¬Transcranial direct current stimulation improves sleep quality in patients with insomnia after traumatic brain injury.

INTRODUCTION: Insomnia is a serious problem after traumatic brain injury (TBI) and partially improves via sleeping pills. We investigated the efficacy of transcranial direct current stimulation (tDCS) with a focus on the role of age and gender. MATERIALS AND METHODS: In a randomized double-blind clinical trial, 60 eligible TBI-induced insomnia patients were assigned to real and sham tDCS groups and were treated for three weeks. Sham but not real tDCS took sleeping pills for the first three weeks of the study and then used the placebo until the end of the study. The placebo was used by the real-tDCS group throughout the study. Sleep quality and insomnia severity were respectively evaluated by Pittsburg Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) at three time points. RESULTS: Real tDCS group reported lower mean ISI and PSQI scores at 3 weeks post treatment onset and maintained this decline for six weeks post treatment onset (P < 0.001). In younger participants and those identified as men, the treatment-induced attenuation of the mean PSQI score was reported higher and more lasting in real than sham tDCS groups. CONCLUSION: Gender and age-specific tDCS protocols may be warranted to optimize the therapeutic effect of tDCS.

Animal Kernicterus Models: Progress and Challenges.

Kernicterus is a leading cause of neonatal death throughout the world, especially in low-middle-income countries. It is developed by an unconjugated hyperbilirubinemia in the blood and brain tissue, triggering pathological processes that spawn neurotoxicity and neurodegeneration. However, the biological mechanism (s) of bilirubin-induced neurotoxicity and Kernicterus development remain to be well elucidated. Likewise, a practical therapeutic approach for human Kernicterus has yet to be found. Undoubtedly, animal models of Kernicterus can be helpful in the identification of underlying biological processes of hyperbilirubinemia evolution to Kernicterus, as well as the evaluation of various treatments efficacy in preclinical studies. More importantly, establishing an animal model that can mimic the Kernicterus and its behavioral, neuro-histological, and hematological manifestations is a severe priority in preclinical studies. So far, several Kernicterus animal models have been established that could partially mimic one or more clinical and paraclinical signs of human Kernicterus. The present study aimed to review all methods modeling Kernicterus with a focus on their potentials and shortcomings and subsequently provide the optimal methods for an ideal Kernicterus animal model.

A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common peripheral nerve disorder of the wrist. Nonsurgical treatments e.g. laser therapy may cause potential beneficial effects. AIM: To compare the dose dependent effects of low level laser therapy (LLLT) and high intensity laser therapy (HILT) on pain and electrophysiology studies in patients with CTS. DESIGN: Double-blind randomized controlled trial. SETTING: Outpatient physiotherapy clinic. POPULATION: Ninety-eight participants with CTS, aged between 20 to 60 years, were randomly assigned to five groups. METHODS: All participants undertook four standard exercises, with one group serving as exercise-only controls. Patients were randomly allocated to either high or low fluence LLLT or high or low fluence HILT received over 5 sessions. All patients were assessed by visual analogue scale, median compound muscle action potential (CMAP) and sensory nerve conduction studies before and 3 weeks after the interventions. RESULTS: VAS was significantly lower in all groups after 3 weeks (P<0.05). CMAP latency decreased in all groups. The interaction of group and time (5×2) was significant for pain (P<0.001), the latency of CMAP (P=0.001) and CMAP amplitude (P=0.02). The interaction of group and time was not significant for the CMAP conduction velocity, sensory nerve latency and amplitude (P>0.05). CONCLUSIONS: HILT with a power of 1.6 W and low fluence of 8 J/cm2 was superior in reduction of pain and improvement of the median motor nerve electrophysiological studies compared to LLLT and exercise-only control groups. CLINICAL REHABILITATION IMPACT: LLLT and HILT in conjunction with exercise program are effective in reducing pain and improving median motor nerve conduction studies of the patients with CTS. It seems that high power and low fluence laser therapy is better than LLLT and exercise interventions to treat these patients.

Ability of serum C-reactive protein and white blood cell cout in predicting acute schemic stroke. A short -term follow-up study.

BACKGROUND: Stroke is one of the leading causes of mortality and long-term morbidity. The aim of the present study was to determine the ability of baseline serum C-reactive protein (CRP) and white blood cell count (WBC) values in predicting the outcome of acute ischemic stroke (AIS). METHODS: This study consisted of patients with first AIS referred to Poursina Hospital, Rasht, Iran. Severity of stroke was determined according to the National Institute of Health (NIH) Stroke Scale at the time of admission. Serum CRP levels and WBC count were measured at the time of admission. All patients were followed-up for 90 days after discharge and the severity of stroke was assessed using modified Rankin Scale. Receiver operating characteristic curve analysis was used for calculating the most appropriate cutoff point of CRP and WBC count for differentiating patients with and without poor outcome at the end of the study period. RESULTS: A total of 53 out of 102 patients (52%) had poor outcome. The most appropriate cutoff value for CRP in differentiating patients with and without poor outcome was 8.5mg/l (sensitivity: 73.1%, specificity: 69.4%) and for WBC the difference did not reach to a significant level. The cutoff points of CRP > 10.5 mg/ml yielded a predictive ability at sensitivity: 75%, specificity: 63.8% whereas predictive ability of WBC for mortality was at a borderline level. CONCLUSION: These findings indicate that high levels of serum CRP in AIS at the time of admission is associated with poor prognosis. However, this study found no ability for WBC in predicting AIS outcome.