不对称减少,胫前肌iEMG增加,功能活动类别改善,腓肠肌Ashworth改良痉挛分类减少,但试验组以上变化均优于对照组。差异有统计学意义(p < 0.05)。结论:足下垂刺激器与运动跑步机联合治疗可显著改善脑卒中患者足部步态,促进髋屈曲、膝关节屈曲、踝关节屈曲的正常化。可以提高步速,明显减少步长不对称,降低腓肠肌的肌张力,改善行走功能。
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引用次数: 4
Effects of Cognitive Behavioral Therapy on Pain and Sleep in Adults with Traumatic Brain Injury: A Systematic Review and Meta-Analysis. 认知行为疗法对成人外伤性脑损伤患者疼痛和睡眠的影响:系统回顾和荟萃分析。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-11-11 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6552246
Xin Li, Yuwei Feng, Jianping Xia, Xuan Zhou, Nan Chen, Zhengquan Chen, Qimeng Fan, Hong Wang, Peiyuan Ding, Qing Du

The objective of this study was to systematically review the literature on the effects of cognitive behavioral therapy (CBT) on insomnia and pain in patients with traumatic brain injury (TBI). PubMed, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases were searched. Outcomes, including pain, sleep quality, and adverse events, were investigated. Differences were expressed using mean differences (MDs) with 95% confidence intervals (CIs). The statistical analysis was performed using STATA 16.0. Twelve trials with 476 TBI patients were included. The included studies did not indicate a positive effect of CBT on pain. Significant improvements were shown for self-reported sleep quality, reported with the Pittsburgh Self-Reported Sleep Quality Index (MD, -2.30; 95% CI, -3.45 to -1.15; P < 0.001) and Insomnia Severity Index (MD, -5.12; 95% CI, -9.69 to -0.55; P = 0.028). No major adverse events related to CBT were reported. The underpowered evidence suggested that CBT is effective in the management of sleep quality and pain in TBI adults. Future studies with larger samples are recommended to determine significance. This trial is registered with PROSPERO registration number CRD42019147266.

本研究的目的是系统回顾认知行为疗法(CBT)对创伤性脑损伤(TBI)患者失眠和疼痛的影响。检索PubMed、Embase、Cochrane图书馆、护理与联合健康累积索引和Web of Science数据库。研究结果包括疼痛、睡眠质量和不良事件。差异用95%置信区间(ci)的平均差异(md)表示。采用STATA 16.0进行统计分析。纳入了476例TBI患者的12项试验。纳入的研究并未表明CBT对疼痛有积极影响。匹兹堡自我报告睡眠质量指数(MD, -2.30;95% CI, -3.45 ~ -1.15;P < 0.001)和失眠严重程度指数(MD, -5.12;95% CI, -9.69 ~ -0.55;P = 0.028)。未发现与CBT相关的重大不良事件。不足的证据表明,CBT在TBI成人的睡眠质量和疼痛管理方面是有效的。建议将来进行更大样本的研究以确定其重要性。该试验注册为PROSPERO注册号CRD42019147266。
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引用次数: 6
Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke. 无创脑刺激治疗脑卒中后吞咽困难的系统评价和网络meta分析。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-11-03 eCollection Date: 2021-01-01 DOI: 10.1155/2021/3831472
Lingling Li, Hailiang Huang, Yuqi Jia, Ying Yu, Zhiyao Liu, Xin Shi, Fangqi Wang

Background: Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia.

Objective: To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS.

Methods: Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI).

Results: Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference (SMD) = 1.44, 95% CI 0.80 to 2.08, P < 0.05) and the water swallow test score (SMD = 6.23, 95% CI 5.44 to 7.03, P < 0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = -1.04, 95% CI -1.50 to -0.58, P < 0.05), the penetration-aspiration scale (PAS) score (SMD = -0.85, 95% CI -1.33 to -0.36, P < 0.05), and the functional dysphagia scale score (SMD = -1.05, 95% CI -1.48 to -0.62, P < 0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS (P = 0.52) > tDCS (P = 0.48), the best probabilistic ranking of the SSA score is rTMS (P = 0.72) > tDCS (P = 0.28), and the best probabilistic ranking of the PAS score is rTMS (P = 0.68) > tDCS (P = 0.32).

Conclusion: Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.

背景:吞咽困难是卒中后常见的后遗症。无创脑刺激(NIBS)是一种在康复过程中用于改变皮质兴奋性和改善吞咽困难的工具。目的:系统评价NIBS治疗脑卒中后吞咽困难的疗效,并比较两种不同NIBS治疗脑卒中后吞咽困难的效果。方法:从PubMed、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、万方数据、VIP和CBM数据库检索自成立至2021年6月的NIBS对脑卒中后吞咽困难影响的随机对照试验。对试验的质量进行评估,并根据Cochrane干预措施系统评价手册提取数据。采用RevMan 5.3和ADDIS 1.16.8进行统计分析。效应量采用标准化平均差(SMD)和95%置信区间(CI)进行评估。结果:最终纳入18项研究,涉及738例患者。meta分析显示,NIBS可改善吞咽困难结局和严重程度量表(DOSS)评分(标准均差(SMD) = 1.44, 95% CI 0.80 ~ 2.08, P < 0.05)和吞咽水测试评分(SMD = 6.23, 95% CI 5.44 ~ 7.03, P < 0.05)。NIBS可降低标准化吞咽评估(SSA)评分(SMD = -1.04, 95% CI -1.50 ~ -0.58, P < 0.05)、穿透-吸入量表(PAS)评分(SMD = -0.85, 95% CI -1.33 ~ -0.36, P < 0.05)和功能性吞咽困难量表评分(SMD = -1.05, 95% CI -1.48 ~ -0.62, P < 0.05)。网络meta分析显示,两种不同NIBS对DOSS评分影响的最佳概率排序为rTMS (P = 0.52) > tDCS (P = 0.48), SSA评分的最佳概率排序为rTMS (P = 0.72) > tDCS (P = 0.28), PAS评分的最佳概率排序为rTMS (P = 0.68) > tDCS (P = 0.32)。结论:已有证据表明NIBS可改善脑卒中后吞咽功能障碍,减少误吸的发生,且rTMS优于tDCS。受纳入研究数量的限制,未来还需要更多的大样本、多中心、双盲、高质量的临床随机对照试验来进一步证实本研究的结果。
{"title":"Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke.","authors":"Lingling Li,&nbsp;Hailiang Huang,&nbsp;Yuqi Jia,&nbsp;Ying Yu,&nbsp;Zhiyao Liu,&nbsp;Xin Shi,&nbsp;Fangqi Wang","doi":"10.1155/2021/3831472","DOIUrl":"https://doi.org/10.1155/2021/3831472","url":null,"abstract":"<p><strong>Background: </strong>Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia.</p><p><strong>Objective: </strong>To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS.</p><p><strong>Methods: </strong>Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the <i>Cochrane Handbook for Systematic Reviews of Interventions</i>. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI).</p><p><strong>Results: </strong>Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference (SMD) = 1.44, 95% CI 0.80 to 2.08, <i>P</i> < 0.05) and the water swallow test score (SMD = 6.23, 95% CI 5.44 to 7.03, <i>P</i> < 0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = -1.04, 95% CI -1.50 to -0.58, <i>P</i> < 0.05), the penetration-aspiration scale (PAS) score (SMD = -0.85, 95% CI -1.33 to -0.36, <i>P</i> < 0.05), and the functional dysphagia scale score (SMD = -1.05, 95% CI -1.48 to -0.62, <i>P</i> < 0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS (<i>P</i> = 0.52) > tDCS (<i>P</i> = 0.48), the best probabilistic ranking of the SSA score is rTMS (<i>P</i> = 0.72) > tDCS (<i>P</i> = 0.28), and the best probabilistic ranking of the PAS score is rTMS (<i>P</i> = 0.68) > tDCS (<i>P</i> = 0.32).</p><p><strong>Conclusion: </strong>Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.</p>","PeriodicalId":51299,"journal":{"name":"Neural Plasticity","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8580697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39876818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 17
Structural and Functional Deficits in Patients with Poststroke Dementia: A Multimodal MRI Study. 脑卒中后痴呆症患者的结构和功能障碍:多模态磁共振成像研究
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-11-03 eCollection Date: 2021-01-01 DOI: 10.1155/2021/3536234
Huaying Cai, Zhiyong Zhao, Linhui Ni, Guocan Han, Xingyue Hu, Dan Wu, Xianjun Ding, Jin Wang

Although many neuroimaging studies have reported structural and functional abnormalities in the brains of patients with cognitive impairments following stroke, little is known about the pattern of such brain reorganization in poststroke dementia (PSD). The present study was aimed at investigating alterations in spontaneous brain activity and gray matter volume (GMV) in PSD patients. We collected T1-weighted and resting-state functional magnetic resonance imaging data from 20 PSD patients, 24 poststroke nondementia (PSND) patients, and 21 well-matched normal controls (NCs). We compared the differences among the groups in GMV and the fractional amplitude of low-frequency fluctuations (fALFF). Then, we evaluated the relationship between these brain measures and cognitive assessments and explored the possible distinguisher for PSD by receiver operating characteristic (ROC) curve analysis. PSD patients showed smaller GMV in the right superior temporal gyrus and lower fALFF values in the right inferior frontal gyrus than both PSND patients and NCs, but such differences were not observed between PSND patients and NCs. Moreover, GMV in the left medial prefrontal cortex showed a significant positive correlation with the Mini-Cog assessment in PSD patients, and GMV in the left CPL displayed the highest area under the ROC curve among all the features for classifying PSD versus PSND patients. Our findings suggest that PSD patients show dementia-specific structural and functional alteration patterns, which may help elucidate the pathophysiological mechanisms underlying PSD.

尽管许多神经影像学研究报告了脑卒中后认知障碍患者大脑结构和功能的异常,但对脑卒中后痴呆(PSD)患者大脑重组的模式却知之甚少。本研究旨在调查 PSD 患者大脑自发活动和灰质体积(GMV)的变化。我们收集了 20 名 PSD 患者、24 名卒中后非痴呆(PSND)患者和 21 名匹配良好的正常对照组(NCs)的 T1 加权和静息态功能磁共振成像数据。我们比较了各组间 GMV 和低频波动分数振幅(fALFF)的差异。然后,我们评估了这些脑部指标与认知评估之间的关系,并通过接收器操作特征曲线(ROC)分析探讨了 PSD 的可能鉴别指标。与 PSND 患者和 NCs 相比,PSD 患者右侧颞上回的 GMV 值较小,右侧额叶下回的 fALFF 值较低,但 PSND 患者和 NCs 之间未观察到这种差异。此外,左侧内侧前额叶皮层的 GMV 与 PSD 患者的 Mini-Cog 评估结果呈显著正相关,而左侧 CPL 的 GMV 在分类 PSD 与 PSND 患者的所有特征中显示出最高的 ROC 曲线下面积。我们的研究结果表明,PSD 患者表现出痴呆症特有的结构和功能改变模式,这可能有助于阐明 PSD 的病理生理机制。
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引用次数: 0
Attention Bias to Pain Words Comes Early and Cognitive Load Matters: Evidence from an ERP Study on Experimental Pain. 疼痛词的注意偏倚出现早,认知负荷影响:来自实验性疼痛的ERP研究的证据。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-10-31 eCollection Date: 2021-01-01 DOI: 10.1155/2021/9940889
Kangling Wang, Yifei Chen, Shimin Huang, Howe Liu, Wen Wu

Attention bias (AB) is a common cognitive challenge for patients with pain. In this study, we tested at what stage AB to pain occurs in participants with experimental pain (EP) and tested whether cognitive load interferes with it. We recruited 40 healthy adults aged 18-27 years, and randomized them into control and EP groups. We sprayed the participants in the EP group with 10% capsaicin paste to mimic acute pain and those in the control group with water, accessing both groups' behavioral results and event-related potential data. We found that high-load tasks had longer response times and lower accuracies than low-load tasks did and that different neural processing of words occurred between the groups. The EP group exhibited AB to pain at an early stage with both attentional avoidance (N1 latency) and facilitated attention (P2 amplitude) to pain words. The control group coped with semantic differentiation (N1) at first, followed by pain word discrimination (P2). In addition, AB to pain occurred only in low-load tasks. As the cognitive load multiplied, we did not find AB in the EP group. Therefore, our study adds further evidence for AB to pain, suggesting the implementation of cognitive load in future AB therapy.

注意偏倚(Attention bias, AB)是疼痛患者常见的认知挑战。在这项研究中,我们测试了实验性疼痛(EP)参与者在什么阶段发生AB到疼痛,并测试了认知负荷是否干扰它。我们招募了40名年龄在18-27岁的健康成年人,将他们随机分为对照组和EP组。我们向EP组的参与者喷洒10%辣椒素膏来模拟急性疼痛,向对照组的参与者喷洒水,获取两组的行为结果和事件相关的潜在数据。我们发现,与低负荷任务相比,高负荷任务的反应时间更长,准确率更低,而且两组之间对单词的神经处理也不同。EP组在疼痛的早期阶段表现为AB,对疼痛词的注意回避(N1潜伏期)和促进注意(P2振幅)均表现为AB。对照组首先处理语义辨析(N1),其次处理疼痛词辨析(P2)。此外,AB - to - pain仅发生在低负荷任务中。随着认知负荷的增加,我们在EP组中没有发现AB。因此,我们的研究为AB疼痛提供了进一步的证据,建议在未来的AB治疗中实施认知负荷。
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引用次数: 0
Experimental Imaging Study of Encephalomalacia Fluid-Attenuated Inversion Recovery (FLAIR) Hyperintense Lesions in Posttraumatic Epilepsy. 脑软化液衰减反转恢复(FLAIR)高强度病变外伤性癫痫的实验影像学研究。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-10-31 eCollection Date: 2021-01-01 DOI: 10.1155/2021/2678379
Dan Wang, Kai Shang, Zheng Sun, Yue-Hua Li

This study introduced new MRI techniques such as neurite orientation dispersion and density imaging (NODDI); NODDI applies a three-compartment tissue model to multishell DWI data that allows the examination of both the intra- and extracellular properties of white matter tissue. This, in turn, enables us to distinguish the two key aspects of axonal pathology-the packing density of axons in the white matter and the spatial organization of axons (orientation dispersion (OD)). NODDI is used to detect possible abnormalities of posttraumatic encephalomalacia fluid-attenuated inversion recovery (FLAIR) hyperintense lesions in neurite density and dispersion. Methods. 26 epilepsy patients associated with FLAIR hyperintensity around the trauma encephalomalacia region were in the epilepsy group. 18 posttraumatic patients with a FLAIR hyperintense encephalomalacia region were in the nonepilepsy group. Neurite density and dispersion affection in FLAIR hyperintense lesions around encephalomalacia were measured by NODDI using intracellular volume fraction (ICVF), and we compare these findings with conventional diffusion MRI parameters, namely, fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Differences were compared between the epilepsy and nonepilepsy groups, as well as in the FLAIR hyperintense part and in the FLAIR hypointense part to try to find neurite density and dispersion differences in these parts. Results. ICVF of FLAIR hyperintense lesions in the epilepsy group was significantly higher than that in the nonepilepsy group (P < 0.001). ICVF reveals more information of FLAIR(+) and FLAIR(-) parts of encephalomalacia than OD and FA and ADC. Conclusion. The FLAIR hyperintense part around encephalomalacia in the epilepsy group showed higher ICVF, indicating that this part may have more neurite density and dispersion and may be contributing to epilepsy. NODDI indicated high neurite density with the intensity of myelin in the FLAIR hyperintense lesion. Therefore, NODDI likely shows that neurite density may be a more sensitive marker of pathology than FA.

本研究介绍了新的MRI技术,如神经突取向弥散和密度成像(NODDI);NODDI将三室组织模型应用于多壳DWI数据,可以检查白质组织的细胞内和细胞外特性。反过来,这使我们能够区分轴突病理的两个关键方面-轴突在白质中的堆积密度和轴突的空间组织(取向分散(OD))。NODDI用于检测创伤后脑软化症液体衰减反转恢复(FLAIR)高强度病变在神经突密度和弥散度方面的可能异常。方法:将26例伴有创伤性脑软化区FLAIR高信号的癫痫患者作为癫痫组。18例创伤后FLAIR高强度脑软化区患者为非癫痫组。脑软化症周围FLAIR高病变的神经突密度和弥散度影响采用NODDI测量细胞内体积分数(ICVF),并与常规弥散MRI参数,即分数各向异性(FA)和表观弥散系数(ADC)进行比较。比较癫痫组与非癫痫组的差异,以及FLAIR高信号部分与FLAIR低信号部分的差异,试图找出这些部分的神经突密度和弥散度差异。结果。癫痫组FLAIR高病变ICVF显著高于非癫痫组(P < 0.001)。ICVF比OD、FA和ADC更能显示脑软化的FLAIR(+)和FLAIR(-)部位的信息。结论。癫痫组脑软化周围FLAIR高信号区ICVF较高,提示该部位神经突密度和弥散度较高,可能与癫痫有关。NODDI显示FLAIR高信号病变的神经突密度高,髓磷脂强度高。因此,NODDI可能表明神经突密度可能是比FA更敏感的病理标志物。
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引用次数: 2
Preconditioning with Cathodal High-Definition Transcranial Direct Current Stimulation Sensitizes the Primary Motor Cortex to Subsequent Intermittent Theta Burst Stimulation. 阴极高清晰度经颅直流电刺激预处理使初级运动皮层对随后的间歇性θ波爆发刺激敏感。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-10-21 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8966584
Wenjun Dai, Yao Geng, Hao Liu, Chuan Guo, Wenxiang Chen, Jinhui Ma, Jinjin Chen, Yanbing Jia, Ying Shen, Tong Wang

Noninvasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) can induce long-term potentiation-like facilitation, but whether the combination of TMS and tDCS has additive effects is unclear. To address this issue, in this randomized crossover study, we investigated the effect of preconditioning with cathodal high-definition (HD) tDCS on intermittent theta burst stimulation- (iTBS-) induced plasticity in the left motor cortex. A total of 24 healthy volunteers received preconditioning with cathodal HD-tDCS or sham intervention prior to iTBS in a random order with a washout period of 1 week. The amplitude of motor evoked potentials (MEPs) was measured at baseline and at several time points (5, 10, 15, and 30 min) after iTBS to determine the effects of the intervention on cortical plasticity. Preconditioning with cathodal HD-tDCS followed by iTBS showed a greater increase in MEP amplitude than sham cathodal HD-tDCS preconditioning and iTBS at each time postintervention point, with longer-lasting after-effects on cortical excitability. These results demonstrate that preintervention with cathodal HD-tDCS primes the motor cortex for long-term potentiation induced by iTBS and is a potential strategy for improving the clinical outcome to guide therapeutic decisions.

无创脑刺激技术如经颅磁刺激(TMS)和经颅直流电刺激(tDCS)可以诱导长时程增强样促进,但TMS和tDCS联合使用是否具有叠加效应尚不清楚。为了解决这一问题,在这项随机交叉研究中,我们研究了阴极高清晰(HD) tDCS预处理对间歇性θ波爆发刺激(iTBS-)诱导的左侧运动皮层可塑性的影响。24名健康志愿者在iTBS前随机接受了阴极HD-tDCS预处理或假干预,洗脱期为1周。在基线和iTBS后的几个时间点(5、10、15和30分钟)测量运动诱发电位(MEPs)的振幅,以确定干预对皮质可塑性的影响。在干预后各时间点,经阴极HD-tDCS预处理后iTBS的MEP幅值均高于假阴极HD-tDCS预处理后iTBS的MEP幅值,且对皮质兴奋性的后效持续时间更长。这些结果表明,通过阴极HD-tDCS的预先干预,为iTBS诱导的长期增强运动皮层提供了启动,是改善临床结果以指导治疗决策的潜在策略。
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引用次数: 2
Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson's Disease Motor Subtypes: A More Accurate Judgment. 左旋多巴刺激试验预测各种帕金森病运动亚型的STN-DBS结果:更准确的判断
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-10-21 eCollection Date: 2021-01-01 DOI: 10.1155/2021/4762027
Zijian Zheng, Zixiao Yin, Bohan Zhang, Houyou Fan, Dan Liu, Yuancheng Zhou, Jian Duan, Dongwei Zhou, Xi Wu, Guohui Lu

Background: The relationship between the levodopa challenge test (LDCT) and postoperative subthalamic nucleus-deep brain stimulation (STN-DBS) benefits is controversial in patients with Parkinson's disease (PD). We aim to evaluate the value of total levodopa response (TLR) and symptom levodopa response (SLR) in predicting postoperative improvement in different PD motor subtypes.

Methods: Studies were split into a training set (147 patients) and a validation set (304 patients). We retrospectively collected data from 147 patients who received the Unified Parkinson's Disease Rating Scale- (UPDRS-) III and the Parkinson's Disease Questionnaire- (PDQ-) 39 evaluation. Patients were classified into tremor-dominant (TD), akinetic-rigid-dominant (AR), and mixed (MX) groups. Clinically important difference (CID) was employed to dichotomize DBS effects. For patients in each subtype group from the training set, we used the correlation and receiver operator characteristic (ROC) curve analyses to explore the strength of their relations. Areas under the curve (AUCs) were calculated and compared through the DeLong test. Results developed from the training set were applied into the validation set to predict postoperative improvement in different PD motor subtypes.

Results: In the validation cohort, TLR significantly correlated with postoperative motor (p < 0.001) and quality of life (QOL) (p < 0.001) improvement in the MX group. The AUC between TLR and UPDRS-III (TU) is 0.800. The AUC between TLR and PDQ-39 (TP) is 0.770. An associated criterion in both TU and TP is around 50%. In the AR group, strong correlation was only found in SLR and PDQ-39 (SP) (p < 0.001). And the AUC of SP is significantly larger than that in TLR and PDQ-39 (TP) (p = 0.034). An associated criterion in SP is around 37%. No significant correlation was found in the TD group.

Conclusions: We provide a more accurate judgment for LDCT. TLR strongly correlated with postoperative UPDRS-III and PDQ-39 improvement in MX patients. A TLR > 50% may indicate a higher possibility of clinically meaningful benefits from STN-DBS comparing to medication only. SLR can well predict QOL improvement in AR patients. Similarly, a SLR > 37% may indicate a higher possibility of clinically significant benefits from STN-DBS. LDCT provides limited information for TD patients.

背景:左旋多巴激发试验(LDCT)与帕金森病(PD)患者术后丘脑下核-深部脑刺激(STN-DBS)获益之间的关系存在争议。我们的目的是评估总左旋多巴反应(TLR)和症状左旋多巴反应(SLR)在预测不同PD运动亚型术后改善方面的价值。方法:研究分为训练集(147例)和验证集(304例)。我们回顾性收集了147名接受统一帕金森病评定量表(UPDRS-) III和帕金森病问卷(PDQ-) 39评估的患者的数据。患者分为震颤主导型(TD)、动硬主导型(AR)和混合型(MX)组。临床重要差异(CID)用于DBS效果的二分类。对于来自训练集的每个亚型组的患者,我们使用相关性和接受者算子特征(ROC)曲线分析来探索它们之间关系的强度。通过DeLong试验计算和比较曲线下面积(auc)。将训练集的结果应用于验证集,以预测不同PD运动亚型的术后改善。结果:在验证队列中,TLR与MX组术后运动(p < 0.001)和生活质量(QOL)改善(p < 0.001)显著相关。TLR与UPDRS-III之间的AUC (TU)为0.800。TLR与PDQ-39 (TP)之间的AUC为0.770。TU和TP的相关标准都在50%左右。AR组仅SLR与PDQ-39 (SP)有较强相关性(p < 0.001)。SP的AUC显著大于TLR和PDQ-39 (TP) (p = 0.034)。SP的相关标准约为37%。在TD组中没有发现明显的相关性。结论:本方法对LDCT的判断更为准确。TLR与MX患者术后UPDRS-III和PDQ-39改善密切相关。TLR > 50%可能表明与单纯药物治疗相比,STN-DBS更有可能获得临床有意义的益处。单反能很好地预测AR患者生活质量的改善。同样,SLR > 37%可能表明STN-DBS有更高的临床显著获益的可能性。LDCT为TD患者提供的信息有限。
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引用次数: 3
Spinal Cord Stimulation and Treatment of Peripheral or Central Neuropathic Pain: Mechanisms and Clinical Application. 脊髓刺激和治疗周围或中枢神经性疼痛:机制和临床应用。
IF 3.1 4区 医学 Q2 Medicine Pub Date : 2021-10-21 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5607898
Liting Sun, Changgeng Peng, Elbert Joosten, Chi Wai Cheung, Fei Tan, Wencheng Jiang, Xiafeng Shen

Spinal cord stimulation (SCS) as an evidence-based interventional treatment has been used and approved for clinical use in a variety of pathological states including peripheral neuropathic pain; however, until now, it has not been used for the treatment of spinal cord injury- (SCI-) induced central neuropathic pain. This paper reviews the underlying mechanisms of SCS-induced analgesia and its clinical application in the management of peripheral and central neuropathic pain. Evidence from recent research publications indicates that nociceptive processing at peripheral and central sensory systems is thought to be modulated by SCS through (i) inhibition of the ascending nociceptive transmission by the release of analgesic neurotransmitters such as GABA and endocannabinoids at the spinal dorsal horn; (ii) facilitation of the descending inhibition by release of noradrenalin, dopamine, and serotonin acting on their receptors in the spinal cord; and (iii) activation of a variety of supraspinal brain areas related to pain perception and emotion. These insights into the mechanisms have resulted in the clinically approved use of SCS in peripheral neuropathic pain states like Complex Regional Pain Syndrome (CRPS) and Failed Back Surgery Syndrome (FBSS). However, the mechanisms underlying SCS-induced pain relief in central neuropathic pain are only partly understood, and more research is needed before this therapy can be implemented in SCI patients with central neuropathic pain.

脊髓刺激(SCS)作为一种循证介入治疗已被用于临床,并被批准用于各种病理状态,包括周围神经性疼痛;然而,到目前为止,它还没有被用于治疗脊髓损伤(SCI)引起的中枢神经性疼痛。本文综述了scs诱导的镇痛机制及其在治疗周围和中枢神经性疼痛中的临床应用。来自最近研究出版物的证据表明,外周和中枢感觉系统的伤害性加工被认为是由SCS通过以下途径进行调节的:(1)脊髓背角释放镇痛神经递质,如GABA和内源性大麻素,抑制上升的伤害性传递;(ii)通过释放去甲肾上腺素、多巴胺和血清素作用于脊髓中的受体,促进下降抑制;(3)激活与疼痛感知和情绪相关的多种脊髓上脑区。这些机制的深入研究已经导致SCS被临床批准用于周围神经性疼痛状态,如复杂区域疼痛综合征(CRPS)和背部手术失败综合征(FBSS)。然而,scs诱导中枢神经性疼痛缓解的机制仅部分被了解,在将该疗法应用于中枢神经性疼痛的SCI患者之前,还需要更多的研究。
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引用次数: 14
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