Protocol on transcranial alternating current stimulation for the treatment of major depressive disorder: a randomized controlled trial.

BACKGROUND: Transcranial alternating current stimulation (tACS) offers a new approach for adult patients with major depressive disorder (MDD). The study is to evaluate the efficacy and safety of tACS treating MDD. METHODS: This is an 8-week, double-blind, randomized, placebo-controlled study. Ninety-two drug-naive patients with MDD aged 18 to 65 years will receive 20 daily 40-min, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas on weekdays for 4 consecutive weeks (week 4), following a 4-week observation period (week 8). The primary outcome is the remission rate defined as the 17-item Hamilton depression rating scale (HDRS-17) score ≤7 at week 8. Secondary outcomes are the rates of response at weeks 4 and 8 and rate of remission at week 4 based on HDRS-17, the proportion of participants having improvement in the clinical global impression-improvement, the change in HDRS-17 score (range, 0-52, with higher scores indicating more depression) over the study, and variations of brain imaging and neurocognition from baseline to week 4. Safety will be assessed by vital signs at weeks 4 and 8, and adverse events will be collected during the entire study. DISCUSSION: The tACS applied in this trial may have treatment effects on MDD with minimal side effects. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800016479; http://www.chictr.org.cn/showproj.aspx?proj=22048.

Cervical spondylotic internal jugular venous compression syndrome.

AIMS: This study aimed to identify the clinical profiles of cervical spondylosis-related internal jugular vein stenosis (IJVS) comprehensively. METHODS: A total of 46 patients, who were diagnosed as IJVS induced by cervical spondylotic compression were recruited. The clinical manifestations and imaging features of IJVS were presented particularly in this study. RESULTS: Vascular stenosis was present in 69 out of the 92 internal jugular veins, in which, 50.7% (35/69) of the stenotic vessels were compressed by the transverse process of C1, and 44.9% (31/69) by the transverse process of C1 combined with the styloid process. The transverse process of C1 compression was more common in unilateral IJVS (69.6% vs 41.3%, P = 0.027) while the transverse process of C1 combined with the styloid process compression had a higher propensity to occur in bilateral IJVS (52.2% vs 30.4%, P = 0.087). A representative case underwent the resection of the elongated left lateral mass of C1 and styloid process. His symptoms were ameliorated obviously at 6-month follow-up. CONCLUSIONS: This study proposes cervical spondylotic internal jugular venous compression syndrome as a brand-new cervical spondylotic subtype. A better understanding of this disease entity can be of great relevance to clinicians in making a proper diagnosis.

Effect of Transcranial Alternating Current Stimulation for the Treatment of Chronic Insomnia: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Clinical Trial.

BACKGROUND: Not all adults with chronic insomnia respond to the recommended therapeutic options of cognitive behavioral therapy and approved hypnotic drugs. Transcranial alternating current stimulation (tACS) may offer a novel potential treatment modality for insomnia. OBJECTIVES: This study aimed to examine the efficacy and safety of tACS for treating adult patients with chronic insomnia. METHODS: Sixty-two participants with chronic primary insomnia received 20 daily 40-min, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas in the laboratory on weekdays for 4 consecutive weeks, followed by a 4-week follow-up period. The primary outcome was response rate measured by the Pittsburgh Sleep Quality Index (PSQI) at week 8. Secondary outcomes were remission rate, insomnia severity, sleep onset latency (SOL), total sleep time (TST), sleep efficiency, sleep quality, daily disturbances, and adverse events at the end of the 4-week intervention and at the 4-week follow-up. RESULTS: Of 62 randomized patients, 60 completed the trial. During the 4-week intervention, 1 subject per group withdrew due to loss of interest and time restriction, respectively. Based on PSQI, at 4-week follow-up, the active group had a higher response rate compared to the sham group (53.4% [16/30] vs. 16.7% [5/30], p = 0.009), but remission rates were not different between groups. At the end of the 4-week intervention, the active group had higher response and remission rates than the sham group (p < 0.001 and p = 0.026, respectively). During the trial, compared with the sham group, the active group showed a statistically significant decrease in PSQI total score, a shortened SOL, an increased TST, improved sleep efficiency, and improved sleep quality (p < 0.05 or p < 0.001). Post hoc analysis revealed that, in comparison with the sham group, the active group had improved symptoms, except for daily disturbances, at the end of the 4-week intervention, and significant improvements in all symptoms at the 4-week follow-up. No adverse events or serious adverse responses occurred during the study. CONCLUSION: The findings show that the tACS applied in the present study has potential as an effective and safe intervention for chronic insomnia within 8 weeks.

Association between clinical features and prognosis of patients with limb-shaking transient ischemic attack.

OBJECTIVE: This review aims to illustrate the relationship between clinical features and the prognosis of patients with limb-shaking transient ischemic attack (LS-TIA). DATA SOURCES: Relevant articles published in two main Chinese medical periodical databases (China National Knowledge Infrastructure and China Science Periodical Database) from 1986 to June 2013 were identified with keywords "limb shaking" and "transient ischemic attack". STUDY SELECTION: Original articles and case reports about LS-TIA were selected. RESULTS: A total of 63 cases collected from 19 articles were included in the pooled analysis. LS-TIA presented in two cerebrovascular diseases, of which atherosclerotic high-grade stenosis or occlusion in carotid artery system and moyamoya disease formed 95.2% and 4.8%, respectively. Of 63 patients, 11 (17.5%) were once misdiagnosed as epileptic and prescribed useless antiepilepsy drugs. The multivariable Logistic regression model showed a significant protective effect of patients with revascularization therapy on prognosis, compared with patients treated with drugs (odds ratio 0.20, 95% CI 0.05-0.74, P = 0.016). CONCLUSIONS: Chronic carotid artery system hypoperfusion can induce limb(s) shaking, followed by high possibility of ischemic stroke in the same brain territorial. Revascularization of the responsible artery may work better than conservative drug-based therapy.

[Intravenous thrombolysis directed by whole-brain computed tomographic perfusion:a case-control study].

OBJECTIVE: To explore the efficacy and safety of intravenous thrombolysis (IVT) directed by whole-brain computed tomographic perfusion (CTP). METHODS: A total of 65 patients with acute ischemic stroke at our hospital during the period of April 2011 to April 2013, selected in accordance with the established CTP or TTW standard (0 to 3.0 h and 3.0 to 4.5 h) for IVT were included for analysis. The primary endpoint events were Barthel index (BI) and the rate of serious adverse events at 14 days post-onset. The latter included mortality and symptomatic intracerebral hemorrhage (ICH). And secondary indicators included the incidence of reperfusion, recanalization, ICH and neurological improvement at Day 14, as well as time indicators, such as onset-to-door time (ODT), door-to-treatment time (DTT) and onset-to-treatment time (OTT). Statistical calculations for continuous variables were compared with t or Mann-Whitney U test. And other comparisons were made with Pearson Chi-square or Fisher's exact test. RESULTS: Twenty-five and 40 cases with acute ischemic stroke were enrolled according to CTP or TTW standard for IVT respectively. Baseline characteristics, including age, gender, risk factors, blood pressure, blood sugar, National Institute of Health stroke scale (NIHSS) and drug dose showed no significant difference among groups. DTT and OTT in CTP group were significantly longer than those of the 0 to 3.0 h subgroup, while similar with those of the 3.0 to 4.5 h subgroup. Interestingly, consistent with a significant higher rate of transferring for consultation in the CTP group comparing with the TTW group (52.0% vs 25.0%, P = 0.03), the rate was also significantly higher than the 0 to 3.0 h subgroup (52.0% vs 7.7%, P = 0.02), but not significantly higher than the 3.0 to 4.5 subgroup. Both primary endpoint events and secondary outcome measures among three groups showed no significant differences. As for secondary outcome measures, CTP group had a higher recanalization than the 3.0 to 4.5 h subgroup (52.0% vs 37.0%, P = 0.28) and there was a trend toward significance. CTP excluded 58 cases, including 20 proved cases of malignant infarction on magnetic resonance imaging. CONCLUSION: CTP is able to select reasonable candidates for IVT in an extended time window with effectiveness and safety comparable to TTW standard. Furthermore, it is quicker and more sensitive than TTW standard in detecting malignant infarction.

[Correlation analysis of collateral circulation and clinical locations in patients with ischemic stroke].

OBJECTIVE: To study the correlation of compensation by collateral circulation and clinical locations in ischemic stroke cases. METHODS: A total of 25 ischemic stroke cases were retrospectively analyzed. MRI (magnetic resonance imaging) and DSA (digital subtraction angiography) were performed in all cases. Each patient was found to have at least one cerebral artery occlusion by DSA. The quantity relationship between collateral circulation and ischemic stroke location was analyzed by SPSS 11.5 statistics software. RESULTS: Among all cases, 46 arterial occlusions were found by chance. DSA demonstrated internal carotid artery occlusion (n = 24) and vertebral & basilar artery occlusion (n = 22). And all cases had at least one collateral circulation. Among 23 cases of single collateral circulation, there were 8 cases of single ischemic stroke locations and 15 cases of multiple ischemic stroke locations; among 23 cases of multiple collateral circulations, there were 18 cases of single ischemic stroke locations and 5 cases of multiple ischemic stroke locations. CONCLUSION: Effective collateral circulation can be established spontaneously through multiple ways when cerebral artery occlusion takes place if an intact Wills circle is present. Multiple collateral circulations may significantly decrease the quantity of ischemic stroke locations.