Stimulation Group Research Articles

Effects of different treatment frequencies of electromagnetic stimulation for urinary incontinence in women: study protocol for a randomized controlled trial

BackgroundUrinary incontinence is highly prevalent in women while pelvic floor muscle training is recommended as the first-line therapy. However, the exact treatment regimen is poorly understood. Also, patients with pelvic floor muscle damage may have decreased muscle proprioception and cannot contract their muscles properly. Other conservative treatments including electromagnetic stimulation are suggested by several guidelines. Thus, the present study aims to compare the effectiveness of electromagnetic stimulation combined with pelvic floor muscle training as a conjunct treatment for urinary incontinence and different treatment frequencies will be investigated.Methods/designThis is a randomized, controlled clinical trial. We will include 165 patients with urinary incontinence from the outpatient center. Participants who meet the inclusion criteria will be randomly allocated to three groups: the pelvic floor muscle training group (active control group), the low-frequency electromagnetic stimulation group (group 1), and the high-frequency electromagnetic stimulation group (group 2). Both group 1 and group 2 will receive ten sessions of electromagnetic stimulation. Group 1 will be treated twice per week for 5 weeks while group 2 will receive 10 days of continuous treatment. The primary outcome is the change in International Consultation on Incontinence Questionnaire–Short Form cores after the ten sessions of the treatment, while the secondary outcomes include a 3-day bladder diary, pelvic floor muscle function, pelvic organ prolapse quantification, and quality of life assessed by SF-12. All the measurements will be assessed at baseline, after the intervention, and after 3 months of follow-up.DiscussionThe present trial is designed to investigate the effects of a conjunct physiotherapy program for urinary incontinence in women. We hypothesize that this strategy is more effective than pelvic floor muscle training alone, and high-frequency electromagnetic stimulation will be superior to the low-frequency magnetic stimulation group.

Effectiveness of multi-modal home-based videoconference interventions on sleep in older adults: study protocol for a randomized controlled trial.

Aging is characterized by substantial changes in sleep architecture that negatively impact fitness, quality of life, mood, and cognitive functioning. Older adults often fail to reach the recommended level of physical activity to prevent the age-related decline in sleep function, partly because of geographical barriers. Implementing home-based interventions could surmount these obstacles, thereby encouraging older adults to stay active, with videoconference administration emerging as a promising solution. Increasing the availability of biological rhythms synchronizers, such as physical activity, light exposure, or vestibular stimulation, represents a viable non-pharmacological strategy for entraining circadian rhythms and potentially fortifying the sleep-wake cycle, thereby enhancing sleep in aging. This study aims to (1) assess the impact of remote physical exercise training and its combination with bright light exposure, and (2) investigate the specific contribution of galvanic vestibular stimulation, to sleep quality among healthy older adults with sleep complaints. One hundred healthy older adults aged 60-70 years with sleep complaints will be randomly allocated to one of four groups: a physical exercise training group (n = 25), a physical exercise training combined with bright light exposure group (n = 25), a galvanic vestibular stimulation group (n = 25) or a control group (i.e., health education) (n = 25). While physical exercise training and health education will be supervised via videoconference at home, bright light exposure (for the physical exercise training combined with bright light exposure group) and vestibular stimulation will be self-administered at home. Pre-and post-tests will be conducted to evaluate various parameters, including sleep (polysomnography, subjective questionnaires), circadian rhythms (actigraphy, temperature), fitness (physical: VO2 peak, muscular function; and motor: balance, and functional mobility), cognition (executive function, long-term memory), quality of life and mood (anxiety and depression). The findings will be anticipated to inform the development of recommendations and non-pharmaceutical preventive strategies for enhancing sleep quality in older adults, potentially leading to improvements in fitness, cognition, quality of life, and mood throughout aging.

Comprehensive assessment of HF-rTMS treatment mechanism for post-stroke dysphagia in rats by integration of fecal metabolomics and 16S rRNA sequencing.

The mechanism by which high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) improves swallowing function by regulating intestinal flora remains unexplored. We aimed to evaluate this using fecal metabolomics and 16S rRNA sequencing. A Post-stroke dysphagia (PSD) rat model was established by middle cerebral artery occlusion. The magnetic stimulation group received HF-rTMS from the 7th day post-operation up to 14th day post-surgery. Swallowing function was assessed using a videofluoroscopic swallowing study (VFSS). Hematoxylin-eosin (H&E) staining was used to assess histopathological changes in the intestinal tissue. Intestinal flora levels were evaluated by sequencing the 16S rRNA V3-V4 region. Metabolite changes within the intestinal flora were evaluated by fecal metabolomics using liquid chromatography-tandem mass spectrometry. VFSS showed that the bolus area and pharyngeal bolus speed were significantly decreased in PSD rats, while the bolus area increased and pharyngeal transit time decreased after HF-rTMS administration (p < 0.05). In the PSD groups, H&E staining revealed damaged surface epithelial cells and disrupted cryptal glands, whereas HF-rTMS reinforced the integrity of the intestinal epithelial cells. 16S rRNA sequencing indicated that PSD can disturb the intestinal flora and its associated metabolites, whereas HF-rTMS can significantly regulate the composition of the intestinal microflora. Firmicutes and Lactobacillus abundances were lower in the PSD group than in the baseline group at the phylum and genus levels, respectively; however, both increased after HF-rTMS administration. Levels of ceramides (Cer), free fatty acids (FA), phosphatidylethanolamine (PE), triacylglycerol (TAG), and sulfoquinovosyl diacylglycerol were increased in the PSD group. The Cer, FA, and DG levels decreased after HF-rTMS treatment, whereas the TAG levels increased. Peptococcaceae was negatively correlated with Cer, Streptococcus was negatively correlated with DG, and Acutalibacter was positively correlated with FA and Cer. However, these changes were effectively restored by HF-rTMS, resulting in recovery from dysphagia. These findings suggest a synergistic role for the gut microbiota and fecal metabolites in the development of PSD and the therapeutic mechanisms underlying HF-rTMS.

The Effects of Transcutaneous Auricular Vagus Nerve Stimulation on Language Retention in College-Aged Students

As our world is becoming more globally connected, the ability to speak another language is increasingly becoming a valuable skill. While there exist many training programs to help acquire a new language, this task becomes increasingly difficult with age—thus presenting the need for a novel method of intervention to assist in this process. Considering this increasing difficulty and poor outcomes of existing methods, a new biologically based intervention could be valuable for improving learning and memory. Previous research conducted in our lab has shown that noninvasive transcutaneous auricular vagus nerve stimulation (taVNS) is an effective intervention in memory-based reading comprehension and letter-sound learning (Thakkar et al., 2020;2023). TaVNS has also been shown to boost associative memory (Jacobs et al., 2015), spatial working memory (Sun et al., 2021), and emotional memory (Ventura-Bort et al., 2021). Despite this knowledge, little is known about taVNS and its effects on long-lasting language retention. Thus, this current study explores whether transcutaneous auricular vagus nerve stimulation can improve learning and retention of vocabulary words in a new language when paired with a training routine. Typically developing college-aged individuals were recruited through an online participant pool. All individuals were screened for age, IQ, reading, memory, and attention for inclusion in this study. The participants completed a one-hour training session in which they were presented with 30 Palauan nouns, the respective English translations, as well as images of the nouns. During this time, the participants received sham, 5 Hz, or 25 Hz stimulation to the posterior of the left tragus. Prior to training, participants completed a translation test to measure their existing knowledge of the Palauan language, and this test was repeated immediately after training and again seven days later to measure learning and retention. After analysis of the results, no effect was found for any stimulation group immediately after training. At retention, however, the 25 Hz taVNS group showed significantly greater performance than both the sham and 5 Hz taVNS groups on recall of material. There was also no statistical difference between the performance of the sham and 5 Hz taVNS groups. Lastly, the results further suggest that stimulation intensity does not impact the efficacy of the intervention. These data suggest that taVNS, regardless of stimulation intensity, may be used to help in the retention of novel words in a new language. These data will be important for ongoing research examining the uses of taVNS, its use as an intervention for learning and retention of a new language, as well as its potential uses in other areas of cognition.

Effects of Neuromuscular Electrical Stimulation with Gastrocnemius Strengthening on Foot Morphology in Stroke Patients: A Randomized Controlled Trial.

This study aimed to investigate the effects of neuromuscular electrical stimulation (NMES) with gastrocnemius (GCM) strength exercise on foot morphology in patients with stroke. Herein, 31 patients with chronic stroke meeting the study criteria were enrolled and divided into two groups; 16 patients were randomized to the gastrocnemius neuromuscular electrical stimulation (GCMNMES) group, and 15 patients to the conventional neuromuscular electrical stimulation (CNMES) group. The GCMNMES group conducted GCM-strengthening exercise with NMES. CNMES group conducted NMES at paretic tibialis anterior muscle with ankle dorsiflexion movement. These patients underwent therapeutic interventions lasting 30 min/session, five times a week for 4 weeks. To analyze changes in foot morphology, 3D foot scanning was used, while a foot-pressure measurement device was used to evaluate foot pressure and weight-bearing area. In an intra-group comparison of 3D-foot-scanning results, the experimental group showed significant changes in longitudinal arch angle (p < 0.05), medial longitudinal arch angle (MLAA) (p < 0.01), transverse arch angle (TAA) (p < 0.01), rearfoot angle (RA) (p < 0.05), foot length (FL) (p < 0.05), foot width (FW) (p < 0.05), and arch height index (AHI) (p < 0.01) of the paretic side and in TAA (p < 0.05) and AHI (p < 0.05) of the non-paretic side. The CNMES group showed significant changes in TAA (p < 0.05) and FW (p < 0.05) of the paretic side and TAA (p < 0.05) and AHI (p < 0.05) of the non-paretic side. An inter-group comparison showed significant differences in MLAA (p < 0.05) and RA (p < 0.05) of the paretic side. In an intra-group comparison of foot pressure assessment, the experimental group showed significant differences in footprint area (FPA) (p < 0.05) of the paretic side and FPA symmetry (p < 0.05). The CNMES group showed a significant difference in only FPA symmetry (p < 0.05). An inter-group comparison showed no significant difference between the two groups (p < 0.05). Thus, NMES with GCM-strengthening exercises yielded positive effects on foot morphology in patients with stroke.

Altered functional brain activity in first-episode major depressive disorder treated with electro-acupuncture: A resting-state functional magnetic resonance imaging study

BackgroundPrevious studies have found electroacupuncture could improve the clinical symptoms of first-episode major depressive disorder (MDD), but the exact neural mechanism of action needs to be further elucidated. MethodsTwenty-eight first-episode MDD patients were randomly divided into 14 electro-acupuncture stimulation (EAS) groups and 14 sham-acupuncture stimulation (SAS) groups, and clinical symptoms were assessed and functional magnetic resonance imaging (fMRI) scans were done in both groups. Amplitude of low-frequency fluctuations (ALFF) was used to observe the changes between the pre-treatment and post-treatment in the two groups, and the altered brain areas were selected as region of interest (ROI) to observe the FC changes. Meanwhile, the correlation between the altered clinical symptoms and the altered ALFF and FC of brain regions in the two groups was analyzed. ResultsThe EAS significantly decreased the HAMD-24 and HAMA-14 scores of MDD than SAS group. The imaging results revealed that both groups were able to increase the ALFF of the left middle temporal gyrus and the left cerebellar posterior lobe. When using the left middle temporal gyrus and the left posterior cerebellar lobe as ROIs, EAS group increased the FC between the left middle temporal gyrus with the left superior frontal gyrus, the left middle frontal gyrus, and the left hippocampus, and decreased the FC between the left posterior cerebellar lobe and the left calcarine gyrus, while SAS group only increased the FC between the left middle temporal gyrus with the left superior frontal gyrus. The alternations in clinical symptoms after EAS treatment were positively correlated with the altered ALFF values in the left middle temporal gyrus and the altered FC values in the left middle temporal gyrus and the left middle frontal gyrus. ConclusionEA demonstrates modulation of functional activity in the default mode network (DMN), sensorimotor network (SMN), cognitive control network (CCN), limbic system, and visual network (VN) for the treatment of the first-episode MDD. Our findings contribute to the neuroimaging evidence for the efficacy of EAS.

147 Medial Septal Nucleus Theta Stimulation Improves Spatial Working Memory and Increases Hippocampal Neurovascular Activity in a Mouse Model of Alzheimers Disease (5xFAD)

INTRODUCTION: Alzheimer’s disease (AD) remains among the most prolific neurodegenerative disorders. The pathogenesis is the result, in part, of aberrant cerebral circuitry; in particular, the mesolimbic-septohippocampal circuit and its associated medial septal nucleus (MSN). Interestingly, the administration of theta stimulation via deep brain stimulation (DBS) to the MSN has been demonstrated to increase hippocampal theta oscillations, which are critical to the role of the hippocampus in learning and memory. Recently, functional ultrasound imaging (fUSI) has emerged as a method of evaluating large-scale neural activity with both high spatiotemporal resolution (∼100 μm3) and sensitivity to slow blood flow (∼1 mm/s). fUSI allows for the in-vivo analyses of neurovascular changes secondary to our theta-burst neuromodulatory intervention. METHODS: 12 male 5xFAD mice were partitioned into two groups, one received theta-burst stimulation targeting the MSN (n = 4) and the other acted as controls (n = 8). Following stimulation, spatial working memory was assessed via the Barnes maze task. An additional 44 C57BL/6 mice were partitioned into three groups: one receiving theta (7.7 Hz) stimulation to the MSN (n = 16), one receiving gamma stimulation to the MSN (100 Hz, n = 14), and the remaining group acting as the control (n = 14). RESULTS: The MSN theta stimulation group of 5xFAD mice demonstrated decreased latency compared to controls (p = 0.003). CBF volumes in the hippocampus were relatively increased in the theta-burst group when compared to both control and gamma stimulation groups. CONCLUSIONS: Our results demonstrate significant improvement in cognitive performance secondary to MSN theta-burst stimulation. Additionally, these changes were mirrored by CBF volume increases in the hippocampus in a frequency-dependent manner. These findings provide evidence for the therapeutic role of theta MSN stimulation in the treatment of AD and furthers fUSI’s role in evaluating in-vivo CBF.

Can cerebellar theta-burst stimulation improve balance function and gait in stroke patients? A randomized controlled trial.

The cerebellum is a key structure involved in balance and motor control, and has become a new stimulation target in brain regulation technology. Interference theta-burst simulation (iTBS) is a novel simulation mode of repetitive transcranial magnetic simulation. However, the impact of cerebellar iTBS on balance function and gait in stroke patients is still unknown. The aim of this study was to determine whether cerebellar iTBS can improve function, particularly balance and gait, in patients with post-stroke hemiplegia. This study is a randomized, double-blind, sham controlled clinical trial. The study was carried out at the Department of Rehabilitation Medicine in a general hospital. Patients with stroke with first unilateral lesions were enrolled in the study. Thirty-six patients were randomly assigned to the cerebellar iTBS group or sham stimulation group. The cerebellar iTBS or pseudo stimulation site is the ipsilateral cerebellum on the paralyzed side, which is completed just before daily physical therapy. The study was conducted five times a week for two consecutive weeks. All patients were assessed before the intervention (T0) and at the end of 2 weeks of treatment (T1), respectively. The primary outcome was the Berg Balance Scale (BBS), while secondary outcome measures included the Fugl Meyer Lower Limb Assessment Scale (FMA-LE), timed up and go (TUG), Barthel Index (BI), and gait analysis. After 2 weeks of intervention, the BBS, FMA-LE, TUG, and BI score in both the iTBS group and the sham group were significantly improved compared to the baseline (all P<0.05). Also, there was a significant gait parameter improvement including the cadence, stride length, velocity, step length compared to the baseline (P<0.05) in the iTBS group, but only significant improvement in cadence was identified in the sham group (P<0.05). Intergroup comparison showed that the BBS (P<0.001), FMA-LE (P<0.001), and BI (P=0.002) in the iTBS group were significantly higher than those in the sham group, and the TUG in the iTBS was significantly lower than that in the sham group (P=0.002). In addition, there were significant differences in cadence (P=0.029), strip length (P=0.046), gain velocity (P=0.002), and step length of affected lower limb (P=0.024) between the iTBS group and the sham iTBS group. Physical therapy is able to improve the functional recovery in hemiplegic patients after stroke, but the cerebellar iTBS can facilitate and accelerate the recovery, particularly the balance function and gait. Cerebellar iTBS could be an efficient and facilitative treatment for patients with stroke. Cerebellar iTBS provides a convenient and efficient treatment modality for functional recovery of patients with stroke, especially balance function and gait.

Effect of flipped venous catheter combined with spinal cord electrical stimulation on functional recovery in patients with sciatic nerve injury.

This study aimed to explore the effect of flipped venous catheters combined with spinal cord electrical stimulation on functional recovery in patients with sciatic nerve injury. 160 patients with hip dislocation and sciatic nerve injury were divided into conventional release and flipped catheter + electrical stimulation groups according to the treatment methods (n=80). Motor nerve conduction velocity (MCV) and lower limb motor function were compared. Serum neurotrophic factors brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were compared. The frequency of complications and quality of life were also compared. The MCV levels of the common peroneal nerve and tibial nerve in the flipped catheter + electrical stimulation group were greater than the conventional lysis group (p<0.05). After treatment, the lower extremity motor score (LMEs) in the flipped catheter + electrical stimulation group was greater than the conventional lysis group (p<0.05). The serum levels of BDNF and NGF in the flip catheter + electrical stimulation group were higher than the conventional lysis group (p<0.05). The complication rate in the flipped catheter + electrical stimulation group was lower than in the conventional release group (6.25% vs. 16.25%, p<0.05). The quality-of-life score in the flip catheter + electrical stimulation group was greater than the conventional lysis group (p<0.05). The flipped venous catheter combined with spinal cord electrical stimulation can improve nerve conduction velocity, lower limb motor function, serum BDNF and NGF levels, reduce complications, and help improve the quality of life of sufferers with sciatic nerve injury. Chictr.org.cn ID: ChiCTR2400080984.

Effects of Russian and Aussie Currents Combined With Isokinetic Training on Symptoms, Pain, Functional Mobility, and Quality of Life in Individuals With Patellofemoral Pain Syndrome: A Randomized, Placebo-Controlled Study.

To find out if burst-modulated medium frequency alternating currents (Russian and Aussie types) contribute to the effects of isokinetic-training in patients with patellofemoral pain, and to compare their effectiveness on symptoms, pain, functional mobility, and quality of life. Forty-five patients with patellofemoral pain were randomized into Russian current, Aussie current or placebo electrical stimulation groups. Patellofemoral Pain Severity Scale, Stair Climbing Test, Anterior Knee Pain Scale, Knee Outcome Survey Activities of Daily Living Scale, and Short Form-36 data were obtained before and after 15 sessions of interventions and at the end of a 3-wk follow-up period. Severity of symptoms and pain decreased; functional mobility, activity limitations and quality of life improved significantly after interventions ( P < 0.05), and these effects were maintained at the follow-up period ( P < 0.05). The amount of improvements in symptom and pain severity, and quality of life was higher in the Russian and Aussie current groups than in the placebo group ( P < 0.05). In patients with patellofemoral pain, burst-modulated medium frequency alternating currents may provide extra benefit in improving symptoms, pain, functional mobility and quality of life, and the Aussie currents provide greater improvement in symptom and pain severity.

Rosiglitazone alleviates LPS-induced endometritis via suppression of TLR4-mediated NF-κB activation.

The aim of this study was to investigate the anti-inflammatory effect of Rosiglitazone (RGZ) on lipopolysaccharide (LPS) -induced Endometritis and explore its possible mechanism. The preventive and therapeutic effects of RGZ on Endometritis were studied in vivo and in vitro. A total of 40 female C57BL/6 mice were randomly divided into the following 4 groups: RGZ+LPS, RGZ control, LPS and DMSO control. The mice uterine tissue sections were performed with HE and immunohistochemical staining. Human endometrial stromal cells (HESCs) were cultured, and different concentrations of LPS stimulation groups and RGZ and/or a TLR4 signaling inhibitor TAK-242 pretreatment +LPS groups were established to further elucidate the underlying mechanisms of this protective effect of RGZ. The HE results in mice showed that RGZ+LPS group had less tissue loss than LPS group. Immunohistochemical staining (IHC) results showed that the expression of TLR4 after RGZ treatment was significantly lower than that in LPS group. These findings suggested that RGZ effectively improves the pathological changes associated with LPS-induced endometritis by inhibiting TLR4. Reverse transcription-polymerase chain reaction and western blot analysis demonstrated that RGZ pretreatment suppresses the expression of Toll-like receptor 4 (TLR4) and its downstream activation of nuclear factor-κB (NF-κB). In vitro, RGZ inhibited LPS-stimulated expression of proinflammatory cytokines in a dose-dependent manner and also downregulated LPS induced toll-like receptor 4 (TLR4) expression and inhibited phosphorylation of LPS-induced nuclear transcription factor-kappa B (NF-κB) P65 protein. These results suggest that RGZ may inhibit LPS-induced endometritis through the TLR4-mediated NF-κB pathway.

Study protocol for a prospective, randomized, multicenter trial to investigate the influence of peripheral nerve stimulation on patients with chronic sacroiliac joint syndrome (SILENCING)

BackgroundThe prevalence of sacroiliac joint pain (SIJP) is estimated to be 10–30% in patients with chronic low back pain. Numerous conservative and surgical treatment modalities for SIJP have been described with limited evidence regarding long-term pain relief.Spinal cord stimulation (SCS) is a well-established technique to treat patients with chronic low back pain. However, the effect on patients with SIJP is not consistent. Therefore, peripheral nerve stimulation (PNS) for chronic SIJP was implemented in experimental trials. Clinical data on PNS for SIJP is still lacking. The authors present a case series and a protocol for a prospective, multicenter study to determine the effect of PNS in patients with chronic intractable SIJP.MethodA multicenter, prospective randomized controlled trial was designed. Patients with chronic intractable SIJP will be recruited and randomized in a 4:3 ratio to either the peripheral nerve stimulation group or to the best medical treatment group. A total of 90 patients are planned to be enrolled (52 in the PNS group and 38 in the BMT group). Patients in the intervention group receive a percutaneous implantation of a unilateral or bilateral lead which is externalized for a trial phase for 3–14 days. After trial phase only patients with at least 50% reduction of pain receive an impulse generator for permanent stimulation. Regular visits for participants are planned on day 0, after 3 months (± 30 days), 6 months (± 30 days), and 12 months (± 60 days). The primary outcome measurements is the difference in Numeric Pain Rating Scale (NRS) between baseline and after 6 months. Secondary outcomes is improvement of pain associated disability (ODI) and improvement of health-related quality of life after 6 and 12 months.DiscussionWe have described the protocol for a prospective, multicenter, randomized trial evaluating the influence of PNS on patients with chronic sacroiliac joint syndrome. We believe that PNS on patients with chronic sacroiliac joint syndrome will show promising results regarding pain relief and quality of life in comparison to BMT after 12 months. The design of this trial promises high evidence in comparison to the data to date.Trial registrationClinicalTrials.gov, NCT05357300. Registered on April 26, 2022.

Effects of M2-type macrophages and GKT137831 on oxidative stress in hepatic stellate cells

Objective: To investigate the effects of reduced nicotinamide adenine dinucleotide phosphooxidase 4 (NOX4) inhibitors GKT137831 and M2-type macrophages on oxidative stress markers NOX4, nuclear factor E2-related factor 2 (Nrf2) and heme oxygenase 1 (HO-1) in the rat hepatic stellate cell line (HSC-T6). Methods: Rat bone marrow macrophages were extracted and induced using interleukin (IL)-4 to differentiate them into M2 phenotype macrophages. HSC-T6 activation was performed with 5 μg/L transforming growth factor β1 (TGF-β1). The proliferation condition of HSC-T6 cells stimulated by the NOX4 inhibitor GKT137831 at a concentration gradient of 5 to 80 μmol/L after 48 hours was detected using the Cell Counting Kit-8 (CCK-8) assay. The optimal drug concentration was chosen and divided into an HSC co-culture group (the control group) and five experimental groups: the TGF-β1 stimulation group, the TGF-β1 +GKT137831 stimulation group, the M2-type macrophage + HSC co-culture group, the M2-type macrophage +TGF-β1 stimulation group, and the M2-type + TGF-β1 + GKT137831 stimulation group. Reactive oxygen species (ROS) production level was detected in each cell using the DCFH-DA probe method. NOX4, α-smooth muscle actin (α-SMA), Nrf2, and HO-1 levels in each group of HSC cells were detected using the qRT-PCR method and the Western blot method. The t-test was used to compare the two groups. The one-way ANOVA method was used to compare multiple groups. Results: Intracellular ROS increased significantly following TGF-β1 stimulation. ROS relative levels in each cell group were 1.03±0.11, 3.88±0.07, 2.90±0.08, 0.99±0.06, 3.30±0.05, 2.21±0.11, F = 686.1, P = 0.001, respectively. The mRNA and protein expressions of NOX4, α-SMA, Nrf2, and HO-1 were significantly increased (P < 0.05). After the addition of GKT137831, ROS, and NOX4, α-SMA mRNA and protein expression were comparatively decreased in the TGF-β1 stimulation group (P < 0.05), while mRNA and protein expressions of Nrf2 and HO-1 were increased (P < 0.05). The expression of ROS and NOX4, as well as α-SMA mRNA and protein, produced by HSC were significantly decreased in the co-culture group compared to the single culture group after TGF-β1 stimulation (P < 0.05). After the addition of GKT137831, ROS, NOX4, α-SMA mRNA, and protein expression were further reduced in the co-culture group compared with the single culture group (P < 0.05), while the mRNA and protein expression of Nrf2 and HO-1 were further increased (P < 0.05). Conclusion: NOX4 inhibitor GKT137831 can reduce RO, NOX4, and α-SMA levels while increasing Nrf2 and HO-1 levels in hepatic stellate cells. After M2-type macrophage co-culture, GKT137831 assists in lowering ROS, NOX4, and α-SMA levels while accelerating Nrf2 and HO-1 levels in hepatic stellate cells, which regulates the balance between oxidative stress and anti-oxidative stress systems, thereby antagonizing the fibrosis process.

Efficacy and safety of tibial nerve stimulation using a wearable device for overactive bladder.

To evaluate the efficacy and safety of a wearable, smartphone-controlled, rechargeable transcutaneous tibial nerve stimulation (TTNS) device in patients with overactive bladder (OAB). This multicentre, prospective, single-blind, randomised clinical trial included eligible patients with OAB symptoms who were randomly assigned to the stimulation group or sham group. The primary efficacy outcome was change from baseline in voiding frequency/24 h after 4 weeks of treatment. The secondary efficacy outcomes included changes in bladder diary outcomes (urgency score/void, nocturia episodes/day, micturition volume/void, and incontinence episodes/day), questionnaires on Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and American Urological Association Symptom Index Quality of Life Score (AUA-SI-QoL) at baseline and after 4 weeks of treatment. Device-related adverse events (AEs) were also evaluated. In the full analysis set (FAS), the mean (sd) change of voiding frequency/24 h in the stimulation group and sham group at 4 weeks were -3.5 (2.9) and -0.6 (2.4), respectively (P < 0.01). Similar results were obtained in the per-protocol set (PPS): -3.5 (2.9) vs -0.4 (2.3) (P < 0.01). In the FAS and PPS, micturition volume/void significantly improved at 4 weeks (P = 0.01 and P = 0.02). PPBC improvement almost reached significance in the FAS (P = 0.05), while it was significant in the PPS (P = 0.02). In the FAS and PPS, AUA-SI-QoL significantly improved at 4 weeks in the two groups (P < 0.01 and P < 0.01), whereas there were no significant differences in urgency score/void, nocturia episodes/day or OABSS between the groups. Also, no device-related serious AEs were reported. The non-invasive neuromodulation technique using the novel ambulatory TTNS device is effective and safe for treating OAB. Its convenience and easy maintenance make it a new potential home-based treatment modality. Future studies are warranted to confirm its longer-term efficacy.

Comparison of Intensive Physical Therapy and Electrical Stimulation to Reduce Spasticity in Stroke

Background: Stroke is a leading cause of disability worldwide, often resulting in spasticity that significantly impairs the functional recovery of individuals. The comparative efficacy of intensive physical therapy and electrical stimulation in mitigating post-stroke spasticity remains a critical area of research. Understanding the impacts of these treatments can guide clinicians in optimizing rehabilitation strategies for stroke survivors. Objective: The study aimed to compare the effectiveness of intensive physical therapy and electrical stimulation in reducing spasticity among stroke patients, with an emphasis on how these interventions influence muscle tone and functional outcomes. Methods: This quasi-experimental trial was conducted at Nishtar Hospital, Multan, over six months, involving 30 participants aged 50-65 years who had experienced a stroke. Participants were randomly assigned to receive either intensive physical therapy or electrical stimulation. Baseline and post-treatment assessments of spasticity were conducted using the Modified Ashworth Scale (MAS). Data were analyzed using SPSS version 25, focusing on changes in MAS scores before and after the interventions. Results: Both interventions showed significant improvements in spasticity levels. The intensive physical therapy group exhibited notable reductions in MAS scores across various joints: shoulder flexors (from 3.13 ± 0.51 to 1.20 ± 0.41), shoulder extensors (from 3.00 ± 0.65 to 1.20 ± 0.67), and hip abduction (from 3.00 ± 0.65 to 1.33 ± 0.72). The electrical stimulation group also demonstrated significant improvements, with MAS scores in wrist flexion (from 2.73 ± 0.70 to 1.33 ± 0.61) and hip extension (from 2.80 ± 0.67 to 1.26 ± 0.45) showing notable reductions. However, no statistically significant differences were observed between the two groups in terms of overall effectiveness in reducing spasticity (p &gt; 0.05). Conclusion: Both intensive physical therapy and electrical stimulation are effective in reducing post-stroke spasticity, with no significant difference in their overall efficacy. This suggests that either treatment can be considered as part of a comprehensive rehabilitation strategy for stroke survivors, depending on individual patient needs, preferences, and specific functional goals.

WITHDRAWN: Analysis of the efficacy of repetitive transcranial magnetic stimulation for neuromodulation in early Bell’s palsy: A prospective randomized controlled study

BackgroundThe current main treatment modality for Bell’s palsy (BP) is medication; however, some patients have a poor recovery or experience sequelae despite receiving medication. There is therefore an urgent need to explore new treatment modalities. We conducted this study to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for neuromodulation in early BP. MethodsSeventy-four patients with BP were randomly assigned to a stimulation (n = 36) or control (n = 38) group. Patients in both groups were treated with conventional medication; the stimulation group also received high-frequency rTMS for 2 weeks. Patients were followed up for a minimum of 9 months. Facial function was assessed in patients at baseline, post-treatment, and follow-up using the Facial Nerve Grading System (FNGS) 2.0. ResultsThere was a significantly larger decrease in FNGS 2.0 scores from before to after treatment in the stimulation group (7.08 ± 2.371) than in the control group (5.03 ± 2.615) (p = 0.001; decrease of 2.057, 95% confidence interval 0.898–3.216). Furthermore, the recovery time of cured individuals at follow-up was significantly shorter in the stimulation group than in the control group (Z = 2.157, p = 0.03), and the stimulated group had a lower complication rate than the control group (p = 0.026). ConclusionsrTMS-induced neuromodulation of the facial nerve trunk at the site at which it exits the mastoid foramen helps to promote the recovery of facial nerve function in BP patients, leading to earlier recovery and a reduced complication rate.

Neuromuscular Electrical Stimulation Improves Frontal Ankle Motor Control in Individuals With Chronic Ankle Instability During Drop Landing.

This study investigated the effect of neuromuscular electrical stimulation on the frontal ankle motor control in individuals with chronic ankle instability during drop landing. This was a randomized, controlled, double-blind trial. Thirty-six individuals with chronic ankle instability were randomly assigned to each group. Participants received 6-wk neuromuscular electrical stimulation intervention and sham stimulation in the neuromuscular electrical stimulation and control groups, respectively. Data were collected at week 0 and week 6 . A mixed-effects model and analysis of covariance were employed to investigate the between-group differences in continuous and discrete outcome variables at week 6 , with the outcome variables at week 0 as covariates. Compared to control group, neuromuscular electrical stimulation group exhibited a 2.66° (2.45, 2.86) reduction in frontal ankle inversion angle, a 47.41°/sec (-16.05, -78.77) decrease in peak ankle inversion angular velocity, and a 0.43 Nm/kg (0.18, 0.68) increase in peak ankle eversion moment during drop landing at week 6 . Applying 6-wk neuromuscular electrical stimulation to the fibularis longus resulted in decreased ankle inversion angle and ankle inversion angular velocity and increased peak ankle eversion moment during drop landing. Consequently, neuromuscular electrical stimulation could be considered an effective modality for individuals with chronic ankle instability to enhance the frontal ankle movement patterns and overall ankle motor control.

Application of transcranial alternating current stimulation to improve eSports-related cognitive performance.

Electronic Sports (eSports) is a popular and still emerging sport. Multiplayer Online Battle Arena (MOBA) and First/Third Person Shooting Games (FPS/TPS) require excellent visual attention abilities. Visual attention involves specific frontal and parietal areas, and is associated with alpha coherence. Transcranial alternating current stimulation (tACS) is a principally suitable tool to improve cognitive functions by modulation of regional oscillatory cortical networks that alters regional and larger network connectivity. In this single-blinded crossover study, 27 healthy college students were recruited and exposed to 10 Hz tACS of the right frontoparietal network. Subjects conducted a Visual Spatial Attention Distraction task in three phases: T0 (pre-stimulation), T1 (during stimulation), T2 (after-stimulation), and an eSports performance task which contained three games ("Exact Aiming," "Flick Aiming," "Press Reaction") before and after stimulation. The results showed performance improvements in the "Exact Aiming" task and hint for a prevention of reaction time performance decline in the "Press Reaction" task in the real, as compared to the sham stimulation group. We also found a significant decrease of reaction time in the visual spatial attention distraction task at T1 compared to T0 in the real, but not sham intervention group. However, accuracy and inverse efficiency scores (IES) did not differ between intervention groups in this task. These results suggest that 10 Hz tACS over the right frontal and parietal cortex might improve eSports-related skill performance in specific tasks, and also improve visual attention in healthy students during stimulation. This tACS protocol is a potential tool to modulate neurocognitive performance involving tracking targets, and might be a foundation for the development of a new concept to enhance eSports performance. This will require however proof in real life scenarios, as well optimization.

A Clinical Randomized Controlled Study of Low-Frequency rTMS Therapy on Lower Limb Motor Dysfunction after Stroke

Objective: To investigate the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation (rTMS) for the treatment of lower limb motor dysfunction after stroke. Methods: A total of 96 patients with stroke and lower limb motor dysfunction were enrolled in this study, and were randomly divided into the experimental group and the sham stimulation group using the method of calculator-generated random numbers. Both groups received conventional medication and rehabilitation therapy. The experimental group received 4 weeks of 1 Hz rTMS treatment in the primary cortical motor area (M1) of the healthy side, with the treatment coil tangent to the skull surface; the sham stimulation group underwent the same procedures as the experimental group, but the treatment coil was perpendicular to the skull surface instead. Lower-extremity subscale of the Fugl-Meyer Assessment (FMA-LE), Berg Balance Scale (BBS), gait analysis, and lower-extremity surface electromyography (LESEM) were performed in both groups before and after rTMS treatment. Results: All 96 patients completed the test with no shedding and no adverse reactions. After treatment, the FMA-LE score and BBS score of the 2 groups of patients were significantly improved as compared with the pre-treatment (P &lt; 0.05), and the TUG test time was reduced as compared with the pre-treatment (P &lt; 0.05). The true stimulation group had greater improvement in all assessment indexes than that of the sham stimulation group (P &lt; 0.05). After treatment, the electromyographic activity of the tibialis anterior and rectus femoris muscles in the true simulation group improved significantly. The step length, step speed, and step frequency were also significantly improved in both groups after treatment, and the symmetrical ratio of step length and support time was reduced (P &lt; 0.05). Comparison between the groups revealed that the true simulation group significantly improved after rTMS treatment as compared to the sham stimulation group (P &lt; 0.05). Conclusion: 1Hz rTMS treatment safely and effectively improved motor and balance function in patients with post-stroke lower limb motor dysfunction.

Is percutaneous tibial nerve stimulation (PTNS) effective for fecal incontinence (FI) in adults compared with sham electrical stimulation? A meta-analysis.

Sacral nerve neuromodulation (SNM) has been considered the optimal second-line treatment for fecal incontinence (FI). However, SNM involves high cost and requires highly skilled operators. Percutaneous tibial nerve stimulation (PTNS) has emerged as an alternative treatment modality for FI, yielding varying clinical outcomes. We conducted this meta-analysis to evaluate the effectiveness and safety of PTNS compared to sham electrical stimulation for FI. PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies from May12, 2012 to May12, 2022. Four randomized controlled studies were included in this review, involving a total of 439 adult patients with FI (300 in the PTNS group and 194 in the sham electrical stimulation group). Our meta-analysis revealed that PTNS demonstrated superior efficacy in reducing weekly episodes of FI compared to the control groups (MD - 1.6, 95%CI - 2.94 to - 0.26, p = 0.02, I2 = 30%). Furthermore, a greater proportion of patients in the PTNS group reported more than a 50% reduction in FI episodes per week (RR 0.73, 95%CI 0.57-0.94, p = 0.02, I2 = 6%). However, no significant differences were observed in any domains of the FI Quality of Life (QoL) and St Mark's incontinence scores (MD -2.41, 95%CI -5.1 to 0.27, p = 0.08, I2 = 67%). Importantly, no severe adverse events related to PTNS were reported in any of the participants. Our meta-analysis revealed that PTNS was more effective than sham stimulation in reducing FI episodes and led to a higher proportion of patients reporting more than a 50% reduction in weekly FI episodes.