Evaluation of the serum zinc level in adult patients with melasma: Is there a relationship with serum zinc deficiency and melasma?

Summary

Background

Melasma is a common acquired hypermelanosis of sun-exposed skin, particularly on the face, which presents as symmetric, light- to gray-brown-colored macules and patches. There are several studies of serum zinc levels in cutaneous disorders. So far, no studies have been carried out to assess the serum zinc level in patients with melasma. The aim of this study is to determine the serum zinc level in patients with melasma compared to healthy subjects.

Materials and methods

A total of 118 patients with melasma and 118 healthy controls were enrolled in this prospective cross-sectional study. The two groups were matched for age and sex. Atomic absorption spectrophotometry was used to measure serum zinc levels. The statistical analysis was performed using SPSS software.

Results

The mean serum level of zinc in melasma patients and controls was 77.4±23.2 μg/dL and 82.2±23.9 μg/dL, respectively (P-value=.0001). Serum zinc deficiency was found in 45.8% and 23.7% of melasma patients and control subjects, respectively. A positive family history of melasma in first-degree relatives was present in 46 (39%) of the cases, and a history of taking oral contraceptive pill was found in 95 (81%) of women with melasma. The aggravating factors for melasma were stated as: sun exposure (11.1%), pregnancy (15.3%), nutrition (2.5%), oral contraceptive pills (18.6%), and emotional stress (5.9%). The malar and centrofacial patterns were seen in 3.4% and 72% of cases, respectively, whereas 24.6% of the patients had both centrofacial distribution and malar distribution, and there was no patient with mandibular pattern. Among patients with melasma, 20.3% had thyroid dysfunction, while in the control subjects, 8.4% had thyroid dysfunction (P=.001).

Conclusion

There is a significant relationship between low levels of zinc and melasma. Zinc deficiency may be involved in the pathogenesis of melasma. Also, treatment with oral zinc supplements can be tried in these patients to see the outcome. However, to make recommendations on screening for zinc deficiency in patients with melasma, future research of good methodological quality is needed.

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Influences of age, ethnic group, and skin sites on a provisory skin marking, experimentally induced, in vivo

Abstract

Background

To study capacity of skin to being imprinted by a marking head rapidly applied (10 seconds) onto the skin under a standardized pressure (15 kPa).

Material and Methods

Referential photographs of skin markings, resulting from different times of application serve at grading the extent of skin imprints. The imprinting tool, equipped with 5 linear bulbs of different sizes but same thickness (1 mm), was applied onto the cheeks of 641 women of different ages (18-80 years) of 3 different ethnic groups. In the cohort of 198 Caucasian women, the marking head was pressed onto 3 different sites (outer arm, cheek, and dorsal forearm) and the kinetics of skin recovery from cheek marking was recorded on a smaller and younger part of this Caucasian cohort, ie, 141 Caucasian women, aged 18-59 years.

Results

The recorded intensities of skin markings were found highly correlated with age in all 3 studied ethnic groups (Chinese, African-American, and Caucasian). Caucasian women seem more sensitive to the marking and the kinetics of recovery from such imprint was found highly dependent from its intensity, ie, the higher the grades, the slower the recovery. In Caucasian women, intensities were different between skin sites, where arm showed higher resistance to marking. Possible impact of photo-aging on the decreased skin resistance to such provoked deformation is likely of minor amplitude, as compared to the one induced by chronological aging.

Conclusion

This method offers a new vision on skin aging, in its variable response to a standard deformation that appears mostly driven by chronological aging.

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Characterization of sweat induced with pilocarpine, physical exercise, and collected passively by metabolomic analysis

Abstract

Background/purpose

The elimination of the pain associated with needle picking is a strong motivation for the development of clinical non-invasive diagnostic methods. Sweat has been described as an alternative biological sample that may have a direct relation to the plasma composition.

Materials and methods

In this study, analysis of sweat of human volunteers obtained by induction with pilocarpine is compared with sweat samples obtained by physical exercise and by passive collection along 7 hours. The sweat samples have been analyzed by 1H nuclear magnetic resonance spectroscopy.

Results

A range of 34 different metabolites has been detected in sweat samples, including lactate, several amino acids, pyroglutamate, and urocanate. Most of the metabolites identified were quantified. The majority of the amino acids detected in sweat seem to have origin in the epidermis surface. No significant differences in sweat samples from female and male were observed by 1H NMR metabolomic analysis.

Conclusions

Principal component analysis (PCA) shows that both physical exercise and pilocarpine methods seem to be equally reproducible methods in terms of sweat metabolite composition presenting better repeatability than natural sweat collection. Nevertheless, this difference is mainly originated from amino acids with origin from the skin surface.

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Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial

BACKGROUND Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance. OBJECTIVE We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time. DESIGN A randomised, observer-blinded, equivalence trial (equivalence margin = 7.4 min). SETTING Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from 12 May 2016 to 10 January 2017. PATIENTS A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia. INTERVENTION In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8 mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5 μg ml−1 and 5 mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle. MAIN OUTCOMES MEASURES We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). RESULTS Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (±SD) total anaesthesia time [15.3 (±6.5) vs. 20.1 (±9.0) min; mean difference, −4.8; 95% confidence interval, −8.1 to −1.9; P = 0.005] and mean (±SD) onset time [10.2 (±5.6) vs. 15.5 (±9.0) min; P = 0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block-related pain, opioid consumption or adverse events. CONCLUSION Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (±7.4 min). TRIAL REGISTRATION www.clinicaltrials in the (Study ID: TCTR20160427003). Correspondence to De Q. Tran, MD, FRCPC, Professor, Department of Anaesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, Montreal, QC, Canada H3G-1A4 Tel: +1 514 934 1934x43261; fax: +1 514 934 8249; e-mail: de_tran@hotmail.com © 2017 European Society of Anaesthesiology

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Prevalence of obesity among adults in Issele-Uku, Delta State Nigeria

Publication date: Available online 12 November 2017
Source:Alexandria Journal of Medicine
Author(s): Otovwe Agofure
BackgroundObesity is gradually assuming an epidemic dimension among adults in Nigeria. Unfortunately, this has led to the increase in the prevalence of chronic diseases.ObjectiveThe study was designed to assess the prevalence of obesity among adults in Issele-uku, Aniocha North Local Government Area of Delta State, Nigeria.Materials and MethodsThe study employed a cross-sectional study design conducted among 201 respondents utilizing a simple random sampling technique. A validated semi-structured questionnaire was administered to obtain information from respondents; while descriptive and inferential statistics was used to analyze the data.ResultsThe results show that more of the respondents were between the ages of 18–40 years, while about half 101(50.50%) were females and 104(52.0%) were married. Furthermore, only 46(23.0%) were overweight while 17.50% and 5.50% were pre-obese and obese respectively. The mean Body Mass Index of the respondents was 23.02±4.42 while the respondents demonstrated positive attitude towards prevention of obesity. In addition, only eating akpu/fufu significantly predicted obesity (R²=0.034) while both sex (P=.350) and educational status (P=0.165) did not significantly influence obesity and some of the respondents' 82(41.0%) exercises once in a while.ConclusionThe study recommended more awareness campaign on the dangers of obesity across communities in Nigeria.



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Oleanonic acid ameliorates pressure overload-induced cardiac hypertrophy in rats: The role of PKCζ-NF-κB pathway

Publication date: Available online 11 November 2017
Source:Molecular and Cellular Endocrinology
Author(s): Hui Gao, Hui Liu, Tiexin Tang, Xiaofei Huang, Dongxiu Wang, Yan Li, Pan Huang, Yingfu Peng
It has been reported that inflammation is closely related with cardiac hypertrophy. Some inflammatory cytokines such as tumor necrosis factor-α, interleukin-1β, and interleukin-6 directly induce cardiac hypertrophy, which is associated with the activation of nuclear factorkappa B (NF-κB). Thus, NF-κB is an attractive target for cardiac hypertrophy. In the present study, oleanonic acid inhibited the elevation of transcriptional activity of NF-κB and reduced the mRNA expressions of hypertrophic genes such as atrial natriuretic factor (ANF) and brain natriuretic peptide (BNP) in a concentration-dependent manner in phenylephrine (PE)-treated cardiomyocytes. Furthermore, we found that oleanonic acid inhibited the phosphorylation of protein kinase C ζ (PKCζ) at Thr410 site and then reduced the activation of NF-κB using gain- and loss-of-function approaches in PE-treated cardiomyocytes. In vivo, similar results were observed in abdominal aortic constriction (AAC) rats that were intragastrically administered with oleanonic acid, and the pathological changes accompanying cardiac hypertrophy were relieved. In conclusion, oleanonic acid can effectively ameliorate cardiac hypertrophy by inhibiting PKCζ-NF-κB signaling pathway.



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Hyperbaric oxygen therapy ameliorates pathophysiology of 3xTg-AD mouse model by attenuating neuroinflammation

Publication date: February 2018
Source:Neurobiology of Aging, Volume 62
Author(s): Ronit Shapira, Beka Solomon, Shai Efrati, Dan Frenkel, Uri Ashery
There is a real need for new interventions for Alzheimer's disease (AD). Hyperbaric oxygen therapy (HBOT), the medical administration of 100% oxygen at conditions greater than 1 atmosphere absolute, has been used successfully to treat several neurological conditions, but its effects on AD pathology have never been thoroughly examined. Therefore, we exposed old triple-transgenic (3xTg) and non-transgenic mice to HBOT followed by behavioral, histological, and biochemical analyses. HBOT attenuated neuroinflammatory processes by reducing astrogliosis, microgliosis, and the secretion of proinflammatory cytokines (IL-1β and TNFα) and increasing expression of scavenger receptor A, arginase1, and antiinflammatory cytokines (IL-4 and IL-10). Moreover, HBOT reduced hypoxia, amyloid burden, and tau phosphorylation in 3xTg mice and ameliorated their behavioral deficits. Therefore, we suggest that HBOT has multifaceted effects that reduce AD pathologies, even in old mice. Given that HBOT is used in the clinic to treat various indications, including neurological conditions, these results suggest HBOT as a novel therapeutic intervention for AD.

Graphical abstract

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Resource forecasting: Differential effects of glucose taste and ingestion on delay discounting and self-control

Publication date: 1 February 2018
Source:Appetite, Volume 121
Author(s): X.T. Wang, Ryan N. Reed, Lee A. Baugh, Kelene A. Fercho
We tested a novel hypothesis that glucose taste acts as a signal for resource acquisition, motivating preference for immediate rewards while actual glucose ingestion prompts resource conservation, promoting future-orientated self-regulation. In Study 1, participants were engaged in a delay-discounting task and a grip-control task before and after a beverage intervention (glucose drink, water drink, or glucose mouth-rinse). Glucose ingestion decreased delay discounting, making larger-and-later rewards more attractive. In contrast, glucose rinse increased delay discounting. Water ingestion had none of the effects. In the grip-control task, only glucose ingestion improved the performance. Study 2 using fMRI revealed that glucose rinse and glucose ingestion resulted in distinct brain activational patterns. Compared to glucose rinse, glucose ingestion deactivated a few brain regions (e.g., the anterior cingulate gyrus and inferior frontal gyrus) that are previously shown to be more active when making more difficult intertemporal choices, suggesting that glucose ingestion eases the process of making intertemporal choice. In sum, our behavioral and neuroimaging findings together suggest a dual signaling role of glucose sensation and ingestion in regulating delay discounting and self-control.



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Feminist approaches to Anorexia Nervosa: a qualitative study of a treatment group

Abstract

Background

Eating disorders (EDs) are now often approached as biopsychosocial problems. But it has been suggested by scholars interested in sociocultural factors that all is not equal within this biospsychosocial framework, with the 'social' aspects of the equation relegated to secondary factors within ED treatment contexts. Although sociocultural influences are well-established as risk factors for EDs, the exploration of whether or how such perspectives are useful in treatment has been little explored. In responding to this context, this article seeks to discuss and evaluate a 10 week closed group intervention based on feminist approaches to EDs at a residential eating disorder clinic in the East of England.

Methods

The data was collected via one-to-one qualitative interviews and then analysed using thematic discourse analysis.

Results

The participants suggested that the groups were helpful in enabling them to situate their problem within a broader cultural and group context, that they could operate as a form of 'protection' from ideologies regarding femininity, and that a focus on the societal contexts for EDs could potentially reduce feelings of self-blame. At the same time, the research pointed to the complexities of participants considering societal rather than individualised explanations for their problems, whilst it also confronted the implications of ambivalent responses toward feminism.

Conclusions

Highly visible sociocultural factors in EDs – such as gender - may often be overlooked in ED clinical contexts. Although based on limited data, this research raises questions about the marginalisation of sociocultural factors in treatment, and the benefits and challenges including the latter may involve.

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Aportación de la PET/TC con 11C-colina en la recidiva bioquímica del cáncer de próstata con antígeno específico prostático sérico inferior a 1 ng/ml

Publication date: Available online 12 November 2017
Source:Revista Española de Medicina Nuclear e Imagen Molecular
Author(s): F.J. Gómez-de la Fuente, I. Martínez-Rodríguez, M. de Arcocha-Torres, R. Quirce, J. Jiménez-Bonilla, N. Martínez-Amador, I. Banzo
ObjetivoLa PET/TC con ¹¹C-colina ha mostrado buenos resultados en la reestadificación del cáncer de próstata (CP) con antígeno específico prostático (PSA) elevado. Su uso con niveles bajos es controvertido. Nuestro objetivo fue evaluar la aportación de la ¹¹C-colina PET/TC en pacientes con CP, recidiva bioquímica y PSA <1ng/ml.Material y métodoSe evaluaron retrospectivamente 50 pacientes consecutivos (edad: 65,9±5,6 años) con recidiva bioquímica de CP y PSA <1ng/ml (media: 0,4±0,2). La PET/TC fue adquirida a los 20 min de la administración intravenosa de 555-740 MBq de ¹¹C-colina. El seguimiento mínimo fue de 30 meses.ResultadosDe los 50 pacientes, 21 (42%) mostraron una ¹¹C-colina PET/TC anormal. En 7 (14%) se confirmó la afectación tumoral (4 en lecho prostático, 4 en ganglios pélvicos, 2 en ganglios mediastínicos y un tumor síncrono sigmoide) y se modificó en todos ellos el tratamiento inicialmente previsto. En 2 pacientes (4%) se confirmó enfermedad benigna (uno con sarcoidosis, otro con secuelas de TBC) y en 3 pacientes (6%) ausencia de enfermedad. En los otros 9 pacientes (18%) los hallazgos no fueron estudiados (7 en ganglios mediastínicos y 4 en pélvicos). La ¹¹C-colina PET/TC fue normal en 29 pacientes (58%). Solo en 2 de ellos se confirmó recidiva a los 30 meses.ConclusiónLa ¹¹C-colina PET/TC demostró su utilidad en la recidiva bioquímica de CP y PSA <1 ng/ml en el 14% de los pacientes al mostrar enfermedad tumoral, lo que tuvo implicaciones terapéuticas. En un 4% se detectó enfermedad benigna. Una ¹¹C-colina PET/TC normal se asoció a una tasa de recurrencia muy baja a los 30 meses.Objective¹¹C-choline PET/CT has demonstrated good results in the restaging of prostate cancer (PCa) with high serum prostate specific antigen (PSA), but its use in patients with low serum PSA is controversial. Our aim was to evaluate the contribution of ¹¹C-choline PET/CT in patients with PCa, biochemical relapse and PSA <1 ng/ml.Material and methodFifty consecutive patients (mean age: 65.9±5.6 years) with biochemical relapse of PCa and serum PSA <1ng/ml were evaluated retrospectively. PET/CT was performed 20min after intravenous administration of 555-740 MBq of ¹¹C-choline. Minimum follow up time was 30 months.ResultsTwenty-one out of 50 patients (42%) had an abnormal ¹¹C-choline PET/CT. In 7 out of 21 patients (14%) tumor was confirmed (4 in prostatic bed, 4 in pelvic lymph nodes, 2 in mediastinal lymph nodes and one synchronous sigmoid carcinoma), and in all cases the initial therapeutic planning was modified. In 2 patients (4%) subsequent tests diagnosed a benign disease (one sarcoidosis, one tuberculosis sequelae) and in 3 patients (6%) they ruled out pathology. The other 9 patients (18%) had no further assessment (7 mediastinal and 4 pelvic lymph nodes). Twenty-nine out of 50 patients (58%) had a normal PET/CT. At 30 months, follow up recurrence was confirmed only in 2 of these patients.Conclusions¹¹C-choline PET/CT proved its usefulness in demonstrating tumor in 14% of patients with BR of PCa and serum PSA <1ng/ml, with therapeutic implications. In 4% of patients a benign condition was detected. A normal ¹¹C-choline PET/CT was associated with a very low rate of recurrence at 30 months.



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An ultrasonographic investigation of deep neck flexor muscles cross-sectional area in forward and normal head posture

Publication date: Available online 12 November 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Roya Eshaghi Moghadam, Leila Rahnama, Noureddin Karimi, Mohsen Amiri, Mahsa Rahnama
BackgroundAs one of the most common work-related musculoskeletal disorders and postural deviations, forward head posture (FHP), is considered to lead to muscle imbalance.ObjectivesTherefore, the aim of this study is to investigate the bilateral cross-sectional area (CSA) of the deep neck flexor muscles at rest and during five stages of the craniocervical flexion (CCF) test in individuals with FHP and the controls with normal head posture.MethodsEighteen students with FHP and 18 controls with normal head posture, all females aged 18–35 years, participated in this study. Participants were categorized into two groups based on their craniovertebral angle. The CSA of the deep neck flexors was measured using ultrasonography while participants lay supine on the table with a pressure biofeedback unit placed under their necks in order to let the examiner measure the CSA of the muscles during rest and five stages of the CCF test including 22, 24, 26, 28, and 30 mmHg of the pressure biofeedback unit.ResultsA significant effect of contraction level was observed in both groups, indicating significant increases of the CSA of the deep neck flexors during contraction (F = 64.37, P < 0.001). No significant difference was evident for the CSA of the deep neck flexors between the groups, although the increase in the CSA of the deep neck flexors was up to 28 mmHg in the normal head posture group compared to 26 mmHg in the FHP group.ConclusionsThe results of the present study showed no significant difference between the performance of the deep neck flexors during the CCF test in FHP and normal head posture individuals, which challenge the common belief of the deep neck flexors weakness in individuals sustaining from FHP.



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Effect of noisy galvanic vestibular stimulation on center of pressure sway of static standing posture

Publication date: Available online 17 October 2017
Source:Brain Stimulation
Author(s): Yasuto Inukai, Naofumi Otsuru, Mitsuhiro Masaki, Kei Saito, Shota Miyaguchi, Sho Kojima, Hideaki Onishi
BackgroundThe vestibular system is involved in the control of standing balance. Galvanic vestibular stimulation (GVS) is a noninvasive technique that can stimulate the vestibular system. In recent years, noisy GVS (nGVS) using noise current stimulation has been attempted, but it has not been clarified whether it affects postural sway in open-eye standing.ObjectiveThe purpose of this study was to clarify the influence of nGVS on the center of pressure (COP) sway measurement in open-eye standing postural control and identify the responders of nGVS.MethodsnGVS (0.1–640 Hz) was delivered at 0.4 and 1.0 mA over the bipolar mastoid. COP sway root mean square area, sway path length, medio-lateral (ML) mean velocity, and antero-posterior (AP) mean velocity before and during nGVS in an open-eye standing posture was measured.ResultsnGVS at 0.4 and 1.0 mA significantly reduced sway path length, mean velocity. The stimulation effect of nGVS was also large in subjects with a long sway path. For subjects with high COP sway of Baseline, nGVS was effective even with stimulation for a short duration (5 s).ConclusionsThese findings suggest that nGVS improves postural sway in an open-eye standing posture among young subjects.



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Global structural integrity and effective connectivity in patients with disorders of consciousness

Publication date: Available online 11 November 2017
Source:Brain Stimulation
Author(s): Olivier Bodart, Enrico Amico, Francisco Gomez, Adenauer G. Casali, Sarah Wannez, Lizette Heine, Aurore Thibaut, Jitka Annen, Melanie Boly, Silvia Casarotto, Mario Rosanova, Marcello Massimini, Steven Laureys, Olivia Gosseries
BackgroundPrevious studies have separately reported impaired functional, structural, and effective connectivity in patients with disorders of consciousness (DOC). The perturbational complexity index (PCI) is a transcranial magnetic stimulation (TMS) derived marker of effective connectivity. The global fractional anisotropy (FA) is a marker of structural integrity. Little is known about how these parameters are related to each other.ObjectiveWe aimed at testing the relationship between structural integrity and effective connectivity.MethodsWe assessed 23 patients with severe brain injury more than 4 weeks post-onset, leading to DOC or locked-in syndrome, and 14 healthy subjects. We calculated PCI using repeated single pulse TMS coupled with high-density electroencephalography, and used it as a surrogate of effective connectivity. Structural integrity was measured using the global FA, derived from diffusion weighted imaging. We used linear regression modelling to test our hypothesis, and computed the correlation between PCI and FA in different groups.ResultsGlobal FA could predict 74% of PCI variance in the whole sample and 56% in the patients' group. No other predictors (age, gender, time since onset, behavioural score) improved the models. FA and PCI were correlated in the whole population (r = 0.86, p < 0.0001), the patients, and the healthy subjects subgroups.ConclusionWe here demonstrated that effective connectivity correlates with structural integrity in brain-injured patients. Increased structural damage level decreases effective connectivity, which could prevent the emergence of consciousness.



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International randomized-controlled trial of transcranial Direct Current Stimulation in depression

Publication date: Available online 27 October 2017
Source:Brain Stimulation
Author(s): Colleen K. Loo, Mustafa M. Husain, William M. McDonald, Scott Aaronson, John P. O'Reardon, Angelo Alonzo, Cynthia Shannon Weickert, Donel M. Martin, Shawn M. McClintock, Adith Mohan, Sarah H. Lisanby
BackgroundEvidence suggests that transcranial Direct Current Stimulation (tDCS) has antidepressant effects in unipolar depression, but there is limited information for patients with bipolar depression. Additionally, prior research suggests that brain derived neurotrophic factor (BDNF) Val66Met genotype may moderate response to tDCS.ObjectiveTo examine tDCS efficacy in unipolar and bipolar depression and assess if BDNF genotype is associated with antidepressant response to tDCS.Methods130 participants diagnosed with a major depressive episode were randomized to receive active (2.5 milliamps (mA), 30 min) or sham (0.034 mA and two 60-second current ramps up to 1 and 0.5 mA) tDCS to the left prefrontal cortex, administered in 20 sessions over 4 weeks, in a double-blinded, international multisite study. Mixed effects repeated measures analyses assessed change in mood and neuropsychological scores in participants with at least one post-baseline rating in the unipolar (N = 84) and bipolar (N = 36) samples.ResultsMood improved significantly over the 4-week treatment period in both unipolar (p = 0.001) and bipolar groups (p < 0.001). Among participants with unipolar depression, there were more remitters in the sham treatment group (p = 0.03). There was no difference between active and sham stimulation in the bipolar sample. BDNF genotype was unrelated to antidepressant outcome.ConclusionsOverall, this study found no antidepressant difference between active and sham stimulation for unipolar or bipolar depression. However, the possibility that the low current delivered in the sham tDCS condition was biologically active cannot be discounted. Moreover, BDNF genotype did not moderate antidepressant outcome.Clinical Trials Registrationwww.clinicaltrials.gov, NCT01562184.



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Report of seizure induced by 10 Hz rTMS over M1

Publication date: Available online 8 November 2017
Source:Brain Stimulation
Author(s): Valentina Bruno, Carlotta Fossataro, Francesca Garbarini




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Number of pulses or number of sessions? An open-label study of trajectories of improvement for once-vs. twice-daily dorsomedial prefrontal rTMS in major depression

Publication date: Available online 7 November 2017
Source:Brain Stimulation
Author(s): Laura Schulze, Kfir Feffer, Christopher Lozano, Peter Giacobbe, Zafiris J. Daskalakis, Daniel M. Blumberger, Jonathan Downar
BackgroundRepetitive transcranial magnetic stimulation (rTMS) shows efficacy in the treatment of major depressive episodes (MDEs), but can require ≥4–6 weeks for maximal effect. Recent studies suggest that multiple daily sessions of rTMS can accelerate response without reducing therapeutic efficacy. However, it is unresolved whether therapeutic effects track cumulative number of pulses, or cumulative number of sessions.ObjectiveThis open-label study reviewed clinical outcomes over a 20–30 session course of high-frequency bilateral dorsomedial prefrontal cortex (DMPFC)-rTMS among patients receiving 6000 pulses/day delivered either in twice-daily sessions 80 min apart (at 20 Hz) or single, longer, once-daily sessions (at 10 Hz).MethodsA retrospective chart review identified 130 MDD patients who underwent 20–30 daily sessions of bilateral DMPFC-rTMS (Once-daily, n = 65; Twice-daily, n = 65) at a single Canadian clinic.ResultsMixed-effects modeling revealed significantly faster improvement (group-by-time interaction) for twice-daily versus once-daily DMPFC-rTMS. Across both groups, the pace of improvement showed a consistent relationship with number of cumulative sessions, but not with cumulative number of pulses. Although the twice-daily group completed treatment in half as many days, final clinical outcomes did not differ significantly between groups on dichotomous measures (response/remission rates: once-daily, 35.4%/33.8%; twice-daily, 41.5%/35.4%), or continuous measures, or on overall response distribution.ConclusionsTwice-daily rTMS appears feasible, tolerable, and capable of achieving comparable results to once-daily rTMS, while also reducing course length approximately twofold. Therapeutic gains tracked the cumulative number of sessions, not pulses. Future randomized studies comparing once-daily to multiple-daily rTMS sessions, while controlling for number of pulses, may be warranted.



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Accelerated HF-rTMS in the elderly depressed: A feasibility study

Publication date: Available online 31 October 2017
Source:Brain Stimulation
Author(s): Alexandre Dardenne, Chris Baeken, Cleo L. Crunelle, Chris Bervoets, Frieda Matthys, Sarah C. Herremans




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tDCS changes in motor excitability are specific to orientation of current flow

Publication date: Available online 7 November 2017
Source:Brain Stimulation
Author(s): Vishal Rawiji, Matteo Ciocca, André Zacharia, David Soares, Dennis Truong, Marom Bikson, John Rothwell, Sven Bestmann
BackgroundMeasurements and models of current flow in the brain during transcranial Direct Current Stimulation (tDCS) indicate stimulation of regions in-between electrodes. Moreover, the folded cortex results in local fluctuations in current flow intensity and direction, and animal studies suggest current flow direction relative to cortical columns determines response to tDCS.MethodsHere we test this idea by using Transcranial Magnetic Stimulation Motor Evoked Potentials (TMS-MEP) to measure changes in corticospinal excitability following tDCS applied with electrodes aligned orthogonal (across) or parallel to M1 in the central sulcus.ResultsCurrent flow models predicted that the orthogonal electrode montage produces consistently oriented current across the hand region of M1 that flows along cortical columns, while the parallel electrode montage produces non-uniform current directions across the M1 cortical surface. We find that orthogonal, but not parallel, orientated tDCS modulates TMS-MEPs. We also show modulation is sensitive to the orientation of the TMS coil (PA or AP), which is thought to select different afferent pathways to M1.ConclusionsOur results are consistent with tDCS producing directionally specific neuromodulation in brain regions in-between electrodes, but shows nuanced changes in excitability that are presumably current direction relative to column and axon pathway specific. We suggest that the direction of current flow through cortical target regions should be considered for targeting and dose-control of tDCS.



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Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression

Publication date: Available online 19 October 2017
Source:Brain Stimulation
Author(s): Kfir Feffer, Hyewon Helen Lee, Farrokh Mansouri, Peter Giacobbe, Fidel Vila-Rodriguez, Sidney H. Kennedy, Zafiris J. Daskalakis, Daniel M. Blumberger, Jonathan Downar
BackgroundPredicting rTMS nonresponse could be helpful in sparing patients from futile treatment, and in improving use of limited rTMS resources. While several predictive biomarkers have been proposed, few are accurate for individual-level prediction; none have entered routine use. An alternative approach in pharmacotherapy predicts outcome from early response; patients showing minimal (e.g., ≤20%) improvement at 2 weeks can be predicted as nonresponders with negative predictive values (NPV) > 80–90%. This approach has recently been extended to ECT, but never before to rTMS.ObjectiveTo assess the accuracy of 2-week clinical response in predicting rTMS treatment outcome.MethodsWe reviewed clinical symptom scores for 101 patients who underwent 20 sessions of dorsomedial prefrontal rTMS for unipolar major depression in a naturalistic retrospective case series, defining nonresponders both at the conventional <50% improvement criterion and at a more stringent <35% criterion.ResultsPatients achieving <20% improvement at session 10 were correctly predicted as nonresponders with NPVs of 88.2% by the conventional and 80.4% by the stringent criterion. Achieving <10% improvement at session 10 predicted nonresponse with NPVs of 89.5% and 86.8% by conventional and stringent criteria, respectively. Using the least-depressed score of either session 5 or 10, <20% improvement predicted nonresponse with NPVs of 91.3% and 82.6%, and <10% improvement predicted nonresponse with NPVs of 93.5% and 93.5%, by conventional and stringent criteria.ConclusionFor DMPFC-rTMS, a '<20% improvement at 2 weeks' rule concurred with previous pharmacotherapy and ECT studies on predicting nonresponse, and could prove useful for treatment decision-making in clinical settings.



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Vagus nerve magnetic modulation facilitates dysphagia recovery in patients with stroke involving the brainstem - A proof of concept study

Publication date: Available online 7 November 2017
Source:Brain Stimulation
Author(s): Wang-Sheng Lin, Chen-Liang Chou, Miao-Hsiang Chang, Yuh-Mei Chung, Fu-Gong Lin, Po-Yi Tsai
Background & aimsStroke involving the brainstem (SBS) causes severe oropharyngeal dysphagia (OD). Research on the therapeutic efficacy of vagus nerve modulation (VNM) by using repetitive transcranial magnetic stimulation (rTMS) in SBS patients with OD has been limited thus far. We aimed to assess the effect of VNM by using rTMS in improving swallowing function after SBS.MethodWe conducted a sham-controlled, double-blinded, parallel pilot study in 28 SBS patients with OD randomly allocated to a real rTMS group (n = 13; TMSreal) or a sham group (n = 15; TMSsham). For VNM, 5-Hz rTMS was applied to the left mastoid in 10 sessions. We evaluated all patients for swallowing function before and after rTMS conditioning, assessed on the 8-point Penetration–Aspiration Scale (PAS) through videofluoroscopy and the Australian Therapy Outcome Measures–Swallowing scale (AusTOMs). We measured the amplitude and latency of cricopharyngeal motor evoked potentials (CP-MEPs) as the neurophysiological parameters.ResultsTMSreal exhibited significant improvement in all swallowing outcomes—neurophysiological, radiological, and functional—compared with TMSsham: We noted higher CP-MEP amplitude (p = 0.004), shorter CP-MEP latency (p = 0.004), a lower PAS score (p = 0.001), and a higher AusTOMs score (p < 0.001) following rTMS in TMSreal. Moreover, the neurophysiological improvements were significantly correlated with the functional outcomes (p < 0.05).ConclusionsOur results encourage the application of VNM by using rTMS for improving swallowing function after SBS. The immediate therapeutic effects suggest that this novel intervention can be an effective complementary therapy to traditional oropharyngeal rehabilitation.Clinical trial registrationURL: http://ift.tt/1xHjpsE. Unique identifier: NCT02893033.



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