Meta-Analysis of Functional Electrical Stimulation Combined with Occupational Therapy on Post-Stroke Limb Functional Recovery and Quality of Life.

OBJECTIVE: This study aimed to investigate whether Functional Electrical Stimulation (FES) and Transcranial Direct Current Stimulation (tDCS) enhanced the effect of Occupational Therapy (OT) on post-stroke limb functional recovery and quality of life, using direct and network meta-analysis. METHODS: A computerized search was conducted in databases such as Medline, Web of Science, Embase, CNKI (China National Knowledge Infrastructure), Wanfang Data, and VIP Information for prospective randomized controlled trials on OT, FES, and tDCS for improving post-stroke limb motor function and quality of life, with the search cutoff date of July 1, 2023. RESULTS: Following the screening process, a total of 8 research articles were incorporated, encompassing 358 participants. Among these, 177 individuals underwent OT exclusively, while 181 individuals underwent a combined regimen of OT alongside electromagnetic therapy. In terms of the intervention methods, the control group received OT treatment only, while the experimental group employed tDCS in 5 studies and FES in 3 studies. Within these investigations, Fugl-Meyer Assessment (FMA) scores were reported in 8 studies. The aggregated mean difference (MD) for FMA scores was 5.08 (95% CI: 2.46, 7.71), with a specific MD of 2.77 (95% CI: 1.46, 4.09) for the tDCS subgroup and 9.04 (95% CI: 5.34, 12.73) for the FES subgroup. Notably, FES combined with OT exhibited significant advantages in enhancing FMA scores when compared to the combination of tDCS and OT. Furthermore, four studies provided data on modified Barthel Index (MBI) scores, yielding a collective MD of 7.20 (95% CI: 4.44, 9.95). CONCLUSION: In patients with stroke, both FES combined with OT and tDCS combined with OT exhibit substantial enhancements in limb function and quality of life compared to OT alone. Notably, FES combined with OT yields superior clinical benefits when compared to the amalgamation of tDCS and OT.

Game-matching background music has an add-on effect for reducing emotionality of traumatic memories during reconsolidation intervention.

Introduction: Hospital is a stressful place of employment, and a high proportion of healthcare workers, especially the ICU (Intensive Care Unit) nurses were found to be at risk of PTSD. Previous studies showed that taxing working memory through visuospatial tasks during the reconsolidation process of aversive memories can reduce the number of intrusions afterwards. However, the finds could not be replicated by some researches, indicating there may be some boundary conditions that are subtle and complex. Methods: We performed a randomized controlled trial (ChiCTR2200055921; URL: www.chictr.org.cn). In our study, a series of ICU nurses or probationers who performed a cardiopulmonary resuscitation (CPR) were enrolled and instructed to play a visuospatial music tapping game ("Ceaseless Music Note", CMN; Beijing Muyuan Technology Co., Ltd., Beijing, China) at the fourth day after CPR. The numbers of intrusions each day were recorded from the first to the seventh days (24 h×6 day), and the vividness and emotionality of CPR memories were rated at the 4th and 7th days. These parameters were compared between different groups (game with background sound; game with sound off; sound only; none). Results: The game-matching background music can have an add-on effect for single tapping game with no sound in reducing the emotionality of previous aversive memories. Discussion: We proposed that flow experience (the subjective experience of effortless attention, reduced self-awareness, and enjoyment, and may be induced by optimal skill-demands compatibility in challenging tasks) as a key boundary condition for successful reconsolidation intervention. Clinical trial registration: www.chictr.org.cn, identifier: ChiCTR2200055921.

Maximal safe resection of diffuse lower grade gliomas primarily within central lobe using cortical/subcortical direct electrical stimulation under awake craniotomy.

Background: Diffuse lower-grade glioma (DLGG) in the central lobe is a challenge for safe resection procedures. To improve the extent of resection and reduce the risk of postoperative neurological deficits, we performed an awake craniotomy with cortical-subcortical direct electrical stimulation (DES) mapping for patients with DLGG located primarily within the central lobe. We investigated the outcomes of cortical-subcortical brain mapping using DES in an awake craniotomy for central lobe DLGG resection. Methods: We performed a retrospective analysis of clinical data of a cohort of consecutively treated patients from February 2017 to August 2021 with diffuse lower-grade gliomas located primarily within the central lobe. All patients underwent awake craniotomy with DES for cortical and subcortical mapping of eloquent brain areas, neuronavigation, and/or ultrasound to identify tumor location. Tumors were removed according to functional boundaries. Maximum safe tumor resection was the surgical objective for all patients. Results: Thirteen patients underwent 15 awake craniotomies with intraoperative mapping of eloquent cortices and subcortical fibers using DES. Maximum safe tumor resection was achieved according to functional boundaries in all patients. The pre-operative tumor volumes ranged from 4.3 cm3 to 137.3 cm3 (median 19.2 cm3). The mean extent of tumor resection was 94.6%, with eight cases (53.3%) achieving total resection, four (26.7%) subtotal and three (20.0%) partial. The mean tumor residue was 1.2 cm3. All patients experienced early postoperative neurological deficits or worsening conditions. Three patients (20.0%) experienced late postoperative neurological deficits at the 3-month follow-up, including one moderate and two mild neurological deficits. None of the patients experienced late onset severe neurological impairments post-operatively. Ten patients with 12 tumor resections (80.0%) had resumed activities of daily living at the 3-month follow-up. Among 14 patients with pre-operative epilepsy, 12 (85.7%) were seizure-free after treatment with antiepileptic drugs 7 days after surgery up to the last follow-up. Conclusions: DLGG located primarily in the central lobe deemed inoperable can be safely resected using awake craniotomy with intraoperative DES without severe permanent neurological sequelae. Patients experienced an improved quality of life in terms of seizure control.

The relationship between the interictal epileptiform discharge source connectivity and cortical structural couplings in temporal lobe epilepsy.

Objective: The objective of this study was to explore the relation between interictal epileptiform discharge (IED) source connectivity and cortical structural couplings (SCs) in temporal lobe epilepsy (TLE). Methods: High-resolution 3D-MRI and 32-sensor EEG data from 59 patients with TLE were collected. Principal component analysis was performed on the morphological data on MRI to obtain the cortical SCs. IEDs were labeled from EEG data and averaged. The standard low-resolution electromagnetic tomography analysis was performed to locate the source of the average IEDs. Phase-locked value was used to evaluate the IED source connectivity. Finally, correlation analysis was used to compare the IED source connectivity and the cortical SCs. Results: The features of the cortical morphology in left and right TLE were similar across four cortical SCs, which could be mainly described as the default mode network, limbic regions, connections bilateral medial temporal, and connections through the ipsilateral insula. The IED source connectivity at the regions of interest was negatively correlated with the corresponding cortical SCs. Significance: The cortical SCs were confirmed to be negatively related to IED source connectivity in patients with TLE as detected with MRI and EEG coregistered data. These findings suggest the important role of intervening IEDs in treating TLE.

Effectiveness of repetitive transcranial magnetic stimulation combined with a brief exposure procedure for post-stroke posttraumatic stress disorder.

The incidence of posttraumatic stress disorder (PTSD) following stroke ranges from 6.5 % to 25 %. Presently few studies have focused on its treatment. Repetitive transcranial magnetic stimulation (rTMS) is often applied as a rehabilitation method after stroke, and it also represents a novel approach to PTSD. The aim of this study was to explore the effect of rTMS (or combined with a brief stroke re-exposure) on treating post-stroke PTSD. Sixty participants with post-stroke PTSD were randomly assigned into three groups (rTMS + brief exposure group, TMS + BE; rTMS alone group, TMS; sham treatment group, ST) and received 10 sessions of treatment accordingly over two weeks. Changes in PTSD symptoms (Impact of Event Scale-Revised, IES-R) were evaluated at pre-treatment (T1), the end of the first (T2), and the end of the second treatment week (T3). At the three-month follow-up (T4), a PTSD interview and IES-R assessment were given. Results showed that from T1 to T3, IES-R (and its intrusion subscale) scores of TMS + BE group and TMS group were significantly lower than the ST group, and the effect remained at three-month follow-up. The treatment effect was comparable between TMS + BE group and TMS group at T3, however, it was better for TMS + BE group than TMS group at T2, indicating a brief exposure promotes the effect of rTMS. At follow-up, the rates of PTSD were lower in TMS + BE group and TMS group than ST group. In conclusion, rTMS can effectively treat post-stroke PTSD and the effects may be accelerated by combining a brief exposure procedure. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100043444.

Psychometric properties of the post-traumatic stress disorder checklist for DSM-5 (PCL-5) in Chinese stroke patients.

BACKGROUND: Stroke is a devastating disease and can be sufficiently traumatic to induce post-traumatic stress disorder (PTSD). Post-stroke PTSD is attracting increasing attention, but there was no study assessing the psychometric properties of the PCL-5 in stroke populations. Our study was conducted to examine the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in Chinese stroke patients. METHODS: This was a cross-sectional observational study conducted at our hospital. Three hundred and forty-eight Chinese stroke patients came to our hospital for outpatient service were recruited. They were instructed to complete the PCL-5 scales and were interviewed for PTSD diagnosis with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The cutoff scores, reliability and validity of the PCL-5 were analyzed. RESULTS: PCL-5 scores in our sample were positively skewed, suggesting low levels of PTSD symptoms. The reliability of PCL-5 was good. Exploratory and confirmatory factor analyses indicated acceptable construct validity, and confirmed the multi-dimensionality of the PCL-5. By CFA analysis, the seven-factor hybrid model demonstrated the best model fit. The PCL-5 also showed good convergent validity and discriminant validity. Receiver operating characteristic (ROC) analyses revealed a PCL-5 score of 37 achieved optimal sensitivity and specificity for detecting PTSD. CONCLUSIONS: Our findings supported the use of PCL-5 as a psychometrically adequate measure of post-stroke PTSD in the Chinese patients.

Longitudinal changes of motor cortex function during motor recovery after stroke.

BACKGROUND AND PURPOSE: Functional magnetic resonance imaging (fMRI) combined with behavioral assessments was used in our study to investigate the dynamic process of motor cortical functional reorganization after infarction. Therefore, we could provide a theoretical basis and build a useful evaluation system for rehabilitation after stroke and various other cerebral injuries. METHODS: Acute stroke patients with a single lesion in the middle cerebral artery supply area and age- and sex-matched healthy volunteers were recruited. A longitudinal observational study involving 20 patients with stroke was conducted using repeated fMRI. Task-based fMRI data were acquired 3 times over a period of 3 months. The behavioral assessment included dynamometer and finger-tapping tests to evaluate the strength and dexterity of each upper arm. RESULTS: Behavioral results: The behavioral assessments demonstrated large improvements in session 2 and session 3. fMRI results: The healthy group showed activation in the contralateral primary sensory-motor cortex (S1M1) when executing tasks with either the left or right hand. Compared with the healthy subjects, the patients demonstrated greater activation in the ipsilateral frontal and parietal cortices and supplementary motor areas (SMAs). Across all sessions, more motor activation was observed in the left infarction group. CONCLUSIONS: Our results show that motor cortical activation induced by moving the paretic hand changes over time. There were differences in motor functional recovery and motor cortex compensation between the dominant hemisphere and nondominant hemisphere after stroke.

Supportive psychological therapy can effectively treat post-stroke post-traumatic stress disorder at the early stage.

Post-traumatic stress disorder (PTSD) can develop after stroke attacks, and its rate ranges from 4 to 37% in the stroke population. Suffering from PTSD not only decreases stroke patient's quality of life, but also relates to their non-adherence of treatment. Since strokes often recur and progress, long-term medical management is especially important. However, previous studies generally focused on the epidemiological characteristics of post-stroke PTSD, while there are literally no studies on the psychological intervention. In our study, 170 patients with a first-ever stroke during the acute phase were recruited. They were randomized into Psycho-therapy group 1 and Control group 1, and were administered with preventive intervention for PTSD or routine health education, respectively. At 2-month follow-up, PTSD symptoms were evaluated. Participants who were diagnosed with post-stroke PTSD were further randomized into Psycho-therapy group 2 and Control group 2, and received supportive therapy or routine health counseling, respectively. At 6-month follow-up (1°month after the therapy was completed), PTSD symptoms were re-evaluated. Our results showed that at 2-month, the PTSD incidence in our series was 11.69%, and the severity of stroke was the only risk factor for PTSD development. The preventive intervention was not superior to routine health education for PTSD prevention. At 6-month, results indicated the supportive therapy did have a fine effect in ameliorating symptoms for diagnosed PTSD patients, superior to routine health counseling. Thus, our study was the first to provide evidence that the supportive therapy was effective in treating post-stroke PTSD early after its diagnosis. This clinical trial was preregistered on www.chictr.org.cn (ChiCTR2100048411).

Brain structural connectivity sub typing in unilateral temporal lobe epilepsy.

To categorize and clinically characterize subtypes of brain structural connectivity patterns in unilateral temporal lobe epilepsy (TLE). Voxel based morphometry (VBM) and surfaced based morphometry (SBM) analysis were used to detect brain structural alterations associated with TLE from MRI data. Principal component analysis (PCA) was performed to identify subtypes of brain structural connectivity patterns. Correlation analysis was used to explore associations between PC scores and clinical characteristics. A total of 59 patients with TLE and 100 healthy adults were included in this study. Widespread cortical atrophy was shown in both left and right TLE (P < 0.05, FWE corrected). Six principal components (PCs) that explained more than 70% of the variance were extracted for left and right TLE, reflecting patterns of brain structural connectivity. PCs representing perisylvian connectivity were positively correlated with verbal IQ (left TLE: r = 0.696, P < 0.001; right TLE: r = 0.484, P = 0.012) and total IQ (left TLE r = 0.608, P < 0.001) and negatively correlated with disease duration (r = -0.448, P = 0.009). In left TLE, the PC in the ipsilateral mesial temporal region was negatively correlated with age at onset (r = -0.382, P = 0.028). In right TLE, the PC representing the default mode network was negatively correlated with number of antiepileptic drugs (r = -0.407, P = 0.039). This study categorized subtypes of unilateral TLE based on brain structural connectivity patterns. Findings may provide insight into seizure pathways, the pathophysiology of epilepsy, including comorbidities such as cognitive impairment, and help predict treatment outcomes.

Activation of CB1 pathway in the perirhinal cortex is necessary but not sufficient for destabilization of contextual fear memory in rats.

According to the reconsolidation theory, memories can be modified through the destabilization-reconsolidation process. The rodent perirhinal cortex (PER; Brodmann areas 35 and 36) critically participates in the process of fear conditioning. Previous studies showed that some of the parahippocampal regions are critical for contextual fear memory reconsolidation. In our research, through a three-day paradigm of CFC, we showed that protein synthesis in PER of rats is required for memory reconsolidation, and activation of CB1 pathway is necessary but not sufficient in inducing memory destabilization. This result underlines parahippocampal regions in destabilization and reconsolidation process of fear memory besides amygdala and hippocampus.

mTORC1-PGC1 axis regulates mitochondrial remodeling during reprogramming.

Metabolic reprogramming, hallmarked by enhanced glycolysis and reduced mitochondrial activity, is a key event in the early phase of somatic cell reprogramming. Although extensive work has been conducted to identify the mechanisms of mitochondrial remodeling in reprogramming, many questions remain. In this regard, different laboratories have proposed a role in this process for either canonical (ATG5-dependent) autophagy-mediated mitochondrial degradation (mitophagy), noncanonical (ULK1-dependent, ATG5-independent) mitophagy, mitochondrial fission or reduced biogenesis due to mTORC1 suppression. Clarifying these discrepancies is important for providing a comprehensive picture of metabolic changes in reprogramming. Yet, the comparison among these studies is difficult because they use different reprogramming conditions and mitophagy detection/quantification methods. Here, we have systematically explored mitochondrial remodeling in reprogramming using different culture media and reprogramming factor cocktails, together with appropriate quantification methods and thorough statistical analysis. Our experiments show lack of evidence for mitophagy in mitochondrial remodeling in reprogramming, and further confirm that the suppression of the mTORC1-PGC1 pathway drives this process. Our work helps to clarify the complex interplay between metabolic changes and nutrient sensing pathways in reprogramming, which may also shed light on other contexts such as development, aging and cancer.

Posttraumatic stress disorder after a first-ever intracerebral hemorrhage in the Chinese population: A pilot study.

The objective of this study was to reveal the prevalence, associated risk factors, and long-term outcomes of Posttraumatic stress disorder (PTSD) in patients after intracerebral hemorrhage (ICH). Consecutive patients admitted to our institute from January 2016 to September 2016 for a first-ever ICH were asked to participate in our study. PTSD was determined with Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5), and questionnaires on mental and physical status were used. Patients were followed at 3 and 12 months after ICH. Sixty-four patients were eventually included for analysis. Compared with patients without PTSD, patients with PTSD were more likely to be female (67% vs. 29%, p = 0.01), and had higher rates of receiving minimally invasive surgery (MIS; 47% vs. 18%, p = 0.04). Patients with PTSD achieved higher IES-R scores, had more intense anxiety and depression, were more habitually use maladaptive coping strategies, and had poorer quality of life and worse stroke-related disability than those without PTSD. At 12-months follow-up, 6 of the 14 (43%) patients initially diagnosed with PTSD had self-recovered. ICH leads to increased PTSD risk in the Chinese population, especially those who are female, more severely disabled, or received MIS.

Posttraumatic stress symptoms (PTSS) in patients with Cushing's disease before and after surgery: A prospective study.

The aim of this study was to investigate the occurrence, correlated factors and prognosis of posttraumatic stress symptoms (PTSS) in patients with Cushing's disease (CD). A total of 49 patients who were newly diagnosed with CD and underwent transsphenoidal surgery in our hospital from April 2015 to August 2017 were asked to participate in this study. Another group of 49 age and sex matched healthy control participants were also included for comparison. PTSS (measured with Impact of Event Scale-Revised, IES-R), depression/anxiety (measured with Hospital Anxiety and Depression scale, HADS) and quality of life (QoL; measured with 36-item short-form, SF-36) were evaluated at pre-surgery, 6 months post-surgery and 12 months post-surgery. The results showed that at preoperative stage, 15 (30.6%) CD patients developed PTSS, and they had higher 24 h UFC, and presented worse levels of depression, anxiety and QoL compared with patients without PTSS. Although most of them recovered postoperatively, there were still 5/15 (33.3%) patients persisted with PTSS for over a year. Additionally, one patient with recurred CD developed PTSS between 6 and 12 months postoperatively. Among the whole group of CD patients, the PTSS severity showed consistent improvement after surgery, which was in accordance with the progressing trends of depression, anxiety and psychological aspects of SF-36. However, compared with healthy individuals, CD patients in remission still performed worse in physical/mental health. In conclusion, patients with CD can develop PTSS, and they may persist for over a year even after successful surgery. Combined psychological intervention is advised for these patients.

Post-traumatic stress disorders in patients with low-grade glioma and its association with survival.

PURPOSE: The primary objective of this study was to investigate the incidence of PTSD at 3 months postoperatively in patients who were newly diagnosed with LGGs, and its association with 5-year survival. Moreover, QoL and other psychiatric disorders like depression and anxiety were also evaluated. METHODS: From February 2011 to April 2013, patients who underwent low-grade glioma surgery at our hospital and come back for reexamination at 3-month follow-up were considered for this study. Interviews, HADS-A, HADS-D, and SF-36 scales were used for evaluating PTSD, anxiety, depression, and quality of life. Participants were asked to complete these assessments at 3 months after surgery. Followed-ups on survival status were made for 5 years. RESULTS: A total of 219 subjects comprising 83 women and 136 men with a mean age of 41.5 years were included in this study. At 3 months after surgery, 35 (16%) patients were diagnosed with PTSD. Younger age (OR = 2.23, [95% CI 1.02-4.84], P = 0.04) and frontal lobe involvement of tumor (OR = 2.57, [95% CI 1.06-6.23], P = 0.04) predicted PTSD. Patients with PTSD had higher anxiety and depression level, and had worse QoL in all eight dimensions of SF-36. Kaplan-Meier analyses demonstrated that diagnosis of PTSD was associated with shorter overall survival in LGG patients (Log-rank = 7.45, P = 0.01). After adjusting for other variables, PTSD remained associated with elevated 5-year overall mortality risk of LGG patients (HR = 2.98 [95% CI 1.10-8.05], P = 0.03). CONCLUSIONS: The results showed that newly diagnosed LGG patients suffering from PTSD at 3 months after surgery had lower rates of 5-year survival. In clinical practice, psychological evaluation is suggested for LGG patients and proper psychotherapy should be considered for those with PTSD.

Risk of probable posttraumatic stress disorder in patients with trigeminal neuralgia.

The object of this study was to reveal the occurrence, risk factors and prognosis of posttraumatic stress disorder (PTSD) in patients with trigeminal neuralgia (TN). Adult patients who were diagnosed with TN were prospectively collected from our neuroscience center. Among the 103 patients recruited, thirty (29.1%) participants were identified as probable PTSD cases measured with PTSD Checklist for DSM-5 (PCL-5). Compared with patients without PTSD, patients with probable PTSD were more likely to be female, have severe pain intensity, be with severely interfered general activities, be with more intense depression and anxiety, and be more habitually using maladaptive coping strategies. Logistic regression analysis showed female sex, severe pain intensity, anxiety and depression predicted probable PTSD. In the 28 patients who were initially identified as probable PTSD and had 6-month follow-up data, 21 reported complete pain relief and 4 reported partial pain relief. Fifteen of the patients who experienced complete pain relief recovered from probable PTSD. Our work indicated that PTSD can develop among patients with TN. Complete pain relief through surgical treatments can help most patients with probable PTSD recover, however, psychological support is advised for those who are still obsessed by mental disorders even after pain relief.

New Insights in Minimally Invasive Surgery for Intracerebral Hemorrhage.

The poor clinical outcome of acute intracerebral hemorrhage (ICH) relates closely to the bleeding amount per unit of time and the hematoma position in the brain. Removal of an intracerebral hematoma in time can effectively improve clinical prognosis. Minimally invasive surgery (MIS) for the treatment of ICH is the main clinical method that is currently used, despite the lack of large-scale, clinical, multi-center, randomized controlled trials. This article comprehensively reviews the history and development of MIS for ICH and analyzes various roles of MIS in ICH treatment. General CT image-guided surgery with the local use of thrombolysis techniques is a major MIS method used in current ICH treatment.

Endovascular treatment for the basilar artery dissection.

PURPOSE: To determine the safety and efficacy of endovascular therapy for the treatment of basilar artery dissection (BAD). METHODS: Patients with BAD admitted to our hospital from June 2002 to December 2011 were retrospectively reviewed. Strict inclusion and exclusion criteria were made. At enrollment, patients' manifestations were evaluated. The different devices and techniques used for each patient were recorded and further classified into two groups: the coiling-only group, in which lesions were treated only with coils; and the stented group, in which lesions were treated with only stents or by stent-assisted embolization. Shapes of BAD were described and classified into three types: dilation, pearl-and-string sign, and stenosis. Presentations of BAD were classified as ruptured or unruptured. Digital subtraction angiography results obtained immediately after intervention and at follow-up were evaluated and classified into two groups: stable/improved or recanalized/worsened. Clinical outcome was evaluated by modified Rankin Scale score. RESULTS: A total of 29 patients were included, and 28 of them were followed up clinically and angiographically. No significant difference of recurrence rate existed between ruptured and unruptured BAD. The coiling-only group demonstrated a significantly higher recurrence rate than the stent-assisted group. In the 22 instances of BAD presenting with dilated shapes, stented cases had better radiological outcome than unstented cases, and initial packing of completely/near completely occluded cases had better radiological follow-up results. CONCLUSION: Endovascular therapy proved safe and effective. Stent placement and initial complete occlusion were favorable factors for follow-up stable/improved outcome.