Subcutaneous endplate bone graft reduction combined with percutaneous pedicle screw fixation for A3+B2 thoracolumbar burst fractures / 中国组织工程研究

BACKGROUND:Bone grafting is one of the important steps in the treatment of thoracolumbar burst fractures.Because the fracture involves the spinal canal or is accompanied by spinal cord nerve damage,severe fracture bleeding and other factors,minimally invasive bone grafting for thoracolumbar burst fractures is restricted.At present,the minimally invasive treatment of thoracolumbar burst fractures is limited to percutaneous screw fixation under the tunnel.Minimally invasive percutaneous bone grafting of injured vertebrae is rarely reported,and percutaneous precise bone grafting under the endplate has not yet been reported. OBJECTIVE:To investigate the clinical effect of subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fractures. METHODS:From June 2017 to December 2021,90 patients with A3+B2 type asymptomatic thoracolumbar burst fracture were randomly divided into 3 groups according to admission time.In group A,33 patients received the bone graft funnel accurately placed through the pedicle channel by percutaneous puncture under C-arm fluoroscopy,bone graft support reduction under the fracture endplate,percutaneous pedicle screw fixation.In group B,30 patients received multifissure intermuscular approach through pedicle bone graft support reduction combined with pedicle screw fixation.In group C,27 patients received percutaneous pedicle screw short-segment fixation under postural reduction.All patients were followed up for at least 18 months after surgery.The clinical data of the three groups,including preoperative,postoperative and last follow-up Cobb angle,anterior edge height ratio and visual analog scale pain score,were compared and analyzed. RESULTS AND CONCLUSION:(1)There were no significant differences in age,sex,injury segment and causative factors among the three groups(P>0.05).(2)All patients at follow-up had no neurological impairment,no obvious lumbar posterior deformity or intractable low back pain.(3)The operation time of group C was less than that of group A and group B(P<0.05).Intraoperative blood loss was less in group A and group C than in group B(P<0.05).(4)There were no significant differences in the anterior edge height ratio and Cobb angle among the three groups(P>0.05).Postoperative data in groups A and B were better than that in group C.At last follow-up,group A and group B outperformed group C(P<0.05).The height and Cobb angle of the vertebral body lost in the three groups were smaller in groups A and B than those in group C(P<0.05).(5)Visual analog scale pain score was better in groups A and C than that in group B after surgery(P<0.05).There was no significant difference in visual analog scale pain score among the three groups at last follow-up(P>0.05).(6)In group C,there was one case of loose internal fixation and displacement in 1 month after surgery,and the vertebral height was lost again with back pain,and after strict bed rest for 6 weeks,the vertebral height loss was not aggravated,the pain was relieved,and the internal fixation was removed after 1 year,and the height loss at the last follow-up was not aggravated.There were no cases of failure of internal fixation in groups A and B.(7)It is indicated that subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fracture has the advantages of less trauma,less bleeding and light postoperative pain symptoms,and the effect of injury vertebral reduction and height maintenance is the same as the reduction through pedicle bone grafting support and short segment fixation with pedicle screws through the multifidus space approach.

The effects of theta burst transcranial magnetic stimulation and rehabilitation training in different sequences on the upper limb functioning of stroke survivors / 中华物理医学与康复杂志

Objective:To explore any effect of intermittent theta burst stimulation (iTBS) and of different sequencing of rehabilitation training on upper limb dysfunction after a stroke.Methods:Thirty-six patients with upper limb motor dysfunction after subacute subcortical cerebral infarction were divided at random into a control group, an experimental group 1, and an experimental group 2, each of 12. The control group was given prosthetic stimulation and upper limb function rehabilitation training. Experimental group l received focal iTBS stimulation on M1 immediately followed by upper limb rehabilitation training. Experimental group 2 received the same treatment but in reverse order. The experiment lasted four weeks. Upper limb functioning and ability in the activities of daily living (ADL) were quantified before and after the interventions using the Fugl-Meyer upper extremity assessment (FMA-UE) and the modified Barthel index (MBI). Cortical latency (CL) was also recorded.Results:Before the treatment there were no significant differences among the three groups, but afterward a significant increase was observed in the average FMA-UE and MBI scores of both experimental groups accompanied by a significant decrease in CL. There was no significant difference between the two experimental groups′ results, on average.Conclusion:Supplementing upper limb rehabilitation training with iTBS can significantly improve the upper limb functioning of ischemic stroke survivors, and the sequencing of the training has no effect on the therapeutic results.

Intermittent theta burst stimulation of the cerebellum can improve the walking of stroke survivors with lower limb dysfunction / 中华物理医学与康复杂志

Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of a cerebellar hemisphere on the walking of stroke survivors with lower limb dysfunction, and to explore its possible mechanism.Methods:Thirty stroke survivors with walking dysfunction were randomly divided into an experimental group and a control group, each of 15. Before their daily routine rehabilitation, the control group received fake iTBS while the experimental group was given 600 pulses of iTBS over 200s. The experiment continued 5 days a week for 3 weeks. The Berg Balance Scale (BBS), the Fugl-Meyer lower extremity assessment (FMA-LE), the Modified Barthel Index (MBI) and Functional Ambulation Categories (FAC) were used before and after the treatment to evaluate the subjects′ balance, lower extremity motor function, walking and ability in the activities of daily living. Gait analysis was also performed. The amplitude of motor evoked potentials (MEPs) and the cortical silent period (CSP) were also noted to assess corticospinal excitability.Results:After the treatment, the average BBS, FMA-LE and MBI scores, FAC grading, stride length, stride speed, stride frequency, and the percentage of swing period in the walking cycle, as well as MEP amplitude and latency had improved significantly in the experimental group. All were then significantly better, on average, than in the control group. The control group also demonstrated significant improvement in all of the outcomes except the percentage of swing period in the walking cycle.Conclusion:iTBS of the cerebellum can improve the walking of stroke survivors with lower limb dysfunction. The mechanism may be related to the cerebellar regulation of spinal cord excitation of the cerebral cortex.

Intermittent Theta Burst Stimulation Attenuates Cognitive Deficits and Alzheimer's Disease-Type Pathologies via ISCA1-Mediated Mitochondrial Modulation in APP/PS1 Mice / 神经科学通报·英文版

Intermittent theta burst stimulation (iTBS), a time-saving and cost-effective repetitive transcranial magnetic stimulation regime, has been shown to improve cognition in patients with Alzheimer's disease (AD). However, the specific mechanism underlying iTBS-induced cognitive enhancement remains unknown. Previous studies suggested that mitochondrial functions are modulated by magnetic stimulation. Here, we showed that iTBS upregulates the expression of iron-sulfur cluster assembly 1 (ISCA1, an essential regulatory factor for mitochondrial respiration) in the brain of APP/PS1 mice. In vivo and in vitro studies revealed that iTBS modulates mitochondrial iron-sulfur cluster assembly to facilitate mitochondrial respiration and function, which is required for ISCA1. Moreover, iTBS rescues cognitive decline and attenuates AD-type pathologies in APP/PS1 mice. The present study uncovers a novel mechanism by which iTBS modulates mitochondrial respiration and function via ISCA1-mediated iron-sulfur cluster assembly to alleviate cognitive impairments and pathologies in AD. We provide the mechanistic target of iTBS that warrants its therapeutic potential for AD patients.

Clinical efficacy of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fracture / 中国脊柱脊髓杂志

Objectives:To explore the safety and early effectiveness of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fractures.Methods:The clinical data of 9 patients with single-segment thoracolumbar burst fracture treated with spinal canal decompression under full-endoscope and percutaneous pedicle screw fixation from April 2021 to June 2022 in our hospital were analyzed retrospectively,including 7 males and 2 females.The age ranged from 23 to 61(39.3±9.1)years old.According to AO classification,there were 6 cases of type A,2 cases of type B and 1 case of type C.Fracture segments were T12 in 2 cases,L1 in 3 cases,L2 in 3 cases,and L3 in 1 case.According to the classification of American Spinal Injury Association(ASIA)grading,there were 2 cases of type C,2 cases of type D,and 5 cases of type E.The decompression and percutaneous pedicle screw fixation were operated through the same incision in the injured vertebrae for screw placing.The operation-related indexes and complications were recorded.The patients'low back pain was evaluated by visual analogue scale(VAS)score before operation,on 3rd day after operation and at the last follow-up.The sagittal Cobb angle,height ratio of vertebral anterior edge,and the rate of spinal canal occupation were measured on spinal X-ray and CT images,and the recovery of neurological function was evaluated at the last follow-up.Results:All 9 patients successfully completed the operation,and the operative time was 105-145min(1 12.4± 21.2min),bleeding volume was 50-110mL(83.9±19.6mL),and hospitalization time was 7-13d(9.1±1.3d).No serious complications such as wound infection,cerebrospinal fluid leakage,aggravated nerve injury occurred.The follow-up time was 6-13months(8.4±3.9 months),all the fractures healed successfully,and the healing time was 3-6 months(4.7±1.6 months).The VAS score of low back pain on the 3rd day after operation and at final follow-up significantly improved compared with that before operation(P＜0.05),and it was also significantly improved at the last follow-up compared with that on the 3rd day after operation(P＜0.05).The Cobb angle,anterior height ratio of injured vertebrae,and invasion rate of spinal canal were significantly improved compared with those before operation(P＜0.05),respectively,but there was no statistical difference between the last follow-up and postoperative 3d(P＞0.05).One patient recovered from grade C to grade D of ASIA classification,while another three patients with neurological injury recovered completely.Conclusions:Decompression under full-endoscope and percutaneous pedicle screw fixation through the same incision in the injured vertebrae for screw placement in the treatment of single-level thoracolumbar burst fractures can obtain effective nerve root and spinal canal decompression,with good correction and small operative trauma,which is a safe and effective option.

Two new prenylated 2-arylbenzofurans from roots of Artocarpus heterophyllus and their anti-respiratory burst activities / 中国中药杂志

Two prenylated 2-arylbenzofurans were isolated from roots of Artocarpus heterophyllus, with a combination of various chromatographic approaches, including ODS, MCI, Sephadex LH-20, and semipreparative high performance liquid chromatography(HPLC). They were identified as 5-[6-hydroxy-4-methoxy-5,7-bis(3-methylbut-2-enyl)benzofuran-2-yl]-1,3-benzenediol(1) and 5-[2H,9H-2,2,9,9-tetramethyl-furo[2,3-f]pyrano[2,3-h][1]benzopyran-6-yl]-1,3-benzenediol(2) with spectroscopic methods, such as HR-ESI-MS, IR, 1D NMR, and 2D NMR, and named artoheterins B(1) and C(2), respectively. The anti-respiratory burst activities of the two compounds were evaluated with rat polymorphonuclear neutrophils(PMNs) stimulated by phorbol 12-myristate 13-acetate(PMA). The results showed that 1 and 2 exhibited significant inhibitory effect on respiratory burst of PMNs with IC_(50) values of 0.27 and 1.53 μmol·L~(-1), respectively.

Microstructure and mechanical properties of hernia mesh / 国际生物医学工程杂志

Objective:The microstructure, tensile strength, and bursting strength of different brands of hernia meshes were compared and analyzed through experiments to evaluate the performance of different meshes.Methods:The balance and microscope were used to test the weight and microstructure of 15 common meshes and the tensile testing machine and burst testing machine were used to test the tensile and bursting properties of the mesh, and the mechanical properties of the mesh were analyzed.Results:The woven structures of the mesh are diamond, polygon and circle. The average weight of inguinal meshes is 0.08 mg/mm 2, and the average weight of abdominal wall hernia meshes is 0.18 mg/mm 2. The wire diameters of G3 - G6 meshes are larger, while the mesh opening ratio of G12 is lower. In the tensile performance test, it is known that G15 has the highest tensile strength, G12 and G14 have lower tensile strengths in lightweight meshes, and G1, G2, and G7 have lower tensile strengths in lightweight meshes. In the burst performance test, it is known that G3, G9, and G15 have the highest burst strength, while G12, G13, and G14 have the lowest burst strength in lightweight meshes. G1, G2, and G4 have the lowest burst strength in lightweight meshes. Conclusions:The mesh with a polygonal mesh and a large mesh opening ratio has better mechanical properties. The results of this study provide experimental evidence for optimizing hernia meshes, which is expected to provide better support for related research and applications.

The effects of supplementing theta burst stimulation of the cerebellum with physical therapy on balance and gait recovery after a stroke: A randomized clinical trial / 中华物理医学与康复杂志

Objective:To explore any effect of combining intermittent theta-burst stimulation (iTBS) of the cerebellum with physiotherapy on the balance function and gait of stroke survivors.Methods:Thirty-two hemiplegic stroke survivors were divided at random into a treatment group and a control group, each of 16. Both groups received conventional physical therapy. Before their physiotherapy sessions the treatment group received iTBS treatment of the cerebellar hemisphere contralateral to the affected cerebral hemisphere, while the control group was given pseudo-stimulation on the same site. The iTBS was given once a day for 200s each time, 6 times a week for 3 weeks consecutively. Before and after the treatment, as well as 3 weeks later, both groups′ balance was evaluated using the Berg Balance Scale (BBS). Their ability to shift their center of gravity, total length of their shaking trajectory, and maximum shaking diameter were also quantified. Walking ability was assessed using 10m walk test (10MWT) times and the Tinetti Gait Assessment Scale (POMA-G). Lower limb motor function was quantified using the relevant Fugl-Meyer assessment (FMA-LE) and the subjects′ ability in the activities of daily living was measured with the Barthel index (BI).Results:After the 3 weeks of treatment and at the follow-up the average BBS score of the treatment group had improved significantly more than the control group′s average, as had its total track length and maximum shake diameter. The average POMA-G, FMA-LE and BI scores of the treatment group were also significantly better.Conclusions:Combining iTBS with physiotherapy can improve the balance and gait of stroke survivors more effectively than physiotherapy alone.

The effects of intermittent theta burst stimulation at different side of the cerebellar hemisphere on swallowing in healthy subjects / 中华物理医学与康复杂志

Objective:To observe any stimulatory effect of intermittent theta burst stimulation (iTBS) on the cerebral swallowing cortex and the cerebellar swallowing motor area and to explore the related mechanisms.Methods:Forty-four healthy right-handed subjects were divided at random into a dominant cerebellum group ( n=15), a non-dominant cerebellum group ( n=15) and a control group ( n=14). In the dominant cerebellum group, iTBS was administered to the cerebellum of the dominant hemisphere, and the other hemisphere was given sham stimulation. In the non-dominant cerebellum group, it was the opposite. The dominant cerebellum received the sham stimulation. In the control group both hemispheres received sham stimulation. Before and after the stimulation, single-pulse transcranial magnetic stimulation (TMS) was applied to the representative regions of suprahyoid muscles in bilateral brain and cerebellum to observe changes of the latency and amplitude of motor evoked potentials (MEPs). Results:After the intervention the MEP amplitude of the bilateral swallowing cortex and the stimulated cerebellum had increased in the non-dominant cerebellum group, with increased MEP amplitude only from the stimulated cerebellum of the dominant cerebellum group. Compared with the control group, the non-dominant cerebellum group showed the greatest improvement in MEP amplitude of the stimulated bilateral cerebral cortex and cerebellum. Improvement in the dominant cerebellum group was significantly smaller. However, there were no significant differences in MEP latency or the percentage change in MEP latency from baseline among the three groups.Conclusions:Applying iTBS to either the non-dominant or the dominant cerebellum excites the brain areas related to swallowing, but in different ways.

Efficacy of theta burst stimulation in treatment of stroke-related insomnia / 中风与神经疾病杂志

@#Objective To investigate the therapeutic effect of continuous theta burst stimulation (cTBS) for stroke-related insomnia. Methods Sixty patients with subacute cerebral infarction were evaluated for sleep disorders using the Pittsburgh Sleep Quality Index (PSQI,global score>7 indicating sleep disturbances). They were divided randomly into drug therapy group and combined treatment group. The drug treatment group was given zolpidem 10 mg orally,and the combined treatment group was given oral zolpidem 5 mg plus cTBS to the right dorsolateral prefrontal lobe and parieto-occipital region. The efficacy of cTBS for stroke-related insomnia was determined by comparing the two groups in terms of time to zolpidem withdrawal,zolpidem withdrawal rate within two weeks,PSQI score reduction rate,and the changes of National Institutes of Health Stroke Scale (NIHSS) score,Hamilton Depression Scale (HAMD) score,and Hamilton Anxiety Scale (HAMA) score. Results Compared with the drug treatment group,the combined treatment group showed a significantly shorter time to zolpidem withdrawal and a significantly higher zolpidem withdrawal rate within two weeks(P<0.05). For both groups,NIHSS,HAMD,and HAMA scores improved with the course of treatment,without significant differences between the two groups at the same follow-up time. However,the interaction P-value was statistically significant,which indicated that HAMD and HAMA scores of the two groups would differ over time. Conclusion cTBS has significant benefits in the treatment of stroke-related insomnia,moderately improving patients'anxiety and depression.

Effect of intermittent theta burst transcranial magnetic stimulation on non-fluent aphasia after stroke / 中国康复理论与实践

ObjectiveTo explore the therapeutic effect and mechanism of intermittent theta burst transcranial magnetic stimulation (iTBS) on non-fluent aphasia after stroke. MethodsFrom August, 2021 to August, 2022, 50 patients with non-fluent aphasia after stroke in the First People's Hospital of Lianyungang were randomly divided into sham stimulation group (n = 25) and iTBS group (n = 25). Both groups accepted speach training. iTBS group accepted iTBS, and the sham stimulation group received sham iTBS, for four weeks. The serum brain-derived neurotrophic factor (BDNF) was measured, and they were assessed by China Rehabilitation Research Center Standard Aphasia Examination (CRRCAE) and Boston Diagnostic Aphasia Examination before and after treatment. ResultsTwo cases in the sham stimulation group and three cases in iTBS group dropped down. The BDNF level, and listen and understand, repeat, name, read aloud, and total score of CRRCAE improved in two groups after treatment (|t| > 5.012, P < 0.001); and they were better in iTBS group than in the sham stimulation group (|t| > 3.968, P < 0.001). The total effective rate was more in iTBS group than in the sham stimulation group (χ2 = 8.835, P < 0.05). ConclusioniTBS can improve speech function in patients with non-fluent aphasia after stroke, which may associate with the promotion of BDNF.

Angelica sinensis polysaccharide promotes stress erythropoiesis in mice caused by 5-FU / 中国药理学通报

Aim To investigate the effects of angelica sinensis polysaccharide (ASP) antagonizing 5-fluorou-raeil (5-FU) on spleen stress erythropoiesis in mice and its related mechanism. Methods C57BL/6J mice aged 6-8 weeks were randomly divided into control group, ASP group, 5-FU group and ASP + 5-FU group. The mouse body weight during the modeling pe-riod was recorded, and peripheral blood routine and the number of mononuclear cells in the bone marrow of femur were measured. Histopathology of spleen was de-tected, also the index and cellularity of spleen were analyzed. BFU-E of spleen mononuclear cells was counted. The number of F4/80

Evaluation of the efficacy of posterior reduction and internal fixation for thoracolumbar burst fractures with Load-sharing classification score of 7 and 8 / 中国脊柱脊髓杂志

Objectives:To investigate the clinical efficacy and safety of posterior reduction and fixations in patients with thoracolumbar burst fractures with Load-sharing classification(LSC)score of 7 and 8 points.Methods:The data of 36 patients with LSC score of 7 and 8 who underwent posterior reduction and internal fixation between October 2009 and December 2014 were retrospectively analyzed.There were 21 males and 15 females,with an average age of 42.67±14.67 years(range 21 to 67 years).The fractured vertebrae were T12-Ll.LSC score was graded according to the imaging data including X-ray radiographs,CT and MRI.The index vertebral Cobb angle and anterior vertebral height were collected at preoperative,postoperative 1 week and final follow-up,respectively.Visual analogue scale(VAS)was used to evaluate residual back pain at final follow-up.The complications were recorded for safety evaluation.Results:All the patients were followed up for 49.83±18.20 months on average(23-86 months),of which 19 cases had internal fixations removed,and the follow-up period for patients after internal fixation removal was 28.00±20.12 months on average(3-69 months).Fracture healing was achieved in all the patients without significant residual pain,or broken screw or rod,or significant kyphosis,or pedicle screw cutting vertebral body or loosening of the internal fixation.For imaging evaluation,the postoperative sagittal Cobb angle was significantly improved to 6.67°±5.06° from the preoperative 15.87°±8.35°,and the postoperative height of anterior margin of the fractured vertebral body recovered to 2.88±0.32cm from 1.81±0.49cm before operation,all with statistically significant differences(P＜0.05).The vertebral body height at the final follow-up was 2.81±0.41cm,and there was no statistically significant difference between postoperative and the final follow-up vertebral body heights(P＞0.05).At the final follow-up,the neurological functions of all the patients recovered compared with the conditions at the time of injury,with no loss of intervertebral space height.The anterior edge height of the vertebral body recovered to(94.92±18.41)％,the middle edge height recovered to(81.16±11.82)％,and the posterior edge height recovered to(97.48±7.63)％,all with significant differences compared to those before surgery(P＜0.05).Conclusions:The posterior reduction and internal fixation for patients with thoracolumbar burst fracture with LSC scores of 7 and 8 can achieve good preservation of vertebral stability at later stage,high safety,and satisfactory clinical efficacy and imaging results.

A CLINICAL STUDY OF ABDOMINAL WOUND DEHISCENCE

INTRODUCTION:-AWD (abdominal wound dehiscence) is a word that is widely used to describe the separation of different layers of an abdominal wound before it has healed completely. Acute laparotomy wound failure and burst abdomen are two more words that are used interchangeably. Wound dehiscence happens when a wound does not develop the necessary strength to withstand the demands exerted on it. Dehiscence happens when sutures are disrupted by external pressures, absorbable sutures dissolve too quickly, or tight sutures rip through tissues due to excessive strain. AWD has been a long-standing problem for which no surgical unit has offered a complete solution (i.e. none of the surgical units worldwide has reported 0 percent failure rate). However, numerous institutes around the world have been successful in achieving and maintaining failure rates considerably below 1%. These ?gures, on the other hand, do not deter researchers from continuing their efforts to solve the problem. In the last ten years, there have been a slew of publications attempting to explain how to solve this problem. The goal of this study is to assess the prevalence of abdominal wound dehiscence in relation to various risk factors, co-morbidities, and treatment options. The study aimed at ?nding out the AIM:- prevalence of abdominal wound dehiscence with respect to demographic factors, nature of preceding surgery and different risk factors and also to study the effective management of abdominal wound dehiscence. An Observational study METHODS:- on 60 patients comprising all patients admitted to Silchar medical College and Hospital a tertiary care center in Assam within the study period of 1st January 2021 to 31st July 2021 with diagnosed abdominal wound Dehiscence after undergoing surgical interventions. :-The majority of the patients in this study were between the ages of 41 and 50. Majority were male. RESULTS 81.67% were operated as emergency surgery. 66.67% have undergone procedures which are classi?ed as contaminated. (80%) were operated with mid line incision. 58% patients with peritonitis due to hollow viscus perforation. 58.33% had hypoalbuminemia. Malnutrition, DM, HT, pulmonary diseases, anemia etc. are important risk factors for wound dehiscence. CONCLUSION:-Because of the poor blood supply at Linea Alba, individuals who had a midline laparotomy had a higher risk of wound dehiscence than those who had a paramedian laparotomy. Wound dehiscence is more likely in people with a BMI greater than 25, compared to those with a BMI less than 25. In this study wound dehiscence is mainly associated with complications like hypoproteinemia and pulmonary complications and anaemia.

Strategies of microspheres and in situ forming gel implants in long-acting and research progress in controlling burst release / 中国药科大学学报

@#Long-acting injectables(LAIs) play an important role in the field of drug preparation research because they can control drug release for a long time and decrease dosing frequency. In this review, two types of LAIs, including injectable microspheres and in situ forming gel implants, were used as the breakthrough point to analyze the strategies and technologies used in the formulation and process to achieve long-acting drug release.At the same time, in view of the common burst release phenomenon, the relevant coping strategies in the current research were summarized, which provides some reference for the design, development and optimization of such long-acting preparations.

Effects of intermittent theta-burst stimulation on functional connectivity in patients with mild cognitive impairment / 中华行为医学与脑科学杂志

Objective:To investigate the effects of single intermittent theta-burst stimulation on functional connectivity in patients with mild cognitive impairment(MCI).Methods:From July to November 2020, forty MCI patients were selected and randomly divided into iTBS true stimulation group and iTBS sham-stimulation group, with 20 patients in each group.iTBS targeted the left dorsolateral prefrontal cortex (DLPFC). Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), activity of daily living scale(ADL), Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were evaluated at baseline.The resting state electroencephalography (rsEEG) was collected for 5 minutes before and after iTBS in the two groups.The phase lag index(PLI) of EEG functional connectivity was calculated, and the functional connectivity matrix diagram was drawn.SPSS 26.0 software was used for statistical analysis.Data were statistically analyzed by χ2 test, Wilcoxon rank sum test and independent sample t-test. Results:There were no significant differences in scores of MoCA, ADL, HAMD and HAMA between the two groups(all P>0.05). In the iTBS true stimulation group, compared with that before iTBS treatment(0.140(0.133, 0.144)), the PLI of β band increased significantly after iTBS treatment(0.146(0.136, 0.167))( P<0.05). The region of increased PLI was mainly concentrated in the central region(C3/C4-T7/T8). Compared with that before iTBS treatment(0.251(0.232, 0.299)), the PLI of α band increased after iTBS treatment(0.286(0.241, 0.359)), but the difference was not statistically significant( P>0.05). Conclusion:Single iTBS treatment can significantly increase the EEG functional connectivity in patients with MCI, indicating that iTBS targeting the left DLPFC can effectively regulate the EEG functional connectivity in patients with MCI, which may reveal the mechanism of iTBS in improving cognitive function in patients with MCI.

Effects of interhemispheric multi-target intermittent theta burst stimulation on upper limb function in patients with stroke / 中国康复理论与实践

ObjectiveTo investigate the effect of intermittent theta burst stimulation (iTBS) of the multi-target cerebral cortex after stroke on functional recovery of the upper limb of the hemiplegic side. MethodsFrom November, 2019 to August, 2020, 40 stroke patients in Gansu Provine Hospital Rehabilitation Center were included and randomly divided into single-target stimulation group (n = 20) and multiple-target stimulation group (n = 20). Both groups underwent basic neurorehabilitation drug therapy and conventional rehabilitation exercises. The single-target stimulation group received repetitive transcranial magnetic stimulation (rTMS) (iTBS mode) only in the primary motor cortex (M1) of the affected side. The multi-target stimulation group received rTMS (iTBS mode) in the cerebellar cortex of the healthy brain and M1 of the affected side, once a day, six days a week, for four weeks. Before and after treatment, the scores of Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and modified Barthel Index (MBI), and the latency and amplitude of somatosensory-evoked potentials N20 were compared. ResultsNo serious adverse reaction occurred during treatment. After treatment, the scores of FMA-UE, MBI and ARAT, and the amplitude and latency of N20 improved in both groups (|t| > 3.478, |Z| > 2.243, P < 0.05); and the scores of FMA-UE and ARAT, and the amplitude of N20 were better in the multiple-target stimulation group than in the single-target stimulation group (t > 2.939, Z = -2.697, P < 0.01). ConclusionMulti-target stimulation is superior to single-target stimulation for improving upper limb motor function and N20 amplitude in the hemiplegics after stroke.

Intermittent theta burst stimulation can improve the spatially-delayed responses of working memory / 中华物理医学与康复杂志

Objective:To observe any effect of intermittent theta burst stimulation (iTBS) on the spatially-delayed responses of working memory using cynomolgus macaques.Methods:The working memory of six male cynomolgus macaques (8-9 years old) was trained using a spatially-delayed response task. They were then randomly divided into an iTBS group and a control group, each of 3. The iTBS group was given iTBS at an intensity of 35% of the maximum output, with 2 seconds of stimulation followed by 8 seconds of rest with trains of 50Hz bursts repeated at a frequency of 5Hz over a period of 192 seconds once daily for 5 days, while the control group was given sham iTBS. Before and after the 5 days, the body weight and working memory of each animal were evaluated. The total number of effective feeding episodes, and of effective feeding episodes with short and long delay periods were recorded.Results:There was no significant change in the average body weight of either group before and after the modeling and iTBS intervention. After the intervention the number of total effective feeding cases and those with a short delay period were both significantly higher in the iTBS group than in the control group. However, no significant inter-group differences in the effective feeding cases with a long delay period were observed.Conclusions:iTBS is effective in improving the spatially-delayed responses of working memory, at least in cynomolgus macaques.

Enfermedad granulomatosa crónica: fisiopatología genética y molecular. Pruebas diagnósticas vigentes / Chronic granulomatous disease: genetic and molecular pathophysiology. Effective diagnostic tests

Introducción: La enfermedad granulomatosa crónica es una inmunodeficiencia primaria congénita del sistema inmune innato, originada por defectos en el complejo enzimático nicotinamida adenina dinucleótido fosfato oxidasa presente en células fagocíticas. Estos defectos funcionales causan incapacidad para producir especies reactivas del oxígeno en los fagocitos, que afectan la eliminación de algunos microorganismos patógenos dentro del fagolisosoma. El diagnóstico de esta enfermedad se realiza actualmente mediante la prueba de 1,2,3-dihidrorodamina asistida por citometría de flujo multiparamétrica, o la tinción de fagocitos con nitroazul de tetrazolio asistida por microscopio óptico. Objetivos: Describir los aspectos fisiopatológicos y moleculares de la enfermedad granulomatosa crónica; y discutir aspectos relacionados con las pruebas de diagnóstico antes mencionadas. Métodos: Se realizó una investigación bibliográfica-documental a partir de artículos científicos publicados desde 1933 hasta 2018, para ello fueron consultadas las bases de datos SciELO, PubMed y Springer. Desarrollo: Se exponen las características fisiopatológicas de la enfermedad granulomatosa crónica, así como la relación entre las mutaciones genéticas más abundantes en la población afectada y la gravedad de las manifestaciones clínicas que presentan los pacientes. Además, se analizan críticamente los beneficios y las deficiencias de dos técnicas que se utilizan actualmente para diagnosticar la enfermedad. Conclusiones: La enfermedad granulomatosa crónica puede generar consecuencias inmunológicas e inflamatorias graves, que se hallan en consonancia con las características genéticas expresadas en el complejo enzimático dañado. El diagnóstico de la enfermedad resulta más confiable, exhaustivo y específico, mediante la citometría de flujo y su prueba de 1,2,3-dihidrorodamina(AU)

Introduction: Chronic granulomatous disease is a congenital primary immunodeficiency of the innate immune system, caused by defects in the nicotinamide adenine dinucleotide phosphate oxidase enzyme complex present in phagocytic cells. These functional defects cause inability to produce reactive oxygen species in phagocytes, affecting the elimination of some pathogenic microorganisms within the phagolysosome. The diagnosis of this disease is currently made by means of the 1,2,3-dihydrorodamine test assisted by multiparametric flow cytometry, or the staining of phagocytes with nitro-blue tetrazolium assisted by light microscopy. Objectives: To characterize molecular and pathophysiologically the chronic granulomatous disease; and to discuss aspects related to the aforementioned diagnostic tests. Methods: In this work, a bibliographic-documentary research was carried out from scientific articles published from 1933 to 2018, for which the SciELO, PubMed and Springer databases were consulted. Development: The pathophysiological characteristics of chronic granulomatous disease are exposed, as well as the relationship between the most abundant genetic mutations in the affected population, and the severity of the clinical manifestations presented by the patients. In addition, the benefits and deficiencies of two techniques currently used to diagnose the disease are critically analyzed. Conclusions: Chronic granulomatous disease can generate severe immunological and inflammatory consequences, which are in line with the genetic characteristics expressed in the damaged enzyme complex. The diagnosis of the disease is more reliable, exhaustive and specific, using flow cytometry and its 1,2,3-dihydrorodamine test(AU)

Theta burst stimulation can relieve dysphagia and cognitive impairment / 中华物理医学与康复杂志

Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of the prefrontal lobe on dysphagia and impaired cognition, and to explore the neural mechanisms involved.Methods:Twenty-eight patients with dysphagia and mild cognitive impairment were randomly divided into an iTBS group of 16 and a control group of 11. The iTBS group received 20 minutes of iTBS (2 seconds on and 8 seconds off) of the right dorsal lateral prefrontal cortex (DLPFC) once daily for 2 weeks, with the intensity at 80% of the resting movement threshold of the right abductor pollicis brevis, while the control group was given sham iTBS. Before and after the treatment, both groups′ cognitive functioning was evaluated using the Montreal Cognitive Assessment Scale (MoCA), a trial marking test, a digit span test and a Stroop color word test. Video-fluoroscopy was used to record oral transmission times (OTTs), hyoid bone anterior displacement and hyoid bone upward displacement during swallowing. Resting-state functional magnetic resonance imaging measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo) and functional connectivity in the patients′ brains.Results:Before the treatment there was no significant difference in the average indices of cognition or swallowing function between the 2 groups. Afterward the average MoCA score had increased significantly in both groups, with the improvement in the iTBS group significantly greater than that of the controls. Average OTT had shortened significantly in both groups, with significantly greater improvement in the iTBS group. The magnetic resonance imaging showed that after iTBS treatment, local excitation indicators and functional connections in several brain regions had changed. ALFF and ReHo in the right anterior cuneus had increased, ReHo in the left middle temporal gyrus, the orbital region of the left inferior frontal gyrus and the left middle cingulate gyrus had decreased, and functional connectivity in the right DLPFC, the bilateral cuneus and the right middle cingulate gyrus had increased.Conclusions:Two weeks of intermittent TBS of the right DLPFC can improve the swallowing and cognition of persons with dysphagia. Functional reorganization of brain networks may be one of the neural mechanisms involved.