2 Minute Medicine Rewind June 17, 2024
Anodal M1 tDCS enhances online learning of rhythmic timing videogame skill
1. Transcranial direct current stimulation (tDCS) shows improvement in the learning of complex rhythmic movements
Evidence Rating Level: 1 (Excellent)
Motor learning is a key component of everyday functioning from simple tasks like pressing a button to more complex, coordinated tasks like playing an instrument. Motor skills can be learned during a single practice session (online) or after the session (offline). Various areas of the brain a responsible for motor learning depending on the task. The primary motor cortex (M1) is crucial for the early stages of learning new skills and occurs through reinforcement mediated synaptic strength changes. Transcranial direct current stimulation (tDCS) is a non-invasive stimulation technique that increases cortical excitability using a sub-threshold electrical current. This has been used to stimulate M1 in the past and improve motor function when doing simple laboratory-based tasks. This randomized, single-blinded study aimed to investigate the effects of tDCS in complex motor learning using a rhythmic video game (Step Mania). Participants were evaluated on how well-timed inputs were (temporal accuracy – TA), the rate of wrong key presses (key error rate – KER), and rate of multiple inputs (tap distribution ratio – TDR). After taking baseline performance tests, both groups were given 5 practice blacks. Over the course of the practice blocks, both the tDCS and SHAM (control) groups improved in all areas. However, tDCS lead to greater improvement compared to SHAM. The tDCS group showed better TA and reduced KER. These gains were especially seen in the 4th and 5th practice blocks where tDCS showed significantly greater improvement than SHAM. Using tDCS shows promise as a tool to help patients with motor learning of complex tasks. In the future, tasks regarding complex movements should be tested (e.g., walking) to determine the effects on real-world tasks.
1. Acceptance and Commitment Therapy in patients with coronary heart disease does not affect short-term biological indicators of risk but does improve psychological well-being timelines
Evidence Rating Level: 1 (Excellent)
This randomized controlled trial aimed to evaluate the efficacy of Acceptance and Commitment Therapy (ACT) on biological and psychological well-being of patients with coronary heart disease. The control group received the usual care (UC) of a 6-week multidisciplinary outpatient cardiac rehabilitation program which includes physical exercise, educational counselling, and medical exams. The experimental group received the same care with the addition of ACT given as 3 group sessions. Over the course of care, participants were tested for low-density lipoproteins (LDL), resting systolic blood pressure, body mass index, and a psychological well-being score (Psychological General Well-Being Index – PGWBI). Additionally, psychological inflexibility, dietary habits, exercise, smoking status and quality of life were assessed using questionnaires. Of the tested measures, the only significant change seen was a time effect seen in PGWBI. The study would have been improved with a larger sample size (n=92) though the heterogeneity in the population due to broad inclusion criteria means the results are more generalizable. Conducting the study with the UC as a control group is also a strength as other studies tend to compare to no treatment. A longer ACT duration should be done to investigate the effect of ACT length on outcomes.
1. Dual antiplatelet therapy with ticagrelor and asprin led to a significantly lower risk of major adverse cardiovascular events over 5 years compared to ticagrelor or asprin monotherapy
2. Bleeding and other adverse events were similar between dual antiplatelet, ticagrelor monotherapy, and asprin monotherapy
Evidence Rating Level: 1 (Excellent)
Typically, asprin monotherapy is recommended after a coronary artery bypass graft surgery to reduce the risk of adverse cardiovascular events and improve graft patency. Dual antiplatelet therapy (ticagrelor 90 mg twice daily plus aspirin 100 mg once daily) is currently limited to patients with high ischemic risk. This trial looked to compare ticagrelor dual antiplatelet therapy, ticagrelor monotherapy and asprin monotherapy 5 years after coronary artery bypass grafting. The primary outcome was major adverse cardiovascular events (a composite of all cause death, myocardial infarction, stroke, and coronary revascularization). A safety outcome was also analyzed post hoc and included major bleeding events, and serious adverse events resulting in hospitalization or emergency department visits. Dual antiplatelet therapy (22.6%) resulted in significantly lower risk of major adverse cardiovascular events compared to asprin (29.9%) or ticagrelor monotherapy (32.9%). No difference was seen between asprin or ticagrelor monotherapy. Patients who received dual antiplatelet therapy in the first year and then switched to aspirin monotherapy had significantly lower risk of major adverse cardiovascular events compared to patients only treated with asprin monotherapy. Major bleeding events were not significantly different between any of the groups. A key limitation is that 82% of the participants were male making the generalizability of this study lower.
1. Treating intracerebral hemorrhage (ICH) with endoscopic evacuation or stereotactic aspiration results in more favourable outcomes
2. Stratifying outcomes by location of hemorrhage shows endoscopy and aspiration are preferred for supratentorial deep hemorrhages whereas no significant difference is seen in supratentorial lobar hemorrhages
Evidence Rating Level: 1 (Excellent)
Intracerebral hemorrhage (ICH) is the deadliest type of acute stroke. It is treated with small-bone flap craniotomy, endoscopic evacuation, or stereotactic aspiration. This trial aimed to determine which surgical method is most effective. Patient outcomes were measured using a modified Rankin scale (mRS) score. A favourable outcome was 0-2 (no symptoms to slight disability, unable to carry out all previous activities but able to care for own needs without assistance) at 6-month follow-up. The endoscopy group had the highest hematoma clearance rate (88.3%) followed by craniotomy (86.5%) and aspiration (60.3%) (p=0.000). Craniotomy had the largest intraoperative blood loss (268 mL, p=0.000) compared to endoscopy (88 mL) and aspiration (38 mL). Craniotomy also resulted in the most stroke-related pneumonia at 31.9%. Endoscopy had 22.6% and aspiration had 18.3% (p=0.002). Intracranial infection showed no significant difference. At the 6-month follow-up, the proportion of patients with favourable outcomes was higher in the endoscopy group and aspiration group relative to the craniotomy group (p=0.017). Similarly, mRS scores of 0-2 were achieved in 33.3% of the endoscopy group, 32.7% of the aspiration group but only 22.2% of the craniotomy group. Comparing outcomes by the location of the hemorrhage showed supratentorial deep hemorrhages of the basal ganglia and/or thalamus showed better outcomes when treated with endoscopic surgery or stereotactic aspiration (p=0.001). Supratentorial lobar hemorrhages showed no significant difference between groups but had a slightly higher rate of favourable outcomes when treated with craniotomy.
1. Total knee arthroplasty (TKA) using a MAKO robot improves short-term efficacy and can assist in planning while maintaining high safety.
Evidence Rating Level: 3 (Average)
Traditional total knee arthroplasties (TKA) are done using cutting guides for osteotomy. The precision of osteotomy and soft tissue balancing can significantly affect the postoperative alignment and prosthetic positioning. The MAKO surgical robot can help plan correction and balance ligament tension during surgery. This study aimed to compare the efficacy of TKA assisted by the MAKO robot and conventional TKA through retrospective analysis. At 24h, 48h, and 72h postoperatively, the MAKO-assisted TKA (MA-TKA) group had lower pain at rest and during activity than the conventional manual TKA group (CM-TKA) (p<0.05). One month and three months postoperatively, MA-TKA showed better functionality using the AKSS Function Score and FJS-12 score (p<0.05). There were no significant differences after the three-month follow-up. Complications were not significantly different in either group. While the MAKO robot had better short-term efficacy, assisted with better planning, and maintained good safety, adaptation is difficult due to cost, requirements in the operating room, and regular maintenance. Due to the single-center, retrospective nature of this study, results can be skewed by surgeon skill. Additionally, outcomes of soft-tissue were not compared which can be an area of great improvement with the MAKO robot and could be an area of exploration in the future.
Image: PD
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