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Journal of Neuroengineering and... Feb 2022Transcranial magnetic stimulation (TMS) has attracted plenty of attention as it has been proved to be effective in facilitating motor recovery in patients with stroke.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transcranial magnetic stimulation (TMS) has attracted plenty of attention as it has been proved to be effective in facilitating motor recovery in patients with stroke. The aim of this study was to systematically review the effects of repetitive TMS (rTMS) and theta burst stimulation (TBS) protocols in modulating cortical excitability after stroke.
METHODS
A literature search was carried out using PubMed, Medline, EMBASE, CINAHL, and PEDro, to identify studies that investigated the effects of four rTMS protocols-low and high frequency rTMS, intermittent and continuous TBS, on TMS measures of cortical excitability in stroke. A random-effects model was used for all meta-analyses.
RESULTS
Sixty-one studies were included in the current review. Low frequency rTMS was effective in decreasing individuals' resting motor threshold and increasing the motor-evoked potential of the non-stimulated M1 (affected M1), while opposite effects occurred in the stimulated M1 (unaffected M1). High frequency rTMS enhanced the cortical excitability of the affected M1 alone. Intermittent TBS also showed superior effects in rebalancing bilateral excitability through increasing and decreasing excitability within the affected and unaffected M1, respectively. Due to the limited number of studies found, the effects of continuous TBS remained inconclusive. Motor impairment was significantly correlated with various forms of TMS measures.
CONCLUSIONS
Except for continuous TBS, it is evident that these protocols are effective in modulating cortical excitability in stroke. Current evidence does support the effects of inhibitory stimulation in enhancing the cortical excitability of the affected M1.
Topics: Cortical Excitability; Evoked Potentials, Motor; Humans; Motor Cortex; Stroke; Transcranial Magnetic Stimulation
PubMed: 35193624
DOI: 10.1186/s12984-022-00999-4 -
European Child & Adolescent Psychiatry Oct 2022Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adolescent major depressive disorder (MDD). Existing evidence on the efficacy of TMS in... (Meta-Analysis)
Meta-Analysis
Transcranial magnetic stimulation in the treatment of adolescent depression: a systematic review and meta-analysis of aggregated and individual-patient data from uncontrolled studies.
Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adolescent major depressive disorder (MDD). Existing evidence on the efficacy of TMS in adolescent MDD awaits quantitative synthesis. A systematic literature search was conducted, and data from eligible studies were synthesized using random-effects models. Treatment-covariate interactions were examined in exploratory analyses of individual-patient data (IPD). Systematic search of the literature yielded 1264 hits, of which 10 individual studies (2 randomized trials) were included for quantitative synthesis of mainly uncontrolled studies. Individual patient data (IPD) were available from five trials (all uncontrolled studies). Quantitative synthesis of aggregated data revealed a statistically significant negative overall standardized mean change (pooled SMCC = 2.04, 95% CI [1.46; 2.61], SE = 0.29, p < .001), as well as a significant overall treatment response rate (Transformed Proportion = 41.30%, 95% CI [31.03; 51.57], SE = 0.05; p < 0.001), considering data from baseline to post-treatment. Exploratory IPD analyses suggests TMS might be more effective in younger individuals and individuals with more severe depression, and efficacy might be enhanced with certain treatment modality settings, including higher number of TMS sessions, longer treatment durations, and unilateral and not bilateral stimulation. Existing studies exhibit methodological shortcomings, including small-study effects and lack of control group, blinding, and randomization-compromising the credibility of the present results. To date, two randomized controlled trials on TMS in adolescent depression have been published, and the only large-scale randomized trial suggests TMS is not more effective than sham stimulation. Future large-scale, randomized, and sham-controlled trials are warranted. Future trials should ensure appropriate selection of patients for TMS treatment and guide precision medicine approaches for stimulation protocols.
Topics: Adolescent; Humans; Depression; Depressive Disorder, Major; Research Design; Transcranial Magnetic Stimulation; Treatment Outcome
PubMed: 35751003
DOI: 10.1007/s00787-022-02021-7 -
Nigerian Journal of Clinical Practice Aug 2022Magnet hospitals are recognized for quality patient outcomes and nursing excellence. It was aimed to examine the effects of Magnet hospitals on mortality rate. Searches... (Review)
Review
Magnet hospitals are recognized for quality patient outcomes and nursing excellence. It was aimed to examine the effects of Magnet hospitals on mortality rate. Searches for this review were carried out using the PubMed, Scopus, and CINAHL databases without any year limitation. Search terms included Magnet hospitals, non-Magnet hospitals, and mortality. Inclusion criteria were: The identified 58 articles published in international journals, and 13 of those articles that met the inclusion criteria were included in this review. This systematic review adhered to the PRISMA guideline. Articles meeting the research criteria were evaluated for methodological quality with the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) Critical Appraisal Tool. The research types used of the included studies were descriptive comparative research (n = 8), cohort study (n = 4), and retrospective, two-stage panel design (n = 1). Three descriptive comparative studies found that there was no difference in the mortality rates of Magnet hospitals and non-Magnet hospitals. By contrast, five descriptive comparative studies and five longitudinal studies determined that mortality rates were lower in Magnet hospitals. Overall, the findings of this systematic review indicated that Magnet hospitals are associated with lower rates of mortality. Considering the organizational consequences of mortality such as quality and cost savings, this systematic review provides significant contributions to hospital executives, as well as the nurse-clinicians, whether or not to obtain magnet status.
Topics: Cohort Studies; Hospitals; Humans; Retrospective Studies
PubMed: 35975364
DOI: 10.4103/njcp.njcp_183_22 -
Journal of Indian Prosthodontic Society 2020To evaluate the survival rate, tissue response, and patient satisfaction of different attachments used in implant overdenture. (Review)
Review
AIM
To evaluate the survival rate, tissue response, and patient satisfaction of different attachments used in implant overdenture.
SETTINGS AND DESIGN
Systematic Review and Meta-analysis.
MATERIALS AND METHODS
Electronic search of peer-review articles published between 2001 and 2019 assessing the attachments used for implant-supported overdentures was done according to PRISMA Guidelies. The review evaluated sixteen articles related to survival of the attachments, the reaction of the soft and hard tissues along with repair and maintenance of the attachments, and overall performance of the overdenture attachments.
STATISTICAL ANALYSIS USED
There is statistically significant heterogeneity (Q =374.7403, df = 15, and < 0.0001). The statistics of fixed-effect model reported an MD of - 0.0880 (95% CI = -0.1536; 0.0225).
RESULT
The review evaluated the 16 articles that met with the inclusion and search criteria. The studies were the combination of bar and ball attachments and their subtypes, magnetic and bar attachments, and locator in combination with other attachments. The meta-analysis of combined 16 studies reported acceptable heterogeneity among 16 studies (I 2 = 96%) and reported to be statistically significant ( < 0.01).
CONCLUSION
The survival rate of attachments was in the range of 95.8%-97.5% for bar, 96.2%-100% for ball, 90%-92% for magnet and locator attachments were in the range of 97% after a mean follow-up period of 3 years. The bar attachments reported moderate tissue reaction in the form of mucosal changes, gingival inflammation, and bone resorption. The locator attachments require higher maintenance and repair. The magnetic attachments produce higher bone resorption and readily displace under functional force. Patient satisfaction and compliance was higher for ball, locator, and bar attachments as well as low for magnetic attachment. Thus, the ball and locator attachments excellently perform in terms of survival rate, tissue response, and patient satisfaction.
PubMed: 33223695
DOI: 10.4103/jips.jips_368_19 -
Saudi Medical Journal Aug 2021To systematically review the occurrence of magnet or receiver/stimulator displacement following cochlear implant (CI) placement complication and evaluate the existing...
OBJECTIVES
To systematically review the occurrence of magnet or receiver/stimulator displacement following cochlear implant (CI) placement complication and evaluate the existing literature on this topic.
METHODS
A systematic literature search was conducted using PubMed, Scopus, Web of Science, Virtual Health Library (VHL), and Cochrane Library. Original studies reporting cases of magnet or receiver-stimulator migration occurring as a complication after CI placement were included. The quality of the included studies was evaluated using the National Institutes of Health Quality Assessment Tool for observational studies and CARE checklist for case studies.
RESULTS
A total of 36 studies, including 6469 patients, were included. Magnet migration was reported in 82 (1.3%) patients, while receiver/stimulator was reported in 4 (0.1%) cases. The cause of magnet migration was identified in 78 cases; MRI-induced movement was the most frequently reported cause (n=43, 55.1%), followed by head trauma (n=25, 32.1%). A total of 20 studies involving 35 patients with magnet migration performed skull radiography to diagnose magnet migration. Revision/exploratory surgery with surgical repositioning or replacement was the most frequent management procedure (n=46).
CONCLUSIONS
Further research on magnet pocket design and standard protocols for MRI in CI users is needed. Early diagnosis of magnet migration and instant referral to specialized CI centers is necessary for proper management and prevention of major complications. PROSPERO REG. NO. CRD: 42020204514.
Topics: Cochlear Implantation; Cochlear Implants; Humans; Magnetic Resonance Imaging; Magnets; Reoperation
PubMed: 34344804
DOI: 10.15537/smj.2021.42.8.20210294 -
Translational Psychiatry Jun 2023Major depressive disorder (MDD) is a very prevalent mental disorder that imposes an enormous burden on individuals, society, and health care systems. Most patients... (Review)
Review
Major depressive disorder (MDD) is a very prevalent mental disorder that imposes an enormous burden on individuals, society, and health care systems. Most patients benefit from commonly used treatment methods such as pharmacotherapy, psychotherapy, electroconvulsive therapy (ECT), and repetitive transcranial magnetic stimulation (rTMS). However, the clinical decision on which treatment method to use remains generally informed and the individual clinical response is difficult to predict. Most likely, a combination of neural variability and heterogeneity in MDD still impedes a full understanding of the disorder, as well as influences treatment success in many cases. With the help of neuroimaging methods like functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), the brain can be understood as a modular set of functional and structural networks. In recent years, many studies have investigated baseline connectivity biomarkers of treatment response and the connectivity changes after successful treatment. Here, we systematically review the literature and summarize findings from longitudinal interventional studies investigating the functional and structural connectivity in MDD. By compiling and discussing these findings, we recommend the scientific and clinical community to deepen the systematization of findings to pave the way for future systems neuroscience roadmaps that include brain connectivity parameters as a possible precision component of the clinical evaluation and therapeutic decision.
Topics: Humans; Depressive Disorder, Major; Diffusion Tensor Imaging; Brain; Electroconvulsive Therapy; Transcranial Magnetic Stimulation; Magnetic Resonance Imaging
PubMed: 37296121
DOI: 10.1038/s41398-023-02499-y -
Stroke Oct 2023Evidence of efficacy of repetitive transcranial magnetic stimulation (rTMS) for stroke recovery is hampered by an unexplained variability of reported effect sizes and an... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidence of efficacy of repetitive transcranial magnetic stimulation (rTMS) for stroke recovery is hampered by an unexplained variability of reported effect sizes and an insufficient understanding of mechanisms of action. We aimed to (1) briefly summarize evidence of efficacy, (2) identify critical factors to explain the reported variation in effects, and (3) provide mechanism-based recommendations for future trials.
METHODS
We performed a systematic review of the literature according to Cochrane and PRISMA Protocols. We included trials with ≥10 patients per treatment group. We classified outcome measures according to the International Classification of Functioning, Disability, and Health. Meta-analysis was done when at least 3 trials were reported on the same construct. In case of significant summary effect sizes with significant heterogeneity, we used sensitivity analyses to test for correlations and differences between found individual effect sizes and possible effect modifiers such as patient-, repetitive transcranial magnetic stimulation-, and trial characteristics.
RESULTS
We included 57 articles (N=2595). Funnel plots showed no publication bias. We found significant effect sizes at the level of body function (upper limb synergies, muscle strength, language functioning, global cognitive functioning, visual/spatial inattention) with repetitive transcranial magnetic stimulation within or beyond 3 months after stroke. We also found significant effect sizes at the level of activities. We found no subgroup differences or significant correlations between individual summary effect sizes and any tested possible effect modifier.
CONCLUSIONS
Repetitive transcranial magnetic stimulation holds the potential to benefit a range of motor and cognitive outcomes after stroke, but the evidence of efficacy is challenged by unexplained heterogeneity across many small sampled trials. We propose large trials with the collection of individual patient data on baseline severity and brain network integrity with sufficiently powered subgroup analyses, as well as protocolized time-locked training of the target behavior. Additional neurophysiological and biomechanical data may help in understanding mechanisms and identifying biomarkers of treatment efficacy.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: CRD42022300330.
Topics: Humans; Transcranial Magnetic Stimulation; Stroke; Brain; Cognition; Language
PubMed: 37747964
DOI: 10.1161/STROKEAHA.123.043159 -
Fluids and Barriers of the CNS Dec 2023The neurovascular unit (NVU) is a complex structure that facilitates nutrient delivery and metabolic waste clearance, forms the blood-brain barrier (BBB), and supports... (Review)
Review
The neurovascular unit (NVU) is a complex structure that facilitates nutrient delivery and metabolic waste clearance, forms the blood-brain barrier (BBB), and supports fluid homeostasis in the brain. The integrity of NVU subcomponents can be measured in vivo using magnetic resonance imaging (MRI), including quantification of enlarged perivascular spaces (ePVS), BBB permeability, cerebral perfusion and extracellular free water. The breakdown of NVU subparts is individually associated with aging, pathology, and cognition. However, how these subcomponents interact as a system, and how interdependencies are impacted by pathology remains unclear. This systematic scoping review identified 26 studies that investigated the inter-relationships between multiple subcomponents of the NVU in nonclinical and neurodegenerative populations using MRI. A further 112 studies investigated associations between the NVU and white matter hyperintensities (WMH). We identify two putative clusters of NVU interdependencies: a 'vascular' cluster comprising BBB permeability, perfusion and basal ganglia ePVS; and a 'fluid' cluster comprising ePVS, free water and WMH. Emerging evidence suggests that subcomponent coupling within these clusters may be differentially related to aging, neurovascular injury or neurodegenerative pathology.
Topics: Magnetic Resonance Imaging; Brain; Blood-Brain Barrier; Water
PubMed: 38129925
DOI: 10.1186/s12987-023-00499-0 -
Therapeutic Advances in Gastroenterology 2023Magnetically controlled capsule endoscopy (MCCE) is a non-invasive, painless, comfortable, and safe equipment to diagnose gastrointestinal diseases (GID), partially... (Review)
Review
BACKGROUND
Magnetically controlled capsule endoscopy (MCCE) is a non-invasive, painless, comfortable, and safe equipment to diagnose gastrointestinal diseases (GID), partially overcoming the shortcomings of conventional endoscopy and wireless capsule endoscopy (WCE). With advancements in technology, the main technical parameters of MCCE have continuously been improved, and MCCE has become more intelligent.
OBJECTIVES
The aim of this systematic review was to summarize the research progress of MCCE and artificial intelligence (AI) in the diagnosis and treatment of GID.
DATA SOURCES AND METHODS
We conducted a systematic search of PubMed and EMBASE for published studies on GID detection of MCCE, physical factors related to MCCE imaging quality, the application of AI in aiding MCCE, and its additional functions. We synergistically reviewed the included studies, extracted relevant data, and made comparisons.
RESULTS
MCCE was confirmed to have the same performance as conventional gastroscopy and WCE in detecting common GID, while it lacks research in detecting early gastric cancer (EGC). The body position and cleanliness of the gastrointestinal tract are the main factors affecting imaging quality. The applications of AI in screening intestinal diseases have been comprehensive, while in the detection of common gastric diseases such as ulcers, it has been developed. MCCE can perform some additional functions, such as observations of drug behavior in the stomach and drug damage to the gastric mucosa. Furthermore, it can be improved to perform a biopsy.
CONCLUSION
This comprehensive review showed that the MCCE technology has made great progress, but studies on GID detection and treatment by MCCE are in the primary stage. Further studies are required to confirm the performance of MCCE.
PubMed: 37900007
DOI: 10.1177/17562848231206991 -
Frontiers in Endocrinology 2022Graves' ophthalmopathy (GO) is an autoimmune disease related to Grave's disease (GD). The therapeutic strategies for GO patients are based on precise assessment of the...
Graves' ophthalmopathy (GO) is an autoimmune disease related to Grave's disease (GD). The therapeutic strategies for GO patients are based on precise assessment of the activity and severity of the disease. However, the current assessment systems require development to accommodate updates in treatment protocols. As an important adjunct examination, magnetic resonance imaging (MRI) can help physicians evaluate GO more accurately. With the continuous updating of MRI technology and the deepening understanding of GO, the assessment of this disease by MRI has gone through a stage from qualitative to precise quantification, making it possible for clinicians to monitor the microstructural changes behind the eyeball and better integrate clinical manifestations with pathology. In this review, we use orbital structures as a classification to combine pathological changes with MRI features. We also review some MRI techniques applied to GO clinical practice, such as disease classification and regions of interest selection.
Topics: Humans; Graves Ophthalmopathy; Magnetic Resonance Imaging; Graves Disease
PubMed: 36267571
DOI: 10.3389/fendo.2022.991588