Electroacupuncture stimulation to modulate neural oscillations in promoting neurological rehabilitation

Electroacupuncture (EA) stimulation is a modern neuromodulation technique that integrates traditional Chinese acupuncture therapy with contemporary electrical stimulation. It involves the application of electrical currents to specific acupoints on the body following acupuncture. EA has been widely used in the treatment of various neurological disorders, including epilepsy, stroke, Parkinson's disease, and Alzheimer's disease. Recent research suggests that EA stimulation may modulate neural oscillations, correcting abnormal brain electrical activity, therefore promoting brain function and aiding in neurological rehabilitation. This paper conducted a comprehensive search in databases such as PubMed, Web of Science, and CNKI using keywords like "electroacupuncture," "neural oscillations," and "neurorehabilitation", covering the period from year 1980 to 2023. We provide a detailed overview of how electroacupuncture stimulation modulates neural oscillations, including maintaining neural activity homeostasis, influencing neurotransmitter release, improving cerebral hemodynamics, and enhancing specific neural functional networks. The paper also discusses the current state of research, limitations of electroacupuncture-induced neural oscillation techniques, and explores prospects for their combined application, aiming to offer broader insights for both basic and clinical research.

Effects of electroacupuncture on imaging and behavior in rats with ischemic stroke through miR-212-5p

BACKGROUND

Ischemic stroke is a serious disease leading to significant disability in humans worldwide. Increasing evidence suggests that some microRNAs (miRNAs) participate in the pathophysiology of ischemic stroke. A key role for MiR-212 has been found in neuronal function and synaptic plasticity. Ischemic stroke can be effectively treated with electroacupuncture (EA); however, there is a lack of understanding of the relevant mechanisms. In this study, we employed behavioral test and resting-state functional magnetic resonance imaging (rs-fMRI) to detect behavioral and brain function alterations in rats suffering from ischemic stroke. The efficacy of EA therapy and miR-212-5p's role in this process were also evaluated.

METHODS AND RESULTS

Forty rats were randomly divided into the following groups: Sham, middle cerebral artery occlusion/reperfusion (MCAO/R), MCAO/R + EA, MCAO/R + EA + antagomir-negative control and MCAO/R + EA + antagomir-212-5p groups. Behavioral changes were assessed by Catwalk gait analysis prior to and after modeling. Rs-fMRI was performed at one week after EA treatment, amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) were calculated to reveal neural activity. Furthermore, neuronal apoptosis in the ischemic penumbra was analyzed using a TUNEL assay. Treatment with EA significantly improved the performance of rats in the behavioral test. The motor and cognition-related brain regions showed decreased ALFF and ReHo following focal cerebral ischemia-reperfusion, and EA treatment could reactivate these brain regions. Moreover, EA treatment significantly decreased MCAO/R-induced cell death. However, the transfection of antagomir-212-5p attenuated the therapeutic effect of EA.

CONCLUSIONS

In conclusion, the results suggested that EA improved the behavioral and imaging outcomes of ischemic stroke through miR-212-5p.

Exploring the Therapeutic Effects and Mechanisms of Transcranial Alternating Current Stimulation on Improving Walking Ability in Stroke Patients via Modulating Cerebellar Gamma Frequency Band-a Narrative Review

The cerebellum plays an important role in maintaining balance, posture control, muscle tone, and lower limb coordination in healthy individuals and stroke patients. At the same time, the relationship between cerebellum and motor learning has been widely concerned in recent years. Due to the relatively intact structure preservation and high plasticity after supratentorial stroke, non-invasive neuromodulation targeting the cerebellum is increasingly used to treat abnormal gait in stroke patients. The gamma frequency of transcranial alternating current stimulation (tACS) is commonly used to improve motor learning. It is an essential endogenous EEG oscillation in the gamma range during the swing phase, and rhythmic movement changes in the gait cycle. However, the effect of cerebellar tACS in the gamma frequency band on balance and walking after stroke remains unknown and requires further investigation.

Neuromodulatory effects of high-definition theta transcranial alternating current stimulation on the parietal cortex: a pilot study of healthy males

Introduction

Transcranial alternating current stimulation (tACS) can regulate brain functions by modulating endogenous brain rhythms. Theta-band neural oscillations are associated with memory function. In particular, theta neural oscillatory power evoked in the parietal cortex is closely related to memory retrieval processes. In this study, the immediate effects of high-definition theta transcranial alternating current stimulation (HDθ-tACS) on the human left parietal cortex were investigated using short-latency afferent inhibition (SAI) and electroencephalography (EEG).

Methods

Ten subjects participated in this study. We used 6-Hz HD tACS to stimulate the left parietal cortex for 15 min. SAI was calculated, and non-linear dynamic analysis of the EEG was performed to analyze neuronal function after HD θ-tACS.

Results

The results showed a significant decrease in SAI (p < 0.05), while the left frontoparietal network was reinforced, leading to brain lateralization after HD θ-tACS. During performance of a memory task, F3 signals showed a significant upward trend in approximate entropy following treatment (p < 0.05). There was also a significant decrease in cross-approximate entropy in the C3-C4 and P3-P4 connections following the intervention (p < 0.05) in a resting eyes-open condition and in the memory task condition.

Discussion

In conclusion, HD θ-tACS could alter cholinergic transmission and cortical excitability between the parietal and motor cortices, as well as reinforcing the frontoparietal network and the left-lateralization phenomenon, which may facilitate memory formation, encoding, and consolidation.

Clinical Research Progress of the Post-Stroke Upper Limb Motor Function Improvement via Transcutaneous Auricular Vagus Nerve Stimulation

Stroke is a disease with high morbidity and disability, and motor impairment is a common sequela of stroke. Transcutaneous auricular vagus nerve stimulation (taVNS) is a type of non-invasive stimulation, which can effectively improve post-stroke motor dysfunction. This review discusses stimulation parameters, intervention timing, and the development of innovative devices for taVNS. We further summarize the application of taVNS in improving post-stroke upper limb motor function to further promote the clinical research and application of taVNS in the rehabilitation of post-stroke upper limb motor dysfunction.

The assessment of interhemispheric imbalance using functional near-infrared spectroscopic and transcranial magnetic stimulation for predicting motor outcome after stroke

Objective

To investigate changes in interhemispheric imbalance of cortical excitability during motor recovery after stroke and to clarify the relationship between motor function recovery and alterations in interhemispheric imbalance, with the aim to establish more effective neuromodulation strategies.

Methods

Thirty-one patients underwent assessments of resting motor threshold (RMT) using transcranial magnetic stimulation (TMS); the cortical activity of the primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA) using functional near-infrared spectroscopy (fNIRS); as well as motor function using upper extremity Fugl-Meyer (FMA-UE). The laterality index (LI) of RMT and fNIRS were also calculated. All indicators were measured at baseline(T1) and 1 month later(T2). Correlations between motor function outcome and TMS and fNIRS metrics at baseline were analyzed using bivariate correlation.

Results

All the motor function (FMA-UE1, FMA-UE2, FMA-d2) and LI-RMT (LI-RMT1 and LI-RMT2) had a moderate negative correlation. The higher the corticospinal excitability of the affected hemisphere, the better the motor outcome of the upper extremity, especially in the distal upper extremity (r = -0.366, p = 0.043; r = -0.393, p = 0.029). The greater the activation of the SMA of the unaffected hemisphere, the better the motor outcome, especially in the distal upper extremity (r = -0.356, p = 0.049; r = -0.367, p = 0.042). There was a significant moderate positive correlation observed between LI-RMT2 and LI-SMA1 (r = 0.422, p = 0.018). The improvement in motor function was most significant when both LI-RMT1 and LI-SMA1 were lower. Besides, in patients dominated by unaffected hemisphere corticospinal excitability during motor recovery, LI-(M1 + SMA + PMC)2 exhibited a significant moderate positive association with the proximal upper extremity function 1 month later (r = 0.642, p = 0.007).

Conclusion

The combination of both TMS and fNIRS can infer the prognosis of motor function to some extent. Which can infer the role of both hemispheres in recovery and may contribute to the development of effective individualized neuromodulation strategies.

World Health Organization survey on the level of integration of traditional Chinese medicine in Chinese health system rehabilitation services

Background

To meet the growing global demand for rehabilitation services, the World Health Organization (WHO) launched Rehabilitation 2030. This study was commissioned by the WHO to investigate the integration degree of traditional Chinese medicine (TCM) in Chinese health system rehabilitation services and the demand for TCM rehabilitation in China.

Methods

Twenty TCM rehabilitation experts and relevant government administrators were invited to complete the questionnaire between September 2019 and January 2022. The development of traditional, complementary, and integrative medicine (TCI) rehabilitation in China was assessed primarily based on six different health system components.

Results

26 policies, regulations, and national strategic plans related to TCI rehabilitation were issued by relevant government departments since 2002; notably, 14 policies related to TCI rehabilitation development were intensively introduced from 2016 to 2021. These policies cover the three main areas of financing, infrastructure development, and service delivery. The National Administration of Traditional Chinese Medicine's investment in TCM clinical capacity infrastructure and scientific research in 2019-2021 increased by 66% compared to 2010-2012, and the average number of TCM hospitals with rehabilitation departments in 2020 increased by 6.5% compared to 2018. The proportion of community health service centers providing TCM services in primary medical and health institutions has increased by 30.8% over the past 10 years.

Conclusion

Long-term continuous policies, substantial financial investment, and expansion of the scope of TCI rehabilitation services in primary care institutions have effectively contributed to the rapid development of TCI rehabilitation. However, human resources and financing mechanisms for TCI rehabilitation need further improvement.

Incidence and Risk Factors for Dysphagia Following Cerebellar Stroke: a Retrospective Cohort Study

The cerebellum is known to play a supportive role in swallowing-related functions; however, wide discrepancies about the incidence rate of swallowing disorders following cerebellar strokes exist within the literature. This study aimed to investigate the incidence rate of dysphagia and the factors which may affect the presence of dysphagia and clinical recovery in individuals diagnosed with cerebellar stroke. A retrospective chart audit of 1651 post-stroke patients (1049 males and 602 females) admitted with a cerebellar stroke to a comprehensive tertiary hospital in China was conducted. Data on demographics, medical, along with swallowing function assessment were collected. Differences between dysphagic and non-dysphagic groups were evaluated using t-tests and Pearson's chi-square test. Univariate logistic regression analysis was performed to establish factors associated with the presence of dysphagia. A total of 11.45% of participants were identified with dysphagia during inpatient admission. Individuals with mixed types of stroke, multiple lesions in the cerebellum, and ages older than 85 years old were more likely to develop dysphagia. Moreover, the prognosis of dysphagia following a cerebellar stroke was associated with lesions in different parts of the cerebellum. The cumulative recovery rates from the best to worse were the right hemisphere group, the cerebellum vermis or peduncle group, and both the hemisphere group and the left hemisphere group, respectively.

Case report: High-frequency repetitive transcranial magnetic stimulation for treatment of hereditary spastic paraplegia type 11

Hereditary spastic paraplegia (HSP) is a heterogeneous group of inherited neurodegenerative disorders that currently have no cure. HSP type 11 (SPG11-HSP) is a complex form carrying mutations in the SPG11 gene. Neuropathological studies demonstrate that motor deficits in these patients are mainly attributed to axonal degeneration of the corticospinal tract (CST). Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that can induce central nervous system plasticity and promote neurological recovery by modulating the excitability of cortical neuronal cells. Although rTMS is expected to be a therapeutic tool for neurodegenerative diseases, no previous studies have applied rTMS to treat motor symptoms in SPG11-HSP. Here, we report a case of SPG11-HSP with lower extremity spasticity and gait instability, which were improved by applying high-frequency rTMS (HF-rTMS) at the primary motor cortex (M1). Clinical and physiological features were measured throughout the treatment, including the Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), the timed up and go (TUG) test and the 10-meter walk test time (10 MWT). The structure and excitability of the CST were assessed by diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS), respectively. After treatment, the patient gained 17 points of BBS, along with a gradual decrease in MAS scores of the bilateral lower extremity. In addition, the TUG test and 10 MWT improved to varying degrees. TMS assessment showed increased motor evoked potential (MEP) amplitude, decreased resting motor threshold (RMT), decreased central motor conduction time (CMCT), and decreased difference in the cortical silent period (CSP) between bilateral hemispheres. Using the DTI technique, we observed increased fractional anisotropy (FA) values and decreased mean diffusivity (MD) and radial diffusivity (RD) values in the CST. It suggests that applying HF-rTMS over the bilateral leg area of M1 (M1-LEG) is beneficial for SPG11-HSP. In this study, we demonstrate the potential of rTMS to promote neurological recovery from both functional and structural perspectives. It may provide a clinical rationale for using rTMS in the rehabilitation of HSP patients.

Effects of integrated action and sensory observation therapy based on mirror neuron and embodied cognition theory on upper limb sensorimotor function in chronic stroke: a study protocol for a randomised controlled trial

INTRODUCTION

This study protocol aims to explore the effectiveness and neural mechanism of the integration of action observation therapy (AOT) and sensory observation therapy (SOT) for post-stroke patients on upper limb sensorimotor function.

METHODS AND ANALYSIS

This is a single-centre, single-blind, randomised controlled trial. A total of 69 patients with upper extremity hemiparesis after stroke will be recruited and randomly divided into an AOT group, a combined action observation and somatosensory stimulation therapy (AOT+SST) group, and a combined AOT and SOT (AOT+SOT) group in a 1:1:1 ratio. Each group will receive 30 min of daily treatment, five times weekly for 4 weeks. The primary clinical outcome will be the Fugl-Meyer Assessment for Upper Extremity. Secondary clinical outcomes will include the Box and Blocks Test, modified Barthel Index and sensory assessment. All clinical assessments and resting-state functional MRI and diffusion tensor imaging data will be obtained at pre-intervention (T1), post-intervention (T2) and 8 weeks of follow-up (T3).

ETHICS AND DISSEMINATION

The trial was approved by the Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Chinese Traditional Medicine (Grant No. 2020-178). The results will be submitted to a peer-review journal or at a conference.

TRIAL REGISTRATION NUMBER

ChiCTR2000040568.

Gamma oscillations and application of 40-Hz audiovisual stimulation to improve brain function

BACKGROUND

Audiovisual stimulation, such as auditory stimulation, light stimulation, and audiovisual combined stimulation, as a non-invasive stimulation, which can induce gamma oscillation, has received increased attention in recent years, and it has been preliminarily applied in the clinical rehabilitation of brain dysfunctions, such as cognitive, language, motor, mood, and sleep dysfunctions. However, the exact mechanism underlying the therapeutic effect of 40-Hz audiovisual stimulation remains unclear; the clinical applications of 40-Hz audiovisual stimulation in brain dysfunctions rehabilitation still need further research.

OBJECTIVE

In order to provide new insights into brain dysfunction rehabilitation, this review begins with a discussion of the mechanism underlying 40-Hz audiovisual stimulation, followed by a brief evaluation of its clinical application in the rehabilitation of brain dysfunctions.

RESULTS

Currently, 40-Hz audiovisual stimulation was demonstrated to affect synaptic plasticity and modify the connection status of related brain networks in animal experiments and clinical trials. Although its promising efficacy has been shown in the treatment of cognitive, mood, and sleep impairment, research studies into its application in language and motor dysfunctions are still ongoing.

CONCLUSIONS

Although 40-Hz audiovisual stimulation seems to be effective in treating cognitive, mood, and sleep disorders, its role in language and motor dysfunctions has yet to be determined.

Effects of multi-mode physical stimulation on APP/PS1 Alzheimer's disease model mice

Some researchers and clinics have reported that non-drug treatments for Alzheimer disease (AD) such as electrical stimulation, light stimulation, music stimulation, laser stimulation, and transcranial magnetic stimulation may have beneficial treatment effects. Following these findings, in this study, we performed multimodel physical stimulation on APP/PS1 mice using visible light, music with a γ rhythm, and an infrared laser. And the effects of physical stimulation on APP/PS1 mice were evaluated by behavioral analysis, the content of amyloid (Aβ40 and Aβ42), and NISSL staining of hippocampal tissue slices. The results of subsequent behavioral and tissue analyses showed that the multi-model physical stimulations could relieve APP/PS1 mice's dementia symptoms, such as the behavior ability, the content of Aβ40 and Aβ42 in the hippocampal tissue suspension, and Nissl staining for hippocampal tissue analyses.

Cryotherapy Modifies Extracellular Matrix Expression of Vocal Fold in Rat Models

OBJECTIVES

Vocal fold (VF) scarring is the major cause of voice disorders. Cryotherapy is an effective anti-scarring therapy for skin lesions. The aim of this study was to explore the anti-scarring potential of cryotherapy in vocal folds.

METHODS

The extracellular matrix (ECM) mRNA expression of cryotherapy on normal VF tissue and the histologic results of cryotherapy on vocal fold healing were studied. Fifteen rats were introduced cryotherapy on the normal VF bilaterally and were harvested for real-time polymerase chain reaction (RT-PCR) analysis for collagen I, collagen III, TGFβ1, decorin, fibronectin and HAS1 at 1 day, 3 days and 7 days. Ten rats were unilaterally injured by stripping lamina propria and immediately treated with or without cryotherapy and were harvested at 2 months for histological and immunohistochemical analysis.

RESULTS

Regenerative effect of cryotherapy was validated of ECM gene expression. Histological and immunohistochemical analysis showed significantly increased hyaluronan, decreased collagen, and increased decorin deposition in injury-cryotherapy cohort compared with injury control cohort and normal control cohort.

CONCLUSIONS

Cryotherapy may provide an optimal environment for vocal fold tissue regeneration. The results of the present investigation suggest that cryotherapy has therapeutic potential in prevention and treatment of vocal fold scarring.

Interaction of High-Sugar Diet and History of Stroke with Risk of Cognitive Decline in Older Adults

Background

Materia/Methods

Results

Conclusions

Lithium chloride promotes neural functional recovery after local cerebral ischaemia injury in rats through Wnt signalling pathway activation

BACKGROUND

Lithium chloride (LiCl) has a significant neuroprotective effect in cerebral ischaemia. However, to date, there is a paucity of evidence on the role of LiCl in neural restoration after brain ischaemia and the signalling pathways involved remain unclear.

MATERIALS AND METHODS

Therefore, to address this gap, the middle cerebral artery occlusion (MCAO) rat model was used to simulate human ischaemia stroke. Male Sprague-Dawley rats were given MCAO for 90 min followed by reperfusion, and Dickkopf-1 (DKK1, 5.0 μg/kg) was administered half an hour before MCAO. Rats were then treated with hypodermic injection of LiCl (2.0 mmol/kg) twice a day for 1 week. After treatment, cognitive impairment was assessed by the Morris water maze test. Neurological deficit score, 2,3,5-triphenyl tetrazolium chloride staining, brain water content, and histopathology were used to evaluate brain damage. Enzyme-linked immunosorbent assay was used to measure oxidative stress damage and inflammatory cytokines. Apoptosis of the hippocampal neurons was tested by western blot. The key factors of Wnt signalling pathway in the ischaemic penumbra were detected by immunofluorescence staining and quantitative real-time polymerase chain reaction.

RESULTS

Current experimental results showed that LiCl treatment significantly improved the impaired spatial learning and memory ability, suppressed oxidative stress, inflammatory reaction, and neuron apoptosis accompanied by attenuating neuronal damage, which subsequently decreased the brain oedema, infarct volume and neurological deficit. Furthermore, the treatment of LiCl activated Wnt signalling pathway. Interestingly, the aforementioned effects of LiCl treatment were markedly reversed by administration of DKK1, an inhibitor of Wnt signalling pathway.

CONCLUSIONS

These results indicate that LiCl exhibits neuroprotective effects in focal cerebral ischaemia by Wnt signalling pathway activation, and it might have latent clinical application for the prevention and treatment of ischaemic stroke.

Characteristics of prefrontal activity during emotional and cognitive processing in patients with bipolar disorder: A multi-channel functional near-infrared spectroscopy study

Bipolar disorder (BD) is a recurrent chronic mental disorder with a broad profile of functional deficits including disturbed emotional processing and cognitive impairments. The goal of the current study was to further explore the underlying neural mechanism of dysfunction in patients with BD from a comprehensive perspective of both cognition and emotion. Forty-six clinical patients with BD and forty-five healthy controls performed emotion induction task and verbal fluency task (VFT), with frontal activity measured by functional near-infrared spectroscopy (fNIRS). Our results show distinct hemodynamic activity in the prefrontal region during emotional and cognitive processing between patients with BD and healthy controls. Patients with BD exhibit valence-dependent prefrontal cortex (PFC) hemodynamic response to emotional stimuli, with bilateral frontal hypoactivity indicating decreased positive reactivity and left frontal hyperactivity indicating increased negative reactivity. On the other hand, patients with BD showed impaired performance with bilateral frontal hypoactivity during VFT. Taken together, frontal dysfunction of cognition and emotionality in patients with BD probed by fNIRS would be a potential biomarker in clinical assessment.

Comparison of Sensory Observation and Somatosensory Stimulation in Mirror Neurons and the Sensorimotor Network: A Task-Based fMRI Study

Objective

This study aimed to investigate brain plasticity by somatosensory stimulation (SS) and sensory observation (SO) based on mirror neuron and embodied cognition theory. Action observation therapy has been widely adopted for motor function improvement in post-stroke patients. However, it is uncertain whether the SO approach can also contribute to the recovery of sensorimotor function after stroke. In this study, we explored the therapeutic potential of SO for sensorimotor dysfunction and provided new evidence for neurorehabilitation.

Methods

Twenty-six healthy right-handed adults (12 men and 14 women), aged 18–27 (mean, 22.12; SD, 2.12) years were included. All subjects were evaluated with task-based functional magnetic resonance imaging (fMRI) to discover the characteristics and differences in brain activation between SO and SS. We adopted a block design with two conditions during fMRI scanning: observing a sensory video of brushing (task condition A, defined as SO) and brushing subjects' right forearms while they watched a nonsense string (task condition B, defined as SS). One-sample t-tests were performed to identify brain regions and voxels activated for each task condition. A paired-sample t-test and conjunction analysis were performed to explore the differences and similarities between SO and SS.

Results

The task-based fMRI showed that the bilateral postcentral gyrus, left precentral gyrus, bilateral middle temporal gyrus, right supramarginal gyrus, and left supplementary motor area were significantly activated during SO or SS. In addition to these brain regions, SO could also activate areas containing mirror neurons, like the left inferior parietal gyrus.

Conclusion

SO could activate mirror neurons and sensorimotor network-related brain regions in healthy subjects like SS. Therefore, SO may be a promising novel therapeutic approach for sensorimotor dysfunction recovery in post-stroke patients.

Effects of tDCS on Depression and Comorbid Generalized Anxiety Disorder: A Brain Function Imaging Case Report

Background

Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation technique that has proven effective for neuropsychiatric disorders. Generalized anxiety disorder (GAD) and depression are common psychiatric disorders that often are comorbid, meaning they occur simultaneously. Current evidence supports the value of tDCS for GAD. The objectives of this report is to explore the effect of tDCS on clinical symptoms and cerebral function in a patient with comorbid GAD and depression.

Methods

Our subject was a semiprofessional athlete diagnosed with comorbid GAD and depression. Symptoms included palpitations, sweating, continuous tension, and anxiety. We designed a B-A-B experimental protocol and used the Beck Anxiety Index (BAI), Beck Depression Index (BDI), and Pittsburgh Sleep Quality Index (PSQI) as assessment tools. Treatment consisted of 2 series of 15 days each, separated by a 3-week washout period. We collected functional near-infrared spectroscopy (fNIRS) data before and after both series, as well as fNIRS data immediately after the first treatment in both series. In addition, we collected functional magnetic resonance imaging data before and after the second series.

Results

After the first series, the scores of the three questionnaires (BAI, BDI and PSQI) decreased significantly, which showed the trend of improvement. The functional connection of bilateral prefrontal partial channels decreased significantly immediately after tDCS treatment. The results of the fNIRS before the second-series treatment showed that prefrontal connectivity returned to the state before the first intervention after the washout period. The results of the fNIRS after the second series treatment showed that the symptoms of depression and anxiety alleviated. The results of the fNIRS showed that the prefrontal connectivity decreased again.

Conclusion

In the treatment of comorbid GAD and depression, tDCS can alleviate symptoms and improve sleep quality and social behavior. Brain imaging is widely used to observe functional changes by tDCS such as fMRI and fNIRS. The study also showed that fNIRS can be a safe, simple, and efficient method to assess brain activity.

[A pedigree study of Loeys-Dietz syndrome type 4 with skeletal deformity related to a novel TGFβ2 mutation]

Objective: Loeys-Dietz syndrome is a rare type of hereditary connective tissue disease. This study was aimed to analyze the clinical characteristics and gene mutations in a family of Loeys-Dietz syndrome with skeletal deformity. Methods: Clinical data of the proband and family members were collected and biochemical measurements and radiological examinations were conducted. Genomic DNA was extracted from peripheral blood of the family members. Whole-exome sequencing was performed to determine the mutation sites in the proband, and Sanger sequencing was applied to verify the candidate mutation in the other family members. Results: The proband is a 34-year-old man with deformities of lower extremities for more than 30 years. Physical examinations showed dolichostenomelia, pes planus, joint laxity and scoliosis. Echocardiography revealed the dilatation of aortic root at the level of the sinuses of Valsalva. A heterozygous missense mutation (c. 220A>C, p.Thr74Pro) in exon 1 of TGFβ2 gene was identified in the proband. The same mutation was detected in his sister and niece with similar clinical features such as deformities of lower extremities and pes planus. This novel mutation has not been reported in ExAC or 1000G and was predicted to be deleterious, supporting a diagnosis of Loeys-Dietz syndrome type 4. Conclusions: Loeys-Dietz syndrome type 4 is caused by TGFβ2 mutations. Skeletal deformity is one of the distinctive features. Genetic testing is helpful for the early diagnosis and differential diagnosis from other connective tissue diseases.

Effects of Liuzijue Qigong Posture on Aerodynamics of Phonation in Healthy Volunteers

OBJECTIVES

To verify the possible function of Liuzijue Qigong (LQG), a kind of traditional Chinese health exercise, in improving phonation.

METHODS

A total of 30 healthy volunteers (10 males, 20 females) without voice disorders were included. The subjects were asked to have phonation tasks at the sitting and LQG postures. Aerodynamic, electroglottographic, and acoustic parameters were measured. Expiratory Volume (FVC); Subglottic Pressure at comfortable phonation (SGP), Glottal Resistance (GR), Glottal Efficiency (GE); Contact Quotient (CQ), Mean Flow (MF), Fundamental frequency (F0), Mean Sound Pressure Level (SPL); Phonation Threshold Pressure (PTP); and Maximum Phonation Time (MPT) were measured and analyzed.

RESULTS

In total subjects, the analysis showed a significant increase in FVC (P = 0.020), SGP (P = 0.043), F0 (P = 0.021), and PTP (P = 0.000) at the LQG posture when compared with the sitting posture, and there is no difference in CQ, MF, SPL, GR, GE, and MPT.

CONCLUSIONS

The results showed LQG posture increased the respiratory support and glottal closure, while induced the respiratory system and vocal system in coordination to improve phonation. It is logical to postulate that LQG has potential in the management of voice disorders with glottal closure insufficiency.

Application of tDCS in children with cerebral palsy: A mini review

Cerebral palsy (CP) refers to a group of diseases characterized by persistent central dyskinesia, postural development disorder and activity limitation syndromes caused by nonprogressive brain injury in the developing fetus or infant, which is often accompanied by sensory, cognitive and attention disorders. The routine rehabilitation methods for children with CP mainly include physical therapy, occupational therapy, speech therapy and other methods. In recent years, noninvasive brain stimulation (NIBS), as a relatively new intervention method, has been widely used because of its potential to regulate cortical excitability and plasticity. Transcranial direct current stimulation (tDCS) is an NIBS technique that is easier and more convenient to perform. It does not require patients to remain stationary for a long time or have a significant impact on treatment results due to children's frequent activities. Compared with other NIBS techniques, tDCS has greater flexibility and no strict restrictions on patients' activities; it also helps the therapist conduct occupational therapy or speech therapy while a child receives tDCS, which markedly reduces the treatment time and avoids burnout due to a long treatment duration. Thus, tDCS is a better and more convenient intervention for CP children and warrants further exploration. Accordingly, this article reviews tDCS application in children with CP and discusses tDCS application prospects for such children to promote its expansion in clinical practice.

Effectiveness and functional magnetic resonance imaging outcomes of Tuina therapy in patients with post-stroke depression: A randomized controlled trial

OBJECTIVE

To investigate the effectiveness and functional magnetic resonance imaging (fMRI) outcomes of Tuina therapy in patients with post-stroke depression (PSD).

METHODS

This was a single-center, randomized, two-armed, controlled trial. Eighty-four patients with PSD were selected and randomly assigned to a Tuina therapy group or a routine rehabilitation control group. The patients underwent five 20-min treatment sessions per week over a period of 2 weeks. The primary outcome measure was change in Hamilton Depression Rating Scale (HAMD) score over the 2 weeks of intervention, whereas the secondary outcome measures were changes in Fugl-Meyer Assessment (FMA) score, Modified Barthel index (MBI), and Mini Mental State Examination (MMSE) score.

RESULTS

The Tuina group showed significantly improved HAMD scores compared to the routine rehabilitation control group (5.85, [2.54, 9.16]). For the secondary outcomes, the Tuina group showed better MMSE scores than the routine rehabilitation group (1.97, [1.19, 2.76]); however, there were no significant differences between the other secondary outcomes of both groups (P > 0.05). After 2 weeks, both groups showed a significant decrease in HAMD score compared to baseline. In addition, the Tuina group showed a significant decrease in MMSE score compared to baseline (2.35, [1.8, 2.9]); however, there were no significant differences in the MBI and FMA scores of the two group after the intervention (P > 0.05). Regarding fMRI results, the zALFF values of the right caudate nucleus, right putamen, right insula, left superior temporal gyrus, right parahippocampal gyrus, right hippocampus, left middle temporal gyrus, left angular gyrus, and left thalamus were higher in the Tuina group. In the Tuina group, the functional connectivity between the hippocampus and thalamus, and the thalamus and caudate nucleus, were significantly different (P <0.01). In addition, the zALFF value of the hippocampus was significantly negatively correlated with HAMD score. No serious adverse events were observed in both groups.

CONCLUSION

Tuina therapy administered 10 times within 2 weeks is safe and can effectively relieve depression and improve cognitive function in patients with PSD. This finding may be closely related to the effect of Tuina therapy on the activation and functional connectivity of the hippocampus.

CLINICAL TRIAL REGISTRATION

http://www.chictr.org.cn/showproj.aspx?proj=55151, identifier ChiCTR200003388.

Augmentative and alternative communication intervention for in-patient individuals with post-stroke aphasia: study protocol of a parallel-group, pragmatic randomized controlled trial

BACKGROUND

People with post-stroke aphasia commonly receive speech-language therapy (SLT) when they are admitted to hospitals. Commonly, these patients reported communication difficulties in in-patient settings. Augmentative and alternative communication (AAC) has been reported as an effective treatment approach to improve communication effectiveness, language performance, decreasing depression, and improving quality of life for this population. However, little evidence has demonstrated the use of AAC intervention (AACT) in early recovery from people with post-stroke aphasia in in-patient rehabilitation settings for improving these patients' communication effectiveness. The pilot randomized controlled trial (RCT) will explore the effectiveness and feasibility of including AACT in regular SLT for in-patient people with post-stroke aphasia.

METHOD

This pilot RCT is a single-blind, randomized controlled trial with two parallel groups. Both groups receive a 1-h treatment session, including either both AACT and SLT or SLT only for ten consecutive days. We aim to include 22 in-patient participants with post-stroke aphasia in each group. Participants will be assessed at pre- and post-intervention and 2 weeks after intervention. The primary outcomes are the ability of communication measured by the communication of basic needs subtest in the Functional Assessment of Communication Skills for Adult (FACS) and the overall language performance measured by the Chinese Standard Aphasia Battery (ABC). The secondary outcomes include a 10-min conversation, the 10-item Hospital version of the Stroke Aphasic Depression Questionnaire (SADQH-10), the Stroke-Specific Quality of Life Scale (SS-QOL), and a patient and caregiver satisfaction questionnaire.

DISCUSSION

This pilot RCT will contribute to new scientific evidence to the field of aphasia rehabilitation in early recovery during the in-patient period. The paper describes the trial, which will explore the effect of combining AACT and SLT and SLT only, our choice of primary and secondary outcome measures, and proposed analyses. The study results will provide information for implementing AACT in the regular in-patient SLT of future RCTs.

TRIAL REGISTRATION

Chinese Clinical Trial Registry database (ChiCTR) ChiCTR2000028870 . Registered on 5 January 2020.

Case Report: Visual Deprivation in Pusher Syndrome Complicated by Hemispatial Neglect After Basal Ganglia Stroke

We aimed to explore whether motor function and activities of daily life (ADL) could be improved with the application of visual deprivation in two patients with Pusher syndrome complicated by hemispatial neglect after right basal ganglia stroke. We assessed two stroke patients suffering from severe motor disturbances, both tilting heavily to the left, with diagnoses of Pusher syndrome and left hemispatial neglect. Vision in the left eye was deprived using patches during clinical rehabilitation. Motor function promotion was confirmed using the Burke Lateropulsion Scale (BLS), Fugl–Meyer Balance Scale (FMBS), and Holden grade (HG), while the Barthel index (BI) assessed ADL immediately and 1 week after intervention. Both patients regained standing balance immediately using visual deprivation, as well as walking ability, although both scored 0 on the FMBS and HG. After 1 week of treatment, one patient increased to 11 and 3 on the FMBS and HG, respectively, while the BLS score decreased from 12 to 2, and the ADL increased from 23 to 70. The other patient demonstrated increases to 10 and 3 on the FMBS and HG, respectively, with the BLS decreasing from 13 to 3, and the ADL increasing from 25 to 60. Therefore, in the rehabilitation treatment of Pusher syndrome complicated by hemispatial neglect due to basal ganglia stroke, visual deprivation can significantly improve motor function and shorten the treatment course.

PLXNA2 knockdown promotes M2 microglia polarization through mTOR/STAT3 signaling to improve functional recovery in rats after cerebral ischemia/reperfusion injury

Ischemic stroke is an acute cerebrovascular disease characterized by high mortality, morbidity and disability rates. Ischemia/reperfusion is a critical pathophysiological basis of motor and cognitive dysfunction caused by ischemic stroke. Microglia, innate immune cells of the central nervous system, mediate the neuroinflammatory response to ischemia/reperfusion. PlexinA2 (PLXNA2) plays an important role in the regulation of neuronal axon guidance, the immune response and angiogenesis. However, it is not clear whether PLXNA2 regulates microglia polarization in ischemic stroke or the underlying mechanism. In the present study, we investigated the role of PLXNA2 in rats with middle cerebral artery occlusion/reperfusion (MCAO/R) and BV2 microglia cells with oxygen and glucose deprivation/reoxygenation (OGD/R). A battery of behavioral tests, including the beam balance test, forelimb placement test, foot fault test, cylinder test, CatWalk gait analysis and Morris water maze test were performed to evaluate sensorimotor function, locomotor activity and cognitive ability. The expression of M1/M2-specific markers in the ischemic penumbra and BV2 microglia cells was detected using immunofluorescence staining, quantitative real-time PCR analysis and Western blot analysis. Our study showed that PLXNA2 knockdown accelerated the recovery of motor function and cognitive ability after MCAO/R. In addition, PLXNA2 knockdown restrained proinflammatory cytokine release and promoted anti-inflammatory cytokine release, and the mammalian target of rapamycin (mTOR)/signal transducer and activator of transcription 3 (STAT3) pathway was involved in PLXNA2 regulated microglia polarization. Taken together, our results indicate that PLXNA2 knockdown reduces neuroinflammation by switching the microglia phenotype from M1 to M2 in the ischemic penumbra of MCAO/R-injured rats, which may be due to the inhibition of mTOR/STAT3 signaling. Treatments targeting PLXNA2 may be a promising therapeutic strategy for ischemic stroke.

The efficacy of Tuina with herbal ointment for patients with post-stroke depression: study protocol for a randomized controlled trial

BACKGROUND

Post-stroke depression (PSD) is a common complication after stroke which hinders functional recovery and return to social participation of stroke patients. Efficacy of conventional drug therapies for patients with PSD is still uncertain. Therefore, many patients prefer to use complementary and alternative therapies for PSD. Tuina (traditional Chinese manual manipulation) with herbal ointment is an integration of manual therapy, and ointment is an important part of traditional Chinese medicine (TCM) therapy. Preliminary experiments have shown that the Tuina with herbal ointment can improve the mental state of patients with PSD. The purpose of this study is to observe and verify the efficacy of Tuina combined with herbal ointment for patients with post-stroke depression, and to lay a foundation for further research on its mechanism of action.

METHODS/DESIGN

In this study, a randomized controlled trial will be conducted in parallel, including two intervention groups: Tuina with herbal ointment group and herbal ointment for control group. A total of 84 eligible participants will be randomly assigned to the groups in a 1:1 ratio. All participants will receive conventional antidepressant venlafaxine treatment (75 mg QD), on which they received two different interventions. The interventions for both groups will be carried out 5 times each week for a period of 2 weeks. The primary outcome will be the Hamilton Rating Scale for Depression (HAMD). Secondary outcomes will include transcranial magnetic stimulation (TMS), as well as 36-item Short-Form Health Survey (SF-36) and Treatment Emergent Symptom Scale (TESS). They will be assessed at the baseline, at the end of the intervention (2 weeks), and during the 1 month and 3 months of follow-up by repeated measures analysis of variance. The significance level is 5%. Adverse events will be monitored at each visit to assess safety. All outcomes will be assessed and analyzed by researchers blinded to the treatment allocation. The purpose of this study will focus on observing the efficacy of Tuina with herbal ointment for patients with post-stroke depression, and to explore further the mechanisms of its effects.

DISCUSSION

This study may evaluate clinical application value and safety of Tuina with herbal ointment in PSD patients, which can provide basis for clinical research and mechanism exploration of PSD.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000033887 . Registered on 15 June 2020.

DISSEMINATION

The results will be published in peer-reviewed journals and disseminated through the study's website and conferences.

Effects of water-based Liuzijue exercise on peak exercise capacity, functional exercise capacity, and quality of life in people with COPD

OBJECTIVES

This study was conducted to investigate the effect of water-based Liuzijue exercise on peak exercise capacity, functional exercise capacity, and quality of life in people with COPD.

METHODS

The study included 50 participants randomly divided into three groups: a control group (CG = 17), a land-based Liuzijue exercise group (LG = 17), and a water-based Liuzijue exercise group (WG = 16). The LG and WG performed Liuzijue exercise in different environments, and the CG had no exercise intervention. All participants received prescribed medical treatment. Liuzijue exercise was performed according to the description of Health Qigong Liuzijue compiled by Chinese Health Qigong Association for 60 minutes, two times per week, for 12 weeks.

RESULTS

After intervention, peak oxygen uptake and peak working rate were significantly improved in WG (P = .02). The results of the 6 minutes walking test (6MWT) and 30 seconds sit-to-stand test were significantly improved in both WG and LG (P < .05), and significant difference was found between WG and CG in 6MWT (P = .03). The St. George's Respiratory Questionnaire (SGRQ) activity score increased significantly in the CG (P = .03), while all domains of SGRQ significantly decreased in both training groups (P < .01). All SGRQ scores showed a significant difference between LG and CG (P < .05) and, except for the activity score, between WG and CG (P < .05).

CONCLUSIONS

Water-based Liuzijue exercise can effectively improve peak exercise capacity, functional exercise capacity, and quality of life in people with COPD, especially with respect to increasing peak VO₂ and 6MWD.

A systematic review and meta-analysis of Liuzijue in stable patients with chronic obstructive pulmonary disease

BACKGROUND

To investigate the effectiveness of Liuzijue exercise on chronic obstructive pulmonary disease (COPD) in the stable phase.

METHODS

We searched six electronic bibliographic databases (PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, and Wan Fang Data) from inception to August 2018. Randomized controlled trials (RCTs) were included if they evaluated the effect of Liuzijue exercise on stable COPD. Cochrane Collaboration risk-of-bias tool (Cochrane Handbook 5.1.0) was used to assess the risk of bias of included RCTs. Meta-analysis was performed using the Review Manager software (RevMan V.5.3.5) provided by the Cochrane Collaboration. Outcomes assessed included dyspnea, exercise capacity, lung function, and quality of life.

RESULTS

Fourteen RCTs involving 920 stable COPD patients were included in this systematic review and meta-analysis. The control groups received usual care. The average number of training sessions per participant was 9.3 per week, and the average length of these training sessions was 31.6 min per week. Training duration varied from 3 to 12 months. Meta-analysis results showed that Liuzijue exercise can effectively improve patients' Modified Medical Research Council Dyspnea Scale scores (MD = - 0.73, 95% CI: - 1.13 to - 0.33, P < 0.05), 6MWD (MD = 17.78, 95% CI: 7.97 to 27.58, P < 0.05), forced expiratory volume in one second (FEV1) (MD = 0.23, 95% CI: 0.07 to 0.38, P < 0.05), the percentage of predicted values of FEV1 (FEV1%pred) (MD = 7.59, 95% CI: 2.92 to 12.26, P < 0.05), FEV1/FVC (Forced vital capacity) ratio (MD = 6.81, 95% CI: 3.22 to 10.40, P < 0.05), Quality of life: St. George's Respiratory Questionnaire total score (MD = - 9.85, 95%CI: - 13.13 to - 6.56, P < 0.05), and Chronic Obstructive Pulmonary Disease Assessment Test score (MD = - 2.29, 95%CI: - 3.27, - 1.30, P < 0.05).

CONCLUSION

Evidence from meta-analysis suggested that Liuzijue exercise could improve dyspnea, exercise endurance, lung function, and quality of life for stable COPD patients. However, owing to the methodological bias and the placebo effect of Liuzijue exercise, there is a need for further research to confirm these findings.

TRIAL REGISTRATION

PROSPERO (ID: CRD42019130973 ).

Effects of mirror neuron system-based training on rehabilitation of stroke patients

OBJECTIVE

To investigate the clinical effects of the mirror neuron system (MNS)-based training on upper extremity motor function and cognitive function in stroke patients.

METHODS

Sixty stroke patients (time from stroke onset 3-9 months) with upper extremity paresis (Brunnstrom stage II-IV) and cognitive impairment (MoCA score ≥ 15) were enrolled in this study. Patients were randomly allocated into MNS treatment group (N = 30) and control group (N = 30). Both groups underwent regular training for upper extremity motor function and cognitive function, and the MNS group was trained with a therapeutic apparatus named mirror neuron system training (MNST) including different levels of action observation training (AOT). Training lasted 20 min/day, 5 days/week for 8 weeks. MoCA, reaction time, and Wisconsin Card Sorting Test (WCST) were assessed at baseline and 8 weeks after training. Furthermore, Fugl-Meyer assessment (FMA) and Modified Barthel index (MBI) were adopted to evaluated upper extremity motor function and daily life ability.

RESULTS

After 8 consecutive weeks' training, both groups showed significant improvements on the upper extremity motor function, cognitive function, and daily life ability score after training (p < .05). The MNS group showed significantly improved upper extremity motor function and cognitive function (p < .05) compared with control group.

CONCLUSIONS

Combining MNS-based and conventional training can improve upper extremity motor function and cognitive function in stroke patients.

Trends of ambulatory oral anticoagulant prescription in five major cities of China, 2012-2017

Background

The introduction of non-VKA oral anticoagulants (NOACs) has changed the landscape of preventing thromboembolism events in many countries. However, the prescription trends of oral anticoagulant (OAC) in China are still unclear, which were evaluated in this study through data extracted and summarized from 5 major cities as representatives.

Methods

This study was designed as a time-series study which was based on pharmacy prescription data. Analysis was performed on yearly aggregated visits and expenditure. The results were also stratified by indications and specialties.

Results

A total of 189,006 prescriptions of 67 hospitals in 6 years were included in the study. The average growth rates of overall visit and expenditure of OAC were 15.8 and 57.5%, respectively. The share of warfarin decreased and NOACs had taken 92% of cost, covering 28% of patients in 2017. The more frequently used NOACs were rivaroxaban and dabigatran. The use of OAC was differed by indication and specialty.

Conclusion

The use of NOACs was found increasing rapidly in both visits and cost, sharing a majority of cost with a minority of patients. Attentions should be paid on the rational use of NOACs.

Expression of Neprilysin in Skeletal Muscle by Ultrasound-Mediated Gene Transfer (Sonoporation) Reduces Amyloid Burden for AD

Amyloid β (Aβ) accumulation in the brain is considered to be one of the major pathological changes in the progression of Alzheimer’s disease (AD). Neprilysin (NEP) is a zinc metallopeptidase that efficiently degrades Aβ. However, conventional approaches for increasing NEP levels or inducing its activation via viral-vector gene delivery have been shown to be problematic due to complications involving secondary toxicity, immune responses, and/or low gene transfer efficiency. Thus, in the present study, a physical and tractable NEP gene-delivery system via ultrasound (US) combined with microbubbles was developed for AD therapy. We introduced the plasmid, human NEP (hNEP), into skeletal muscle of 6-month-old amyloid precursor protein/presenilin-1 (APP/PS1) AD mice. Interestingly, we found a significantly reduced Aβ burden in the brain at 1 month after the delivery of overexpressed hNEP into skeletal muscle. Moreover, hNEP-treated AD mice exhibited improved performance in the Morris water maze compared to that of untreated AD mice. In addition, there were no apparent injuries in the injected muscle or in the lungs or kidneys at 1 month after the delivery of hNEP into skeletal muscle. These findings suggest that the introduction of hNEP into skeletal muscle via US represents an effective and safe therapeutic strategy for ameliorating AD-like symptoms in APP/PS1 mice, which may have the potential for clinical applications in the future.

The Effectiveness of Action Observation Therapy Based on Mirror Neuron Theory in Chinese Patients with Apraxia of Speech after Stroke

Objective: The present study aimed to evaluate the efficacy of action observation therapy (AOT) on apraxia of speech (AOS) in patients after stroke. Materials and Methods: Forty-two patients diagnosed with AOS after stroke were randomly divided into an experimental group (n = 21) and a control group (n = 21). Both groups received 30 min of conventional language therapy twice daily, 5 days a week for 4 weeks. The patients in the experimental group additionally received 20 min of AOT before 10 min language therapy each day. The speech function and aphasia severity of the 2 groups were assessed using the speech apraxia assessment method of the China Rehabilitation Research Center, Western Aphasia Battery (WAB), and the Boston Diagnostic Aphasia Examination before and after treatment. Results: AOS and WAB scores increased significantly after treatment in both groups (p < 0.05). AOS and WAB scores exhibited significant differences between the experimental group and the control group after training (p < 0.05). The response rate in the experimental group was significantly higher than that in the control group (p < 0.05). Conclusion: AOT based on mirror neuron theory may improve language function in patients with AOS after stroke.

Evaluation of isokinetic muscle strength of upper limb and the relationship with pulmonary function and respiratory muscle strength in stable COPD patients

Background

Upper limb muscle strength plays an important role in respiratory and pulmonary function, and limited research focuses on the role of strength and endurance of the elbow extensor and flexor. This study was conducted to accurately assess upper limb muscle function and quantified associations with pulmonary function and respiratory muscle strength in patients with stable chronic obstructive pulmonary disease (COPD).

Methods

In this cross-sectional study, patients with stable COPD treated in Yue-Yang Integrative Medicine Hospital from March 2014 to March 2016 were recruited. All participants underwent a pulmonary function test (forced expiratory volume in first second/forced vital capacity, FEV1/FVC; percentage value of predicted FEV1, FEV1%pred), a respiratory muscle strength test (maximal inspiratory pressure, MIP; maximal expiratory pressure, MEP), and an isokinetic test of dominant upper limb after a 24-hr interval (peak torque, PT; PT/body weight, PT/BW; total work, TW; endurance ratio, ER).

Results

A total of 88 patients with stable COPD (age: 65.5±8.7 years) were recruited, of which 73% (64 patients) were male. In the multiple stepwise regression analysis, sex remained as significant impactors in the final model for FEV1%pred (adjusted R²=0.243, P<0.001). Elbow flexor PT/BW and ER, sex, and BMI remained as significant impactors in the final model for FEV1/FVC (adjusted R²=0.255, P<0.01). Elbow flexor TW remained as significant impactors for MIP (adjusted R²=0.112, P=0.001), while elbow extensor PT and PT/BW and sex remained as significant impactors for MEP (adjusted R =0.385, P<0.01).

Conclusion

In stable COPD, pulmonary function and respiratory muscle strength are associated with upper limb muscle strength. In particular, elbow flexor endurance is likely an important impactor for pulmonary function and inspiratory muscle strength, while elbow extensor strength is of importance for expiratory muscle strength.

Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also impacts exercise capacity and forms a vicious circle in which it further aggravates the condition of patients and accelerates disease progression. As a functional holistic exercise, traditional Chinese exercises (TCE) play an important role in the rehabilitation of COPD on the basis of adjusting the breath and performing coordinated movements. This study investigates the effects of prescribed pulmonary exercises (which are modified from TCE) on exercise capacity of upper and lower limbs, endurance exercise capacity, and quality of life in stable COPD patients. The goal is to determine the accessibility of these prescribed exercises in COPD rehabilitation. Participants are randomly divided into a non-exercise control group (CG) or prescribed pulmonary exercise group (PG) at a ratio of 1: 1. The PG receives intervention for 60 min twice per day, 7 days a week, for a total of 3 months. The intensity is measured using the Borg category-ratio 10 scale and with a heart-rate monitor. Then, an exercise capacity test and quality of life questionnaire are scheduled at 1 week before and after the formal intervention. After 3 months of intervention, the 30 s arm curl test, 30 s sit-to-stand test, 6 min walking test, and quality of life show significant improvement in COPD patients (p < 0.05). These findings indicate that prescribed pulmonary exercises can be applied as alternative, convenient, and effective home- and community-based exercises for stable COPD patients.

Jasmonic acid-induced hydrogen sulfide activates MEK1/2 in regulating the redox state of ascorbate in Arabidopsis thaliana leaves

In this paper, we investigated the relationship between hydrogen sulfide (H₂S) and mitogen-activated protein kinase kinase (MEK1/2) in jasmonic acid (JA)-regulated the redox state of ascorbate in the leaves of Arabidopsis thaliana. The results showed that JA significantly enhanced the phosphorylation level of MEK1/2, the production of endogenous H₂S and the ratio of reduced ascorbate (AsA) to dehydroascorbate (DHA) (AsA/DHA) in wild type of A. thaliana (WT). However, there were no obvious effects of JA on above indicators in H₂S synthetic mutant of A. thaliana (MT). H₂S scavenger hypotaurine (HT) markedly reduced JA-induced the phosphorylation level of MEK1/2, AsA/DHA ratio and the production of endogenous H₂S in WT. Application of H₂S donor sodium hydrosulfide (NaHS) to JA-treated MT plants increased above indicators. Application of NaHS to (HT+JA)-treated MT plants did not reverse the effects of HT on above JA-induced indicators. MEK1/2 inhibitor PD98059 decreased JA-induced AsA/DHA ratio and the transcript levels and the activities of ascorbate peroxidase (APX), glutathione reductase (GR), monodehydroascorbate reductase (MDHAR), dehydroascorbate reductase (DHAR) and L-galactono-1,4-lactone dehydrogenase (GalLDH) in WT. However, PD98059 had no effect on JA-induced the production of endogenous H₂S in WT. Compared with Control-MT, there were no obvious effects of JA on the production of endogenous H₂S, AsA/DHA ratio and the transcript levels and activities of above enzymes in MT. However, application of PD98059 reduced above JA-induced indicators except the production of endogenous H₂S and DHA content in MT. Our results suggested that H₂S activated MEK1/2 in JA-regulated AsA/DHA ratio in A. thaliana leaves through enzymes in ascorbate metabolism.

Skin resistance to UVB-induced oxidative stress and hyperpigmentation by the topical use of Lactobacillus helveticus NS8-fermented milk supernatant

AIMS

In this study, we investigated the preventive properties of the supernatant of Lactobacillus helveticus NS8-fermented milk (NS8-FS) against UV light-induced skin oxidative damage and hyperpigmentation.

METHODS AND RESULTS

NS8-FS exhibited significant radical scavenging activity in tests with ABST⁺ and DPPH scavenging methods, and as well strongly inhibited 3-morpholinosydnonimine (Sin-1)-induced ROS generation in HaCat keratinocytes. Unexpectedly, NS8-FS was found to inhibit melanin production in B16F10 melanoma cells and to exhibit inhibitory effects both to the enzymatic activity of tyrosinase (TYR) and the expression of proteins required for melanin synthesis. In SKH-1 hairless mice, topical application of NS8-FS alleviated UVB-induced skin photodamage, including the improvement of the appearance of epidermal thickness, transepidennal water loss and lipid peroxidation levels. In the tanning guinea pig model, the whitening effect of NS8-FS was demonstrated using Masson-Fontana staining and TYR staining. Furthermore, NS8-FS was shown to stimulate the nuclear translocation and activation of the Nrf2 protein, along with recovery of antioxidant enzyme activities.

CONCLUSION

NS8-FS exhibits the protective capacities against UV light-induced skin oxidative damage and hyperpigmentation.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our findings indicate the potential of cell-free fermented products of lactic acid bacteria in topical photoprotection.

Higher-order power harmonics of pulsed electrical stimulation modulates corticospinal contribution of peripheral nerve stimulation

It is well established that electrical-stimulation frequency is crucial to determining the scale of induced neuromodulation, particularly when attempting to modulate corticospinal excitability. However, the modulatory effects of stimulation frequency are not only determined by its absolute value but also by other parameters such as power at harmonics. The stimulus pulse shape further influences parameters such as excitation threshold and fiber selectivity. The explicit role of the power in these harmonics in determining the outcome of stimulation has not previously been analyzed. In this study, we adopted an animal model of peripheral electrical stimulation that includes an amplitude-adapted pulse train which induces force enhancements with a corticospinal contribution. We report that the electrical-stimulation-induced force enhancements were correlated with the amplitude of stimulation power harmonics during the amplitude-adapted pulse train. In an exploratory analysis, different levels of correlation were observed between force enhancement and power harmonics of 20–80 Hz (r = 0.4247, p = 0.0243), 100–180 Hz (r = 0.5894, p = 0.0001), 200–280 Hz (r = 0.7002, p < 0.0001), 300–380 Hz (r = 0.7449, p < 0.0001), 400–480 Hz (r = 0.7906, p < 0.0001), 500–600 Hz (r = 0.7717, p < 0.0001), indicating a trend of increasing correlation, specifically at higher order frequency power harmonics. This is a pilot, but important first demonstration that power at high order harmonics in the frequency spectrum of electrical stimulation pulses may contribute to neuromodulation, thus warrant explicit attention in therapy design and analysis.

[Ventilator-associated pneumonia among premature infants <34 weeks' gestational age in neonatal intensive care unit in China: a multicenter study]

Objective: To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China. Method: A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis. Result: A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children's hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%). Conclusion: The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.

5 Hz Repetitive Transcranial Magnetic Stimulation with Maximum Voluntary Muscle Contraction Facilitates Cerebral Cortex Excitability of Normal Subjects

BACKGROUND

Recently, high-frequency repetitive transcranial magnetic stimulation (rTMS) is reported to evaluating the corticospinal pathway and improving both cortical excitability and motor function significantly in subjects. According to some previous reports, the maximum voluntary muscle contraction (MVC) of target muscle can reinforce the influence by rTMS. The aim of this study was to confirm 5 Hz rTMS with MVC in healthy individuals is an effective method to facilitate motor neuron excitability and the efficiency can last at least 30 min post stimulation.

OBJECTIVE

To compare the motor evoked potentials (MEPs) elicited by 5Hz rTMS and 5Hz rTMS combined with MVC.

METHODS

In this randomized, controlled, assessor-blinded, crossover trial, 40 healthy right-handed subjects were divided into group A (n=20) and group B (n=20). All subjects received rTMS over the primary motor cortex area (M1) in the left hemisphere. The parameters of rTMS were 5 Hz, 90.of the resting motor threshold (RMT), for a total of 500 pulses in 100 trains (1-sec inter-stimulus and 8- sec inter-interval). Method 1: All subjects received rTMS over the hand area of left M1. Method 2: All subjects received rTMS at the same stimulated point, combined with maximum voluntary hand griping in each 10 trains. Test 1: group A underwent method 1, while group B underwent method 2. Test 2: A week later, group B underwent method 1, while group A underwent method 2. In each test, the MEP amplitude and latency was measured before (P-rTMS), 5 min after (Post 1) and 30 min after (Post 2) the rTMS intervention.

RESULTS

MEP amplitude increased significantly from baseline at 5 minutes post intervention under both treatment regimes. However for both sequences, it decreased towards baseline under the rTMS intervention at 30 minutes post intervention but remained relatively high when rTMS was combined with MVC. MEP latency decreased significantly from baseline at 5 minutes post intervention under both treatment regimes. For both sequences, it then increased again towards baseline under both treatment regimes at 30 minutes post intervention. Although there was a trend for a less pronounced increase under the combined treatment, this effect was not significant.

CONCLUSION

Both 5 Hz rTMS and 5 Hz rTMS combined with MVC facilitate motor cortical excitability, but the enhancement in rTMS with MVC is more pronounced and maintained longer than simple rTMS.

Oxidative Stress and Adult Neurogenesis

There is a growing evidence that adult neurogenesis is critical for brain function. The reactive oxygen species (ROS) is accumulated during adult neurogenesis as a physiological mechanism; while ROS overload impairs adult neurogenesis during ageing, neuroinflammation and neurodegeneration. Here we propose that targeting oxidative stress provides a novel way to regulate adult neurogenesis and manage different brain diseases.

Targeting 6-phosphogluconate dehydrogenase in the oxidative PPP sensitizes leukemia cells to antimalarial agent dihydroartemisinin

The oxidative pentose phosphate pathway (PPP) is crucial for cancer cell metabolism and tumor growth. We recently reported that targeting a key oxidative PPP enzyme, 6-phosphogluconate dehydrogenase (6PGD), using our novel small molecule 6PGD inhibitors Physcion and its derivative S3, shows anti-cancer effects. Notably, humans with genetic deficiency of either 6PGD or another oxidative PPP enzyme, glucose-6-phosphate dehydrogenase (G6PD), exhibit non-immune hemolytic anemia upon exposure to aspirin and various anti-malarial drugs. Inspired by these clinical observations, we examined the anti-cancer potential of combined treatment with 6PGD inhibitors and anti-malarial drugs. We found that stable knockdown of 6PGD sensitizes leukemia cells to anti-malarial agent dihydroartemisinin (DHA). Combined treatment with DHA and Physcion activates AMP-activated protein kinase, leading to synergistic inhibition of human leukemia cell viability. Moreover, our combined therapy synergistically attenuates tumor growth in xenograft nude mice injected with human K562 leukemia cells and cell viability of primary leukemia cells from human patients, but shows minimal toxicity to normal hematopoietic cells in mice as well as red blood cells and mononucleocytes from healthy human donors. Our findings reveal the potential for combined therapy using optimized doses of Physcion and DHA as a novel anti-leukemia treatment without inducing hemolysis.

Neuromuscular interaction is required for neurotrophins-mediated locomotor recovery following treadmill training in rat spinal cord injury

Recent results have shown that exercise training promotes the recovery of injured rat distal spinal cords, but are still unclear about the function of skeletal muscle in this process. Herein, rats with incomplete thoracic (T10) spinal cord injuries (SCI) with a dual spinal lesion model were subjected to four weeks of treadmill training and then were treated with complete spinal transection at T8. We found that treadmill training allowed the retention of hind limb motor function after incomplete SCI, even with a heavy load after complete spinal transection. Moreover, treadmill training alleviated the secondary injury in distal lumbar spinal motor neurons, and enhanced BDNF/TrkB expression in the lumbar spinal cord. To discover the influence of skeletal muscle contractile activity on motor function and gene expression, we adopted botulinum toxin A (BTX-A) to block the neuromuscular activity of the rat gastrocnemius muscle. BTX-A treatment inhibited the effects of treadmill training on motor function and BDNF/TrKB expression. These results indicated that treadmill training through the skeletal muscle-motor nerve-spinal cord retrograde pathway regulated neuralplasticity in the mammalian central nervous system, which induced the expression of related neurotrophins and promoted motor function recovery.

A retrospective study to compare the use of tacrolimus and cyclosporine in combination with adriamycin in post-transplant liver cancer patients

The aim of this study was to compare the clinical effect of tacrolimus (TAC) versus cyclosporine (CycA) in post-transplant hepatic cancer patients undergoing adriamycin hydrochloride (ADM) chemotherapy. Patients with advanced hepatic cancer who underwent liver transplant and subsequent therapy between March 2007 and March 2009 in our hospital were selected for this study. All of these patients were treated with chemotherapeutic agent adriamycin, with respect to immunosuppressant, whereas they received either TAC or CycA, and hence represented two groups, TAC and controls, respectively. The short- and long-term outcomes of two therapies, ADM + TAC and ADM + CsA, were compared. The TAC group patients showed improved remission compared to the control group (40 cases with 46.0 % versus 32 cases with 31.1 % remission, respectively). The 5-year survival in TAC group was significantly prolonged (20.7 %) compared to that of the controls (8.7 %). The short-term outcomes, such as serum levels of calcium, biomarkers of cardiac toxicity/functioning, and regulatory T lymphocytes counts (markers of immune functioning), were found to be significantly more auspicious with TAC treatment than with CycA. Our study showed that use of TAC plus ADM resulted in improved patient survival, tolerance of the graft, and remission compared to CycA combined with ADM. The serum levels of various markers in the short follow-up analysis indicated a better cardiac and immune functioning with TAC than with CycA treatment.