Comparative analysis of millet bran nanocelluloses with various morphologies: Revealing differences in the formation mechanism and structure characteristics.

To investigate the differences of nanocelluloses with various morphologies, ammonium persulphate (APS) oxidation, H3PO4 dissolution and regeneration, and ball milling combined with 1-butyl-3-methylimidazolium chloride ([BMIM]Cl) as a medium were applied to isolate cellulose nanocrystals (MCNCs), cellulose nanospheres (MCNSs) and cellulose fibrils (MCNFs) from millet bran. The structure, properties, and formation mechanism of three nanocelluloses were comparatively investigated by Fourier transform infrared spectroscopy, X-ray diffraction, thermogravimetric analysis, atomic force microscope, scanning electronic microscope, and emulsifying ability evaluation. MCNCs had needle-like structures due to the removal of amorphous regions, MCNFs appeared fibrous structures due to swelling and mechanical force, and MCNSs displayed spherical structures through self-assembly. MCNCs and MCNFs were confirmed to exhibit cellulose I structures with crystallinities of 61.24 % and 50.09 %, respectively. MCNSs showed the highest crystallinity of 68.41 % with a cellulose II structure. MCNFs and MCNSs exhibited higher initial decomposition temperatures, while MCNCs showed the highest residual mass. MCNFs suspension showed the highest apparent viscosity, while MCNSs suspension demonstrated superior dispersion. MCNSs-emulsion displayed the smallest droplet size, and MCNFs-emulsion exhibited the highest viscosity. This study reveals the formation mechanisms and relationship between morphologies and properties of three millet bran nanocelluloses, providing a theoretical basis for their application.

Gut microbiota in preterm infants with late-onset sepsis and pneumonia: a pilot case-control study.

BACKGROUND: Late-onset sepsis (LOS) and pneumonia are common infectious diseases, with high morbidity and mortality in neonates. This study aimed to investigate the differences in the gut microbiota among preterm infants with LOS, or pneumonia, and full-term infants. Furthermore, this study aimed to determine whether there is a correlation between intestinal pathogenic colonization and LOS. METHODS: In a single-center case‒control study, 16 S rRNA gene sequencing technology was used to compare gut microbiota characteristics and differences among the LOS group, pneumonia group, and control group. RESULTS: Our study revealed that the gut microbiota in the control group was more diverse than that in the LOS group and pneumonia group (P < 0.05). No significant differences in diversity were detected between the LOS and pneumonia groups (P > 0.05). Compared with the control group, the abundances of Akkermansia, Escherichia/Shigella, and Enterococcus increased, while the abundances of Bacteroides and Stenotrophomonas decreased in the LOS and pneumonia groups. The pathogenic bacteria in infants with LOS were consistent with the distribution of the main bacteria in the intestinal microbiota. An increase in Escherichia/Shigella abundance may predict a high risk of LOS occurrence, with an area under the curve (AUC) of 0.773. CONCLUSION: Changes in the gut microbiota composition were associated with an increased risk of LOS and pneumonia. The dominant bacteria in the gut microbiota of the LOS group were found to be associated with the causative pathogen of LOS. Moreover, preterm infants exhibiting an elevated abundance of Escherichia/Shigella may be considered potential candidates for predicting the onset of LOS.

Associations of bisphenol A exposure with metabolic syndrome and its components: A systematic review and meta-analysis.

Mounting evidence shows that bisphenol A (BPA) is associated with metabolic risk factors. The aim of this study was to review related epidemiologic studies and conduct a meta-analysis to quantitatively estimate the association between BPA and metabolic syndrome. Four electronic databases were systematically searched to identify suitable articles. A total of 47 published studies were finally included. Two studies involved metabolic syndrome. Of the 17, 17, 14, and 13 studies on the relationship between BPA with abdominal obesity, blood pressure, fasting plasma glucose, and dyslipidemia, 10, 6, 3, and 4 studies were included in the meta-analysis, respectively. The results showed that the risk of abdominal obesity increased with the increase of BPA exposure, especially in the group with higher BPA exposure levels (Quartile 2 vs. Quartile 1, pooled OR = 1.16, 95%CI: 1.01, 1.33; Q3 vs. Q1, pooled OR = 1.31, 95%CI: 1.13, 1.51; Q4 vs. Q1, pooled OR = 1.40, 95%CI: 1.21, 1.61). However, there was no significant correlation between BPA exposure and metabolic syndrome components including hypertension, abnormal fasting plasma glucose, and dyslipidemia. The present study found that BPA exposure is significantly associated with a higher risk of abdominal obesity. However, the relationship between BPA with metabolic syndrome and its other components needs further longitudinal studies to verify.

Pickering emulsions stabilized by starch nanocrystals prepared from various crystalline starches by ultrasonic assisted acetic acid: Stability and delivery of curcumin.

Ultrasonic assisted acetic acid hydrolysis was applied to prepare starch nanocrystals (SNCs) from native starches with different crystalline structures (A, B, and C types). The structure properties, morphology, Pickering emulsion stability and curcumin deliver capacity of both SNCs and native starches were investigated and compared. Compared with native starches, SNCs showed smaller size and higher crystallinity. The size of SNCs varied with different crystalline types, with C-type starch exhibiting the smallest SNCs (107.4 nm), followed by A-type (113.8 nm), and B-type displaying the largest particle size (149.0 nm). SNCs-Pickering emulsion showed enhanced stability with smaller emulsion droplets, higher static stability, and denser oil/water interface. SNCs-Pickering emulsions displayed higher curcumin loading efficiency (53.53 %-61.41 %) compared with native starch-Pickering emulsions (13.93 %-19.73 %). During in vitro digestion, SNCs-Pickering emulsions proved to be more proficient in protecting and prolonging the biological activity of curcumin due to their smaller size and better interfacial properties. These findings demonstrated the potential of SNCs for application in Pickering emulsion and delivery of bioactive components.

Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus.

OBJECTIVE: To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions. DATA SOURCES: A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years. REVIEW METHODS: Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts. RESULTS: Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain. CONCLUSIONS: The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

Repetitive peripheral magnetic stimulation combined with transcranial magnetic stimulation in rehabilitation of upper extremity hemiparesis following stroke: a pilot study.

OBJECTIVE: To investigate the effect of combined repetitive peripheral magnetic stimulation and transcranial magnetic stimulation on upper extremity function in subacute stroke patients. DESIGN: Pilot study. SUBJECTS: Subacute stroke patients. METHODS: Included patients were randomized into 3 groups: a central-associated peripheral stimulation (CPS) group, a central-stimulation-only (CS) group, and a control (C) group. The CPS group underwent a new paired associative stimulation (combined repetitive peripheral magnetic stimulation and transcranial magnetic stimulation), the CS group underwent repetitive transcranial magnetic stimulation, and the C group underwent sham stimulation. All 3 groups received physiotherapy after the stimulation or sham stimulation. The treatment comprised 20 once-daily sessions. Primary outcome was the Fugl-Meyer Assessment Upper Extremity (FMA-UE) score, and secondary outcomes were the Barthel Index and Comprehensive Functional Assessment scores, and neurophysiological assessments were mainly short-interval intracortical inhibition. A 3-group (CPS, CS, C) × 2-time (before, after intervention) repeated measures analysis of variance was conducted to determine whether changes in scores were significantly different between the 3 groups. RESULTS: A total of 45 patients were included in the analysis. Between-group comparisons on the FMA-UE demonstrated a significant improvement (group × time interaction, F2,42 = 4.86; p = 0.013; C vs CS, p = 0.020; C vs CPS, p = 0.016; CS vs CPS, p = 0.955). Correlation analysis did not find any substantial positive correlation between changes in FMA-UE and short-interval intracortical inhibition variables (C, r = -0.196, p = 0.483; CS, r = -0.169, p = 0.546; CPS, r = -0.424, p = 0.115). CONCLUSION: This study suggests that the real-stimulus (CS and CPS) groups had better outcomes than the control (C) group. In addition, the CPS group showed a better trend in clinical and neurophysiological assessments compared with the CS group.

Advances in Traditional Chinese Medicine research in diabetic kidney disease treatment.

CONTEXT: Diabetic kidney disease (DKD) is a prominent complication arising from diabetic microangiopathy, and its prevalence and renal impact have placed it as the primary cause of end-stage renal disease. Traditional Chinese Medicine (TCM) has the distinct advantage of multifaceted and multilevel therapeutic attributes that show efficacy in improving clinical symptoms, reducing proteinuria, protecting renal function, and slowing DKD progression. Over recent decades, extensive research has explored the mechanisms of TCM for preventing and managing DKD, with substantial studies that endorse the therapeutic benefits of TCM compounds and single agents in the medical intervention of DKD. OBJECTIVE: This review lays the foundation for future evidence-based research efforts and provide a reference point for DKD investigation. METHODS: The relevant literature published in Chinese and English up to 30 June 2023, was sourced from PubMed, Cochrane Library, VIP Database for Chinese Technical Periodicals (VIP), Wanfang Data, CNKI, and China Biology Medicine disc (CBM). The process involved examining and summarizing research on TCM laboratory tests and clinical randomized controlled trials for DKD treatment. RESULTS AND CONCLUSIONS: The TCM intervention has shown the potential to inhibit the expression of inflammatory cytokines and various growth factors, lower blood glucose levels, and significantly affect insulin resistance, lipid metabolism, and improved renal function. Furthermore, the efficacy of TCM can be optimized by tailoring personalized treatment regimens based on the unique profiles of individual patients. We anticipate further rigorous and comprehensive clinical and foundational investigations into the mechanisms underlying the role of TCM in treating DKD.

High-efficiency preparation of starch nanocrystals with small size and high crystallinity by ethanol-acid penetration and dry-heating pretreatment.

Ethanol-acid penetration and drying-heating treatment was developed to shorten the preparation time and improve the quality of starch nanocrystals (SNCs). After treatment by optimized parameters, including 40 % ethanol solution, 10.6 mM chloric acid, and heating time of 1.5 h or 2.0 h, the starches exhibited weakened internal structure and relatively complete crystalline structure. Compared with the regular preparation of only acid hydrolysis, the regular final yield (8.5 % after 5 days) was reached in 48 h and 12 h of the starch heated at 1.5 h and 2.0 h, respectively. The micromorphology, molecular weight, and crystalline structure evaluation demonstrated that the collected nanoparticles were indeed SNCs with smaller size and higher relative crystallinity than regular SNCs. Further analysis found that the SNCs had better crystalline lamellae, higher thermal stability, and lower proportion of phosphorus and sulfur atoms than regular SNCs. This provided a potential method for the high-efficiency preparation of SNCs.

Structural analysis, nutritional evaluation, and flavor characterization of parched rice made from proso millet.

This study investigated the structure and quality characteristics of hard and crispy parched rice obtained from raw proso millet through steaming, roasting, and milling. Results showed that thermal treatment disrupted the structure of samples and transformed the crystal from A-type in raw proso to V-type in parched rice. Rheological and thermodynamic analyses revealed that thermal treatment reduced the stability of parched rice. Gelatinization tests demonstrated that the parched rice was easier to gelatinize and had a lower viscosity. The digestibility of hard parched rice and crispy parched rice improved, with rapidly digestible starch content increasing by 73.62% and 76.95%, respectively, compared with that of raw proso millet. Headspace solid-phase microextraction/gas chromatography-mass spectrometry results further indicated that thermal treatment enhanced the flavor substances of parched rice. These findings demonstrated the unique properties of parched rice and supported its production and processing as a whole grain.

A highly stable chain-based EuIII metal-organic framework as a turn-on and blue-shift luminescent sensor for dipicolinic acid.

The development of a rapid and selective method for the identification of dipicolinic acid (DPA), a specific biomarker in Bacillus anthracis spores, is of great importance for the avoidance of anthrax infection. Herein, a chain-based EuIII metal-organic framework with the formula {[Eu3(BTDB)3(µ3-OH)3(H2O)]·solvents}n (JXUST-38, H2BTDB = (benzo[c][1,2,5]thiadiazole-4,7-diyl)dibenzoic acid) was obtained using 2-fluorobenzoic acid as the pH regulator. JXUST-38 exhibits good chemical and thermal stability and can specifically recognize DPA in N,N-dimethylformamide solution through luminescence enhancement and blue-shift effects with a detection limit of 0.05 µM. Furthermore, the significant luminescence enhancement and blue shift under UV lamps are obviously observable by the naked eye. The luminescence sensing mechanism is attributed to absorbance-induced enhancement between JXUST-38 and DPA. Test paper and mixed-matrix membrane based on JXUST-38 are designed for DPA detection. In addition, the feasibility of using JXUST-38 in biosensing is discussed in detail.

Characterization of quinoa starch nanoparticles as a stabilizer for oil in water Pickering emulsion.

Quinoa starch nanoparticles (QSNPs) prepared by nanoprecipitation had a uniform particle size of 191.20 nm. QSNPs with amorphous crystalline structure had greater contact angle than QS with orthorhombic crystalline structure, which can therefore be utilized to stabilize Pickering emulsions. QSNPs-based Pickering emulsions prepared by suitable formulations (QSNPs concentration of 2.0-2.5 %, oil volume fraction of 0.33-0.67) exhibited good stability against pH of 3-9 and ionic strength of 0-200 mM. The oxidative stability of the emulsions increased with increasing starch concentration and ionic strength. Microstructural and rheological results indicated that the structure of the starch interfacial film and the thickening effect of the water phase affected the emulsion stability. The emulsion had excellent freeze-thaw stability and can be produced as a re-dispersible dry emulsion using the freeze-drying technique. These results implied that the QSNPs had great potential for application in the preparation of Pickering emulsions.

Monolayer AsC5 as the Promising Hydrogen Storage Material for Clean Energy Applications.

One of the critical techniques for developing hydrogen storage applications is the advanced research to build novel two-dimensional materials with significant capacity and effective reversibility. In this work, we perform first-principles unbiased structure search simulations to find a novel AsC5 monolayer with a variety of functionally advantageous characteristics. Based on theoretical simulations, the proposed AsC5 has been found to be energetically, dynamically, and thermally stable, supporting the viability of experiment. Since the coupling between H2 molecules and the AsC5 monolayer is quite weak due to physisorption, it is crucial to be enhanced by thoughtful material design. Hydrogen storage capacity can be greatly enhanced by decorating the AsC5 monolayer with Li atoms. Each Li atom on the AsC5 substrate is shown to be capable of adsorbing up to four H2 molecules with an advantageous average adsorption energy (Ead) of 0.19 eV/H2. The gravimetric density for hydrogen storage adsorption with 16Li and 64 H2 of a Li-decorated AsC5 monolayer is about 9.7 wt%, which is helpful for the possible application in hydrogen storage. It is discovered that the desorption temperature (TD) is much greater than the hydrogen critical point. Therefore, such crucial characteristics make AsC5-Li be a promising candidate for the experimental setup of hydrogen storage.

Education Changes Child Health Behavior in China: A Mediating Role of Information Technology.

Objectives: In this study, we aimed to explore the impact of education in changing child health behavior in China and mediating role of information technology. Methods: The theoretical framework of this study incorporated variables including mental health literacy, health education, information technology, and health behavior. This is a quantitative study that has utilized secondary data for determining the results. Based on the cross-sectional data collection method, 778 responses were considered for structural equation modeling. Smart PLS 3 was used to validate the research hypotheses. Results: We found that health education and mental health literacy have a substantial impact on Chinese child health behavior. Furthermore, our data also revealed that the mediating role of information technology is useful for children's health behavior enhancement. Conclusions: The health behavior of children is influenced by education and information technology mediates the health education-health behavior relationship.

Association between motoric cognitive risk syndrome and future falls among Chinese community-dwelling elderly: A nationwide cohort study.

BACKGROUND: Motoric Cognitive Risk syndrome (MCR), known as the predementia stage, is characterized by both subjective cognitive complaint (SCC) and slow gait. This study aimed to investigate the causal relationship between MCR, its components, and falls. METHODS: Participants aged ≥ 60 years were selected from China Health and Retirement Longitudinal Study. SCC was determined by participants' responses to the question "How would you rate your memory at present?" with "poor" being the indicative answer. Slow gait was defined as one standard deviation or more below age- and gender-appropriate mean values of gait speed. MCR was identified when both SCC and slow gait were presented. Future falls were investigated by the question "have you fallen down during follow-up until wave 4 in 2018?" Logistic regression analysis was performed to test the longitudinal association of MCR, its components and future falls during the following 3 years. RESULTS: Of 3748 samples in this study, the prevalence of MCR, SCC, and slow gait was 5.92%, 33.06%, and 15.21%, respectively. MCR increased the risk of falls during the following 3 years by 66.7% compared to non-MCR after controlling for covariates. In the fully adjusted models, with the healthy group as reference, MCR (OR = 1.519, 95%CI = 1.086-2.126) and SCC (OR = 1.241, 95%CI = 1.018-1.513), but not slow gait, increased the risk of future falls. CONCLUSIONS: MCR independently predicts future falls risk in the following 3 years. Measuring MCR can be a pragmatic tool for early identification of falls risk.

Association between Respiratory Function and Motor Function in Different Stages of Parkinson's Disease.

INTRODUCTION: Respiratory dysfunction in patients with Parkinson's disease (PD) could present in the early stage and worsen in the late stages. These changes could be a factor affecting the ability of daily living and quality of life of patients with PD. The primary objective of this study was to assess the respiratory function and its association with motor function in patients with different stages of PD. METHODS: This was a cross-sectional study conducted at the Huashan Hospital of Fudan University in Shanghai, China. The study included 65 patients diagnosed with PD (the Hoehn and Yahr scale between 1 and 4) and 20 healthy individuals of similar age, gender, weight, and height. The ventilatory function was assessed using the spirometry. Motor function was evaluated using subscale III of the United Parkinson's disease rating scale (UPDRS-III). After confirming the normality of data distribution, we performed one-way ANOVA with a Tukey's post hoc test. RESULTS: Compared with the healthy individuals, there was no statistical significance in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) in the H&Y 1 group and H&Y 2 group (p > 0.05) but reduced peak expiratory flow (PEF) in the H&Y 2 group (p = 0.002). Reduced FVC, FEV1, and PEF was seen in the H&Y 3 group (p = 0.002, p = 0.001, and p = 0.0001, respectively). Reduced FVC, FEV1, PEF, and FEF25-75% was seen in the H&Y 4 group (p = 0.001, p = 0.0001, p = 0.0001, and p = 0.025, respectively). The correlation analysis revealed that there was a significant negative correlation between FVC and UPDRS-III scores (r = -0.248, p = 0.046), disease duration (r = -0.276, p = 0.026), H&Y scale (r = -0.415, p = 0.001). FEV1 was negatively correlated with UPDRS-III scores (r = -0.277, p = 0.025), disease duration (r = -0.291, p = 0.019), H&Y scale (r = -0.434, p = 0.0001). FEF25-75% was negatively correlated with disease duration (r = -0.247, p = 0.047), H&Y scale (r = -0.278, p = 0.025). CONCLUSION: Our findings revealed that respiratory impairment is present in moderate and advanced PD patients, and directly related to the severity of the disease. It is important to conduct respiratory function test in the clinical practice.

Low-intensity pulsed ultrasound promotes skeletal muscle regeneration via modulating the inflammatory immune microenvironment.

Background: Low-intensity pulsed ultrasound (LIPUS, a form of mechanical stimulation) can promote skeletal muscle functional repair, but a lack of mechanistic understanding of its relationship and tissue regeneration limits progress in this field. We investigated the hypothesis that specific energy levels of LIPUS mediates skeletal muscle regeneration by modulating the inflammatory microenvironment. Methods: To address these gaps, LIPUS irritation was applied in vivo for 5 min at two different intensities (30mW/cm2 and 60mW/cm2) in next 7 consecutive days, and the treatment begun at 24h after air drop-induced contusion injury. In vitro experiments, LIPUS irritation was applied at three different intensities (30mW/cm2, 45mW/cm2, and 60mW/cm2) for 2 times 24h after introduction of LPS in RAW264.7. Then, we comprehensively assessed the functional and histological parameters of skeletal muscle injury in mice and the phenotype shifting in macrophages through molecular biological methods and immunofluorescence analysis both in vivo and in vitro. Results: We reported that LIPUS therapy at intensity of 60mW/cm2 exhibited the most significant differences in functional recovery of contusion-injured muscle in mice. The comprehensive functional tests and histological analysis in vivo indirectly and directly proved the effectiveness of LIPUS for muscle recovery. Through biological methods and immunofluorescence analysis both in vivo and in vitro, we found that this improvement was attributable in part to the clearance of M1 macrophages populations and the increase in M2 subtypes with the change of macrophage-mediated factors. Depletion of macrophages in vivo eliminated the therapeutic effects of LIPUS, indicating that improvement in muscle function was the result of M2-shifted macrophage polarization. Moreover, the M2-inducing effects of LIPUS were proved partially through the WNT pathway by upregulating FZD5 expression and enhancing ß-catenin nuclear translocation in macrophages both in vitro and in vivo. The inhibition and augment of WNT pathway in vitro further verified our results. Conclusion: LIPUS at intensity of 60mW/cm2 could significantly promoted skeletal muscle regeneration through shifting macrophage phenotype from M1 to M2. The ability of LIPUS to direct macrophage polarization may be a beneficial target in the clinical treatment of many injuries and inflammatory diseases.

Highly pH-Responsive Sensor Based on a EuIII Metal-Organic Framework with Efficient Recognition of Arginine and Lysine in Living Cells.

A lanthanide-based three-dimensional metal-organic framework with excellent water, acid/base, and solvent stability, namely {[(CH3)2NH2]0.7[Eu2(BTDBA)1.5(lac)0.7(H2O)2]·2H2O·2DMF·2CH3CN}n (JXUST-29, H4BTDBA = 4',4‴-(benzo[c][1,2,5]thiadiazole-4,7-diyl)bis([1,1'-biphenyl]-3,5-dicarboxylic acid), Hlac = lactic acid), has been synthesized and characterized. Since the N atoms of the thiadiazole group will not coordinate with lanthanide ions, JXUST-29 has a free basic N-site accessible to small H+ ions, which allows it to be used as a promising pH fluorescence sensor. Interestingly, the luminescence signal was significantly enhanced, with an approximately 54-fold enhancement in the emission intensity when the pH value was increased from 2 to 5, which is the typical behavior of pH probes. In addition, JXUST-29 can also be used as a luminescence sensor to detect l-arginine (Arg) and l-lysine (Lys) in an aqueous solution through fluorescence enhancement and the blue-shift effect. The detection limits were 0.023 and 0.077 µM, respectively. In addition, JXUST-29-based devices were designed and developed to facilitate detection. Importantly, JXUST-29 is also capable of detecting and sensing Arg and Lys in living cells.

Rare earth upconversion luminescent composite based on energy transfer for specific and sensitive detection of cysteine.

Abnormal levels of thiols in cysteine (Cys) have been shown to be associated with growth retardation, skin lesions, and neurotoxicity in humans. Herein, we designed and synthesized a rare earth upconversion luminescent (UCL) nanocomposite probe UCNP-PEG-NOF1 for the UCL detection of Cys using NOF1 developed by our group as a Cys probe. The core structure of rare earth nanoparticles can absorb light at 980 nm and convert it into visible light. The detection principle of Cys was based on the change in absorption peak before and after the reaction between NOF1 and Cys, as well as the change in UCL intensity. The rare earth nanocomposite in the probe could be excited by near-infrared light and had low background fluorescence and strong penetration ability; thus, the probe was successfully employed to specifically and sensitively detect Cys with a low background signal. Overall, the developed UCNP-PEG-NOF1 probe had good selectivity and high sensitivity for Cys; its detection limit was as low as 83 nM.

The Effect of Cerebellar rTMS on Modulating Motor Dysfunction in Neurological Disorders: a Systematic Review.

The effectiveness of cerebellar repetitive transcranial magnetic stimulation (rTMS) on motor dysfunction in patients with neurological disorders has received increasing attention because of its potential for neuromodulation. However, studies on the neuromodulatory effects, parameters, and safety of rTMS implementation in the cerebellum to alleviate motor dysfunction are limited. This systematic review aimed to evaluate the effectiveness and safety of cerebellar rTMS treatment for motor dysfunction caused by neurological disorders and to review popular stimulation parameters. Five electronic databases-Medline, Web of Science, Scopus, Cochrane Library, and Embase-were searched for relevant research published from inception to July 2022. All randomized controlled trials (RCTs) that reported the effects of cerebellar rTMS combined with behavioral rating scales on motor dysfunction were eligible for enrollment. Additionally, reference lists of the enrolled studies were manually checked. Among 1156 articles screened, 21 RCTs with 666 subjects were included. rTMS conducted on the cerebellum showed an improvement in stroke (spasticity, balance, and gait), cervical dystonia, Parkinson's disease (tremor), cerebellar ataxia, and essential tremor but not in multiple sclerosis. The 8-shaped coil with a diameter of 70 mm was determined as the most common therapeutic choice. None of the studies reported severe adverse events except mild side effects in three. Therefore, rTMS appears to be a promising and safe technique for the treatment of motor dysfunction, targeting the cerebellum to induce motor behavioral improvement. Further rigorous RCTs, including more samples and longer follow-up periods, are required to precisely explore the effective stimulation parameters and possible mechanisms.