Background:Acupuncture is widely used in modulating brain excitability and motor function,as a form of complementary and alternative medicine.However,there is no existing meta-analysis evaluating the effectiveness and...Background:Acupuncture is widely used in modulating brain excitability and motor function,as a form of complementary and alternative medicine.However,there is no existing meta-analysis evaluating the effectiveness and safety of acupuncture on corticospinal excitability(CSE),and the credibility of the evidence has yet to be quantified.Objective:This study was designed to assess the efficacy and safety of electroacupuncture(EA)and manual acupuncture(MA)in enhancing brain excitability,specifically focusing on CSE as measured by transcranial magnetic stimulation(TMS).Search strategy:This study followed a systematic approach,searching 9 databases up to August 2024 and examining grey literature,in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Inclusion criteria:Studies were included if they compared the clinical efficacy of EA or MA with sham acupuncture,no treatment or usual training.Data extraction and analysis:Three investigators independently conducted literature screening,data extraction,and risk of bias assessment.The primary outcome focused on motor-evoked potentials as measured by TMS,with treatment effects quantified using mean differences or standardized mean differences between pre-and post-treatment.Subgroup analyses were conducted using mixed-effects models,while random-effects or fixed-effects models were used to estimate average treatment differences across studies.Results:Based on 34 studies involving 1031 adults,acupuncture techniques significantly enhanced CSE.EA had a greater impact than MA,with effect sizes of 0.53 mV vs 0.43 mV(95%confidence interval[CI]:[0.30,0.76],P<0.00001 vs 95%CI:[0.28,0.59],P<0.00001).The 5 most frequently used acupoints were LI4(Hegu,32 times),ST36(Zusanli,10 times),LI11(Quchi,7 times),TE5(Waiguan,6 times),and GB34(Yanglingquan,5 times).Conclusion:This systematic review indicates that both EA and MA could effectively and safely enhance CSE,bringing the corticospinal pathway closer to the threshold for firing,which may ultimately improve motor function.LI4,ST36,LI11,TE5 and GB34 are the most commonly used acupoints.展开更多
As the global population gets older, depression in the elderly is emerging as an important health issue. A major challenge in treating geriatric depression is the lack of robust efficacy for many treatments that are o...As the global population gets older, depression in the elderly is emerging as an important health issue. A major challenge in treating geriatric depression is the lack of robust efficacy for many treatments that are of significant benefit to depressed working age adults. Repetitive transcranial magnetic stimulation(r TMS) is a novel physical treatment approach used mostly in working age adults with depression. Many TMS trials and clinics continue to exclude the elderly from treatment citing lack of evidence in this age group. In this review, we appraise the evidence regarding the safety and efficacy of rT MS in the elderly. A consistent observation supporting a high degree of tolerability and safety among the elderly patients emerged across the Randomised Controlled Trials and the uncontrolled trials. Further, there is no reliable evidence negating the utility of rT MS in the elderly with depression. We also identified several factors other than age that moderate the observed variations in the efficacy of rT MS in the elderly. These factors include but not limited to:(1) brain atrophy;(2) intensity and number of pulses(dose-response relationship); and(3) clinical profile of patients. On the basis of the current evidence, the practice of excluding elderly patients from TMS clinics and trials cannot be supported.展开更多
Transcutaneous renal artery denervation （RND） has beeninitially developed for destruction of efferent nerve fireswith luminal delivery of radiofrequency or ultrasonic energyaiming blood pressure reduction in patient...Transcutaneous renal artery denervation （RND） has beeninitially developed for destruction of efferent nerve fireswith luminal delivery of radiofrequency or ultrasonic energyaiming blood pressure reduction in patients with refractoryhypertension. However, other positive results of RNDwere described afterwards, and they include suppression ofatrial fibrillation and ventricular tachycardia （VT） storm.展开更多
Excessive theta(θ)frequency oscillation and synchronization in the basal ganglia(BG)has been reported in elderly parkinsonian patients and animal models of levodopa(L-dopa)-induced dyskinesia(LID),particularly theθo...Excessive theta(θ)frequency oscillation and synchronization in the basal ganglia(BG)has been reported in elderly parkinsonian patients and animal models of levodopa(L-dopa)-induced dyskinesia(LID),particularly theθoscillation recorded during periods when L-dopa is withdrawn(the off L-dopa state).To gain insight into processes underlying this activity,we explored the relationship between primary motor cortex(M1)oscillatory activity and BG output in LID.We recorded local field potentials in the substantia nigra pars reticulata(SNr)and M1 of awake,inattentive resting rats before and after L-dopa priming in Sham control,Parkinson disease model,and LID model groups.We found that chronic L-dopa increasedθsynchronization and information flow between the SNr and M1 in off L-dopa state LID rats,with a SNr-to-M1 flow directionality.Compared with the on state,θoscillational activity(θsynchronization and informationflow)during the off state were more closely associated with abnormal involuntary movements.Our findings indicate thatθoscillation in M1 may be consequent to abnormal synchronous discharges in the BG and support the notion that M1θoscillation may participate in the induction of dyskinesia.展开更多
We read with interest the article by Olechowski, et aL recently published in the Journal of Geriatric Cardiology. The results of this retrospective analysis of patients under- going cardiac resynchronization therapy ...We read with interest the article by Olechowski, et aL recently published in the Journal of Geriatric Cardiology. The results of this retrospective analysis of patients under- going cardiac resynchronization therapy （CRT） device implantation are in line with previous reports, suggesting that resynchronization therapy in the elderly is feasible and may lead to significant improvement of cardiac function and clinical status.展开更多
文摘Background:Acupuncture is widely used in modulating brain excitability and motor function,as a form of complementary and alternative medicine.However,there is no existing meta-analysis evaluating the effectiveness and safety of acupuncture on corticospinal excitability(CSE),and the credibility of the evidence has yet to be quantified.Objective:This study was designed to assess the efficacy and safety of electroacupuncture(EA)and manual acupuncture(MA)in enhancing brain excitability,specifically focusing on CSE as measured by transcranial magnetic stimulation(TMS).Search strategy:This study followed a systematic approach,searching 9 databases up to August 2024 and examining grey literature,in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Inclusion criteria:Studies were included if they compared the clinical efficacy of EA or MA with sham acupuncture,no treatment or usual training.Data extraction and analysis:Three investigators independently conducted literature screening,data extraction,and risk of bias assessment.The primary outcome focused on motor-evoked potentials as measured by TMS,with treatment effects quantified using mean differences or standardized mean differences between pre-and post-treatment.Subgroup analyses were conducted using mixed-effects models,while random-effects or fixed-effects models were used to estimate average treatment differences across studies.Results:Based on 34 studies involving 1031 adults,acupuncture techniques significantly enhanced CSE.EA had a greater impact than MA,with effect sizes of 0.53 mV vs 0.43 mV(95%confidence interval[CI]:[0.30,0.76],P<0.00001 vs 95%CI:[0.28,0.59],P<0.00001).The 5 most frequently used acupoints were LI4(Hegu,32 times),ST36(Zusanli,10 times),LI11(Quchi,7 times),TE5(Waiguan,6 times),and GB34(Yanglingquan,5 times).Conclusion:This systematic review indicates that both EA and MA could effectively and safely enhance CSE,bringing the corticospinal pathway closer to the threshold for firing,which may ultimately improve motor function.LI4,ST36,LI11,TE5 and GB34 are the most commonly used acupoints.
基金Supported by Transformational funding support from the National Health Services,Nottinghamshire Healthcare NHS TrustLena Palaniyappan received benefit in kind to speak at a conference organised by Magstim Limited
文摘As the global population gets older, depression in the elderly is emerging as an important health issue. A major challenge in treating geriatric depression is the lack of robust efficacy for many treatments that are of significant benefit to depressed working age adults. Repetitive transcranial magnetic stimulation(r TMS) is a novel physical treatment approach used mostly in working age adults with depression. Many TMS trials and clinics continue to exclude the elderly from treatment citing lack of evidence in this age group. In this review, we appraise the evidence regarding the safety and efficacy of rT MS in the elderly. A consistent observation supporting a high degree of tolerability and safety among the elderly patients emerged across the Randomised Controlled Trials and the uncontrolled trials. Further, there is no reliable evidence negating the utility of rT MS in the elderly with depression. We also identified several factors other than age that moderate the observed variations in the efficacy of rT MS in the elderly. These factors include but not limited to:(1) brain atrophy;(2) intensity and number of pulses(dose-response relationship); and(3) clinical profile of patients. On the basis of the current evidence, the practice of excluding elderly patients from TMS clinics and trials cannot be supported.
文摘Transcutaneous renal artery denervation （RND） has beeninitially developed for destruction of efferent nerve fireswith luminal delivery of radiofrequency or ultrasonic energyaiming blood pressure reduction in patients with refractoryhypertension. However, other positive results of RNDwere described afterwards, and they include suppression ofatrial fibrillation and ventricular tachycardia （VT） storm.
基金supported by the National Natural Science Foundation of China(81771210)the Natural Science Foundation of Guangdong Province,China(2015A030313288)。
文摘Excessive theta(θ)frequency oscillation and synchronization in the basal ganglia(BG)has been reported in elderly parkinsonian patients and animal models of levodopa(L-dopa)-induced dyskinesia(LID),particularly theθoscillation recorded during periods when L-dopa is withdrawn(the off L-dopa state).To gain insight into processes underlying this activity,we explored the relationship between primary motor cortex(M1)oscillatory activity and BG output in LID.We recorded local field potentials in the substantia nigra pars reticulata(SNr)and M1 of awake,inattentive resting rats before and after L-dopa priming in Sham control,Parkinson disease model,and LID model groups.We found that chronic L-dopa increasedθsynchronization and information flow between the SNr and M1 in off L-dopa state LID rats,with a SNr-to-M1 flow directionality.Compared with the on state,θoscillational activity(θsynchronization and informationflow)during the off state were more closely associated with abnormal involuntary movements.Our findings indicate thatθoscillation in M1 may be consequent to abnormal synchronous discharges in the BG and support the notion that M1θoscillation may participate in the induction of dyskinesia.
文摘We read with interest the article by Olechowski, et aL recently published in the Journal of Geriatric Cardiology. The results of this retrospective analysis of patients under- going cardiac resynchronization therapy （CRT） device implantation are in line with previous reports, suggesting that resynchronization therapy in the elderly is feasible and may lead to significant improvement of cardiac function and clinical status.
