Background and Purpose-The purpose of this study was to perform a meta-analysis of studies that investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function in patients with stroke. Methods-We searched for randomized controlled trials published between January 1990 and October 2011 in PubMed, Medline, Cochrane, and CINAHL using the following key words: stroke, cerebrovascular accident, and repetitive transcranial magnetic stimulation. The mean effect size and a 95% CI were estimated for the motor outcome and motor threshold using fixed and random effect models. Results-Eighteen of the 34 candidate articles were included in this analysis. The selected studies involved a total of 392 patients. A significant effect size of 0.55 was found for motor outcome (95% CI, 0.37-0.72). Further subgroup analyses demonstrated more prominent effects for subcortical stroke (mean effect size, 0.73; 95% CI, 0.44 -1.02) or studies applying low-frequency rTMS (mean effect size, 0.69; 95% CI, 0.42-0.95). Only 4 patients of the 18 articles included in this analysis reported adverse effects from rTMS. Conclusions-rTMS has a positive effect on motor recovery in patients with stroke, especially for those with subcortical stroke. Low-frequency rTMS over the unaffected hemisphere may be more beneficial than high-frequency rTMS over the affected hemisphere. Recent limited data suggest that intermittent theta-burst stimulation over the affected hemisphere might be a useful intervention. Further well-designed studies in a larger population are required to better elucidate the differential roles of various rTMS protocols in stroke treatment. (Stroke. 2012;43:1849-1857.)

Primary somatosensory (SI) cortical inhibition to repetitive stimuli tends to decline with increasing age. However, aging effects on the inhibition mechanism of secondary somatosensory cortex (SII) remain elusive. We aimed to study the aging-related changes of cortical inhibition in the human somatosensory system. Neuromagnetic responses to paired-pulse electrical stimulation to the median nerve were recorded in 21 young and 20 elderly male adults. Paired-pulse suppression (PPS) of SI and SII activities was estimated by the ratio of the response to Stimulus 2 to the response to Stimulus 1. Based on equivalent current dipole modeling, PPS ratios of the contralateral (SIIc) and ipsilateral (SIIi) secondary somatosensory cortices were higher in elderly than in young subjects (p < 0.001 in SIIc and p = 0.034 in SIIi). At an individual basis, a higher PPS ratio in SIIc than in SI was found in 16 (80 %) out of the 20 elderly participants; in contrast, the PPS ratios of SIIc and SI cortices were similar in young participants (p = 0.031). In conclusion, a larger PPS ratio in elderly suggests an aging-related decline in somatosensory cortical inhibition. Furthermore, compared to SI, the electrophysiological responses of SII cortex are especially vulnerable to aging in terms of cortical inhibition to repetitive stimulation.

Context: Gut dysbiosis has been proposed as one of pathologies in patients with Alzheimer’s disease (AD) spectrum. Despite such enthusiasm, the relevant results remain substantially controversial. Objective: A systematic review and meta-analysis were performed to investigate the differences of gut microbiota (GM) between patients with AD spectrum (including mild cognitive impairment [MCI] and AD) and healthy controls (HC). Data sources: PubMed, MEDLINE, Scopus, and Cochrane Library from January 2000 to August 2021. Eligibility criteria for study selection: Observational trials and pre-intervention data of intervention trials that investigated the abundance of GM in patients with AD spectrum and HC. Data extraction and synthesis: Two reviewers independently identified articles, extracted data, and evaluated the risk of bias. The effect sizes were performed by a random-effect, inverse-variance weighted model. The effects of different countries and of clinical stages on GM abundance were also examined. Results: 11 studies consisting of 378 HC and 427 patients with AD spectrum were included in the meta-analysis. Patients with AD, but not MCI, showed significantly reduced GM diversity as compared to HC. We also found more abundance of Proteobacteria , Bifidobacterium and Phascolarctobacterium , but less abundance of Firmicutes , Clostridiaceae , Lachnospiraceae and Rikenellaceae in patients with AD spectrum as compared with HC. The profiles of abundance of Alistipes and Bacteroides in HC and AD spectrum were differentially affected by countries. Finally, when considering clinical stage as a moderator, the comparisons of abundance in Clostridiaceae and Phascolarctobacterium showed large effect sizes, with gradient changes from MCI to AD stage. Limitations: The inclusion of studies originating only from China and the U.S. was a possible limitation. Conclusions: Patients with AD spectrum demonstrated altered GM abundance, which was differentially mediated by countries and clinical stages.