Investigation of Therapeutic Response Markers for Acupuncture in Parkinson's Disease: An Exploratory Pilot Study.

In this preliminary pilot study, we investigated the specific genes implicated in the therapeutic response to acupuncture in patients with Parkinson's disease (PD). Transcriptome alterations following acupuncture in blood samples collected during our previous clinical trial were analyzed along with the clinical data of six patients with PD, of which a representative patient was selected for transcriptomic analysis following acupuncture. We also examined the changes in the expression of PD biomarker genes known to be dysregulated in both the brain and blood of patients with PD. We validated these gene expression changes using quantitative real-time polymerase chain reaction (qPCR) in the blood of the remaining five patients with PD who received acupuncture treatment. Following acupuncture treatment, the transcriptomic alterations in the representative patient were similar to those induced by dopaminergic therapy. Among the PD biomarkers, ankyrin repeat domain 22 (ANKRD22), upregulated following dopaminergic therapy, and synapsin 1 (SYN1), a common gene marker for synaptic dysfunction in PD, were upregulated following acupuncture. These alterations correlated with changes in gait parameters in patients with PD. Our data suggest ANKRD22 and SYN1 as potential biomarkers to predict/monitor therapeutic responses to acupuncture in patients with PD, especially in those with gait disturbance. Further research is needed to confirm these findings in a large sample of patients with PD.

Wearable myoelectric interface enables high-dose, home-based training in severely impaired chronic stroke survivors.

BACKGROUND: High-intensity occupational therapy can improve arm function after stroke, but many people lack access to such therapy. Home-based therapies could address this need, but they don't typically address abnormal muscle co-activation, an important aspect of arm impairment. An earlier study using lab-based, myoelectric computer interface game training enabled chronic stroke survivors to reduce abnormal co-activation and improve arm function. Here, we assess feasibility of doing this training at home using a novel, wearable, myoelectric interface for neurorehabilitation training (MINT) paradigm. OBJECTIVE: Assess tolerability and feasibility of home-based, high-dose MINT therapy in severely impaired chronic stroke survivors. METHODS: Twenty-three participants were instructed to train with the MINT and game for 90 min/day, 36 days over 6 weeks. We assessed feasibility using amount of time trained and game performance. We assessed tolerability (enjoyment and effort) using a customized version of the Intrinsic Motivation Inventory at the conclusion of training. RESULTS: Participants displayed high adherence to near-daily therapy at home (mean of 82 min/day of training; 96% trained at least 60 min/day) and enjoyed the therapy. Training performance improved and co-activation decreased with training. Although a substantial number of participants stopped training, most dropouts were due to reasons unrelated to the training paradigm itself. INTERPRETATION: Home-based therapy with MINT is feasible and tolerable in severely impaired stroke survivors. This affordable, enjoyable, and mobile health paradigm has potential to improve recovery from stroke in a variety of settings. Clinicaltrials.gov: NCT03401762.

Gait Disturbance Improvement and Cerebral Cortex Rearrangement by Acupuncture in Parkinson's Disease: A Pilot Assessor-Blinded, Randomized, Controlled, Parallel-Group Trial.

BACKGROUND: Parkinson's disease (PD) leads to impaired mobility and limited independence. OBJECTIVE: We investigated the effects of acupuncture on gait disturbance and analyzed hemodynamic changes caused by acupuncture in the cerebral cortex of patients with PD. METHODS: Participants (n = 26) with gait disturbance due to PD were randomly assigned to the intervention (acupuncture twice a week for 4 weeks + conventional therapy) or control (conventional therapy) groups. We analyzed gait parameters using the GAITRite system and hemodynamic responses in the cerebral cortices using functional near-infrared spectroscopy, Unified Parkinson's Disease Rating Scale (UPDRS) scores, neurotransmitter levels, as well as the immediate effects of acupuncture in patients with PD. RESULTS: The participants tended to walk with hypometric gait (high cadence, short steps) overground. After acupuncture treatment, those in the intervention group showed a significant reduction in cadence and the UPDRS scores involving "walking and balance" compared with those in the control group (P = .004 and P = .020, respectively); the stride, swing, and single support times were significantly increased (P = .006, P = .001, and P = .001, respectively). Oxyhemoglobin levels in the intervention group while walking on a treadmill were significantly increased in the prefrontal and supplementary motor areas. The oxyhemoglobin levels in the prefrontal cortex and swing time revealed significant positive correlations. CONCLUSIONS: Our findings indicated that acupuncture tended to improve hypometric gait and rearranged activation of the cerebral cortex. Thus, acupuncture may be a useful complementary treatment for gait disturbance, including hypometric gait, in patients with PD. Trial Registration Number. Clinical Research Information Service (KCT0002603), https://cris.nih.go.kr/cris/index.jsp.

Effects of Acupuncture Therapy on MCI Patients Using Functional Near-Infrared Spectroscopy.

Acupuncture therapy (AT) is a non-pharmacological method of treatment that has been applied to various neurological diseases. However, studies on its longitudinal effect on the neural mechanisms of patients with mild cognitive impairment (MCI) for treatment purposes are still lacking in the literature. In this clinical study, we assess the longitudinal effects of ATs on MCI patients using two methods: (i) Montreal Cognitive Assessment test (MoCA-K, Korean version), and (ii) the hemodynamic response (HR) analyses using functional near-infrared spectroscopy (fNIRS). fNIRS signals of a working memory (WM) task were acquired from the prefrontal cortex. Twelve elderly MCI patients and 12 healthy people were recruited as target and healthy control (HC) groups, respectively. Each group went through an fNIRS scanning procedure three times: The initial data were obtained without any ATs, and subsequently a total of 24 AT sessions were conducted for MCI patients (i.e., MCI-0: the data prior to ATs, MCI-1: after 12 sessions of ATs for 6 weeks, MCI-2: another 12 sessions of ATs for 6 weeks). The mean HR responses of all MCI-0-2 cases were lower than those of HCs. To compare the effects of AT on MCI patients, MoCA-K results, temporal HR data, and spatial activation patterns (i.e., t-maps) were examined. In addition, analyses of functional connectivity (FC) and graph theory upon WM tasks were conducted. With ATs, (i) the averaged MoCA-K test scores were improved (MCI-1, p = 0.002; MCI-2, p = 2.9e -4); (ii) the mean HR response of WM tasks was increased (p < 0.001); and (iii) the t-maps of MCI-1 and MCI-2 were enhanced. Furthermore, an increased FC in the prefrontal cortex in both MCI-1/MCI-2 cases in comparison to MCI-0 was obtained (p < 0.01), and an increasing trend in the graph theory parameters was observed. All these findings reveal that ATs have a positive impact on improving the cognitive function of MCI patients. In conclusion, ATs can be used as a therapeutic tool for MCI patients as a non-pharmacological method (Clinical trial registration number: KCT 0002451 https://cris.nih.go.kr/cris/en/).

Classification of gallstones using Fourier-transform infrared spectroscopy and photography.

BACKGROUND: Gallstones have conventionally been classified by gross inspection into 4 categories: cholesterol gallstones, black pigment (calcium bilirubinate) gallstones, brown gallstones, and mixed gallstones that contain both cholesterol and calcium bilirubinate. Classification using Fourier-transform infrared (FT-IR) spectroscopy supplements gross inspection; however, the issue of ambiguity in gallstone classification has not been fully addressed to date. METHODS: Twenty-six gallstones obtained after surgical gallbladder removal were examined using FT-IR spectroscopy and digital photography, and classified into 6 gallstone groups according to characteristic FT-IR absorption bands. RESULTS: FT-IR spectra of nine gallstones matched well with that of pure cholesterol, and the gallstones were thus classified as cholesterol stones. Twelve gallstones were classified as calcium bilirubinate stones as they showed characteristic absorption bands of calcium bilirubinate. However, the FT-IR spectra of these gallstones always showed a broad absorption band of bound water at 3600-2400 cm- 1. The other five gallstones were classified as mixed stones with combinations of cholesterol, calcium bilirubinate, and calcium carbonate. CONCLUSION: FT-IR spectroscopy is a powerful and convenient method for gallstone classification. Nevertheless, one should take serious note of the superposition of FT-IR absorption bands of different chemical components of gallstones including that of bound water.