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      Central and Peripheral Effects of Transcutaneous Acupuncture Treatment for Nausea in Patients with Diabetic Gastroparesis

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          Abstract

          Background/Aims

          Nausea, an unpleasant symptom of diabetic gastroparesis (DMGP), has been reported to be alleviated by needleless transcutaneous electrical acupuncture (TEA). Our study was designed to utilize electroencephalography (EEG) and electrogastrography (EGG) recordings to investigate the central and peripheral responses of TEA in the treatment of nausea in DMGP patients.

          Methods

          Eleven DMGP subjects underwent simultaneous EEG and EGG testing while grading the severity of nausea following 30-minute intervals of: (1) baseline, (2) visual stimulation (VS) to provoke more nausea, (3) active VS together with TEA, and (4) TEA alone, and a final 15-minute recording without any intervention.

          Results

          The nausea score was increased to 5.9 ± 1.5 with VS ( P < 0.05, vs 3.5 ± 1.0 at baseline), then reduced to 3.5 ± 1.2 with VS plus TEA, and to 2.5 ± 1.3 with TEA alone, while it continued at a score of 2.9 ± 1.0 post TEA (all significant, P < 0.05, vs VS without TEA). The mean percentage of normal gastric slow waves was decreased to 60.0 ± 5.7% with VS ( P < 0.05, vs 66.6 ± 4.5% at baseline), then improved to 69.2 ± 4.8% with VS plus TEA, and maintained at 70 ± 3.6% with TEA alone. During initial VS, EEG signals showed right inferior frontal activity as the prominent finding, but during VS with TEA, left inferior frontal activity predominated.

          Conclusions

          In DMGP, TEA improves gastric dysrhythmia and ameliorates nausea. TEA treatment of nausea provoked by VS resulted in a change of dominance from right to left inferior frontal lobe activity. These data provide new understandings of peripheral and central mechanisms for nausea, and potential future directions for DMGP treatment approaches.

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          Most cited references 34

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          We used a 3-compartment boundary element method (BEM) model from an averaged magnetic resonance image (MRI) data set (Montreal Neurological Institute) in order to provide simple access to realistically shaped volume conductor models for source reconstruction, as compared to individually derived models. The electrode positions were transformed into the model's coordinate system, and the best fit dipole results were transformed back to the original coordinate system. The localization accuracy of the new approach was tested in a comparison with simulated data and with individual BEM models of epileptic spike data from several patients. The standard BEM model consisted of a total of 4770 nodes, which describe the smoothed cortical envelope, the outside of the skull, and the outside of the skin. The electrode positions were transformed to the model coordinate system by using 3-5 fiducials (nasion, left and right preauricular points, vertex, and inion). The transformation consisted of an averaged scaling factor and a rigid transformation (translation and rotation). The potential values at the transformed electrode positions were calculated by linear interpolation from the stored transfer matrix of the outer BEM compartment triangle net. After source reconstruction the best fit dipole results were transformed back into the original coordinate system by applying the inverse of the first transformation matrix. Test-dipoles at random locations and with random orientations inside of a highly refined reference BEM model were used to simulate noise-free data. Source reconstruction results using a spherical and the standardized BEM volume conductor model were compared to the known dipole positions. Spherical head models resulted in mislocation errors at the base of the brain. The standardized BEM model was applied to averaged and unaveraged epileptic spike data from 7 patients. Source reconstruction results were compared to those achieved by 3 spherical shell models and individual BEM models derived from the individual MRI data sets. Similar errors to that evident with simulations were noted with spherical head models. Standardized and individualized BEM models were comparable. This new approach to head modeling performed significantly better than a simple spherical shell approximation, especially in basal brain areas, including the temporal lobe. By using a standardized head for the BEM setup, it offered an easier and faster access to realistically shaped volume conductor models as compared to deriving specific models from individual 3-dimensional MRI data.
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            The role of asymmetric frontal cortical activity in emotion-related phenomena: a review and update.

            Conceptual and empirical approaches to the study of the role of asymmetric frontal cortical activity in emotional processes are reviewed. Although early research suggested that greater left than right frontal cortical activity was associated with positive affect, more recent research, primarily on anger, suggests that greater left than right frontal cortical activity is associated with approach motivation, which can be positive (e.g., enthusiasm) or negative in valence (e.g., anger). In addition to reviewing this research on anger, research on guilt, bipolar disorder, and various types of positive affect is reviewed with relation to their association with asymmetric frontal cortical activity. The reviewed research not only contributes to a more complete understanding of the emotive functions of asymmetric frontal cortical activity, but it also points to the importance of considering motivational direction as separate from affective valence in psychological models of emotional space. Copyright © 2009 Elsevier B.V. All rights reserved.
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              Gastric emptying in diabetes: clinical significance and treatment.

              The outcome of recent studies has led to redefinition of concepts relating to the prevalence, pathogenesis and clinical significance of disordered gastric emptying in patients with diabetes mellitus. The use of scintigraphic techniques has established that gastric emptying is abnormally slow in approx. 30-50% of outpatients with long-standing Type 1 or Type 2 diabetes, although the magnitude of this delay is modest in many cases. Upper gastrointestinal symptoms occur frequently and affect quality of life adversely in patients with diabetes, although the relationship between symptoms and the rate of gastric emptying is weak. Acute changes in blood glucose concentration affect both gastric motor function and upper gastrointestinal symptoms. Gastric emptying is slower during hyperglycaemia when compared with euglycaemia and accelerated during hypoglycaemia. The blood glucose concentration may influence the response to prokinetic drugs. Conversely, the rate of gastric emptying is a major determinant of post-prandial glycaemic excursions in healthy subjects, as well as in Type 1 and Type 2 patients. A number of therapies currently in development are designed to improve post-prandial glycaemic control by modulating the rate of delivery of nutrients to the small intestine.
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                Author and article information

                Journal
                J Neurogastroenterol Motil
                J Neurogastroenterol Motil
                Journal of Neurogastroenterology and Motility
                Korean Society of Neurogastroenterology and Motility
                2093-0879
                2093-0887
                April 2017
                01 April 2017
                : 23
                : 2
                : 245-253
                Affiliations
                [1 ]Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
                [2 ]Center of Excellence of Neuroscience, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
                [3 ]Division of Gastroenterology and Hepatology, Johns Hopkins Center of Neurogastroenterology, Baltimore, MD, USA
                Author notes
                [* ]Correspondence: Richard W McCallum, MD, FACP, FRACP (AUST) FACG, AGAF, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Albert Avenue, El Paso, TX 79905, USA, Tel: +1-915-215-5218 (direct office: +1-915-545-6634), Fax: +1-913-706-6746, E-mail: richard.mccallum@ 123456ttuhsc.edu

                Irene Sarosiek and Gengqing Song contributed equally to this work.

                Article
                jnm-23-245
                10.5056/jnm16097
                5383119
                28163260
                © 2017 The Korean Society of Neurogastroenterology and Motility

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Original Article

                Neurology

                acupuncture, diabetes, electroencephalogram, electrogastrogram, gastroparesis

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