Motor imagery training induces changes in brain neural networks in stroke patients.

Motor imagery is the mental representation of an action without overt movement or muscle activation. However, the effects of motor imagery on stroke-induced hand dysfunction and brain neural networks are still unknown. We conducted a randomized controlled trial in the China Rehabilitation Research Center. Twenty stroke patients, including 13 males and 7 females, 32-51 years old, were recruited and randomly assigned to the traditional rehabilitation treatment group (PP group, n = 10) or the motor imagery training combined with traditional rehabilitation treatment group (MP group, n = 10). All patients received rehabilitation training once a day, 45 minutes per session, five times per week, for 4 consecutive weeks. In the MP group, motor imagery training was performed for 45 minutes after traditional rehabilitation training, daily. Action Research Arm Test and the Fugl-Meyer Assessment of the upper extremity were used to evaluate hand functions before and after treatment. Transcranial magnetic stimulation was used to analyze motor evoked potentials in the affected extremity. Diffusion tensor imaging was used to assess changes in brain neural networks. Compared with the PP group, the MP group showed better recovery of hand function, higher amplitude of the motor evoked potential in the abductor pollicis brevis, greater fractional anisotropy of the right dorsal pathway, and an increase in the fractional anisotropy of the bilateral dorsal pathway. Our findings indicate that 4 weeks of motor imagery training combined with traditional rehabilitation treatment improves hand function in stroke patients by enhancing the dorsal pathway. This trial has been registered with the Chinese Clinical Trial Registry (registration number: ChiCTR-OCH-12002238).

Decreased Resting-State Activity in the Precuneus Is Associated With Depressive Episodes in Recurrent Depression.

OBJECTIVE: To investigate alterations in resting-state spontaneous brain activity in patients with major depressive disorder (MDD) experiencing multiple episodes. METHODS: Between May 2007 and September 2014, 24 recurrent and 22 remitted patients diagnosed with MDD with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and 69 healthy controls matched for age, sex, and educational level participated in this study. Among them, 1 healthy control was excluded due to excessive head motion. The fractional amplitude of low-frequency fluctuation (fALFF) was assessed for all recruited subjects during the completion of resting-state functional magnetic resonance imaging. Relationships between fALFF and clinical measurements, including number of depressive episodes and illness duration, were examined. RESULTS: Compared to patients with remitted MDD and to healthy controls, patients with recurrent MDD exhibited decreased fALFF in the right posterior insula and right precuneus and increased fALFF in the left ventral anterior cingulate cortex. Decreased fALFF in the right precuneus and increased fALFF in the right middle insula were correlated with the number of depressive episodes in the recurrent MDD groups (r = -0.75, P < .01 and r = 0.78, P < .01, respectively) and remitted MDD groups (r = -0.63, P < .01 and r = 0.41, P = .03, respectively). In addition to regions in the default mode network (DMN) and salience network, the altered resting-state activity in the middle temporal and visual cortices was also identified. CONCLUSIONS: Altered resting-state activity was observed across several neural networks in patients with recurrent MDD. Consistent with the emerging theory that altered DMN activity is a risk factor for depression relapses, the association between reduced fALFF in the right precuneus and number of depressive episodes supports the role of the DMN in the pathology of recurrent depression.

Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients.

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

Alteration of spontaneous neuronal activity within the salience network in partially remitted depression.

Of major depression patients, 29-66% show only partial remission on a single antidepressant trial. Such patients are characterized by residual depressive symptoms such as anhedonia, psychic anxiety, sleep disturbance, and cognitive dysfunction. Despite having a tremendous impact on outcomes such as future relapse, morbidity, and mortality, the neural mechanisms of partially remitted depression remain unclear. Using the amplitude of low-frequency fluctuations (ALFF) approach, we investigated the intrinsic neural oscillation alterations during resting state in partially remitted depression. A total of 23 partially remitted depression patients and 68 healthy controls underwent magnetic resonance imaging for functional imaging. We compared ALFF differences between groups as well as correlations between clinical measurements and ALFF in the brain regions showing significant group differences. Compared with healthy controls, partially remitted depression patients showed increased ALFF in the left ventral anterior insula, bilateral posterior insula, and bilateral supramarginal gyrus, and decreased ALFF in the left calcarine gyrus. A trend positive correlation between the number of depressive episodes and ALFF values was found in the right posterior insula in the partially remitted depression group. In addition, the ALFF in the right supramarginal gyrus were negatively correlated with Hamilton Depression Rating Scale scores. Consistent with the emerging theory of the role of the salience network in sensing the changes of homeostasis that contributes to partially remitted depression, the current findings suggest that the increased intrinsic neural oscillation of the insula is related to the refractoriness to treatment and may be an imaging marker for predicting future depression recurrence.

Abnormal spontaneous neural activity in the anterior insular and anterior cingulate cortices in anxious depression.

OBJECTIVE: Anxious depression is a distinct clinical subtype of major depressive disorder (MDD) characterized by palpitations, somatic complaints, altered interoceptive awareness, high risk of suicide, and poor response to pharmacotherapy. However, the neural mechanisms of anxious depression are still not well understood. In this study we investigated changes in neural oscillation during the resting-state of patients with anxious depression by measuring differences in the amplitude of low-frequency fluctuation (ALFF). METHODS: Resting-state functional magnetic resonance imaging was acquired in 31 patients with anxious depression, 18 patients with remitted depression, as well as 68 gender- and age-matched healthy participants. We compared the differences both in the ALFF and fractional ALFF (fALFF) among the three groups. We also examined the correlation between the ALFF/fALFF and the severity of anxiety as well as depression. RESULTS: Anxious depression patients showed increased ALFF/fALFF in the right dorsal anterior insular cortex and decreased ALFF/fALFF in the bilateral lingual gyrus relative to remitted depression patients and healthy controls. The increased ALFF in the dorsal anterior insula was also positively correlated with stronger anxiety in the anxious depression group. Anxious depression patients also displayed increased fALFF in the right ventral anterior cingulate cortex (ACC) compared to remitted depression patients and healthy controls. CONCLUSIONS: Our results suggest that alterations of the cortico-limbic networks, including the right dorsal anterior insula and right ventral ACC, may play a critical role in the physiopathology of anxious depression.

Mental practice combined with physical practice to enhance hand recovery in stroke patients.

OBJECTIVES: To evaluate whether combining mental practice with physical practice training enhances hand function in patients with stroke. METHODS: 10 for treatment and 10 for control were recruited for this pre/posttraining matched case control study. In the treatment group, subjects underwent combining mental practice with physical practice for four weeks. In the control group, subjects only participated in physical practice. Change of hand function and the number of activated voxels of the contralateral somatosensory motor cortex (SMC) acquired by functional magnetic resonance imaging were measured. RESULTS: After training, the Action Research Arm Test score increased by 12.65 for treatment and by 5.20 for control. There was a significant difference in the Action Research Arm Test score between the two groups (P = 0.04). The activated voxels number of the contralateral SMC increased in both groups, but the activated voxels number in the contralateral SMC and the improvement of hand function for treatment were greater than for control. In the treatment group, the number of activated voxels of the contralateral SMC was positively correlated with better hand function scores. CONCLUSIONS: Combining mental practice with physical practice may be a more effective treatment strategy than physical training alone for hand recovery in stroke patients.

[Study on the natural history of HIV among former commercial plasma donors caused by contaminated plasma donation in central China].

OBJECTIVE: To investigate the natural history of HIV infection caused by contaminated plasma donation among former commercial plasma donors in China. METHODS: Ambispective cohort study among HIV/AIDS cases and suspected AIDS deaths was conducted from January 1, 1995 to March 31, 2008 in 7 administrative villages in Shangcai county of Henan province. Information regarding diagnostic criteria, deaths and anti-retrovirus treatment was collected. Incubation and survival time were calculated using Kaplan-Meier and life-tables method. Sensitive analysis on the time of outcome was conducted. RESULTS: A total number of 2569 cases of HIV infection including 483 suspected AIDS deaths were involved in a cohort. 200 patients with rapid progress (7.8%) and 337 long-term but non-progressive patients (13.1%) were identified. Results from the sensitive analysis showed that the median incubation period from HIV infection to AIDS was between 8.5 and 8.9 years, with incidence as 11.7 - 12.0 cases/100 person-years and the median survival time for HIV progression to death was from 8.8 to 10.7 years, with the death rate as 6.9 - 8.3 cases/100 person-years. The median survival time for AIDS patient was from 1.2 to 2.0 years, with death rate as 34.9 - 51.5 cases/100 person-years. CONCLUSION: According to sensitive analysis, the incubation period for HIV progression to AIDS, the median survival time for HIV progression to death and the median survival time for AIDS patient to death were 8.8 years, 1.2 years and 9.8 years, respectively.

Chinese word processing in nonfluent aphasic patients.

BACKGROUND: Chinese nonfluent aphasic patients experience apparent speech production deficit, but it remains less known in which part of Chinese speech production this deficit occurs. The present study aimed to examine the ability of nonfluent aphasic patients in Chinese orthography, phonological and semantic processing via two experiments. Experiment I disclosed the general pattern of deficit of Chinese nonfluent aphasic patients in speech production. Experiment II tested whether this deficit occurs in orthography, phonological or semantic processing. METHODS: The present study adopted neuropsychological testing methods to compare speech production and Chinese word processing between nonfluent aphasic patients (the patient group) and normal individuals (the control group). Character reading and word reading tasks were used to test speech production. Chinese radical decision, rhyme decision and semantic decision tasks were used to examine word processing. Reaction time and the correct answer rate were collected. RESULTS: The patient group had a longer reaction time and was more prone to errors in both character reading and word reading tasks than was the control group. For the patient group, there was no difference between the reaction time of character reading and word reading, the error rate of the former was higher than the latter. In radical decision task the reaction time and error rate to the radical "mu " were higher in the patient group than in the control group. In the rhyme decision task, the reaction time and error rate to the rhyme "ang" were higher for the aphasic patients. In the semantic decision task the reaction time to characters in the category of animals was higher for the aphasic patients, yet the error rate was not significantly different between the two groups. CONCLUSIONS: Nonfluent aphasic patients seemingly have decreased speed of speech production and an increased error rate. There is a deficit in phonological processing of aphasic patients while their semantic processing may remain intact.

[Single nucleotide polymorphisms of DAT and DRD(2) genes in Han Chinese population and their association with stuttering].

OBJECTIVE: To explore the correlations of dopamine transporter gene (DAT) and dopamine D(2) receptor gene (DRD2) to stuttering. METHODS: To examine the correlations of the 5 single nucleotide polymorphisms (SNPs) in dopaminergic gene (C252T, C1804T, and C1820T in DAT gene, and T1054C and C1072T in DRD(2) gene) to stuttering in Han Chinese individuals, a case-control study involving 112 patients with stuttering and 112 gender-matched controls was carried out. Genotyping was performed by a combined approach using polymerase chain reaction (PCR) and pyrosequencing. RESULTS: C1804T showed no polymorphism in either the patients or the control subjects and was therefore excluded from the following analysis. The C allele frequency at C1072T site was significantly higher, but T allele frequency significantly lower in the stuttering group than in the control group. The patients had significantly higher CC and lower CT genotype frequencies than the control group. There were no significant differences in the allelic frequencies of C252T, C1820T and T1054C between the patients and the controls, suggesting a Hardy-Weinberg equilibrium at these 3 loci. CONCLUSION: The presence of the C allele at C1072T in DRD(2) gene is associated with increased susceptibility to stuttering in Han Chinese, whereas the T allele provides protection against the onset of stuttering.

[Gray matter abnormalities in developmental stuttering determined with voxel-based morphometry].

OBJECTIVE: To investigate the differences of regional grey matter volume between adults with persistent developmental stuttering and fluent speaking adults, and to determine whether stutterers have anomalous anatomy of speech-relevant brain areas that possibly affect speech fluency. METHODS: High-resolution magnetic resonance imaging (MRI) scanning was performed on 10 adults with developmental stuttering, aged 26 (21 - 35) with the onset age of 4 (3 - 7) and 12 age, sex, hand preference, and education-matched controls. The customized brain templates were created in order to improve spatial normalization and segmentation. Then automated preprocessing of MRI data was conducted using an optimized version of VBM, a fully automated unbiased and objective whole-brain MRI analysis technique. RESULTS: VBM analysis revealed that compared with the controls, the stuttering adults had significant clusters of locally gray matter volume increased in the superior temporal, middle temporal, precentral and postcentral gyrus, and inferior parietal lobule of the bilateral hemisphere (P < 0.001), the numbers of increased gray matter volume in the right and left hemispheres were 60,247 and 48,782 voxels respectively. The, Grey matter decrease was shown with an overall decreased gray matter volume of 32 394 voxels, mainly in the bilateral cerebella posterior lobe and dorsal part of medulla, especially inferior semi-lunar lobule, followed by cerebellar tonsil and bilateral medulla in comparison with the controls (P < 0.001). CONCLUSION: The reduction of the regional gray matter volume of bilateral cerebella and medulla is related to the neural mechanism of the controlling disorder of speech production and may be the essential cause of stuttering. Some areas with increased gray matter volume in temporal lobe, parietal lobe, and frontal lobe, may be the result of long term functional compensation for the cerebella and medulla function deficiency.