Comparative Effectiveness of Combined and Single Neurostimulation and Traditional Dysphagia Therapies for Post-Stroke Dysphagia: A Network Meta-Analysis.

BACKGROUND: Comparative therapeutic benefits of combined and single neurostimulation therapies including neuromuscular electrical stimulation (NMES), pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and traditional dysphagia therapy (TDT) remain unknown in post-stroke dysphagia (PSD) rehabilitation. Therefore, we performed the first network meta-analysis (NMA) to determine comparative effectiveness of combined and single neurostimulation and traditional dysphagia therapies for PSD. METHODS: A frequentist NMA model was performed with therapy effect sizes presented as standardized mean differences (SMD) and corresponding 95% confidence interval (95% CI) for therapy comparisons while netrank function ranked the therapies in R-Software. Meta-regression models for study characteristics were analyzed using Bayesian NMA Model. RESULTS: Overall, 50 randomized controlled studies with 2250 participants were included. NMES + TDT 3.82 (95% CI, 1.62-6.01), tDCS + TDT 3.34 (95% CI, 1.09-5.59), rTMS + TDT 3.32 (95% CI, 1.18-5.47), NMES 2.69 (95% CI, 0.44-4.93), and TDT 2.27 (95% CI, 0.12-4.41) demonstrated very large effect in improving swallowing function. NMES + TDT -0.50 (95% CI, -0.68 to -0.32, rTMS + TDT -0.44 (95% CI, -0.67 to -0.21), TDT -0.28 (95% CI, -0.46 to -0.10), and NMES -0.19 (95% CI, -0.34 to -0.04) demonstrated medium to small effect in reducing pharyngeal transit time (PTT). rTMS -0.51 (95% CI, -0.93 to -0.08) demonstrated medium effect in reducing oral transit time (OTT). No significant therapy comparison differences were found for reducing aspiration/penetration. The highest ranked therapy was NMES + TDT for better swallowing function and reduction of PTT, rTMS for reduction of OTT, and tDCS + TDT for reduction of aspiration/penetration. Therapeutic effects of the therapies were moderated by frequency, sessions, and duration. CONCLUSION: Combined therapies including NMES + TDT, tDCS + TDT, and rTMS + TDT demonstrate better therapeutic effect for improved swallowing function and reduction of PTT, OTT, and aspiration/penetration for PSD.

Dose-response analysis of toxic effect from palm oil mill effluent (POME) by-products on biohydrogen producing bacteria - A preliminary study on microbial density and determination of EC50.

The stimulant and toxicity effects of reported organic (acetic acid, propionic acid, butyric acid, formic acid, oil & grease) and inorganic (copper) by-products presented in palm oil mill effluent on anaerobic bacterial population were examined in this paper. The toxicity test had shown that acetic, propionic and butyric acids tend to stimulate the bacterial density level (survival rate more than 50%), while formic acid, copper, oil and grease were shown to have suppressed the density level (survival rate less than 50%). The highest biomass recorded was 1.66 mg/L for the concentration of acetic acid at 216 mg/L and lowest biomass concentration, 0.90 mg/L for copper at 1.40 mg/L. Biohydrogen-producing bacteria have a favourable growth rate around pH 5.5. The comparison of half maximal effective concentration (EC50) values between two test duration on the effects of organic and inorganic by-products postulate that bacteria had a higher tolerance towards volatile fatty acids. While acetic, butyric and propionic acids had exhibited higher tolerance EC50 values for bacteria, but the opposite trend was observed for formic acid, copper and oil & grease.

Safety Assessment of the Auto Manipulation Device for Acupuncture in Sprague-Dawley Rats: Preclinical Evaluation of the Prototype.

BACKGROUND: The Auto Manipulation Device for Acupuncture (AMDA) is designed for providing stable, quantified effects and higher frequency when doing lifting and thrusting manipulation. The purpose of this study is to investigate the safety of manipulation by AMDA in different frequency and duration in healthy rats. METHODS: The study was divided into two parts: single intervention and once a day for a week. 12 rats and 15 rats were randomly allocated to different groups: Control (needle insertion only), AMDA (2Hz/10Mins), AMDA (2Hz/20Mins), AMDA (20Hz/10Mins), and AMDA (20Hz/20Mins) for single and repeated interventions. Real-time physiological functions, laboratory data, and the bilateral muscle tissue of acupoint (ST 36) were obtained after the intervention. RESULTS: We found neither real-time physiological functions nor laboratory data differences between control group and AMDA groups in both parts. In the muscle tissue samples, the slight damage had been observed in the AMDA group with a frequency of 2 Hz for 20 minutes after once intervention, and the repeated session groups noted more obvious tissue damage with fibrotic change. Although the period was shorter, higher frequency manipulation caused more damage that fibroblast nuclei became more slender and obvious. However, no significant adverse effect was noted such as crippled and molting in the whole process. CONCLUSION: Our study suggested that the safety issue of AMDA operation in rats is feasible because there was no difference between control group and AMDA groups among real-time physiological functions and laboratory data. However, manipulation with higher frequency should be more preserved.

The neural generators of the mismatch responses to Mandarin lexical tones: an MEG study.

The present magnetoencephalography study used the cortically constrained minimum-norm estimates of human brain activity to elucidate functional roles of neural generators for detecting different magnitudes of lexical tones changes. A multiple-deviant oddball paradigm was used in which the syllable "yi" with a low-dipping tone (T3) was the common standard sound and the same syllable with a high-level tone (T1) or a high-rising tone (T2) were the large and small deviant sounds, respectively. The data revealed a larger magnetic mismatch field (MMNm) for large deviant in the left hemisphere. The source analysis also confirmed that the MMNm to lexical tone changes was generated in bilateral superior temporal gyri and only the large deviant revealed left lateralization. A set of frontal generators was activated at a later time and revealed differential sensitivities to the degree of deviance. The left anterior insula, the right anterior cingulate cortex, and the right ventral orbital frontal cortex were activated when detecting a large deviant, whereas the right frontal-opercular region was sensitive to the small deviant. These frontal generators were thought to be associated with various top-down mechanisms for attentional modulation. The time frequency (TF) analysis showed that large deviants yielded large theta band (5-7Hz) activity over the left anterior scalp and the left central scalp, while small deviants yielded large alpha band activity (9-11Hz) over the posterior scalp. The results of TF analyses implied that mechanisms of working memory and functional inhibition involved in the processes of acoustic change detection.

Development of Automatic Manipulation Device for Acupuncture (AMDA).

Needle lifting and thrusting manipulation is one of common skills in acupuncture. However, there exists artificial error in frequency and amplitude due to individual difference when performing lifting and thrusting during acupuncture. For providing stable and quantified effects and higher frequency when doing lifting and thrusting manipulation, a well controlled device is needed. The aim of this article is to report the preliminary results of the development of Auto Manipulation Device for Acupuncture (AMDA) and characterization of its functional parameters. A tissue-simulating Agar gel phantom with 4.8%, 5.2%, and 5.4% concentrations was prepared and used for characterization of the AMDA. Tests of the linearity, reliability and safety of the AMDA were implemented with conditions of different drive voltages, frequencies, and simulated tissues. Our preliminary results have demonstrated the developed AMDA its plausibility in the clinical application of acupuncture.