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Huang MX, Harrington DL, Angeles-Quinto A, Ji Z, Robb-Swan A, Huang CW, Shen Q, Hansen H, Baumgartner J, Hernandez-Lucas J, Nichols S, Jacobus J, Song T, Lerman I, Bazhenov M, Krishnan GP, Baker DG, Rao R, Lee RR. EMG-projected MEG High-Resolution Source Imaging of Human Motor Execution: Brain-Muscle Coupling above Movement Frequencies. medRxiv 2023:2023.06.23.23291825. [PMID: 37425691 PMCID: PMC10327237 DOI: 10.1101/2023.06.23.23291825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Magnetoencephalography (MEG) is a non-invasive functional imaging technique for pre-surgical mapping. However, movement-related MEG functional mapping of primary motor cortex (M1) has been challenging in presurgical patients with brain lesions and sensorimotor dysfunction due to the large numbers of trails needed to obtain adequate signal to noise. Moreover, it is not fully understood how effective the brain communication is with the muscles at frequencies above the movement frequency and its harmonics. We developed a novel Electromyography (EMG)-projected MEG source imaging technique for localizing M1 during ~1 minute recordings of left and right self-paced finger movements (~1 Hz). High-resolution MEG source images were obtained by projecting M1 activity towards the skin EMG signal without trial averaging. We studied delta (1-4 Hz), theta (4-7 Hz), alpha (8-12 Hz), beta (15-30 Hz), and gamma (30-90 Hz) bands in 13 healthy participants (26 datasets) and two presurgical patients with sensorimotor dysfunction. In healthy participants, EMG-projected MEG accurately localized M1 with high accuracy in delta (100.0%), theta (100.0%), and beta (76.9%) bands, but not alpha (34.6%) and gamma (0.0%) bands. Except for delta, all other frequency bands were above the movement frequency and its harmonics. In both presurgical patients, M1 activity in the affected hemisphere was also accurately localized, despite highly irregular EMG movement patterns in one patient. Altogether, our EMG-projected MEG imaging approach is highly accurate and feasible for M1 mapping in presurgical patients. The results also provide insight into movement related brain-muscle coupling above the movement frequency and its harmonics.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
- Department of Electrical and Computer Engineering, University of California, San Diego, CA, USA
| | - Deborah L. Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | - Ashley Robb-Swan
- Department of Radiology, University of California, San Diego, CA, USA
| | - Charles W. Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Qian Shen
- Department of Radiology, University of California, San Diego, CA, USA
| | - Hayden Hansen
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jared Baumgartner
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Joanna Jacobus
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Maksim Bazhenov
- Department of Medicine, University of California, San Diego, CA, USA
| | - Giri P Krishnan
- Department of Medicine, University of California, San Diego, CA, USA
| | - Dewleen G. Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Ramesh Rao
- Department of Electrical and Computer Engineering, University of California, San Diego, CA, USA
| | - Roland R. Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
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2
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Bu Y, Harrington DL, Lee RR, Shen Q, Angeles-Quinto A, Ji Z, Hansen H, Hernandez-Lucas J, Baumgartner J, Song T, Nichols S, Baker D, Rao R, Lerman I, Lin T, Tu XM, Huang M. Magnetoencephalogram-based brain-computer interface for hand-gesture decoding using deep learning. Cereb Cortex 2023:7161766. [PMID: 37183188 DOI: 10.1093/cercor/bhad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023] Open
Abstract
Advancements in deep learning algorithms over the past decade have led to extensive developments in brain-computer interfaces (BCI). A promising imaging modality for BCI is magnetoencephalography (MEG), which is a non-invasive functional imaging technique. The present study developed a MEG sensor-based BCI neural network to decode Rock-Paper-scissors gestures (MEG-RPSnet). Unique preprocessing pipelines in tandem with convolutional neural network deep-learning models accurately classified gestures. On a single-trial basis, we found an average of 85.56% classification accuracy in 12 subjects. Our MEG-RPSnet model outperformed two state-of-the-art neural network architectures for electroencephalogram-based BCI as well as a traditional machine learning method, and demonstrated equivalent and/or better performance than machine learning methods that have employed invasive, electrocorticography-based BCI using the same task. In addition, MEG-RPSnet classification performance using an intra-subject approach outperformed a model that used a cross-subject approach. Remarkably, we also found that when using only central-parietal-occipital regional sensors or occipitotemporal regional sensors, the deep learning model achieved classification performances that were similar to the whole-brain sensor model. The MEG-RSPnet model also distinguished neuronal features of individual hand gestures with very good accuracy. Altogether, these results show that noninvasive MEG-based BCI applications hold promise for future BCI developments in hand-gesture decoding.
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Affiliation(s)
- Yifeng Bu
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Deborah L Harrington
- Radiology, Research Services, VA, San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Roland R Lee
- Radiology, Research Services, VA, San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Qian Shen
- Radiology, Research Services, VA, San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Annemarie Angeles-Quinto
- Radiology, Research Services, VA, San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Zhengwei Ji
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Hayden Hansen
- Radiology, Research Services, VA, San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Jared Baumgartner
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Tao Song
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Sharon Nichols
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Dewleen Baker
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Ramesh Rao
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Imanuel Lerman
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Tuo Lin
- Division of Biostatistics and Bioinformatics, University of California, San Diego, CA 92093, USA
| | - Xin Ming Tu
- Division of Biostatistics and Bioinformatics, University of California, San Diego, CA 92093, USA
| | - Mingxiong Huang
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
- Radiology, Research Services, VA, San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
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Herbert MS, McLean CL, Chu GM, Lerman I, Baker DG, Lang AJ. High Fiber Plant-based Diet for Chronic Pain and Posttraumatic Stress Disorder: A Feasibility Study. Pain Med 2022:6958558. [PMID: 36562557 DOI: 10.1093/pm/pnac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Caitlin L McLean
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Gage M Chu
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Imanuel Lerman
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Anesthesiology, Center for Pain Medicine, University of California, San Diego, CA, USA.,Department of Electrical and Computer Engineering, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Ariel J Lang
- Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
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Diaz MM, Caylor J, Strigo I, Lerman I, Henry B, Lopez E, Wallace MS, Ellis RJ, Simmons AN, Keltner JR. Toward Composite Pain Biomarkers of Neuropathic Pain—Focus on Peripheral Neuropathic Pain. Front Pain Res 2022; 3:869215. [PMID: 35634449 PMCID: PMC9130475 DOI: 10.3389/fpain.2022.869215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
Chronic pain affects ~10–20% of the U.S. population with an estimated annual cost of $600 billion, the most significant economic cost of any disease to-date. Neuropathic pain is a type of chronic pain that is particularly difficult to manage and leads to significant disability and poor quality of life. Pain biomarkers offer the possibility to develop objective pain-related indicators that may help diagnose, treat, and improve the understanding of neuropathic pain pathophysiology. We review neuropathic pain mechanisms related to opiates, inflammation, and endocannabinoids with the objective of identifying composite biomarkers of neuropathic pain. In the literature, pain biomarkers typically are divided into physiological non-imaging pain biomarkers and brain imaging pain biomarkers. We review both types of biomarker types with the goal of identifying composite pain biomarkers that may improve recognition and treatment of neuropathic pain.
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Affiliation(s)
- Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
- *Correspondence: Monica M. Diaz
| | - Jacob Caylor
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
| | - Irina Strigo
- Department of Psychiatry, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Imanuel Lerman
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
| | - Brook Henry
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Eduardo Lopez
- Department of Psychiatry, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Mark S. Wallace
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
| | - Ronald J. Ellis
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Alan N. Simmons
- Department of Psychiatry, San Diego & Center of Excellence in Stress and Mental Health, Veteran Affairs Health Care System, University of California, San Diego, San Diego, CA, United States
| | - John R. Keltner
- Department of Psychiatry, San Diego & San Diego VA Medical Center, University of California, San Diego, San Diego, CA, United States
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5
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Conic RRZ, Caylor J, Cui CL, Reyes Z, Nelson E, Yin S, Lerman I. Sex-specific differences in the efficacy of traditional low frequency versus high frequency spinal cord stimulation for chronic pain. Bioelectron Med 2022; 8:8. [PMID: 35484578 PMCID: PMC9052649 DOI: 10.1186/s42234-022-00090-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/01/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Spinal cord stimulation (SCS), an FDA-approved therapy for chronic pain, uses paresthesia (low frequency SCS (LF-SCS)) or paresthesia-free (such as high-frequency SCS (HF-SCS)) systems, providing analgesia through partially-elucidated mechanisms, with recent studies indicating a sexual dimorphism in pain pathogenesis (Bretherton et al., Neuromodulation, 2021; Paller et al., Pain Med 10:289–299, 2009; Slyer et al., Neuromodulation, 2019; Van Buyten et al., Neuromodulation 20:642–649, 2017; Mekhail et al., Pain Pract, 2021). We aim to evaluate SCS therapy sex effects based on paradigm, utilizing visual analog scores (VAS), perceived pain reduction (PPR), and opioid use. Methods A retrospective cohort study of SCS patients implanted between 2004 and 2020 (n = 237) was conducted. Descriptive statistics and linear mixed methods analyses were used. Results HF-SCS (10 kHz) was implanted in 94 patients (40 females, 54 males), and LF-SCS in 143 (70 females, 73 males). At 3 months and 6 months, HF-SCS (p < 0.001) and LF-SCS (p < 0.005) had lower VAS scores compared to baseline (p < 0.005), with no differences across groups. PPR improved in both post-implantation (p < 0.006) and at 3 months (p < 0.004 respectively), compared to baseline persisting to 6 (p < 0.003) and 12 months (p < 0.01) for HF-SCS, with significantly better PPR for HF-SCS at 3 (p < 0.008) and 6 (p < 0.001) months compared to LF-SCS. There were no differences in opioid use from baseline for either modality; however LF-SCS patients used more opioids at every time point (p < 0.05) compared to HF-SCS. VAS was improved for all modalities in both sexes at 3 months (p = 0.001), which persisted to 6 months (p < 0.05) for HF-SCS males and females, and LF-SCS females. Female HF-SCS had improved PPR at 3 (p = 0.016) and 6 (p = 0.022) months compared to baseline, and at 6 (p = 0.004) months compared to LF-SCS. Male HF-SCS and LF-SCS had improved PPR post-implantation (p < 0.05) and at 3 months (p < 0.05), with HF-SCS having greater benefit at 3 (p < 0.05) and 6 (p < 0.05) months. LF-SCS males but not females used less opioids at 6 months (p = 0.017) compared to baseline; however this effect did not persist. On linear mixed model analyses, including age, sex and stimulator type, VAS decreased with age, at each timepoint, and had a trend towards increasing with female sex, while PPR increased at 3 and 6 months and lastly HF-SCS was associated with decreased opioid use. Discussion PPR at 3 and 6 months improved to a greater extent in HF-SCS. HF-SCS females had improved PPR at 3 and 6 months, and only LF-SCS males used less opioids at 6 months, potentially indicating sex-based pathway. Future studies should further elucidate differences in sex-based pathways and identify optimal SCS opioid-sparing paradigms for chronic pain patients. Supplementary Information The online version contains supplementary material available at 10.1186/s42234-022-00090-2.
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Affiliation(s)
- Rosalynn R Z Conic
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.,Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jacob Caylor
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA.,Northwest Pain Care, PS, Spokane, WA, USA
| | - Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Zabrina Reyes
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Eric Nelson
- College of Osteopathic Medicine of the Pacific Western University of Health Sciences, Pomona, CA, USA
| | - Sopyda Yin
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Imanuel Lerman
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA. .,Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA. .,VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA. .,Affiliate Electrical and Computer Engineering, VA San Diego Healthcare System, Center for Stress and Mental Health, Center for Pain Medicine, UC San Diego Health, Qualcomm Institute, California Institute for Telecommunications and Information Technology (Calit2), VA San Diego, 3350 La Jolla Village Dr, (MC116A), San Diego, CA, 92161, USA.
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Klaming R, Simmons AN, Spadoni AD, Lerman I. Effects of Noninvasive Cervical Vagal Nerve Stimulation on Cognitive Performance But Not Brain Activation in Healthy Adults. Neuromodulation 2022; 25:424-432. [PMID: 35396072 PMCID: PMC8144242 DOI: 10.1111/ner.13313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES While preliminary evidence suggests that noninvasive vagal nerve stimulation (nVNS) may enhance cognition, to our knowledge, no study has directly assessed the effects of nVNS on brain function and cognitive performance in healthy individuals. The aim of this study was therefore to assess whether nVNS enhances complex visuospatial problem solving in a normative sample. Functional magnetic resonance imaging (fMRI) was used to examine underlying neural substrates. MATERIAL AND METHODS Participants received transcutaneous cervical nVNS (N = 15) or sham (N = 15) stimulation during a 3 T fMRI scan. Stimulation lasted for 2 min at 24 V for nVNS and at 4.5 V for sham. Subjects completed a matrix reasoning (MR) task in the scanner and a forced-choice recognition task outside the scanner. An analysis of variance (ANOVA) was used to assess group differences in cognitive performance. And linear mixed effects (LMEs) regression analysis was used to assess main and interaction effects of experimental groups, level of MR task difficulty, and recall accuracy on changes in blood oxygen level-dependent (BOLD) signal. RESULTS Subjects who received nVNS showed higher accuracy for both easy (p = 0.017) and hard (p = 0.013) items of the MR task, slower reaction times for hard items (p = 0.014), and fewer false negative errors during the forced-choice recognition task (p = 0.047). MR task difficulty related to increased activation in frontoparietal regions (p < 0.001). No difference between nVNS and sham stimulation was found on BOLD response during performance of the MR task. CONCLUSIONS We hypothesize that nVNS increased attention compared to sham, and that this effect led to enhanced executive functions, and consequently to better performance on visuospatial reasoning and recognition tasks. Results provide initial support that nVNS may be a low-risk, low-cost treatment for cognitive disorders.
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Affiliation(s)
- Ruth Klaming
- San Diego Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; San Diego State University, San Diego, CA, USA.
| | - Alan N Simmons
- San Diego Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Andrea D Spadoni
- San Diego Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Imanuel Lerman
- San Diego Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
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Bu Y, Prince J, Mojtahed H, Kimball D, Shah V, Coleman T, Sarkar M, Rao R, Huang M, Schwindt P, Borna A, Lerman I. Peripheral Nerve Magnetoneurography With Optically Pumped Magnetometers. Front Physiol 2022; 13:798376. [PMID: 35370794 PMCID: PMC8975546 DOI: 10.3389/fphys.2022.798376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Electrodiagnosis is routinely integrated into clinical neurophysiology practice for peripheral nerve disease diagnoses, such as neuropathy, demyelinating disorders, nerve entrapment/impingement, plexopathy, or radiculopathy. Measured with conventional surface electrodes, the propagation of peripheral nerve action potentials along a nerve is the result of ionic current flow which, according to Ampere’s Law, generates a small magnetic field that is also detected as an “action current” by magnetometers, such as superconducting quantum interference device (SQUID) Magnetoencephalography (MEG) systems. Optically pumped magnetometers (OPMs) are an emerging class of quantum magnetic sensors with a demonstrated sensitivity at the 1 fT/√Hz level, capable of cortical action current detection. But OPMs were ostensibly constrained to low bandwidth therefore precluding their use in peripheral nerve electrodiagnosis. With careful OPM bandwidth characterization, we hypothesized OPMs may also detect compound action current signatures consistent with both Sensory Nerve Action Potential (SNAP) and the Hoffmann Reflex (H-Reflex). In as much, our work confirms OPMs enabled with expanded bandwidth can detect the magnetic signature of both the SNAP and H-Reflex. Taken together, OPMs now show potential as an emerging electrodiagnostic tool.
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Affiliation(s)
- Yifeng Bu
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Jacob Prince
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Hamed Mojtahed
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Donald Kimball
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | | | - Todd Coleman
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Mahasweta Sarkar
- Electrical and Computer Engineering Department, San Diego State University, Stanford, CA, United States
| | - Ramesh Rao
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Mingxiong Huang
- Department of Radiology, Radiology Imaging Laboratory, University of California San Diego, San Diego, CA, United States
| | - Peter Schwindt
- Quantum Information Sciences, Sandia National Laboratories, Albuquerque, NM, United States
| | - Amir Borna
- Quantum Information Sciences, Sandia National Laboratories, Albuquerque, NM, United States
| | - Imanuel Lerman
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, San Diego, CA, United States
- Veterans Health Administration, VA San Diego, Center for Stress and Mental Health, San Diego, CA, United States
- *Correspondence: Imanuel Lerman,
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8
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Lerman I, Klaming R, Spadoni A, Baker DG, Simmons AN. Non-invasive cervical vagus nerve stimulation effects on reaction time and valence image anticipation response. Brain Stimul 2022; 15:946-956. [PMID: 35738468 PMCID: PMC9721369 DOI: 10.1016/j.brs.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/28/2022] [Accepted: 06/10/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Norepinephrine (NE) driven noninvasive vagus nerve stimulation (nVNS), which improves attention and reduces reaction time, augments learning. Equally important, endogenous NE mediated arousal is highly dependent on the valence (positive or negative) of the exogenous stimulus. But to date, no study has measured valence specific effects of nVNS on both functional magnetic resonance imaging (fMRI) anticipation task response and reaction time in healthy individuals. Therefore, the aim of this pilot study was to assess whether nVNS vs sham modulates valence cortical anticipation task response and reaction time in a normative sample. METHODS Participants received right sided transcutaneous cervical nVNS (N = 12) or sham (N = 12) stimulation during a 3T fMRI scan. Subjects first performed a continuous performance task (CPT) and then a cued anticipation task to images of positively and negatively valenced events during fMRI. Reaction times to cues and Blood oxygen level dependent (BOLD) response were examined over phase to identify effects of nVNS/sham over time. RESULTS nVNS reduced reaction time for all valenced image anticipation trials. With the fMRI anticipation task, we observed a valence-specific effect; nVNS increased responsivity to images with negative valence and decreased responsivity to images with positive valence, whereas sham showed an inverse valence response. CONCLUSIONS nVNS was linked to reduced reaction time during the anticipation task. In tandem, nVNS consistently enhanced responsivity to negatively valenced images and diminished responsivity to positively valenced images, suggesting specific nVNS driven endogenous neurotransmitter signaling may contribute.
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Affiliation(s)
- Imanuel Lerman
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, United States.
| | - Ruth Klaming
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Andrea Spadoni
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Alan N Simmons
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
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9
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Huang MX, Huang CW, Harrington DL, Nichols S, Robb-Swan A, Angeles-Quinto A, Le L, Rimmele C, Drake A, Song T, Huang JW, Clifford R, Ji Z, Cheng CK, Lerman I, Yurgil KA, Lee RR, Baker DG. Marked Increases in Resting-State MEG Gamma-Band Activity in Combat-Related Mild Traumatic Brain Injury. Cereb Cortex 2021; 30:283-295. [PMID: 31041986 DOI: 10.1093/cercor/bhz087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/08/2023] Open
Abstract
Combat-related mild traumatic brain injury (mTBI) is a leading cause of sustained impairments in military service members and veterans. Recent animal studies show that GABA-ergic parvalbumin-positive interneurons are susceptible to brain injury, with damage causing abnormal increases in spontaneous gamma-band (30-80 Hz) activity. We investigated spontaneous gamma activity in individuals with mTBI using high-resolution resting-state magnetoencephalography source imaging. Participants included 25 symptomatic individuals with chronic combat-related blast mTBI and 35 healthy controls with similar combat experiences. Compared with controls, gamma activity was markedly elevated in mTBI participants throughout frontal, parietal, temporal, and occipital cortices, whereas gamma activity was reduced in ventromedial prefrontal cortex. Across groups, greater gamma activity correlated with poorer performances on tests of executive functioning and visuospatial processing. Many neurocognitive associations, however, were partly driven by the higher incidence of mTBI participants with both higher gamma activity and poorer cognition, suggesting that expansive upregulation of gamma has negative repercussions for cognition particularly in mTBI. This is the first human study to demonstrate abnormal resting-state gamma activity in mTBI. These novel findings suggest the possibility that abnormal gamma activities may be a proxy for GABA-ergic interneuron dysfunction and a promising neuroimaging marker of insidious mild head injuries.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Charles W Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Ashley Robb-Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Annemarie Angeles-Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Lu Le
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Carl Rimmele
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Angela Drake
- Cedar Sinai Medical Group Chronic Pain Program, Beverly Hills, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jeffrey W Huang
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Royce Clifford
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, CA, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychological Sciences, Loyola University, New Orleans, LA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
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10
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Huang MX, Huang CW, Harrington DL, Robb-Swan A, Angeles-Quinto A, Nichols S, Huang JW, Le L, Rimmele C, Matthews S, Drake A, Song T, Ji Z, Cheng CK, Shen Q, Foote E, Lerman I, Yurgil KA, Hansen HB, Naviaux RK, Dynes R, Baker DG, Lee RR. Resting-state magnetoencephalography source magnitude imaging with deep-learning neural network for classification of symptomatic combat-related mild traumatic brain injury. Hum Brain Mapp 2021; 42:1987-2004. [PMID: 33449442 PMCID: PMC8046098 DOI: 10.1002/hbm.25340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 11/16/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Combat‐related mild traumatic brain injury (cmTBI) is a leading cause of sustained physical, cognitive, emotional, and behavioral disabilities in Veterans and active‐duty military personnel. Accurate diagnosis of cmTBI is challenging since the symptom spectrum is broad and conventional neuroimaging techniques are insensitive to the underlying neuropathology. The present study developed a novel deep‐learning neural network method, 3D‐MEGNET, and applied it to resting‐state magnetoencephalography (rs‐MEG) source‐magnitude imaging data from 59 symptomatic cmTBI individuals and 42 combat‐deployed healthy controls (HCs). Analytic models of individual frequency bands and all bands together were tested. The All‐frequency model, which combined delta‐theta (1–7 Hz), alpha (8–12 Hz), beta (15–30 Hz), and gamma (30–80 Hz) frequency bands, outperformed models based on individual bands. The optimized 3D‐MEGNET method distinguished cmTBI individuals from HCs with excellent sensitivity (99.9 ± 0.38%) and specificity (98.9 ± 1.54%). Receiver‐operator‐characteristic curve analysis showed that diagnostic accuracy was 0.99. The gamma and delta‐theta band models outperformed alpha and beta band models. Among cmTBI individuals, but not controls, hyper delta‐theta and gamma‐band activity correlated with lower performance on neuropsychological tests, whereas hypo alpha and beta‐band activity also correlated with lower neuropsychological test performance. This study provides an integrated framework for condensing large source‐imaging variable sets into optimal combinations of regions and frequencies with high diagnostic accuracy and cognitive relevance in cmTBI. The all‐frequency model offered more discriminative power than each frequency‐band model alone. This approach offers an effective path for optimal characterization of behaviorally relevant neuroimaging features in neurological and psychiatric disorders.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Charles W Huang
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Ashley Robb-Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Annemarie Angeles-Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, California, USA
| | - Jeffrey W Huang
- Department of Computer Science, Columbia University, New York, New York, USA
| | - Lu Le
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, California, USA
| | - Carl Rimmele
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, California, USA
| | - Scott Matthews
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, California, USA
| | - Angela Drake
- Cedar Sinai Medical Group Chronic Pain Program, Beverly Hills, California, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, California, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, California, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, California, USA
| | - Qian Shen
- Department of Radiology, University of California, San Diego, California, USA
| | - Ericka Foote
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychological Sciences, Loyola University New Orleans, Louisiana, USA
| | - Hayden B Hansen
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Robert K Naviaux
- Department of Medicine, University of California, San Diego, California, USA.,Department of Pediatrics, University of California, San Diego, California, USA.,Department of Pathology, University of California, San Diego, California, USA
| | - Robert Dynes
- Department of Physics, University of California, San Diego, California, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
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11
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Huang MX, Nichols S, Robb-Swan A, Angeles-Quinto A, Harrington DL, Drake A, Huang CW, Song T, Diwakar M, Risbrough VB, Matthews S, Clifford R, Cheng CK, Huang JW, Sinha A, Yurgil KA, Ji Z, Lerman I, Lee RR, Baker DG. MEG Working Memory N-Back Task Reveals Functional Deficits in Combat-Related Mild Traumatic Brain Injury. Cereb Cortex 2020; 29:1953-1968. [PMID: 29668852 DOI: 10.1093/cercor/bhy075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/24/2022] Open
Abstract
Combat-related mild traumatic brain injury (mTBI) is a leading cause of sustained cognitive impairment in military service members and Veterans. However, the mechanism of persistent cognitive deficits including working memory (WM) dysfunction is not fully understood in mTBI. Few studies of WM deficits in mTBI have taken advantage of the temporal and frequency resolution afforded by electromagnetic measurements. Using magnetoencephalography (MEG) and an N-back WM task, we investigated functional abnormalities in combat-related mTBI. Study participants included 25 symptomatic active-duty service members or Veterans with combat-related mTBI and 20 healthy controls with similar combat experiences. MEG source-magnitude images were obtained for alpha (8-12 Hz), beta (15-30 Hz), gamma (30-90 Hz), and low-frequency (1-7 Hz) bands. Compared with healthy combat controls, mTBI participants showed increased MEG signals across frequency bands in frontal pole (FP), ventromedial prefrontal cortex, orbitofrontal cortex (OFC), and anterior dorsolateral prefrontal cortex (dlPFC), but decreased MEG signals in anterior cingulate cortex. Hyperactivations in FP, OFC, and anterior dlPFC were associated with slower reaction times. MEG activations in lateral FP also negatively correlated with performance on tests of letter sequencing, verbal fluency, and digit symbol coding. The profound hyperactivations from FP suggest that FP is particularly vulnerable to combat-related mTBI.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Ashley Robb-Swan
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Angela Drake
- Cedar Sinai Medical Group Chronic Pain Program, Beverly Hills, CA, USA
| | - Charles W Huang
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Mithun Diwakar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Victoria B Risbrough
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Scott Matthews
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Royce Clifford
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, CA, USA
| | | | - Anusha Sinha
- California Institute of Technology, Pasadena, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Loyola University New Orleans, LA, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
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12
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Lerman I, Bu T, Huang M, Wu V, Coleman T. Non‐invasive Targeted Gastric Vagal Complex Stimulation: Preliminary in Human Cutaneous Measures of Gastric Slow Wave Function. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.09477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Reddy R, Lerman I, Chen J. A Letter to the Editor: Impact of Neck Position on the Probability of Common Carotid Artery Puncture during Ultrasound-Guided Stellate Ganglion Block. PM R 2019; 11:1250-1251. [PMID: 31397974 DOI: 10.1002/pmrj.12238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/31/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Rajiv Reddy
- UC San Diego Health Center, Department of Anesthesia, Pain Medicine, San Diego, CA
| | - Imanuel Lerman
- UC San Diego Health Center, Department of Anesthesia, Pain Medicine, San Diego, CA
| | - Jeffrey Chen
- UC San Diego Health Center, Department of Anesthesia, Pain Medicine, San Diego, CA
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14
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Caylor J, Reddy R, Yin S, Cui C, Huang M, Huang C, Rao R, Baker DG, Simmons A, Souza D, Narouze S, Vallejo R, Lerman I. Spinal cord stimulation in chronic pain: evidence and theory for mechanisms of action. Bioelectron Med 2019; 5:12. [PMID: 31435499 PMCID: PMC6703564 DOI: 10.1186/s42234-019-0023-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/30/2019] [Indexed: 12/30/2022] Open
Abstract
Well-established in the field of bioelectronic medicine, Spinal Cord Stimulation (SCS) offers an implantable, non-pharmacologic treatment for patients with intractable chronic pain conditions. Chronic pain is a widely heterogenous syndrome with regard to both pathophysiology and the resultant phenotype. Despite advances in our understanding of SCS-mediated antinociception, there still exists limited evidence clarifying the pathways recruited when patterned electric pulses are applied to the epidural space. The rapid clinical implementation of novel SCS methods including burst, high frequency and dorsal root ganglion SCS has provided the clinician with multiple options to treat refractory chronic pain. While compelling evidence for safety and efficacy exists in support of these novel paradigms, our understanding of their mechanisms of action (MOA) dramatically lags behind clinical data. In this review, we reconstruct the available basic science and clinical literature that offers support for mechanisms of both paresthesia spinal cord stimulation (P-SCS) and paresthesia-free spinal cord stimulation (PF-SCS). While P-SCS has been heavily examined since its inception, PF-SCS paradigms have recently been clinically approved with the support of limited preclinical research. Thus, wide knowledge gaps exist between their clinical efficacy and MOA. To close this gap, many rich investigative avenues for both P-SCS and PF-SCS are underway, which will further open the door for paradigm optimization, adjunctive therapies and new indications for SCS. As our understanding of these mechanisms evolves, clinicians will be empowered with the possibility of improving patient care using SCS to selectively target specific pathophysiological processes in chronic pain.
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Affiliation(s)
- Jacob Caylor
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Rajiv Reddy
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Sopyda Yin
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Christina Cui
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Mingxiong Huang
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA USA
- Department of Radiology, VA San Diego Healthcare System, La Jolla, CA USA
| | - Charles Huang
- Department of Radiology, VA San Diego Healthcare System, La Jolla, CA USA
- Department of Bioengineering, Stanford University, Palo Alto, CA USA
| | - Ramesh Rao
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA USA
| | - Dewleen G. Baker
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA USA
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Alan Simmons
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA USA
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Dmitri Souza
- Center for Pain Medicine, Western Reserve Hospital. Department of Surgery, Northeast Ohio Medical School (NEOMED), Athens, OH USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital. Department of Surgery, Northeast Ohio Medical School (NEOMED), Athens, OH USA
| | - Ricardo Vallejo
- Basic Science Research, Millennium Pain Center, Bloomington, IL USA
- School of Biological Sciences, Illinois State University, Normal, IL USA
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL USA
| | - Imanuel Lerman
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA USA
- Department of Radiology, VA San Diego Healthcare System, La Jolla, CA USA
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA USA
- Present Address: VA San Diego, 3350 La Jolla Village Dr, (MC116A), San Diego, CA 92161 USA
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15
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Lerman I, Davis B, Huang M, Huang C, Sorkin L, Proudfoot J, Zhong E, Kimball D, Rao R, Simon B, Spadoni A, Strigo I, Baker DG, Simmons AN. Noninvasive vagus nerve stimulation alters neural response and physiological autonomic tone to noxious thermal challenge. PLoS One 2019; 14:e0201212. [PMID: 30759089 PMCID: PMC6373934 DOI: 10.1371/journal.pone.0201212] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/12/2018] [Indexed: 11/23/2022] Open
Abstract
The mechanisms by which noninvasive vagal nerve stimulation (nVNS) affect central and peripheral neural circuits that subserve pain and autonomic physiology are not clear, and thus remain an area of intense investigation. Effects of nVNS vs sham stimulation on subject responses to five noxious thermal stimuli (applied to left lower extremity), were measured in 30 healthy subjects (n = 15 sham and n = 15 nVNS), with fMRI and physiological galvanic skin response (GSR). With repeated noxious thermal stimuli a group × time analysis showed a significantly (p < .001) decreased response with nVNS in bilateral primary and secondary somatosensory cortices (SI and SII), left dorsoposterior insular cortex, bilateral paracentral lobule, bilateral medial dorsal thalamus, right anterior cingulate cortex, and right orbitofrontal cortex. A group × time × GSR analysis showed a significantly decreased response in the nVNS group (p < .0005) bilaterally in SI, lower and mid medullary brainstem, and inferior occipital cortex. Finally, nVNS treatment showed decreased activity in pronociceptive brainstem nuclei (e.g. the reticular nucleus and rostral ventromedial medulla) and key autonomic integration nuclei (e.g. the rostroventrolateral medulla, nucleus ambiguous, and dorsal motor nucleus of the vagus nerve). In aggregate, noninvasive vagal nerve stimulation reduced the physiological response to noxious thermal stimuli and impacted neural circuits important for pain processing and autonomic output.
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Affiliation(s)
- Imanuel Lerman
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States of America
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States of America
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, United States of America
- * E-mail:
| | - Bryan Davis
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States of America
| | - Mingxiong Huang
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, United States of America
- Department of Radiology, VA San Diego Healthcare System, La Jolla, CA, United States of America
| | - Charles Huang
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, United States of America
- Department of Radiology, VA San Diego Healthcare System, La Jolla, CA, United States of America
| | - Linda Sorkin
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States of America
| | - James Proudfoot
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States of America
| | - Edward Zhong
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, United States of America
| | - Donald Kimball
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, United States of America
| | - Ramesh Rao
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, United States of America
| | - Bruce Simon
- electroCore LLC, Basking Ridge NJ, United States of America
| | - Andrea Spadoni
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States of America
- Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States of America
| | - Irina Strigo
- Department of Psychiatry, VA San Francisco Healthcare System, San Francisco, CA, United States of America
| | - Dewleen G. Baker
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States of America
- Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States of America
| | - Alan N. Simmons
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States of America
- Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States of America
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16
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Bendel MA, O'Brien T, Hoelzer BC, Deer TR, Pittelkow TP, Costandi S, Walega DR, Azer G, Hayek SM, Wang Z, Eldrige JS, Qu W, Rosenow JM, Falowski SM, Neuman SA, Moeschler SM, Wassef C, Kim C, Niazi T, Saifullah T, Yee B, Kim C, Oryhan CL, Warren DT, Lerman I, Mora R, Hanes M, Simopoulos T, Sharma S, Gilligan C, Grace W, Ade T, Mekhail NA, Hunter JP, Choi D, Choi DY. Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants. Neuromodulation 2017; 20:553-557. [DOI: 10.1111/ner.12636] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/22/2017] [Accepted: 06/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brian Yee
- Center for Pain Relief; Charleston WV USA
| | - Chong Kim
- Center for Pain Relief; Charleston WV USA
| | | | | | | | - Ruben Mora
- University of California at San Diego; La Jolla CA USA
| | | | | | - Sanjiv Sharma
- Beth Israel Deaconess Medical Center; Brookline MA USA
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17
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Hoelzer BC, Bendel MA, Deer TR, Eldrige JS, Walega DR, Wang Z, Costandi S, Azer G, Qu W, Falowski SM, Neuman SA, Moeschler SM, Wassef C, Kim C, Niazi T, Saifullah T, Yee B, Kim C, Oryhan CL, Rosenow JM, Warren DT, Lerman I, Mora R, Hayek SM, Hanes M, Simopoulos T, Sharma S, Gilligan C, Grace W, Ade T, Mekhail NA, Hunter JP, Choi D, Choi DY. Spinal Cord Stimulator Implant Infection Rates and Risk Factors: A Multicenter Retrospective Study. Neuromodulation 2017; 20:558-562. [DOI: 10.1111/ner.12609] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/17/2017] [Accepted: 03/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Bryan C. Hoelzer
- Department of Anesthesiology; Division of Pain Medicine; Mayo Clinic, Rochester, MN USA
| | - Mark A. Bendel
- Department of Anesthesiology; Division of Pain Medicine; Mayo Clinic, Rochester, MN USA
| | | | - Jason S. Eldrige
- Department of Anesthesiology; Division of Pain Medicine; Mayo Clinic, Rochester, MN USA
| | - David R. Walega
- Department of Anesthesiology; Division of Pain Medicine and Department of Neurosurgery, Northwestern University Medical Center; Chicago, IL USA
| | - Zhen Wang
- Department of Anesthesiology; Division of Pain Medicine; Mayo Clinic, Rochester, MN USA
| | - Shrif Costandi
- Department of Anesthesiology; Division of Pain Medicine; Cleveland Clinic, Cleveland, OH USA
| | - Gerges Azer
- Department of Anesthesiology; Division of Pain Medicine; Cleveland Clinic, Cleveland, OH USA
| | - Wenchun Qu
- Department of Anesthesiology; Division of Pain Medicine; Mayo Clinic, Rochester, MN USA
| | - Steven M. Falowski
- Department of Neurosurgery; St. Luke University Health Network; Fountain Hill, PA USA
| | | | - Susan M. Moeschler
- Department of Anesthesiology; Division of Pain Medicine; Mayo Clinic, Rochester, MN USA
| | - Catherine Wassef
- Department of Neurosurgery; St. Luke University Health Network; Fountain Hill, PA USA
| | | | - Tariq Niazi
- Department of Anesthesiology; Division of Pain Medicine; Cleveland Clinic, Cleveland, OH USA
| | - Taher Saifullah
- Department of Anesthesiology; Division of Pain Medicine; Cleveland Clinic, Cleveland, OH USA
| | - Brian Yee
- Center for Pain Relief; Charleston, WV USA
| | - Chong Kim
- Center for Pain Relief; Charleston, WV USA
| | - Christine L. Oryhan
- Department of Anesthesiology; Division of Pain Medicine, Virginia Mason Medical Center; Seattle, WA USA
| | - Joshua M. Rosenow
- Department of Anesthesiology; Division of Pain Medicine and Department of Neurosurgery, Northwestern University Medical Center; Chicago, IL USA
| | - Daniel T. Warren
- Department of Anesthesiology; Division of Pain Medicine, Virginia Mason Medical Center; Seattle, WA USA
| | - Imanuel Lerman
- Department of Anesthesiology; Division of Pain Medicine, University of California at San Diego; La Jolla, CA USA
| | - Ruben Mora
- Department of Anesthesiology; Division of Pain Medicine, University of California at San Diego; La Jolla, CA USA
| | - Salim M. Hayek
- Division of Pain Medicine; Case Western, Cleveland, OH USA
| | - Michael Hanes
- Division of Pain Medicine; Case Western, Cleveland, OH USA
| | - Thomas Simopoulos
- Department of Anesthesiology; Division of Pain Medicine, Beth Israel Deaconess Medical Center; Brookline, MA USA
| | - Sanjiv Sharma
- Department of Anesthesiology; Division of Pain Medicine, Beth Israel Deaconess Medical Center; Brookline, MA USA
| | - Chris Gilligan
- Department of Anesthesiology; Division of Pain Medicine, Beth Israel Deaconess Medical Center; Brookline, MA USA
| | | | - Timothy Ade
- Division of Pain Medicine; Case Western, Cleveland, OH USA
| | - Nagy A. Mekhail
- Department of Anesthesiology; Division of Pain Medicine; Cleveland Clinic, Cleveland, OH USA
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Lerman I, Davis BA, Bertram TM, Proudfoot J, Hauger RL, Coe CL, Patel PM, Baker DG. Posttraumatic stress disorder influences the nociceptive and intrathecal cytokine response to a painful stimulus in combat veterans. Psychoneuroendocrinology 2016; 73:99-108. [PMID: 27490714 DOI: 10.1016/j.psyneuen.2016.07.202] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/09/2016] [Accepted: 07/12/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Although posttraumatic stress disorder (PTSD) and chronic pain frequently occur in tandem, the pathophysiological mechanisms mediating this comorbidity are poorly understood. Because excessive inflammation occurs in both conditions, we examined the cerebrospinal fluid (CSF) concentrations of inflammatory response mediators interleukin 1-beta (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor-alpha (TNFα) and interleukin 10 (IL-10) after prolonged suprathreshold pain stimulus in 21 male combat veterans; 10 with PTSD and 11 combat controls (CC). METHODS After completing baseline quantitative sensory testing (QST) and psychological profiling, all patients received an injection of capsaicin into the quadriceps muscle. Spontaneously reported pain was measured for 30min after the capsaicin injection. The evoked pain measure of temporal summation was tested between 70 and 110min post capsaicin injection. Inflammatory (IL-1β, IL-6, IL-8 TNFα) and anti-inflammatory (IL-10) CSF cytokines were measured before (baseline) and after capsaicin injection over a time frame of 110min. RESULTS Following intramuscular capsaicin injection, pro-inflammatory cytokines [TNFα, IL-6, IL-8] significantly increased (percent rise from baseline) in both groups, whereas IL-1β significantly increased in the PTSD group only. The anti-inflammatory cytokine IL-10 showed an immediate (within 10min) increase in the CC group; however, the IL-10 increase in the PTSD group was delayed and not consistently elevated until 70min post injection. CONCLUSION These findings show significant central nervous system (CNS) differences in the inflammatory response to a deep pain stimulus in combat veterans with and without PTSD. They support the concept that abnormally elevated neuroinflammatory response to pain stimuli may be one CNS mechanism accounting for the high co-occurrence of PTSD and pain.
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Affiliation(s)
- Imanuel Lerman
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States; University of California San Diego, San Diego, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States; Clinical and Translational Research Institute, San Diego, CA, United States.
| | - Bryan A Davis
- University of California San Diego, San Diego, CA, United States
| | | | - James Proudfoot
- University of California San Diego, San Diego, CA, United States; Clinical and Translational Research Institute, San Diego, CA, United States
| | - Richard L Hauger
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States; University of California San Diego, San Diego, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | | | - Piyush M Patel
- University of California San Diego, San Diego, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States; University of California San Diego, San Diego, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States
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19
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Lerman I, Hauger R, Sorkin L, Proudfoot J, Davis B, Huang A, Lam K, Simon B, Baker DG. Noninvasive Transcutaneous Vagus Nerve Stimulation Decreases Whole Blood Culture-Derived Cytokines and Chemokines: A Randomized, Blinded, Healthy Control Pilot Trial. Neuromodulation 2016; 19:283-90. [PMID: 26990318 DOI: 10.1111/ner.12398] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/20/2015] [Accepted: 12/17/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of this study was to test the transcutaneous noninvasive vagus nerve stimulator (nVNS) (gammaCore©) device to determine if it modulates the peripheral immune system, as has been previously published for implanted vagus nerve stimulators. MATERIALS AND METHODS A total of 20 healthy males and females were randomized to receive either nVNS or sham stimulation (SST). All subjects underwent an initial blood draw at 8:00 am, followed by stimulation with nVNS or SST at 8:30 am. Stimulation was repeated at 12:00 pm and 6:00 pm. Additional blood samples were withdrawn 90 min and 24 hour after the first stimulation session. After samples were cultured using the Myriad RBM TruCulture (Austin, TX) system (WBCx), levels of cytokines and chemokines were measured by the Luminex assay and statistical analyses within and between groups were performed using the Wilcoxon Signed Ranks Test and Mann-Whitney U with the statistical program R. RESULTS A significant percent decrease in the levels of the cytokine interleukin [IL]-1β, tumor necrosis factor [TNF] levels, and chemokine, interleukin [IL]-8 IL-8, macrophage inflammatory protein [MIP]-1α, and monocyte chemoattractant protein [MCP]-1 levels was observed in the nVNS group non-lipopolysaccharide (LPS)-stimulated whole blood culture (n-WBCx) at the 24-hour time point (p < 0.05). In SST group, there was a significant percent increase in IL-8 at 90 min post-stimulation (p < 0.05). At 90 min, the nVNS group had a greater percent decrease in IL-8 concentration (p < 0.05) compared to SST group. The nVNS group had a greater percent decrease in cytokines (TNF, IL-1β) and chemokines (MCP-1 and IL-8) at 24 hour (p < 0.05) in comparison to SST. LPS-stimulated whole blood cultures (L-WBCx) did not show a significant decrease in cytokine levels in either the nVNS or SST group across any time points. The nVNS group showed a significant percent increase in LPS-stimulated IL-10 levels at the 24-hour time point in comparison to SST. CONCLUSIONS nVNS downregulates inflammatory cytokine release suggesting that nVNS may be an effective anti-inflammatory treatment.
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Affiliation(s)
- Imanuel Lerman
- Department of Psychiatry, Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Richard Hauger
- Department of Psychiatry, Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Linda Sorkin
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - James Proudfoot
- Department of Anesthesiology, Clinical and Translational Research Institute, University of California, San Diego, San Diego, CA, USA
| | - Bryan Davis
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Andy Huang
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Katie Lam
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Bruce Simon
- Electrocore Research Unit, Basking Ridge, NJ, USA
| | - Dewleen G Baker
- Department of Psychiatry, Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Kulak MV, Ilinykh FA, Zaykovskaya AV, Epanchinzeva AV, Evstaphiev IL, Tovtunec NN, Sharshov KA, Durimanov AG, Penkovskaya NA, Shestopalov AM, Lerman I, Drozdov IG, Swayne DE. Surveillance and Identification of Influenza A Viruses in Wild Aquatic Birds in the Crimea, Ukraine (2006–2008). Avian Dis 2010; 54:1086-90. [DOI: 10.1637/9272-020510-resnote.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Lerman I, Harrison BC, Freeman K, Hewett TE, Allen DL, Robbins J, Leinwand LA. Genetic variability in forced and voluntary endurance exercise performance in seven inbred mouse strains. J Appl Physiol (1985) 2002; 92:2245-55. [PMID: 12015333 DOI: 10.1152/japplphysiol.01045.2001] [Citation(s) in RCA: 203] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The goal of this study was to characterize the genetic contribution to both forced and voluntary exercise performance and to determine whether performance in these two paradigms is controlled by similar genetic influences. There were marked strain differences in treadmill exercise performance, with Swiss Webster (SW) and FVB/NJ mice showing elevated performance and C57BL/6J animals showing decreased performance compared with all other strains. There was no apparent relationship between treadmill performance and voluntary wheel performance, with the exception of SW mice, which demonstrated high performances on both the treadmill and the voluntary wheel. Numerous properties were measured to attempt to understand the basis for these differences in exercise performance. DBA/1J and SW mice exhibited significantly greater cardiac contractility than all other analyzed strains. Conversely, BALB/cByJ mice exhibited significantly reduced cardiac contractility compared with all other strains. Expression of molecular indicators of hypertrophy (atrial natriuretic factor and beta-myosin heavy chain) was significantly elevated in DBA/2J myocardium compared with all other analyzed strains.
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Affiliation(s)
- Imanuel Lerman
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado at Boulder, 80309, USA.
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22
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Freeman K, Lerman I, Kranias EG, Bohlmeyer T, Bristow MR, Lefkowitz RJ, Iaccarino G, Koch WJ, Leinwand LA. Alterations in cardiac adrenergic signaling and calcium cycling differentially affect the progression of cardiomyopathy. J Clin Invest 2001; 107:967-74. [PMID: 11306600 PMCID: PMC199560 DOI: 10.1172/jci12083] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The medical treatment of chronic heart failure has undergone a dramatic transition in the past decade. Short-term approaches for altering hemodynamics have given way to long-term, reparative strategies, including beta-adrenergic receptor (betaAR) blockade. This was once viewed as counterintuitive, because acute administration causes myocardial depression. Cardiac myocytes from failing hearts show changes in betaAR signaling and excitation-contraction coupling that can impair cardiac contractility, but the role of these abnormalities in the progression of heart failure is controversial. We therefore tested the impact of different manipulations that increase contractility on the progression of cardiac dysfunction in a mouse model of hypertrophic cardiomyopathy. High-level overexpression of the beta(2)AR caused rapidly progressive cardiac failure in this model. In contrast, phospholamban ablation prevented systolic dysfunction and exercise intolerance, but not hypertrophy, in hypertrophic cardiomyopathy mice. Cardiac expression of a peptide inhibitor of the betaAR kinase 1 not only prevented systolic dysfunction and exercise intolerance but also decreased cardiac remodeling and hypertrophic gene expression. These three manipulations of cardiac contractility had distinct effects on disease progression, suggesting that selective modulation of particular aspects of betaAR signaling or excitation-contraction coupling can provide therapeutic benefit.
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Affiliation(s)
- K Freeman
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado, Boulder, CO 80309-0347, USA
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Abstract
OBJECTIVES Several studies have demonstrated that a large percentage of older people are inadequately immunized against tetanus. The aim of this study was to assess the immunity against tetanus in a group of individuals aged 69 and older and to examine the immune response to a single dose of tetanus toxoid. DESIGN A convenience sample of 115 residents of a large retirement home, aged 69 and older, was studied. After a blood sample for anti-tetanus antibody titer, a single dose of tetanus toxoid vaccine was administered. Repeat titers were obtained 6 weeks after the vaccination and analyzed by ELISA assay. Antibody levels equal to or greater than 0.1 IU/mL were considered protective. RESULTS Sixty-seven of 115 (58.3%) individuals had adequate antibody titers. Those individuals who reported having been vaccinated with tetanus toxoid in the past were more likely to be immunized adequately compared with those who reported having never been vaccinated (66.7% vs 39.3%, P = .02). After vaccination, 34 of 46 (73.9%) individuals with inadequate antibody titers became seropositive. Those who remained seronegative had mean prevaccination antibody titers significantly lower than those who seroconverted. Sixteen of 17 (94.1%) persons who reported having been vaccinated in the past and were found to be seronegative developed adequate antibody titers following vaccination, compared with only nine of 16 (56.2%) who reported never having been vaccinated (P = .04). There was no association between seroconversion rate and age, sex, underlying diseases, and army service. CONCLUSIONS Most individuals will develop an adequate anti-tetanus antibody titer following administration of a single dose of tetanus vaccine. A history of past immunization is a good predictor of becoming adequately immunized. It is important that physicians follow the current recommendations for adult immunization and initiate campaigns to ensure that the older population is protected against tetanus.
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Affiliation(s)
- T Shohat
- Tel-Aviv Health District and the Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Israel
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24
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del Rincón JP, Lerman I, Vázquez-Lamadrid J, Gómez-Pérez FJ, Granados J, Morales JJ, Mutchinick O. Hypopituitarism in Two Brothers Born by Breech Delivery. Endocr Pract 1999; 5:143-7. [PMID: 15251687 DOI: 10.4158/ep.5.3.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe two brothers with hypopituitarism who had been born by breech delivery and to discuss whether this condition corresponds to a familial form or to a pituitary stalk section as a result of the breech delivery. METHODS We present the clinical, biochemical, and magnetic resonance imaging (MRI) characteristics of two Mexican brothers, 19 and 21 years old, with hypopituitarism and a history of breech delivery. RESULTS Physical examination of both patients showed short stature with normal body proportions, an obviously younger appearance than that expected for their chronologic age, high-pitched voice, irregularly positioned teeth, no axillary or pubic hair, and prepubertal genitalia. Biochemical testing showed low thyroxine and free thyroxine values with inadequate or normal thyrotropin, low basal testosterone, and mildly increased serum prolactin levels. Stimulation tests showed a normal and a delayed thyrotropin response to thyrotropin-releasing hormone, subnormal serum cortisol, considerably blunted growth hormone (GH) response to insulin-induced hypoglycemia, and absence of GH response to GH-releasing hormone in both cases. MRI showed an ectopic neuropituitary gland. In case 1, a caudal portion of a very thin pituitary stalk was observed, suggesting the preservation of a vascular component of the stalk. Because both parents of these brothers shared the major histocompatibility complex haplotype HLA-A*2301, B*3501, DRB1*0407, DQA1*03, DQB1*0201, consanguinity was suggested. CONCLUSION The phenotype of these patients differs from that described in families with POU1F1 (Pit-1) and PROP1 mutations. These cases are most likely related to an autosomal recessive gene mutation that warrants further research. To our knowledge, this is the first report of hypopituitarism in two brothers born by breech delivery.
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Affiliation(s)
- J P del Rincón
- Department of Endocrinology, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico
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25
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Bautista-Martinez S, Aguilar-Salinas CA, Lerman I, Velasco ML, Castellanos R, Zenteno E, Guillen LE, Murcio R, Wong B, Gómez Pérez FJ, Rull-Rodrigo JA. Diabetes knowledge and its determinants in a Mexican population. Diabetes Educ 1999; 25:374-81. [PMID: 10531857 DOI: 10.1177/014572179902500308] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to measure the level of diabetes knowledge in a representative group of Mexican individuals with diabetes and to identify the factors that influence it. METHODS A validated questionnaire was administered to 570 outpatients; 11.2% had Type 1 diabetes, 36.4% had Type 2 diabetes treated with insulin, and 52.2% had Type 2 diabetes treated with oral agents. Samples for HbA1c determination also were obtained. RESULTS The percentage of correct answers in each section of the questionnaire was low. Type 1 patients had the highest scores, followed by the insulin-treated Type 2 patients; those with chronic complications also had high scores. Educational background, attendance at diabetes courses, age, and HbA1c concentration were the main predictors of knowledge. Attendance at courses was influenced by the severity of the disease. CONCLUSIONS The amount of patient knowledge about diabetes-related issues was low in this representative Mexican population. The educational efforts were focused on those with the worst metabolic control and/or with diabetes complications.
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Affiliation(s)
- S Bautista-Martinez
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - C A Aguilar-Salinas
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - I Lerman
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - M L Velasco
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - R Castellanos
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - E Zenteno
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - L E Guillen
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - R Murcio
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - B Wong
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - F J Gómez Pérez
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
| | - J A Rull-Rodrigo
- The Department of Diabetes and Lipid Metabolism, National Institute of Nutrition Salvador Zubrian (INNSZ), Mexico City, Mexico
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Schmidt L, Li F, Brown RS, Berg S, Chen F, Wei MH, Tory K, Lerman I, Zbar B. Mechanism of tumorigenesis of renal carcinomas associated with the constitutional chromosome 3;8 translocation. Cancer J Sci Am 1995; 1:191-195. [PMID: 9166475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE Members of a family carrying a constitutional balanced translocation [t(3;8) (p14;q24)] have a high risk of developing multiple, bilateral clear-cell renal carcinomas. Two genetic mechanisms of carcinogenesis for this malignancy have been proposed: (1) disruption of a gene at the translocation breakpoint and (2) mutation of the von Hippel-Lindau tumor-suppressor gene at 3p25. This study further evaluates the role of the von Hippel-Lindau gene in the etiology and pathogenesis of t(3;8)-associated renal carcinomas. METHODS Two new t(3;8)-associated renal carcinomas were tested for mutations in the von Hippel-Lindau gene by single-stranded conformational polymorphism analysis followed by direct DNA sequencing, for loss of alleles on chromosomes 3p and 8, and for methylation abnormalities in the first cloned exon of the von Hippel-Lindau gene. RESULTS A missense mutation in the von Hippel-Lindau gene was found in one of the two t(3;8)-associated renal carcinomas. This mutation would produce a stop codon and a truncated protein. Both tumors showed a loss of alleles on the derivative 8 chromosome. When these results were combined with the results of our previous studies, two of the four t(3;8)-associated renal carcinomas, which were examined for molecular genetic changes, showed different von Hippel-Lindau somatic mutations. All renal tumors from the 3;8 translocation family showed loss of the translocated portion of chromosome 3. CONCLUSIONS These results support a mechanism of tumorigenesis in the chromosome (3;8) translocation family that involves the loss of both copies of the von Hippel-Lindau gene.
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Affiliation(s)
- L Schmidt
- Biological Carcinogenesis and Development Program, Program Resources, Inc./DynCorp, USA
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28
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Sienra Pérez JC, Hernández R, Lerman I, Ríos JM, Gómez T, Rull JA, Gómez-Pérez FJ. [Comparison of various methods of determining blood sugar levels using reactive strips]. Rev Invest Clin 1988; 40:265-9. [PMID: 3217618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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29
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Lerman I, Wadgymar A. [Polycystic kidneys of the adult. Report of 54 cases]. Rev Invest Clin 1986; 38:129-34. [PMID: 3738274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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