Clinical Trial Demonstrates Efficacy of Transcranial Direct Current Stimulation (tDCS) in Improving Pain Management from Post-Laminectomy Syndrome

Chronic pain, a multidimensional experience affecting individuals’ sensory, cognitive, and emotional aspects, significantly impacts their quality of life. Post-laminectomy syndrome, a condition characterized by persistent back pain following spinal surgery, often leads to disability and increased healthcare utilization. Methods: This randomized, controlled, blind clinical trial aimed to investigate the efficacy of Transcranial Direct Current Stimulation (tDCS) in managing pain from post-laminectomy syndrome in patients. Twenty-four participants were assigned to three groups: sham stimulation, active stimulation over primary motor cortex (M1), or stimulation over dorsolateral prefrontal cortex (DLPFC). Stimulation was administered for five consecutive days, 20 minutes per session, using a current of 1.5 mA through 25 cm2 electrodes. Pain intensity was assessed using Visual Analog Scale (VAS) before, during, and after intervention. Results: An ANOVA model demonstrates significant reduction in pain intensity compared to baseline in VAS, (F(7, 285) = 12.292;p 0.001;Power = 1.000;η2p = 0.534), in tDCS applied to M1, after five days of intervention. After stimulation, a significant improvement was observed in WHOQoL-Bref Quality of life item 1 (p = 0.04), considering statistical significant difference p 0.05. Correlation between the variables: quality of life, depression, anxiety and pain also demonstrates reduction in depression and anxiety according to Beck’s Depression and Anxiety Inventories (BDI and BAI), p 0.05. This effect was not observed in DLPFC stimulation group. Patients who believed they received active stimulation, in sham group, demonstrated potential for effective blinding. Conclusion: The tDCS applied to primary motor cortex effectively improved pain management and psychiatry symptoms in post-laminectomy syndrome patients. The technique’s low cost, ease of use, and high tolerability make it a promising adjuvant therapy for chronic pain conditions like post-laminectomy syndrome.

Laser evoked potential: Analysis of the methodology in post herpetic neuralgia

Background: selective activation and the contempo- rary recording of A delta and C fibers from Yap laser on the scalp is a new neurophysiological assessment, allowing the selective activation of the nociceptive system. Objectives: to evaluate if the damage of the nociceptive system was related to post herptic nevral-gia (PHN) development in a sample of 26 patients affected by Herpes zooster (HZ);secondly to assess if the impairment of thermal pathway and PHN development were related. Methods: Thirty-two patients were selected for the study, 26 of these were included in the study, whereas 6 were excluded because of cog- nitive impairment. All 26 study patients were sub- mitted to LEP analysis at baseline (T0) and after six months (T1), and the correlation between clinical thermal disease and the development of PHN was monitored. Results: pain duration was evidenced by the presence or absence of an instrumental signal in patients with acute HZ infection. There was total concordance between the absence of LEP signal and pain duration. The concordance between the clinical thermal disease and the pain duration was statisti- cally significant for 43% of the sample. Conclusions: our results suggested a possible role of LEP for PHN prognosis estimation;indeed, most patients affected by acute HZ, with absence of instrumental LEP signal had pain > 6 months. We also noted a significant (43% of cases) clinical concordance between the thermal pathway damage, the absence of instrumental signal and PHN development. Further studies are needed to address this issue.

Muscle fatigue in women with primary biliary cirrhosis:Spectral analysis of surface electromyography

AIM： To evaluate the myoelectric manifestations of peripheral fatigability in patients with primary biliary cirrhosis in comparison to healthy subjects. METHODS： Sixteen women with primary biliary cirrhosis without comorbidity and 13 healthy women matched for age and body mass index （BMI） completed the selfreported questionnaire fatigue impact scale. All subjects underwent surface electromyography assessment of peripheral fatigability. Anterior tibial muscle isometric voluntary contraction was executed for 20 s at 80% of maximal voluntary isometric contraction. During the exercise electromyographic signal series were recorded and root mean square （expression of central drive） as well as mean and median of electromyographic signal frequency spectrum （estimates of muscle fatigability） were com- puted. Each subject executed the trial two times. EMG parameters were normalized, then linear regression was applied and slopes were calculated. RESULTS： Seven patients were fatigued （median fatigue impact scale score： 38, range： 26-66） and 9 were not fatigued （median fatigue impact scale score： 7, range： 0-17）. The maximal voluntary isometric contraction was similar in patients （82, 54-115 N） and controls （87, 74-101 N）, and in patients with high （81, 54-115 N） and low fatigue impact scale scores （86, 65-106 N）. Root mean square as well as mean and median of frequency spectrum slopes were compared with the Mann-Whitney U test, and no significant difference was found between fatigued and non-fatigued patients and controls. CONCLUSION： No instrumental evidence of peripheral fatigability can be found in women with primary biliary cirrhosis but no comorbidity, suggesting that fatigue in such patients may be of central origin.

A study of the effect of antioxidant status on the outcome of malignant gliomas

Objective:To explore the relationship of the effect of antioxidant status of patients with malignant gliomas at the time of their admission to a tertiary care hospital and the clinical condition after a post operative follow up over a period of two years.Methods: Several antioxidant enzymes like erythrocytic glutathione reductase,glutathione peroxidase,catalase,superoxide dismutase,plasma ceruloplasmin,antioxidant vitamins A,E and C and lipid peroxidation products like erythrocytic thiobarbituric acid reacting substances and plasma conjugated dienes were analyzed both in controls and glioma patients.Results: It was observed that patients who exhibited an overall higher turnover of antioxidants presented with recurrence.Conclusion: Free radical toxicity may adversely affect the outcome of such cancer patients.

Sleep Disorders in Menopause: Review of the Literature and Occurrence through Menopausal Stages

We here review principal literature data about sleep disorders in menopause and we compared it with data obtained from a systematical screening of a sample of 161 menopausal women through questionnaires and clinical evaluation. Our data reveal high occurrence of sleep disorders in this group of women if compared to literature data about general population, in the absence of statistically significant differences among the three menopausal stages: we find only a trend toward a higher risk of OSAS (Obstructive Sleep Apnea Syndrome) in PM versus early PM and MT. However, none of women in our survey underwent PSG (polysomnography), essential to confirm the diagnosis of OSAS and none was diagnosed with RLS (Restless Legs Syndrome) (prior to our survey) by the Gynecologist or General Pratictioner: these data reveal the issue of too low attention towards sleep disorders in this contest. Generic “sleep complaints” are clearly associated with depressed mood and worse-quality life along the menopausal process. In our sample, a non-specific definition of insomnia shows a peculiar relationship with a mood disorder: it is only variable not associated with higher BDI and KI scores, in fact. This might suggest that the conditions linked to depression of these women could be more specific sleep disturbances, such as RLS and OSAS.

Extended Daily Schedule of Temozolomide in Recurrent Glioblastoma: Single-Institution Report on a Series of 43 Patients

Background: Despite advances in surgical and first-line adjuvant treatment, glioblastoma multiforme (GBM) always recurs as disease natural history. Currently, there is no consensus as to the optimal second-line treatment of recurrent GBM. Patients and Methods: This is a retrospective study of a series of adult patients consecutively treated at a single institution for supratentorial cerebral GBM at first relapse. All patients had previously received the standard concomitant radiochemotherapy protocol as first-line therapy. At recurrence/progression, all patients were treated with a metronomic temozolomide (TMZ) schedule at a daily dosage of 50 mg/m2 of body surface. Radiologic, clinical, and laboratory data were collected for all patients, with a minimum follow-up of 18 months. Results: From January 2010 to June 2011, 43 patients were treated at our facility. A mean of 10 metronomic TMZ cycles (range, 3 - 21) was administered. Radiologically, we observed 2 complete responses (4.6%), 16 partial responses (37.2%), 18 stable disease (41.9%) and 7 progressive disease (16.3%). Steroids administration was safely tapered in 23 patients (53.5%). Karnofsky-Performance-Status (KPS) results improved in 20 patients (46.5%), stabilized in 20 (46.5%), and worsened in 3 patients (7.0%), with a mean KPS score increased from 65.1 at baseline to 75.3 at follow-up. Six-month progression-free survival was 53.5. One year after recurrence/progression diagnosis, 22 patients were still alive, with a 1-year overall survival rate of 51.6%. Conclusions: The proposed TMZ schedule seems a safe and effective option for patients with recurrent GBM, with high radiologic response rates and good clinical impact. Strict clinical observation of patients may enable obtaining better results than those already present in the literature and further investigation appears auspicable.

Suicide Attempts in a General Hospital: A Case-Control

Objective: This study aims is to conduct a comparative analysis of the clinical and sociodemographic profiles of individuals referred to Consultation-Liaison Psychiatry (CLP) at a tertiary general hospital, specifically focusing on those seeking assistance due to suicide attempts (TS) versus CLP requests for other reasons (non-TS) between the years 2010 and 2020. Additionally, we aim to assess factors associated with suicide attempts. Method: This retrospective controlled study involves a thorough examination of medical records encompassing 3913 patients who received CLP services at the Hospital de Base (HB) and the Children and Maternity Hospital (HCM) of São José do Rio Preto Medical School Foundation (Funfarme) from June 2010 to June 2020. The patient cohort is categorized into two groups: those with requests for SA (n = 677) and those with requests for other reasons. Results: In the SA group, as opposed to the non SA group, statistically significant differences were observed for gender (predominantly female), employment status (employed), marital status (single), and age (younger). Notably, a higher prevalence of psychiatric antecedents (88.7%, n = 555 vs. 73.6% n = 2018) was found in the SA group, indicating a significant association. The frequency of SA requests remained stable over the years. Among the SA group, mood disorders were the most prevalent (39%, n = 372), followed by disorders related to substance use (21.2%, n = 202), and personality disorders (16%, n = 152). A history of previous suicide attempts emerged as a crucial factor for the recurrence of SA (p-value ≤ 0.001). Exogenous intoxication emerged as the most frequently employed method in attempts (79.6%, n = 539), particularly prevalent among patients diagnosed with mood disorders (41%, n = 314). A significant association was observed between the method of attempt and the nosological psychiatric diagnosis (χ2 = 42.277;p ≤ 0.001). Regarding outcomes, the majority of patients were referred for outpatient follow-up (23%, n = 336) in specialized mental health services or at the Primary Healthcare Unit, highlighting the general hospital’s pivotal role in integrating patients into the broader healthcare network. Conclusion: Variables such as gender (female), age group (young adults), and psychiatric history exhibited stronger associations with suicide attempts compared to the group assisted by CLP for other reasons. Furthermore, a noteworthy correlation between the method employed and the psychiatric diagnosis was identified.

经鼻蝶内镜下鞍区手术后颅底多层重建技术

目的探讨内镜下鞍区手术后颅底多层重建技术的应用价值。方法收集病例12例,其中颅咽管瘤4例,鞍区脑膜瘤3例,巨大垂体瘤5例,均行内镜下经鼻蝶扩大入路肿瘤切除术,术中采用多层重建技术进行颅底重建。结果所有病例术后及随访3-6个月均未出现脑脊液漏和张力性气颅等并发症。结论内镜下经鼻蝶鞍区手术后颅底多层重建技术是一种简单安全有效的方法。

Can cinnamon bring aroma in Parkinson's disease treatment?

While in one hand, due to genetic alterations, lifestyle changes, infections or injuries, or sudden turn of life events, we get health problems, on the other, we have been endowed with enormous natural remedies to take care our health. Cinnamon, the brown bark of cinna- mon tree, is one such natural product that has already been being used for centuries throughout the world as spice or flavoring agent. In addition, medieval physicians used cinnamon for medical purposes to treat a variety of disorders including arthritis, coughing, hoarseness, sore throats, etc. It was once so highly-prized that several wars were fought over it.

大量多发性硬化症患者的脑萎缩和损伤负荷

Objective: To measure white matter (WM) and gray matter (GM) atrophy and lesion load in a large population of patients with multiple sclerosis (MS) using a fully automated, operatorindependent,multiparametric segmentation method. Methods: The study population consisted of 597 patients with MS and 104 control subjects. The MRI parameters were abnormal WM fraction (AWM-f), global WM-f (gWM-f), and GM fraction (GM-f). Results: Significant differences between patients with MS and control subjects included higher AWM-f and reduced gWM-f and GM-f. MRI data showed significant differences between patients with relapsing-remitting and secondary progressive forms of MS. Significant correlations between MRI parameters and between MRI and clinical data were found. Conclusions: Patients with multiple sclerosis have significant atrophy of both white matter (WM) and gray matter (GM); secondary progressive patients have significantly more atrophy of both WM and GM than do relapsing-remitting patients and a significantly higher lesion load (abnormal WM fraction); lesion load is related to both WM and even more to GM atrophy; lesion load and WM and GM atrophy are significantly related to Expanded Disability Status Scale score and age at onset (suggesting that the younger the age at disease onset, the worse the lesion load and brain atrophy); and GM atrophy is the most significant MRI variable in determining the final disability.

中枢神经系统淋巴瘤的毛细血管生理及给药

To evaluate whether the chemosensitivity of primary central nervous system ly mphomas to water soluble drugs could result from improved drug delivery, we qu antitatively assessed pharmacokinetic factors in seven patients. The capillary p ermeability surface product was found to be significantly increased in central n ervous system lymphomas compared with glioblastoma multiforme, medulloblastomas, and metastases. Tumoral blood flow was significantly greater than in normal whi te matter. Our results suggest favorable pharmacokinetics to water and lipid soluble drugs in primary central nervous system lymphomas.

Factors associated with hopelessness in epileptic patients

AIM: To investigate factors related to hopelessness in a sample of epileptic patients, including measures of depression and quality of life(QOL). METHODS: Sixty-nine participants were administered the following psychometric instruments: Beck Depression Inventory-Ⅱ, Beck Hopelessness Scale(BHS), and QOLin Epilepsy(QOLIE)-89. Patients were dichotomized into two categories: those affected by epilepsy with generalized tonic-clonic seizures vs those having epilepsy with partial seizures. RESULTS: The groups differed on the QOLIE Role Limitation/Emotional dimension. Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems than patients with other types of epilepsy(89.57 ± 25.49 vs 72.86 ± 36.38; t 63 =-2.16; P < 0.05). All of the respondents reported moderate to severe depression, and 21.7% of patients with generalized seizures and 28.6% of patients with other diagnoses had BHS total scores ≥ 9 indicating a higher suicidal risk. The study did not control for years of the illness. CONCLUSION: Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems compared to patients with other types of seizures. Patients at increased suicide risk as evaluated by the BHS were older than those who had a lower suicidal risk. Future studies are required to further investigate the impact of hopelessness on the outcome of epileptic patients.

神经对大鼠骨骼肌小电导钙激活钾通道(SK3)表达的影响

目的小电导钙激活的钾通道(SK3)介导了动作电位后的后超极化电位的产生,在调节可兴奋细胞的膜电位中起关键作用。使去神经支配和肌强直营养不良患者骨骼肌SK3表达显著上调。本实验拟观察神经对骨骼肌SK3钾通道表达的调节作用。方法在Wistar大鼠,分别通过切断坐骨神经和局部注射河豚毒素(TTX)建立比目鱼肌去神经支配模型,和通过钳夹损伤比目鱼肌神经建立比目鱼肌去神经后神经再支配模型。在体给予去神经比目鱼肌频率为30Hz的电刺激(100脉冲/100 s)。实验结束后,免疫荧光法测定比目鱼肌中SK3钾通道的表达和定位;提取比目鱼肌组织总mRNA和蛋白,逆转录PCR和Western Blot分别检测SK3 mRNA和蛋白水平。结果切断坐骨神经能显著上调比目鱼肌SK3 mRNA和蛋白表达,且分别在术后第6 d和第9 d到达稳定。TTX诱导肌肉瘫痪也能显著上调比目鱼肌SK3 mRNA和蛋白表达。钳夹比目鱼肌神经所造成的暂时神经损伤能诱导SK3蛋白表达上调,而随着神经功能的恢复SK3蛋白表达也随之显著下调。在切断除坐骨神经术后6 d,在体给予电刺激6 d能显著下调比目鱼肌SK3的高表达;而且,在去除坐骨神经的同时给予电刺激则能阻止比目鱼肌SK3表达的上调。结论神经对骨骼肌SK3钾通道表达具有抑制作用,其作用与唤起肌肉活性密切相关。在体电刺激能抑制和防止去神经诱导的骨骼肌SK3蛋白表达上调,可能是改善神经损伤后或相关疾病所致的肌强直症状的有效手段之一。

Alpha-rhythm stimulation using brain entrainment enhances heart rate variability in subjects with reduced HRV

In the present research, we have used the brain entrainment (BWE) treatment simultaneously recording time series data of R-R intervals of the ECG during rest condition. In detail, we have used alpha brain stimulation and we have found that it induces an enhancement of HRV, particularly in Total Variability and Vagal Modulation activities. The experiment has been performed by us on ten subjects with age ranging from 20 to 70 years old. The risk induced from low HRV is by this time well known in literature. Therefore, the obtained result promises to be of valuable interest not only in terms of the basic neurological investigation but also because it delineates new possibilities in terms of clinical application.

Targeting BPOZ-2 in Lewy body disease

Formation of Lewy body inclusions（LBs）in the substantia nigra（SN）is a very well-characterized pathological hallmark of Parkinson’s disease（PD）.LBs are aggregates of many biologically inactive proteins including structural elements,alpha-synuclein（asyn）-binding proteins,synphilin-1-binding proteins,and components of the ubiquitin-proteasome system.

多发硬化病人首次发病1年后灰白质的变化:MRI检查

目的应用MRI评价临床孤立综合征(CIS)病人发病1年后其白质(WM)及灰质(GM)的纵向改变。材料与方法本研究为前瞻性,符合HIPPA法案。

肝炎相关性混合型冷球蛋白血症周围神经病变的电生理学随访研究

A retrospective study was performed on 27 patients withhepatitis C (HCV)-rela ted mixed cryoglobulinemia (purpura,arthralgia, hepatitis, glomerulonephritis, p eripheral neuropathy)to assess peripheral nerve involvement during follow-up of up to 8 years. All patients had the same degree of organ/system involvement ini tially and were clinically evaluated at least annually. All 27 patients received steroids; 15 also received recombinant interferon-α2b (rIFN-α2b). At first examination, neurological signs and electrodiagnostic findings consistent with p eripheral neuropathy were found in 20(74%) and in 24 (88.8%) patients, respect ively. Neurological evaluation and electrodiagnostic data at 3 and 8 years revea led worsening of neuropathy, whereas the other manifestations of mixed cryoglobu linemia (MC) were stable. At the last examination, clinical and electrodiagnosti c signs of neuropathy were found in 25 patients (92.5%), occurring in 1 of 3 pa tients with normal initial findings, and worsened in 8. A more severe neuropathy was observed in 3(25%) of the patients treated with prednisone alone and in 6 (40%) of the patients additionally treated with rIFN-α2b.Our data confirm tha t in patients with HCV-related MC, peripheral nerve involvement is frequent, is progressive, and does not seem to benefit by addition of rIFN-α2b to steroid treatment.

多发性硬化症欧洲标准化临床描述的确立

Objectives The EDMUS system is a clinical database specifically tailored to the description of multiple sclerosis (MS). The EVALUED(Evaluation of the EDMUS system) study is an European project with two Abstract:Objectives: 1) to assess the interexaminer reliability of the whole EDMUS system; 2) to validate the EDMUS- Grading Scale (EGS), which is a simplified version of the Kurtzke Disability Status Scale (DSS). Methods The protocol included 12 neurologists working in pairs within six European centres (Bari, Basel, Florence, London, Lyon, Wü rzburg). They assessed independently 30 MS patients in their centre, filling in the EDMUS forms. The reliability of the system was assessed on selected key items in the history of the MS onset, the clinical course and the disease course classification. The clinical examination of the patients permitted an assessment of the Kurtzke Expanded Disability Status Scale (EDSS) and the EGS. Level of agreement was measured in terms of kappa and weighted kappa indexes whenever appropriate. Results The study included 180 patients with definite or probable MS of whom 37 % were males. Age was 35.8± 9.6 years (mean± SD), disease duration 7.8 ± 5.7 years, and mean EDSS score 4.1 ± 2.2. The disease course was relapsing- remitting in 67 % , secondary progressive in 22 % , and progressive from disease onset in 11 % . For key items of the history, the inter- examiner reliability level ranged from moderate to excellent. Concerning the disability scales, perfect agreement was reached in 59 % for EDSS and 78 % for EGS. The close correlation and linear association (r = 0.94, p < 0.0001) between both scales demonstrated EGS’ s construct validity. Conclusion The EDMUS system allows a consistent clinical description of MS using a common language. This standardized follow- up of MS patients is valuable especially in studies requiring a critical mass of informative patients.

经颅磁刺激引起的运动后运动诱发电位易化及抑制:关于多发性硬化症的研究

Objective: To evaluate motor cortex excitability changes by transcranial magnetic stimulation (TMS) following repetitive muscle contractionsE in patients with multiple sclerosis (MS); to state whether a typical pattern of post exercise motor evoked potentials (MEPs) is related to clinical fatigue in MS.Methods: In 41 patients with definite MS (32 with fatigue and 9 without fatigue according to Fatigue Severity Scale) and 13 controls, MEPs were recorded at rest: at baseline condition, following repetitive contractions until fatigue, and after fatigue, to evaluate post exerciseMEP facilitation (PEF) and depression (PED). Results: After exercise,MEP amplitude significantly increased both in patients and controls (PEF). When fatigue set in, MEP amplitude was significantly reduced in normal subjects (PED), but not in patients. Post exercise MEP findings were similar both in patients with and without fatigue. Conclusions: Our findings suggest an intracortical motor dysfunction following a voluntary contraction in MS patients, possibly due to failure of depression of facilitatory cortical circuits, or alternatively of inhibitory mechanisms.