Ubuhlungu buyindlela yomzimba womntu okwenzakalayo kwingozi okanye ukugula, kwaye ngokuqhelekileyo isilumkiso sokuba into engalunganga. Emva kokuba ingxaki iphilisiwe, ngokuqhelekileyo siyeke ukuhlangabezana nale mpawu ebuhlungu, nangona kunjalo, kwenzeka ntoni xa intlungu iqhubeka ixesha elide emva kokuba imbangela ihambe? Ubuhlungu obungapheliyo ichazwe ngokuchanekileyo njengentlungu eqhubekayo eyenza i3 kwiinyanga ze-6 okanye ngaphezulu. Ubuhlungu obungapheliyo kuyimeko enzima ukuhlala nayo, echaphazela yonke into ukusuka kumanqanaba omsebenzi ngamnye kunye nokukwazi kwabo ukusebenza kunye nobudlelwane babo kunye neemeko zengqondo. Kodwa, ngaba uyazi ukuba intlungu engapheliyo ingaphinda ifuthe kwisakhiwo kunye nomsebenzi wengqondo yakho? Kuye kwenzeka ukuba olu tshintsho lwengqondo lunokubangela ukuphazamiseka kwengqondo kunye nengqondo.

 

Ubuhlungu obungapheliyo abuchaphazeli nje indawo engumnye wengqondo, njengento enokubangela ukuba utshintsho kwiindawo ezininzi ezibalulekileyo zobuchopho, ezininzi zazo zibandakanya kwiinkqubo ezininzi nemisebenzi. Uphando oluthile lophando malunga neminyaka luye lwafumana utshintsho kwi-hippocampus, kunye nokunciphisa imbobo egciniweyo kwi-cortex, i-amygdala, i-brainstem kunye ne-cortex efanelekileyo, ukubiza abantu abambalwa, abanxulumene nobuhlungu obungapheliyo. Ukuphazamiseka kwezimbalwa zesakhiwo kule mimandla kunye nemisebenzi enxulumene nayo kunokunceda ukubeka loo ngqondo inguqu kumxholo, ngenxa yabantu abaninzi abaneentlungu ezingapheliyo. Injongo yale nqaku ilandelayo kukubonisa kunye nokuxubusha iinguqu zengqondo kunye nezomsebenzi ezinxulumene nentlungu engapheliyo, ingakumbi kwimeko apho kubonakala ukuba akukho monakalo okanye i-atrophy.

 

Ubunzima boBunjine Utshintsho olusisigxina Ukucamngca Mhlawumbi akukho Monakalo okanye i-Atrophy

 

Abstract

 

Iintlungu ezingapheliyo zibonakala zinxulunyaniswa nokuncitshiswa kwengqondo engwevu kwindawo ezinokuhanjiswa kwentlungu. Inkqubo ye morphological exhasa olu tshintsho lolwakhiwo, mhlawumbi kulandela ukuhlengahlengiswa kokusebenza kunye neplastikhi esembindini kwingqondo, zihlala zingacacanga. Intlungu kwi-hip osteoarthritis yenye yeempawu zentlungu ezinganyangekiyo ezinganyangekiyo ngokuyintloko. Siphande izigulana ezingama-20 ezineentlungu ezingapheliyo ngenxa ye-coxarthrosis engabandakanyekanga (iminyaka yobudala engama-63.25 9.46 (SD), iminyaka eli-10 yabasetyhini) ngaphambi kotyando oludibeneyo lwe-hip (imeko yeentlungu) kunye nokujonga imeko yotshintsho lobuchopho ukuya kunyaka omnye emva kotyando: iiveki ezi-1 6 , Iiveki ezili-8-12 kunye neenyanga ezili-18 10 xa kungekho ntlungu kwaphela. Izigulana ezineentlungu ezinganyangekiyo ngenxa ye-coxarthrosis ye-unilateral yayinemicimbi engwevu kangako xa kuthelekiswa nolawulo lwe-cortex yangaphakathi (i-ACC), i-insular cortex kunye ne-operculum, i-dorsolateral preortal cortex (DLPFC) kunye ne-orbitofrontal cortex. Le mimandla isebenza njengezinto zokudibanisa ezininzi ngexesha lamava kunye nolindelo lwentlungu. Xa abaguli babekhululekile kwintlungu emva kokuchacha kuqhaqho lwe-endoprosthetic, inyani engwevu inyuka phantse kwiindawo ezifanayo. Sikwafumene ukonyuka okuqhubekekayo kwento engwevu yengqondo kwindawo yecortex yangaphambi kwendawo kunye nendawo eyongezelelweyo yemoto (SMA). Siphetha ngelithi ukungaqheleki komba ongwevu kwintlungu engapheliyo ayingonobangela, kodwa kwesibini kwesi sifo kwaye ubuncinci kwinxalenye ngenxa yotshintsho kwimoto kunye nokudityaniswa komzimba.

 

intshayelelo

 

Ubungqina bokuhlengahlengiswa okusebenzayo kunye nolwakhiwo kwizigulana ezinganyangekiyo ezixhasa uluvo lokuba iintlungu ezingapheliyo akufuneki zichazwe kuphela njengombuso osebenzayo, kodwa nanjengesiphumo seplastikhi yokusebenza kwengqondo kunye nolwakhiwo [1], [2], [3], [4], [5], [6]. Kule minyaka mithandathu idlulileyo, kupapashwe izifundo ezingaphezu kwe-20 ezibonisa utshintsho lobume bengqondo kwii-syndromes ezili-14 zentlungu engapheliyo. Inqaku elothusayo lazo zonke ezi zifundo kukuba utshintsho lwezinto ezingwevu aluzange luhanjiswe ngokungacwangciswanga, kodwa lwenzeka kwiindawo ezichaziweyo nezisebenza ngokukodwa zobuchwephesha - oko kukuthi, ukubandakanyeka ekusebenzeni kwenkqubo ye-supraspinal nociceptive. Iziphumo ezigqwesileyo zifunyenwe zihlukeneyo kwiintlungu zesifo ngasinye, kodwa zigqitywe kwi-cingate cortex, i-orbitofrontal cortex, i-insula kunye ne-dorsal pons [4]. Olunye ulwakhiwo lubandakanya i-thalamus, i-dorsolateral preortal cortex, indawo ye-basal ganglia kunye nehippocampal. Ezi ziphumo zihlala zixoxwa njenge-atrophy yeselula, eqinisa umbono wokonakala okanye ukulahleka kwengqondo engwevu yengqondo [7], [8], [9]. Ngapha koko, abaphandi bafumanise unxibelelwano phakathi kwengqondo engwevu iyancipha kunye nobude beentlungu [6], [10]. Kodwa ubude beentlungu bunxulunyaniswa nobudala besigulana, kunye nobudala obuxhomekeke kubudala behlabathi, kodwa nakwindawo ethile ukwehla kwezinto ezingwevu kubhalwe kakuhle [11]. Kwelinye icala, olu tshintsho lolwakhiwo lunokuba nokuhla kobungakanani beseli, ulwelo lwangaphandle, isynaptogenesis, angiogenesis okanye nangenxa yotshintsho lwevolumu yegazi [4], [12], [13]. Nokuba uyintoni na umthombo, kutoliko lwethu lweziphumo kubalulekile ukubona ezi zinto zifunyanisiweyo morphometric ekukhanyeni kobutyebi bezifundo ze-morphometric kwiiplastiki ezixhomekeke ekusebenzeni, ngenxa yokuba utshintsho oluthile lobume bengingqi lubonakaliswe kaninzi kulandela ukuzilolonga nokuzilolonga [ 14].

 

Akuqondwa ukuba kutheni inani elincinci labantu liphuhlisa isifo esinganyangekiyo, kuthathelwa ingqalelo ukuba iintlungu ngamava endalo iphela. Umbuzo uphakama ukuba ngaba abanye abantu umahluko wolwakhiwo kwiinkqubo zangaphakathi zokudlulisa iintlungu zinokusebenza njenge-diathesis yentlungu engapheliyo. Utshintsho lwento engwevu kwintlungu ye-phantom ngenxa yokunqunyulwa [15] kunye nokulimala kwentambo yomqolo [3] kubonisa ukuba utshintsho lwe-morphological yengqondo, ubuncinci ngokuyinxalenye, sisiphumo sobuhlungu obungapheliyo. Nangona kunjalo, iintlungu kwi-hip osteoarthritis (OA) sesinye sezifo zentlungu ezinganyangekiyo ezinganyangekiyo, njengoko i-88% yezi zigulana zihlala zikhululekile kwintlungu kulandela utyando lwe-hip olupheleleyo (THR) [16]. Kwisifundo somqhubi wenqwelomoya siye sahlalutya izigulana ezilishumi ezine-hip OA ngaphambi nasemva nje kotyando. Sifumene ukuncipha kwento engwevu kwi-cortex yangaphakathi ye-cingulated (ACC) kunye ne-insula ngexesha leentlungu ezingapheliyo ngaphambi kotyando lwe-THR kwaye safumana ukwanda kwezinto ezingwevu kwiindawo ezihambelana nengqondo kwimeko yentlungu emva kotyando [17]. Ukugxila kwesi siphumo, ngoku sizandisile izifundo zethu siphanda abaguli abaninzi (n? =? 20) emva kokuphumelela kwe-THR kunye nokujonga ubume bengqondo kulwakhiwo kumatyeli amane amaxesha, ukuya kunyaka omnye emva kotyando. Ukulawula utshintsho kwimicimbi engwevu ngenxa yokuphuculwa kweemoto okanye uxinzelelo sikwalawula amaphepha emibuzo ejolise ekuphuculeni ukusebenza kweemoto nakwimpilo yengqondo.

 

Impahla nenkqubo

 

Amavolontiya

 

Izigulana ezichazwe apha liqela elincinci lezigulana ezingama-20 kwizigulana ezingama-32 ezipapashwe kutshanje ezazithelekiswa neqela elilawulayo elisempilweni- kunye nesini [17] kodwa bathatha inxaxheba kuphando olulandelayo lonyaka. Emva kotyando abaguli abali-12 baphuma ngenxa yoqhaqho lwesibini lwe-endoprosthetic (n? =? 2), isifo esibi (n? =? 2) kunye nokurhoxa kwemvume (n? =? 8). Oku kushiye iqela lezigulana ezingamashumi amabini ezine-unilateral primary hip OA (iminyaka yobudala engama-63.25 9.46 (SD), i-10 yabasetyhini) ebiphandwe izihlandlo ezine: ngaphambi kotyando (imeko yeentlungu) kwaye kwakhona i-6 8 kunye ne-12-18 iiveki kunye ne-10 14 iinyanga emva kotyando lwe-endoprosthetic, xa kungekho ntlungu kwaphela. Zonke izigulana ezine-OA ephambili ye-hip zinembali yentlungu engaphezulu kweenyanga ezili-12, ukusuka kwi-1 ukuya kwi-33 iminyaka (kuthetha iminyaka eyi-7.35) kunye nenqaku leentlungu ezingama-65.5 (ukusukela kwi-40 ukuya kwi-90) kwisikali se-analogue (VAS) esivela 0 (akukho ntlungu) ukuya kwi-100 (eyona ntlungu inokwenzeka). Sivavanye nakuphi na ukwenzeka kweziganeko zentlungu encinci, kubandakanya izinyo-, indlebe- kunye nentloko ukuya kuthi ga kwiiveki ezi-4 ngaphambi kophononongo. Siphinde sakhetha ngokungacwangciswanga idatha kwi-20 yesini- kunye nobudala obuhambelana nolawulo olusempilweni (iminyaka yobudala engama-60,95 8,52 (SD), iminyaka eli-10 yabasetyhini) yama-32 kwesi sifundo sichazwe ngentla [17]. Akukho namnye kwizigulana ezingama-20 okanye i-20 yesini- kunye nobudala ehambelana namavolontiya asempilweni ayenayo nayiphi na imbali yezonyango okanye yangaphakathi. Isifundo sanikwa imvume yokuziphatha ngekomiti yeenqobo ezisesikweni kwaye imvume ebhaliweyo enolwazi yafunyanwa kubo bonke abathathi-nxaxheba ngaphambi koviwo.

 

Idatha yokuziphatha

 

Siqokelele idatha yoxinzelelo, ukomelela komzimba, unxunguphalo, iintlungu kunye nempilo yomzimba kunye nengqondo kuzo zonke izigulana kwaye onke amanqaku asine usebenzisa le mibuzo ilandelayo: I-Beck Depression Inventory (BDI) [18], Uluhlu olufutshane lweMpawu (BSI) [19], ISchmerzempfindungs-Skala (SES? =? Isikali sokungonwabi kwentlungu) [20] kunye noPhando lwezeMpilo i-36-Item yeFom emfutshane (SF-36) [21] kunye neProfayile yezeMpilo yeNottingham (NHP). Senze amanyathelo aphindaphindiweyo i-ANOVA kunye ne-t-test ta-tired ezimbini zokuhlalutya idatha yokuziphatha ye-longitudinal usebenzisa i-SPSS 13.0 yeWindows (SPSS Inc., Chicago, IL), kwaye sasebenzisa ukulungiswa kweGreenhouse Geisser ukuba ingcinga yokuba isiphithiphithi siphuliwe. Inqanaba lokubaluleka lisetelwe p <0.05.

 

I-VBM - Idatha yokuFumana

 

Ukufumana umfanekiso. Isisombululo esiphakamileyo se-MR senziwa kwinkqubo ye-3T MRI (i-Nokia Trio) ene-coil yentloko ye-12. Ngexesha ngalinye lamanqaku amane, skena mna (phakathi kosuku olu-1 kunye nenyanga ezi-3 ngaphambi kotyando lwe-endoprosthetic), scan II (kwiiveki ezi-6 ukuya kwezi-8 emva kotyando), skena III (kwiiveki ezili-12 ukuya kwezi-18 emva kotyando) kunye nokuskena i-IV (10-14 iinyanga emva koqhaqho), i-T1 enesisindo se-MRI yafunyanwa kwisigulana ngasinye kusetyenziswa ulandelelwano lwe-3D-FLASH (TR 15 ms, TE 4.9 ms, flip angle 25 , 1 mm slices, FOV 256V256, voxel size 1 1 1 mm).

 

UkuPhathwa kweZithombe kunye noHlolo lokuShwankathela

 

Ukulungiselela kwangaphambili kwedatha kunye nohlalutyo lwenziwa nge-SPM2 (iSebe le-Wellcome leCognitive Neurology, eLondon, e-UK) eqhuba phantsi kweMatlab (Mathworks, Sherborn, MA, USA) kwaye iqulethe i-voxel-based morphometry (VBM) -bhokisi yebhokisi yedatha ende, isekwe kwisisombululo esiphakamileyo semifanekiso ye-MR ye-3D kwaye ivumela ukusetyenziswa kwezibalo ze-voxel-wise ukubona ukungafani kwengingqi kubuninzi bezinto ezingwevu okanye imiqulu [22], [23]. Isishwankathelo, ukwenziwa kwangaphambili kokubandakanya ukubekwa kwindawo yesiqhelo, ukwahlulwa kwezinto ezingwevu kunye ne-10 mm yokuthanjiswa kwendawo ene-kernel yaseGaussian. Kumanyathelo okuphambi kokulungiswa, sisebenzise umthetho olungiselelwe [22], [23] kunye neskena- kunye nesifundo sokujonga grey template [17]. Sisebenzise i-SPM2 kune-SPM5 okanye i-SPM8 ukwenza olu hlalutyo luthelekiswe nesifundo sethu somqhubi [17]. njengoko ivumela ukuqhelaniswa okuhle kunye nokwahlulahlulwa kwedatha ende. Nangona kunjalo, njengohlaziyo lwamva nje lwe-VBM (VBM8) ifumaneke kutshanje (dbm.neuro.uni-jena.de/vbm/Sisebenzise iVBM8.

 

Uhlalutyo lweCandelo

 

Sisebenzise iisampulu ezimbini t-kuvavanywa ukuze kufunyanwe umahluko wengingqi kwimiba engwevu yengqondo phakathi kwamaqela (abaguli ngexesha lokuvavanywa kwe-I (iintlungu ezingapheliyo) kunye nolawulo olusempilweni). Sisebenzise umda we-p <0.001 (engachanekanga) kuyo yonke ingqondo ngenxa yokuba sinamandla e-hypothesis, esekwe kwizifundo ezizimeleyo ze-9 kunye namaqela abonisa ukwehla kwento engwevu kwizigulana ezingapheliyo [7], [8], [ 9], [15], [24], [25], [26], [27], [28], ukuba ukunyuka kwezinto ezingwevu kuya kuvela kwindawo enye (yokulungisa iintlungu ezifanelekileyo) njengakwisifundo sethu sokuqhuba (17 ). Amaqela afanelwe ubudala kunye nesondo kungekho mahluko ubalulekileyo phakathi kwamaqela. Ukuphanda ukuba ngaba umahluko phakathi kwamaqela utshintshile emva konyaka omnye, sikwathelekisa abaguli ngexesha lokuvavanywa kwe-IV (iintlungu ezikhululekileyo, ukulandelelwa konyaka omnye) kwiqela lethu lolawulo olusempilweni.

 

Uhlalutyo olude

 

Ukufumana umohluko phakathi kwamanqaku exesha (Skena I IV) sithelekise iskena ngaphambi kotyando (imeko yeentlungu) kwaye kwakhona iiveki ezi-6 kunye ne-8-12 kunye neenyanga ezili-18 ukuya ku-10 emva kotyando lwe-endoprosthetic (iintlungu ezikhululekileyo) njengenyathelo eliphindiweyo le-ANOVA. Ngenxa yokuba naluphi na utshintsho lobuchopho ngenxa yeentlungu ezingapheliyo lunokudinga ixesha lokuyeka ukusebenza kunye nokupheliswa kwentlungu kwaye ngenxa yentlungu emva kotyando oluchazwe zizigulana, sithelekise kuhlalutyo olude lwe-I kunye no-II ngovavanyo lwe-III no-IV. Ukufumanisa utshintsho olungahambelani ngokusondeleyo nentlungu, sikwajonga utshintsho oluqhubela phambili ngalo lonke ixesha lokuhamba. Sitshintshile iingqondo zezigulana ezine-OA zethambo lasekhohlo (n? =? 14) ukulungiselela imeko yesiqhelo kwicala leentlungu kubo bobabini, ukuthelekiswa kweqela kunye nohlalutyo olude, kodwa ikakhulu kuhlalutywa idatha engafakwanga. Sisebenzise inqaku le-BDI njenge-covariate kwimodeli.

 

iziphumo

 

Idatha yokuziphatha

 

Zonke izigulana zixele iintlungu ezingapheliyo ngaphambi kotyando kwaye zazingenazintlungu (ngokubhekisele kwintlungu engapheliyo) kwangoko emva kotyando, kodwa zaxela iintlungu zasemva koqhaqho kwi-scan II eyahlukileyo kwintlungu ngenxa ye-osteoarthritis. Inqaku lempilo yengqondo le-SF-36 (F (1.925 / 17.322)? =? 0.352, p? =? 0.7) kunye nenqaku le-BSI lehlabathi GSI (F (1.706 / 27.302)? =? 3.189, p? =? 0.064 ) khange abonise lutshintsho kwikhosi yexesha kwaye akukho buhlungu bokuziphatha ngengqondo. Akukho nanye kulawulo oluchaze nayiphi na intlungu ebuhlungu okanye engapheliyo kwaye akukho namnye ubonakalise naziphi na iimpawu zoxinzelelo okanye ukukhubazeka emzimbeni / engqondweni.

 

Phambi kotyando, ezinye izigulana zabonisa ukudakumba okuphakathi ukuya kumodareyitha amanqaku e-BDI anciphise kakhulu kwiskena III (t (17)? =? 2.317, p? =? 0.033) kunye ne-IV (t (16)? =? 2.132, p? =? 0.049). Ukongeza, amanqaku e-SES (iintlungu ezingathandekiyo) zazo zonke izigulana ziphuculwe kakhulu ukuskena mna (ngaphambi kotyando) ukuskena II (t (16)? =? 4.676, p <0.001), scan III (t (14)? =? 4.760, p <0.001) kunye nokuskena i-IV (t (14)? =? 4.981, p <0.001, 1 unyaka emva kotyando) njengentlungu yokungathandeki yehle ngoxinzelelo lwentlungu. Ukulinganiswa kwentlungu kwiskena 1 kunye no-2 kwakulungile, ukulinganiswa okufanayo ngosuku lwe-3 nolwe-4 olubi. I-SES ichaza kuphela umgangatho wentlungu ebonwayo. Kwakunjalo ke ngomhla we-1 kunye no-2 (kuthetha ukuba ngu-19.6 ngosuku lwe-1 kunye ne-13.5 ngosuku lwe-2) kunye nokungalunganga (na) ngomhla we-3 & 4. Nangona kunjalo, ezinye izigulana zazingayiqondi le nkqubo kwaye zisebenzisa i-SES njengobulungisa behlabathi yomlinganiselo wobomi. Kungenxa yoko le nto zonke izigulana zacelwa ngemini enye ngokwahlukeneyo nangomntu ofanayo ngokubhekisele kwintlungu.

 

Kwifomu emfutshane yophando lwezempilo (i-SF-36), equka amanyathelo okushwankathela amaNqaku eMpilo eMzimbeni kunye neNqaku lezeMpilo yeNgqondo [29], abaguli baphuculwe kakhulu kumanqaku eMpilo yezeMpilo ukuskena I ukuskena II (t ( 17)? = ?? 4.266, p? =? 0.001), skena III (t (16)? = ?? 8.584, p <0.001) kunye no-IV (t (12)? = ?? 7.148, p <0.001), kodwa hayi kuManqaku eMpilo yeNgqondo. Iziphumo ze-NHP zazifana, kwi-subscale pain (reversible polarity) sabona utshintsho olukhulu kwiskena I ukuskena II (t (14)? = ?? 5.674, p <0.001, scan III (t (12) )? = ?? 7.040, p <0.001 kunye nokuskena IV (t (10)? = ?? 3.258, p? =? 0.009) Sikwafumene ukonyuka okubonakalayo kwi-subscale physical mobility ukusuka kwiskena I ukuskena III (t (12)? = ?? 3.974, p? =? 0.002) kunye nokuskena i-IV (t (10)? = ?? 2.511, p? =? 0.031) Kwakungekho lutshintsho lubalulekileyo phakathi kokuskena mna kunye no-scan II ( iiveki ezintandathu emva kotyando).

 

Iinkcukacha zeZakhiwo

 

Uhlalutyo lwamacandelo. Sibandakanye iminyaka yobudala njenge-covariate kwimodeli yomgca ngokubanzi kwaye asifumananga siphithiphithi sobudala. Xa kuthelekiswa nokwabelana ngesondo kunye nobudala kuhambelana nolawulo, abaguli abane-OA ephambili ye-hip (n? =? 20) babonise ukusebenza kwangaphambili (Skena I) kuncitshiswe into engwevu kwi-cortex yangaphakathi (i-ACC), i-cortex yangaphakathi, i-operculum, i-dorsolateral preortal cortex ( I-DLPFC), ipali yexeshana lasekunene kunye necerebellum (1 Table kunye noMzobo 1). Ngaphandle kwe-putamen elungileyo (x? =? 31, y? = ?? 14, z? = ?? 1; p <0.001, t? =? 3.32) akukho lonyuka lubalulekileyo kubunzulu bezinto ezingwevu olufunyenwe kwizigulana ezine-OA xa kuthelekiswa kulawulo olusempilweni. Ukuthelekisa izigulana ngexesha lokuvavanywa kwe-IV kunye nolawulo oluhambelanayo, iziphumo ezifanayo zafunyanwa kuhlalutyo olunamacandelo kusetyenziswa i-scan endiyithelekisileyo nolawulo.

 

 

 

Ukutsiba idatha yezigulana ezine-hip OA yasekhohlo (n? =? 7) kunye nokuzithelekisa nolawulo olusempilweni akuzange kutshintshe iziphumo kakhulu, kodwa ukwehla kwe-thalamus (x? =? 10, y? = ?? 20, z? =? 3, p <0.001, t? =? 3.44) kunye nokwanda kwe-cerebellum elungileyo (x? =? 25, y? = ?? 37, z? = ?? 50, p <0.001, t? =? 5.12) engakhange ifikelele ekubalulekeni kwedatha engafakwanga yezigulana ngokuthelekiswa nolawulo.

 

Uhlalutyo olude. Kuhlalutyo lwe-longitudinal, ukwanda okubonakalayo (p <.001 okungalunganga) kwento engwevu kwafunyanwa ngokuthelekisa ukuskena kokuqala kunye nesibini (iintlungu ezingapheliyo / iintlungu zasemva koqhaqho) kunye novavanyo lwesithathu nolwesine (ngaphandle kwentlungu) kwi-ACC, I-cortex ye-insular, i-cerebellum kunye ne-par orbitalis kwizigulana ezine-OA (2 Table kunye noMzobo 1). Imba engwevu yehle ngokuhamba kwexesha (p <.001 uhlalutyo lobuchwephesha olungalunganga) kwi-cortex yesibini ye-somatosensory, hippocampus, midcingulate cortex, thalamus kunye ne-caudate nucleus kwizigulana ezine-OA (Umzobo 2).

 

 

 

Ukutsiba idatha yezigulana ezine-hip OA yasekhohlo (n? =? 7) khange itshintshe iziphumo kakhulu, kodwa ukwehla kwemeko engwevu yengqondo kwiHeschl s Gyrus (x? = ?? 41, y? = ?? 21, z? =? 10, p <0.001, t? =? 3.69) kunye nePrecuneus (x? =? 15, y? = ?? 36, z? =? 3, p <0.001, t? =? 4.60) .

 

Ngokuchasanisa ukuskena kokuqala (unyango lokuqala) kunye nezikeni 3 + 4 (isithuba sokuhlinzwa), sifumene ukwanda kwento engwevu kwi-cortex yangaphambili nakwi-motor cortex (p <0.001 engachanekanga). Siyaqaphela ukuba lo mmahluko awunangxaki njengoko ngoku sinesikeni esincinci kwimeko nganye (iintlungu kuthelekiswa non-iintlungu). Xa sihlisa umbundu siphinda into esiyifumeneyo sisebenzisa umahluko ka-1 + 2 no-3 + 4.

 

Ngokujonga iindawo ezonyuka ngaphezulu kwamaxesha onke, safumana utshintsho lwengqondo engwevu kwimimandla yeemoto (indawo ye-6) kwizigulana ezine-coxarthrosis elandela ukutshintshwa kwe-hip iyonke (scan Idbm.neuro.uni-jena.de/vbm/) sinokuluphinda olu phando kwi-cortex yangaphakathi kunye ne-cingate cortex kunye nakwi-insulae engaphandle.

 

Sabala ubungakanani besiphumo kunye nohlalutyo lwamacandelo (izigulana ngokuchasene nolawulo) kwavelisa iCohen sd ye-1.78751 kwincopho ye-voxel ye-ACC (x? = ?? 12, y? =? 25, z? = ?? 16). Sikwabala iCohen sd yohlalutyo lobude (umahluko wokuskena 1 + 2 vs. scan 3 + 4). Oku kukhokelele kwi-Cohen sd ye-1.1158 kwi-ACC (x? = ?? 3, y? =? 50, z? =? 2). Ngokumalunga ne-insula (x? =? 33, y? =? 21, z? =? 13) kwaye inxulumene nolwahluko ofanayo, uCohen sd ngu-1.0949. Ukongeza, sibala intsingiselo yexabiso elingeyo-zero voxel yemephu yeCohen sd ngaphakathi kwe-ROI (enecandelo langaphambili le-cingate gyrus kunye ne-subcallosal cortex, ethathwe kwiHarvard-Oxford Cortical Structural Atlas): 1.251223.

 

Insight of Dr. Alex Jimenez

Izigulane zomsindo ezingapheliyo zinokuhlangabezana neemeko zempilo ezahlukahlukeneyo ngexesha elide, ngaphandle kweempawu zabo ezidityanisiweyo. Ngokomzekelo, abaninzi abantu baya kuba neengxaki zokulala ngenxa yeentlungu zabo, kodwa ngokubaluleke kakhulu, intlungu engapheliyo ingakhokelela kwimicimbi eyahlukeneyo yempilo yengqondo, kuquka ukuxhalaba nokuxinezeleka. Imiphumo enokuba neentlungu ezinokubakho kwiingqondo zingabonakala zinzima kakhulu kodwa ubungqina obukhulayo bubonisa ukuba utshintsho lwengqondo aluyiyo isigxina kwaye lunokuguqulwa xa izigulane ezingapheliyo zifumana unyango olufanelekileyo kwimicimbi yazo yezempilo. Ngokwalo nqaku, into ebomvu efumaneka kwintlungu engapheliyo ingabonakali umonakalo wengqondo, kodwa kunoko, isisiphumo esibuyiselwayo esiqhelekileyo xa intlungu iphathwa ngokufanelekileyo. Ngethamsanqa, iindlela ezahlukeneyo zonyango ziyafumaneka ukunceda ukuphucula iimpawu ezibuhlungu kunye nokubuyisela isakhiwo kunye nomsebenzi wengqondo.

 

ingxoxo

 

Ukubeka iliso kulwakhiwo lobuchopho ngokuhamba kwexesha, siqinisekisa kwaye sandisa idatha yolingo yethu epapashwe kutshanje [17]. Sifumene utshintsho kwimicimbi engwevu yengqondo kwizigulana ezine-hip osteoarthritis ephambili kwisifo esinganyangekiyo, esiguquka ngokuyinxenye xa ezi zigulana zingenazintlungu, kulandela utyando lwe-hip joint endoprosthetic. Ukonyuka okuthe ngcembe kwinto engwevu emva kotyando kuphantse kwaba kwindawo ezifanayo apho ukubonwa kwezinto ezingwevu kuye kwabonwa ngaphambi kotyando. Ukutsiba idatha yezigulana ezine-hip OA yasekhohlo (kwaye ke ukuqheleka kwicala leentlungu) kube nefuthe elincinci kwiziphumo kodwa kubonise ukwehla kwezinto ezingwevu kwi-Heschl s gyrus kunye ne-Precuneus esingakwaziyo ukuyichaza ngokulula kwaye, njengoko kungekho priori hypothesis ekhoyo, jonga ngononophelo olukhulu. Nangona kunjalo, umahluko obonwe phakathi kwezigulana kunye nolawulo olusempilweni lokuskena bendisajongwa kuhlalutyo lwecandelo lokuvavanywa kwe-IV. Ukonyuka kwesihlobo kwento engwevu ngokuhamba kwexesha kungoko kungacacanga, okt akufani ngokwaneleyo ukuba kube nefuthe kuhlalutyo lwecandelo, into esele ibonisiwe kwizifundo eziphanda ngamava eplastikhi exhomekeke kumava [30], [31]. Siyaqaphela ukuba inyani yokuba sibonisa iinxalenye ezithile zotshintsho lobuchopho ngenxa yeentlungu ezingapheliyo ukuba ziguquke azibandakanyi ukuba ezinye iindawo zolu tshintsho azinakuphikwa.

 

Kuyathakazelisa, sabona ukuba imbobo engcolileyo iyancipha kwi-ACC kwizigulane ezingapheliyo ngaphambi kokuba unyango lubonakale liqhubeka neveki ze-6 emva kokuhlinzwa (i-scan II) kwaye kwanda kuphela ukukhangela ii-III kunye ne-IV, mhlawumbi ngenxa yosizi lwe-post-surgery, okanye ukuncipha kwi-motor msebenzi. Oku kuhambelanayo nedatha yokuziphatha yesikhokelo sokuhamba ngomzimba esiqukelelwe kwi-NHP, leyo eyabonakalisiweyo emva kokusebenza engabonakali nayiphi na inguqu ephawulekayo kwixesha le-II kodwa ngokunyuka kakhulu kwandisa ukukhangela i-III ne-IV. Ingqalelo, izigulane zethu zichaze ukuba akukho buhlungu ebudeni emva kokuhlinzwa, kodwa iintlungu zentsebenzo emva kwenkqubo yokuhlinzwa, eziye zabonakala zihluke kakhulu kwizigulane. Nangona kunjalo, njengoko izigulane zisaxela ezinye iintlungu ezicatshungulwayo II, sahluke ngokutsha ukukhangela (ukuhlinzwa kwangaphambili) ngeesisombululo se-III + IV (emva kokuhlinzwa), sityhila ukwanda kwezinto ezimpunga kwi-cortex yangaphambili kunye ne-cortex. Siyaqaphela ukuba lo mlinganiso awuncinci ngenxa yokujonga ngaphantsi kwimeko (intlungu ngokungahambisani nentlungu). Xa siwunciphisa umyinge siphindaphinda oko sikufumene ngokusebenzisa u-I + II kunye no-III + IV.

 

Idatha yethu icebisa ukuba utshintsho lwezinto ezingwevu kwizigulana ezinganyangekiyo, ezihlala zifumaneka kwiindawo ezibandakanyeka ekusebenzeni kwe-supraspinal nociceptive process [4] azikho ngenxa ye-neuronal atrophy okanye ukonakala kwengqondo. Inyaniso yokuba olu tshintsho lubonwe kwimeko yentlungu engapheliyo aluguquki ngokupheleleyo lunokuchazwa ngexesha elifutshane lokujonga (unyaka omnye emva kokusebenza kuthelekiswa neminyaka esixhenxe yentlungu engapheliyo ngaphambi kokusebenza). Utshintsho lobuchopho be-Neuroplastic olunokuthi luphuhle kwiminyaka eliqela (njengesiphumo sokufakwa rhoqo kwe-nociceptive) kufuneka ixesha elininzi lokubuyela umva ngokupheleleyo. Enye into enokubangela ukuba ukwanda kwezinto ezingwevu kufumaneke kuphela kwidatha ye-longitudinal kodwa kungabi kwidatha enqamlezileyo (okt phakathi kwamaqela ngexesha le-IV) kukuba inani lezigulana (n? =? 20) lincinci kakhulu. Kufuneka kuboniswe ukuba umahluko phakathi kweengqondo zabantu abaliqela mkhulu kakhulu kwaye idatha ye-longitudinal inethuba lokuba umahluko mncinci njengoko iingqondo ezifanayo ziskenwa amatyeli aliqela. Ngenxa yoko, utshintsho olufihlakeleyo luya kufumaneka kuphela kwidatha ye-longitudinal [30], [31], [32]. Ewe asinakukhetha ngaphandle ukuba olu tshintsho ubuncinci alunakuphinda lubuyeke nangona oko kungenakulindeleka, kunikwe iziphumo zenkqubo ethile yolwakhiwo kunye nolungelelwaniso ngokutsha [4], [12], [30], [33], [34]. Ukuphendula lo mbuzo, izifundo ezizayo kufuneka ziphande abaguli kaninzi ngaphezulu kwamaxesha amade, kunokwenzeka iminyaka.

 

Siyabona ukuba sinokwenza izigqibo ezilinganiselweyo malunga nokuguqulwa kwengqondo yengqondo ngokutshintsha ixesha. Isizathu kukuba xa senze le ngxelo kwi-2007 kwaye sitshintshwe kwi-2008 kunye ne-2009, kwakungaziwa ukuba utshintsho lwezakhiwo luya kwenzeka nantoni na ngenxa yezizathu ezinokwenzeka zokukhetha iintsuku zokukhangela kunye nexesha elichazwe apha. Omnye unokuthetha ukuba inguqu ebomvu iguquka ngexesha, esiyichaza ngayo iqela lesigulane, mhlawumbi lenzeke kwiqela lolawulo kunye (umphumo wexesha). Nangona kunjalo, nayiphi na utshintsho ngenxa yokuguga, ukuba kukho konke, kulindeleke ukuba kuhla kwexabiso. Ukunikezelwa kweengcamango ze-priori, ngokusekelwe kwizifundo ezizimeleyo ze-9 kunye namaqabane abonisa ukwehla kwimiba ebomvu kwizigulane zentlungu ezingapheliyo [7], [8], [9], [15], [24], [25], [26], [27], [28], sigxile ekunyuseni kwengingqi kwixesha kwaye ngoko kukholelwa ukuba ukufumana kwethu kungabi yinto elula. Inqaku, asikwazi ukulawula ukuba imbali ebomvu iyancipha ngaphezu kwexesha esiyifumene kwiqela lethu lesigulane sinokuba ngenxa yempembelelo yexesha, njengoko singakhange sitshintshe iqela lethu lokulawula ngexesha elifanayo. Ukunikezelwa kweziphumo, iinjongo ezizayo kufuneka zijolise kwixesha elifutshane kunye nelifutshane, ngenxa yokuba utshintsho lwengqondo oluxhomekeke kwi-morphometric lungenzeka ngokukhawuleza emva kweveki ye1 [32], [33].

 

Ukongezelela kwimpembelelo yecalactifptive aspect of pain in question brain grey [17], [34] sabona ukuba utshintsho kwintsebenzo yemoto mhlawumbi lufaka isandla kwiinguqulelo zesakhiwo. Sifumane imoto kunye neendawo zangaphambili (indawo ye-6) ukwandisa ngaphezu kwexesha elide (Umfanekiso 3). Intuitively oku kungakho ngenxa yokuphucula umsebenzi wexesha elifanelekileyo njengoko izigulane zazingekho mfuneko yokuphila ubomi obuqhelekileyo. Ngokucacileyo asizange sigxininise ekusebenzeni kwemoto kodwa kuphuculwe kwimeko yamava, sinikezela umbuzo wethu wokuqala ukuphanda ukuba ukunciphisa kwaziwa ngokugqithiseleyo kwengqondo ebomvu kwizigulane ezingapheliyo kugqityiweyo. Ngenxa yoko, asizange sisebenzise izixhobo ezithile zokuphanda umsebenzi wemoto. Nangona kunjalo, (esebenzayo) i-motor cortex ukulungiswa kwezigulane ezineentlungu zesifo zibhalwe kakuhle [35], [36], [37], [38]. Ngaphezu koko, i-cortex yemoto iyona nto ijoliswe kwiindlela zokuthintela izigulane ezingenakunyangekiyo ezigulisa ingqondo (39], [40], i-transcranial ngokukhawuleza ngokukhuphayo [41], kunye nokuphindaphindiweyo kwe-magnetic stimulation [42], [43]. Iindlela ezichanekileyo zokumodareyithwa (ukulungelelaniswa kunye nokuphazamiseka, okanye ukuphazamiseka nje kwiintanethi ezinxulumene nentlungu) azange zichazwe [40]. Uphando olutshanje lubonise ukuba isipiliyoni semoto esithile singatshintsha isakhiwo sengqondo [13]. I-Synaptogenesis, ukulungiswa kwakhona kwemibonakalo yokunyakaza kunye ne-angiogenesis kwisixhobo se-cortex sinokufuna iimfuno ezizodwa zomsebenzi wemoto. Tsao et al. wabonisa ukulungiswa kwakhona kwi-motor cortex yezigulane ezineentlungu ezingapheliyo ezinqabileyo ezibonakala zibuhlungu ngokukhethekileyo [44] kunye nePuri et al. yabona ukunciphisa umgangatho wegridi wendawo engasese ekhohlo kwi-fibromyalgia abagulayo [45]. Isifundo sethu asizange senzelwe ukuphazamisa iinkalo ezahlukeneyo ezinokutshintsha ingqondo ebuhlungu obungapheliyo kodwa sichaza idatha yethu malunga nokuguquka kwempuphuko engabonakaliyo kuphela kwimiphumo yokufaka i-nociceptive input. Enyanisweni, uphando olutshanje kwizigulane zentlungu ye-neuropathic luchaza ukungaqhelekanga kwimiba yengqondo equka ukuqonda, ukuzimela, kunye neentlungu, nto leyo ebonisa ukuba badlala indima ebalulekileyo kwi-klinikhi yomfanekiso wentsholongwane engapheliyo [28].

 

 

Izifundo ezimbini zokugqibela zamagosa ezijoliswe kwi-hip replacement therapy kwizigulane ze-osteoarthritis, i-syndrome kuphela yentsholongwane ehambayo ephilisa ngokupheleleyo [17], [46] kwaye le nkcukacha zixutywe ngophando olutshanje olwenziwe kwizigulane ezingapheliyo ezibuhlungu [ 47]. Ezi zifundo zimele zibonwe ekukhanyeni kwezifundo ezininzi eziphambili zophando lwama-neuronal plastic-dependence level in humans [level 30], [31] kwaye uphando olutshanje lwengqondo lusetshintsho kumavolontiya anempilo avuselelwa ngokuphindaphindiweyo (34] . Umyalezo oyintloko walezi zifundo kukuba umlinganiselo ophezulu kwisakhiwo sobuchopho phakathi kwezigulane zentlungu kunye nokulawula kunganciphisa xa intlungu iphiliswa. Nangona kunjalo, kufuneka kuthathelwe ingqalelo ukuba akucaci ukuba ngaba utshintsho kwizigulane zintlungu ezingapheliyo kuphela ngenxa yongeniso lwe-nociceptive okanye ngenxa yeziphumo zentlungu okanye zombini. Kukho okungakumbi ukuba ukuguquka kokuziphatha, njengokunciphisa okanye ukuphuculwa koqhagamshelwano loluntu, ubuchule, ukuqeqeshwa ngokomzimba kunye noshintsho lwesitayela somzimba kunelungelo lokwenza ubuchopho [6], [12], [28], [48]. Ukudandatheka ngokukodwa njengentsebenziswano yokubandezeleka okanye ngenxa yentlungu ngumviwa oyintloko ekuchazeni umahluko phakathi kwezigulane kunye nokulawula. Iqela elincinane lezigulane zethu ezine-OA zabonisa iimpawu ezidityanisiweyo ezize zithe zatshintsha ngexesha. Asizange sithole ukuguqulwa kwesakhiwo ukuba sibe ne-covary ngokubaluleka kakhulu kumanqaku eBDI kodwa umbuzo uphawula ukuba zingaphi ezinye iinguqu zokuziphatha ngenxa yokungabikho kweentlungu kunye nokuphucula imoto kunokufaka isandla kwiziphumo kunye nokuba zithini. Ezi zinguqu zendlela yokuziphatha zingaphathisa umba wegrey wehla kwiintlungu ezingapheliyo kunye nokunyuka kwengqondo xa kuvela intlungu.

 

Enye into ebalulekileyo enokuyichaphazela ukutolika kwethu kweziphumo kukuba phantse zonke izigulane ezineentlungu ezingapheliyo zithatha imithi kwiintlungu, eziye zayeka xa zintlungu. Omnye unokuxela ukuba ii-NSAID ezifana ne-diclofenac okanye ibuprofen zinemiphumo ethile kwiinkqubo ze-neural kwaye zifana ne-opioids, i-antiepileptics kunye ne-anti-depressants, imichiza edlalwa rhoqo kwiyeza zonyango. Impembelelo yababulali kunye namanye amayeza kwiingqinisiso ze-morphometric ingabaluleka (48). Akukho sifundo okwangoku siye sabonisa imiphumo yesifo sengqondo kwi-brain morphology kodwa amaphepha amaninzi afumene ukuba utshintsho kwisakhiwo sobuchopho kwizigulane ezingapheliyo zichazwe kuphela ngeentlungu ezibangelwa ukungasebenzi [15], okanye ngamachiza ensizi [7], [9], [49]. Nangona kunjalo, uphando oluthile lusekho. Uphando olongezelelweyo kufuneka lujolise kwiinguqu ezixhomekeke kumava kwi-cortical plasticity, enokuba nefuthe elikhulu kwiinkliniki zokunyanga iintlungu.

 

Siphinde safumana ukuhla kwezinto ezimpunga ekuhlalutyweni kwexesha elide, mhlawumbi ngenxa yeenkqubo ezilungelelaniswayo ezihamba kunye neenguqu kwizinto zokusebenza kunye nentlungu yokuqonda. Kukho ulwazi oluncinci olukhoyo malunga noshintsho olude kwimeko yengqondo ebomvu kwiimeko ezibuhlungu, ngenxa yesi sizathu asinayo ingcamango yento ebomvu eyancipha kule mimandla emva kokusebenza. Teutsch et al. [25] wathola ukunyuka kwengqondo ebomvu kwingqungquthela ye-somatosensory kunye ne-midcingulate kwiivolontiya ezinempilo ezafumana ukuvuselela okubuhlungu kwimihla ngemihla yeentsuku ezilandelelanayo ezilandelelanayo. Ukufunyanwa kwezinto ezimpunga kwandele emva kwenkalo yokuhlola isicatshulwa esilungelelanisa ngokwemvelo kwinqanaba elithile kunye nokuncipha kwengqondo ebomvu kulolu cwaningo kwizigulana eziphilisiweyo zintlungu engapheliyo. Oku kuthetha ukuba i-nociceptive input kwiivolontiya eziphilileyo iholele ekutshintsheni umsebenzi oxhomekeke kwisigxina, njengokuba kunokwenzeka kwizigulane ezinentlungu engapheliyo, kwaye ukuba ezi zinguqu ziphendulela kumavolontiya anempilo xa i-nociceptive input iyeka. Ngenxa yoko, ukwehla kwengxaki ebomvu kule mimandla ebonwe kwizigulane ezine-OA kunokutshilwa ukulandela inkqubo efanayo efanayo: ukutshintshelwa koxhomekeke kwimeko yengqondo (50]. Njengendlela engeyiyo inomdla, uM MR Morphometry yilona ilungileyo lokufuna ukufumana izifo eziphathekayo zezifo, ukwandisa ukuqonda kwethu ubudlelwane phakathi kwesakhiwo sobuchopho kunye nomsebenzi, kwanokubeka iliso ukungenelela kwindlela yokwelapha. Enye yemingeni emikhulu kwixesha elizayo kukuzilungelelanisa esi sixhobo esinamandla semilingo emininzi kunye neyonyango lwezilonda ezingapheliyo.

 

Imida yale Sifundo

 

Nangona olu phononongo lulwandiso lwesifundo sethu sangaphambili sokwandisa idatha yokulandela ukuya kwiinyanga ze-12 kwaye siphanda abaguli ngakumbi, umgaqo wethu wokufumanisa ukuba ingqondo ye-morphometric iyatshintsha kwiintlungu ezingapheliyo ziyahlengahlengiswa kunokuba kungangqalanga. Iziphumo zesayizi zincinci (jonga apha ngasentla) kwaye iziphumo ziqhutywa kukuncitshiswa okungaphezulu komthamo wengwevu yengqondo yengingqi ngexesha lesikena. Xa singabandakanyi idatha kwiskena 2 (ngqo emva kotyando) kubalulekile ukwanda kwemeko engwevu yengqondo yemoto yecortex kunye necortex yangaphambili iphila kumda we-p <2 engalunganga (Itheyibhile 0.001).

 

 

isiphelo

 

Akunakwenzeka ukwahlula ukuba kungakanani ukuguqulwa kwesakhiwo esikubonayo ngenxa yeenguqu kwii-nociceptive input, utshintsho kwimisebenzi yemoto okanye ukusetyenziswa kwamachiza okanye utshintsho kwimpilo enjalo. Ukumisa iqela elihlukeyo lokuqala kunye nokugqibela lokutshintshana omnye nomnye kubonakalisa ukungalingani kangako kunokuba kulindeleke. Ngokuqinisekileyo, ukuguqulwa kwengqondo ngenxa yokubuhlungu okungapheliyo yonke imiphumo kuphuhliswa ngaphezu kwexesha elide kwaye kunokufuna ixesha lokubuyisela. Nangona kunjalo, ezi ziphumo zibonakalisa iinkqubo zokulungiswa kwakhona, zibonisa ukuba ingongoma engapheliyo ye-nociceptive ne-motor impairment kulezi zi gulane ikhokelela ekutshintshisweni kwimihlaba ye-cortical kwaye ngenxa yoko iinguqu zengqondo zengqungquthela ezisemgangathweni.

 

Imibulelo

 

Siyabulela onke amavolontiya ngokuthatha inxaxheba kulolu phofu kunye neChysics kunye neNkqubo zeNdlela kwi-NeuroImage Nord e-Hamburg. Isifundo sanikezwa imvume yecandelo lekomiti yoLungileyo kunye nemvume ebhaliweyo enolwazi yafunyanwa kubo bonke abathathi-nxaxheba phambi kokuba bahlolwe.

 

Ingxelo Yenkxaso

 

Lo msebenzi wawuxhaswa yimalikelo evela kwi-DFG (i-German Research Foundation) (i-MA 1862 / 2-3) kunye ne-BMBF (i-Federal Ministry of Education and Research) (371 57 01 ne-NeuroImage Nord). Abaxhasi babenalo nxaxheba kwiplani yokufunda, ukuqokelela idatha kunye nokuhlalutya, isigqibo sokupapasha, okanye ukulungiswa kweso siqendu.

 

 

Inkqubo ye-Endocannabinoid: Inkqubo eyiNtloko ongazange wayiva

 

Ukuba awuzange uve nge-endocannabinoid system, okanye i-ECS, akukho sidingo sokuba uhlazeke. Emuva kwi-1960, abaphandi ababenomdla kwi-bioactivity ye-Cannabis ekugqibeleni baninzi amaninzi eekhemikhali zawo ezisebenzayo. Kwathatha enye i-30 iminyaka, nangona kunjalo, kubaphandi bafunda iifom zezilwanyana ukuze bafumane i-receptor yezi khemikhali ze-ECS kwiibhokhwe zamagundane, ukufumanisa okuvulwe umhlaba wonke uphando kwi-ECS i-receptors ikhona kunye nokuba yintoni injongo yabo yokuphila.

 

Ngoku siyazi ukuba ininzi iilwanyana, kwiintlanzi ukuya kwiinyoni ziya kuba ne-endocannabinoid, kwaye siyazi ukuba abantu abagcini nje ngokwenza i-cannabinoids yabo enxulumene nale nkqubo, kodwa sivelisa nezinye iimveliso ezidibanisa ne-ECS, ezo ezibonakala kwizityalo ezininzi kunye nokutya, ngaphaya kweentlobo ze-Cannabis.

 

Njengendlela yokusebenza komzimba womntu, i-ECS ayiyona ndawo yesikhokelo esicacileyo njengendlela ye-nervous system okanye ye-cardiovascular system. Esikhundleni salo, i-ECS yiseti yama-receptors esasazwa ngokubanzi kuwo wonke umzimba osebenze ngokusetyenzwa kweelandi esaziwa ngokubanzi njenge-endocannabinoids, okanye i-endogannabinoid endogenous. Zomibini eziqinisekisiweyo zokufumana i-CB1 kunye ne-CB2, nangona kukho ezinye ezicetywayo. Iipalati ze-PPAR ne-TRP zidibanisa neminye imisebenzi. Ngokufanayo, uya kufumana kuphela i-endocannabinoids emibini egcinwe kakuhle: i-anadamide ne-2-arachidonoyl glycerol, okanye i-2-AG.

 

Ngaphezu koko, isisiseko kwinkqubo yokugcina i-endocannabinoid yi-enzymes edibanisa kwaye iphule i-endocannabinoids. I-Endocannabinoids ikholelwa ukuba ihlanganiswe kwisiseko esifanelekileyo. Ama-enzymes ephambili abandakanyekayo yi-diacylglycerol lipase kunye ne-N-acyl-phosphatidylethanolamine-phospholipase D, elandelana ngokulandelelana nge-2-AG kunye ne-anandamide. Ezi zimbini zi-enzyme ezihlaziyileyo zi-fatty acid amide hydrolase, okanye i-FAAH, ephula i-anandamide, kunye ne-monoacylglycerol lipase, okanye i-MAGL, ephula i-2-AG. Ukulawulwa kwezi zimbini ze-enzyme kunokwandisa okanye kunciphise umodyuli we-ECS.

 

Iyintoni umsebenzi we-ECS?

 

I-ECS yinkqubo eyintloko yokulawula i-homeostatic yomzimba. Inokuthi ibonwe ngokukhawuleza njengenkqubo ye-adaptogenic yangaphakathi, rhoqo isebenza ukugcina umlinganiselo wemisebenzi eyahlukeneyo. I-Endocannabinoids isebenze ngokubanzi njenge-neuromodulators kwaye, njengaloo ndlela, ilawula uluhlu olubanzi lweenkqubo zomzimba, ukusuka kwenzalo ukuya kwintlungu. Eminye yale mi sebenzi eyaziwayo e-ECS yile ndlela ilandelayo:

 

System nervous

 

Ukususela kwinkqubo yomnatha, okanye i-CNS, ukuvuselelwa ngokubanzi kwe-CB1 receptors kuyakuvimba ukukhululwa kwe-glutamate kunye ne-GABA. Kwi-CNS, i-ECS inendima ekwakheni imemori nokufunda, ikhuthaza i-neurogenesis kwi-hippocampus, iphinda ilawule ukunyaniseka kwe-neuronal. I-ECS nayo idlala inxaxheba kwindlela iingqondo eziza kusabela ngayo xa zilimala kunye nokuvuvukala. Ukususela kumgca womgudu, i-ECS ihlengahlengisa intlungu kwaye isondeza i-analgesia yemvelo. Kwinkqubo yenzwa ye-peripheral, apho i-CB2 i-receptors ilawula, i-ECS isebenza ngokusisiseko kwinkqubo yeentlonelo zentlungu ukulawula imisebenzi yamaphepheni emathumbu emathumbu, emanzini kunye nokuzala.

 

Ukuxinezeleka kunye neMood

 

I-ECS ineempembelelo ezininzi kwiimpendulo zoxinzelelo kunye nokulawulwa ngokomzwelo, njengokuqaliswa kwezimpendulo zomzimba kwiimeko ezixinzelelekileyo kunye nokulungelelanisa ngexesha elide kwiimvakalelo zangexesha elide, njengokwesaba nokuxhalabisa. Inkqubo yokugcina i-endocannabinoid esebenzayo ibaluleke kakhulu kwindlela abantu abahamba ngayo phakathi kweqondo eliyanelisayo lokuvuthwa xa kuthelekiswa nezinga eligqithisileyo nelingathandekiyo. I-ECS nayo inendima ekwakheni imemori kwaye mhlawumbi ngokukodwa kwindlela apho ubuchopho bukhumbuza khona izikhumbuzo zengcinezelo okanye ukulimala. Ngenxa yokuba i-ECS ihlengahlengisa ukukhululwa kwe-dopamine, i-noradrenaline, i-serotonin kunye ne-cortisol, nayo inokuchaphazela kakhulu iimpendulo zemoya kunye nokuziphatha.

 

System Digestive

 

I-tractes tract ehlala kwi-CB1 kunye ne-CB2 receptors ezilawula iinkalo ezibalulekileyo zezempilo ze-GI. Kucingelwa ukuba i-ECS ingaba "ikhonkco elahlekileyo" ekuchazeni isiqhagamshelo se-gut-brain-immune edlala indima ebalulekileyo kwimpilo esebenzayo yendlela yokutya. I-ECS ngumlawuli we-immune immunity, mhlawumbi ngokunciphisa umzimba wokuzikhusela ekubhubhiseni imifuno ephilileyo, kunye nokutyunjwa kwe-cytokine. I-ECS imodareyitha impendulo yokuvuvukala kwendalo kwindlela yokutya, eneempembelelo ezibalulekileyo kwimibandela ephakamileyo yempilo. I-Gastric kunye ne-GI motility ebonakalayo ibonakala ilawulwa yi-ECS.

 

Ukutya kunye neMetabolism

 

I-ECS, ngokukodwa i-CB1 receptors, idlala inxalenye yesondlo, i-metabolism, kunye nokulawulwa kwamathambo omzimba. Ukukhuthazwa kwama-receptor ye-CB1 kuphakamisa ukuziphatha kokufuna ukudla, kuphucula ulwazi lokunuka, kukwazisa ukulinganisela kwamandla. Zomibini izilwanyana kunye nabantu abagqithisileyo banokugqithiseleka kwe-ECS engakhokelela kule nkqubo ukuba ibe yingozi, egalela ekudleni kunye nokunciphisa inkcitho yamandla. Amanqanaba omjikelezo we-anandamide kunye ne-2-AG abonakaliswe ukuba aphakanyiswe ekunyanyeni, oko kunokuthi ube yinxalenye ngenxa yokunciphisa umveliso we-FAAH enzyme ehlazolayo.

 

Impilo ye-Immune kunye nokuphendula okuvuthayo

 

Iiseli kunye namalungu omzimba omzimba atyebile ngeempendulo ze-endocannabinoid. Iimvumi ze-Cannabinoid zibonakaliswe kwi-thymus gland, i-tleen, i-toni, kunye nomnatha wethambo, kunye ne-T- kunye ne-B-lymphocytes, i-macrophages, iiseli zesigxina, i-neutrophils, kunye neeseli zokubulala zendalo. I-ECS ithathwa njengomqhubi oyintloko wokuhlaziywa kwe-immune system kunye ne-homeostasis. Nangona kungekho yonke imisebenzi ye-ECS kwi-immune system eqondakalayo, i-ECS ibonakala ilawula ukuveliswa kwe-cytokine kunye nokuba negalelo ekukhuseleni ukungasebenzi komzimba kwi-immune system. Ukuvutha kuyingxenye yendalo yempendulo yomzimba, kwaye idlala indima eqhelekileyo ekuhlaselweni okusemzimbeni, kuquka ukulimala kunye nezifo; Nangona kunjalo, xa ingagcinwanga ingqwalasela ingaba yinto engapheliyo kwaye igalelo ekukhuselweni kweengxaki zempilo ezimbi, ezifana nentlungu engapheliyo. Ngokugcina iimpendulo zokuzivikela ngomzimba, i-ECS inceda ukugcina impendulo enokulinganisela emzimbeni.

 

Ezinye iindawo zempilo ezilawulwa yi-ECS:

 

• Impilo yeThambo
• Ukhula
• Impilo yengqondo
• I-Arterial and respiratory health
• Ukulala kunye nesigqi

 

Indlela engcono yokuxhasa i-ECS enempilo ngumbuzo abaninzi abaphandi abazama ukuphendula. Hlalani nilungelelanisa ngolwazi olungakumbi malunga nesi sihloko esikhulayo.

 

Ukuququmbela,Intlungu ye-ronicchronic idibene neenguqu zengqondo, kubandakanywa nokunciphisa into ebomvu. Nangona kunjalo, inqaku elingentla libonise ukuba iintlungu ezingapheliyo zinokutshintsha ubume kunye nokusebenza kwengqondo. Nangona iintlungu ezingapheliyo zinokukhokelela koku, phakathi kweminye imicimbi yezempilo, unyango olululo lweempawu zesigulana ezinokubuyisa utshintsho lwengqondo kunye nokulawula imvi. Ukongezelela, uphando olwenziweyo kunye nolunye uphando luye lwavela emva kokubaluleka kwenkqubo ye-endocannabinoid kwaye isebenza ekulawuleni nasekulawuleni ubuhlungu obungapheliyo kunye neminye imiba yezempilo. Ulwazi olukhankanyiweyo kwiZiko leSizwe loLwazi lweBiotechnology (NCBI) .Ububanzi bolwazi lwethu bunqunyelwe kwi-chiropractic kunye nakulimala komqolo kunye neemeko. Ukuxoxa ngomxholo, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi ku915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

Umqolo obuhlungu enye yezona zizathu ezibangeleko zokukhubazeka kunye neentsuku eziphosakeleyo emhlabeni wonke. Njengokuba kunjalo, iintlungu zenziwa emva kweyona sibini isizathu esivakalayo sokutyelela iofisi yee-dkt. Ngokumalunga neepesenti ze-80 zabemi ziya kuba nolunye uhlobo lweentlungu zentlungu ubuncinane kanye kanye ebomini babo. Umgudu uyisakhiwo esiyinkimbinkimbi esakhiwa ngamathambo, amajoyina, iigaments kunye nezihlunu, phakathi kwezinye iifomthi ezithambileyo. Ngenxa yoko, ukulimala kunye / okanye iimeko ezihlaziyiweyo, ezifana disni, ekugqibeleni unokukhokelela kwiimpawu zentlungu. Ukulimala kwezemidlalo okanye ukulimala kwengozi yeemoto ngokuqhelekileyo kubangelwa yintlungu yokubuhlungu, kodwa ngamanye amaxesha ukuhamba kwezinto ezilula kunokuba neziphumo ezibuhlungu. Ngethamsanqa, ezinye iindlela zokhathalela unyango, ezifana nokunyamekelwa kwe-chiropractic, kunokunceda ukubuyisela intlungu emva kokusetyenziswa kwemilenze kunye nokunyanzeliswa kwemigaqo, ekugqibeleni ukuphucula intlungu.

 

 

 

ISIHLOKO ESIBALULEKILEYO: Ulawulo oluPhantsi lwePain Pain

 

IINKCUKACHA NGOKUGQITHISILEYO: UKONGEZA KWEZINTLOKO: PainUbuhlungu obungapheliyo kunye nonyango