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Objective:To explore vibration, position and motion proprioception of the ankle joints after a stroke.Methods:Twenty-eight stroke survivors with impaired ankle proprioception were divided into a right-side stroke group ( n=18) and a left-side stroke group ( n=8). Twenty-two healthy volunteers constituted a control group. Vibration perception thresholds, passive and active joint angle resetting, and motion minimum thresholds were quantified among the stroke survivors on both the healthy and the affected side. With the controls the dominant and non-dominant sides were used. The differences in proprioception between the healthy volunteers and the stroke patients, between the affected side and the healthy side of the stroke patients, and between left- and right-side stroke patients were analyzed and compared. Results:Among the stroke survivors the vibration perception threshold on the affected side averaged (28.91±22.53)μm. The absolute difference in the perception of passive positioning was (5.49±5.39)° for 15° of plantar flexion and (4.48±3.89)° for 5° of dorsal extension. In active positioning plantar flexion was (5.23±4.34)° and for 30° of plantar flexion it was (3.26±1.73)°. The 5° dorsal extension error was (4.97±3.48)°. The motion perception thresholds between 20° of plantar flexion, 10° of plantar flexion and the neutral position were significantly higher, on average, than among the control group. The stroke group also had significantly higher motion perception thresholds than the control group.Conclusion:The vibration, position, and motion sense of the ankle joint on a stroke survivor′s affected side tend to be impaired, with the impairment of vibration and motion sensing tend to be more substantial. After stroke, there is also mild impairment of vibration, position and motion sensing in the healthy ankle joint. The impairment of proprioception caused by right cerebral hemisphere injury may be more serious than that caused by injury on the left.
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Objective:To test the utility of monofilament cutaneous threshold testing among patients with impaired touch sensation caused by central nervous system injury.Methods:Thirty stroke survivors and 30 patients with spinal cord injury were recruited. Monofilament threshold testing and cotton wool tests were performed on the bilateral forehead, face, palms and dorsum of feet among the stroke survivors. Among those with a spinal cord injury both tests were performed on each side of the L 4, L 5 and S 1 vertebrae. One week later, all were retested. Intra-class correlation coefficients (ICCs) were used to quantify the test-retest reliability of the tests. Kappa values were calculated to determine the degree of agreement between them. Stepwise multiple linear regressions were evaluated to examine the relationship between touch perception thresholds and age, height, gender, type of injury and injured site. Results:①The ICC for the monofilament test was between 0.74 and 0.95, higher than that of the cotton wool test (ICC: 0.60 to 0.83). ②The kappa value between the monofilament and cotton wool tests was 0.550, indicating good agreement. ③The types of injury and injured sites were independent correlates of the touch perception thresholds, but there was no significant correlation between the touch perception thresholds and age, height, gender or group.Conclusions:The monofilament cutaneous threshold test has good test-retest reliability, better than the cotton wool test. Therefore, it may be useful as a tool for assessing impaired touch sensation caused by central nervous system injury.
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【Objective】 To investigate the transfusion ratio of plasma to RBC suspension during DIC caused by sever postpartum hemorrhage, so as to improve the clinical blood transfusion protocol. 【Methods】 A total of 82 parturients, who gave birth in our obstetrics department from January 2008 to December 2019 and treated successfully for DIC due to sever postpartum hemorrhage, were selected for the study. According to the plasma/RBC suspension ratio range (from 0.4 to 2.0) during DIC rescue, the included population was divided into four groups according to the ratio interval of 0.4: Group 1: 0.4~0.8 (13 people, median 0.7), Group 2 : 0.8~1.2(30 people, median 1.0), Group 3: 1.2~1.6(30 people, median 1.3), and Group 4: 1.6~2.0 (9 people, median 1.8). The general conditions, way of delivery, number of uterine artery perfusion embolization and surgical operations performed in the 4 groups were recorded. Once spontaneous postpartum hemorrhage occurred, blood cell analysis and coagulation function examinations were carried out every 1 to 2 hours until the condition was stable. The 24-hour blood loss, transfusion units of RBC suspension, fresh frozen plasma(FFP), platelet apheresis and fibrinogen during DIC and throughout the rescue of 4 groups were recorded and compared. Locally Weighted Regression (Lowess) method was applied to analyze the nonlinear association between the plasma/RBC suspension ratio and the duration of DIC, according to the duration of DIC in 4 groups. 【Results】 1) The shortest duration of DIC (326.15 min) was observed in DIC patients transfused with a plasma/ red blood cell suspension ratio=1.8. The duration of DIC (min) in the four groups were 505.21±259.53, 435.67±307.18, 420.93±259.43, and 247.86±215.77, respectively (P<0.05). 2) The coagulation indexes PT(s), INR, APTT(s) and Fib(g/L) gradually recovered between 2.9~13.9 h after transfusion in all four groups, especially in group 4 (median plasma/RBC suspension ratio of 1.8), whose changes were most pronounced in PT, INR, and Fib at 4.3 h, 2.9 h, and 5 h, respectively (P<0.05). 【Conclusion】 Fresh frozen plasma should be given as early as possible during blood transfusion treatment of DIC rescue. The increase of the ratio of plasma/RBC suspension is beneficial to the early recovery of DIC, and the optimal ratio of plasma to RBC suspension is 1.8.
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Objective To investigate the effect of telerehabilitation on memory disorders. Methods From August, 2010 to April, 2015, 81 patients with memory disorders were randomized into control group (n=26), computer-assisted training group (n=33) and telerehabilita-tion training group (n=22). All the patients accepted medicine to facilitate the recovery of memory. Besides, the computer-assisted training group and the telerehabilitation training group accepted memory-based training programs with cognitive rehabilitation system locally or on network respectively, for six weeks. They were evaluated with Wechsler Memory Scale, Rivermead Behavioural Memory Test-2nd Edition and Rey Auditory Verbal Learning Test before and after training. Results Both computer-assisted and telerehabilitation training groups im-proved in all the assessment after training (t>4.059, P0.05). There was no sig-nificant improvement in the control group after training (t0.05). Conclusion Memory rehabilitation training can significantly im-prove memory abilities, similar with locally or telerehabilitation system.
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Objective To investigate the characteristics of executive function in patients with brain injury. Methods From March 1st, to June 30th, 2015, 44 patients with brain injury were investigated with Wisconsin Card Sorting Test (WCST), the indexes including Responses Answer, Categories Completed, Correct Responses, Errors Responses, Trials to Complete First Category, Percent Conceptual Level Respons-es Percentage, Perseverative Responses Errors, Nonperseverative Responses Errors, Failure to Maintain Set, and Learning to Learn. Results The abnormal rates were the most in Nonperseverative Responses Errors and Percent Conceptual Level Responses Percentage (61.36%), and then in Responses Answer/Categories Completed/Correct Responses (59.09%), Correct Responses (43.18%), Trials to Complete First Category (38.64%), Perseverative Errors (29.51%), Learning to Learn (25.00%), and Failure to Maintain Set (9.09%). The patients with trau-matic brain injury were different from those with stroke in Responses Answer, Errors Responses, Perseverative Responses Errors, Catego-ries Completed, Percent Conceptual Level Responses Percentage, and Learning to Learn (Z>2.444, t>2.156, P<0.05). The patients injured in frontal lobe were different from those in other areas in Perseverative Responses Errors (t=2.595, P=0.015). Conclusion Executive function damaged generally in patients with brain injury, which related to concentration, abstract, shifting attention, working memory, etc. The frontal lobe damage may associate with the disorder of shifting attention.
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@# Objective To investigate the characteristic of picture forgetting in closed traumatic brain injury (CTBI) patients during recovery. Methods From October, 2012 to August, 2013, 60 colour slides of target or interference picture were presented to 38 CTBI patients during recovery and 31 matched healthy controls. Their discriminability index (d′) was observed 10 minutes, 30 minutes and 24 hours later. Results Forteen patients failed to attain d′ of 2.0 10 minutes later, and were excluded from further study. The d′ of the other 24 patients was less than that of the controls 10 minutes, 30 minutes and 24 hours later (t>2.044, P<0.05). The d′ in the patients was more of 10 minutes and 30 minutes than that of 24 hours (P<0.05). Conclusion Some patients with CTBI during recovery exhibit impairment in acquisition of pictorial information, and accelerated forgetting is found in the others without impairment.
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Objective To investigate the correlation between Semmes-Weinstein monofilament test and light touch exam of international standard for spinal cord injury (SCI). Methods 84 inpatients with SCI were assessed with Semmes-Weinstein monofilament test and light touch exam of international standard to determine the SCI level. The results were recorded as right-side and left-side of the body respective-ly. Results The normal tactual level of monofilament test and the normal light touch level of International Standard of Spinal Cord Injury (ISSCI) was consistent in 36%result to the unilateral level of SCI. For the 45 cases with ASIA A injury, 71%of the key points below the SCI level lost the tactual sensation in monofilament test, and 84%lost in light touch exam of ISSCI. Conclusion The result of monofilament test is poorly consistent with light touch exam of SCI, which may result from tactile sensitization after SCI. It is recommended to combine these exam in practices.
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Objective To measure the temperature sensation threshold of trunk skin in healthy adults. Methods The threshold of cold sensation, warm sensation, cold pain sensation and heat pain sensation of trunk skin key points (T3, T7 and T11) were measured with Thermal Sensory Analyzer in 123 healthy adults. Results The thresholds of cold, warm, cold pain and heat pain sensations were obtained. The stan-dard deviation of cold and warm threshold was less than that of heat pain. The range of cold sensation threshold was the largest. The heat pain sensation threshold increased with segmental declining and the sensation threshold increased with age. Conclusion Normal reference value should be established variously with the segment and age. The threshold of cold, warm varies less, while the threshold of cold pain and heat pain varies too much.
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@#Objective To investigate the correlation between Semmes-Weinstein monofilament test and light touch exam of international standard for spinal cord injury (SCI). Methods 84 inpatients with SCI were assessed with Semmes-Weinstein monofilament test and light touch exam of international standard to determine the SCI level. The results were recorded as right-side and left-side of the body respectively. Results The normal tactual level of monofilament test and the normal light touch level of International Standard of Spinal Cord Injury (ISSCI) was consistent in 36% result to the unilateral level of SCI. For the 45 cases with ASIA A injury, 71% of the key points below the SCI level lost the tactual sensation in monofilament test, and 84% lost in light touch exam of ISSCI. Conclusion The result of monofilament test is poorly consistent with light touch exam of SCI, which may result from tactile sensitization after SCI. It is recommended to combine these exam in practices.
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@#Objective To compare the efficacy of different models of attention rehabilitation on attention deficits after acquired brain injury. Methods According to the training models, 47 patients with attention deficits were randomly assigned to 3 groups: computer-assisted training group(n=16), face-to-face training group(n=21) and control group(n=10). The training groups were given attention training once a day which sustained 30 minutes for 6 weeks. All patients were tested with the Montreal Cognitive Assessment (MoCA) and the Loewenstein Occupational Therapy Cognitive Assessment Battery (LOTCA) before and 6 weeks after the rehabilitation. Results The performance of both the computer-assisted training group and the face-to-face training group significantly improved (P<0.05). The various of the scores was the most in the computer-assisted training group among them (P<0.05). Conclusion The computer-assisted training is a high-effective method for attention deficits.
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@#Objective To compare the efficacy of different rehabilitation models on acalculia after acquired brain injury. Methods 113 cases were randomly assigned to 3 groups: control group(n=37), computer-assisted training group(n=38) and face-to-face training group(n=38). The control group just received cognitive dysfunction evaluation. The training groups received cognitive rehabilitation training 5 days a week and 30 minutes a day which sustained for 6 weeks. And 33 patients were selected to prolong for 12 weeks. They were evaluated with Revised EC301Calculation and Number Processing Battery in Chinese version (EC301-CR) at the beginning, the 6th week point and the 12th week point respectively. Results 6-week after treatment, The performance of both the computer-assisted training group and face-to-face training group significantly improved(P<0.001); It showed that computer-assisted group>face-to-face group>control group(P<0.001) both 6 weeks and 12 weeks latter. Significant negative correlation was found between age and performance of EC301-CR(P<0.05).Conclusion The effect of computer-assisted training on acalculia is superior to face-to-face training; The first 6 weeks of training is the best period for rehabilitation; The younger the patient is, the better results are.
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@#Objective To investigate the effect of rehabilitation on memory deficits after acquired brain injury, to compare different training models of memory rehabilitation and to analyze the possible factors affecting memory rehabilitation. Methods 144 patients with acquired brain injury following memory deficits were randomly assigned to computer-assisted training group, face-to-face training group and control group. Both training groups were given memory-based cognitive training program once a day which sustained 30 minutes for 6 or 12 weeks. The instantaneous memory, short-term memory and long-term memory were evaluated and compared before and after training. The effect of gender, age, education, course, site of injury and coma time on training efficacy were analyszed as well. Results 6 weeks and 12 weeks at training, both computer-assisted and face-to-face training groups showed a significant improvement in memory abilities when compared to controls (P<0.01), with the former making more progress (P<0.01). Negative correlation was found between age and memory performance. Conclusion Effectiveness of memory rehabilitation is proven. 12 weeks training can significantly improve memory. Cognitive training using professional equipment is significantly more effective than the face-to-face training and should be recommended.
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@#Objective To analyze the reliability and validity of Revised EC301Calculation and Number Processing Battery in Chinese version (EC301-CR); To establish diagnostic criteria by EC301-CR for acalculia in order to provide an effective assessment tool clinically. Methods The items of EC301were adjusted. 103 patients with acquired brain injury and 37 normal controls were randomly selected. 24 normal controls randomly selected were retested 6 weeks latter. Results The Cronbach's coefficient, the split-half reliability and the retest reliability coefficients were 0.907, 0.744, and 0.965, respectively. The correlation coefficient within subscales was more than the correlation coefficient between subscales. 4 first-order factors were extracted which accounted for 69.359% of the accumulated variance, which were mental calculation, number transcoding, written calculation and approximation, and understanding of numbers. Control data (n=37) showed that the P10 of EC301-CR was 222.6. Conclusion The critical value of acalculia is 222.6 in EC301-CR test. Psychometric properties analysis shows that EC301-CR is a reliable and validated instrument for acalculia.
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@#Memory disorders is the commonest cognitive impairment of people with traumatic brain injury, cerebral vascular disease, senile dementia and so on. Recently researchers at home and abroad used different rehabilitation training methods to treat the memory disorders in patients with brain injury, and has made some progress. This study reviewed the methods and efficacy of recent rehabilitation about memory disorders, and discussed the optimum rehabilitation programs.
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<p><b>OBJECTIVE</b>To investigate the relationship among -75 bp/+83 bp polymorphism in apolipoprotein A1 (apo A1) gene, lipids levels and the occurrence of coronary atherosclerosis disease (CAD).</p><p><b>METHODS</b>We determined distributions of two MspI polymorphisms of the apo A1 gene at -75 bp and +83 bp, and blood lipids levels among 137 Chinese patients (92 with CAD and 45 in the control group) in relation to circulating lipids and coronary angiography.</p><p><b>RESULTS</b>The demographic information for 137 subjects showed that subjects with CAD tended to have more unfavorable lipoprotein variables. Genotype distributions at both sites were different between the CAD and control groups. Furthermore, the control group had higher M1-/M2- frequencies than the CAD group (M1: P < 0.005; M2: P < 0.05) and the "M1-" (A) and "M2-" alleles were associated with increased high-density lipoprotein cholesterol (HDL-C) (M1-: P < 0.0001; M2-: P < 0.05) and apo A1 (M1-: P < 0.0001; M2-: P < 0.05) levels. "M1-" and "M2-" were significantly negatively correlated with CAD (P < 0.01 and P < 0.05, respectively).</p><p><b>CONCLUSIONS</b>Our results suggest that changes from G to A at the -75 bp site and from C to T or G to A at the +83 bp site do increase circulating levels of apo A1 and HDL-C. And those individuals with these changes are likely to have a lower risk of developing CAD.</p>
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Female , Humans , Male , Middle Aged , Apolipoprotein A-I , Blood , Genetics , Case-Control Studies , Cholesterol, HDL , Blood , Coronary Artery Disease , Blood , Genetics , Lipids , Blood , Polymorphism, GeneticABSTRACT
<p><b>OBJECTIVE</b>To investigate whether patients, who are at risk of major acute coronary events, are safe to undergo and benefit from early intervention after using simvastatin.</p><p><b>METHODS</b>The study was a randomized, open, two-dosage-controlled trial to evaluate the safety and benefits of simvastatin administered to 197 patients (10 mg group, n = 98 and 20 mg group, n = 99), within 48 hours of hospitalization for a diagnosis of unstable angina or acute myocardial infarction (MI), with total cholesterol (TC) >/= 180 mg/dL or low-density lipoprotein cholesterol (LDL-C) >/= 100 mg/dL. Lipid levels were measured immediately, followed by the 3rd, 6th and 12th month after admission and all adverse events were recorded during follow-up.</p><p><b>RESULTS</b>TC levels fell by 10.15% and 14.52% in the 10 mg and 20 mg groups (P < 0.05), and LDL-C levels fell 13.87% and 19.38% in the 10 mg and 20 mg groups, respectively (P < 0.01), 12 months after using simvastatin. The rates of achieving target TC reached 26.3% and 36.5% in the 10 mg and 20 mg groups (P < 0.01), and that of LDL-C reached 28.2% and 40.3% in the 10 mg and 20 mg groups, respectively (P < 0.01). There were higher rates of MI and re-hospitalization resulting from angina pectoris and revascularization in the 10 mg group compared with the 20 mg group.</p><p><b>CONCLUSIONS</b>The results suggest that early intervention with the HMG-CoA reductase inhibitor, simvastatin, in acute coronary syndromes is possible and safe. It also indicates that the clinical dosage of simvastatin are relatively smaller than that for satisfactory lipid control in patients with acute coronary syndromes.</p>