Effects of parietal repetitive transcranial magnetic stimulation in prolonged disorders of consciousness: A pilot study.

Objective: Although the parietal cortex is related to consciousness, the dorsolateral prefrontal and primary motor cortices are the usual targets for repetitive transcranial magnetic stimulation (rTMS) for prolonged disorders of consciousness (pDoC). Herein, we applied parietal rTMS to patients with pDoC, to verify its neurobehavioral effects and explore a new potential rTMS target. Materials and methods: Twenty-six patients with pDoC were assigned to a rTMS or sham group. The rTMS group received 10 sessions of parietal rTMS; the sham group received 10 sessions of sham stimulation. The Coma Recovery Scale-Revised (CRS-R) and event-related potential (ERP) were collected before and after the 10 sessions or sham sessions. Results: After the 10 sessions, the rTMS group showed: a significant CRS-R score increase; ERP appearance of a P300 waveform and significantly increased Fz amplitudes; increased potentials on topographic mapping, especially in the left prefrontal cortex; and an increase in delta and theta band powers at Fz, Cz, and Pz. The sham group did not show such changes in CRS-R score or ERP results statistically. Conclusion: Parietal rTMS shows promise as a novel intervention in the recovery of consciousness in pDoC. It showed neurobehavioral enhancement of residual brain function and may promote frontal activity by enhancing frontal-parietal connections. The parietal cortex may thus be an alternative for rTMS therapy protocols.

An update on noninvasive neuromodulation in the treatment of patients with prolonged disorders of consciousness.

BACKGROUND: With the improvement of emergency techniques, the survival rate of patients with severe brain injury has increased. However, this has also led to an annual increase in the number of patients with prolonged disorders of consciousness (pDoC). Hence, recovery of consciousness is an important part of treatment. With advancing techniques, noninvasive neuromodulation seems a promising intervention. The objective of this review was to summarize the latest techniques and provide the basis for protocols of noninvasive neuromodulations in pDoC. METHODS: This review summarized the advances in noninvasive neuromodulation in the treatment of pDoC in the last 5 years. RESULTS: Variable techniques of neuromodulation are used in pDoC. Transcranial ultrasonic stimulation (TUS) and transcutaneous auricular vagus nerve stimulation (taVNS) are very new techniques, while transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) are still the hotspots in pDoC. Median nerve electrical stimulation (MNS) has received little attention in the last 5 years. CONCLUSIONS: Noninvasive neuromodulation is a valuable and promising technique to treat pDoC. Further studies are needed to determine a unified stimulus protocol to achieve optimal effects as well as safety.

Structural and functional changes in the brain after chronic complete thoracic spinal cord injury.

This study aimed to investigate whether brain anatomical structures and functional network connectivity are altered after chronic complete thoracic spinal cord injury (cctSCI) and to determine how these changes impact clinical outcomes. Structural and resting-state functional MRI was performed for 19 cctSCI patients (18 for final statistics) and 19 healthy controls. Voxel-based morphometry (VBM) was used to assess gray matter volume (GMV) with differences between cctSCI patients and controls. VBM results were used as seeds for whole-brain functional connectivity (FC) analysis. The relationship between brain changes and clinical variables was investigated. Compared with those of the control group, the left triangular inferior frontal gyrus, middle frontal gyrus, orbital inferior frontal gyrus, precuneus and parietal superior gyrus volumes of SCI patients decreased, while the left superior frontal gyrus and supplementary motor area volumes increased. Additionally, when the regions with increased GMV were used as seeds, the FC of the parahippocampus and thalamus increased. Subsequent partial correlation analysis showed a positive correlation between FC and total sensorimotor score based on the ASIA criteria (p = 0.001, r = 0.746). Overall, the structural and functional changes in the brain after cctSCI occurred in some visual and cognitive areas and sensory or motor control areas. These findings aid in improving our understanding of the underlying brain injury mechanisms and the subsequent structural and functional reorganization to reveal potential therapeutic targets and track treatment outcomes.

A Comparison of the Neuromodulation Effects of Frontal and Parietal Transcranial Direct Current Stimulation on Disorders of Consciousness.

Frontal transcranial direct current stimulation (tDCS) and parietal tDCS are effective for treating disorders of consciousness (DoC); however, the relative efficacies of these techniques have yet to be determined. This paper compares the neuromodulation effects of frontal and parietal tDCS on DoC. Twenty patients with DoC were recruited and randomly assigned to two groups. One group received single-session frontal tDCS and single-session sham tDCS. The other group received single-session parietal tDCS and single-session sham tDCS. Before and after every tDCS session, we recorded coma recovery scale-revised (CRS-R) values and an electroencephalogram. CRS-R was also used to evaluate the state of consciousness at 9-12-month follow-up. Both single-session frontal and parietal tDCS caused significant changes in the genuine permutation cross-mutual information (G_PCMI) of local frontal and across brain regions (p < 0.05). Furthermore, the changes in G_PCMI values were significantly correlated to the CRS-R scores at 9-12-month follow-up after frontal and parietal tDCS (p < 0.05). The changes in G_PCMI and CRS-R scores were also correlated (p < 0.05). Both frontal tDCS and parietal tDCS exert neuromodulatory effects in DoC and induce significant changes in electrophysiology. G_PCMI can be used to evaluate the neuromodulation effects of tDCS.

Prebiotics modulate the microbiota-gut-brain axis and ameliorate cognitive impairment in APP/PS1 mice.

PURPOSE: Prebiotics, including fructo-oligosaccharides (FOS) and galacto-oligosaccharides (GOS), stimulate beneficial gut bacteria and may be helpful for patients with Alzheimer's disease (AD). This study aimed to compare the effects of FOS and GOS, alone or in combination, on AD mice and to identify their underlying mechanisms. METHODS: Six-month-old APP/PS1 mice and wild-type mice were orally administered FOS, GOS, FOS + GOS or water by gavage for 6 weeks and then subjected to relative assays, including behavioral tests, biochemical assays and 16S rRNA sequencing. RESULTS: Through behavioral tests, we found that GOS had the best effect on reversing cognitive impairment in APP/PS1 mice, followed by FOS + GOS, while FOS had no effect. Through biochemical techniques, we found that GOS and FOS + GOS had effects on multiple targets, including diminishing Aß burden and proinflammatory IL-1ß and IL-6 levels, and changing the concentrations of neurotransmitters GABA and 5-HT in the brain. In contrast, FOS had only a slight anti-inflammatory effect. Moreover, through 16S rRNA sequencing, we found that prebiotics changed composition of gut microbiota. Notably, GOS increased relative abundance of Lactobacillus, FOS increased that of Bifidobacterium, and FOS + GOS increased that of both. Furthermore, prebiotics downregulated the expression levels of proteins of the TLR4-Myd88-NF-κB pathway in the colons and cortexes, suggesting the involvement of gut-brain mechanism in alleviating neuroinflammation. CONCLUSION: Among the three prebiotics, GOS was the optimal one to alleviate cognitive impairment in APP/PS1 mice and the mechanism was attributed to its multi-target role in alleviating Aß pathology and neuroinflammation, changing neurotransmitter concentrations, and modulating gut microbiota.

Early Mobilization for Critically Ill Patients.

Advances in the field of critical care medicine have helped improve the survival rate of these ill patients. Several studies have demonstrated the potential benefits of early mobilization as an important component of critical care rehabilitation. However, there have been some inconsistent results. Moreover, the lack of standardized mobilization protocols and the associated safety concerns are a barrier to the implementation of early mobilization in critically ill patients. Therefore, determining the appropriate modalities of implementation of early mobilization is a key imperative to leverage its potential in these patients. In this paper, we review the contemporary literature to summarize the strategies for early mobilization of critically ill patients, assess the implementation and validity based on the International Classification of Functioning, Disability and Health, as well as discuss the safety aspects of early mobilization.

Neurofunctional Correlates of Activities of Daily Living in Patients with Posterior Cortical Atrophy.

BACKGROUND: Research on posterior cortical atrophy (PCA) has focused on cognitive decline, especially visual processing deficits. However, few studies have examined the impact of PCA on activities of daily living (ADL) and the neurofunctional and neuroanatomic bases of ADL. OBJECTIVE: To identify brain regions associated with ADL in PCA patients. METHODS: A total of 29 PCA patients, 35 typical Alzheimer's disease (tAD) patients, and 26 healthy volunteers were recruited. Each subject completed an ADL questionnaire that included basic and instrumental subscales (BADL and IADL, respectively), and underwent hybrid magnetic resonance imaging and 18F fluorodeoxyglucose positron emission tomography. Voxel-wise regression multivariable analysis was conducted to identify specific brain regions associated with ADL. RESULTS: General cognitive status was similar between PCA and tAD patients; however, the former had lower total ADL scores and BADL and IADL scores. All three scores were associated with hypometabolism in bilateral parietal lobes (especially bilateral superior parietal gyri) at the whole-brain level, PCA-related hypometabolism level, and PCA-specific hypometabolism level. A cluster that included the right superior parietal gyrus showed an ADL×group interaction effect that was correlated with the total ADL score in the PCA group (r = -0.6908, p = 9.3599e-5) but not in the tAD group (r = 0.1006, p = 0.5904). There was no significant association between gray matter density and ADL scores. CONCLUSION: Hypometabolism in bilateral superior parietal lobes contributes to a decline in ADL in patients with PCA and can potentially be targeted by noninvasive neuromodulatory interventions.

Severe secretion retention: a predictor of decannulation outcome in severe brain injury patients with tracheostomy.

BACKGROUND: Identifying accurate predictors of decannulation outcome is essential to ensure safe and timesaving decannulation. Studies indicated hypopharyngeal secretion retention is closely associated with compromised airway protection and patients with it are less likely to be decannulated. However, data verifying the link between secretion retention and decannulation outcome are lacking. AIM: The aim of this study was to identify the association between hypopharyngeal secretion-retention (indicated by Murray Secretion Scale [MSS]) and decannulation outcomes in a large cohort of severe acquired brain injury (sABI) patients with tracheotomy. To test the diagnostic performance of secretion retention in decision making of decannulation. DESIGN: Retrospective cross-sectional study. SETTING: The setting of the study is neurorehabilitation department in a tertiary teaching hospital. POPULATION: A total of 144 adult patients with sABI and tracheostomy were retrospectively selected from the database from September 1, 2019, to August 31, 2021. METHODS: The results of hypopharyngeal secretion-retention observed by fiberoptic endoscopy on the day that decision on decannulation was made were collected. The association between severity of secretion retention and decannulation outcomes was investigated through logistic regression, which was used to adjust covariates, including presence of food/liquid aspiration, decreased laryngeal sensation and conscious level. The optimal cut-off values of MSS for decannulation status prediction was determined by maximizing the Youden Index. RESULTS: One hundred twenty-one patients were included in the sample. The age was 55.6±15.2 years, 84 (69.4%) patients were male. Eighty-four (69.4%) of them were successfully decannulated during their hospital stay. Multivariable logistic regression analysis indicated severe secretion retention (MSS level3) was independently associated with prolonged tracheostomy (adjusted odds ratio 65.23, 95% CI 6.58-646.35, P<0.001). The sensitivity and specificity of MSS level3 to assess the probability of prolonged decannulation were 78.4% and 96.4%, respectively. The area under the curve was 0.894 (95% CI 0.819-0.969). CONCLUSIONS: Our results add to the evidence supporting screening of secretion retention severity in sABI population to identify patients at risk of prolonged tracheostomy. Whether decreasing secretion retention increases probability of successful decannulation deserves to be investigated by further study. CLINICAL REHABILITATION IMPACT: This study could provide evidence for establishing objective decannulation criteria based on fiberoptic endoscopy and be helpful for implementing targeted rehabilitation interventions to promote successful decannulation.

Impact of cognition on test-retest reliability and concurrent validity of n-back for Chinese stroke patients.

OBJECTIVE: The objective of this study was the measurement of the test-retest reliability of n-back in Chinese stroke patients. METHODS: Seventy-five sub-acute stroke patients performed n-back twice in three days. The test-retest reliability of n-back was analyzed by correlation coefficient. RESULTS: The n-back had excellent test-retest reliability in stroke patients. Pearson or Spearman coefficients ranged from 0.81 to 0.88. The intra-class correlation coefficients ranged from 0.72 to 0.87. The Chinese version of Montreal Cognitive Assessment-Basic (MoCA-BC) score was significantly correlated with the performance of n-back. MoCA-BC and n-back accuracy were significantly related in the Mild Cognitive Impairment (MCI) group (r = 0.60 in 1-back, p = .002; r = 0.43 in 2-back, p = .040). However, MoCA-BC was correlated with reaction time (RT) in the Cognitively Normal (CN) group (r = -0.44 in 1-back, p = .003; r = -0.36 in 2-back, p = .018). The test-retest reliability of CN group was mostly higher than that of MCI group RT: 0.71-0.76 in MCI, 0.80-0.88 in CN; accuracy: 0.80-0.85 in MCI, 0.75-0.86 in CN). The practice effect was observed in the CN group instead of the MCI group. CONCLUSIONS: This study indicated that the test-retest reliability of n-back was high in stroke patients. N-back was correlated with cognition. It was preferable to conduct subgroup analyses according to the level of cognitive assessment of patients with stroke.

Neural substrates in patients with visual-spatial neglect recovering from right-hemispheric stroke.

Visual-spatial attention disorder after stroke seriously affects recovery and quality of life in stroke patients. Previous studies have shown that some patients recovery rapidly from visual-spatial neglect (VSN), but the brain networks underlying this recovery are not well understood. Using functional magnetic resonance imaging, we aimed to identify network differences between patients who rapidly recovered from VSN and those with persistent VSN. The study included 30 patients with VSN who suffered subacute stroke. Patients were examined 2-4 weeks after stroke onset and 4 weeks after the initial assessment. At the last evaluation, patients in the persistent VSN (n = 15) and rapid recovery (n = 15) groups underwent paper-and-pencil tests. We defined the bilateral frontal eye fields, bilateral intraparietal sulcus in the dorsal attention network, and right temporoparietal junction and ventral frontal cortex areas in the ventral attention network as regions of interest (ROI) and measured whole-brain ROI-based functional connectivity (FC) and amplitude of low-frequency fluctuations (ALFF) in subacute right-hemisphere stroke patients. VSN recovery was associated with changes in the activation of multiple bilateral attentional brain regions. Specifically, persistent VSN was associated with lower FC in the right superior frontal gyrus, right inferior temporal gyrus, right medial orbitofrontal cortex, left precuneus, right inferior parietal gyrus, right medial frontal gyrus, right rectus gyrus, left superior frontal gyrus, left middle cingulate gyrus, right superior temporal pole, right postcentral gyrus, and right posterior cingulate gyrus compared to that in those with rapid recovery, whereas ALFF in the left cerebellum were decreased in patients with persistent VSN. Our results demonstrate that the DAN rather than the VAN, plays a more important role in recovery from VSN, and that the cerebellum is involved in recovery. We believe that our results supplement those of previous studies on recovery from VSN.

Resting-state electroencephalography changes in poststroke patients with visuospatial neglect.

Background: This study aimed to explore the electrophysiological characteristics of resting-state electroencephalography (rsEEG) in patients with visuospatial neglect (VSN) after stroke. Methods: A total of 44 first-event sub-acute strokes after right hemisphere damage (26 with VSN and 18 without VSN) were included. Besides, 18 age-matched healthy participants were used as healthy controls. The resting-state electroencephalography (EEG) of 64 electrodes was recorded to obtain the power of the spectral density of different frequency bands. The global delta/alpha ratio (DAR), DAR over the affected hemispheres (DARAH), DAR over the unaffected hemispheres (DARUH), and the pairwise-derived brain symmetry index (pdBSI; global and four bands) were compared between groups and receiver operating characteristic (ROC) curve analysis was conducted. The Barthel index (BI), Fugl-Meyer motor function assessment (FMA), and Berg balance scale (BBS) were used to assess the functional state of patients. Visuospatial neglect was assessed using a battery of standardized tests. Results: We found that patients with VSN performed poorly compared with those without VSN. Analysis of rsEEG revealed increased delta and theta power and decreased alpha and beta power in stroke patients with VSN. Compared to healthy controls and poststroke non-VSN patients, patients with VSN showed a higher DAR (P < 0.001), which was significantly positively correlated with the BBS (DAR: r = -0.522, P = 0.006; DARAH: r = -0.521, P = 0.006; DARUH: r = -0.494, P = 0.01). The line bisection task was positively correlated with DAR (r = 0.458, P = 0.019) and DARAH (r = 0.483, P = 0.012), while the star cancellation task was only positively correlated with DARAH (r = 0.428, P = 0.029). DARAH had the best discriminating value between VSN and non-VSN, with an area under the curve (AUC) of 0.865. Patients with VSN showed decreased alpha power in the parietal and occipital areas of the right hemisphere. A higher parieto-occipital pdBSIalpha was associated with a worse line bisection task (r = 0.442, P = 0.024). Conclusion: rsEEG may be a useful tool for screening for stroke patients with visuospatial neglect, and DAR and parieto-occipital pdBSIalpha may be useful biomarkers for visuospatial neglect after stroke.

Predicting the success of multimodal rehabilitation in chronic ankle instability based on patient-reported outcomes.

BACKGROUND: The aim of this study was to identify potential indicators to predict the success of multimodal rehabilitation in chronic ankle instability (CAI) patients based on patient-reported outcomes. METHODS: Sixty patients with self-reported CAI participated. Their demographic information, injury history, and symptoms were recorded. Physical examinations and dynamic posture control tests were performed. The participants underwent sixteen 30-min treatment sessions of multimodal rehabilitation over 8 weeks. Fifty-one patients (85.0%) were available for follow-up after 8 weeks of the intervention. Treatment success was defined based on the participants' perceived recovery using the global rating of change (GRC). Potential predictor variables were entered into a stepwise logistic regression model to identify variables for the prediction of treatment success. RESULTS: Forty of 51 participants (78.4%) were considered to have a successful outcome. Of the variables assessed, time since last sprain ≤ 8 months was a predictor of treatment success (p < 0.05). If a patient met the criteria, there was an 88.03% probability of successful multimodal rehabilitation. CONCLUSION: A time since the last sprain ≤ 8 months may predict successful patient-reported outcomes after multimodal rehabilitation in CAI patients. LEVEL OF EVIDENCE: Prospective study, Level 2.

P300 correlates with tDCS response in minimally conscious state patients.

BACKGROUND: Several recent studies indicated that transcranial direct current stimulation (tDCS) of the left dorsolateral prefrontal cortex (DLPFC) showed promising results in patients in a minimally conscious state (MCS). However, the neurological characteristics of patients in MCS considered to be tDCS responders have not been firmly established. OBJECTIVES: In the current study, we aimed to explore a reliable electrophysiological biomarker of tDCS response before the patients' inclusion in a tDCS protocol. METHOD: A hierarchical auditory event-related potential (ERP) pattern was applied to thirty-one MCS patients who subsequently received 20 anodal tDCS sessions of the left DLPFC over 10 consecutive working days. The patients were divided into responders and non-responders according to the Coma Recovery Scale-Revised (CRS-R) behavioral evaluation, and the differences in cortical information processing were compared using the P300 component in the ERP pattern. RESULTS: For the Tone-SON (TO) paradigm, CRS-R score (OR = 2.229, 95% CI: 1.241-4.005, P = 0.007) at admission was independently associated with tDCS response, while in the SDN-SON (DO) paradigm, CRS-R score at admission (OR = 2.369, 95% CI: 1.143-4.908, P = 0.020) and P300 (OR = 22.795, 95% CI: 1.823-285.038, P = 0.015) were independently associated with tDCS response in MCS patients. CONCLUSION: Our findings showed that higher total CRS-R score and presence of P300 in the hierarchical auditory ERP pattern, especially P300 in the DO paradigm, are associated with tDCS response in MCS patients. We speculate that P300 in the DO paradigm indicates patients with more preserved semantic processing abilities, and a priority to recover. The results provide important information for guidelines on the use of tDCS in MCS patients.

More is less: Effect of ICF-based early progressive mobilization on severe aneurysmal subarachnoid hemorrhage in the NICU.

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that occurs due to a ruptured intracranial aneurysm. Although advanced therapies have been applied to treat aSAH, patients still suffer from functional impairment leading to prolonged stays in the NICU. The effect of early progressive mobilization as an intervention implemented in the ICU setting for critically ill patients remains unclear. Methods: This retrospective study evaluated ICF-based early progressive mobilization's validity, safety, and feasibility in severe aSAH patients. Sixty-eight patients with aSAH with Hunt-Hess grades III-IV were included. They were divided into two groups-progressive mobilization and passive movement. Patients in the progressive mobilization group received progressive ICF-based mobilization intervention, and those in the passive movement group received passive joint movement training. The incidence of pneumonia, duration of mechanical ventilation, length of NICU stay, and incidence of deep vein thrombosis were evaluated for validity. In contrast, the incidence of cerebral vasospasm, abnormally high ICP, and other safety events were assessed for safety. We also described the feasibility of the early mobilization initiation time and the rate of participation at each level for patients in the progressive mobilization group. Results: The results showed that the incidence of pneumonia, duration of mechanical ventilation, and length of NICU stay were significantly lower among patients in the progressive mobilization group than in the passive movement group (P = 0.031, P = 0.004, P = 0.012), but the incidence of deep vein thrombosis did not significantly differ between the two groups. Regarding safety, patients in the progressive mobilization group had a lower incidence of cerebral vasospasm than those in the passive movement group. Considering the effect of an external ventricular drain on cerebral vasospasm (P = 0.015), we further analyzed those patients in the progressive mobilization group who had a lower incidence of cerebral vasospasm in patients who did not have an external ventricular drain (P = 0.011). Although we found 2 events of abnormally increased intracranial pressure in the progressive mobilization group, there was no abnormal decrease in cerebral perfusion pressure in the 2 events. In addition, among other safety events, there was no difference in the occurrence of adverse events between the two groups (P = 0.073), but the number of potential adverse events was higher in the progressive mobilization group (P = 0.001). Regarding feasibility, patients in the progressive mobilization group were commonly initiated 72 h after admission to the NICU, and 47.06% were in the third level of the mobilization protocol. Discussion: We conclude that the ICF-based early progressive mobilization protocol is an effective and feasible intervention tool. For validity, more mobilization interventions might lead to less pneumonia, duration of mechanical ventilation and length of stay for patients with severe aSAH in the NICU, Moreover, it is necessary to pay attention over potential adverse events (especially line problems), although we did not find serious safety events.

Current perception threshold testing in chronic ankle instability.

BACKGROUND: Damage to sensory input is an underlying pathology of chronic ankle instability (CAI). Therefore, it is necessary to evaluate the sensory function of patients with CAI. The present study quantitatively evaluated sensory nerve function in patients with CAI and healthy controls using current perception threshold (CPT) measurements, as well as the influence of sex, age, and body mass index (BMI) on CPT values and the relations between CPT frequencies. METHODS: Fifty-nine subjects with CAI and 30 healthy controls participated in this study. CPT values at the anterior talofibular ligament region were recorded on the injured and uninjured sides in CAI patients and on both sides in the healthy control group. Between group differences were compared. The influence of sex, age and BMI on CPT values was evaluated. Correlations between different frequencies were also studied. RESULTS: There were no significant differences in age, sex, height, weight or BMI between the CAI and healthy control groups. The CPT values did not show a significant difference by sex. The CPT values did not significantly correlate with age or BMI. Compared to the control group, the CAI group had significantly higher CPT values on the injured and uninjured sides under 250-Hz and 5-Hz electrical stimuli; the difference between the groups was significant (p < 0.01), and the effect size were large. No significant difference was observed under 2000-Hz stimuli. There were correlations between CPT values at different frequencies (p < 0.01), especially 250 Hz and 5 Hz. CONCLUSION: The present study revealed increased sensory thresholds in 250-Hz- and 5-Hz-related sensory nerve fibres in the injured and uninjured ankles of patients with CAI. This increase may indicate dysfunction of A-delta and C fibres. Sex, age and BMI did not significantly impact CPT values. There were correlations between CPT values at different frequencies, especially 250 Hz and 5 Hz. LEVEL OF EVIDENCE: Level III, case-control study.

Therapeutic Effects of Transcranial Magnetic Stimulation on Visuospatial Neglect Revealed With Event-Related Potentials.

This study aimed to investigate changes in attention processing after low-frequency repetitive transcranial magnetic stimulation (rTMS) over the left posterior parietal cortex to better understand its role in visuospatial neglect (VSN) rehabilitation. The current study included 10 subacute stroke patients with VSN consecutively recruited from the inpatient stroke rehabilitation center at Xuanwu Hospital (the teaching hospital affiliated with Capital Medical University) between March and November 2019. All patients performed a battery of tasks (including line bisection, line cancellation, and star cancellation tests) two weeks before treatment and at the beginning and end of treatment; the attentive components of the test results were analyzed. In addition, low-frequency rTMS was used to stimulate the left posterior parietal cortex for 14 days and event-related potential data were collected before and after the stimulation. Participants were evaluated using a target-cue paradigm and pencil-paper tests. No significant differences were detected on the battery of tasks before rTMS. However, we found that rTMS treatment significantly improved the response times and accuracy rates of patients with VSN. After rTMS, the treatment side (left) amplitude of P300 following an event-related potential was higher than that before treatment (left target, p = 0.002; right target, p = 0.047). Thus, our findings suggest that rTMS may be an effective treatment for VSN. The observed increase in event-related potential amplitude supports the hypothesized compensational role of the contralesional hemisphere in terms of residual performance. Our results provide electrophysiological evidence that may help determine the mechanisms mediating the therapeutic effects of rTMS.

Multidimensional review of cognitive impairment after spinal cord injury.

Cognitive impairment is highly prevalent in the population with spinal cord injury (SCI) and exerts a significant impact on functional independence and quality of life in this population. A number of neuroscientists have conducted preliminary investigations of cognitive deficits after SCI, but achieved marginally contradictory results due to some limitations such as the heterogeneity in the sample population, sample size, types of tests utilized, study design, and time since SCI. Therefore, this review mainly focuses on the characteristics, assessments, potential causality and treatment of cognitive impairment for better understanding such deficits in the SCI population.

Exploring the neural correlates of self-related names in healthy subjects.

OBJECTIVES: This study aimed to clarify the neural correlates and underlying mechanisms of the subject's own name (SON) and the unique name derived from the SON (SDN). METHODS: A name that was most familiar to the subject (SFN) was added as a self-related reference. We used 4 auditory stimuli-pure tone (1000 Hz), SON, SDN, and SFN-to evaluate the corresponding activated brain areas in 19 healthy subjects by using functional magnetic resonance imaging. RESULTS: Our results demonstrated that pure tone activated the fewest brain regions. Although SFN was a very strong self-related stimulus, it failed to activate many midline structures. The brain regions activated by SON and SDN were very similar. SFN as a self-related stimulus was less self-related compared with SDN. What's more, the additionally activated fusiform gyrus and parahippocampal gyrus of SDN might revealed its processing path. CONCLUSIONS: SDN, which has created by us, is a new and self-related stimulus similar to SON. They might provide a useful reference for consciousness assessment with SON and SDN.

Autogenous bone particles combined with platelet-rich plasma can stimulate bone regeneration in rabbits.

Long-term bone defects are a key clinical problem. Autogenous bone graft remains the gold standard for the treatment of these defects; however, improving the osteogenic properties and reducing the amount of autogenous bone is challenging. Autologous platelet-rich plasma (PRP) has been widely considered for treatment, due to its potentially beneficial effect on bone regeneration and vascularization. The aim of the present study was to explore the effects of autogenous bone particles combined with PRP on repairing segmental bone defects in rabbits. Briefly, a critical-size diaphyseal radius defect was established in 45 New Zealand White rabbits. Animals were randomly divided into four groups, according to the different implants: Group A, empty bone defect; group B, PRP; group C, autogenous bone particles + bone mesenchymal stem cells (BMSCs) on the left radius; group D, autogenous bone particles + PRP + BMSCs on the right radius. Bone samples were collected and further analyzed using X-ray, histology and histomorphometry 4, 8 and 12 weeks post-surgery. In addition, the effect of PRP on cell proliferation was detected by Cell Counting Kit-8 and the concentrations of growth factors (GFs), transforming GF (TGF)-ß1 and platelet-derived GF (PDGF), in PRP were verified by ELISA. X-ray, histology and histomorphometry data revealed that the fraction area of the newly formed bone was larger in group D. In addition, PRP could improve cell proliferation, osteogenic differentiation and the release of GFs, TGF-ß1 and PDGF-AB. In conclusion, these findings indicated that an autogenous bone particle + PRP + BMSC scaffold may be used as a potential treatment strategy for segmental defects in humans.

Recovery from prolonged disorders of consciousness: A dual-center prospective cohort study in China.

BACKGROUND: Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness (DoC). Data are lacking regarding the long-term outcomes of those patients in China. It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life. AIM: To present the preliminary results of a DoC cohort. METHODS: This was a two-center prospective cohort study of inpatients with vegetative state (VS)/unresponsive wakefulness syndrome (UWS). The study outcomes were the recovery from VS/UWS to minimally conscious state (MCS) and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years. The patients were evaluated using the Glasgow coma scale, coma recovery scale-revised, and Glasgow outcome scale. The endpoint of follow-up was recovery of full consciousness or death. The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline. RESULTS: The study population included 93 patients (62 VS/UWS and 31 MCS). The post-injury interval range was 28-634 d. Median follow-up was 20 mo (interquartile range, 12-37 mo). At the endpoint, 33 transitioned to an emergence from MCS or full consciousness, eight had a locked-in syndrome, and there were 35 patients remaining in a VS/UWS and 11 in an MCS. Seven (including one locked-in syndrome) patients (7.5%) died within 12 mo of injury. Compared with the unresponsive group (n = 52) at 12 mo, the responsive group (n = 41) had a higher proportion of males (87.8% vs 63.5%, P = 0.008), shorter time from injury (median, 40.0 d vs 65.5 d, P = 0.006), higher frequency of vascular etiology (68.3% vs 38.5%, P = 0.007), higher Glasgow coma scale score at admission (median, 9 vs 6, P < 0.001), higher coma recovery scale-revised score at admission (median, 9 vs 2.5, P < 0.001), at 1 mo (median, 14 vs 5, P < 0.001), and at 3 mo (median, 20 vs 6, P < 0.001), lower frequency of VS/UWS (36.6% vs 90.0%, P < 0.001), and more favorable Glasgow outcome scale outcome (P < 0.001). CONCLUSION: Patients with severe DoC, despite having strong predictors of poor prognosis, might recover consciousness after a prolonged time of rehabilitation. An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.