1) The study investigated the differences in cerebral activity and clinical efficacy between acupuncture and sham acupuncture treatment for functional dyspepsia (FD).
2) 72 FD patients were randomly assigned to receive either real acupuncture or sham acupuncture for 4 weeks. 10 patients from each group also underwent PET scans before and after treatment.
3) Results showed acupuncture was more effective at reducing dyspeptic symptoms compared to sham acupuncture based on clinical scores. Acupuncture also produced greater deactivation of brain regions like the brainstem, anterior cingulate cortex, insula, thalamus, and hypothalamus compared to sham acupuncture. Deactivation of these regions correlated with improvement in clinical scores for
Efficacy of classification-based_cft_in_nsclbpMeziat
Artigo (6) importante para a preparação para o curso de dor lombar crônica. "Eficácia da Terapia Cognitiva Funcional em pacientes com dor lombar crônica inespecífica: ensaio clínico randomizado controlado."
Efficacy of classification-based_cft_in_nsclbpMeziat
Artigo (6) importante para a preparação para o curso de dor lombar crônica. "Eficácia da Terapia Cognitiva Funcional em pacientes com dor lombar crônica inespecífica: ensaio clínico randomizado controlado."
Watch the webinar recording: http://bit.ly/1hnf3Os
Objectives:
1.Understanding when delirium can and cannot be assessed, and how sedatives make an accurate assessment more complicated
2.Understanding why different genetics, administering more than one drug or duration of sedative drug administration can change therapeutic effect and why it matters in the critically ill
Watch the webinar recording: http://bit.ly/1hnf3Os
Objectives:
1.Understanding when delirium can and cannot be assessed, and how sedatives make an accurate assessment more complicated
2.Understanding why different genetics, administering more than one drug or duration of sedative drug administration can change therapeutic effect and why it matters in the critically ill
Creation of a Statewide Survey of Incentives and Disincentives for the Use of...Anne Arendt
Creation of a Statewide Survey of Incentives and Disincentives
for the Use of OpenCourseWare in Utah
Teaching with Technology Idea Exchange TTIX10
University of Utah
June 10, 2010
El Diclonius (Humanos con dos pequeños cuernos) son unos mutantes creados por el hombre con un don que se le podría denominar como un sexto sentido. Estos seres, tienen el poder necesario como para eliminar toda la humanidad.La humanidad esta preocupada y comienza a estudiarlos para buscar un remedio. Lucy, uno de los diclonius, se escapa de su cámara de contención, matando a todo aquel que se interpone en su camino, hasta caer al mar por un intento fallido de acabar con ella. Al dia siguiente acaba en una playa, donde Kouta y Yuka la encuentran y la alojan en su finca con el nombre de Nyu.
El Maestro Sri Deva Fénix, investigador por naturaleza, nos devela una parte de la historia perdida de Venezuela, poco conocida por la gran mayoría de sus habitantes... El proceso evolutivo de la cultura venezolana es corto. Empieza con la llegada de los españoles y corre hasta nuestros días. Cuenta apenas 5 siglos.
Un sentimiento de venezolanidad, de identidad no se debe limitar al estudio de los 5 siglos, sino bucear en las grandes heredades indígenas, africanas e ibéricas de donde proceden los pueblos, los arquetipos y los símbolos que nos alientan y explican en el tránsito de existir y de ser, de donde venimos y a donde vamos...
Efficacy and safety of traditional Chinese medicine kidney-nourishing formula...LucyPi1
Abstract Objective: Finding an effective therapy against Alzheimer’s disease (AD) has been associate increasingly pressing issue and traditional Chinese medicine (TCM) is widespread in the prevention and treatment of AD in China. The aim of this study was to judge the efficaciousness and safety of TCM kidney-nourishing (the changes of pathological state of kidney deficiency by means of TCM treatment and so on) formula (TKNF) for AD in comparison with donepezil. Methods: The retrieval period of seven databases was from the establishment of each database to April 2019. Two authors independently identified randomized controlled trials (RCTs), fetched data and assessed bias risk. Comprehensive analysis process was conducted with review manager for eligible and appropriate RCTs. Results: A complete of 981 AD patients from 13 studies were enclosed. Meta-analysis of RCTs showed that there was no significant difference in the improvement of Alzheimer's disease assessment scale-cognitive subscale score between 2 groups in short term, but the effect of long-term treatment may exceed donepezil; there was a significant difference in the improvement of activities of daily living score between 2 groups; there was a significant difference in TCM curative efficacy between 2 groups with long-term treatment. There was no significant difference in the incidence of adverse events between 2 groups. The quality of the evidence was high or moderate. Conclusion: Compared with donepezil, TKNF was an effective drug for AD patients and the clinical application of TKNF was safe. TKNF's long-term benefits need more evidence to verify.
Risk of pulmonary aspiration with the outpatient electroconvulsive therapy: C...Ahmed Elaghoury
A case study presented at the 2nd International Brain Stimulation in Barcelona.
Cite as: Gad, M., & Elaghoury, A. (2017). Risk of pulmonary aspiration with the outpatient electroconvulsive therapy: Case report. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 10(2), 419.
http://dx.doi.org/10.1016/j.brs.2017.01.244
Depression Involved in the Chemotherapy Induced Event-based Prospective Memor...IJEAB
The aim of this study was to investigate the relationships between depression and occurrence of chemotherapy induced prospective memory impairment in patients with breast cancer (BC).The 63 BC patients before and after chemotherapy were administered with the self-rating depression scale (SDS) and a battery of cognitive neuropsychological tests including event-based and time-based prospective memory (EBPM and TBPM, respectively) tasks. The changes in their prospective memory and cognitive neuropsychological characteristics before and after chemotherapy were compared. Compared with the scores before chemotherapy, the EBPM score exhibited a statistically significant difference after chemotherapy (t = 6.069, P < 0.01), while the TBPM score showed no significant difference (t = 1.087, P > 0.05). Further, compared with the patients without depression, the patients with depression exhibited a statistically significant difference in the EBPM score (t = -4.348, P < 0.01), while the TBPM scores did not show a statistically significant difference between the two groups (t = -1.260, P > 0.05). Post-chemotherapy, EBPM and overall cognitive functions in BC patients merged with depression were found to decline, while TBPM did not show a significant change, suggesting that the combination of chemotherapy and depression might be related with the occurrence of post-chemotherapy EBPM impairment.
An Exploration of Acupuncture Treatment to Meniere’s Disease by Tong Zheng Hong by Advancements in Bioequivalence & Bioavailability
Yin-Yang balance is absolutely the unique concept of traditional Chinese medicine (TCM) that distinguishes TCM from the Western medicine. A disease indicates a loss of the balance of Yin-Yang. The research shows acupuncture combined with western medicine comprehensive treatment (WMCT) can be more effective for the symptoms of Meniere’s disease such as vertigo and dizziness, but it remains uncertain whether acupuncture is good for hearing loss.
Does Liuzijue Qigong affect anxiety in patients with chronic obstructive pulm...LucyPi1
Abstract Background: Anxiety is a common comorbidity associated with chronic obstructive pulmonary disease (COPD), but no well-recognized method can provide effective relief. Liuzijue Qigong (LQG) is a traditional Chinese fitness method, based on breath pronunciation. This study aimed to examine the efficacy of LQG to relieve anxiety in COPD patients and to explore the factors that influence anxiety, including whether LQG is effective during the coronavirus disease 2019 (COVID-19) outbreak. Methods: We conducted an open-label, randomized, controlled, clinical trial. A total of 60 patients with stable COPD were randomly assigned to two groups. Both groups were given routine medical treatment, and the patients in the pulmonary rehabilitation (PR) group were given an extra intervention in the form of LQG, performed for 30 minutes each day for 12 weeks. Data collection was performed at baseline and 12 weeks (during the COVID-19 epidemic). The primary outcomes were the self-rating anxiety scale (SAS) scores, and the secondary outcomes were relevant information during the epidemic and analyses of the related factors that influenced SAS scores during the COVID-19 outbreak. Results: Compared with baseline, patients in both groups demonstrated varying degrees of improvements in their SAS scores (all P < 0.01). An analysis of covariance, adjusted for baseline scores, indicated that the SAS scores improved more dramatically in the PR group than in the control group (F = 9.539, P = 0.004). During the outbreak, the SAS scores for sleep disorder were higher than all other factors, reaching 1.38 ± 0.67, and the scores for “I can breathe in and out easily” for the PR group were lower than the scores for the control group (Z = −2.108, P = 0.035). Significant differences were identified between the two groups for the categories “How much has the outbreak affected your life”, “Do you practice LQG during the epidemic” and “Do you practice other exercises during the epidemic” (all P < 0.05). Compared with current reports, LQG had a relatively high adherence rate (80.95%). A multiple linear regression analysis revealed multiple predictors for SAS scores during the outbreak: group (b = −3.907, t = −3.824, P < 0.001), COPD assessment test score (b = 0.309, t = 2.876, P = 0.006), SAS score at baseline (b = 0.189, t = 3.074, P = 0.004), and living in a village (b = 4.886, t = 2.085, P = 0.043). Conclusion: LQG could effectively reduce the risks of anxiety among COPD patients, even during the COVID-19 outbreak. For those COPD patients with high COPD assessment test and high baseline SAS scores or who live in villages, we should reinforce the management and intervention of psychological factors during the epidemic.
Efficacy and safety of human placental extract solution on fatigue (http://pl...Swapan Das
From:http://placentrex.blogspot.com/
For the readers of Human Placental Extract (HPE) Blog blog we have come up with the following study recently conducted by a Korean team on the efficacy and safety of Human Placental Extract solution on fatigue. Fatigue is a common symptom, but only a few effective treatments are available. This study was supported by a grant from Unimed Pharm., INC. and was conducted at the requests of the Korea Food and Drug Administration (KFDA).
http://placentrex.blogspot.com/2011/09/kfda-requests-for-study-of-hpes-role-on.html
Highly active antiretroviral therapyi (HAART), a combination of drugs (lamivudine, zidovudine and nevirapine) used for pre-exposure prophylaxis and management of Human Immunodeficiency Virus infection in sub-Saharan Africa. The objective of this research work was to investigate the potential Ameliorative effect of neuroviteon on HAART induced toxicity on the cerebellum. Thirty two Wistar rats were divided into 4 groups of 8 rats each. Group A served as the control, while group B were administered with 9.28 mg/kg of HAART, group C received 9.28 mg/kg of HAART and 0.07mg/kg of folic acid and group D received 0.07mg/kg folic acid. Drugs were administered twice daily for 30 days after which neurobehavioural test of open field maze was perform. The rats were then sacrificed and their cerebellum harvested, processed and stained using haematoxylin and eosin method and nuro-fillament (NF) immunochemistry method. The slides were viewed under light microscope. Results showed a significant reduction in the brain to body weight index between the HAART group and the control and folic acid group. There was significant reduction in locomotor activity following administration of HAART to the animals compared with control, there were also significant reduction in rearing frequency , walling frequency and freezing duration, with a significant increased in freezing duration in the HAART treatment group. The freezing frequency, central line crossing and grooming frequency were not significantly different. The cerebella were affected with mild to moderate shrinkage of pyramidal cells and distortion of the granular cells. There was increased expression of NF in the HAART group compared to controls. HAART affects the weight, histology of the cerebellum and neurobehaviour. Neurovite has the potential of ameliorating the histological distortion and may be beneficial to people taking HAART.
The selection rules of acupoints and meridians of traditional acupuncture for...LucyPi1
Abstract Background: Postoperative nausea and vomiting (PONV) refers to a problem commonly occurring after surgery. Acupuncture is considered a critical complementary alternative therapy for PONV. The acupoints selection critically determines the efficacy of acupuncture, whereas the selection rules remain unclear. The objective of the present study was to delve into the principles of acupoints selection for PONV using data mining technology. Methods: The clinical trials assessing the acupuncture effect for PONV were searched with the use of computer in PubMed, China National Knowledge Infrastructure, and Chinese Biomedical Database; the time span was confined as 2009–2019. The database of acupuncture prescriptions for PONV was built using Excel 2016; the description and association were analyzed by IBM SPSS modeler 18. Result: Eighty-three relevant literatures were screened out. The number of specific acupoints took up 72.5% of all acupoints; specific acupoints exhibited the frequency taking up 91.30% of the total frequency. As revealed from the result, Neiguan (PC 6), Zusanli (ST 36), Hegu (LI 4), and Zhongwan (CV 12) were most frequently applied, suggesting the tightest associations. Most acupoints were taken from the stomach meridian and pericardium meridian. The common acupoints were concentrated in the lower limbs, chest, as well as abdomen. Conclusion: Data mining acts as a feasible method to identify acupoints selection and compatibility characteristics. As suggested from our study, the acupoints selection for PONV prioritizes specific acupoints and related meridians. The selection and combination of acupoints comply with the theory of traditional Chinese medicine.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. 2 Zeng et al.
health-care and social issue because of its high prevalence (3), unclear Chinese Medicine from December 2008 to May 2010. Patients
pathology, unsatisfactory treatment options (4), large medical were enrolled if they met the following criteria: (i) were right-
burden (5), and serious reduction in quality of life (QOL) (6). handed and aged 20 to 30 years; (ii) matched the Rome III diagno-
FUNCTIONAL GI DISORDERS
Hence, both patients and practitioners desire effective alternative sis criteria for FD; (iii) matched the Rome III diagnosis criteria for
therapies. postprandial distress syndrome; (iv) were acupuncture-naïve; and
In China and some other Asian countries, acupuncture, a major (v) signed an informed-consent form. Participants were screened
medical resource, has been used to treat gastrointestinal symptoms out if they (i) were pregnant, might become pregnant, or were lac-
for several millennia. In Western countries, acupuncture is being tating; (ii) suffered from or had a history of serious neurological,
increasingly accepted as an alternative treatment for functional cardiovascular, respiratory, or renal illnesses; (iii) had a history of
gastrointestinal disorders (7,8). During the past decade, a consid- head trauma with loss of consciousness; (iv) suffered from men-
erable number of clinical and experimental studies have indicated tal disorders including major depressive disorder such as anxi-
that acupuncture is able to relieve gastric symptoms such as belch, ety disorder, bipolar disorder, schizophrenia, or claustrophobic
abdominal distension, and stomachache and to alter gastrointesti- syndrome; (v) were using aspirin, nonsteroidal anti-inflamma-
nal motility functions (9–12), as well as that acupuncture points on tory drugs, steroids, phenothiazines, selective serotonin reuptake
the stomach meridian were the most effective sites for gastric dis- inhibitors, medications affecting gastrointestinal motility, or cer-
orders (11,12). However, it is not fully understood how needling at tain other drugs; (vi) were currently participating in other clini-
acupuncture points works and how real acupuncture differs from cal trials; or (vii) had any contraindications to acupuncture (e.g.,
sham acupuncture. anticoagulation therapy).
Many studies have demonstrated that most of the clinical ben- After a 2-week baseline period, the enrolled patients were ran-
efits of acupuncture are mediated by the central nervous system domly assigned to either the acupuncture group or the sham
(13,14), but the specific effects of acupuncture on the human acupuncture group using a computer-generated randomization
brain remain uncertain. With the development of neuroimaging sequence. The sequence was concealed from the care providers
techniques, the use of positron emission tomography (PET) and through the use of sealed, opaque, sequentially numbered enve-
functional magnetic resonance imaging to explore the central lopes. Patients were blinded to group assignment.
mechanism of acupuncture has been an active area of research. This study was performed according to the principles of the
However, most current studies are centered on the healthy state or Declaration of Helsinki (Edinburgh version, 2000). The study
organic diseases, and little work has been undertaken with regard protocol was approved by the Ethics Committee of the 1st Teach-
to functional disorders, which is where the advantages of acupunc- ing Hospital of the Chengdu University of Traditional Chinese
ture treatment lie. Medicine.
In a previous study, we found that FD patients showed an
extensive increasing cerebral glycometabolism, especially in Acupuncture interventions
the homeostatic afferent processing network, compared with Each group’s treatment consisted of 20 sessions of acupuncture
healthy subjects. The anterior cingulate cortex (ACC), insula, and treatment, with a duration of 30 min, each administered over
thalamus/hypothalamus might be the regions most closely related a period of 4 weeks (five sessions per week). The acupuncture
to the severity of FD (15). We hypothesize that successful acupunc- treatment was performed on four classic acupuncture points
ture therapy will reduce the increase in cerebral glycometabolism for gastric disorders: ST34 (Liangqiu), ST36 (Zusanli), ST40
and regulate the activity of these key regions. Our previous work (Fenglong), and ST42 (Chongyang). The sham acupuncture treat-
also suggested that affecting cerebral activity might be the mecha- ment was performed on four non–acupuncture points (points
nism through which short-term manual acupuncture treatment 1–4), which were selected in accordance with the findings of
relieves FD (16). However, the differences in efficacy and cerebral previous studies (17–19) (Figure 1).
responses between acupuncture and sham acupuncture were not All acupuncture points and non–acupuncture points were punc-
addressed in our previous study. Hence, the present study aimed to tured unilaterally and alternated between left side and right side.
(i) assess the efficacy of acupuncture treatment for FD by compar- After the skin was cleaned with tincture iodine and alcohol, sterile
ing the differences in therapeutic effects between acupuncture and acupuncture needles (0.25 mm in diameter, 25 or 40 mm long,
sham acupuncture and (ii) investigate the influence of acupunc- Hwatuo, Suzhou, China) were inserted for 15–25 mm and gently
ture and sham acupuncture on cerebral glycometabolism and ana- twisted, lifted, and thrusted in even amplitude, force and speed
lyze the possible correlations between clinical variables and brain four to six times until a deqi response (soreness, numbness, disten-
responses in order to explore the potential central mechanism of sion, and heaviness) was obtained. Then, auxiliary needles were
acupuncture treatment. inserted in the proximal limbs or trunk laterally to the acupunc-
ture points and non–acupuncture points to a depth of 2 mm with-
out stimulation. Each acupuncture needle and its auxiliary needle
METHODS were connected to the electrical leads of the HAN Acupoint Nerve
Participants Stimulator (HANS, Model LH 200A TENS, Nanjing, China) for
FD patients were recruited from the outpatient department in the 30 min, with a stimulation frequency of 2/100 Hz and a stimulation
1st Teaching Hospital of the Chengdu University of Traditional intensity varying from 0.1 to 1.0 mA.
The American Journal of GASTROENTEROLOGY VOLUME 104 | XXX 2012 www.amjgastro.com
4. 4 Zeng et al.
to provide 30 patients in each group in order to meet the require- In this way, we could gain regions of interest for correlation anal-
ment of minimum sample size. ysis. After voxels not belonging to the same anatomical region
within the cluster were discarded, the activities of the survived
FUNCTIONAL GI DISORDERS
Clinical variables. The clinical variables were analyzed with voxels were extracted and averaged. Pearson coefficients were cal-
SPSS 16.0 (SPSS, Chicago, IL) by two blinded evaluators. The culated between the mean activity of the cluster and the increase
data analysis was based on an intention-to-treat population. We in NDI score, the mean activity of the cluster, and the decrease in
omitted the cases with missing data, which reflected only the SID score.
baseline measurement. Analysis of variance and the Kruskal– Based on individual cerebral activity changes before and after
Wallis test were used for numerical variables. A χ2 test was used real/sham acupuncture treatment, we performed a two-sample
for categorical variables. A two-sided test was applied for all t-test to further detect between-group differences using the
available data. A P value < 0.05 was considered statistically sig- following contrast: real acupuncture group (each FD patient: after
nificant. treatment minus at baseline) minus sham acupuncture group (each
FD patient: after treatment minus at baseline).
PET-CT data. The PET-CT data were processed with the statisti- For visualization, all results were transformed into the Talairach
cal parametric mapping technique (SPM5; http://www.fil.ion.ucl. stereotactic space and overlaid on MRIcro (http://www.sph.s.c.
ac.uk/spm) and MATLAB (The Math Works, Sherborn, MA). The edu/comd/rorden/mricro.html) for presentation.
data preprocessing entailed the following steps. (i) Individual PET
images were subjected to coregistration onto their corresponding
CT images to improve the accuracy of the spatial normalization. RESULTS
(ii) The PET images from each subject were spatially normalized From December 2008 to May 2010, 72 FD patients were randomly
to the standard SPM-PET template and resliced to 2-mm isotropic assigned. In all, 64 patients (34 in the acupuncture group and
resolution. The first step of the normalization was to determine 30 in the sham acupuncture group) comprised the pre-proto-
the optimal 12-parameter affine transformation. The affine reg- col population. Twenty patients (10 in each group) finished the
istration was followed by estimation of nonlinear deformations, PET-CT scans.
whereby the deformations are defined by a linear combination
of three-dimensional discrete cosine transform basis functions. The baseline characteristics
(iii) The resultant transformation was applied to the coregistered Demographics, including age, sex, weight and height, and dis-
PET images so that all subjects matched the same spatial template. ease status as indicated by, for example, duration of symptoms,
(iv) The normalized data set was spatially smoothed with a 6-mm NDI score, and SID score, did not differ between the two groups
full width at half maximum Gaussian kernel. (P > 0.05) (Table 1).
To detect the cerebral activity changes in FD patients after
treatment, we compared the differences in the cerebral glycome- The therapeutic effects
tabolism pattern between FD patients at baseline and after treat- In the acupuncture group, the SID score for postprandial disten-
ment. Statistical parametric maps were constructed by computing sion significantly decreased, from 1.912±0.571 to 0.880±0.640
a paired t-test, which was defined as FD patients after treatment (P < 0.05); the SID score for early satiety significantly decreased,
minus FD patients at baseline. To explore the possible correlation from 1.352±0.810 to 0.530±0.661 (P < 0.05); and the NDI score
between cerebral responses and clinical efficacy, we employed significantly increased, from 77.812±10.121 to 90.028±8.910
correlation analysis to investigate the correlations of cerebral (P < 0.05) after treatment (Table 2).
glycometabolism changes with the decrease in SID score (end In the sham acupuncture group, the SID score for postpran-
of treatment minus baseline) and increase in NDI score (end of dial distension significantly decreased, from 1.930±0.641 to
treatment minus baseline). The selection of regions of interest was 1.400±0.721 (P < 0.05), and the NDI score significantly increased,
based mainly on our previous study (15) and involved the within- from 78.212±9.223 to 86.040±9.210 (P < 0.05) after treatment. The
group subtraction analysis. In our previous study (15), we found decrease in SID score for early satiety was not significant (P > 0.05)
that the glycometabolism increase in the ACC, middle cingulate (Table 2).
cortex, insula, thalamus, cerebellum, hypothalamus, prefrontal The decrease in SID scores (end of treatment minus baseline) in
cortex, brainstem, hippocampus, and parahippocampal gyrus was the acupuncture group was significantly greater than that in the
significantly related to or tended to be associated with the symp- sham acupuncture group (P<0.05). The increase in NDI score (end
tom severity of FD patients. In the present study, the within-group of treatment minus baseline) between the two groups was not sig-
analysis showed that the activity of these regions changed to a dif- nificant (P > 0.05). Only the increase in NDI score in the acupunc-
ferent degree after treatment. Hence, we chose these 10 regions for ture group was clinically significant because it was greater than the
correlation analysis. For each patient, we chose the MNI coor- minimal clinically important difference (Table 3).
dinates of the maximally abnormal voxel within an anatomical
area as the center to draw a sphere 8 mm in diameter (25). Within Cerebral glycometabolism changes
this sphere, the voxels located in the white matter and ventricles In the acupuncture group, a decrease in cerebral glycometa-
were removed to ensure the integrity of its structure and function. bolism was observed after treatment in the bilateral brainstem,
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6. 6 Zeng et al.
Table 3. Comparison of the therapeutic effects between acupuncture group and sham acupuncture group
Items Acupuncture group Sham acupuncture group Statistical value P value
FUNCTIONAL GI DISORDERS
No. of patients 34 30
NDI score
End of treatment, mean (95% CI) 90.028 (86.920; 93.136) 86.040 (82.600; 89.480) 368.000 0.056
End of treatment—baseline, mean (95% CI) 12.216 (8.533; 15.898) 7.828(4.912; 10.743) 376.500 0.072
SID score: postprandial distension
End of treatment, mean (95% CI) 0.880 (0.660; 1.110) 1.400 (1.130; 1.670) 321.000 0.003
End of treatment—baseline, mean (95% CI) − 1.029 ( − 1.333; − 0.726) − 0.533 ( − 0.768; − 0.299) 343.000 0.014
SID score: early satiety, mean (95% CI)
End of treatment, mean (95% CI) 0.530 (0.300; 0.760) 0.930 (0.620; 1.240) 365.000 0.030
End of treatment—baseline, mean (95% CI) − 0.824 ( − 1.102; − 0.546) − 0.167 ( − 0.428; 0.094) 277.500 0.001
CI, confidence interval; NDI, Nepean Dyspepsia Index; SID, Symptom Index of Dyspepsia.
SID or with NDI were not even might be attributable to the (Table 2). Second, the alleviations in postprandial distension and
different numerical ranges in the SID and NDI scores. early satiety in acupuncture group were greater than those in the
In the sham acupuncture group, the increase in NDI score sham acupuncture group (P<0.05) (Table 3). Furthermore, only
tended to be associated with the glycometabolism decrease in the improvement in QOL caused by acupuncture treatment was
the brainstem (r = − 0.720) and thalamus (r = − 0.724) (P<0.1, clinically valuable (Table 2). Therefore, the differences in clini-
corrected) (Figure 3a). cal efficacy between the two groups indicated that the efficacy of
acupuncture treatment was not nonspecific and that acupuncture
treatment was more effective than sham acupuncture treatment for
DISCUSSION FD patients.
This is the first neuroimaging study that focuses on the poten- Our results were partly in line with those of a study by Park
tial central mechanism of real and sham acupuncture treatments et al. (28), who found that both acupuncture at classic points (real
for FD. It demonstrates the similarities and differences in clinical acupuncture) and acupuncture at nondefined points (sham acu-
efficacy and brain responses between real and sham acupuncture puncture) decreased dyspepsia symptoms and improved the QOL
treatments. of FD patients and that there were no significant differences between
the real acupuncture group and sham acupuncture group. Some
Similarities and differences in clinical efficacy between real methodology issues, including the method of acupuncture stimu-
and sham acupuncture treatments lation (manual acupuncture vs. electro-acupuncture), the length of
In this study, clinical improvements were found in both groups time the needle was kept inserted, duration of treatment, and loca-
after treatment. Both treatments remarkably alleviated post- tion of non–acupuncture point, probably contribute to the differ-
prandial distension and improved the QOL (P<0.05) (Table 2); ences in results. Furthermore, the differences in treatment frequency
in addition, the improvement in QOL between the two groups might be a factor causing the efficacy difference (29). In our study,
did not differ (P > 0.05) (Table 3). These similarities might result the electro-acupuncture treatment was performed five times per
from a placebo effect. In fact, placebo response rates are found to week on each patient for 4 weeks, consistent with the standard prac-
be high in functional gastrointestinal disorder (26). A recent sys- tice in China, whereas in the study by Parket al., the manual acu-
tematic review (27) demonstrated that in all trials of acupuncture puncture treatment was performed on patients three times per week
treatments for gastrointestinal diseases, the significant improve- for 2 weeks. Hence, the stimulating quantity in our study was greater
ments of QOL were independent of real or sham acupuncture. than that in the study by Park et al. However, the influence of treat-
The efficacy of acupuncture in improving QOL in irritable bowel ment frequency on clinical efficacy needs further investigation.
syndrome and inflammatory bowel disease may be explained by
nonspecific effects, whereas specific acupuncture effects may be Similarities and differences in cerebral responses to real and
shown by clinical scores. sham acupuncture treatments
However, based on the results, we found that acupuncture treat- The potential common mechanism of real acupuncture and
ment was significantly superior to sham acupuncture treatment, sham acupuncture treatments for FD. In the present study, both
especially in alleviating symptoms. First, sham treatment was acupuncture treatment and sham acupuncture treatment elicited
effective only for postprandial distension, whereas acupuncture cerebral glycometabolism changes to different degrees. The com-
treatment alleviated both postprandial distension and early satiety mon areas responding to acupuncture and sham acupuncture
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8. 8 Zeng et al.
Table 4. Continued
Region Side Acupuncture group Sham acupuncture group
FUNCTIONAL GI DISORDERS
Talairach t value BA Sign Talairach t value BA Sign
X Y Z X Y Z
Temporal pole L − 44 15 − 30 − 7.59 BA38 ↓
R 47 21 − 23 10.53 BA38 ↓
Middle temporal L − 56 −2 − 25 − 7.59 BA21 ↓
gryrus
R 58 −4 − 24 − 8.04 BA21 ↓ 59 1 − 20 − 13.22 BA21 ↓
Inferior temporal L − 40 − 15 − 20 − 9.63 BA20 ↓
gryrus
R 51 − 10 − 35 − 8.27 BA20 ↓
Middle occipital L − 35 − 65 26 − 24.58 BA39 ↓
gryrus
R 32 − 94 12 − 9.89 BA18 ↓
Postcentral gyrus R 48 − 21 39 16.65 BA3 ↑
Precuneus L − 11 − 64 34 16.88 BA7 ↑
R 9 − 69 45 15.97 BA7 ↑ 5 − 45 18 − 8.04 BA 30 ↓
Parietal inferior L − 29 − 54 45 18.01 BA7 ↑
lobe
ACC, anterior cingulate cortex; BA, Brodmann area; FD, functional dyspepsia; L, left; MCC, middle cingulate cortex; PCC, posterior cingulate cortex; R, right.
Up or down arrow (↑/↓) indicates whether the structure showed a signal increase or decrease, respectively.
P < 0.05, family-wise error corrected with a minimal cluster size of 50 voxels.
2 7 –7 –32 –6
Acupuncture group
12 6 –4 –14 –6
Sham acpuncture group
–35 –6 +6 +35
Figure 2. Cerebral glycometabolism changes in functional dyspepsia (FD) patients after treatment. Acupuncture and sham acupuncture elicited cerebral
glycometabolism changes to different degrees, but acupuncture evoked more pronounced changes in cerebral activity, especially in the homeostatic
afferent processing network. P<0.05, family-wise error corrected with a minimal cluster size of 50 voxels.
included the brainstem, thalamus, some regions in the prefrontal acupuncture group (P<0.1, corrected). The results suggested
cortex, somatosensory cortex, and visual-related cortex. Among that the improvement of QOL might be associated with the
these areas, the glycometabolism decrease in the brainstem deactivations of the brainstem and thalamus in both groups.
and thalamus were significantly related to the increase in NDI The brainstem is the pathway for all fiber tracts passing up and
score in the acupuncture group (P<0.05, corrected) and tended down from the peripheral nerves and spinal cord to the highest
to be associated with an increase in NDI score in the sham parts of the brain, and it serves as a lower center in functions such
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10. 10 Zeng et al.
a b × 1000 c
× 10000
× 10000
0 0 0
Insula (post–pre)
Insula (post–pre)
Insula (post–pre)
–0.3 –0.3
r = –0.85
FUNCTIONAL GI DISORDERS
–0.6 –0.6
Acu –5 Acu
–0.9 –0.9
r = 0.77
–1.2 –1.2
–1.5 –10 –1.5
–5 0 5 10 15 20 25 30 35 Acu Sham –5 –4 –3 –2 –1 0
NDI (post–pre) SID (post–pre)
× 1000
Thalamus (post–pre)
Thalamus (post–pre)
Thalamus (post–pre)
× 10000
× 10000
0 0 0
–0.3
r = –0.72* –0.3
Acu
–0.6 –0.6
–5 r = 0.83 Acu
–0.9 Sham –0.9
r = –0.87
–1.2 –1.2
–1.5 –10 ** –1.5
–5 0 5 10 15 20 25 30 35 Acu Sham –5 –4 –3 –2 –1 0
NDI (post–pre) SID (post–pre)
× 1000
× 10000
× 10000
0 0 0
BS (post–pre)
BS (post–pre)
BS (post–pre)
–0.3 –0.3
r = –0.72* Acu
–0.6 –0.6
r = –0.85 –5 Acu
–0.9 –0.9
r = 0.72*
Sham
–1.2 –1.2
–1.5 –10 –1.5
–5 0 5 10 15 20 25 30 35 Acu Sham –5 –4 –3 –2 –1 0
NDI (post–pre) SID (post–pre)
× 1000
0 × 10000 0
× 10000
0
ACC (post–pre)
ACC (post–pre)
ACC (post–pre)
–0.3 –0.3
r = –0.84
–0.6 Acu –0.6
–5 r = 0.78 Acu
–0.9 –0.9
–1.2 ** –1.2
–1.5 –10 –1.5
–5 0 5 10 15 20 25 30 35 Acu Sham –5 –4 –3 –2 –1 0
NDI (post–pre) SID (post–pre)
× 1000
0 0
× 10000
0
× 10000
HYPO (post–pre)
HYPO (post–pre)
HYPO (post–pre)
–0.3 0 –0.3
r = –0.76
–0.6 Acu –0.6
–5 r = 0.79 Acu
–0.9 –0.9
–5
–1.2 –1.2
–1.5 –10 –1.5
–5 0 5 10 15 20 25 30 35 Acu Sham –5 –4 –3 –2 –1 0
–10
NDI (post–pre) SID (post–pre)
Figure 3. The correlation coefficients of brain responses and clinical variables. (a) In the acupuncture group, the increase in Nepean Dyspepsia
Index (NDI) score was significantly related to the glycometabolism decrease in the insula, thalamus, brainstem, anterior cingulate cortex (ACC), and
hypothalamus (P<0.05, corrected); in the sham acupuncture group, the increase in NDI score tended to be associated with the glycometabolism decrease
in the brainstem and thalamus (P<0.1, corrected). (b) Compared with the sham acupuncture group, the glycometabolism in the thalamus and ACC in
the acupuncture group significantly decreased (P<0.05). (c) In the acupuncture group, the decrease in Symptom Index of Dyspepsia (SID) score was
significantly related to the glycometabolism decrease in the insula, thalamus, ACC, and hypothalamus (P<0.05, corrected); the decrease in SID score
tended to be associated with the glycometabolism decrease in the brainstem (P<0.1, corrected). BS, brainstem; Hypo, hypothalamus; r, correlation
coefficient; *P<0.1, corrected; **P<0.05.
The majority of these deactivated regions in the acupuncture fiber activation. Nonpainful and painful visceral and somatic
group belong to the homeostatic afferent processing network as stimuli, as well as emotional stimuli, can activate this network
well as the corticolimbic network. (33). Our previous study (15) indicated that, as compared with
The homeostatic afferent processing network is a brain network healthy subjects, FD patients showed higher glycometabolism
that is consistently activated in response to homeostatic afferent in the key regions of the homeostatic afferent processing network,
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12. 12 Zeng et al.
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