The Effect of Swallowing Action Observation Therapy on Resting fMRI in Stroke Patients with Dysphagia.

Objective: Many stroke victims have severe swallowing problems. Previous neuroimaging studies have found that several brain regions scattered in the frontal, temporal, and parietal lobes, such as Brodmann's areas (BA) 6, 21, and 40, are associated with swallowing function. This study sought to investigate changes in swallowing function and resting-state functional magnetic resonance imaging (rs-fMRI) in stroke patients with dysphagia following action observation treatment. It also sought to detect changes in brain regions associated with swallowing in stroke patients. Methods: In this study, 12 healthy controls (HCs) and 12 stroke patients were recruited. Stroke patients were given 4 weeks of action observation therapy. In order to assess the differences in mfALFF values between patients before treatment and HCs, the fractional amplitude of low-frequency fluctuations (fALFF) in three frequency bands (conventional frequency band, slow-4, and slow-5) were calculated for fMRI data. The significant brain regions were selected as regions of interest (ROIs) for subsequent analysis. The mfALFF values were extracted from ROIs of the three groups (patients before and after treatment and HCs) and compared to assess the therapeutic efficacy. Results: In the conventional band, stroke patients before treatment had higher mfALFF in the inferior temporal gyrus and lower mfALFF in the calcarine fissure and surrounding cortex and thalamus compared to HCs. In the slow-4 band, there was no significant difference in related brain regions between stroke patients before treatment and HCs. In the slow-5 band, stroke patients before treatment had higher mfALFF in inferior cerebellum, inferior temporal gyrus, middle frontal gyrus, and lower mfALFF in calcarine fissure and surrounding cortex compared to HCs. We also assessed changes in aberrant brain activity that occurred both before and after action observation therapy. The mfALFF between stroke patients after therapy was closed to HCs in comparison to the patients before treatment. Conclusion: Action observation therapy can affect the excitability of certain brain regions. The changes in brain function brought about by this treatment may help to further understand the potential mechanism of network remodeling of swallowing function.

Effects of Virtual Reality-Based Exercise on Balance in Patients With Stroke: A Systematic Review and Meta-analysis.

OBJECTIVE: The aim of the study is to quantify the effects of virtual reality-based exercise on balance after stroke. DESIGN: The PubMed, Embase, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature, and Web of Science databases were searched until December 31, 2021. Independent investigators abstracted data, assessed the quality of the evidence, and rated the certainty of the evidence. The intergroup differences were determined by calculating mean difference and 95% confidence interval by RevMan 5.3 software. RESULTS: Fourteen randomized controlled trials involving 423 stroke patients were included. Patients who received virtual reality-based exercise illustrated marked improvements in the Berg Balance Scale (mean difference, 1.35; 95% confidence interval, 0.58 to 1.86; P < 0.00001; I2 = 44%), Timed Up and Go test (mean difference, -0.81; 95% confidence interval, -1.18 to -0.44; P < 0.0001; I2 = 0%), Functional Reach Test (mean difference, 3.06; 95% confidence interval, 1.31-4.80; P = 0.0006; I2 = 0%), 10-Meters Walking Test (mean difference, -1.53; 95% confidence interval, -2.92 to -0.13; P = 0.03; I2 = 33%), and Modified Barthel Index (mean difference, 5.26; 95% confidence interval, 1.70 to 8.82; P = 0.004; I2 = 0%) compared with the control group. CONCLUSIONS: Existing low-evidence analyses showed that virtual reality-based exercise could effectively and safely improve balance in chronic stroke. Longer-term virtual reality-based exercise was more effective on functional ability of stroke.

The Predicted Value of Kidney Injury Molecule-1 (KIM-1) in Healthy People.

Purpose: Recent studies have focused on whether kidney injury molecule-1 (KIM-1) might serve as a marker of acute kidney tubular injury. Our study analyzed the levels of KIM-1 in the healthy population of different ages to explore the correlation between KIM-1 and age. Moreover, we constructed a model to predict kidney age. Methods: A cross-sectional study was conducted by Huashan Hospital, Shanghai, China, between April 2020 and December 2020. KIM-1 and other kidney biomarkers were measured in 176 healthy individuals ranging from 26 to 91 years old. Statistical correlated analyses for urinary KIM-1, creatinine (uCREA), potassium (K), sodium (Na) and chlorine (Cl), plasmic renin, angiotensin-2 (AngII) and aldosterone (ALD), and serum microalbuminuria (MALB), ß2-microglobulin (B2MG), cystatin C (CYSC), urea nitrogen (BUN), creatinine (CREA), and glucose (GLU) were performed to assess the correlation between age and kidney biomarkers. All variables were selected as independent variables for the prediction of age by multiple linear regression. Results: KIM-1 positively correlated with age in kidney healthy people (r = 0.41, p < 0.05), whether among females (r = 0.51, p < 0.05) or males (r = 0.27, p < 0.05). It was much related to K (r = 0.34), B2MG (r = 0.28), and CL (r = 0.23). The predicted model was constructed with eGFR, Cl, ALD, CYSC, KIM-1, BUN, GLU and AngII, reaching an adjusted R2 of 69.5% and a standard error of the estimated 7.84 years. Conclusion: The level of urinary KIM-1 increases with age in healthy people. The model constructed by KIM-1 and the other 7 biomarkers can predict kidney age in healthy people.

Visual feedback therapy for restoration of upper limb function of stroke patients.

OBJECTIVE: To investigate the effects of mirror neuron theory-based visual feedback therapy (VFT) on restoration of upper limb function of stroke patients and motor-related cortical function using functional magnetic resonance imaging (fMRI). METHODS: Hemiplegic stroke patients were randomly divided into two groups: a VFT group and a control (CTL) group. Sixteen patients in the VFT group received conventional rehabilitation (CR) and VFT for 8 weeks, while 15 patients in the CTL group received only CR. The Barthel Index (BI) was used to assess the activities of daily living at baseline and the 8th week of the recovery training period. The Fugl-Meyer assessment (FMA) scale, somatosensory evoked potential (SEP), and fMRI were used to evaluate the recovery effect of the training therapies. The latencies and amplitudes of N9 and N20 were measured. Before recovery training, fMRI was performed for all patients in the VFT and CTL groups. In addition, 17 patients (9 in the VFT group and 8 in the CTL group) underwent fMRI for follow-up 2 months after treatment. Qualitative data were analyzed using the χ 2 test. The independent sample t-test was used to compare normally distributed data among different groups, the paired sample t-test was used to compare data between groups, and the non-parametric test was used to comparing data without normal distribution among groups. RESULTS: There were no significant differences between the VFT and CTL group in all indexes. However, after 8 weeks of recovery training, these indexes were all significantly improved (P < 0.05). As compared with the CTL group, the FMA scores, BI, and N9/N20 latencies and amplitudes of SEP in the VFT group were significantly improved (P < 0.05). Two months after recovery training, fMRI showed that the degree of activation of the bilateral central anterior gyrus, parietal lobe, and auxiliary motor areas was significantly higher in the VFT group than the CTL group (P < 0.05). CONCLUSIONS: VFT based on mirror neuron theory is an effective approach to improve upper extremity motor function and daily activity performance of stroke patients. The therapeutic mechanism promotes motor relearning by activating the mirror neuron system and motor cortex. SEP amplitudes increased only for patients who participated in visual feedback. VFT promotes sensory-motor plasticity and behavioral changes in both the motor and sensory domains.

Machine learning-based genome-wide interrogation of somatic copy number aberrations in circulating tumor DNA for early detection of hepatocellular carcinoma.

BACKGROUND: DNAs released from tumor cells into blood (circulating tumor DNAs, ctDNAs) carry tumor-specific genomic aberrations, providing a non-invasive means for cancer detection. In this study, we aimed to leverage somatic copy number aberration (SCNA) in ctDNA to develop assays to detect early-stage HCCs. METHODS: We conducted low-depth whole-genome sequencing (WGS) to profile SCNAs in 384 plasma samples of hepatitis B virus (HBV)-related HCC and cancer-free HBV patients, using one discovery and two validation cohorts. To fully capture the robust signals of WGS data from the complete genome, we developed a machine learning-based statistical model that is focused on detection accuracy in early-stage HCC. FINDINGS: We built the model using a discovery cohort of 209 patients, achieving an overall area under curve (AUC) of 0.893, with 0.874 for early-stage (Barcelona clinical liver cancer [BCLC] stage 0-A) and 0.933 for advanced-stage (BCLC stage B-D). The performance of the model was then assessed in two validation cohorts (76 and 99 patients) that only consisted of patients with stage 0-A HCC. Our model exhibited a robust predictive performance, with an AUC of 0.920 and 0.812 for the two validation cohorts. Further analyses showed the impact of tumor sample heterogeneity in model training on detecting early-stage tumors, and a refined model addressing the heterogeneity in the discovery cohort significantly increased model performance in validation. INTERPRETATION: We developed an SCNA-based, machine learning-driven model in the non-invasive detection of early-stage HCC in HBV patients and demonstrated its performance through strict independent validations.