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Objective@#To systematically evaluate evidence for the use of interventions based on appied behavior analysis (ABA) to manage various symptoms of children with autism spectrum disorder (ASD). @*Methods@#Sensitivity analyses were conducted by removing any outlying studies and subgroup analyses were performed to compare the effectiveness of ABA and early start denver model (ESDM), picture exchange communication systems (PECS) and discrete trial training (DTT). @*Results@#14 randomized control trials of 555 participants were included in this meta-analysis. The overall standardized mean difference was d=-0.36 (95% CI -1.31, 0.58; Z=0.75, p=0.45) for autism general symptoms, d=0.11 (95% CI -0.31, 0.54; Z=0.52, p=0.60) for socialization, d=0.30 (95% CI -0.02, 0.61; Z=1.84, p=0.07) for communication and d=-3.52 (95% CI -6.31, -0.72; Z=2.47, p=0.01) for expressive language, d=-0.04 (95% CI -0.44, 0.36; Z=0.20, p=0.84) for receptive language. Those results suggested outcomes of socialization, communication and expressive language may be promising targets for ABA-based interventions involving children with ASD. However, significant effects for the outcomes of autism general symptoms, receptive language, adaptive behavior, daily living skills, IQ, verbal IQ, nenverbal IQ, restricted and repetitive behavior, motor and cognition were not observed. @*Conclusion@#The small number of studies included in the present study limited the ability to make inferences when comparing ABA, ESDM, PECS and DTT interventions for children with ASD.
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Objective To compare the efficacy of goal_activity_motor environment( xAmE)therapy and neurodevelopmental therapy(NDT)in the early intervention of high_risk infants with cerebral palsy(IHRCP),and to provide scientific evidence_based medical basis for early intervention of IHRCP. Methods A total of 62 cases of IHRCP were enrolled in the Children＇s Neurological Rehabilitation Center of the First Affiliated Hospital of Anhui medi_cal University from June 2017 to December 2018. They were divided into xAmE group(32 cases)and NDT group(30 cases)according to the admission order. xross motor Function Scale(xmFm),Fine motor Function measure(FmFm) and xesell Development Scale(xDS)were used for detection and comparison. The differences among the gross motor, the fine motor score and the developmental quotient( D匝)between two groups before treatment,9 months after treat_ment and 12 months after treatment,and the normalization rate and the incidence of cerebral palsy between the two groups at 12 months of age were compared. Results ( 1 )motor function was as follows:at 9 months[ xAmE:(32. 63 ± 15. 83)scores,(30. 03 ± 15. 88)scores],[NDT:(33. 37 ± 15. 61)scores,(29. 67 ± 12. 54)scores]and at 12 months[xAmE:(40. 56 ± 15. 79)scores,(36. 31 ± 14. 98)scores],[NDT:(40. 47 ± 15. 50)scores,(36. 73 ± 14. 58)scores]after treatment,and xmFm and FmFm scores in xAmE and NDT groups were significantly higher than those before treatment[xAmE:(27. 56 ± 14. 24)scores,(21. 75 ± 11. 35)scores],[ NDT:(26. 93 ± 14. 96)scores, (21. 30 ± 10. 67)scores],and the differences were significant( all P<0. 01),but there was no significant difference between the 2 groups(all P> 0. 05).(2)D匝 had no significant difference in D匝 between xAmE group(63. 59 ± 10. 83)and NDT group(61. 59 ± 7. 96)before treatment(P>0. 05). The total D匝 at 9 months,12 months,the total D匝 of xAmE group(73. 67 ± 12. 00,81. 59 ± 13. 03)was significantly higher than that of NDT group(66. 05 ± 9. 54, 75. 17 ± 1. 92)(all P<0. 05). Among them,the improvement of xAmE in speech(79. 84 ± 16. 56,83. 19 ± 17. 05)at 9 months and 12 months,and adaptive ability(78. 63 ± 16. 37,85. 78 ± 13. 60)were significantly higher than that of NDT group(71. 63 ± 13. 36,72. 53 ± 12. 77),(68. 20 ± 14. 97,77. 43 ± 12. 10),and the differences were significant( all P<0. 05).(3)Prognosis was as follows:at 12 months after treatment,25 cases in xAmE group and 23 cases in NDT group developed into normal children,there was no significant difference in the normalization rate between the 2 groups( P>0. 05);the incidence of cerebral palsy was present in 6 cases in xAmE group and 5 cases in NDT group,and there was no significant difference between the 2 groups(P>0. 05). Conclusions xAmE therapy and NDT had significant effects on both gross and fine exercise of IHRCP,and the efficacy of the two methods is similar. Both xAmE therapy and NDT can equally promote IHRCP development into normal infants and reduce the incidence of cerebral palsy.
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Objective@#To compare the efficacy of goal-activity-motor environment (GAME) therapy and neurodevelopmental therapy (NDT) in the early intervention of high-risk infants with cerebral palsy (IHRCP), and to provide scientific evidence-based medical basis for early intervention of IHRCP.@*Methods@#A total of 62 cases of IHRCP were enrolled in the Children′s Neurological Rehabilitation Center of the First Affiliated Hospital of Anhui Medi-cal University from June 2017 to December 2018.They were divided into GAME group (32 cases) and NDT group (30 cases) according to the admission order.Gross Motor Function Scale (GMFM), Fine Motor Function Measure (FMFM) and Gesell Development Scale (GDS) were used for detection and comparison.The differences among the gross motor, the fine motor score and the developmental quotient (DQ) between two groups before treatment, 9 months after treatment and 12 months after treatment, and the normalization rate and the incidence of cerebral palsy between the two groups at 12 months of age were compared.@*Results@#(1) Motor function was as follows: at 9 months[GAME: (32.63±15.83) scores, (30.03±15.88) scores], [NDT: (33.37±15.61) scores, (29.67±12.54) scores] and at 12 months[GAME: (40.56±15.79) scores, (36.31±14.98) scores], [NDT: (40.47±15.50) scores, (36.73±14.58) scores] after treatment, and GMFM and FMFM scores in GAME and NDT groups were significantly higher than those before treatment[GAME: (27.56±14.24) scores, (21.75±11.35) scores], [NDT: (26.93±14.96) scores, (21.30±10.67) scores], and the differences were significant (all P<0.01), but there was no significant difference between the 2 groups (all P> 0.05). (2) DQ had no significant difference in DQ between GAME group(63.59±10.83) and NDT group (61.59±7.96) before treatment (P>0.05). The total DQ at 9 months, 12 months, the total DQ of GAME group (73.67±12.00, 81.59±13.03) was significantly higher than that of NDT group (66.05±9.54, 75.17±1.92) (all P<0.05). Among them, the improvement of GAME in speech (79.84±16.56, 83.19±17.05) at 9 months and 12 months, and adaptive ability(78.63±16.37, 85.78±13.60) were significantly higher than that of NDT group(71.63±13.36, 72.53±12.77), (68.20±14.97, 77.43±12.10), and the differences were significant (all P<0.05). (3) Prognosis was as follows: at 12 months after treatment, 25 cases in GAME group and 23 cases in NDT group developed into normal children, there was no significant difference in the normalization rate between the 2 groups (P>0.05); the incidence of cerebral palsy was present in 6 cases in GAME group and 5 cases in NDT group, and there was no significant difference between the 2 groups (P>0.05).@*Conclusions@#GAME therapy and NDT had significant effects on both gross and fine exercise of IHRCP, and the efficacy of the two methods is similar.Both GAME therapy and NDT can equally promote IHRCP development into normal infants and reduce the incidence of cerebral palsy.
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<p><b>OBJECTIVE</b>To study the effects of acupuncture combined with rat nerve growth factor (NGF) on the cerebral palsy infant rats and the proteins which associated with growth, apoptosis and metabolism.</p><p><b>METHODS</b>Seventy infant rats were selected, Fifty infant rats of which were made the cerebral palsy infant model by the ligation of unilateral carotid artery for cerebral ischemia and oxygen-deficient environment, then the 30 model rats were randomly divided into a model group, a NGF group and a combined group, 10 rats in each group. Twenty infant rats were used in the sham-operated group and the blank control group, 10 rats in each group. The treatment was not given in the blank control group. The rats in the sham-operated group were cut the neck skin and separated the left carotid artery, and then sutured and disinfected the wound. The intraperitoneal injection of NGF (2000 U•kg•d) was used in the NGF group. Based on the injection in the NGF group, acupuncture was used in the combined group, once a day, and the acupoints were "Baihui" (GV 20), left "nieⅠ" (extra), "Dazhui" (GV 14), "Jizhong" (extra), "Quchi" (LI 11), "Yongquan" (KI 1), "Hegu" (LI 4), "Zhoujie" (extra) and "Xiqianxue" (extra). The same volume of saline was intraperitoneally injected in the model group for continuous 14 days. Neurobehavioral ability score was evaluated after treatment. TUNEL were conducted to detect the brain cell apoptosis rate and the expressions of apoptosis associated gene Bax, Bcl-2 and Casp3 were detected by PCR. The level of nerve growth associated protein (GAP-43) and energy metabolism-related protein monocarboxylate transporter protien 1(MCT 1) were detected by Western blot.</p><p><b>RESULTS</b>After intervention, the neurobehavioral ability of baby rats in the blank control and sham-operated group was normal, but there was various degrees of abnormity in the model group, NGF group and combined group. The scores of neurobehavioral ability of the combined group and NGF group were better than those of the model control (all <0.05), and the scores in the combined group was better than those in the NGF group (all <0.05). The left brain cell apoptosis rate, expressions of Bax and Casp3 in the combined group and NGF group were lower and the expressions of Bcl-2 were higher than those of the model group (all <0.05), with more obvious results of Bax and Gasp3 in the combined group than those in the NGF group (all <0.05). The protein levels of GAP-43 and MCT 1 in the combined group and NGF group were higher than those in the model group (all <0.05), with higher expressions in the combined group compared with those in the NGF group (both <0.05).</p><p><b>CONCLUSION</b>Acupuncture combined with NGF could improve the neurobehavioral ability of cerebral palsy infant rats, inhibit the nerve cell apoptosis and improve the brain tissue injure and energy metabolism by up-regulating the expressions of GAP-43 and MCT 1.</p>
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Objective To investigate the effect of miRNA-146a expression on the differentiations and functions of CD4 + T lymphocyte in children with psoriasis vulgaris.Methods Thirty children with psoriasis vulgaris and 30 normal controls were enrolled in this study.Quantitative reverse transcription polymerase chain reaction (RT-PCR)was used to detect the expression of miRNA-146a in CD4 + T lymphocytes of the peripheral blood.The CD4 + T lymphocytes were isolated from mononuclear cells prepared with Ficoll-Hypaque density-gradients centrifugation from human peripheral blood by magnetic cells sorting system.The CD4 + T lymphocytes were divided into 3 groups for the experiment:control group,miRNA-146a group,and miRNA-146a inhibitor group.The number of Th1 cells was measured by flow cytometry analysis (FACS).The protein levels and expressions of IFN-γRα were measured by using Western blot and RT-PCR,respectively.The levels of IFN-γ in culture supernatants of CD4 + T lymphocytes were detected by using enzyme-linked immunosorbent assay(ELISA).Results Compared with the normal control group,there was significant increase in the expression of miRNA-146a and serum level of IFN-γ in the psoriasis vulgaris group[2.43±0.94vs1.05 ±0.23,(27.69 ±7.64) ng/Lvs (9.75 ±2.81) ng/L] (t=6.651,4.237,allP＜0.01).There was a positive correlation between miRNA-146a and serum IFN-γ (r =0.837,P ＜ 0.01).However,in vitro,the number of Th1,and supernatant IFN-γ increased,and the expression of IFN-γRα protein decreased in miRNA-146a group compared with that of the control group(all P ＜ 0.01).And the miRNA-146a inhibitor could attenuate the effect of miRNA-146a effectively.Conclusions The miRNA-146a can promote differentiation and improve the function of Th1,It may play an important role in the pathogenesis of psoriasis vulgaris in children.