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JACC. Cardiovascular Imaging Feb 2015Angina without coronary artery disease (CAD) has substantial morbidity and is present in 10% to 30% of patients undergoing angiography. Coronary microvascular... (Review)
Review
Angina without coronary artery disease (CAD) has substantial morbidity and is present in 10% to 30% of patients undergoing angiography. Coronary microvascular dysfunction (CMD) is present in 50% to 65% of these patients. The optimal treatment of this cohort is undefined. We performed a systematic review to evaluate treatment strategies for objectively-defined CMD in the absence of CAD. We included studies assessing therapy in human subjects with angina and coronary flow reserve or myocardial perfusion reserve <2.5 by positron emission tomography, cardiac magnetic resonance imaging, dilution methods, or intracoronary Doppler in the absence of coronary artery stenosis ≥50% or structural heart disease. Only 8 papers met the strict inclusion criteria. The papers were heterogeneous, using different treatments, endpoints, and definitions of CMD. The small sample sizes severely limit the power of these studies, with an average of 11 patients per analysis. Studies evaluating sildenafil, quinapril, estrogen, and transcutaneous electrical nerve stimulation application demonstrated benefits in their respective endpoints. No benefit was found with L-arginine, doxazosin, pravastatin, and diltiazem. Our systematic review highlights that there is little data to support therapies for CMD. We assess the data meeting rigorous inclusion criteria and review the related but excluded published data. We additionally describe the next steps needed to address this research gap, including a standardized definition of CMD, routine assessment of CMD in studies of chest pain without obstructive CAD, and specific therapy assessment in the population with confirmed CMD.
Topics: Coronary Angiography; Coronary Circulation; Diagnosis, Differential; Humans; Magnetic Resonance Imaging, Cine; Microcirculation; Microvascular Angina; Myocardial Revascularization; Positron-Emission Tomography; Practice Guidelines as Topic; Regional Blood Flow
PubMed: 25677893
DOI: 10.1016/j.jcmg.2014.12.008 -
Frontiers in Aging Neuroscience 2022To investigate the association between diffusion tensor imaging (DTI) findings and domain-specific cognitive impairment in cerebral small vessel disease (CSVD).
OBJECTIVE
To investigate the association between diffusion tensor imaging (DTI) findings and domain-specific cognitive impairment in cerebral small vessel disease (CSVD).
METHODS
Databases such as PubMed, Excerpta Medical Database (EMBASE), Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure Databases (CNKI), Wanfang, Chinese Biomedical Literature Database (SinoMed), and Chongqing Chinese Science and Technology Periodical Database (VIP) were comprehensively retrieved for studies that reported correlation coefficients between cognition and DTI values. Random effects models and meta-regression were applied to account for heterogeneity among study results. Subgroup and publication bias analyses were performed using Stata software.
RESULTS
Seventy-seven studies involving 6,558 participants were included in our meta-analysis. The diagnosis classification included CSVD, white matter hyperintensities (WMH), subcortical ischemic vascular disease, cerebral microbleeding, cerebral amyloid angiopathy (CAA), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), and Fabry disease. The pooled estimates showed that the fractional anisotropy (FA)-overall exhibited a moderate correlation with general cognition, executive function, attention, construction, and motor performance ( = 0.451, 0.339, 0.410, and 0.319), and the mean diffusitivity/apparent diffusion coefficient (MD/ADC)-overall was moderately associated with general cognition, executive function, and memory ( = -0.388, -0.332, and -0.303, respectively; < 0.05). Moreover, FA in cingulate gyrus (CG), cerebral peduncle (CP), corona radiata (CR), external capsule (EC), frontal lobe (FL), fornix (FOR), internal capsule (IC), and thalamic radiation (TR) was strongly correlated with general cognition ( = 0.591, 0.584, 0.543, 0.662, 0.614, 0.543, 0.597, and 0.571), and a strong correlation was found between MD/ADC and CG ( = -0.526), normal-appearing white matter (NAWM; = -0.546), and whole brain white matter (WBWM; = -0.505). FA in fronto-occipital fasciculus (FOF) ( = 0.523) and FL ( = 0.509) was strongly associated with executive function. Only MD/ADC of the corpus callosum (CC) was strongly associated with memory ( = -0.730). Besides, FA in CG ( = 0.532), CC ( = 0.538), and FL ( = 0.732) was strongly related to the attention domain. Finally, we found that the sample size, etiology, magnetic resonance imaging (MRI) magnet strength, study type, and study quality contributed to interstudy heterogeneity.
CONCLUSION
Lower FA or higher MD/ADC values were related to more severe cognitive impairment. General cognition and executive function domains attracted the greatest interest. The FL was commonly examined and strongly associated with general cognition, executive function, and attention. The CC was strongly associated with memory and attention. The CG was strongly related to general cognition and attention. The CR, IC, and TR were also strongly related to general cognition. Indeed, these results should be validated in high-quality prospective studies with larger sample sizes.
SYSTEMATIC REVIEW REGISTRATION
http://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021226133.
PubMed: 36483114
DOI: 10.3389/fnagi.2022.1019088 -
BMC Psychiatry Jul 2023Several meta-analyses demonstrated the efficacy of unilateral High-Frequency Left-sided (HFL) repetitive Transcranial Magnetic Stimulation (rTMS) for individuals with... (Meta-Analysis)
Meta-Analysis
Efficacy of repetitive transcranial magnetic stimulation (rTMS) adjunctive therapy for major depressive disorder (MDD) after two antidepressant treatment failures: meta-analysis of randomized sham-controlled trials.
BACKGROUND
Several meta-analyses demonstrated the efficacy of unilateral High-Frequency Left-sided (HFL) repetitive Transcranial Magnetic Stimulation (rTMS) for individuals with Major Depressive Disorder (MDD); however, results are contradictory due to heterogeneity of the included studies.
METHODS
A systematic literature review (SLR) of English language articles published since 2000 was performed in March 2022 on PubMed and Scopus databases. Empirical evidence on the relative efficacy of rTMS treatment compared with standard pharmacotherapy in Treatment-Resistant Depression (TRD) were extracted. Random effects models were used to assess the effects of rTMS on response and remission rates.
RESULTS
19 randomized double-blinded sham-controlled studies were included for quantitative analysis for response (n = 854 patients) and 9 studies for remission (n = 551 patients). The risk ratio (RR) for response and remission are 2.25 and 2.78, respectively for patients after two treatment failures using rTMS as add-on treatment compared to standard pharmacotherapy. Cochrane's Q test showed no significant heterogeneity. No publication bias was detected.
CONCLUSIONS
rTMS is significantly more effective than sham rTMS in TRD in response and remission outcomes and may be beneficial as an adjunctive treatment in patients with MDD after two treatment failures. This finding is consistent with previous meta-analyses; however, the effect size was smaller than in the formerly published literature.
Topics: Humans; Depressive Disorder, Major; Transcranial Magnetic Stimulation; Treatment Failure; Antidepressive Agents; Depressive Disorder, Treatment-Resistant; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37501135
DOI: 10.1186/s12888-023-05033-y -
Brain Communications 2022Myelin-sensitive MRI such as magnetization transfer imaging has been widely used in multiple sclerosis. The influence of methodology and differences in disease subtype... (Review)
Review
Myelin-sensitive MRI such as magnetization transfer imaging has been widely used in multiple sclerosis. The influence of methodology and differences in disease subtype on imaging findings is, however, not well established. Here, we systematically review magnetization transfer brain imaging findings in relapsing-remitting multiple sclerosis. We examine how methodological differences, disease effects and their interaction influence magnetization transfer imaging measures. Articles published before 06/01/2021 were retrieved from online databases (PubMed, EMBASE and Web of Science) with search terms including 'magnetization transfer' and 'brain' for systematic review, according to a pre-defined protocol. Only studies that used human quantitative magnetization transfer imaging in adults with relapsing-remitting multiple sclerosis (with or without healthy controls) were included. Additional data from relapsing-remitting multiple sclerosis subjects acquired in other studies comprising mixed disease subtypes were included in meta-analyses. Data including sample size, MRI acquisition protocol parameters, treatments and clinical findings were extracted and qualitatively synthesized. Where possible, effect sizes were calculated for meta-analyses to determine magnetization transfer (i) differences between patients and healthy controls; (ii) longitudinal change and (iii) relationships with clinical disability in relapsing-remitting multiple sclerosis. Eighty-six studies met inclusion criteria. MRI acquisition parameters varied widely, and were also underreported. The majority of studies examined the magnetization transfer ratio in white matter, but magnetization transfer metrics, brain regions examined and results were heterogeneous. The analysis demonstrated a risk of bias due to selective reporting and small sample sizes. The pooled random-effects meta-analysis across all brain compartments revealed magnetization transfer ratio was 1.17 per cent units (95% CI -1.42 to -0.91) lower in relapsing-remitting multiple sclerosis than healthy controls (-value: -8.99, < 0.001, 46 studies). Linear mixed-model analysis did not show a significant longitudinal change in magnetization transfer ratio across all brain regions [ = 0.12 (-0.56 to 0.80), -value = 0.35, = 0.724, 14 studies] or normal-appearing white matter alone [ = 0.037 (-0.14 to 0.22), -value = 0.41, = 0.68, eight studies]. There was a significant negative association between the magnetization transfer ratio and clinical disability, as assessed by the Expanded Disability Status Scale [ = -0.32 (95% CI -0.46 to -0.17); -value = -4.33, < 0.001, 13 studies]. Evidence suggests that magnetization transfer imaging metrics are sensitive to pathological brain changes in relapsing-remitting multiple sclerosis, although effect sizes were small in comparison to inter-study variability. Recommendations include: better harmonized magnetization transfer acquisition protocols with detailed methodological reporting standards; larger, well-phenotyped cohorts, including healthy controls; and, further exploration of techniques such as magnetization transfer saturation or inhomogeneous magnetization transfer ratio.
PubMed: 35652121
DOI: 10.1093/braincomms/fcac088 -
A systematic review of the association between dementia risk factors and cerebrovascular reactivity.Neuroscience and Biobehavioral Reviews May 2023Cumulative evidence suggests that impaired cerebrovascular reactivity (CVR), a regulatory response critical for maintaining neuronal health, is amongst the earliest... (Review)
Review
Cumulative evidence suggests that impaired cerebrovascular reactivity (CVR), a regulatory response critical for maintaining neuronal health, is amongst the earliest pathological changes in dementia. However, we know little about how CVR is affected by dementia risk, prior to disease onset. Understanding this relationship would improve our knowledge of disease pathways and help inform preventative interventions. This systematic review investigates 59 studies examining how CVR (measured by magnetic resonance imaging) is affected by modifiable, non-modifiable, and clinical risk factors for dementia. We report that non-modifiable risk (older age and apolipoprotein ε4), some modifiable factors (diabetes, traumatic brain injury, hypertension) and some clinical factors (stroke, carotid artery occlusion, stenosis) were consistently associated with reduced CVR. We also note a lack of conclusive evidence on how other behavioural factors such as physical inactivity, obesity, or depression, affect CVR. This review explores the biological mechanisms underpinning these brain-behaviour associations, highlights evident gaps in the literature, and identifies the risk factors that could be managed to preserve CVR in an effort to prevent dementia.
Topics: Humans; Brain; Stroke; Risk Factors; Magnetic Resonance Imaging; Dementia; Cerebrovascular Circulation
PubMed: 36944391
DOI: 10.1016/j.neubiorev.2023.105140 -
Seminars in Perinatology Dec 2016Up to 35% of very preterm infants survive with neurodevelopmental impairments (NDI) such as cognitive deficits, cerebral palsy, and attention deficit disorder. Advanced... (Review)
Review
Up to 35% of very preterm infants survive with neurodevelopmental impairments (NDI) such as cognitive deficits, cerebral palsy, and attention deficit disorder. Advanced MRI quantitative tools such as brain morphometry, diffusion MRI, magnetic resonance spectroscopy, and functional MRI at term-equivalent age are ideally suited to improve current efforts to predict later development of disabilities. This would facilitate application of targeted early intervention therapies during the first few years of life when neuroplasticity is optimal. A systematic search and review identified 47 published studies of advanced MRI to predict NDI. Diffusion MRI and morphometry studies were the most commonly studied modalities. Despite several limitations, studies clearly showed that brain structural and metabolite biomarkers are promising independent predictors of NDI. Large representative multicenter studies are needed to validate these studies.
Topics: Brain; Developmental Disabilities; Fetal Organ Maturity; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intensive Care, Neonatal; Magnetic Resonance Imaging; Neuroimaging; Predictive Value of Tests
PubMed: 27863706
DOI: 10.1053/j.semperi.2016.09.005 -
Neuropharmacology Feb 2023The microbiota-gut-brain axis (MGBA) refers to the bidirectional communication between the brain and the gut microbiota and recent studies have linked the MGBA to health... (Review)
Review
The microbiota-gut-brain axis (MGBA) refers to the bidirectional communication between the brain and the gut microbiota and recent studies have linked the MGBA to health and disease. Research has so far investigated this axis mainly from microbiota to brain but less is known about the other direction. One approach to examine the MGBA from brain to microbiota is through understanding if and how neuromodulation might impact microbiota. Neuromodulation encompasses a wide range of stimulation techniques and is used to treat neurological, psychiatric and metabolic disorders, like Parkinson's Disease, depression and obesity. Here, we performed a systematic review to investigate whether neuromodulation is associated with subsequent changes in the gut microbiota. Searches in PsycINFO and MEDLINE were performed up to March 2022. Included studies needed to be clinical or preclinical studies comparing the effects of deep brain stimulation, electroconvulsive therapy, repetitive transcranial magnetic stimulation, transcranial direct current stimulation or vagal nerve stimulation on the gut microbiota before and after treatment or between active and control groups. Seven studies were identified. Neuromodulation was associated with changes in relative bacterial abundances, but not with (changes in) α-diversity or β-diversity. Summarizing, currently reported findings suggest that neuromodulation interventions are associated with moderate changes in the gut microbiome. However, findings remain inconclusive due to the limited number and varying quality of included studies, as well as the large heterogeneity between studies. More research is required to more conclusively establish whether, and if so, via which mechanism(s) of action neuromodulation interventions might influence the gut microbiota.
Topics: Transcranial Direct Current Stimulation; Transcranial Magnetic Stimulation; Vagus Nerve Stimulation; Deep Brain Stimulation; Brain
PubMed: 36334762
DOI: 10.1016/j.neuropharm.2022.109318 -
Journal of Affective Disorders Nov 2020Major Depressive Disorder (MDD) is a global disorder that negatively affects mood and quality of life. Antidepressant medication and psychotherapy are the most commonly... (Review)
Review
BACKGROUND
Major Depressive Disorder (MDD) is a global disorder that negatively affects mood and quality of life. Antidepressant medication and psychotherapy are the most commonly prescribed treatments, but prior research has called their clinical efficacy into question. These treatments may be less effective when the patient has a diagnosed comorbid disorder.
METHOD
A systematic review of the literature was conducted to investigate whether an alternative method of treatment, Transcranial Magnetic Stimulation (TMS), is effective for MDD with a diagnosed comorbidity. 110 articles were identified, of which 8 were included in the current review.
RESULTS
Response and remission rates vary. A range of 39.5-70% of participants experienced an antidepressant response to treatment, and 16.6-76.9% of patients achieved remission from MDD. A range of 48.6-84.6% of participants responded to treatment of their comorbid disorder, and 50-84.6% achieved remission of comorbid symptoms.
LIMITATIONS
Limitations of the current review include small sample sizes, limited statistical power, homogenous samples, and a lack of sham or placebo-controlled studies.
CONCLUSION
Preliminary results support that TMS is effective at treating symptoms of MDD and a comorbid disorder. Additional studies are needed to confirm these results.
Topics: Antidepressive Agents; Depression; Depressive Disorder, Major; Humans; Quality of Life; Transcranial Magnetic Stimulation; Treatment Outcome
PubMed: 32871677
DOI: 10.1016/j.jad.2020.07.025 -
PloS One 2017There is limited information on the costs and benefits of alternative adjunct non-pharmacological treatments for knee osteoarthritis and little guidance on which should... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is limited information on the costs and benefits of alternative adjunct non-pharmacological treatments for knee osteoarthritis and little guidance on which should be prioritised for commissioning within the NHS. This study estimates the costs and benefits of acupuncture, braces, heat treatment, insoles, interferential therapy, laser/light therapy, manual therapy, neuromuscular electrical stimulation, pulsed electrical stimulation, pulsed electromagnetic fields, static magnets and transcutaneous electrical nerve Stimulation (TENS), based on all relevant data, to facilitate a more complete assessment of value.
METHODS
Data from 88 randomised controlled trials including 7,507 patients were obtained from a systematic review. The studies reported a wide range of outcomes. These were converted into EQ-5D index values using prediction models, and synthesised using network meta-analysis. Analyses were conducted including firstly all trials and secondly only trials with low risk of selection bias. Resource use was estimated from trials, expert opinion and the literature. A decision analytic model synthesised all evidence to assess interventions over a typical treatment period (constant benefit over eight weeks or linear increase in effect over weeks zero to eight and dissipation over weeks eight to 16).
RESULTS
When all trials are considered, TENS is cost-effective at thresholds of £20-30,000 per QALY with an incremental cost-effectiveness ratio of £2,690 per QALY vs. usual care. When trials with a low risk of selection bias are considered, acupuncture is cost-effective with an incremental cost-effectiveness ratio of £13,502 per QALY vs. TENS. The results of the analysis were sensitive to varying the intensity, with which interventions were delivered, and the magnitude and duration of intervention effects on EQ-5D.
CONCLUSIONS
Using the £20,000 per QALY NICE threshold results in TENS being cost-effective if all trials are considered. If only higher quality trials are considered, acupuncture is cost-effective at this threshold, and thresholds down to £14,000 per QALY.
Topics: Combined Modality Therapy; Cost-Benefit Analysis; Female; Humans; Male; Osteoarthritis, Knee; Physical Therapy Modalities; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 28267751
DOI: 10.1371/journal.pone.0172749 -
Developmental Medicine and Child... Aug 2015The neurobiological contributions of childhood language disorder are not well understood. Yet there is increasing evidence that language disorder is associated with... (Review)
Review
AIM
The neurobiological contributions of childhood language disorder are not well understood. Yet there is increasing evidence that language disorder is associated with differences in brain structure and/or function in core language regions. A key hypothesis has been that children with language disorder do not show the same degree of leftward asymmetry of these regions as observed in typically developing children. We aimed to systematically review structural and functional magnetic resonance imaging (fMRI) studies to examine brain commonalities and differences between children with language disorder and typically developing controls; and differences in leftward asymmetry between these groups.
METHOD
A systematic review was conducted using MeSH terms synonymous with childhood language disorder and brain MRI methods. The search identified 1443 papers, and 18 articles met the criteria and were appraised for level and quality of evidence.
RESULTS
Atypical brain structure and function was reported within traditionally recognized language regions across studies, including the inferior frontal gyrus, posterior superior temporal gyrus, and caudate nucleus. The direction of difference (e.g. increased/decreased) was variable, however, likely because of differences in language disorder groups examined and magnetic resonance data acquisition and analysis approaches. As regards asymmetry, there was some evidence of reduction of the anticipated structural and functional leftward asymmetry in frontal language regions in language disorder groups.
INTERPRETATION
Mounting evidence suggests that children with language disorder have atypical brain structure and function within neural regions integral to language. There is limited support for the hypothesis that children with language disorder show a reduction of leftward structural and/or functional asymmetry in frontal language regions. Interpretation is limited, however, by a high degree of variability in language disorder assessment and phenotype, and in magnetic resonance methodologies. A large-scale magnetic resonance study of brain structure and function is required in a well-defined language disorder population cohort, with replication, to provide confirmatory data on the neural correlates of childhood language disorder.
Topics: Brain; Child; Humans; Language Disorders
PubMed: 25692930
DOI: 10.1111/dmcn.12714