简介：AbstractBackground:Transcranial alternating current stimulation (tACS) offers a new approach for adult patients with major depressive disorder (MDD). The study is to evaluate the efficacy and safety of tACS treating MDD.Methods:This is an 8-week, double-blind, randomized, placebo-controlled study. Ninety-two drug-naive patients with MDD aged 18 to 65 years will receive 20 daily 40-min, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas on weekdays for 4 consecutive weeks (week 4), following a 4-week observation period (week 8). The primary outcome is the remission rate defined as the 17-item Hamilton depression rating scale (HDRS-17) score ≤7 at week 8. Secondary outcomes are the rates of response at weeks 4 and 8 and rate of remission at week 4 based on HDRS-17, the proportion of participants having improvement in the clinical global impression-improvement, the change in HDRS-17 score (range, 0–52, with higher scores indicating more depression) over the study, and variations of brain imaging and neurocognition from baseline to week 4. Safety will be assessed by vital signs at weeks 4 and 8, and adverse events will be collected during the entire study.Discussion:The tACS applied in this trial may have treatment effects on MDD with minimal side effects.Trial registration:Chinese Clinical Trial Registry, ChiCTR1800016479; http://www.chictr.org.cn/showproj.aspx?proj=22048.

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简介：摘要OBJECTIVEOur goal was to determine if pairing transcranial direct current stimulation (tDCS) with rehabilitation for two weeks could augment adaptive plasticity offered by these residual pathways to elicit longer-lasting improvements in motor function in incomplete spinal cord injury (iSCI)．DESIGNLongitudinal, randomized, controlled, double-blinded cohort study.SETTINGCleveland Clinic Foundation, Cleveland, Ohio, USA.PARTICIPANTSEight male subjects with chronic incomplete motor tetraplegia.INTERVENTIONSMassed practice (MP) training with or without tDCS for 2 hrs, 5 times a week.OUTCOME MEASURESWe assessed neurophysiologic and functional outcomes before, after and three months following intervention. Neurophysiologic measures were collected with transcranial magnetic stimulation (TMS). TMS measures included excitability, representational volume, area and distribution of a weaker and stronger muscle motor map. Functional assessments included a manual muscle test (MMT), upper extremity motor score (UEMS), action research arm test (ARAT) and nine hole peg test (NHPT)．RESULTSWe observed that subjects receiving training paired with tDCS had more increased strength of weak proximal (15% vs 10%), wrist (22% vs 10%) and hand (39% vs. 16%) muscles immediately and three months after intervention compared to the sham group. Our observed changes in muscle strength were related to decreases in strong muscle map volume (r＝0.851), reduced weak muscle excitability (r＝0.808), a more focused weak muscle motor map (r＝0.675) and movement of weak muscle motor map (r＝0.935)．CONCLUSIONOverall, our results encourage the establishment of larger clinical trials to confirm the potential benefit of pairing tDCS with training to improve the effectiveness of rehabilitation interventions for individuals with SCI.

简介：摘要ObjectiveThe purpose of this study is to determine the cognitive improvement and neurophysiological effects of repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex(L-DLPFC) in subacute stroke patients.MethodsTwelve consecutive first-ever stroke patients with cognitive impairment were enrolled. All subjects were randomly assigned to real or sham stimulation group and completed 10 sessions of rTMS for 2 weeks (Figure 1). 10Hz of navigation rTMS were applied (5sec stimulation and 25sec resting, total 1500 pulses) on the L-DLPFC at 80% of resting motor threshold (rMT). At the time of baseline, 1 month and 3 months after stroke onset, all subjects received the cognitive, behavioral and depression assessments. In addition, the vascular cognitive impairment harmonization standards (VCIHS), motor evoked potentials (MEP), event-related potentials (ERPs) and resting state functional magnetic resonance imaging (RS fMRI) were completed for the neuroplasticity at baseline and 3 months after stroke onset.ResultsAfter the treatment period, the real stimulation group improved significantly in the Montreal Cognitive (MoCA), Fugl-Meyer Assessment (FMA), Modified Bathel Index (MBI) and Geriatric Depression Scale (GDS) compared with sham stimulation group. And these effects lasted after three months. Among the VCIHS parameters, Z-scores of executive and memory function showed higher delta value between baseline and 3months timepoints in rTMS group. The MEP showed higher TIME x GROUP interaction in the percentage of intracortical inhibition and facilitation amplitude ratio in right hand. It suggests that there is beneficial effect on premotor cortical excitability of rTMS. The change of P300 amplitude in ERPs was more increased in real stimulation group significantly. The RS fMRI analysis results showed more increased functional connectivity of left frontal pole, Middle frontal gyrus, posterior parietal cortex and Right posterior parietal cortex after stimulation compare with the sham group.ConclusionsThese results suggest that high frequency rTMS on the L-DLPFC improves cognitive function and functional network activity in subacute stroke. The rTMS seems to be an recommendable treatment in stroke patients with cognitive impairment.

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简介：Becausethelargermetallicsurroundsareheatedbytheeddycurrent,whichisgeneratedbytheACcurrentflowingthroughtheACbusbarintheInternationalThermonuclearExperimentalReactor(ITER)poloidalfield(PF)convertersystem,shieldingoftheACbusbarisrequiredtodecreasethetemperatureriseofthesurroundstosatisfythedesignrequirement.ThreespecialtypesofACbusbarwithnaturalcooling,aircoolingandwatercoolingbusbarstructurehavebeenproposedandinvestigatedinthispaper.Foreachcoolingscheme,a3Dfinitemodelbasedontheproposedstructurehasbeendevelopedtoperformtheelectromagneticandthermalanalysistopredicttheiroperationbehavior.Comparingtheanalysisresultsofthethreedifferentcoolingpatterns,watercoolinghasmoreadvantagesthantheotherpatternsanditisselectedtobethethermaldissipationpatternfortheACbusbarofITERPFconverterunit.TheapproachtoqualifythesuitablecoolingschemeinthispapercanbeprovidedasareferenceonthethermaldissipationdesignofACbusbarintheconvertersystem.

简介：摘要ObjectiveBecause the reliability of repetitive transcranial magnetic stimulation (rTMS) in treating poststroke cognitive impairment has not been convincingly demonstrated, we systematically examined the effectiveness of this regimen with 2 protocols.MethodsWe randomly allocated 41 patients with poststroke cognitive impairment to receive 5 Hz rTMS (n＝11), intermittent theta burst stimulation (iTBS; n＝15) or sham stimulation (n＝15). Each group received 10 stimulation sessions over the left dorsolateral prefrontal cortex. We performed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Beck Depression Inventory at baseline and after the intervention.ResultsThe 5 Hz rTMS group showed significantly greater improvement than the sham group in RBANS total score (P＝0.006), attention (P＝0.001) and delayed memory (P<0.001). The iTBS group showed significantly greater improvement than the sham group in RBANS total score (P＝0.005) and delayed memory (P＝0.007). The 5 Hz rTMS group exhibited a superior modulating effect in attention compared to the iTBS group (P＝0.016). Patients without comorbid hypertension (P＝0.008) were predisposed to favourable therapeutic outcomes.ConclusionsOur results demonstrated that both 5 Hz rTMS and iTBS were effective for poststroke cognitive impairment in terms of global cognition, attention and memory function; the domain of attention was susceptible to 5 Hz modulation. Treatment with 5 Hz rTMS may slow cognitive decline, representing both a pivotal process in poststroke cognitive impairment and an aspect of neuroplasticity that contributes to disease-modifying strategies.

简介：摘要ObjectiveTo demonstrate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the ipsilesional dorsolateral prefrontal cortex (DLPFC) on neurological recovery in patients with subacute phase stroke.MethodsPatients with supratentorial hemispheric stroke who were hospitalized for intensive rehabilitation in the subacute phase were enrolled for this retrospective analysis. Two groups of patients were selected: the rTMS group who received high-frequency (20 Hz) rTMS ≥ 5 times over the ipsilesional DLPFC, and a control group who did not receive any rTMS. The patients were further divided into groups with right- or left-side brain lesions. Functional measurements for cognitive ability, mood, speech, and activities of daily living, which were assessed at baseline and at the 1-month follow-up as a routine clinical practice, were used for analyses.ResultsAmong 270 patients with available clinical data, 133 (women, 51; age, 61.0±13.8 years) met the inclusion criteria and were enrolled for analysis. There were no differences in demographic data and functional scores at baseline between the rTMS (n＝49) and control (n＝84) groups. The rTMS group showed a higher gain in the mini-mental status examination (MMSE) total score and subscores of all domains, forward digit span, and FIM-cognition than the control group (P<0.05). Among the patients with left hemispheric lesions (n＝57), the rTMS group showed better outcomes in cognition and depression through scores of total and " attention and concentration" subscores of MMSE, FIM-cognition, and the geriatric depression scale (P<0.05). Among the patients with right hemispheric lesions (n＝76), the rTMS group showed better outcomes in cognition through the MMSE total score and subscores of " attention and concentration，" " registration，" and " recall，" and scores of both forward and backward digit spans (P<0.05)．ConclusionsHigh-frequency rTMS over the ipsilesional DLPFC has beneficial effects on the recovery of cognition on both sides as well as mood in patients with left-sided hemispheric lesions.

简介：摘要ObjectiveThis study aims to figure out cerebral functional manipulation of rTMS in patients with PSCI through using the resting-state functional magnetic resonance imaging (rs-fMRI)．MethodsThirty patients with PSCI were recruited and randomly allocated into two groups: the rTMS intervention group and control group. The rTMS intervention group was given 20 min of 5 Hz rTMS (or control) over left dorsolateral prefrontal cortex (DLPFC) besides routine cognitive intervention training for 3 consecutive weeks, five times per week, on weekdays. Cognition performance was assessed by the Minimum Mental State Examination (MMSE) and Montreal cognitive assessment (MoCA). Neural activity and functional connectivity (FC) changes were acquired by rs-fMRI with fractional amplitude of low-frequency fluctuation (fALFF) and seed-based correlation analysis.ResultsCognition improvements were observed both in rTMS intervention group and control group (P<0.01), while the rTMS group got more significant improvent than control group (P<0.05). To be specified, compared with the control group, the rTMS group got higher fALFF values in these brain regions including superior temporal gyrus, inferior frontal gyrus and parahippocampal gyrus, while lower fALFF values in middle temporal gyrus, middle frontal gyrus and fusiform gyrus. In addition, the rTMS group showed increased FC between LDPFC and toprecuneus, inferior temporal gyrus, middle and inferior frontal gyrus and marginal gyrus, while decreased FC between LDPFC and middle temporal gyrus and thalamus.ConclusionsThe increase and decrease of neural activity and FC in cognition-related regions detected by rs-fMRI are good indicators to clarify the underlining mechanisms of rTMS on PSCI.

简介：摘要ObjectivePost-stroke cognitive impairment (PSCI) is resistant to treatment. Recent studies have widely applied repetitive transcranial magnetic stimulation (rTMS) to treat various brain dysfunctions, such as post-stroke syndromes. Nonetheless, a protocol for PSCI has not been established. Therefore, this study is aimed to evaluate the therapeutic effect of our high-frequency rTMS protocol for PSCI during the chronic phase of stroke.MethodsIn this prospective study, ten patients with PSCI were enrolled and received high-frequency rTMS on the ipsilesional dorsola-teral prefrontal cortex (DLPFC) for 10 sessions (5 days per week for 2 weeks). Cognitive and affective abilities were assessed at baseline and 2 and 14 weeks after rTMS initiation. To investigate the therapeutic mechanism of rTMS, the mRNA levels of pro-inflammatory cytokines (interleukin (IL)-6, IL-1β，transforming growth factor beta [TGF-β], and tumor necrosis factor alpha [TNF-α]) in peripheral blood samples were quantified using reverse transcription polymerase chain reaction, and cognitive functional magnetic resonance imaging (fMRI) was conducted at baseline and 14 weeks in two randomly selected patients after rTMS treatment.ResultsThe scores of several cognitive evaluations, i．e., the Intelligence Quotient (IQ) of Wechsler Adult Intelligence Scale, auditory verbal learning test (AVLT), and complex figure copy test (CFT), were increased after completion of the rTMS session. After 3 months, these improvements were sustained, and scores on the Mini-Mental Status Examination and Montreal Cognitive Assessment (MoCA) were also increased (P<0.05). While the Geriatric Depression Scale (GeDS) did not show change among all patients, those with moderate-to-severe depression showed amelioration of the score, with marginal significance. Expression of pro-inflammatory cytokines was decreased immediately after the ten treatment sessions, among which, IL-1β remained at a lower level after 3 months. Furthermore, strong correlations between the decrease in IL-6 and increments in AVLT (r＝0.928) and CFT (r＝0.886) were found immediately after the rTMS treatment (P<0.05). Follow-up fMRI revealed significant activation in several brain regions, such as the medial frontal lobe, hippocampus, and angular area.ConclusionsHigh-frequency rTMS on the ipsilesional DLPFC may exert immediate efficacy on cognition with the anti-inflammatory response and changes in brain network in PSCI, lasting at least 3 months.

简介：摘要ObjectiveThis single-center study aimed to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on modulation of thyroid hormone levels and cognition in the recovery stage of patients with cognitive dysfunction following stroke.MethodsSeventy post-stroke patients who had cognitive impairment were randomly assigned to either the rTMS group or the control (sham) group. Both groups were administered basic treatment, with the rTMS group receiving rTMS (1 Hz, 90% MT, 1000 pulse/20 min, once a day for 5 days, for a total of 20 times), the stimulation site was the contralateral dorsolateral prefrontal cortex (DLPFC), and the sham group receiving sham stimulation which had the same stimulation parameters and site, except that the coil plane was placed perpendicular to the surface of the scalp. Cognitive function assessment and thyroid function tests were performed before and after 4 weeks of treatment.Resultserum levels of triiodothyronine (T3), free triiodothyronine (FT3), and thyroid stimulating hormone (TSH) showed a positive correlation with Montreal Cognitive Assessment (MoCA) scale score of stroke patients in the recovery phase. The post-treatment change in the scores of MoCA and Modified Barthel Index (MBI) and scores of 3 cognitive domains (visuospatial function, memory, and attention), as well as serum T3, FT3, and TSH levels, were improved more significantly in the rTMS group, and T3 and FT3 levels significantly affected the MoCA scores within the reference range.ConclusionsSerum T3, FT3, and TSH levels of stroke patients in the recovery phase were positively correlated with MoCA score. rTMS increased T3, FT3, and TSH levels and also improved MoCA and MBI of patients in the recovery phase of stroke.

简介：摘要ObjectiveThis research was designed to probe into the effects of fluoxetine combined with repetitive transcranial magnetic stimulation (rTMS) on the psychological emotions and the cognitive and neurological functions of acute post-stroke depression patients.MethodsThis experiment recruited 115 acute post-stroke depression patients who were treated in our hospital from February 2018 to April 2020 as the study cohort. 55 of the patients were treated with fluoxetine, and 60 were treated with fluoxetine combined with rTMS. Both groups were treated for 2 months. The self-rating anxiety scale (SAS), the self-rating depression scale (SDS), the National Institutes of Health stroke scale (NIHSS), the mini mental state scale (MMSE), the Barthel index, and the quality of life scale (SF-36) scores were observed.ResultsCompared with the control group (CG), the SAS, SDS, and NIHSS scores in the research group (RG) decreased, while the MMSE and Barthel index scores increased (P<0.05). After the treatment, the SF-36 scores in the RG were higher than they were in the CG (P<0.05)．ConclusionsFluoxetine combined with rTMS can effectively improve the psychological emotions and the cognitive and neurological functions of acute post-stroke depression patients, so it is worthy of clinical promotion.

简介：Theeffectsofexerciseondecision-makingperformancehavebeenstudiedusingawidevarietyofcognitivetasksandexerciseinterventions.Althoughthecurrentliteraturesupportsabeneficialinfluenceofacuteexerciseoncognitiveperformance,themechanismsunderlyingthisphenomenonhavenotyetbeenelucidated.Wereviewstudiesthatusedsingle-pulsetranscranialmagneticstimulation(TMS)toprobetheexcitabilityofmotorstructuresduringwhole-bodyexerciseandpresentaframeworktoaccountforthefacilitatingeffectsofacuteexerciseonmotorprocesses.Recentresultssuggestthat,evenintheabsenceoffatigue,theincreaseincorticospinalexcitabilityclassicallyreportedduringsubmaximalandexhaustingexercisesmaybeaccompaniedbyareductioninintracorticalinhibition.Weproposethatreducedintracorticalinhibitionelicitsanadaptivecentralmechanismthatcounteractstheprogressivereductioninmuscleresponsivenesscausedbyperipheralfatigue.Suchareductionwouldrenderthemotorcortexmoresensitivetoupstreaminfluences,thuscausingincreasedcorticospinalexcitability.Furthermore,reductionofintracorticalinhibitionmayaccountforthemoreefficientdescendingdriveandfortheimprovementofreactiontimeperformanceduringexercise.Theadaptivemodulationinintracorticalinhibitioncouldbeimplementedthroughageneralincreaseinreticularactivationthatwouldfurtheraccountforenhancedsensorysensitivity.

简介：Posttraumatictremorisoftenoneofthecausesofdisabilityinheadinjurypatients.Usually,pharmacotherapyforthistypeoftremorisnoteffective.Sinceearly1970s,surgicalablationoftheventralthalamushasbeenusedtotreatvarioustypesoftremor.1Nowadays,deepbrainstimulation(DBS)confirmsitsefficacyinalleviatingdifferentformsoftremor,includingposttraumatictremor.2,3Suchtherapyhasbeenreportedachievingaround80%successrateinthetreatmentofposttraumatictremor.

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简介：Inrecentyears,pulsemagneticstimulationtechniquehasbeenpaidmoreandmoreattentionbythepeopleengagedinnoninvasivediagnosisandtherapywork.Comparedwithelectricstimulation,ithastheadvantagesofbeingnoninvasive,pain-lessandsafe,andhasbeenusedtoexamineandtreatdisordersofnervesystemsuc-cessfully.Applicationinotherfieldsisstillachallengetomanyresearchers.Wehave

简介：Thepurposeofthisstudyistoinvestigatedifferentfactorsoftheartifactinsurfaceelectromyography(EMG)signalcausedbyfunctionalelectricalstimulation(FES).Thefactorsinvestigatedincludethesizeofstimulationelectrodepads,theamplitude,frequency,andpulsewidthofthestimulationwaveformandthedetectingelectrodepoints.Wecalculatetherootmeansquare(RMS)ofEMGsignaltoanalyzetheeffectofthesefactorsontheM-waveproperties.TheresultsindicatethattheM-wavemainlydependsonthestimulationamplitudeandthedistributionofdetectingelectrodes,butnotontheotherfactors.Thisstudycanassistthereductionofartifactandtheselectionofdetectingelectrodepoints.

简介：目的：分析耳郭刺激抗衰老的疗效，寻求一种简便、安全的抗衰老的保健方法。方法：综合分析耳郭刺激与抗衰老的文献报道，从衰老与耳的关系，耳郭抗衰老的刺激方法、临床应用及机理研究等方面进行探讨。结果与结论：耳郭刺激通常选用与五脏相对应的耳穴心、肝、脾、肺、肾及内分泌、皮质下。耳郭刺激，尤其是耳穴贴压和耳郭按摩法，是简便有效的无创伤性保健、治疗方法，应当在抗衰老中起更大作用。

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