Right arcuate fasciculus as outcome predictor after low-frequency repetitive transcranial magnetic stimulation in nonfluent aphasic stroke.

BACKGROUND AND PURPOSE: A reliable neuroimaging biomarker to predict language improvement after neuromodulation in post-stroke aphasia is lacking. It is hypothesized that aphasic patients with stroke injuries in the left primary language circuits but with sufficient right arcuate fasciculus (AF) integrity might respond to low-frequency repetitive transcranial magnetic stimulation (LF-rTMS), leading to language improvement. This study aimed to assess the microstructural indices of the right AF before LF-rTMS treatment and further correlate with language improvement after the treatment. METHODS: Thirty-three patients with at least 3 months after stroke in the left hemisphere and nonfluent aphasia were recruited in this randomized double-blind study. All patients received real 1-Hz LF-rTMS (n = 16) or sham stimulation (n = 17) at the right pars triangularis for 10 consecutive weekdays. Fractional anisotropy, axial diffusivity, radial diffusivity and apparent diffusion coefficient of the right AF were extracted using diffusion tensor imaging before the rTMS treatment and correlated with the measured functional improvement by the Concise Chinese Aphasia Test. RESULTS: The Concise Chinese Aphasia Test change scores revealed a stronger language improvement in auditory/reading comprehension and expression in the rTMS group than in the sham group. Regression analysis showed that the pre-treatment fractional anisotropy, axial diffusivity and apparent diffusion coefficient of the right AF significantly correlated with the expression abilities (R2 > 0.700, p < 0.044) and comprehension abilities (R2 > 0.702, p < 0.039) in the rTMS group. CONCLUSIONS: It was concluded that the right AF could be a predictor in language recovery induced by LF-rTMS after the injuries of primary language circuits.

Laryngeal Helicobacter pylori Infection and Laryngeal Cancer-Case Series and a Systematic Review.

Helicobacter pylori (H. pylori) infection involves the development of gastric cancer and may be associated with laryngeal cancer. However, laryngeal H. pylori infection in Taiwanese patients with newly diagnosed laryngeal cancer has not been reported. This study was aimed to investigate the possible association between laryngeal H. pylori infection and laryngeal cancer in Taiwan and perform a systematic review of previous reports in other countries. An analysis of 105 patients with laryngeal lesions found the positive rates of H. pylori DNA (determined by polymerase chain reaction) and antigen (determined by immunohistochemistry) of the laryngeal lesions were relatively low (vocal polyps: 3% and 3%; vocal fold leukoplakia: 0% and 0%; laryngeal cancers: 0% and 2%). Furthermore, H. pylori-associated laryngopharyngeal reflux and the expression of E-cadherin and CD1d (determined by immunohistochemistry) were comparable among the three subgroups. Fifteen studies were involved in the systematic review of the digital literature database, distributed to February 2021. The data of patients with laryngeal cancer and controls showed that the laryngeal H. pylori infection rates were 29.4% and 16.7%, respectively. Although current evidence supported that laryngeal H. pylori infection was associated with laryngeal cancer globally, it might not play a role in the development of laryngeal cancer in Taiwan.

Low-Frequency vs. Theta Burst Transcranial Magnetic Stimulation for the Treatment of Chronic Non-fluent Aphasia in Stroke: A Proof-of-Concept Study.

BACKGROUND: Although low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) has shown promise in the treatment of poststroke aphasia, the efficacy of high-frequency rTMS (HF-rTMS) has yet to be determined. PURPOSE: We investigated the efficacy of intermittent theta burst stimulation (iTBS) in ameliorating chronic non-fluent aphasia and compared it with that of LF-rTMS. METHODS: We randomly assigned patients with poststroke non-fluent aphasia to an ipsilesional iTBS (n = 29), contralesional 1-Hz rTMS (n = 27), or sham (n = 29) group. Each group received the rTMS protocol executed in 10 daily sessions over 2 weeks. We evaluated language function before and after the intervention by using the Concise Chinese Aphasia Test (CCAT). RESULTS: Compared with the sham group, the iTBS group exhibited significant improvements in conversation, description, and expression scores (P = 0.0004-0.031), which characterize verbal production, as well as in auditory comprehension, reading comprehension, and matching scores (P < 0.01), which characterize language perception. The 1-Hz group exhibited superior improvements in expression, reading comprehension, and imitation writing scores compared with the sham group (P < 0.05). The iTBS group had significantly superior results in CCAT total score, matching and auditory comprehension (P < 0.05) relative to the 1-Hz group. CONCLUSION: Our study findings contribute to a growing body of evidence that ipsilesional iTBS enhances the language recovery of patients with non-fluent aphasia after a chronic stroke. Auditory comprehension was more preferentially enhanced by iTBS compared with the 1-Hz protocol. Our findings highlight the importance of ipsilesional modulation through excitatory rTMS for the recovery of non-fluent aphasia in patients with chronic stroke. CLINICAL TRIAL REGISTRATION: [www.ClinicalTrials.gov], identifier [NCT03059225].

The application of thermal oscillation method to augment the effectiveness of autologous platelet rich plasma in treating elderly patients with knee osteoarthritis.

Elderly patients with knee osteoarthritis (OA) are often troubled with joint soreness, swelling, weakness, and pain. Knee intra-articular (IA) injection of autologous platelet rich plasma (PRP) is one of the options that can be used in treating knee OA. However, there are doubts on the effect of PRP when used in treating elderly patients with moderate to severe degrees of knee OA. In this study, 47 elderly patients with moderate degree of knee OA combined with supra-patellar bursitis were recruited. Musculoskeletal ultrasound was used for accurate needle placement for the aspiration of bursa synovial fluid SF followed by PRP injections. In group 1, 23 patients received conventional liquid-form IA PRP injections. In group 2, 24 patients received IA injections of thermal oscillation prepared PRP injectants. It was discovered that when the liquid-form PRP was heated up to a temperature of 75 °C and simultaneously oscillated under 200 revolutions per minute (rpm) for 15 min, the end product became paste-form like and with a viscosity similar to that of an anti-cough syrup. Under incubation, the highest number of platelet-derived growth factor (PDGF) was obtained on the 8th day. At one month after the completion of PRP injections, group 2 patients revealed significant decreases in SF total protein concentrations, SF volumes, and Lequesne index values. Proteins associated with inflammation, such as apolipoprotein A-I, haptoglobin, immunoglobulin kappa chain, transferrin, and matrix metalloproteinase also decreased significantly. Therefore, the thermal oscillation preparation method can augment the effectiveness of autologous PRP in treating elderly patients with moderate knee OA. It may be recommended that the PRP injectant should be prepared first using the thermal oscillation method to increase its viscosity, enabling prolonged release of growth factors once it is injected into the knee joint.

Acute liver abscess after non-operative management of blunt liver injury: A rare case managed with laparoscopic drainage.

INTRODUCTION: Liver abscess may develop as a rare complication of the non-operative management (NOM) of blunt liver injury. PRESENTATION: A 36-year-old male was injured in a motorcycle accident on November 28, 2017. First aid was performed at the local hospital, then he was transferred to our trauma center for further management. The abdominal computed tomography (CT) revealed a segment 7/8 liver laceration, and the liver injury was of grade III according to the American Association for the Surgery of Trauma-Organ Injury Scale for liver injury. Intermittent high fever was observed for the first 3 days after NOM, and repeat abdominal CT showed an abscess with rupture at the previously injured liver parenchyma. He underwent laparoscopic drainage of the liver abscess, and culture revealed the presence of Salmonella enterica, serogroup D. After laparoscopic drainage, the patient recovered well, with a 21-day hospital stay. DISCUSSION: Liver abscess as a complication after NOM of blunt liver injury is a rare entity, with an incidence rate of 1.5%. It is usually seen in major liver injuries (grade III and above) and the abscesses take a median of 6 days (range, 1-12 days) to form and be diagnosed. The management of liver abscess may be by surgical drainage (laparotomy or laparoscopy) or percutaneous drainage. CONCLUSION: This report reminds us the liver abscess complication after NOM of blunt liver injury, although it is a rare entity. Results of this patient support drainage of the liver abscess can be safely and effectively performed by laparoscopy.