BackgroundMuscle spasticity is a disability caused by damage to the pyramidal system. Standard treatments for spasticity include muscle stretching, antispastic medications, and tendon release surgeries, but treatment outcomes remain unsatisfactory. Anodal transcranial direct current stimulation (tDCS) in patients with muscle spasticity is known to result in significant improvement in spastic tone (p < 0.001). However, the mechanism of action by which tDCS treatment affects spasticity remains unclear. This pilot study aimed to investigate the effect of anodal tDCS upon brain metabolites in the left basal ganglia and ipsilateral primary motor cortex (M1) in children with spastic cerebral palsy (CP).Materials and methodsThis study consisted of three steps: a baseline evaluation, a treatment period, and a follow-up period. During the treatment period, patients were given 20 min of 1 mA anodal tDCS over the left M1 for five consecutive days. Outcomes were compared between pre- and immediate posttreatment in terms of brain metabolites, Tardieu scales, and the quality of upper extremity skills test.ResultsTen patients with spastic CP were enrolled. Following tDCS, there were significant increases in the ratio of N-acetylaspartate (NAA)/creatine (Cr) (p = 0.030), choline (Cho)/Cr (p = 0.043), and myoinositol (mI)/Cr (p = 0.035) in the basal ganglia. Moreover, increased glutamine–glutamate (Glx)/Cr ratio in the left M1 (p = 0.008) was found. In addition, we also observed improvements in the extent of spasticity and hand function (p = 0.028).ConclusionFive consecutive days of anodal tDCS over the left M1 appeared statistically to reduce the degree of spasticity and increase NAA, Cho, mI, and Glx. Future research studies, involving a larger sample size of spastic CP patients undergoing tDCS is now warranted.
Background:To evaluate the role of diffusion MRI in differentiating pediatric posterior fossa tumors and determine the cut-off values of ADC ratio to distinguish medulloblastoma from other common tumors. Methods: We retrospectively reviewed MRI of 90 patients (7.5-year median age) with pathologically proven posterior fossa tumors (24 medulloblastoma, 7 ependymoma, 4 anaplastic ependymoma, 13 pilocytic astrocytoma, 30 diffuse intrinsic pontine glioma (DIPG), 4 ATRT, 3 diffuse astrocytoma, 2 high grade astrocytoma, 2 glioblastoma, and 1 low grade glioma). The conventional MRI characteristics were evaluated. Two readers reviewed DWI visual scale and measured ADC values by consensus. ADC measurement was performed at the solid component of tumors. ADC ratio between the tumors to cerebellar white matter were calculated. Results: The ADC ratio of medulloblastoma was significantly lower than ependymoma, pilocytic astrocytoma and DIPG. The ADC cut-off ratio of ≤ 1.115 allowed discrimination medulloblastoma from other posterior fossa tumors with sensitivity, specificity, PPV and NPV of 95.8%, 81%, 67.6% and 97.9%, respectively. ADC ratio cut-off level to differentiate medulloblastoma from ependymoma was ≤ 0.995 with area under the curve (AUC)= 0.8693. ADC ratio cut-off level for differentiate medulloblastoma from pilocytic astrocytoma at ≤ 1.17 with AUC = 0.9936. ADC cut-off level for differentiate medulloblastoma from DIPG at ≤ 1.195 with AUC = 0.9681. The ADC ratio was correlated with WHO grading by the lower ADC ratio associated with the higher grade. Furthermore, High DWI visual scale was associated with high grade tumor. Conclusion: Diffusion MRI has a significant role in diagnosis of pediatric posterior fossa tumors. ADC ratio can be used to distinguish medulloblastoma from other posterior fossa tumor with good level of diagnostic performance.
Background: Whole body vibration (WBV) training is a regime of training on a vibration platform that provides oscillatory movement to the body. Vibration training may be a potentially useful therapeutic strategy to control diabetes and its complications. This study aimed to evaluate the effect of WBV on glycemic indices and peripheral blood flow in type II diabetic patients.Methods: A parallel group clinical trial was conducted with 1:1 allocation ratio at Khon Kaen University between February and May 2010. The study included diabetic patients receiving diet or oral medication control over the previous year and excluded patients with serious medical and musculoskeletal disorders. Forty type II diabetic patients [14 males, 26 females, 63.2 (7.7) y, mean (SD)] were randomised into two groups (WBV and control) by computer software using a block of four design. The WBV group was given two sets of six one-minute vibration squats, three times per week for twelve weeks. The control group maintained their normal physical activity levels. The primary outcome was the patients glycemic indices.Results: We found no significant difference in glycosylated haemoglobin (HbA1c), fasting blood sugar, insulin level and insulin sensitivity between WBV and control groups. Compared to the control group, WBV training resulted in a substantial reduction in resting diastolic blood pressure -7.1 mmHg (95% CI: -10.9, -3.3, P = 0.001) and peak systolic velocity -7.3 cm.sec -1 (95% CI: -14.7, -0.03, P = 0.049), but made little difference to resting heart rate, systolic blood pressure, end diastolic velocity, and popliteal artery diameter.Conclusion: Whole body vibration improved resting diastolic blood pressure and peak systolic velocity, however, any beneficial effect of WBV on glycemic indices remains unclear.
with the current use of high-resolution US techniques (Popoveniuc et al., 2012). Nodules can be benign or malignant. Some studies have shown that less than 10% of thyroid nodules are malignant (Boniface et al., 2013). Fine-needle aspiration (FNA) biopsy plays a major role in the differential diagnosis, but its execution needs to be selective, due to associated cost, potential non-diagnostic results and the risk of overdiagnosis (Grani et al., 2018). A number of classification systems have been
Objectives: Previous research has provided evidence that transcranial direct current stimulation (tDCS) can reduce severity of autism spectrum disorder (ASD); however, the exact mechanism of this effect is still unknown. Magnetic resonance spectroscopy has demonstrated low levels of brain metabolites in the anterior cingulate cortex (ACC), amygdala, and left dorsolateral prefrontal cortex (DLPFC) in individuals with ASD. The aim of this study was to investigate the effects of anodal tDCS on social functioning of individuals with ASD, as measured by the social subscale of the Autism Treatment Evaluation Checklist (ATEC), through correlations between pretreatment and posttreatment concentrations of brain metabolites in the areas of interest (DLPFC, ACC, amygdala, and locus coeruleus) and scores on the ATEC social subscale. Methods: Ten participants with ASD were administered 1 mA anodal tDCS to the left DLPFC for 20 min over five consecutive days. Measures of the ATEC social subscale and the concentrations of brain metabolites were performed before and immediately after the treatment. Results: The results showed a significant decrease between pretreatment and immediately posttreatment in the ATEC social subscale scores, significant increases in N-acetylaspartate (NAA)/creatine (Cr) and myoinositol (mI)/Cr concentrations, and a decrease in choline (Cho)/Cr concentrations in the left DLPFC and locus coeruleus after tDCS treatment. Significant associations between decreased ATEC social subscale scores and changed concentrations in NAA/Cr, Cho/Cr, and mI/Cr in the locus coeruleus were positive.
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