Ubuhlungu buyindlela engokwemvelo yokusabela komzimba womuntu ekulimaleni noma ekuguleni, futhi ngokuvamile yisixwayiso sokuthi kukhona okungalungile. Uma inkinga isilashiwe, ngokuvamile siyayeka ukubhekana nalezi zimpawu ezibuhlungu, nokho-ke, kwenzekani lapho ubuhlungu buqhubeka isikhathi eside ngemva kokuba imbangela isihambile? Ubuhlungu obungapheliyo kuchazwa ngokwezokwelapha njengobuhlungu obuqhubekayo obuhlala izinyanga ezingu-3 kuya kwezingu-6 noma ngaphezulu. Ubuhlungu obungapheli buyisimo esiyinselele okufanele uphile naso, esithinta yonke into kusukela kumazinga omsebenzi womuntu kanye nekhono lakhe lokusebenza kanye nobudlelwane bakhe bomuntu siqu nezimo zengqondo. Kodwa, ingabe uyazi ukuthi ubuhlungu obungapheli bungase buthinte ukwakheka nokusebenza kobuchopho bakho? Kuvela ukuthi lezi zinguquko zobuchopho zingase ziholele kukho kokubili ukukhubazeka kwengqondo nengqondo.

 

Ubuhlungu obungapheli abuthinti nje indawo eyodwa yengqondo, empeleni, bungabangela izinguquko ezindaweni eziningi ezibalulekile zobuchopho, eziningi zazo ezibandakanyeka ezinqubweni nasemisebenzini eminingi ebalulekile. Ucwaningo oluhlukahlukene phakathi neminyaka luye lwathola izinguquko ku-hippocampus, kanye nokunciphisa indaba empunga kusukela ku-dorsolateral prefrontal cortex, i-amygdala, i-brainstem kanye ne-cortex ye-insular kwesokudla, ukubiza ezimbalwa, ezihambisana nobuhlungu obungapheli. Ukuhlukaniswa kwesakhiwo esincane salezi zifunda kanye nemisebenzi yazo ehlobene kungasiza ukubeka lezi zinguquko zobuchopho zibe umongo, kubantu abaningi abanobuhlungu obungapheli. Inhloso yalesi sihloko esilandelayo ukukhombisa kanye nokuxoxa ngezinguquko zobuchopho ezihlelekile nezisebenzayo ezihlobene nobuhlungu obungapheli, ikakhulukazi esimweni lapho lezo zingabonisi cishe umonakalo noma i-atrophy.

 

Izinguquko Zobuchopho Besakhiwo Ezinhlungwini Ezingapheli Zibonisa Cishe Akuwona Umonakalo Noma I-Atrophy

 

abstract

 

Ubuhlungu obungapheli bubonakala buhlotshaniswa nokuncishiswa kwento empunga ebuchosheni ezindaweni ezithintekayo ekudluliselweni kobuhlungu. Izinqubo ze-morphological ezingaphansi kwalezi zinguquko zesakhiwo, cishe kulandela ukuhlelwa kabusha kokusebenza kanye ne-plasticity emaphakathi ebuchosheni, zihlala zingacacile. Ubuhlungu be-hip osteoarthritis bungesinye sezinhlungu ezimbalwa ezingapheli ezilapheka ngokuyinhloko. Siphenye iziguli ezingu-20 ezinobuhlungu obungapheli ngenxa ye-unilateral coxarthrosis (iminyaka yobudala engama-63.25�9.46 (SD), abesifazane abangu-10) ngaphambi kokuhlinzwa kwe-hip joint endoprosthetic (isimo sobuhlungu) futhi saqapha izinguquko zesakhiwo sobuchopho kuze kufike onyakeni ongu-1 ngemva kokuhlinzwa: amaviki angu-6�8. , amaviki angu-12�18 kanye nezinyanga ezingu-10�14 lapho kungekho zinhlungu ngokuphelele. Iziguli ezinobuhlungu obungapheli ngenxa ye-unilateral coxarthrosis zinento encane kakhulu empunga uma iqhathaniswa nezilawuli ku-anterior cingulate cortex (ACC), i-insular cortex ne-operculum, i-dorsolateral prefrontal cortex (DLPFC) ne-orbitofrontal cortex. Lezi zifunda zisebenza njengezakhiwo eziningi ezihlanganisayo phakathi nesipiliyoni kanye nokulindela ubuhlungu. Lapho iziguli zingenabuhlungu ngemva kokululama ekuhlinzweni kwe-endoprosthetic, ukwanda kwento empunga cishe ezindaweni ezifanayo kwatholakala. Siphinde sathola ukwanda okuqhubekayo kokumpunga kobuchopho ku-premotor cortex kanye ne-supplementary motor area (SMA). Siphetha ngokuthi izinto ezimpunga ezingavamile ebuhlungu obungapheli akuyona imbangela, kodwa yesibili yesifo futhi okungenani ngokwengxenye ngenxa yezinguquko ekusebenzeni kwezimoto nokuhlanganiswa komzimba.

 

Isingeniso

 

Ubufakazi bokuhlelwa kabusha okusebenzayo kanye nesakhiwo ezigulini ezibuhlungu ezingapheli zisekela umbono wokuthi ubuhlungu obungapheli akufanele bucatshangwe njengendawo eguquliwe yokusebenza, kodwa futhi njengomphumela we-plasticity yobuchopho obusebenzayo nesakhiwo [1], [2], [3], [4], [5], [6]. Eminyakeni eyisithupha edlule, izifundo ezingaphezu kwe-20 zanyatheliswa ezibonisa izinguquko zobuchopho besakhiwo kuma-syndromes ezinhlungu ezingapheli ze-14. Isici esiphawulekayo sazo zonke lezi zifundo yiqiniso lokuthi izinguquko ezimpunga azizange zisakazwe ngokungahleliwe, kodwa zenzeka ezindaweni zobuchopho ezichazwe futhi ezisebenzayo kakhulu - okungukuthi, ukubandakanyeka ekucubunguleni i-nociceptive ye-supraspinal. Okutholwe okuvelele kakhulu kwakuhlukile ku-syndrome ngayinye yobuhlungu, kodwa kudlulele ku-cingulate cortex, i-orbitofrontal cortex, i-insula kanye ne-dorsal pons [4]. Ezinye izakhiwo zihlanganisa i-thalamus, i-dorsolateral prefrontal cortex, i-basal ganglia nendawo ye-hippocampal. Lokhu okutholakele kuvame ukuxoxwa ngakho njenge-atrophy yeselula, iqinisa umbono wokulimala noma ukulahleka kobuchopho obumpunga [7], [8], [9]. Eqinisweni, abacwaningi bathola ukuhlobana phakathi kwezinto ezimpunga zobuchopho kuncipha kanye nobude bobuhlungu [6], [10]. Kodwa ubude besikhathi sobuhlungu bubuye buhlotshaniswe neminyaka yesiguli, kanye nobudala obuncike emhlabeni jikelele, kodwa futhi ukwehla okuqondile kwesifunda kwe-gray matter kubhalwe kahle [11]. Ngakolunye uhlangothi, lezi zinguquko zesakhiwo zingase futhi zibe ukwehla kosayizi weseli, uketshezi oluphuma ngaphandle, i-synaptogenesis, i-angiogenesis noma ngenxa yokushintsha kwevolumu yegazi [4], [12], [13]. Kungakhathaliseki ukuthi uyini umthombo, ukuze sichaze lokho okutholakele kubalulekile ukubona lokhu okutholakele kwe-morphometric ekukhanyeni kwengcebo yezifundo ze-morphometric ekusebenziseni i-plasticity encike, njengoba kunikezwe ukuthi izinguquko ezithile zobuchopho besakhiwo sesifunda ziye zaboniswa ngokuphindaphindiwe kulandela ukuvivinya ingqondo nomzimba [ 14].

 

Akuqondakali ukuthi kungani ingxenye encane kuphela yabantu ihlakulela isifo sobuhlungu obungapheli, kucatshangelwa ukuthi ubuhlungu buyinto yonke indawo. Umbuzo uphakama ukuthi ngabe kwabanye abantu umehluko wesakhiwo ezinhlelweni zokudlulisa ubuhlungu obuphakathi kungase kusebenze njenge-diathesis yobuhlungu obungapheli. I-Grey indaba ishintsha ebuhlungu be-phantom ngenxa yokunqunywa [15] nokulimala komgogodla [3] kubonisa ukuthi izinguquko ze-morphological zobuchopho, okungenani ingxenye, umphumela wobuhlungu obungapheli. Kodwa-ke, ubuhlungu be-hip osteoarthritis (OA) bungenye ye-syndrome ebuhlungu engapheli eselapheka ngokuyinhloko, njengoba i-88% yalezi ziguli ihlala ingenabuhlungu ngokulandela ukuhlinzwa okuphelele kwe-hip replacement (THR) [16]. Ocwaningweni lokuhlola sihlaziye iziguli eziyishumi ezine-hip OA ngaphambi nangemva kokuhlinzwa. Sithole ukuncipha kwento empunga ku-anterior cingulated cortex (ACC) kanye ne-insula ngesikhathi sobuhlungu obungapheli ngaphambi kokuhlinzwa kwe-THR futhi sathola ukwanda kwento empunga ezindaweni ezihambisanayo zobuchopho esimweni esingenabuhlungu ngemva kokuhlinzwa [17]. Ngokugxila kulo mphumela, manje sesandise izifundo zethu eziphenya iziguli ezengeziwe (n?=?20) ngemva kwe-THR eyimpumelelo futhi saqapha izinguquko zobuchopho besakhiwo ngezikhathi ezine, kuze kufike onyakeni owodwa ngemva kokuhlinzwa. Ukuze silawule izinguquko ezimpunga ngenxa yokuthuthukiswa kwemoto noma ukucindezeleka siphinde saphatha imibuzo eqondise ukuthuthukiswa kokusebenza kwemisipha nempilo yengqondo.

 

Izimpahla nezindlela

 

Amavolontiya

 

Iziguli ezibikwe lapha ziyiqembu elincane leziguli ezingama-20 ezigulini ezingama-32 ezishicilelwe kamuva nje eziqhathaniswe neqembu elilawula impilo elihambisana nobudala nobulili [17] kodwa zabamba iqhaza ophenyweni olwengeziwe lokulandelela unyaka owodwa. Ngemva kokuhlinzwa iziguli ezingu-12 ziye zayeka ngenxa yokuhlinzwa kwesibili kwe-endoprosthetic (n?=?2), ukugula okunzima (n?=?2) nokuhoxiswa kwemvume (n?=?8). Lokhu kushiye iqembu leziguli ezingamashumi amabili ezine-Unilateral primary hip OA (iminyaka yobudala engama-63.25�9.46 (SD), abesifazane abayi-10) abaphenywa izikhathi ezine: ngaphambi kokuhlinzwa (isimo sobuhlungu) futhi futhi 6�8 kanye 12�amaviki angu-18 kanye ne-10 �Izinyanga eziyi-14 ngemuva kokuhlinzwa kwe-endoprosthetic, lapho kungekho zinhlungu ngokuphelele. Zonke iziguli ezine-OA eyinhloko ye-hip zazinomlando wobuhlungu isikhathi eside kunezinyanga ze-12, kusukela ku-1 kuya eminyakeni engu-33 (okusho iminyaka engu-7.35) kanye nesilinganiso sobuhlungu be-65.5 (kusukela ku-40 kuya ku-90) esikalini se-analogue esibonakalayo (VAS) kusukela 0 (abukho ubuhlungu) kuya ku-100 (ubuhlungu obubi kakhulu obungacatshangwa). Sihlole noma yikuphi ukwenzeka kwezenzakalo ezibuhlungu ezincane, kuhlanganise nezinyo-, indlebe- kanye nekhanda elibuhlungu kuze kube amasonto angu-4 ngaphambi kocwaningo. Siphinde futhi sakhetha ngokungahleliwe idatha kusukela ku-20 ubulili- kanye nobudala obufana nezilawuli ezinempilo (iminyaka yobudala engama-60,95�8,52 (SD) iminyaka, 10 abesifazane) kokungu-32 kocwaningo lokuhlola olushiwo ngenhla [17]. Asikho ezigulini ezingama-20 noma kwabaneminyaka engama-20 ubudala kanye nobudala obufana namavolontiya anempilo esinomlando wezokwelapha wangaphakathi noma wezinzwa. Ucwaningo lunikezwe imvume yezimiso zokuziphatha yikomiti lendawo Lezimiso futhi imvume ebhaliwe enolwazi yatholwa kubo bonke ababambiqhaza bocwaningo ngaphambi kokuhlolwa.

 

Idatha Yokuziphatha

 

Siqoqe idatha ngokudangala, ukuhlangana, ukukhathazeka, ubuhlungu kanye nempilo engokomzimba nengqondo kuzo zonke iziguli kanye nawo wonke amaphuzu ezikhathi ezine sisebenzisa imibuzo elandelayo ejwayelekile: I-Beck Depression Inventory (BDI) [18], I-Symptom Inventory emfushane (BSI) [19], Schmerzempfindungs-Skala (SES?=?pain unpleasantness scale) [20] kanye neHealth Survey 36-Item Short Form (SF-36) [21] kanye ne-Nottingham Health Profile (NHP). Senze izinyathelo eziphindaphindiwe ze-ANOVA futhi sabhangqa i-t-Test enemisila emibili ukuze sihlaziye idatha yokuziphatha ye-longitudinal sisebenzisa i-SPSS 13.0 ye-Windows (SPSS Inc., Chicago, IL), futhi sasebenzisa ukulungiswa kwe-Greenhouse Geisser uma ukucatshangelwa kwe-sphericity kuphuliwe. Izinga lokubaluleka lalibekwe ku-p<0.05.

 

I-VBM - Ukutholwa Kwedatha

 

Isithombe sokuthola. Ukuskena kwe-MR okunokulungiswa okuphezulu kwenziwa ohlelweni lwe-3T MRI (Siemens Trio) ngekhoyili yekhanda leshaneli engu-12 evamile. Iphuzu ngalinye kwamane, skena I (phakathi kosuku olu-1 nenyanga engu-3 ngaphambi kokuhlinzwa kwe-endoprosthetic), scan II (amaviki angu-6 kuya kwayi-8 ngemva kokuhlinzwa), skena III (amaviki angu-12 kuya kwangu-18 ngemva kokuhlinzwa) bese uskena IV (10�14) izinyanga ngemuva kokuhlinzwa), i-MRI enesisindo ye-T1 yatholwa esigulini ngasinye kusetshenziswa ukulandelana kwe-3D-FLASH (TR 15 ms, TE 4.9 ms, flip angle 25�, 1 mm tincetu, FOV 256�256, usayizi wevoxel 1�1� 1 mm).

 

Ukucutshungulwa Kwesithombe Nokuhlaziywa Kwezibalo

 

Ukucutshungulwa kwangaphambili kwedatha nokuhlaziywa kwenziwa nge-SPM2 (Wellcome Department of Cognitive Neurology, London, UK) esebenza ngaphansi kweMatlab (Mathworks, Sherborn, MA, USA) futhi iqukethe ibhokisi lamathuluzi le-voxel-based morphometry (VBM) ledatha longitudinal, isekelwe ekulungisweni okuphezulu kwezithombe ze-3D MR futhi ivumela ukusebenzisa izibalo ezihlakaniphile ze-voxel ukuze kutholwe umehluko wesifunda wokuminyana kwezinto ezimpunga noma amavolumu [22], [23]. Kafushane, ukucubungula kwangaphambili kuhilela ukujwayela kwendawo, ukuhlukaniswa kwento empunga kanye nokushelela kwendawo okungu-10 mm nge-Gaussian kernel. Ezinyathelweni zokucubungula ngaphambilini, sisebenzise iphrothokholi ethuthukisiwe [22], [23] kanye nesithwebuli- nesifanekiso esiqondene ne-grey matter [17]. Sisebenzise i-SPM2 esikhundleni se-SPM5 noma i-SPM8 ukwenza lokhu kuhlaziya kuqhathanise nocwaningo lwethu lomshayeli [17]. njengoba kuvumela ukujwayela okuhle kakhulu nokuhlukaniswa kwedatha ye-longitudinal. Kodwa-ke, njengoba ukuvuselelwa kwakamuva kwe-VBM (VBM8) kusanda kutholakala (dbm.neuro.uni-jena.de/vbm/), siphinde sasebenzisa i-VBM8.

 

Ukuhlaziywa Kweziqephu

 

Sisebenzise ukuhlolwa kwe-t okuyisampula ezimbili ukuze sithole umehluko wesifunda endaweni empunga yobuchopho phakathi kwamaqembu (iziguli ngesikhathi sokuskena isikhathi I (ubuhlungu obungapheli) nezilawuli ezinempilo). Sisebenzise umkhawulo we-p <0.001 (engalungisiwe) kuwo wonke ubuchopho ngenxa ye-hypothesis yethu eqinile, esekelwe ezifundweni ezizimele ze-9 kanye namaqoqo abonisa ukwehla kwezindaba ezimpunga ezigulini ezibuhlungu ezingapheli [7], [8], [ I-9], [15], [24], [25], [26], [27], [28], ukuthi ukwanda kwe-grey kuzovela endaweni efanayo (ngokucubungula ubuhlungu obufanele) izifunda njengasocwaningweni lwethu lomshayeli (17) ). Amaqembu amataniswa ngokweminyaka kanye nocansi kungekho mehluko omkhulu phakathi kwamaqembu. Ukuze siphenye ukuthi ngabe umehluko phakathi kwamaqembu ushintshile ngemva konyaka owodwa, siphinde saqhathanisa iziguli ngesikhathi sokuskena i-IV (izinhlungu ezingenabuhlungu, ukulandelwa konyaka owodwa) eqenjini lethu lokulawula elinempilo.

 

Ukuhlaziywa kweLongitudinal

 

Ukuthola umehluko phakathi kwamaphoyinti esikhathi (Scan I�IV) siqhathanise izikena ngaphambi kokuhlinzwa (isimo sobuhlungu) saphinda futhi amaviki angu-6�8 nangu-12�18 kanye nezinyanga ezingu-10�14 ngemva kokuhlinzwa kwe-endoprosthetic (okungenayo ubuhlungu) njengesilinganiso esiphindaphindiwe i-ANOVA. Ngenxa yokuthi noma yikuphi ukuguqulwa kobuchopho ngenxa yobuhlungu obungapheli kungase kudinge isikhathi esithile sokuhlehla ngemva kokusebenza nokuyeka ubuhlungu futhi ngenxa yobuhlungu bokuhlinzwa ngemva kokuhlinzwa iziguli ezibikiwe, siqhathanise ekuhlaziyeni kwe-longitudinal scan I no-II nge-scan III ne-IV. Ukuthola izinguquko ezingahlobene eduze nobuhlungu, siphinde sabheka izinguquko eziqhubekayo kuzo zonke izikhathi. Siphendule ubuchopho beziguli ezine-OA ye-hip yesokunxele (n?=?7) ukuze kujwayeleke ohlangothini lobuhlungu kokubili, ukuqhathanisa kweqembu kanye nokuhlaziywa kwe-longitudinal, kodwa ngokuyinhloko kuhlaziye idatha engaphenduliwe. Sisebenzise amaphuzu e-BDI njenge-covariate kumodeli.

 

Imiphumela

 

Idatha yokuziphatha

 

Zonke iziguli zabika ubuhlungu be-hip obungapheli ngaphambi kokuhlinzwa futhi zazingenabuhlungu (ngokuphathelene nalokhu buhlungu obungapheli) ngokushesha ngemva kokuhlinzwa, kodwa zabika ubuhlungu obukhulu ngemva kokuhlinzwa ku-scan II obuhlukile ebuhlungwini ngenxa ye-osteoarthritis. Isikolo sempilo yengqondo ye-SF-36 (F(1.925/17.322)?=?0.352, p?=?0.7) kanye ne-BSI yamaphuzu womhlaba jikelele we-GSI (F(1.706/27.302)?=?3.189, p?=?0.064 ) akazange abonise izinguquko ngokuhamba kwesikhathi futhi akukho ukugula kwengqondo. Azikho izilawuli ezibike noma yibuphi ubuhlungu obukhulu noma obungapheli futhi akekho obonise izimpawu zokucindezeleka noma ukukhubazeka ngokomzimba/ngokwengqondo.

 

Ngaphambi kokuhlinzwa, ezinye iziguli zabonisa izimpawu zokucindezeleka ezimaphakathi kuya kwezilingene kuzikolo ze-BDI ezehle kakhulu ku-scan III (t(17)?=?2.317, p?=?0.033) kanye ne-IV (t(16)?=?2.132, p? =?0.049). Ukwengeza, amaphuzu e-SES (ubuhlungu obungajabulisi) azo zonke iziguli athuthuke kakhulu kusukela ku-scan I (ngaphambi kokuhlinzwa) ukuze kuskenwe II (t(16)?=?4.676, p<0.001), scan III (t(14)?=? 4.760, p<0.001) kanye ne-scan IV (t(14)?=?4.981, p<0.001, unyaka ongu-1 ngemva kokuhlinzwa) njengoba ubuhlungu obungajabulisi behla ngokuqina kobuhlungu. Isilinganiso sobuhlungu ku-scan 1 no-2 besihle, isilinganiso esifanayo ngosuku lwe-3 no-4 olunegethivu. I-SES ichaza kuphela ikhwalithi yobuhlungu obubonakalayo. Ngakho-ke kwaba kuhle ngosuku 1 no-2 (okusho u-19.6 ngosuku 1 kanye no-13.5 ngosuku 2) kanye ne-negative (na) ngosuku 3 & 4. Nokho, ezinye iziguli azizange ziyiqonde le nqubo futhi zasebenzisa i-SES njengekhwalithi � yomhlaba wonke. yempilo� isilinganiso. Yingakho zonke iziguli zabuzwa ngosuku olulodwa ngabanye futhi ngumuntu ofanayo mayelana nokuvela kobuhlungu.

 

Ohlelweni olufushane lwenhlolovo yezempilo (SF-36), equkethe izinyathelo ezifingqiwe ze-Physical Health Score kanye ne-Mental Health Score [29], iziguli zithuthuke kakhulu kumphumela we-Physical Health kusukela ku-scan I kuya ku-scan II (t( 17)?=??4.266, p?=?0.001), scan III (t(16)?=??8.584, p<0.001) kanye ne-IV (t(12)?=??7.148, p<0.001), kodwa hhayi ku-Mental Health Score. Imiphumela ye-NHP ibifana, esikalini �ubuhlungu� (i-polarity ehlehlisiwe) sibone ushintsho olubalulekile ukusuka ku-scan I kuya kuskena II (t(14)?=??5.674, p<0.001, scan III (t(12) )?=??7.040, p<0.001 bese uskena i-IV (t(10)?=??3.258, p?=?0.009). Siphinde sathola ukwanda okukhulu kwesikali �ukuhamba komzimba� ukusuka ku-scan I kuya ku-III (t(12)?=??3.974, p?=?0.002) bese uskena IV (t(10)?=??2.511, p?=?0.031). Alukho ushintsho olubalulekile phakathi kwe-scan I ne-scan II ( amasonto ayisithupha ngemva kokuhlinzwa).

 

Idatha yesakhiwo

 

Ukuhlaziywa kwezigaba. Sifake iminyaka yobudala njenge-covariate kumodeli yomugqa ojwayelekile futhi asitholanga ukudideka kweminyaka. Uma kuqhathaniswa nobulili nezilawuli ezihambisana nobudala, iziguli ezine-primary hip OA (n?=?20) zibonise ngaphambi kokusebenza (Scan I) ezincishisiwe ezimpunga ku-anterior cingulate cortex (ACC), i-insular cortex, i-operculum, i-dorsolateral prefrontal cortex ( I-DLPFC), isigxobo sesikhashana esingakwesokudla kanye ne-cerebellum (Ithebula 1 kanye nomfanekiso 1). Ngaphandle kwe-putamen efanele (x?=?31, y?=??14, z?=??1; p<0.001, t?=?3.32) akukho ukwanda okuphawulekayo kokuminyana kwezinto ezimpunga okutholwe ezigulini ezine-OA uma kuqhathaniswa kuzilawuli ezinempilo. Ukuqhathanisa iziguli ngesikhathi sokuskena kwe-IV ngezilawuli ezifanisiwe, imiphumela efanayo itholwe njengokuhlaziywa kwesigaba esiphambanayo kusetshenziswa ukuskena I uma kuqhathaniswa nezilawuli.

 

 

 

Ukuphequlula idatha yeziguli ezine-OA ye-hip kwesokunxele (n?=?7) nokuziqhathanisa nezilawuli ezinempilo akuzange kuguqule imiphumela ngokuphawulekayo, kodwa ngenxa yokuncipha kwe-thalamus (x?=?10, y?=??20, z?=?3, p<0.001, t?=?3.44) kanye nokwanda kwe-cerebellum efanele (x?=?25, y?=??37, z?=??50, p<0.001, t? =?5.12) engazange ifinyelele ukubaluleka kudatha engaphenyisiwe yeziguli uma kuqhathaniswa nezilawuli.

 

Ukuhlaziywa kwe-longitudinal. Ekuhlaziyweni kwe-longitudinal, ukwanda okuphawulekayo (p<.001 okungalungisiwe) kwento empunga kutholwe ngokuqhathanisa ukuskena kokuqala nokwesibili (ubuhlungu obungapheli / ubuhlungu obungemuva kokuhlinzwa) nge-scan yesithathu neyesine (i-pain free) ku-ACC, i-insular cortex, i-cerebellum ne-pars orbitalis ezigulini ezine-OA (Ithebula 2 kanye nomfanekiso 1). Udaba olumpunga lwehla ngokuhamba kwesikhathi (p<.001 yonke ukuhlaziywa kobuchopho okungalungiswanga) ku-cortex yesibili ye-somatosensory, i-hippocampus, i-midcingulate cortex, i-thalamus ne-caudate nucleus ezigulini ezine-OA (Umfanekiso 2).

 

 

 

Ukuphequlula idatha yeziguli ezine-OA ye-hip kwesokunxele (n?=?7) akuzange kuguqule imiphumela ngokuphawulekayo, kodwa ngenxa yokuncipha kwe-brain grey ku-Heschl�s Gyrus (x?=??41, y?=?? 21, z?=?10, p<0.001, t?=?3.69) kanye no-Precuneus (x?=?15, y?=??36, z?=?3, p<0.001, t?=?4.60) .

 

Ngokuqhathanisa ukuskena kokuqala (ukuhlinzwa) nokuskena okungu-3+4 (ukuhlinzwa), sithole ukwanda kombala ompunga ku-frontal cortex kanye ne-motor cortex (p<0.001 engalungiswanga). Siyaqaphela ukuthi lokhu kuqhathanisa kuqinile kancane njengoba manje sinokuskena okuncane esimweni ngasinye (ubuhlungu ngokumelene nokungewona ubuhlungu). Uma sehlisa umkhawulo siphinda esikutholile sisebenzisa ukugqama kuka-1+2 vs. 3+4.

 

Ngokubheka izindawo ezikhuphuka ngaso sonke isikhathi, sithole izinguquko zobuchopho obumpunga ezindaweni zezimoto (indawo engu-6) ezigulini ezine-coxarthrosis ezilandela ukushintshwa okuphelele kwe-hip (scan Idbm.neuro.uni-jena.de/vbm/) singaphinda lokhu okutholakele ku-cortex yangaphambili naphakathi kwe-cingulate nakuzo zombili i-insulae yangaphambili.

 

Sibale osayizi bomphumela kanye nokuhlaziywa kwezingxenye ezihlukene (iziguli vs. Izilawuli) kuveze i-Cohen�sd engu-1.78751 ku-voxel ephezulu ye-ACC (x?=??12, y?=?25, z?=?? 16). Siphinde sabala i-Cohen�sd yokuhlaziya longitudinal (ukuqhathanisa ukuskena 1+2 vs. ukuskena 3+4). Lokhu kuphumele ku-Cohen�sd ka-1.1158 ku-ACC (x?=??3, y?=?50, z?=?2). Ngokuphathelene ne-insula (x?=??33, y?=?21, z?=?13) futhi ehlobene nokugqama okufanayo, i-Cohen�sd ithi 1.0949. Ukwengeza, sibale incazelo yamanani e-voxel angewona aziro emephu ye-Cohen�sd ngaphakathi kwe-ROI (ehlanganiswe nokuhlukaniswa kwangaphambili kwe-cingulate gyrus kanye ne-subcallosal cortex, etholakala ku-Harvard-Oxford Cortical Structural Atlas): 1.251223.

 

Ukuqonda kukaDkt Alex Jimenez

Iziguli ezinezinhlungu ezingapheli zingabhekana nezinkinga ezihlukahlukene zezempilo ngokuhamba kwesikhathi, ngaphandle kwezimpawu zazo ezivele zibuthakathaka. Isibonelo, abantu abaningi bazothola izinkinga zokulala ngenxa yobuhlungu babo, kodwa okubaluleke kakhulu, ubuhlungu obungapheli bungabangela nezinkinga ezihlukahlukene zempilo yengqondo, kuhlanganise nokukhathazeka nokucindezeleka. Imiphumela ubuhlungu obungaba nayo ebuchosheni ingase ibonakale ingaphezu kwamandla kodwa ubufakazi obukhulayo bubonisa ukuthi lezi zinguquko zobuchopho azihlali unomphela futhi zingahlehliswa lapho iziguli ezibuhlungu ezingapheli zithola ukwelashwa okufanele ezindabeni zabo zempilo eziyisisekelo. Ngokusho kwalesi sihloko, izinto ezimpunga ezingavamile ezitholakala ebuhlungu obungapheli akubonisi ukulimala kobuchopho, kodwa kunalokho, kuwumphumela obuyiselwayo ojwayelekile lapho ubuhlungu zelashwa ngokwanele. Ngenhlanhla, izindlela zokwelapha ezihlukahlukene ziyatholakala ukuze kusize ukudambisa izimpawu zobuhlungu obungapheli nokubuyisela isakhiwo nokusebenza kobuchopho.

 

Ingxoxo

 

Ukuqapha ukwakheka kobuchopho bonke ngokuhamba kwesikhathi, siqinisekisa futhi sandise idatha yethu yomshayeli eshicilelwe kamuva nje [17]. Sithole izinguquko ebuchosheni obumpunga ezigulini ezine-primary hip osteoarthritis esimweni sobuhlungu obungapheli, obuhlehla kancane uma lezi ziguli zingenabuhlungu, kulandela ukuhlinzwa kwe-hip joint endoprosthetic. Ukwanda kwengxenye yento empunga ngemva kokuhlinzwa cishe kusezindaweni ezifanayo lapho ukuncipha kwento empunga kubonakale ngaphambi kokuhlinzwa. Ukuphequlula idatha yeziguli ezine-OA ye-hip kwesokunxele (futhi ngenxa yalokho ukujwayela ohlangothini lobuhlungu) kube nomthelela omncane kuphela emiphumeleni kodwa ngaphezu kwalokho kwabonisa ukuncipha kwento empunga ku-Heschl's gyrus kanye ne-Precuneus esingakwazi ukuyichaza kalula futhi, njengoba ingekho i-priori hypothesis ekhona, bheka ngokucophelela okukhulu. Kodwa-ke, umehluko obonwe phakathi kweziguli nezilawuli ezinempilo ku-scan bengisawubona ekuhlaziyweni kwezigaba ezihlukene kuskeni IV. Ngakho-ke ukwanda okuhlobene kwe-grey ngokuhamba kwesikhathi kucashile, okungukuthi akuhlukani ngokwanele ukuze kube nomthelela ekuhlaziyweni kwesigaba esiphambanayo, okutholakele osekuvele kukhonjisiwe ezifundweni eziphenya ipulasitiki encike kwisipiliyoni [30], [31]. Siyaqaphela ukuthi iqiniso lokuthi sibonisa ezinye izingxenye zobuchopho-izinguquko ngenxa yobuhlungu obungapheli okumele bubuyiselwe emuva alikhiphi ukuthi ezinye izingxenye zalezi zinguquko azikwazi ukuhlehliswa.

 

Kuyathakazelisa ukuthi sabona ukuthi indaba empunga iyancipha ku-ACC ezigulini ezibuhlungu ezingapheli ngaphambi kokuhlinzwa kubonakala sengathi iqhubeka amasonto e-6 ngemva kokuhlinzwa (i-scan II) futhi iyanda kuphela ekuhloleni i-III ne-IV, mhlawumbe ngenxa yobuhlungu obungemuva kokuhlinzwa, noma ukunciphisa imoto. umsebenzi. Lokhu kuhambisana nedatha yokuziphatha yesilinganiso sokuhamba ngokomzimba esifakwe ku-NHP, okwathi ngemva kokuhlinzwa ayizange ibonise noma yiluphi ushintsho oluphawulekayo ngesikhathi sephuzu II kodwa yanda kakhulu ku-scan III ne-IV. Okuqaphelekayo, iziguli zethu zabika ukuthi azikho ubuhlungu e-hip ngemva kokuhlinzwa, kodwa zabhekana nobuhlungu bangemva kokuhlinzwa emisipha ezungezile nesikhumba esabonwa iziguli ngendlela ehluke kakhulu. Kodwa-ke, njengoba iziguli zisabika ubuhlungu obuthile ku-scan II, siphinde saqhathanisa ukuskena kokuqala (ngaphambi kokuhlinzwa) ngezikrini ze-III + IV (ngemuva kokuhlinzwa), okuveza ukwanda kwegrey ku-cortex yangaphambili kanye ne-motor cortex. Siyaqaphela ukuthi lokhu kuqhathanisa kuqinile kancane ngenxa yokuskena okuncane kwesimo ngasinye (ubuhlungu ngokumelene nokungewona ubuhlungu). Uma sehlisa i-threshold siphinda esikutholile sisebenzisa umehluko we-I+II vs. III+IV.

 

Idatha yethu iphakamisa ngokuqinile ukuthi ukuguqulwa kwezindaba ezimpunga ezigulini ezibuhlungu ezingapheli, ezivame ukutholakala ezindaweni ezihilelekile ekucubunguleni i-nociceptive ye-supraspinal [4] akubangelwa i-neuronal atrophy noma ukulimala kobuchopho. Iqiniso lokuthi lezi zinguquko ezibonwe esimweni sobuhlungu obungapheli aziguquki ngokuphelele zingachazwa ngesikhathi esifushane sokubheka (unyaka owodwa ngemva kokuhlinzwa ngokumelene nesilinganiso seminyaka eyisikhombisa yobuhlungu obungapheli ngaphambi kokuhlinzwa). Izinguquko zobuchopho be-neuroplastic okungenzeka ukuthi zathuthuka eminyakeni eminingana (njengomphumela wokufakwa njalo kwe-nociceptive) zidinga cishe isikhathi esengeziwe sokuhlehla ngokuphelele. Okunye okungenzeka ukuthi kungani ukwanda kwe-grey matter kungatholwa kuphela kudatha ye-longitudinal kodwa hhayi kudatha ye-cross-sectional (okungukuthi phakathi kwama-cohorts ngesikhathi sephoyinti IV) ukuthi inani leziguli (n?=?20) lincane kakhulu. Kudingeka kuphawulwe ukuthi umehluko phakathi kobuchopho babantu abambalwa mkhulu kakhulu nokuthi idatha ye-longitudinal inenzuzo yokuthi umehluko kuncane uma kuqhathaniswa njengoba ubuchopho obufanayo buskenwa izikhathi ezimbalwa. Ngenxa yalokho, izinguquko ezicashile zizobonakala kuphela kudatha yobude [30], [31], [32]. Yebo ngeke sikukhiphe ngaphandle ukuthi lezi zinguquko okungenani azikwazi ukuhlehliswa ngokwengxenye nakuba lokho kungenzeki, uma kubhekwa imiphumela yokusetshenziswa kwepulasitiki yesakhiwo esithile kanye nokuhlelwa kabusha [4], [12], [30], [33], [34]. Ukuze uphendule lo mbuzo, izifundo zesikhathi esizayo zidinga ukuphenya iziguli ngokuphindaphindiwe ngezikhathi ezinde, mhlawumbe iminyaka.

 

Siyaqaphela ukuthi singenza kuphela iziphetho ezilinganiselwe mayelana nokuguquguquka kwezinguquko zobuchopho be-morphological ngokuhamba kwesikhathi. Isizathu ukuthi ngenkathi siklama lolu cwaningo ngo-2007 futhi siskena ngo-2008 nango-2009, kwakungaziwa noma izinguquko zesakhiwo zizokwenzeka nhlobo futhi ngenxa yezizathu zokuba nokwenzeka sakhetha izinsuku zokuskena nezikhathi zesikhathi njengoba kuchazwe lapha. Omunye angase aphikise ngokuthi indaba empunga iyashintsha ngesikhathi, esiyichaza eqenjini lesiguli, kungenzeka ukuthi yenzeke eqenjini lokulawula kanye (umphumela wesikhathi). Kodwa-ke, noma yiziphi izinguquko ngenxa yokuguga, uma kunjalo, kulindeleke ukuthi zibe ukwehla kwevolumu. Njengoba sinikezwe i-priori hypothesis, esekelwe ezifundweni ezizimele ze-9 kanye nama-cohorts abonisa ukwehla kwezindaba ezimpunga ezigulini ezibuhlungu ezingapheli [7], [8], [9], [15], [24], [25], [26], [27], [28], sigxile ekwandeni kwesifunda ngokuhamba kwesikhathi ngakho-ke sikholelwa ukuthi ukuthola kwethu akuwona umphumela wesikhathi olula. Okuqaphelekayo, ngeke sikukhiphele ngaphandle ukuthi ukuncipha kwento empunga ngokuhamba kwesikhathi esisithole eqenjini lethu lesiguli kungase kubangelwe umthelela wesikhathi, njengoba singazange siskene iqembu lethu lokulawula ngesikhathi esifanayo. Njengoba kunikezwe okutholakele, izifundo zesikhathi esizayo kufanele zihlose izikhathi eziningi nezifushane, uma kubhekwa ukuthi izinguquko zobuchopho ezincike ku-morphometric zingenzeka ngokushesha nje ngemva kweviki le-1 [32], [33].

 

Ngaphandle komthelela wesici se-nociceptive sobuhlungu obumpunga ebuchosheni [17], [34] sabona ukuthi izinguquko ekusebenzeni kwezimoto cishe futhi zifaka isandla ekushintsheni kwesakhiwo. Sithole izindawo zezimoto nezangaphambili (indawo yesi-6) ukuze zande kuzo zonke izikhawu zesikhathi (Umfanekiso 3). Ngokwengqondo lokhu kungase kube ngenxa yokuthuthukiswa kokusebenza kwezimoto ngokuhamba kwesikhathi njengoba iziguli zazingasenamingcele ekuphileni ukuphila okuvamile. Ngokuphawulekayo asizange sigxile ekusebenzeni kwezimoto kodwa ukuthuthukiswa kokuhlangenwe nakho kobuhlungu, kunikezwe isifiso sethu sokuqala sokuphenya ukuthi ukuncipha okwaziwayo kwenkinga yobuchopho ezigulini ezinobuhlungu obungapheli empeleni kungabuyiselwa emuva. Ngenxa yalokho, asizange sisebenzise amathuluzi athile ukuze siphenye ukusebenza kwemoto. Noma kunjalo, (ukusebenza) ukuhlelwa kabusha kwe-motor cortex ezigulini ezine-syndromes yobuhlungu kubhalwe kahle [35], [36], [37], [38]. Ngaphezu kwalokho, i-motor cortex iyinhloso eyodwa ezindleleni zokwelapha ezigulini ezibuhlungu ezingapheli ezingenakuphulukiswa ezisebenzisa ukuvuselela ubuchopho obuqondile [39], [40], ukukhuthazwa kwamanje okuqondile kwe-transcranial [41], nokuphindaphinda kwe-transcranial magnetic stimulation [42], [43]. Izindlela eziqondile zokuguquguquka okunjalo (ukusiza ngokumelene nokuvimbela, noma ukumane ukuphazanyiswa kumanethiwekhi ahlobene nobuhlungu) azikakacaciswa [40]. Ucwaningo lwakamuva lubonise ukuthi isipiliyoni semoto ethile singashintsha ukwakheka kobuchopho [13]. I-Synaptogenesis, ukuhlelwa kabusha kwezethulo zokunyakaza kanye ne-angiogenesis ku-motor cortex kungase kwenzeke ngezidingo ezikhethekile zomsebenzi wemoto. Tsao et al. wabonisa ukuhlelwa kabusha ku-motor cortex yeziguli ezinezinhlungu ezingapheli ezibuhlungu emuva okubonakala sengathi kubuhlungu emuva emuva [44] kanye noPuri et al. wabona ukuncipha kwento empunga yesokunxele kwesobunxele kwabagulayo be-fibromyalgia [45]. Ucwaningo lwethu lwalungaklanyelwe ukuhlukanisa izici ezihlukahlukene ezingase ziguqule ubuchopho ebuhlungu obungapheli kodwa sihumusha idatha yethu mayelana nezinguquko ezimpunga ezingabonisi kuphela imiphumela yokufaka i-nociceptive njalo. Eqinisweni, ucwaningo lwakamuva ezigulini ezibuhlungu ze-neuropathic lubonise ukungavamile ezindaweni zobuchopho ezihlanganisa umbono womzwelo, ukuzimela, nobuhlungu, okusho ukuthi badlala indima ebalulekile esithombeni somtholampilo somhlaba wonke sobuhlungu obungapheli [28].

 

 

Ucwaningo olubili lwakamuva lomshayeli lugxile ekwelashweni esikhundleni kwe-hip ezigulini ze-osteoarthritis, okuwukuphela kwe-syndrome ebuhlungu engelapheka ngokuyinhloko ngokushintshwa kwe-hip [17], [46] futhi le datha ihlanganiswe nocwaningo lwakamuva kakhulu ezigulini ezibuhlungu eziphansi emuva [ 47]. Lezi zifundo zidinga ukubonwa ekukhanyeni kwezifundo eziningana ze-longitudinal eziphenya i-plasticity ye-neuronal encike ekuhlangenwe nakho kubantu ezingeni lesakhiwo [30], [31] kanye nocwaningo lwakamuva mayelana nezinguquko zobuchopho besakhiwo kumavolontiya anempilo abhekana nokuvuselela okubuhlungu okuphindaphindiwe [34] . Umlayezo oyinhloko wazo zonke lezi zifundo ukuthi umehluko omkhulu wesakhiwo sobuchopho phakathi kweziguli ezibuhlungu kanye nezilawuli zingahle zihlehle lapho ubuhlungu zelashwa. Kodwa-ke, kufanele kucatshangelwe ukuthi akucaci ukuthi izinguquko ezigulini ezibuhlungu ezingapheli zibangelwa ukufakwa kwe-nociceptive noma ngenxa yemiphumela yobuhlungu noma kokubili. Kungenzeka ukuthi izinguquko zokuziphatha, njengokuncishwa noma ukuthuthukiswa kokuxhumana nabantu, ukushesha, ukuqeqeshwa ngokomzimba kanye nezinguquko zesitayela sokuphila kwanele ukulolonga ubuchopho [6], [12], [28], [48]. Ikakhulukazi ukucindezeleka njenge-co-morbidity noma umphumela wobuhlungu kuyikhandidethi elibalulekile lokuchaza umehluko phakathi kweziguli nezilawuli. Iqembu elincane leziguli zethu ezine-OA labonisa izimpawu zokucindezeleka ezithambile ezithambile ezimaphakathi ezashintsha ngokuhamba kwesikhathi. Asizange sithole ukuguqulwa kwesakhiwo ku-covary ngokuphawulekayo nge-BDI-score kodwa umbuzo uphakama ukuthi zingaki ezinye izinguquko zokuziphatha ngenxa yokungabikho kobuhlungu nokuthuthukiswa kwezimoto kungase kube nomthelela emiphumeleni nokuthi benza kangakanani. Lezi zinguquko zokuziphatha zingaba nomthelela ekuncipheni kokumpunga ebuhlungu obungapheli kanye nokwanda kwento empunga lapho ubuhlungu bungasekho.

 

Esinye isici esibalulekile esingase sicheme ukuchazwa kwethu kwemiphumela yiqiniso lokuthi cishe zonke iziguli ezinobuhlungu obungapheli zathatha imithi ngokumelene nobuhlungu, ezaziyiyeka lapho zingenabuhlungu. Omunye angase aphikise ngokuthi ama-NSAID afana ne-diclofenac noma ibuprofen anemiphumela ethile ezinhlelweni ze-neural futhi okufanayo kuyiqiniso kuma-opioid, ama-antiepileptics nama-antidepressants, imithi evame ukusetshenziswa ekwelapheni ubuhlungu obungapheli. Umthelela wababulali bezinhlungu neminye imithi ekutholweni kwe-morphometric kungase kubaluleke kakhulu (48). Alukho ucwaningo kuze kube manje oluye lwabonisa imiphumela yemithi yobuhlungu ku-morphology yobuchopho kodwa amaphepha amaningana athola ukuthi izinguquko esakhiweni sobuchopho ezigulini ezibuhlungu ezingapheli azichazwanga kuphela ukungasebenzi okuhlobene nobuhlungu [15], noma ngemithi yobuhlungu [7], [9], [49]. Nokho, izifundo ezithile ziyashoda. Ucwaningo olwengeziwe kufanele lugxile ekushintsheni okuncike ekuhlangenwe nakho ku-plasticity ye-cortical, okungase kube nemiphumela eminingi yomtholampilo ekwelapheni ubuhlungu obungapheli.

 

Siphinde sathola ukuncipha kwento empunga ekuhlaziyweni kwe-longitudinal, mhlawumbe ngenxa yezinqubo zokuhlela kabusha ezihambisana nezinguquko ekusebenzeni kwezimoto kanye nokubona ubuhlungu. Kunolwazi oluncane olutholakalayo mayelana nezinguquko ze-longitudinal ebuchosheni obumpunga ezimweni ezibuhlungu, ngenxa yalesi sizathu asinakho i-hypothesis yokunciphisa indaba empunga kulezi zindawo ngemva kokuhlinzwa. Teutsch et al. [25] uthole ukwanda kobuchopho obumpunga ku-somatosensory kanye ne-midcingulate cortex kumavolontiya anempilo athola ukukhuthazwa okubuhlungu kuphrothokholi yansuku zonke izinsuku eziyisishiyagalombili ezilandelanayo. Ukutholwa kwezindaba ezimpunga kukhuphuka ngokulandela ukufakwa kwe-nociceptive yokuhlola kudlulele ngokwe-anatomically ngezinga elithile nokuncipha kwendaba empunga yobuchopho kulolu cwaningo ezigulini ezelashwa ebuhlungu obungapheli obuhlala njalo. Lokhu kusho ukuthi ukufakwa kwe-nociceptive kumavolontiya anempilo kuholela ekusebenziseni izinguquko ezincike kwesakhiwo, njengoba kungenzeka ezigulini ezinezinhlungu ezingapheli, nokuthi lezi zinguquko zibuyela emuva kumavolontiya anempilo lapho okokufaka kwe-nociceptive kuyeka. Ngenxa yalokho, ukuncipha kwe-grey matter kulezi zindawo ezibonwa ezigulini ezine-OA kungahunyushwa ukulandela inqubo efanayo eyisisekelo: izinguquko ezincike ekuzivivinyeni zishintsha ubuchopho [50]. Njengenqubo engahlanyisi, i-MR Morphometry iyithuluzi elifanelekile lokufuna ukuthola izingxenye ze-morphological zezifo, sijulise ukuqonda kwethu ubudlelwano phakathi kwesakhiwo sobuchopho nokusebenza, ngisho nokuqapha ukungenelela kokwelapha. Enye yezinselelo ezinkulu esikhathini esizayo ukulungisa leli thuluzi elinamandla lokuhlola izikhungo eziningi kanye nokwelapha ubuhlungu obungapheli.

 

Imikhawulo yalolu cwaningo

 

Nakuba lolu cwaningo luyisandiso socwaningo lwethu lwangaphambilini olwandisa idatha yokulandelela ezinyangeni ze-12 futhi siphenya iziguli eziningi, isimiso sethu sokuthola ukuthi izinguquko zobuchopho be-morphometric ebuhlungu obungapheli zibuyiselwa emuva kunalokho zicashile. Osayizi bomphumela bancane (bona ngenhla) futhi imiphumela iqhutshwa ngokwengxenye ukuncishiswa kwevolumu ye-grey yobuchopho besifunda ngesikhathi sokuskena 2. Uma singafaki idatha ekuskeneni 2 (ngqo ngemva kokusebenza) okubalulekile kuphela ukwanda kodaba olumpunga lobuchopho lwe-motor cortex kanye ne-frontal cortex kusinda emngceleni we-p<0.001 engalungiswanga (Ithebula 3).

 

 

Isiphetho

 

Akunakwenzeka ukuhlukanisa ngezinga elingakanani ukuguqulwa kwesakhiwo esikubonile ngenxa yezinguquko ekufakweni kwe-nociceptive, izinguquko ekusebenzeni kwezimoto noma ukusetshenziswa kwemithi noma izinguquko enhlalakahleni kanjalo. Ukwenza ukugqama kweqembu kokuskena kokuqala nokokugcina komunye nomunye kuveze umehluko omncane kakhulu kunobekulindelekile. Ngokunokwenzeka, ukuguqulwa kobuchopho ngenxa yobuhlungu obungapheli nayo yonke imiphumela kuyakhula esikhathini eside futhi kungase kudinge isikhathi esithile ukuze kubuyele. Noma kunjalo, le miphumela yembula izinqubo zokuhlela kabusha, iphakamisa ngokuqinile ukuthi okokufaka okungapheli kwe-nociceptive kanye nokukhubazeka kwezimoto kulezi ziguli kuholela ekucutshungulweni okushintshiwe ezindaweni ze-cortical futhi ngenxa yalokho izinguquko zobuchopho zesakhiwo ezihlehliswa kabusha.

 

Ukuvuma

 

Sibonga wonke amavolontiya ngokubamba iqhaza kulolu cwaningo kanye neqembu le-Physics and Methods e-NeuroImage Nord e-Hamburg. Ucwaningo lunikezwe imvume yezimiso zokuziphatha yikomiti lendawo Lezimiso futhi imvume ebhaliwe enolwazi yatholwa kubo bonke ababambiqhaza bocwaningo ngaphambi kokuhlolwa.

 

Isitatimende Sezimali

 

Lo msebenzi wasekelwa izibonelelo ezivela DFG (German Research Foundation) (MA 1862/2-3) kanye BMBF (The Federal Ministry of Education and Research) (371 57 01 kanye NeuroImage Nord). Abaxhasi babengenayo indima ekwakhiweni kocwaningo, ukuqoqwa kwedatha nokuhlaziya, isinqumo sokushicilela, noma ukulungiswa kombhalo wesandla.

 

 

Uhlelo lwe-Endocannabinoid: Uhlelo Olubalulekile Ongakaze Uzwe Ngalo

 

Uma kwenzeka ungakaze uzwe ngohlelo lwe-endocannabinoid, noma i-ECS, asikho isidingo sokuzizwa unamahloni. Emuva ngawo-1960, abaphenyi ababenesithakazelo ku-bioactivity yeCannabis bagcina behlukanise amakhemikhali ayo amaningi asebenzayo. Kwathatha eminye iminyaka engu-30, nokho, kubacwaningi abafunda izibonelo zezilwane ukuze bathole isamukeli salawa makhemikhali e-ECS ebuchosheni bamagundane, ukutholakala okwavula umhlaba wonke wophenyo ngobukhona be-ECS receptors nokuthi iyini injongo yabo yokuphila.

 

Manje sesiyazi ukuthi izilwane eziningi, kusukela ezinhlanzini kuye ezinyonini kuye ezilwaneni ezincelisayo, zine-endocannabinoid, futhi siyazi ukuthi abantu abagcini nje ngokwenza ama-cannabinoids abo asebenzisana nalolu hlelo oluthile, kodwa futhi sikhiqiza ezinye izinhlanganisela ezisebenzisana ne-ECS, lezo ezibonwa ezitshalweni nasekudleni okuningi okuhlukene, ngale kwezinhlobo zeCannabis.

 

Njengohlelo lomzimba womuntu, i-ECS ayiyona inkundla yesakhiwo esodwa njengohlelo lwezinzwa noma uhlelo lwenhliziyo. Esikhundleni salokho, i-ECS isethi yama-receptors asatshalaliswa kabanzi kuwo wonke umzimba avulwa ngesethi yama-ligand esiwazi ngokuhlangene njengama-endocannabinoids, noma ama-cannabinoids angapheli. Womabili ama-receptors aqinisekisiwe abizwa nje ngokuthi i-CB1 ne-CB2, nakuba kukhona amanye ahlongozwayo. Iziteshi ze-PPAR ne-TRP nazo zilamula eminye imisebenzi. Ngokufanayo, uzothola ama-endocannabinoids amabili kuphela abhalwe kahle: i-anadamide ne-2-arachidonoyl glycerol, noma i-2-AG.

 

Ngaphezu kwalokho, okubalulekile ohlelweni lwe-endocannabinoid ama-enzyme ahlanganisa futhi aphule ama-endocannabinoids. Ama-Endocannabinoids kukholakala ukuthi ahlanganiswa ngesisekelo esidingekayo. Ama-enzyme ayinhloko ahilelekile yi-diacylglycerol lipase ne-N-acyl-phosphatidylethanolamine-phospholipase D, ngokulandelanayo synthesize 2-AG ne-anandamide. Ama-enzyme amabili ayinhloko ahlambalaza ama-fatty acid amide hydrolase, noma i-FAAH, ephula i-anandamide, ne-monoacylglycerol lipase, noma i-MAGL, ephula i-2-AG. Ukulawulwa kwalawa ma-enzyme amabili kungase kwandise noma kunciphise ukuguqulwa kwe-ECS.

 

Uyini Umsebenzi we-ECS?

 

I-ECS iwuhlelo oluyinhloko lokulawula i-homeostatic lomzimba. Kungase kubhekwe kalula njengesistimu ye-adapogenic yangaphakathi yomzimba, esebenza njalo ukugcina ibhalansi yemisebenzi ehlukahlukene. Ama-Endocannabinoids asebenza kabanzi njengama-neuromodulators futhi, ngenxa yalokho, alawula uhla olubanzi lwezinqubo zomzimba, kusukela ekuzaleni kuya ebuhlungu. Eminye yaleyo misebenzi eyaziwa kangcono evela ku-ECS imi kanje:

 

System Ngethukile

 

Kusukela ohlelweni lwezinzwa oluphakathi, noma i-CNS, ukukhuthazwa okujwayelekile kwama-receptors e-CB1 kuzovimbela ukukhululwa kwe-glutamate ne-GABA. Ku-CNS, i-ECS idlala indima ekwakhiweni kwenkumbulo nokufunda, ikhuthaza i-neurogenesis ku-hippocampus, iphinde ilawule injabulo ye-neuronal. I-ECS iphinde ibambe iqhaza endleleni ubuchopho obuzosabela ngayo ekulimaleni nokuvuvukala. Kusukela entanjeni yomgogodla, i-ECS ilungisa ukubonakaliswa kobuhlungu futhi ikhulise i-analgesia yemvelo. Esimisweni sezinzwa se-peripheral, lapho ama-receptors e-CB2 alawula khona, i-ECS isebenza ngokuyinhloko ohlelweni lwezinzwa olunozwela ukuze lilawule imisebenzi yamathumbu, umchamo, kanye namapheshana okuzala.

 

Ingcindezi kanye Nesimo Senhliziyo

 

I-ECS inemithelela eminingi ekuphenduleni kokucindezeleka nokulawulwa ngokomzwelo, njengokuqaliswa kwalokhu kusabela komzimba ekucindezelekeni okunamandla nokuzivumelanisa nezimo ngokuhamba kwesikhathi emizweni yesikhathi eside, njengokwesaba nokukhathazeka. Uhlelo olusebenza kahle lwe-endocannabinoid lubalulekile endleleni abantu abaziphatha ngayo phakathi kwezinga elenelisayo lokuvuka uma kuqhathaniswa nezinga eleqile nelingemnandi. I-ECS iphinde ibe nendima ekwakhiweni kwenkumbulo futhi mhlawumbe ikakhulukazi ngendlela ubuchopho obucindezela ngayo izinkumbulo kusukela ekucindezelekeni noma ekulimaleni. Ngenxa yokuthi i-ECS ilungisa ukukhululwa kwe-dopamine, i-noradrenaline, i-serotonin, ne-cortisol, ingaba nomthelela kabanzi ekuphenduleni kwemizwelo nokuziphatha.

 

I-Digestive System

 

Umgudu wokugaya ukudla ugcwele womabili ama-CB1 kanye ne-CB2 receptors alawula izici ezimbalwa ezibalulekile zempilo ye-GI. Kucatshangwa ukuthi i-ECS ingase ibe "isixhumanisi esingekho" ekuchazeni isixhumanisi se-gut-brain-immune esidlala indima ebalulekile empilweni esebenzayo yendlela yokugaya ukudla. I-ECS iyisilawuli sokuvikeleka kwamathumbu, mhlawumbe ngokunciphisa isimiso somzimba sokuzivikela ekubhubhiseni izitshalo ezinempilo, futhi nangokuguquguquka kokubonisa i-cytokine. I-ECS ilungisa impendulo yokuvuvukala yemvelo emgudwini wokugaya ukudla, okunomthelela obalulekile ezinhlobonhlobo zezinkinga zezempilo. I-Gastric and general GI motility nayo ibonakala ibuswa kancane yi-ECS.

 

Isifiso sokudla kanye ne-Metabolism

 

I-ECS, ikakhulukazi ama-receptors e-CB1, ibamba iqhaza ekulawulweni, ekusetshenzisweni kwemetabolism, nasekulawuleni amafutha omzimba. Ukukhuthazwa kwama-receptors e-CB1 kuphakamisa ukuziphatha kokufuna ukudla, kuthuthukisa ukuqwashisa ngephunga, futhi kulawula ibhalansi yamandla. Kokubili izilwane kanye nabantu abakhuluphele ngokweqile bane-ECS dysregulation engase iholele lesi simiso ukuba sisebenze ngokweqile, okunomthelela kokubili ukudla ngokweqile nokunciphisa ukusetshenziswa kwamandla. Amazinga ajikelezayo e-anandamide kanye ne-2-AG aboniswe ukuthi aphakeme ngokukhuluphala, okungenzeka ngokwengxenye ngenxa yokuncipha kokukhiqizwa kwe-enzyme eyonakalisayo ye-FAAH.

 

Impilo Yamasosha omzimba kanye Nokusabela Kokuvuvukala

 

Amaseli nezitho zamasosha omzimba acebile ngama-endocannabinoid receptors. Ama-cannabinoid receptors aboniswa ku-thymus gland, i-spleen, amathani, nomnkantsha wamathambo, kanye nakuma-T- no-B-lymphocyte, ama-macrophages, ama-mast cells, ama-neutrophils, namaseli abulalayo emvelo. I-ECS ithathwa njengomshayeli oyinhloko wokulinganisela kwamasosha omzimba kanye ne-homeostasis. Nakuba kungeyona yonke imisebenzi ye-ECS evela kumasosha omzimba eqondwayo, i-ECS ibonakala ilawula ukukhiqizwa kwe-cytokine futhi ibe nendima ekuvimbeleni ukusebenza ngokweqile esimisweni sokuzivikela komzimba. Ukuvuvukala kuyingxenye yemvelo yokusabela komzimba, futhi kudlala indima evamile kakhulu ekuthukweni okunamandla emzimbeni, okuhlanganisa ukulimala kanye nesifo; noma kunjalo, uma ingagcinwa ihlolwa ingaba yizimo ezingelapheki futhi ibe nomthelela ekwandeni kwezinkinga zempilo ezimbi, njengobuhlungu obungapheli. Ngokugcina impendulo yokuzivikela komzimba ihlola, i-ECS isiza ukugcina impendulo yokuvuvukala elinganiselayo ngomzimba.

 

Ezinye izindawo zezempilo ezilawulwa yi-ECS:

 

• I-Bone impilo
• Ukuzala
• Impilo yesikhumba
• Impilo ye-arterial neyokuphefumula
• Ukulala nesigqi se-circadian

 

Indlela yokusekela kangcono i-ECS enempilo umbuzo abacwaningi abaningi abazama ukuwuphendula manje. Hlala ubukele ukuze uthole ulwazi olwengeziwe ngalesi sihloko esivelayo.

 

Ekuphetheni,�Ubuhlungu obungapheli buye bahlotshaniswa nezinguquko zobuchopho, okuhlanganisa nokuncipha kwento empunga. Kodwa-ke, isihloko esingenhla sibonise ukuthi ubuhlungu obungapheli bungashintsha ukwakheka nokusebenza kobuchopho jikelele. Nakuba ubuhlungu obungapheli bungase buholele kulokhu, phakathi kwezinye izindaba zezempilo, ukwelashwa okufanele kwezimpawu eziyisisekelo zesiguli kungahlehlisa izinguquko zobuchopho futhi kulawule indaba empunga. Ngaphezu kwalokho, ucwaningo olwengeziwe luye lwavela ngemuva kokubaluleka kohlelo lwe-endocannabinoid futhi lusebenza ekulawuleni nasekulawuleni ubuhlungu obungapheli nezinye izinkinga zezempilo. Ulwazi olubhekiselwe ku-National Center for Biotechnology Information (NCBI).�Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic kanye nokulimala komgogodla nezimo. Ukuze uxoxe ngesihloko, sicela ukhululeke ukubuza uDkt. Jimenez noma usithinte kokuthi�915-850-0900 .

 

Ikhethwe nguDkt Alex Jimenez

Izihloko Ezengeziwe: Ubuhlungu Emuva

Ukuhlungu obusemhlane ingenye yezimbangela ezivame kakhulu zokukhubazeka nokuphuthelwa izinsuku emsebenzini emhlabeni wonke. Eqinisweni, ubuhlungu beqolo buye babhekwa njengesizathu sesibili esivame kakhulu sokuvakashelwa kwehhovisi likadokotela, okudlula kuphela izifo eziphezulu zokuphefumula. Cishe amaphesenti angu-80 abantu azothola uhlobo oluthile lobuhlungu emuva okungenani kanye kukho konke ukuphila kwabo. Umgogodla uyisakhiwo esiyinkimbinkimbi esakhiwe ngamathambo, amalunga, imigqa kanye nemisipha, phakathi kwezinye izicubu ezithambile. Ngenxa yalokhu, ukulimala kanye/noma izimo ezimbi, njengokuthi i-discni herniated, ekugcineni kungaholela ezimpawu zobuhlungu beqolo. Ukulimala kwezemidlalo noma ukulimala kwengozi yemoto ngokuvamile kuyimbangela evame kakhulu yobuhlungu beqolo, noma kunjalo, ngezinye izikhathi ukunyakaza okulula kakhulu kungaba nemiphumela ebuhlungu. Ngenhlanhla, ezinye izindlela zokwelapha, njengokunakekelwa kwe-chiropractic, zingasiza ekudambiseni izinhlungu emuva ngokusebenzisa ukulungiswa komgogodla kanye nokuphathwa ngesandla, ekugcineni kuthuthukise ukukhululeka kobuhlungu.

 

 

 

ISIHLOKO ESIBALULEKILE ENGEZIWE: Ukulawulwa Kobuhlungu Beqolo

 

IZIHLOKO EZINYE IZIHLOKO: EZENGEZIWEYO:�Ubuhlungu obungapheli kanye nokwelashwa