Cerebellar repetitive transcranial magnetic stimulation (rTMS) for essential tremor: A double-blind, sham-controlled, crossover, add-on clinical trial

BACKGROUND

There is controversial evidence about the effect of cerebellar low-frequency stimulation in patients with essential tremor (ET).

OBJECTIVES

In this study we assessed safety and effectiveness of 1 Hz (low-frequency) cerebellar repetitive transcranial magnetic stimulation (rTMS) on tremor severity in patients with essential tremor in a sham-controlled crossover trial.

METHODS

A total of 23 patients assigned into two groups to receive either sham (n = 10) or rTMS (n = 13) treatment, with crossing over after a two-month washout period. Intervention consisted of 900 pulses of 1 Hz rTMS at 90% resting motor threshold or the same protocol of sham stimulation over each cerebellar hemisphere for 5 consecutive days. Tremor severity was assessed by Fahn-Tolosa-Marin (FTM) scale at baseline and at days 5, 12 and 30 after intervention. The FTM consists of 3 subscales including tremor severity rating, performance of motor tasks, and functional disability. Carry-over and treatment effects were analyzed using independent samples t-test.

RESULTS

There was no significant improvement in the total FTM scores in rTMS compared to the sham stimulation on day 5 (p = 0.132), day 12 (p = 0.574), or day 30 (p = 0.382). Similarly, FTM subscales, including tremor severity rating, motor tasks, and functional disability did not improve significantly after rTMS treatment. Mild headache and local pain were the most frequent adverse events.

CONCLUSION

Although cerebellar rTMS seems to have acceptable safety when used in ET patients, this study could not prove any efficacy for it in reduction of tremor in these patients. Larger studies are needed to evaluate efficacy of this therapeutic intervention and to provide evidence about the optimal stimulation parameters.

Combinational System of Lipid-Based Nanocarriers and Biodegradable Polymers for Wound Healing: An Updated Review

Skin wounds have imposed serious socioeconomic burdens on healthcare providers and patients. There are just more than 25,000 burn injury-related deaths reported each year. Conventional treatments do not often allow the re-establishment of the function of affected regions and structures, resulting in dehydration and wound infections. Many nanocarriers, such as lipid-based systems or biobased and biodegradable polymers and their associated platforms, are favorable in wound healing due to their ability to promote cell adhesion and migration, thus improving wound healing and reducing scarring. Hence, many researchers have focused on developing new wound dressings based on such compounds with desirable effects. However, when applied in wound healing, some problems occur, such as the high cost of public health, novel treatments emphasizing reduced healthcare costs, and increasing quality of treatment outcomes. The integrated hybrid systems of lipid-based nanocarriers (LNCs) and polymer-based systems can be promising as the solution for the above problems in the wound healing process. Furthermore, novel drug delivery systems showed more effective release of therapeutic agents, suitable mimicking of the physiological environment, and improvement in the function of the single system. This review highlights recent advances in lipid-based systems and the role of lipid-based carriers and biodegradable polymers in wound healing.

Five-Year Case Fatality Following First-Ever Stroke in the Mashhad Stroke Incidence Study: A Population-Based Study of Stroke in the Middle East

BACKGROUND AND PURPOSE

Despite recent declines in stroke mortality in high-income countries, the incidence and mortality of stroke have increased in many low- and middle-income countries. Population-based information on stroke in such countries is a research priority to address this rising trend. This study was designed to evaluate 5-year stroke mortality and its associated factors.

METHODS

During a 12-month period beginning from November 2006, 624 patients with first-ever stroke (FES) living in Mashhad, Iran, were recruited and followed longitudinally. Kaplan-Meier analyses were used to determine the cumulative risk of death. Prognostic variables associated with death were assessed using a Cox proportional hazard, backward logistic regression model.

RESULTS

The 5-year cumulative risk of death was 53.8% for women and 60.5% for men (log rank = .1). The most frequent causes of death were stroke (41.2%), myocardial infarction/vascular diseases (16.4%), and pneumonia (14.2%). In multivariable Cox proportional hazard analysis, male gender (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.01-1.64), age (HR: 1.04, 95% CI: 1.03-1.05, per 1-year increase), National Institute of Health Stroke Scale score at admission (HR: 1.11, 95% CI: 1.09-1.12, per 1-point increase), atrial fibrillation (HR: 1.78, CI: 1.24-2.54), and education < 12 years (HR: 1.61, 95% CI: 1.08-2.4) were associated with greater 5-year case fatality.

CONCLUSIONS

Long-term case fatality following stroke in Iran is greater than that observed in many high-income countries. Targeting strategies to reduce the poor outcome following stroke, such as treating AF, is likely to reduce this disparate outcome.

Isokinetic muscle strength cannot be related to the odds ratio of musculoskeletal injuries in young elite wrestlers

Background

Wrestling is considered one of the oldest sports in the world. There is a high rate of injuries in Wrestling. To prevent injuries, it is necessary to identify the risk factors. Despite the functional importance of strength in wrestling, few studies have investigated the relationship between isokinetic strength and the rate of injuries in the sport.

Objectives

The objective of the present study was to investigate the relationship between the isokinetic strength of elite wrestlers and the rate of injuries prospectively.

Method

A total of 72 young wrestlers with at least 2 years of experience in the Tehran Wrestling Premier League participated in this study. Before the start of the competition season, the isokinetic strength of flexor and extensor muscles of the knee and shoulder were measured at different velocities by an isokinetic dynamometer. The injuries and training hours of these wrestlers were then recorded for nine months.

Results

The study results showed no significant relationship between isokinetic strength of flexor and extensor muscles of the knee or shoulder at different angular speeds of 60, 180, and 300°/s. There was neither significant between the ratio of the strength flexor/extensor for knee and/or shoulder in young elite wrestlers with injuries.

Conclusion

Isokinetic strength of lower and upper limb muscles alone cannot predict wrestlers' injuries. Therefore, the use of these tests is not recommended to evaluate the risk of injury in this population.

Periodical low eggshell temperatures during incubation and post hatch dietary arginine supplementation: Effects on performance and cold tolerance acquisition in broilers

An experiment was conducted to evaluate the effects of a periodically low eggshell temperature exposure during incubation and dietary supplementation of arginine on performance, ascites incidence, and cold tolerance acquisition in broilers. A total of 2,400 hatching eggs were randomly assigned to 2 treatment groups (16 replicates of 75 eggs per treatment). The eggs were incubated at a constant eggshell temperature (EST) of 37.8ºC throughout the incubation period (CON) or were periodically exposed to 15°C for one hour on days 11, 13, 15, and 17 of incubation and the EST was measured (periodical low EST; PLE). After hatching, 240 one-day-old male broiler chicks from both treatment groups were reared for 42 d with or without dietary arginine supplementation in a completely randomized design with a 2 × 2 factorial arrangement. In order to induce ascites, all chicks were exposed to a 15°C room temperature from 14 d onwards. Results showed that second grade chicks and yolk sac weight were decreased, and final body weight was increased in the PLE group. Ascites mortality rate was decreased only in the PLE group and dietary arginine supplementation had no apparent effect. In the PLE group, the packed cell volume (PCV) percentage and red blood cell (RBC) count were decreased. In conclusion, the results showed that the PLE treatment during incubation was associated with improved hatchability, chick quality, and productive performance of broilers and decreased ascites incidence during post hatch cold exposure. Dietary arginine supplementation had no beneficial effects in cold exposed broilers.

Brain proton magnetic resonance spectroscopy in patients with Parkinson's disease

Background: The accuracy of current laboratory and imaging studies for diagnosis and monitoring of Parkinson's disease (PD) severity is low and diagnosis is mainly dependent on clinical examination. Proton magnetic resonance spectroscopy (MRS) is a non-invasive technique that can assess the chemical profile of the brain. In this study, we evaluated the utility of proton MRS in diagnosis of PD and determination of its severity. Methods: Patients with PD and healthy age-matched controls were studied using proton MRS. The level of N-acetylaspartate (NAA), total creatine (Cr), and total choline (Cho), and their ratios were calculated in substantia nigra (SN), putamen (Pu), and motor cortex. PD severity was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale. Results: Compared to 25 healthy controls (18 men, age: 59.00 ± 8.39 years), our 30 patients with PD (24 men, age: 63.80 ± 12.00 years, 29 under treatment) showed no significant difference in the metabolite ratios in SN, Pu, and motor cortex. Nigral level of NAA/Cr was significantly correlated with total UPDRS score in patients with PD (r = -0.35, P = 0.08). Moreover, patients with PD with Hoehn and Yahr scale score ≥ 2 had a lower NAA/Cr level in SN compared to patients with a lower stage. Conclusion: This study shows that 1.5 tesla proton MRS is unable to detect metabolite abnormalities in patients with PD who are under treatment. However, the NAA/Cr ratio in the SN might be a useful imaging biomarker for evaluation of disease severity in these patients.

Benign joint hypermobility syndrome among children with inguinal hernia

BACKGROUND

Benign joint hypermobility syndrome (BJHS) is a disorder due to laxity of supporting connective tissue of joints. Inguinal hernia is also proposed due to weak supporting tissue that may be a clinical presentation of a more widespread problem of connective tissue.

MATERIALS AND METHODS

In a cross-sectional study, prevalence of benign hypermobility joint syndrome (BHJS) was assessed among 100 children aged 2-12 year admitted with inguinal hernia during 2010-2011.

RESULTS

BJHS (Beighton score ≥ 4) were detected in most of children (92%) with inguinal hernias.

CONCLUSION

BHJS amongst this population was substantially greater than reported prevalence in healthy children and due to subsequent clinical significances; it is worthy to screen such patient s for BHJS.

Exploring the influence of a 10-week specific detraining on injury risk factors among elite young wrestlers: a prospective study

Extended periods of inactivity in sports can impact athletes' performance and overall well-being. The current study examined the effects of a 10-week wrestling -specific detraining period on the isokinetic strength of knee and shoulder flexor and extensor muscles, knee proprioception, and dynamic balance among young male elite wrestlers. This prospective study included 63 male wrestlers : age (19.33 ± 3 years), height (174.32 ± 6.8 cm), weight (80.21 ± 22.01 kg), BMI (25.34 ± 5.89), fat percentage (13.25 ± 5.80) in Tehran's premier wrestling league. Baseline measurements, including isokinetic strength of knee and shoulder flexors and extensors, knee proprioception, and dynamic balance, were evaluated using the Biodex 4 dynamometer and Biodex balance meter, respectively, and repeated after a 10-week lockdown during the COVID-19 pandemic at Shahid Beheshti University, Tehran, Iran. Statistical analysis utilized dependent t-tests to compare the results. Significant differences were observed in the isokinetic strength of shoulder and knee flexor and extensor muscles at angular speeds of 60, 180, and 300 degrees per second after 10 weeks of detraining (p < 0.05). Additionally, a decrease in the accuracy of knee joint proprioception was found, including active angle restoration at angles of 30°, 60°, and 90° and passive movement detection in flexion and extension at a 90-degree angle (p < 0.05). Moreover, dynamic balance significantly reduced in the single-leg form (p < 0.05). The findings revealed that wrestling -specific detraining period can significantly affect musculoskeletal and proprioceptive parameters in wrestlers, increasing the risk of injuries and reducing the performance and physical fitness. Consistent engagement in wrestling -specific training is essential to ensure optimal fitness and overall well-being, particularly for elite athletes.