NeuroImage
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Randomized Controlled Trial
Determining the optimal level of smoothing in cortical thickness analysis: a hierarchical approach based on sequential statistical thresholding.
The extent of smoothing applied to cortical thickness maps critically influences sensitivity, anatomical precision and resolution of statistical change detection. Theoretically, it could be optimized by increasing the trade-off between vertex-wise sensitivity and specificity across several levels of smoothing. But to date neither parametric nor nonparametric methods are able to control the error at the vertex level if the null hypothesis is rejected after smoothing of cortical thickness maps. ⋯ The hierarchical method was further validated in a cross-sectional study comparing moderate Alzheimer's disease (AD) patients with healthy elderly subjects. Results suggest that the extent of cortical thinning reported in previous AD studies might be artificially inflated by the choice of inadequate smoothing. In these cases, interpretation should be based on the location of local maxima of suprathreshold regions rather than on the spatial extent of the detected signal in the statistical parametric map.
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Randomized Controlled Trial
Xenon-induced changes in CNS sensitization to pain.
Electrophysiological investigations of the spinal cord in animals have shown that pain sensitizes the central nervous system via glutamate receptor dependent long-term potentiation (LTP) related to an enhancement of pain perception. To expand these findings, we used functional magnetic resonance (fMRI), blood oxygen level dependent (BOLD) and perfusion imaging in combination with repeated electrical stimulation in humans. Specifically we monitored modulation of somatosensory processing during inhibition of excitatory transmission by ocular application of the glutamate receptor antagonist xenon. ⋯ Moreover, effects of xenon on behavioral, fMRI and perfusion data scaled with stimulus intensity. The dependence of pain sensitization on sufficient pre-activation reflects a multistage process which is characteristic for glutamate receptor related processes of LTP. This study demonstrates how LTP related processes known from the cellular level can be investigated at the brain systems level.
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Randomized Controlled Trial
Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs).
Controversy remains regarding the mechanisms of acupuncture analgesia. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and mu-opioid receptors (MORs). This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. ⋯ These short- and long-term effects were absent in the sham group where small reductions were observed, an effect more consistent with previous placebo PET studies. Long-term increases in MOR BP following TA were also associated with greater reductions in clinical pain. These findings suggest that divergent MOR processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture.
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Randomized Controlled Trial
An fMRI study on the interaction and dissociation between expectation of pain relief and acupuncture treatment.
It is well established that expectation can significantly modulate pain perception. In this study, we combined an expectancy manipulation model and fMRI to investigate how expectation can modulate acupuncture treatment. Forty-eight subjects completed the study. ⋯ Thus, expectation should be used as an important covariate in future studies evaluating acupuncture efficacy. In addition, we also observed dissociation between subjective reported analgesia and objective fMRI signal changes to calibrated pain in the analysis across all four groups. We hypothesize that as a peripheral-central modulation, acupuncture needle stimulation may inhibit incoming noxious stimuli; while as a top-down modulation, expectancy (placebo) may work through the emotional circuit.
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Randomized Controlled Trial
Expectancy and treatment interactions: a dissociation between acupuncture analgesia and expectancy evoked placebo analgesia.
Recent advances in placebo research have demonstrated the mind's power to alter physiology. In this study, we combined an expectancy manipulation model with both verum and sham acupuncture treatments to address: 1) how and to what extent treatment and expectancy effects - including both subjective pain intensity levels (pain sensory ratings) and objective physiological activations (fMRI) - interact; and 2) if the underlying mechanism of expectancy remains the same whether placebo treatment is given alone or in conjunction with active treatment. ⋯ We believe our study provides brain imaging evidence for the existence of different mechanisms underlying acupuncture analgesia and expectancy evoked placebo analgesia. Our results also suggest that the brain network involved in expectancy may vary under different treatment situations (verum and sham acupuncture treatment).