Surgical treatment of coronal shear fractures of the distal humerus with an intact lateral epicondyle by the lateral combined approach.

BACKGROUND: Coronal shear fractures of the distal humerus are not only rare and prone to misdiagnosis, but their surgical treatment can be challenging. We aimed to investigate the feasibility of exposing distal humeral coronal shear fractures with a combined lateral approach that preserves the extensors and lateral ulnar collateral ligament (LUCL) and to analyze the clinical efficacy of open reduction and internal fixation (ORIF) in the treatment of these injuries. METHODS: We included 45 patients who sustained coronal shear fractures of the distal humerus with the lateral epicondyle intact and were treated with ORIF from January 2013 to August 2020. The fractures were exposed by the lateral combined approach in which the tendons involving the common extensor, the extensor carpi ulnaris (ECU), and the LUCL were preserved. Two observation windows were formed anterior to and posterior to these tendons and the LUCL was used to achieve fracture reduction. Countersunk screws, with or without a plate placed on the posterior lateral condyle, were used to fix the fragments. The functional outcomes of these patients were reviewed and assessed with physical and radiographic examinations, range of motion (ROM) measurements, and self-evaluation Mayo Elbow Performance Index (MEPI) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS: In total, 40 patients were followed up with for over 1 year and were included in the final analysis. The mean follow-up duration was 42±30 months (range, 12-107 months). The patients' mean age was 42 years (range, 14-74 years). According to the Dubberley Classification, there were 15 type I, 17 type II, and 8 type III fractures. At the final follow-up, the mean flexion-extension arc was 131° (range, 65-150) and mean pronation and supination was 73° (range, 45-80) and 71° (range, 40-80), respectively. The mean MEPI score was 88 (range, 61-97) points; the results were excellent in 21, good in 13, fair in 4, and poor in 2 patients. The mean DASH score was 11 (range, 0-42) points. Neither functional score nor range of movement was associated with age, sex, fracture type, injury type, or surgical timing. CONCLUSION: Reduction and stable fixation with internal fixation for coronal shear fractures of the distal humerus can be achieved by the lateral combined approach. Early functional mobilization allows for satisfactory restoration of elbow function.

Arthroscopic Medial Bi-portal Extra-articular Debridement for Recalcitrant Medial Epicondylitis.

Medial epicondylitis, or golfer's elbow, is characterized by pain and tenderness at the tendon insertion points of the pronator teres and flexor carpi radialis. Conservative treatment is sufficient for most patients, whereas surgical treatment is the best choice for intractable medial epicondylitis. With open surgery or arthroscopic surgery, good clinical results have been reported. However, there is still no consensus on which surgical technique is more ideal. We describe our technique of arthroscopic medial bi-portal extra-articular debridement, which is a safe and effective technique that allows more accurate debridement and maximum protection of the ulnar nerve while reducing surgical scars, relieving postoperative pain, reducing the probability of elbow infection and ankylosis, and shortening the recovery time.

Catalytic performance and mechanism study of the isomerization of 2,5-dichlorotoluene to 2,4-dichlorotoluene.

This work investigates the influence of catalyst HZSM-5 on the isomerization of 2,5-dichlorotoluene (2,5-DCT) to produce 2,4-dichlorotoluene (2,4-DCT). We observe that hydrothermal treatment leads to a decrease in total acidity and Brønsted/Lewis ratio of HZSM-5 while generating new secondary pores. These characteristics result in excellent selectivity for post-hydrothermal modified HZSM-5 in the isomerization reaction from 2,5-DCT to 2,4-DCT. Under atmospheric pressure at 350 °C, unmodified HZSM-5 achieves a selectivity of 66.4% for producing 2,4-DCT, however after hydrothermal modification the selectivity increases to 78.7%. Density Functional Theory (DFT) calculations explore the thermodynamic aspects of adsorption between the HZSM-5 surface and 2,4-DCT. The kinetic perspective investigates the mechanism involving proton attack on the methyl group of 2,5-DCT followed by rearrangement leading to formation of 2,4-DCT during isomerization. The consistency between simulation and experimental results provides evidence for the feasibility of isomerizing 2,5-DCT to 2,4-DCT. This work fills the gap in the low value-added product 2,5-DCT isomer conversion, indicating its significant practical application potential and provides a valuable reference and guidelines for industrial research in this field.

Design of Light-Driven Biocompatible and Biodegradable Microrobots Containing Mg-Based Metallic Glass Nanowires.

Light-driven microrobots capable of moving rapidly on water surfaces in response to external stimuli are widely used in a variety of fields, such as drug delivery, remote sampling, and biosensors. However, most light-driven microrobots use graphene and carbon nanotubes as photothermal materials, resulting in poor biocompatibility and degradability, which greatly limits their practical bioapplications. To address this challenge, a composition and microstructure design strategy with excellent photothermal properties suitable for the fabrication of light-driven microrobots was proposed in this work. The Mg-based metallic glass nanowires (Mg-MGNWs) were embedded with polyhydroxyalkanoates (PHA) to fabricate biocompatible and degradable microrobots with excellent photothermal effect and complex shapes. Consequently, the microrobot can be precisely driven by a near-infrared laser to achieve high efficiency and remote manipulation on the water surface for a long period of time, with a velocity of 9.91 mm/s at a power density of 2.0 W/cm2. Due to the Marangoni effect, programmable and complex motions of the microrobot such as linear, clockwise, counterclockwise, and obstacle avoidance motions can be achieved. The biocompatible and degradable microrobot fabrication strategy could have great potential in the fields of environmental detection, targeted drug delivery, disease diagnosis, and detection.

Joining of metallic glasses in liquid via ultrasonic vibrations.

Joining processes especially for metallic materials play critical roles in manufacturing industries and structural applications, therefore they are essential to human life. As a more complex technique, under-liquid joining has far-reaching implications for national defense, offshore mining. Furthermore, up-to-now, the effective joining of metals in extreme environments, such as the flammable organo-solvent or the arctic liquid nitrogen, is still uninvestigated. Therefore, an efficient under-liquid joining approach is urgently called for. Here we report a method to join different types of metallic glasses under water, seawater, alcohol and liquid-nitrogen. The dynamic heterogeneity and liquid-like region expansion induces fluid-like behavior under ultrasonic vibration to promote oxide layer dispersion and metal bonding, allowing metallic glasses to be successfully joined in heat-free conditions, while still exhibiting excellent tensile strength (1522 MPa), bending strength (2930 MPa) and improved corrosion properties. Our results provide a promising strategy for manufacturing under offshore, polar, oil-gas and space environments.

Hepatotoxicity screening and ranking of structurally different pyrrolizidine alkaloids in zebrafish.

Pyrrolizidine alkaloids (PAs) are phytotoxins distributed in ∼6000 plant species. PA-contaminated/containing foodstuffs/herbs/supplements pose a potential threat to human health. Various regulatory authorities established different PA margins of exposure assuming an equal hepatotoxic potency of structurally diverse PAs, although they exhibit different toxic potencies. Therefore, understanding hepatotoxic potencies of different PAs would facilitate a more appropriate risk assessment of PA exposure. In this study, a zebrafish model, which mimics physiological processes of absorption, distribution, metabolism, and excretion, was selected to evaluate acute hepatotoxic potency of different PAs (7 PAs and 2 PA N-oxides) and explore possible physiological pathways involved in PA-induced hepatotoxicity. After 6 h oral administration, PAs caused distinct structure-dependent hepatotoxicity with a series of biochemical and histological changes in zebrafish. Based on the measured toxicological endpoints, the relative toxic potency order of different PAs was derived as lasiocarpine âˆ¼ retrorsine > monocrotaline > riddelliine > clivorine > heliotrine > retrorsine N-oxide âˆ¼ riddelliine N-oxide≫>platyphyline. Further, compared to control group, different upregulation/downregulation of mRNA expression in PA-treated groups indicated that inflammation, apoptosis, and steatosis were involved in PA-induced hepatotoxicity in zebrafish. These findings demonstrate that zebrafish model is useful for screening and ranking hepatotoxicity of PAs with diverse structures, which would facilitate the more accurate risk assessment of PA exposure.

High-Temperature Mechanical and Dynamical Properties of γ-(U,Zr) Alloys.

High-temperature body-centered cubic (BCC) γ-U is effectively stablized by γ-(U,Zr) alloys that also make it feasible to use it as a nuclear fuel. However, relatively little research has focused on γ-(U,Zr) alloys due to their instability at room temperature. The effect of Zr composition on its mechanical properties is not clear yet. Herein, we perform molecular dynamics simulations to investigate the mechanical and dynamical stabilities of γ-(U,Zr) alloys under high temperatures, and we calculate the corresponding lattice constants, various elastic moduli, Vickers hardness, Debye temperature, and dynamical structure factor. The results showed that γ-U, ß-Zr, and γ-(U,Zr) are all mechanically and dynamically stable at 1200 K, which is in good agreement with the previously reported high-temperature phase diagram of U-Zr alloys. We found that the alloying treatment on γ-U with Zr can effectively improve its mechanical strength and melting points, such as Vickers hardness and Debye temperature, making it more suitable for nuclear reactors. Furthermore, the Zr concentrations in γ-(U,Zr) alloys have an excellent effect on these properties. In addition, the dynamical structure factor reveals that γ-U shows different structural features after alloying with Zr. The present simulation data and insights could be significant for understanding the structures and properties of UZr alloy under high temperatures.

Dissolvable templates to prepare Pt-based porous metallic glass for the oxygen reduction reaction.

Oxygen reduction reaction (ORR) plays a crucial role in electrochemical energy conversion and storage devices such as metal-air batteries and water electrolyzers. Herein, a hierarchical nanoporous platinum-based metallic glass (NPMG) was developed by a facile fabrication method by dissolving in a liquid. The surface topography of the sample can be easily modulated by controlling the particle size of sodium chloride. As a result, the NPMG was proved to be efficient and robust as the ORR catalysts with super hydrophilicity and self-renewal capacity. The half-wave potential of the platinum-based porous material was 835 mV at 0.1 M KOH, even higher than that of the commercial Pt/C catalyst (823 mV) and the previously reported platinum material. In particular, platinum-based porous materials have extremely long stability (more than 500 h) through the self-renewal surface, which perfectly meets the requirements of catalyst stability in batteries. Our study has a better inspiration for developing and applying novel catalysts to prepare metal-air batteries.

Chronic subdural hematoma caused by excessive drainage in a patient with ventriculoperitoneal shunt valve breakdown in brain injury: a case report.

INTRODUCTION: Chronic subdural hematoma (CSDH) often occurs 3 weeks to 3 months after brain injury, which is mainly caused by bleeding of the bridging vein. For patients with ventriculoperitoneal (V-P) shunt, excessive drainage can also cause CSDH. We present a rare case of CSDH caused by shunt valve breakdown in brain injury. CASE REPORT: We report a 68-year-old man with V-P shunt for 8 years. He presented with bilateral CSDH with disappearance of lateral ventricles nearly 1 month after a brain injury caused by being hit with a stick. After burr hole drainage (BHD), the patient's symptoms improved and lateral ventricles reappeared, but disappeared rapidly with CSDH recurrence within a short time. We considered the cause to be medium pressure shunt valve breakdown caused by hitting with a stick, which was confirmed by the engineer's test after the operation and excessive drainage of cerebrospinal fluid. BHD replaced the adjustable pressure shunt valve, and the patient recovered. CONCLUSION: V-P shunt is a common operation in neurosurgery, and postoperative shunt valve breakdown may lead to poor outcome. We report a rare case of CSDH caused by shunt valve breakdown due to excessive external forces, suggesting that patients after V-P shunt should pay attention to the protection of the shunt valve.

Genome-wide identification of DnaJ gene family in Catalpa bungei and functional analysis of CbuDnaJ49 in leaf color formation.

DnaJs are the common molecular chaperone proteins with strong structural and functional diversity. In recent years, only several DnaJ family members have been found to be able to regulate leaf color, and it remains to be explored whether there are other potential members that also regulate this character. Here, we identified 88 putative DnaJ proteins from Catalpa bungei, and classified them into four types according to their domain. Gene-structure analysis revealed that each member of CbuDnaJ family had same or similar exon-intron structure. Chromosome mapping and collinearity analysis showed that tandem and fragment duplication occurred in the process of evolution. Promoter analyses suggested that CbuDnaJs might be involved in a variety of biological processes. The expression levels of DnaJ family members in different color leaves of Maiyuanjinqiu were respectively extracted from the differential transcriptome. Among these, CbuDnaJ49 was the largest differentially expressed gene between the green and yellow sectors. Ectopic overexpression of CbuDnaJ49 in tobacco showed that the positive transgenic seedlings exhibited albino leaves, and the contents of chlorophyll and carotenoid were significantly reduced compared with those of wild type. The results suggested that CbuDnaJ49 played an important role in regulating leaf color. This study not only identified a novel gene of DnaJ family members regulating leaf color, but also provided new germplasm for landscaping.

Combined analysis of plasma metabolome and intestinal microbiome sequencing to explore jiashen prescription and its potential role in changing intestine-heart axis and effect on chronic heart failure.

Background: Heart failure (HF) is a syndrome with global clinical and socioeconomic burden worldwide owing to its poor prognosis. Jiashen Prescription (JSP), a traditional Chinese medicine (TCM) formula, exhibits unambiguous effects on treating HF. Previously, we have reported that underlying mechanisms of JSP by an untargeted metabolomics approach, but the contribution of gut microbiota and metabolic interaction to the cardioprotective efficacy of JSP remains to be elucidated. Materials and methods: Firstly, the rat model of heart failure was established by the permanent ligation of the left anterior descending coronary artery. The efficacy evaluation of JSP in treating HF rats was per-formed by left ventricular ejection fraction (LVEF). Then, 16S rRNA gene sequencing and LC/MS-based metabolomic analysis were utilized to explore the characteristics of cecal-contents microecology and plasma metabolic profile, respectively. After that, the correlation between intestinal micro-ecological characteristics and plasma metabolic characteristics was analyzed to explore the potential mechanism of the JSP treatment in HF. Results: JSP could improve the cardiac function of heart failure rats and thus ameliorate heart failure via enhancing rat LVEF. Results of intestinal flora analysis revealed that JSP not only adjusted gut microbiota disturbances by enriching species diversity, reducing the abundance of pathogenic bacteria (such as Allobaculum, Brevinema), as well as increasing the abundance of beneficial bacteria (such as Lactobacillus, Lachnospiraceae_NK4A136_group), but also improved metabolic disorders by reversing metabolite plasma levels to normality. Through the conjoint analysis of 8 metabolites and the OTUs relative abundance data in the 16srRNA sequencing results by WGCNA method, 215 floras significantly related to the eight compounds were identified. The results of the correlation analysis demonstrated a significant association between intestinal microbiota and plasma metabolic profile, especially the significant correlation of Ruminococcaceae_UCG-014 and Protoporphyrin IX, Ruminococcaceae_UCG-005, Christensenellaceae_R-7_group and nicotinamide, dihydrofolic acid. Conclusion: The present study illustrated the underlying mechanism of JSP to treat heart failure by affecting intestinal flora and plasma metabolites, provide a potential therapeutic strategy against heart failure.

Effects of transcranial magnetic stimulation on cerebellar ataxia: A systematic review and meta-analysis.

Objective: To determine the effectiveness of transcranial magnetic stimulation in improving cerebellar ataxia. Data sources: PubMed, EMBASE, the Cochrane Library, Springer, Science Direct, the China National Knowledge Infrastructure (CNKI) and the China Science and Technology Journal Database (VIP) were searched until 2022. Review methods: Trials with transcranial magnetic stimulation on the effects on cerebellar ataxia were included, and the effect size was evaluated using the standardized mean difference (SMD) or mean difference (MD) and a 95% confidence interval (CI). Results: Eight studies comprising 272 participants, published between 2014 and 2022, were included. The results revealed that the effect of TMS on patients with cerebellar ataxia as assessed by the International Cooperative Ataxia Rating Scale (ICRAS), the Scale for the Assessment and Rating of Ataxia (SARA), the Berg Balance Scale (BBS), and the Timed Up and Go (TUG) test was statistically significant (P < 0.01) with low heterogeneity among the studies (I2 = 4, 27, 0, and 0% respectively). Conclusion: The effects of transcranial magnetic stimulation in improving cerebellar ataxia in the affected patients are significant. TMS targeting the cerebellar structures can induce changes in the excitability of the cerebellar-thalamus-cortical pathways; thus, it is necessary to carry out large-scale research with good design and high quality in the future.

Metavirome of 31 tick species provides a compendium of 1,801 RNA virus genomes.

The increasing prevalence and expanding distribution of tick-borne viruses globally have raised health concerns, but the full repertoire of the tick virome has not been assessed. We sequenced the meta-transcriptomes of 31 different tick species in the Ixodidae and Argasidae families from across mainland China, and identified 724 RNA viruses with distinctive virome compositions among genera. A total of 1,801 assembled and complete or nearly complete viral genomes revealed an extensive diversity of genome architectures of tick-associated viruses, highlighting ticks as a reservoir of RNA viruses. We examined the phylogenies of different virus families to investigate virome evolution and found that the most diverse tick-associated viruses are positive-strand RNA virus families that demonstrate more ancient divergence than other arboviruses. Tick-specific viruses are often associated with only a few tick species, whereas virus clades that can infect vertebrates are found in a wider range of tick species. We hypothesize that tick viruses can exhibit both 'specialist' and 'generalist' evolutionary trends. We hope that our virome dataset will enable much-needed research on vertebrate-pathogenic tick-associated viruses.

Neonatal Outcomes in Pregnant Women With Repaired and Unrepaired Congenital Heart Disease in Zhejiang, China.

OBJECTIVES: To compare the neonatal outcomes in pregnant women with repaired vs unrepaired congenital heart disease (CHD). METHODS: Data on pregnant women with CHD was retrieved from our hospital records for the duration April, 2014 to December, 2021. Pregnant women with CHD were divided into two groups: simple CHD and moderate-to-complex CHD. RESULTS: In simple CHD group, neonatal outcomes were similar in pregnant women with repaired and unrepaired CHD. By contrast, in moderate-to-complex CHD group, the offspring of women with unrepaired CHD had lower gestational age [mean (SD) 34.3 (2.7) vs 36.8 (2.1) week; P=0.016] and lower birth weight [mean (SD) 2126.8 (711.9) vs 2720 (645.7); P=0.037] than those with repaired CHD. Infants of women with unrepaired moderate-to-complex CHD had a higher risk of premature delivery (87.5% vs 45.5%, P=0.013), low birth weight (81.3% vs 36.4%, P=0.04) and neonatal intensive care unit (NICU) admission (68.8% vs 27.3%, P=0.034). CONCLUSION: Surgical repair before pregnancy in women with moderate-to-complex CHD significantly minimized the risks of neonatal complications.

The Method of Screening and Identification of Transcription Factor in Klebsiella.

This protocol describes a method for verifying the specific transcription factor regulating glycerol dehydratase (GDH) expression in Klebsiella. DNA pull-down accompanied with mass spectrometry is used to screen and identify the transcription factor interacting with the promoter region of the key gene in Klebsiella. EMSA method is used to validate the specific binding of the transcription factor to the promoter region in vitro. In addition, the target DNA fragments are constructed by fusion PCR to prepare competent cells from Klebsiella for electrical transformation and further transformed to obtain key gene deletion strains to verify the transcription factor responsible for the target gene expression in Klebsiella.

Plasma metabolomic analysis reveals the therapeutic effects of Jiashen tablets on heart failure.

Background: Heart failure is a chronic progressive condition that significantly affects the quality of life of patients with high hospitalization and mortality rates. Jiashen tablets (JST), a Chinese herbal formula, have been reported to be an effective treatment against heart failure, however the underlying mechanisms remain obscure. This study was designed to determine the effect of JST on the treatment of heart failure and delineate the underlying mechanisms by an untargeted metabolomics approach. Materials and methods: The chronic heart failure model was established by the permanent ligation of the left anterior descending coronary artery in rats. The cardiac functions of rats, including left ventricular ejection fraction (LVEF) and fractional shortening (LVFS), left ventricular internal diameter end diastole (LVIDd) and end systole (LVIDs), and interventricular septum thickness in diastole (IVSd) and in systole (IVSs), were measured by echocardiography. Biochemical analysis and histopathological examination were also performed to evaluate therapeutic effects of JST for treating heart failure. UHPLC-QTOF-MS/MS coupled with multivariate statistical analyses were applied for plasma metabolic profiling to identify biomarkers and potential mechanisms of JST in the treatment of heart failure. Results: Jiashen tablets could improve the cardiac function of heart failure rats and thus ameliorate heart failure via enhancing rat LVEF and LVFS and decreasing LVIDd, LVIDs, IVSd, and IVSs. Results of biochemical analysis and histopathological examination revealed that JST could reduce the serum lactate dehydrogenase (LDH) activity and the level of NT-pro BNP, markers of heart failure and myocardial damage, and inhibit myocardial fibrosis. Furthermore, in metabolomics analysis, a total of 210 metabolites with significant differences were identified between heart failure rats and normal rats, among which 29 metabolites were significantly restored after JST treatment. These metabolites were primarily involved in tryptophan metabolism, branched-chain amino acid metabolism, fatty acids ß-oxidation, and glycerophospholipid metabolism. Conclusion: The present study illustrated the therapeutic effect of JST for the treatment of heart failure and delineated the underlying mechanisms mainly relating to the regulation of amino acid metabolism and lipid metabolism in heart failure rats.

Point Defects Stability, Hydrogen Diffusion, Electronic Structure, and Mechanical Properties of Defected Equiatomic γ(U,Zr) from First-Principles.

At present, many experimental fast reactors have adopted alloy nuclear fuels, for example, U-Zr alloy fuels. During the neutron irradiation process, vacancies and hydrogen (H) impurity atoms can both exist in U-Zr alloy fuels. Here, first-principles density functional theory (DFT) is employed to study the behaviors of vacancies and H atoms in disordered-γ(U,Zr) as well as their impacts on the electronic structure and mechanical properties. The formation energy of vacancies and hydrogen solution energy are calculated. The effect of vacancies on the migration barrier of hydrogen atoms is revealed. The effect of vacancies and hydrogen atom on densities of states and elastic constants are also presented. The results illustrate that U vacancy is easier to be formed than Zr vacancy. The H interstitial prefers the tetrahedral site. Besides, U vacancy shows H-trap ability and can raise the H migration barrier. Almost all the defects lead to decreases in electrical conductivity and bulk modulus. It is also found that the main effect of defects is on the U-5f orbitals. This work provides a theoretical understanding of the effect of defects on the electronic and mechanical properties of U-Zr alloys, which is an essential step toward tailoring their performance.

The central-peripheral coupling effect of ocular acupuncture kinesitherapy in post-stroke dyskinesia: A functional neuroimaging and neurotic electrophysiology study protocol.

Background: Dyskinesia is a common manifestation after stroke. Motor functional rehabilitation after stroke is of great significance to the maintenance of national health. Ocular Acupuncture Kinesitherapy (OAKT) can repair nerve injuries, improve motor function, reduce rehabilitation time, and promote dyskinesia recovery after stroke. The mechanism, however, remains a mystery, necessitating urgent research. The M1-thalamus-spinal cord neural signaling pathway is linked to limb motor function. Bold-fMRI can represent the cerebral functional state, and TMS-MEP is of certain practical utility for assessing motor neural function and prognosis. Combining fMRI scanning with TMS-MEP detection is predicted to advance brain-spinal cord regulation and muscle response linkage control mechanism research, as well as completely investigate the central-peripheral coupling effect of Ocular Acupuncture Kinesitherapy on dyskinesia after stroke (PSD). Methods: This is a prospective functional neuroimaging and neurotic electrophysiological study with a case-control design between the PSD with the HC groups and a randomized controlled design within the 3 PSD groups (OAKT group, ocular acupuncture group, and kinesitherapy group). Using fMRI scans and TMS-MEP approach, we will assess the central-peripheral neural function alterations in PSD as well as the coupling effects of OAKT on PSD. We plan to enroll 90 participants at the Hospital of Chengdu University of Traditional Chinese Medicine from Aug 31, 2022, to Dec 31, 2023, including 45 PSD and 45 HC subjects. After enrollment and on the last day after 4-weeks of waiting (HC subjects) or intervention (PSD subjects), all eligible subjects will be evaluated using fMRI scanning, TMS-MEP detection, and the MMT and Fugl-Mayer scales assessment. The MMT and Fugl-Meyer scores will be recorded, and a Pearson correlation analysis will be performed to assess the correlation between clinical and imaging outcomes. Discussion: Findings of this study will help to explain the central-peripheral coupling effect of OAKT on PSD and to further provide the neural processing of acupuncture kinesitherapy covering the entire pathway from peripheral to central nervous system. Clinical trial registration: This study is registered with an identifier (ChiCTR2200060483) at the Chinese Clinical Trial Registry in June 2022. http://www.chictr.org.cn/index.aspx.

Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials.

Background: Non-invasive brain stimulation (NIBS) techniques and mirror therapy (MT) are promising rehabilitation measures for stroke. While the combination of MT and NIBS has been employed for post-stroke upper limb motor functional rehabilitation, its effectiveness has not been examined. Objective: This study aimed to evaluate the effectiveness of combined MT and NIBS in the recovery of upper limb motor function in stroke patients. Methods: The search was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Science Direct, CNKI, WANFANG and VIP until December 2021. Randomized clinical trials (RCTs) comparing MT or NIBS alone with the combination of NIBS and MT in improving upper extremity motor recovery after stroke were selected. A meta-analysis was performed to calculate the mean differences (MD) or the standard mean differences (SMD) and 95% confidence intervals (CI) with random-effect models. Subgroup analyses were also conducted according to the types of control group, the types of NIBS, stimulation timing and phase poststroke. Results: A total of 12 articles, including 17 studies with 628 patients, were reviewed in the meta-analysis. In comparison with MT or NIBS alone, the combined group significantly improved body structure and function (MD = 5.97; 95% CI: 5.01-6.93; P < 0.05), activity levels (SMD = 0.82; 95% CI 0.61-1.02; P < 0.05). For cortical excitability, the motor evoked potential cortical latency (SMD = -1.05; 95% CI:-1.57--0.52; P < 0.05) and the central motor conduction time (SMD=-1.31 95% CI:-2.02--0.61; P < 0.05) of the combined group were significantly shortened. A non-significant homogeneous summary effect size was found for MEP amplitude (SMD = 0.47; 95%CI = -0.29 to 1.23; P = 0.23). Subgroup analysis showed that there is an interaction between the stimulation sequence and the combined treatment effect. Conclusion: In this meta-analysis of randomized clinical trials, in comparison to the control groups, MT combined with NIBS promoted the recovery of upper extremity motor function after stroke, which was reflected in the analysis of body structure and function, activity levels, and cortical excitability. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022304455.