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Čeko M, Baeuerle T, Webster L, Wager TD, Lumley MA. The effects of virtual reality neuroscience-based therapy on clinical and neuroimaging outcomes in patients with chronic back pain: a randomized clinical trial. Pain 2024; 165:1860-1874. [PMID: 38466872 DOI: 10.1097/j.pain.0000000000003198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/06/2024] [Indexed: 03/13/2024]
Abstract
ABSTRACT Chronic pain remains poorly managed. The integration of immersive technologies (ie, virtual reality [VR]) with neuroscience-based principles may provide effective pain treatment by targeting cognitive and affective neural processes that maintain pain and therefore potentially changing neurobiological circuits associated with pain chronification and amplification. We tested the effectiveness of a novel VR neuroscience-based therapy (VRNT) to improve pain-related outcomes in n = 31 participants with chronic back pain, evaluated against usual care (waitlist control; n = 30) in a 2-arm randomized clinical trial ( NCT04468074) . We also conducted pre-treatment and post-treatment MRI to test whether VRNT affects brain networks previously linked to chronic pain and treatment effects. Compared with the control condition, VRNT led to significantly reduced pain intensity (g = 0.63) and pain interference (g = 0.84) at post-treatment vs pre-treatment, with effects persisting at 2-week follow-up. These improvements were partially mediated by reduced kinesiophobia and pain catastrophizing. Several secondary clinical outcomes were also improved by VRNT, including disability, quality of life, sleep, and fatigue. In addition, VRNT was associated with increases in dorsomedial prefrontal functional connectivity with the superior somatomotor, anterior prefrontal and visual cortices, and decreased white matter fractional anisotropy in the corpus callosum adjacent to the anterior cingulate, relative to the control condition. Thus, VRNT showed preliminary efficacy in significantly reducing pain and improving overall functioning, possibly through changes in somatosensory and prefrontal brain networks.
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Affiliation(s)
- Marta Čeko
- Institute of Cognitive Science, University of Colorado, Boulder, CO, United States
| | | | - Lynn Webster
- U.S. Center for Policy, Scientific Affairs, Dr. Vince Clinical Research, Salt Lake City, UT, United States
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, United States
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Shigemura T, Osone F, Hara A, Miyano K, Okada A, Yokokawa T, Shirayama Y. Alterations in metabolites in the anterior cingulate cortex and thalamus and their associations with pain and empathy in patients with chronic mild pain: a preliminary study. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02791-1. [PMID: 38896135 DOI: 10.1007/s00702-024-02791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024]
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) has shown inconsistent alterations in the brain metabolites of individuals with chronic pain. We used 3T 1H-MRS to investigate the brain metabolites in the anterior cingulate cortex and thalamus of 22 patients with chronic mild pain and no gait disturbance and 22 healthy controls. The chronic-pain group included patients with chronic low back pain and/or osteoarthritis but none suffering from hypersensitivity. There were no significant between group-differences in glutamate, glutamate plus glutamine (Glx), N-acetylaspartate, glycerophosphorylcholine (GPC), glutamine, creatine plus phosphocreatine, or myo-inositol in the anterior cingulate cortex, but the patients showed a significant decrease in GPC, but not other metabolites, in the thalamus compared to the controls. The GPC values in the patients' thalamus were significantly correlated with pain components on the Short-Form McGill Pain Questionnaire (SF-MPQ-2) and affective empathy components on the Questionnaire of Cognitive and Affective Empathy (QCAE). The GPC in the patients' anterior cingulate cortex showed significant correlations with cognitive empathy components on the QCAE. Myo-inositol in the controls' anterior cingulate cortex and Glx in the patients' thalamus each showed significant relationships with peripheral responsivity on the QCAE. These significances were not significant after Bonferroni corrections. These preliminary findings indicate important roles of GPC, myo-inositol, and Glx in the brain of patients with chronic mild pain.
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Affiliation(s)
- Tomonori Shigemura
- Department of Orthopedics, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Fumio Osone
- Department of Radiology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Akira Hara
- Department of Radiology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Kanako Miyano
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Okada
- Department of Psychology, Sapporo International University, Sapporo, Japan
| | - Tokuzou Yokokawa
- Department of Radiology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Yukihiko Shirayama
- Department of Psychiatry, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111, Japan.
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Wei X, Lai Y, Lan X, Tan Y, Zhang J, Liu J, Chen J, Wang C, Zhou X, Tang Y, Liu D, Zhang J. Uncovering brain functional connectivity disruption patterns of lung cancer-related pain. Brain Imaging Behav 2024; 18:576-587. [PMID: 38316730 DOI: 10.1007/s11682-023-00836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 02/07/2024]
Abstract
Pain is a pervasive symptom in lung cancer patients during the onset of the disease. This study aims to investigate the connectivity disruption patterns of the whole-brain functional network in lung cancer patients with cancer pain (CP+). We constructed individual whole-brain, region of interest (ROI)-level functional connectivity (FC) networks for 50 CP+ patients, 34 lung cancer patients without pain-related complaints (CP-), and 31 matched healthy controls (HC). Then, a ROI-based FC analysis was used to determine the disruptions of FC among the three groups. The relationships between aberrant FCs and clinical parameters were also characterized. The ROI-based FC analysis demonstrated that hypo-connectivity was present both in CP+ and CP- patients compared to HC, which were particularly clustered in the somatomotor and ventral attention, frontoparietal control, and default mode modules. Notably, compared to CP- patients, CP+ patients had hyper-connectivity in several brain regions mainly distributed in the somatomotor and visual modules, suggesting these abnormal FC patterns may be significant for cancer pain. Moreover, CP+ patients also showed increased intramodular and intermodular connectivity strength of the functional network, which could be replicated in cancer stage IV and lung adenocarcinoma. Finally, abnormal FCs within the prefrontal cortex and somatomotor cortex were positively correlated with pain intensity and pain duration, respectively. These findings suggested that lung cancer patients with cancer pain had disrupted connectivity in the intrinsic brain functional network, which may be the underlying neuroimaging mechanisms.
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Affiliation(s)
- Xiaotong Wei
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Yong Lai
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Yong Tan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Jing Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Jiang Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Jiao Chen
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Chengfang Wang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Xiaoyu Zhou
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Yu Tang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China.
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China.
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Li X, Meng F, Huang W, Cui Y, Meng F, Wu S, Xu H. The Alterations in the Brain Corresponding to Low Back Pain: Recent Insights and Advances. Neural Plast 2024; 2024:5599046. [PMID: 38529366 PMCID: PMC10963108 DOI: 10.1155/2024/5599046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 03/27/2024] Open
Abstract
Low back pain (LBP) is a leading cause of global disabilities. Numerous molecular, cellular, and anatomical factors are implicated in LBP. Current issues regarding neurologic alterations in LBP have focused on the reorganization of peripheral nerve and spinal cord, but neural mechanisms of exactly what LBP impacts on the brain required further researches. Based on existing clinical studies that chronic pain problems were accompanying alterations in brain structures and functions, researchers proposed logical conjectures that similar alterations occur in LBP patients as well. With recent extensive studies carried out using noninvasive neuroimaging technique, increasing number of abnormalities and alterations has been identified. Here, we reviewed brain alterations including white matters, grey matters, and neural circuits between brain areas, which are involved in chronic LBP. Moreover, brain structural and functional connectivity abnormalities are correlated to the happening and transition of LBP. The negative emotions related to back pain indicate possible alterations in emotional brain regions. Thus, the aim of this review is to summarize current findings on the alterations corresponding to LBP in the brain. It will not only further our understanding of etiology of LBP and understanding of negative emotions accompanying with back pain but also provide ideas and basis for new accesses to the diagnosis, treatment, and rehabilitation afterward based on integral medicine.
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Affiliation(s)
- Xuyang Li
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Fancheng Meng
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Wenye Huang
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
- College of Life Sciences, Northwest University, Xi'an, China
| | - Yue Cui
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Fanbo Meng
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Shengxi Wu
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Hui Xu
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
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Yang HJ, Wu HM, Li XH, Jin R, Zhang L, Dong T, Zhou XQ, Zhang B, Zhang QJ, Mao CP. Functional disruptions of the brain network in low back pain: a graph-theoretical study. Neuroradiology 2023; 65:1483-1495. [PMID: 37608218 DOI: 10.1007/s00234-023-03209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE The aim of this study was to investigate alterations in the topological organization of whole-brain functional networks in patients with chronic low back pain (CLBP) and characterize the relationship of these alterations with pain characteristics. METHODS Thirty-three CLBP patients and 34 matched healthy controls (HCs) underwent fMRI scans. A graph-theoretical approach was applied to identify brain network changes in patients suffering from chronic low back pain given its nonspecific etiology and complexity. Graph theory-based analysis was used to construct functional connectivity matrices and extract the features of small-world networks of the brain in both groups. Then, the whole-brain functional connectivity differences were characterized by network-based statistics (NBS) analysis, and the relationship between the altered brain features and clinical measures was explored. RESULTS At the global level, patients with CLBP showed significantly decreased gamma, sigma, global efficiency, and local efficiency and increased lambda and shortest path length compared with HCs. At the regional level, there were deficits in nodal efficiency within the default mode network and salience network. NBS analysis demonstrated that decreased functional connectivity was present in the CLBP patients, mainly in the frontolimbic circuit and temporal regions. Furthermore, aspects of topological dysfunctions in CLBP were correlated with pain severity. CONCLUSION This study highlighted the aberrant topological organization of functional brain networks in CLBP, which may shed light on the pathophysiology of CLBP and support the development of pain management approaches.
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Affiliation(s)
- Hua Juan Yang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Hong Mei Wu
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Xiao Hui Li
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Rui Jin
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Lei Zhang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Ting Dong
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Xiao Qian Zhou
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Bo Zhang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Qiu Juan Zhang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China.
| | - Cui Ping Mao
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China.
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Li Y, Wang L, Han Q, Han Q, Jiang L, Wu Y, Feng Y. Preoperative resting-state microstate as a marker for chronic pain after breast cancer surgery. Brain Behav 2023; 13:e3196. [PMID: 37496396 PMCID: PMC10570483 DOI: 10.1002/brb3.3196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Chronic postoperative pain poses challenges, emphasizing the importance of accurately predicting pain in advance. Generally, pain perception is associated with the temporal dynamics of the brain, which can be represented by microstates. Specifically, microstates are transient and patterned brain topographies formed by temporally overlapping and spatially synchronized oscillatory activities. Consequently, by characterizing brain activity, microstates offer valuable insights into pain perception. METHODS In this prospective study, 66 female patients undergoing breast cancer surgery were included. Their preoperative resting-state electroencephalography (EEG) was recorded. Preoperative resting-state EEG was recorded and four specific brain microstates (labeled as A, B, C, and D) were extracted. Temporal characteristics were then analyzed from these microstates. Patients were classified into two groups based on their Numerical Rating Scale (NRS) scores at three months postoperatively. Those with NRS scores ranging from 4 to 10 were classified as the high pain group, while patients with NRS ranging from 0 to 3 were classified as the lowpain group. Statistical analyses were performed to compare the microstate characteristics between these two groups. RESULTS Twenty-one patients (32%) were classified as the high pain group and forty-five (68%) as the low-pain group. The occurrence and coverage of microstate C were significantly higher in the high pain group. Additionally, there were significant differences in the microstates transitions between the two groups. Furthermore, the study revealed a positive correlation between the coverage of microstate C and the NRS. CONCLUSIONS Preoperative resting-state microstate features have shown correlations with postoperative pain. This study presents a novel and advanced perspective on the potential of microstates as a marker for postoperative pain.
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Affiliation(s)
- Yaru Li
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
| | - Lu Wang
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
| | - Qiaoyu Han
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
| | - Qi Han
- Key Laboratory of Carcinogenesis and Translational ResearchMinistry of EducationBeijingChina
- Department of AnesthesiologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Luyang Jiang
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
| | - Yaqing Wu
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
| | - Yi Feng
- Department of AnesthesiologyPeking University People's HospitalBeijingChina
- Department of Pain MedicinePeking University People's HospitalBeijingChina
- Key Laboratory for NeuroscienceMinistry of Education of China and National Health CommissionBeijingChina
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Čeko M, Baeuerle T, Webster L, Wager TD, Lumley MA. The Effects of Virtual Reality Neuroscience-based Therapy on Clinical and Neuroimaging Outcomes in Patients with Chronic Back Pain: A Randomized Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.24.23293109. [PMID: 37546872 PMCID: PMC10402228 DOI: 10.1101/2023.07.24.23293109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Chronic pain remains poorly managed. The integration of innovative immersive technologies (i.e., virtual reality (VR)) with recent neuroscience-based principles that position the brain as the key organ of chronic pain may provide a more effective pain treatment than traditional behavioral therapies. By targeting cognitive and affective processes that maintain pain and potentially directly changing neurobiological circuits associated with pain chronification and amplification, VR-based pain treatment has the potential for significant and long-lasting pain relief. We tested the effectiveness of a novel VR neuroscience-based therapy (VRNT) to improve pain-related outcomes in n = 31 participants with chronic back pain, evaluated against usual care (n = 30) in a 2-arm randomized clinical trial ( NCT04468074) . We also conducted pre- and post-treatment MRI to test whether VRNT affects brain networks previously linked to chronic pain and treatment effects. Compared to the control condition, VRNT led to significantly reduced pain intensity (g = 0.63) and pain interference (g = 0.84) at post-treatment vs. pre-treatment, with effects persisting at 2-week follow-up. The improvements were partially mediated by reduced kinesiophobia and pain catastrophizing. Several secondary clinical outcomes were also improved, including disability, quality of life, sleep, and fatigue. In addition, VRNT was associated with modest increases in functional connectivity of the somatomotor and default mode networks and decreased white matter fractional anisotropy in the corpus callosum adjacent to anterior cingula, relative to the control condition. This, VRNT showed preliminary efficacy in significantly reducing pain and improving overall functioning, possibly via changes in somatosensory and prefrontal brain networks.
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Yang H, Li X, Guo XL, Zhou J, Shen ZF, Liu LY, Wei W, Yang L, Yu Z, Chen J, Liang FR, Yu SY, Yang J. Moxibustion for primary dysmenorrhea: A resting-state functional magnetic resonance imaging study exploring the alteration of functional connectivity strength and functional connectivity. Front Neurosci 2022; 16:969064. [PMID: 36110091 PMCID: PMC9469737 DOI: 10.3389/fnins.2022.969064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionPrimary dysmenorrhea (PDM) is a common gynecological disease and chronic pain disorder. Moxibustion, a form of traditional Chinese medicine therapy, has proven to be effective for PDM. However, the central mechanisms of PDM and moxibustion for PDM are still unclear. This study aims to explore the potential central mechanism of PDM and clarify the possible mechanism of moxibustion for relieving pain.Materials and methodsA total of 23 PDM patients and 23 matched healthy controls (HCs) were enrolled. For PDM patients, resting-state functional magnetic resonance imaging (rs-fMRI) data were collected pre- and post-moxibustion treatment of 3 consecutive menstrual cycles, respectively. For HCs, rs-fMRI data were collected in the baseline. The resting-state functional connectivity strength (rs-FCS) analysis and the resting-state functional connectivity (rs-FC) analysis based on the region of interest (ROI) were combined to be conducted.ResultsCompared to HCs, PDM patients showed weaker rs-FCS in the left inferior frontal gyrus (IFG). After the moxibustion treatment, rs-FCS in the left IFG was increased with clinical improvement. Then, the left IFG was chosen as ROI, and the rs-FC analysis was conducted. It showed that the left IFG rs-FC in the bilateral anterior cingulate cortex (ACC)/middle cingulate cortex (MCC), the left posterior cingulate cortex (PCC)/precuneus (PCU), and the left parahippocampal gyrus (PHG) decreased after moxibustion treatment, most of which belong to the default mode network (DMN).ConclusionOur results highlight the role of the left IFG and the DMN in PDM. Specifically, the central mechanism of moxibustion for analgesia may be related to modulating the disorders of the reappraisal and processing of pain stimuli through influencing the cognition of pain.
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Affiliation(s)
- Han Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-li Guo
- Chengdu Xi’nan Gynecological Hospital, Chengdu, China
| | - Jun Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhi-fu Shen
- Department of Traditional Chinese and Western Medicine, North Sichuan Medical College, Nanchong, China
| | - Li-ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Wei
- Chengdu Xi’nan Gynecological Hospital, Chengdu, China
| | - Lu Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zheng Yu
- College of Medical Information and Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiao Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fan-rong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Si-yi Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jie Yang,
| | - Jie Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu Xi’nan Gynecological Hospital, Chengdu, China
- Si-yi Yu,
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