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Frontiers in Human Neuroscience 2023Dysphagia is a major cause of stroke infection and death, and identification of structural and functional brain area changes associated with post-stroke dysphagia (PSD)... (Review)
Review
OBJECTIVES
Dysphagia is a major cause of stroke infection and death, and identification of structural and functional brain area changes associated with post-stroke dysphagia (PSD) can help in early screening and clinical intervention. Studies on PSD have reported numerous structural lesions and functional abnormalities in brain regions, and a systematic review is lacking. We aimed to integrate several neuroimaging studies to summarize the empirical evidence of neurological changes leading to PSD.
METHODS
We conducted a systematic review of studies that used structural neuroimaging and functional neuroimaging approaches to explore structural and functional brain regions associated with swallowing after stroke, with additional evidence using a live activation likelihood estimation (ALE) approach.
RESULTS
A total of 35 studies were included, including 20 studies with structural neuroimaging analysis, 14 studies with functional neuroimaging analysis and one study reporting results for both. The overall results suggest that structural lesions and functional abnormalities in the sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections in individuals with stroke may contribute to dysphagia, and the ALE analysis provides additional evidence for structural lesions in the right lentiform nucleus and right thalamus and functional abnormalities in the left thalamus.
CONCLUSION
Our findings suggest that PSD is associated with neurological changes in brain regions such as sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections. Adequate understanding of the mechanisms of neural changes in the post-stroke swallowing network may assist in clinical diagnosis and provide ideas for the development of new interventions in clinical practice.
PubMed: 36742358
DOI: 10.3389/fnhum.2023.1077234 -
Medicine and Science in Sports and... Mar 2020Whether there are age-related differences in neural drive during maximal effort contractions is not clear. This review determined the effect of age on voluntary... (Meta-Analysis)
Meta-Analysis
Whether there are age-related differences in neural drive during maximal effort contractions is not clear. This review determined the effect of age on voluntary activation during maximal voluntary isometric contractions. The literature was systematically reviewed for studies reporting voluntary activation quantified with the interpolated twitch technique (ITT) or central activation ratio (CAR) during isometric contractions in young (18-35 yr) and old adults (>60 yr; mean, ≥65 yr). Of the 2697 articles identified, 54 were eligible for inclusion in the meta-analysis. Voluntary activation was assessed with electrical stimulation and transcranial magnetic stimulation on five different muscle groups. Random-effects meta-analysis revealed lower activation in old compared with young adults (d = -0.45; 95% confidence interval, -0.62 to -0.29; P < 0.001), with moderate heterogeneity (52.4%). To uncover the sources of heterogeneity, subgroup analyses were conducted for muscle group, calculation method (ITT or CAR), and stimulation type (electrical stimulation or transcranial magnetic stimulation) and number (single, paired, or train stimulations). The age-related reduction in voluntary activation occurred for all muscle groups investigated except the ankle dorsiflexors. Both ITT and CAR demonstrated an age-related reduction in voluntary activation of the elbow flexors, knee extensors, and plantar flexors. ITT performed with paired and train stimulations showed lower activation for old than young adults, with no age difference for the single electrical stimulation. Together, the meta-analysis revealed that healthy older adults have a reduced capacity to activate some upper and lower limb muscles during maximal voluntary isometric contractions; however, the effect was modest and best assessed with at least paired stimulations to detect the difference.
Topics: Aging; Electric Stimulation; Humans; Isometric Contraction; Lower Extremity; Muscle Strength; Muscle, Skeletal; Transcranial Direct Current Stimulation; Upper Extremity
PubMed: 31688647
DOI: 10.1249/MSS.0000000000002179 -
Cancer Cell International Dec 2023Lymphocyte-activation gene 3 (LAG3) is a recently discovered immune checkpoint molecule that has been linked to immunosuppression and the advancement of cancer in... (Review)
Review
BACKGROUND
Lymphocyte-activation gene 3 (LAG3) is a recently discovered immune checkpoint molecule that has been linked to immunosuppression and the advancement of cancer in different types of solid tumors. This study aimed to evaluate the prognostic importance of LAG3 and its role in the immune system within solid tumors.
METHODS
Extensive literature searches were conducted using the Pubmed, EMBASE, and Cochrane Library databases to identify relevant studies exploring the effect of LAG3 on survival outcomes. Pooled hazard ratios (HRs) with its 95% confidence intervals (CIs) were calculated to evaluate the prognostic values of LAG3. Afterwards, subgroup analysis and sensitivity analysis were conducted. Pan-cancer analysis investigated the possible relationships between LAG3 expression and genetic alterations, RNA methylation modification-related genes, genomic instability, immune checkpoint genes, and infiltration of immune cells.
RESULTS
A total of 43 studies with 7,118 patients were included in this analysis. Higher expression of LAG3 was associated with worse overall survival (HR = 1.10, 95% CI 1.01-1.19, P = 0.023), but not disease-free survival (HR = 1.41, 95% CI 0.96-2.07, P = 0.078), progression-free survival (HR = 1.12, 95% CI 0.90-1.39, P = 0.317) or recurrence-free survival (HR = 0.98, 95% CI 0.81-1.19, P = 0.871). Subgroup analysis showed that LAG3 might play different prognostic roles in different solid tumors. LAG3 expression was positively associated with immune cell infiltration and immune checkpoint genes in all of the cancers included. LAG3 expression was also found to be associated with microsatellite instability (MSI), copy number variation (CNV), simple nucleoside variation (SNV), tumor mutation burden (TMB), and neoantigen in various types of cancers.
CONCLUSIONS
Elevated expression of LAG3 is linked to poorer prognosis among patients diagnosed with solid cancers. LAG3 might play varying prognostic roles in different types of solid tumors. Given its substantial involvement in cancer immunity and tumorigenesis, LAG3 has garnered attention as a promising prognostic biomarker and a potential target for immunotherapy.
PubMed: 38041068
DOI: 10.1186/s12935-023-03157-5 -
Neuroscience and Biobehavioral Reviews Jan 2022Behavioral research supports the efficacy of intervention for reading disability, but the brain mechanisms underlying improvement in reading are not well understood.... (Meta-Analysis)
Meta-Analysis Review
Behavioral research supports the efficacy of intervention for reading disability, but the brain mechanisms underlying improvement in reading are not well understood. Here, we review 39 neuroimaging studies of reading intervention to characterize links between reading improvement and changes in the brain. We report evidence of changes in activation, connectivity, and structure within the reading network, and right hemisphere, frontal and sub-cortical regions. Our meta-analysis of changes in brain activation from pre- to post- reading intervention in eight studies did not yield any significant effects. Methodological heterogeneity among studies may contribute to the lack of significant meta-analytic findings. Based on our qualitative synthesis, we propose that brain changes in response to intervention should be considered in terms of interactions among distributed cognitive, linguistic and sensory systems, rather than via a "normalized" vs. "compensatory" dichotomy. Further empirical research is needed to identify effects of moderating factors such as features of intervention programs, neuroimaging tasks, and individual differences among participants.
Topics: Brain; Brain Mapping; Dyslexia; Humans; Magnetic Resonance Imaging; Neuronal Plasticity
PubMed: 34856223
DOI: 10.1016/j.neubiorev.2021.11.011 -
Journal of Affective Disorders Aug 2018Behavioral activation (BA) is an evidence-based treatment for depression which has attracted interest and started to accumulate evidence for other conditions when... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Behavioral activation (BA) is an evidence-based treatment for depression which has attracted interest and started to accumulate evidence for other conditions when delivered face-to-face. Due to its parsimoniousness, it is suitable to be delivered via the Internet. The goal of this systematic review and meta-analysis was to examine evidence from randomized controlled trials (RCTs) to determine the efficacy of Internet-based BA and assess the quality of this evidence.
METHODS
Studies were identified from electronic databases (EMBASE, ISI Web of Knowledge, Medline, CINHAL, PsychINFO, Cochrane) and reference lists of included studies. Two reviewers independently screened articles for inclusion and extracted data. They assessed the quality of evidence for each outcome using The Grading of Recommendations Assessment, Development and Evaluation framework.
RESULTS
Nine RCTs on different forms of depression were included with 2157 adult participants. Random effects meta-analyses showed that in non-clinical settings, guided Internet-based BA was non-inferior to other forms of behavioral therapy and mindfulness (mainly very low to low quality evidence) and superior to physical activity (very low quality evidence), psychoeducation/treatment as usual (moderate quality evidence) and waitlist (low quality evidence) at reducing depression and anxiety outcomes at post-treatment and short follow-up.
LIMITATIONS
The poor quality of some of the findings means that results should be cautiously interpreted.
CONCLUSIONS
Evidence for the efficacy of Internet-based BA as a treatment for depression is promising. However, high quality studies with longer follow-ups are needed to increase confidence in findings and determine its efficacy in clinical settings and other conditions.
Topics: Adult; Anxiety; Behavior Therapy; Depression; Female; Humans; Internet; Male; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 29649708
DOI: 10.1016/j.jad.2018.02.073 -
NeuroImage. Clinical 2017To summarize and meta-analyze studies on changes in grey matter (GM) in patients with migraine. We aimed to determine whether there are concordant structural changes in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To summarize and meta-analyze studies on changes in grey matter (GM) in patients with migraine. We aimed to determine whether there are concordant structural changes in the foci, whether structural changes are concordant with functional changes, and provide further understanding of the anatomy and biology of migraine.
METHODS
We searched PubMed and Embase for relevant articles published between January 1985 and November 2015, and examined the references within relevant primary articles. Following exclusion of unsuitable studies, meta-analysis were performed using activation likelihood estimation (ALE).
RESULTS
Eight clinical studies were analyzed for structural changes, containing a total of 390 subjects (191 patients and 199 controls). Five functional studies were enrolled, containing 93 patients and 96 controls. ALE showed that the migraineurs had concordant decreases in the GM volume (GMV) in the bilateral inferior frontal gyri, the right precentral gyrus, the left middle frontal gyrus and the left cingulate gyrus. GMV decreases in right claustrum, left cingulated gyrus, right anterior cingulate, amygdala and left parahippocampal gyrus are related to estimated frequency of headache attack Activation was found in the somatosensory, cingulate, limbic lobe, basal ganglia and midbrain in migraine patients.
CONCLUSION
GM changes in migraineurs may indicate the mechanism of pain processing and associated symptoms. Changes in the frontal gyrus may predispose a person to pain conditions. The limbic regions may be accumulated damage due to the repetitive occurrence of pain-related processes. Increased activation in precentral gyrus and cingulate opposed to GMV decrease might suggest increased effort duo to disorganization of these areas and/or the use of compensatory strategies involving pain processing in migraine. Knowledge of these structural and functional changes may be useful for monitoring disease progression as well as for therapeutic interventions.
Topics: Databases, Bibliographic; Gray Matter; Humans; Magnetic Resonance Imaging; Migraine Disorders
PubMed: 28180071
DOI: 10.1016/j.nicl.2017.01.019 -
The British Journal of Psychiatry : the... Nov 2017Behavioural activation is an effective treatment for depression in the general adult population but it is unclear whether it is effective for older people.To... (Meta-Analysis)
Meta-Analysis Review
Behavioural activation is an effective treatment for depression in the general adult population but it is unclear whether it is effective for older people.To systematically review randomised controlled trials (RCTs) of behavioural activation for depression in older people.We searched Medline, EMBASE, PsycINFO, CINAHL and online trial registers for RCTs of behavioural activation for depression in older people.Eighteen trials were included in the meta-analyses. Behavioural activation reduced mean depression scores for older people living in the community as a stand-alone treatment: standardised mean difference (SMD) -0.72, 95% Cl -1.04 to -0.41. It was also effective as part of a multicomponent intervention (SMD -0.44, 95% CI -0.56 to -0.32).Behavioural activation significantly reduces depressive symptoms in older people in the community; however, given that most studies are small and with significant bias results should be interpreted with caution. Further high-quality trials of behavioural activation for this age group are needed.
Topics: Aged; Aging; Behavior Therapy; Depressive Disorder; Humans
PubMed: 28982660
DOI: 10.1192/bjp.bp.117.205021 -
Worldviews on Evidence-based Nursing Jun 2023Chronic kidney disease (CKD) is a complex health condition that profoundly impacts an individual's general health and well-being throughout their entire lifetime. People... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chronic kidney disease (CKD) is a complex health condition that profoundly impacts an individual's general health and well-being throughout their entire lifetime. People with CKD require the knowledge, confidence, and skills to actively self-manage their health. This is referred to as patient activation. The efficacy of interventions to increase patient activation in the CKD population is unclear.
AIM
This study aimed to examine the effectiveness of patient activation interventions on behavioral health-related outcomes among people with CKD stages 3-5.
METHODS
A systematic review and meta-analysis of randomized controlled trials (RCTs) of patients with CKD stages 3-5 was performed. MEDLINE, EMCARE, EMBASE, and PsychINFO databases were searched between 2005 and February 2021. Risk of bias was assessed using the Joanna Bridge Institute critical appraisal tool.
RESULTS
Nineteen RCTs that enrolled 4414 participants were included for synthesis. Only one RCT reported patient activation using the validated 13-item patient activation measure (PAM-13). Four studies demonstrated strong evidence that the intervention group developed a higher level of self-management compared to the control group (standardized mean differences [SMD] = 1.12, 95% CI [0.36, 1.87], p = .004). Eight RCTs led to a significant improvement in self-efficacy (SMD = 0.73, 95% CI [0.39, 1.06], p < .0001). There was weak to no evidence on the effect of the strategies shown on the physical component and mental components of health-related quality of life, and medication adherence.
LINKING EVIDENCE TO ACTION
This meta-analysis highlights the importance of including tailored interventions using a cluster approach including patient education, goal setting with individualized action plan, and problem-solving to engage patients to be more actively involved in the self-management of their CKD.
Topics: Humans; Adult; Patient Participation; Renal Insufficiency, Chronic; Quality of Life; Self-Management
PubMed: 36906914
DOI: 10.1111/wvn.12634 -
Annals of Physical and Rehabilitation... Mar 2023Neuromuscular alterations are common in people with knee osteoarthritis (KOA). A comprehensive understanding of these alterations is important to enable targeted... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Neuromuscular alterations are common in people with knee osteoarthritis (KOA). A comprehensive understanding of these alterations is important to enable targeted rehabilitation strategies.
OBJECTIVES
This systematic review and meta-analysis aimed to comprehensively understand the neuromuscular alterations around the knee joint in people with KOA.
METHODS
Moderate- and high-quality studies based on a modified version of the Downs and Black checklist, comparing neuromuscular function of peri‑articular muscles between people with KOA and controls were retrieved from five databases from inception to October 2020. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and torque-related outcomes. Data were pooled according to structural KOA severity with sensitivity analysis based on sex. Evidence levels are presented in evidence gap maps.
RESULTS
A total of 7 high-quality and 22 moderate-quality studies were retained (1146 people with KOA and 1353 age- and sex-matched controls). Studies demonstrated quadriceps and hamstring strength deficits and increased hamstring-to-quadriceps strength ratios across KOA severities. Women presented lower quadriceps strength at early KOA (very limited evidence) and lower voluntary activation at end stage KOA (very limited evidence) as compared with controls, whereas men did not (moderate evidence). People with KOA also demonstrated lower quadriceps force control ability with no change in rapid force production (very limited evidence). Voluntary activation deficits for quadriceps were evident (moderate evidence), with no change in quadriceps cortical excitability (very limited evidence) or soleus spinal reflexes (very limited evidence). No muscle size change was demonstrated except for the vastus medialis (limited evidence). Evidence gaps were found for neural and torque-related measures and differences in hamstring, gastrocnemius, soleus, and popliteus.
CONCLUSIONS
Neuromuscular deficits are evident across different structural KOA severities and are seen in muscle strength, voluntary activation, muscle size, and force control ability. Women may exhibit these alterations to a greater extent than men.
PROSPERO REGISTRATION NUMBER
CRD42019160845.
Topics: Male; Humans; Female; Osteoarthritis, Knee; Muscle, Skeletal; Knee Joint; Quadriceps Muscle; Leg; Muscle Strength
PubMed: 35364316
DOI: 10.1016/j.rehab.2022.101662 -
Journal of Psychiatric Research Aug 2022Behavioral activation is recognized as a stand-alone, evidence-based therapy for depression. Internet-delivered psychological interventions are easy to access and low... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Behavioral activation is recognized as a stand-alone, evidence-based therapy for depression. Internet-delivered psychological interventions are easy to access and low cost. Therefore, it is important to determine whether internet-delivered behavioral activation (iBA) is an effective option for improving depressive symptoms and other health-related outcomes. This systematic review and meta-analysis aimed to examine the effects of iBA on individuals with depressive symptoms.
METHODS
A comprehensive search was conducted within four databases to identify randomized controlled trials (RCTs) that involved iBA for people with depressive symptoms. The quality of the included RCTs was assessed using the Cochrane Collaboration risk-of-bias tool. Depending on I statistic values for heterogeneity, either a random effects model or fixed effects model was used. Subgroup analyses were conducted according to the type of control groups.
RESULTS
Twenty RCTs met the eligibility criteria. Meta-analyses showed iBA had small to medium effects on depressive symptoms, anxiety, quality of life, functioning, perceived social support, and behavioral activation (BA) in people suffering from depressive symptoms at the immediate posttest and follow-up compared to control conditions.
LIMITATIONS
Relatively fewer studies were conducted to compare effects of iBA on outcomes other than depressive symptoms and BA process measures compared to comparison or control conditions. The overall risk of bias across the included RCTs was unclear.
CONCLUSIONS
Further high-quality studies are needed to verify the effects of iBA on varied health outcomes and BA process measures for individuals with depressive symptoms.
Topics: Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy; Depression; Humans; Internet
PubMed: 35717866
DOI: 10.1016/j.jpsychires.2022.05.031