Functional Magnetic Resonance Is Used To Study The Neural Mechanism Of Cognitive Impairment, Syndrome Of Positivity Syndrome And The Therapeutic Effect Of Naosuikang Intervention

Bibliometrics and systematic review of functional magnetic resonance research in the field of Chinese Medicine relatively poor clinical practice and the heterogeneities of imaging results,it was necessary to interpret the clinical results carefully.Objective:To reveal the present situation,hot spots and development tendency of functional magnetic resonance imaging?fMRI?in the field of Chinese Medicine?CM?,and the application status,problems and prospects of fMRI in the field of CM clinical efficacy.Methods:PubMed,Web of Science,China Biology Medicine?CBM?,Chinese National Knowledge Infrastructure?CNKI?,VIP database?VIP?and Wanfang database were searched by computer.The retrieval time was from the establishment of the database to December 2018.We established a literature research database in accordance with uniform criteria for inclusion and exclusion.This paper analyzed the general trends from six aspects:annual changes of literature quantity,literature sources and research directions,journals,number of articles published,research directions of core authors and keyword clustering.The co-occurrence network visualization of the authors and keywords were carried out based on Gephi.At the same time,the modal selection,parameter report,data analysis,image target level of fMRI in the field of CM clinical efficacy,and their study quality,participants,intervention measures and results were systematically reviewed.Results:?1?fMRI studies in the field of CM have been significantly developed in recent 10 years.The clinical efficacy and CM syndromes are the hotspots of this field.?2?Of the 141 articles included,93.19%of the researchers published papers less than 2,and only 28 researchers published 3 papers or more.Most of the high-quality research teams were located in Beijing.?3?Interdisciplinary studies were the biggest characteristic in this field.clinical experts of Chinese Medicine needed to cooperate with experts in the field of imaging,cognitive neuroscience and et al.?4?There were 47 fMRI studies on clinical efficacy of Chinese Medicine,including 27 studies using BOLD sequence,13 studies using MRs sequence,4 studies using DTI sequence,and 3 studies using 2 or more sequences at the same time.?5?25 studies were randomized controlled studies?53.19%?.But the overall quality of these studies was not high.The proportion of appropriate randomization,allocation concealment,blindness and reporting of missing visits were 32.00%,24.00%,40.00%and 48.00%,respectively.?6?Both theory-driven and data-driven processing methods have been used.But the choice of region of interest was of high heterogeneity,which limited the comparability of different DTI and MRS results.?7?Generally,due to theConclusion:Studies on fMRI of Chinese Medicine is still in the primary stage of development,the regional distribution of scientific research forces is uneven,the quality of research is not satisfactory,interdisciplinary research is both an opportunity and a challenge.With the development of brain science background technology,it can be further optimized in the aspects of multimodal fusion,target selection and data analysis of node-loop-network,and will significantly improve the research quality of fMRI of Chinese Medicine.It provides more reliable evidence for explaining the scientific problems of Chinese Medicine and exploring the original discovery of Chinese Medicine.Clinical study of resting state fMRI in mild vascular cognitive impairment caused by subcortical cerebral small vessel diseaseObjective:To investigate the neural mechanism of fMRI in clinical efficiency of mild vascular cognitive impairment caused by subcortical cerebral small vessel disease intervened by Naosuikang capsule,and in Chinese Medicine Syndrome Differentiation of deficiency and excess pattern.Methods:40 patients were randomly recruited and divided into two groups:Chinese Medicine group and western medicine group.The patients in the Chinese Medicine group were treated with Naosuikang capsule?Guangdong ZB20111279?,3 granule at a time and three times a day.Patients in western medicine group was treated with nimodipine?produced by Zhengda Youth Bao Pharmaceutical Co.,Ltd.,H33022285?,40 mg at a time and three times a day.And the intervention course was 6 months.Twenty-five healthy subjects matched with sex and age were recruited as blank control group.All patients were divided into two groups according to the syndrome differentiation scale of vascular dementia?SDSVD?.Neuropsychological data as Montreal Cognitive Assessment?MOCA?,Hachinski Ischemia scale?HIS?,activity of Daily living scale?ADL?and Hamilton Depression scale 17?HAMD-17?were collected for all subjects.The conventional structural sequences and functional sequence were collected on GE MR750 magnetic resonance imaging?GE Discovery MR750 3.0T?in the radiology department,Shenzhen traditional Chinese Medicine Hospital.Under the environment ofMATLAB 2012b?http://www.mathworks.com/products/matlab/?,the DPARSF V3.0 Advanced edition?http://rfinri.org?,based on SPM?http://www.fil.ion.ucl.ac.uk/spm?and DPABI,was used for image preprocessing.It included format conversion,Realign,Normalize,Smooth,Detrending and Filter.The fractional amplitude of low frequency fluctuation?fALFF?was used as the study index of brain function.In the study of brain network,the whole brain was divided into 116 regions by AAL template,and the average value of time series of all voxels in each region was extracted.The connection matrix and binary matrix were constructed by bivariate correlation analysis.When sparsity was from 0.05 to 0.40,the global topological indexes are calculated:global effect?Eglob?,local effect?Eloc?,clustering coefficient?Cp?,characteristic path length?Lp?,standardized clustering coefficient???,standardized shortest path length???and small world???.The local topological indexes were calculated in the same sparsity range:node efficiency?Ne?and node degree?Dc?.The baseline data were used to calculate the differences of the above indexes at two levels:?1?patients vs healthy control,?2?deficiency pattern patients vs healthy control,excess pattern patients vs healthy control;longitudinal data were used to calculate the group difference regarding the above indexes:patients response to Chinese Medicine vs patients not response,patients response to Western Medicine vs patients not response.Pearson correlation analysis were used to determine the correlation between the above abnormal imaging parameters and SDSVD scores,MoCA scores and HAMD-17 scores.Results:?1?Compared with healthy controls,patients with significantly decreased and increased activation regions were the left frontal gyrus and right cerebellum,respectively.But regions in patients with deficiency pattern were the right middle frontal gyrus and right cerebellum,respectively.Regions in patients with excess pattern were the left orbitofrontal region and left cerebellum,respectively.?2?There was a positive correlation between kidney essence deficiency syndrome scores and the fALFF value of the right cerebellum?r=0.557,P=0.000?,and a negative correlation with the fALFF value of the right middle frontal gyrus?r=0.486,P=0.001?;however,phlegm turbid obstruction syndrome scores were positively correlated with the fALFF value of the left cerebellum?r=0.382,P=0.020?,and negatively correlated with the fALFF value of the left orbital frontal gyrus?r=0.575,P=0.000?.?3?Regarding to the global attribute,all of the patient group,the deficiency syndrome group and the healthy control group had the "small world" attribute.However,there was no significant group differences between the former two groups and the healthy control group,respectively?p>0.05?,but the "small world"attribute of patients in the deficiency pattem group was significantly lower than that of subjects in the healthy control group?P<0.05?.?4?Regarding to the nodal attribute,both the node efficiency?Nc?and node degree?Dc?can significantly distinguish the patient group from the healthy control group,and also the excess pattern group from the healthy control group.But the node efficiency?Ne?cannot effectively distinguish the deficiency pattern group from the healthy control group,and moreover,node degree?Dc?was only increased in the right posterior central gyrus,the right superior frontal gyrus and Vermis₆ but not decreased,when compared with the healthy control group.?5?After 6 months of treatment,20 cases the traditional Chinese medicine group and 17 cases in the western medicine group completed the whole study.There was no significant difference in the total effective rate of MoCa score between the two groups?80.00%vs 76.48%??p=0,553>0.05?.But there was significant difference in the total effective rate of SDSVD?90.00%vs 58.82%??p=0.034<0.05?.?6?When compared with the ineffective patients,the activation of the right superior frontal gyrus was significantly increased for the Chinese Medicine group?P<0.05?,and the activation of the right middle frontal gyrus was significantly increased for the western medicine group?P<0.05?.?7?All of patients response to Chinese Medicine,patients response to western medicine and patients not response had the "small world" attribute,but there were no significant differences when the former groups compared with patients not response,respectively?p>0.05?.?8?When compared with patients not response,node efficiency?Ne?of patients response to western medicine was significantly higher in the brain area of the left superior orbitofrontal gyrus,right amygdala,Vermis₇,Vermis₈ and Vermis₉,and the node efficiency?Ne?was significantly lower in the right triangle?P<0.05?.The node degree?Dc?was significantly increased in the right inferior cerebellar gyrus and Vermis₇,while was significantly decreased in the right triangular inferior frontal gyrus and the left superior marginal gyrus.Nevertheless,the node efficiency?Ne?of patients response to western medicine was significantly increased in the left superior temporal gyrus and the right middle temporal gyrus,and there was no decreased areas,when compared with patients not response.The node degree?Dc?was significantly increased in left superior temporal gyrus,right triangular inferior frontal gyrus,right orbital inferior frontal gyrus and right supplementary motor area,but was significantly decreased in right cuneiform lobe and right caudate nucleus.Conclusion:?1?The deficiency pattern and excess pattern showed left and right lateralization difference in local brain function,and the excess pattern was significantly different from the deficiency pattern in the global network topology attribute,showing that the small world attribute was significantly decreased.It can effectively explain that the deficiency pattern and excess pattern were two completely different clinical phenotypes,which have neural basis and will be helpful for the further purification of clinical samples with imaging techniques.And it provides a methodological basis for the study of biological subtypes of diseases from the point of Chinese Medicine pattern.?2?Compared with the local brain function index,the brain network topology indexes can better depict the difference between the response group and the not response group.And the positive brain areas are widely distributed in the frontal parietal lobe,limbic system and infratentorial cerebellum and other brain regions.It provides a basis for further studies of multi-target efficacy of Chinese Medicine.