Direct comparison of efficacy of the motor cortical plasticity induction and the interindividual variability between TBS and QPS

BackgroundTheta burst stimulation (TBS) and quadripulse stimulation (QPS) are known to induce synaptic plasticity in humans. There have been no head-to-head comparisons of the efficacy and variability between TBS and QPS.ObjectiveTo compare the efficacy and interindividual variability between the original TBS and QPS protocols. We hypothesized that QPS would be more effective and less variable than TBS.MethodsForty-six healthy subjects participated in this study. Thirty subjects participated in the main comparison experiment, and the other sixteen subjects participated in the experiment to obtain natural variation in motor-evoked potentials. The facilitatory effects were compared between intermittent TBS (iTBS) and QPS5, and the inhibitory effects were compared between continuous TBS (cTBS) and QPS50. The motor-evoked potential amplitudes elicited by transcranial magnetic stimulation over the primary motor cortex were measured before the intervention and every 5 min after the intervention for 1 h. To investigate the interindividual variability, the responder/nonresponder/opposite-responder rates were also analyzed.ResultsThe facilitatory effects of QPS5 were greater than those of iTBS, and the inhibitory effects of QPS50 were much stronger than those of cTBS. The responder rate of QPS was significantly higher than that of TBS. QPS had a smaller number of opposite responders than TBS.ConclusionQPS is more effective and stable for synaptic plasticity induction than TBS.     

Accelerated iTBS treatment applied to the left DLPFC in depressed patients results in a rapid volume increase in the left hippocampal dentate gyrus,not driven by brain perfusion

BackgroundAccelerated intermittent Theta Burst Stimulation (aiTBS) has been shown to be an effective antidepressant treatment. Although neurobiological changes shortly after this intervention have been reported, whether aiTBS results in structural brain changes must still be determined. Furthermore, it possible that rapid volumetric changes are driven by factors other than neurotrophic processes.ObjectivesWe examined whether possible grey matter volumetric (GMV) increases after aiTBS treatment could be driven by increased brain perfusion, measured by Arterial Spin Labeling (ASL).Methods46 treatment-resistant depressed patients were randomized to receive 20 sessions of active or sham iTBS applied to the left dorsolateral prefrontal cortex. All sessions were delivered over 4 days at 5 sessions per day (trial registration: http://clinicaltrials.gov/show/NCT01832805). Patients were scanned the day before starting stimulation and three days after aiTBS.ResultsThere was a significant cluster of increased left hippocampal GMV in the dentate gyrus related to HRSD changes after active aiTBS, but not after sham stimulation. These GMV increases became more pronounced when accounting for changes in cerebral perfusion.ConclusionsActive, but not sham, aiTBS, resulted in acute volumetric changes in parts of the left dentate gyrus, suggesting a connection with adult neurogenesis. Furthermore, taking cerebral perfusion measurements into account impacts on detection of the GMV changes. Whether these hippocampal volumetric changes produced by active aiTBS are necessary for long-term clinical improvement remains to be determined.     

Subtractive screening reveals up-regulation of NADPH oxidase expression in Crohn's disease intestinal macrophages

Macrophages play a central role during the pathogenesis of inflammation. In normal intestinal mucosa surface expression of typical macrophage markers such as CD14, CD16, CD11b or T-cell co-stimulatory molecules such as CD80 or CD86 is low indicating anergy and low pro-inflammatory activity of these cells. During inflammatory bowel disease (IBD) the mucosa is invaded by a population of macrophages displaying these markers, secreting higher cytokine levels and representing an activated cell population. CD33(+) cells (macrophages) were isolated from normal and Crohn's disease mucosa and mRNA was isolated by polyT magnetic beads. A subtractive screening was performed subtracting mRNA from normal macrophages from those of Crohn's disease macrophages. Oxidative burst activity was determined by flow cytometry. Seventy clones were obtained by the subtractive mRNA screening. Sequencing showed > 99% homology to mRNA of monocyte chemoattractant protein-1 (MCP-1) for three clones. Five clones obtained by subtraction revealed > 99% homology to mRNA of cytochrome b (subunit gp91). Differential expression of the cytochrome b subunit gp91 and the cytosolic NADPH oxidase subunit p67 was confirmed by RT-PCR and 'virtual' Northern blots. The fluorescence ratio of stimulated versus unstimulated cells was 0.9 +/- 0.16 in control macrophages indicating a lack of oxidative burst activity. In Crohn's disease this ratio was significantly increased to 1.80 +/- 0.8 (P = 0.004) confirming the molecular data. In conclusion NADPH oxidase mRNA is down-regulated or absent in macrophages from normal mucosa correlating with a lack of oxidative burst activity. In IBD macrophage-oxidative burst activity is increased and NADPH oxidase mRNA induced. Inhibition of NADPH oxidase could be a new therapeutical target in IBD and reduce mucosal tissue damage in active IBD.     

Neurophysiology of hearing in patients with mucopolysaccharidosis type IV

Background

Hearing impairment is a common problem in patients with mucopolysaccharidosis IV (MPS IV) throughout their life. Many of the adult patients with MPS IV exhibit permanent or severe hearing loss. However, there has been no systematic review of detailed audiological test results in MPS IV.

间接减压经椎弓根植骨在胸腰椎爆裂骨折中的应用价值

目的比较在胸腰椎爆裂骨折中后路间接减压经椎弓根植骨与开放减压后外侧植骨2种手术方法的临床疗效。方法回顾性分析1998年4月—2008年3月所收治的胸腰椎爆裂骨折并经完整随访的患者56例,将其分为2组:间接减压组32例,于伤后早期(72 h内)经后路行短节段椎弓根钉棒系统复位固定、间接减压,经伤椎椎弓根植入自体松质骨浆;开放复位组24例,行半椎板或全椎板切除,短节段椎弓根螺钉系统内固定,半椎板、横突或关节突融合。观察2组手术中的情况及并发症,评价各组在脊柱的矫形、Cobb角的矫正及神经功能恢复情况。结果2组手术时间分别为1.81 h、2.23 h,出血量为360 mL、440 mL,2组比较均有显著性差异(P均<0.05),全部病例经9~24个月随访,平均15.2个月,2组患者术前、术后脊髓功能Frankel分级、椎体前缘压缩率、Cobb角均无显著性差异(P均>0.05),术前2组脊髓功能恢复、椎体畸形的矫正率、Cobb角的矫正率比较均无显著性差异(P均>0.05),而2组术后脊髓功能均有明显恢复,Frankel分级分别提高1~4级,4例脊髓完全损伤者神经功能Frankel分级提高1级、2级,椎体前缘压缩率、Cobb角的矫正均明显好转(P均<0.05),全部病例基本达解剖复位,术后无内固定物失败,内固定物取出后矫正丢失率分别为0.8%,8.6%。结论后路器械复位间接减压能有效提供神经修复空间,经椎弓根植骨可有效降低内植物的失败及矫正度的丢失,同时能够缩短手术时间,减少出血量,是治疗胸腰椎爆裂骨折的可靠有效方法。     

野菊花提取物对慢性支气管炎大鼠TNF-α及中性粒细胞功能的影响

目的 研究野菊花提取物对慢性支气管炎模型大鼠肿瘤坏死因子(TNF-α)水平及中性粒细胞功能的影响,以阐明其部分疗效机制.方法 Wistar大鼠随机玢为正常对照组,慢支模型组,喘息灵对照组,野菊花提取物低、中、高剂量组;以气管内注入脂多糖建立慢支大鼠模型,药物干预后,ELISA法测定大鼠血清及支气管肺泡灌洗液TNF-α含量,流式细胞术测定大鼠中性粒细胞(PMN)吞噬能力及呼吸爆发的强度.结果 模型组血清及肺泡灌洗液TNF-α含量以及PMN吞噬功能、呼吸爆发强度较正常对照组明显升高,野菊花提取物可显著降低慢支模型大鼠血清及肺泡灌洗液中的TNF-α水平、降低PMN吞噬功能及呼吸爆发强度的异常升高.结论 降低慢支大鼠体内TNF-α水平、PMN吞噬功能及呼吸爆发强度可能是野菊花提取物减轻慢性支气管炎炎症效应的机理之一.     

间歇性θ节律刺激对脑梗死患者偏瘫侧肱二、三头肌表面肌电信号及其功能的影响

目的:了解间歇性θ节律刺激(i TBS)对脑梗死患者偏瘫侧肱二头肌、肱三头肌表面肌电信号(RMS、CR)及其功能的影响。方法:选择符合入选标准的脑梗死偏瘫患者43例,随机分成刺激组(22例)及对照组(21例)。对照组行常规康复,刺激组在常规康复基础上于病灶侧大脑M1区实施为期2周的i TBS刺激。分别于治疗前、治疗2周后采集偏瘫侧肱二头肌、肱三头肌均方根值(RMS)、协同收缩率(CR)及上肢Fugl-Meyer (FMA-UL)评分、改良Barthel指数(MBI)。对数据行统计学分析比较。结果:治疗2周后,两组患者的RMS值、FMA-UL及MBI评分均较治疗前明显增加(P0.05),CR值均较治疗前显著下降(P0.01);且刺激组RMS、CR值、FMA-UL及MBI评分变化均较对照组显著(P0.05)。结论:与单纯常规康复相比,在常规康复基础上联合i TBS刺激更能提高脑梗死患者偏瘫侧上肢肱二头肌、肱三头肌的均方根值,降低其协同收缩率;同时也更有利于脑梗死患者偏瘫侧上肢及整体功能的改善。     

经椎弓根短节段固定治疗胸腰椎爆裂性骨折

目的 探讨后路短节段固定治疗胸腰椎爆裂性骨折的方法.方法 应用短节段钉棒系统经椎弓根复位、固定,Ⅰ期植骨融合,治疗胸腰椎爆裂性骨折32例.有神经损伤或压迫症状者,术中椎管造影,如确定后突骨块复位不满意者,行半椎板切除,椎管扩大减压,椎体间植骨.结果 术后29例基本解剖复位,3例大部分复位,并恢复了正常的脊柱力线.不全瘫者10例术后均有不同程度的功能恢复,完全瘫者3例,2例功能无恢复.26例经随访1～3年,矫正角度基本未丢失,未出现断钉、脱棒等现象,23例植骨融合,融合率达88.5%.结论 该手术方法复位满意,固定可靠,对椎管的间接减压是有效的,并最大限度地保留了未损伤的运动节段功能,但患者需另取髂骨,部分患者供区遗留顽固性疼痛.     

胸腰椎爆裂骨折的AF钉内固定

目的：探讨应用AF钉内固定治疗胸腰椎爆裂骨折的临床效果。方法：回顾性分析自1997年8月至2001年6月27例胸腰椎爆裂骨折患者，均行了AF椎弓根钉系统内固定手术治疗。结果：经7个月～4年(平均16个月)随访，其中22例获解剖复住，脊柱生理弯曲恢复。椎体前缘高度术前平均41％，术后96％，21例神经功能恢复按Franke1分级提高1～3级。结论：经AF短节段的椎弓根钉系统是治疗胸腰椎爆裂骨折的有效方法，它具有创伤小，操作简便，固定可靠等优点。     

螺旋CT三维重建诊断腰椎爆裂骨折的价值

目的探讨螺旋CT多模式三维重建诊断腰椎爆裂骨折(LBF)的价值。方法对54例LBF患者摄腰椎X线片;采用3～5 mm层厚连续螺旋CT扫描,1.5～2.5 mm间距后重建,于AW4.0工作站行SSD、MPR及MIP、仿真椎间盘镜(VMED)三维重建;34例行腰椎MRI检查;采用SSPS 16.0软件分析。结果螺旋CT与平片诊断LBF差异有统计学意义(χ2=4.167,P<0.05);SSD与MIP能取得清晰立体图,MPR能多向观察骨折细节,VMED能模拟MED显示椎管梗阻。MRI能清楚显示椎管受压及脊髓损伤。结论腰椎多模式三维重建对复杂性腰椎骨折诊断、分型与手术模拟等有重要价值。