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@#Objective To observe the effect of Botulinum toxin type A (BTX-A) injection on spastic hamstring in the children with cerebral palsy. Methods 39 cerebral palsy children with spastic hamstring were divided into control group (n=20) and experimental group (n= 19). The control group accepted physical therapy, while the experimental group accepted BTX-A injection in affected hamstring in addition.They were assessed with modified Ashworth Scale (MAS), Gross Motor Fucntion Measure (GMFM-88) and flexion angle of knee joints before and after treatment. Results The scores of MAS and GMFM-88, and flexion angle of knee joints improved significantly 6 weeks after treatment in the experimental group (P<0.05), and improved more than that in the control group (P<0.05). Only the score of GMFM-88 improved significantly in the control group (P<0.05). Conclusion BTX-A injection can relieve hamstring spasticity in children with cerebral palsy, which may be helpful to correct abnormal gait and improve the motor function.
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<p><b>OBJECTIVE</b>To perform a meta-analysis of randomized controlled trials (RCTs) assessing the benefit of providing branched chain amino acid (BCAA)-enriched nutrition to improve hepatic function in patients undergoing hepatic operation.</p><p><b>METHODS</b>The electronic databases of PubMed, Springerlink, the Chinese Biomedical Database (CBM), the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) were searched for relevant RCTs using the following search terms: nutritional support, enteral nutrition, parenteral nutrition, hepatic/liver surgery, liver cirrhosis, cancer, hepatectomy, and liver transplantation. The quality of the retrieved RCTs was assessed according to the scale developed by the Cochrane Collaboration. The meta-analysis was conducted using RevMan software, version 5.2.</p><p><b>RESULTS</b>A total of 11 relevant RCTs, representing 510 patients, were included in the meta-analysis. Compared to patients in the control (normal nutrition) group, the patients in the BCAA group experienced an effective improvement in hepatic function, as evidenced by significant decreases in total bilirubin (by 0.07 mumol/L; 95% confidence interval (CI): -0.18 to 0.05, P more than 0.05]. In addition, the BCAA group showed improvements in plasma levels of albumin (weighted mean difference (WMD) = 0.07; 95% CI: 0.06, 0.24, P less than 0.05) and alanine aminotransferase (WMD = +5.61; 95% CI: -8.63 to 19.86, P more than 0.05] but neither of the changes reached the threshold of a statistically significant improvement. The BCAA group did however show significantly lower complication rate after operation (65%, 95% CI: 0.48, 0.87, P less than 0.01] and mean duration of hospital stay (4.61 days; 95% CI: -6.61, -2.61, P less than 0.01].</p><p><b>CONCLUSION</b>BCAA-enriched nutrition improves hepatic function in patients undergoing hepatic operation, thereby helping to reduce the complication risk, duration of hospital stay, and financial burden. BCAA-enriched nutrition is a safe and effective therapy and further clinical application may be beneficial.</p>
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Humans , Amino Acids, Branched-Chain , Therapeutic Uses , Hepatectomy , Methods , Intraoperative Period , Liver , Physiology , General Surgery , Liver Transplantation , Methods , Nutritional Support , Methods , Randomized Controlled Trials as TopicABSTRACT
Objective To compare the advantages and disadvantages of botulinum toxin A (BTX-A) and phenol block in the treatment of spasticity in children with cerebral palsy. Methods Four hundred and twenty children with spastic cerebral palsy were divided into an experimental group (375 cases) and a control group (45 cases).The children were aged from 1 to 22 years ( average age 6 years).The children in the experimental group were treated with BTX-A block at a dosage of 55 to 350 IU (average 130.5 IU).The children in the control group were treated with a 5％ phenol solution block at a dosage of 0.5 to 4.6 ml ( average 2.2 ml).Children of both groups were given systematic functional rehabilitation training. All the children were evaluated with a physician rating scale (PRS) and the modified Ashworth scale (MAS) before and after the blocking.Effectiveness rates,effectiveness durations and side effects rates were calculated. Results Before treatment there was no significant difference in terms of motor disorder or spasticity between the 2 groups.After treatment,spasticity had been significantly reduced in both groups.The effectiveness rate was 98.4％ in the experimental group and 95.6％ in the control group,a difference which was not significant.The average effectiveness duration was ( 24.9 ± 5.76 ) weeks in the experimental group and ( 69.2 ± 13.76) weeks in the control group,significantly longer.The side effects rate was 5.33 ％ in the experimental group and 15.56％ in the control group,also a significant difference. Conclusion BTX-A could be more widely used because of its safety and credibility.
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@# Objective To investigate the long-term efficacy of Botulinum toxin type A (BTX-A) on spasticity in cerebral palsy, and theeffect of rehabilitation on it. Methods 230 children with spastic cerebral palsy were treated with BTX-A block. The dose of BTX-A wasidentified with the weight of the children and the Modified Ashworth Scale (MAS). They were divided into group A who exercised morethan 2 h/d, and group B who exercised less than 2 h/d or not. They were assessed with Gross Motor Function Measure (GMFM) 1 year aftertreatment. Results There was no significant difference between group A and B with ages, weight, MAS, GMFM before block (P>0.05), norwith BTX-A effect time (P>0.05). The GMFM improved significantly in both group A and B 1 year after block (P<0.05), and it improvedmore in group A than group B (P<0.01). Conclusion The long-term efficacy of BTX-A block is positive. The rehabilitation training afterblock can help children to improve their gross motor function.
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@#Objective To evaluate the validity of Community Extremity Disability Assessment Schedule (CEDA) in community rehabilitation. Methods 313 patients with hemiplegia after stroke were divided into rehabilitation group and control group. The rehabilitation group received community-based rehabilitation (CBR) for 3 months, and was assessed with Community Extremity Disability Assessment Schedule before and 1 month, 2 months and 3 months after rehabilitation respectively. And it was compared with Fugl-Meyer Assessment (FMA). The control group received the same evaluation only. Results The scores of CEDA and FMA improved more in the rehabilitation group than in the control group 2 months after rehabilitation (P<0.01). The score of CEDA positively correlated with the FMA (r=0.643, P<0.01). Conclusion CEDA can be used to evaluate the efficacy of community rehabilitation.
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OBJECTIVE To understand the pathogens and their drugs resistance in general surgery department and provide rational suggestion of antibiotics use for clinic treatment.METHODS A total of 158 cases with nosocomial infection among the general surgery department inpatients from Jun 2006 to Oct 2008 were retrospectively analyzed and summarized.RESULTS The common nosocomial infection sites were the lower respiratory tract,gastrointestinal tract,urinary tract and surgical sites.The G-bacilli of nosocomial infections in turn were Escherichia coli(18.02%),Acinetobacter baumannii(11.26%),Pseudomonas aeruginosa(7.66%),and Klebsiella pneumoniae(4.50%).The main G+cocci were Staphylococcus aureus(21.62%),Enterococcus faecium(5.86%)and E.faecalis(3.15%)in turn.In G-bacilli,the sensitivity to imipenem was the highest from 58.82% to 100.00%.The sensitivity to amikacin were more than 70.00% except A.baumannii,and to sulbactam/cefoperazone were more than 50.00% except Pseudomonas aeruginosa.In G+ cocci,the sensitivity to vancomycin of S.aureus and E.faecium was 100.00% and 84.62%.CONCLUSIONS Investigating the pathogens and their drug resistance in general surgery department is very important to prevent and control nosocomial infections.
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Objective To investigate the effects of locomotor training on improving locomotor function after spinal cord injury(SCI)and the mechanism of spinal cord plasticity.Methods A model of complete thoracic cord transection was established using 84 adult female rats divided into sham,SCI and treadmill training(BWSTT) groups.The hind limb locomotor function of all the rats was evaluated.The fluorescence intensities due to (EphA4),vesicular glutamate transporter 2(VGluT2)and EphA4/VGluT2 double-positive neurons in the ventromedial area of the anterior horn of the lumbar COrd were detected using immunofluorescence double labeling and laser confocal microscopy.Results The rats in the BWSTT group showed better functional recovery in their hind limbs than those in the SCI group.BWSTT was correlated with markedly increased EphA4.VGIuT2 and EphA4/VGluT2 intensities in the ventromedial area.Conclusion BWSTT improves hind limb locomotor function in rats with thoracic cord transections by elevating the expression of EphA4/VGluT2,promoting neuronal plasticity in the lumbar anterior horn.
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@# Objective To investigate the effect of problem based learning (PBL) applied in the course of Assessment & Evaluation of Physical Therapy. Methods PBL and traditional teaching were applied in different classes. Their scores of the final examination were compared, and the students were investigated with the questionnaire. Results The scores of final examination were higher in the PBL class than that in the traditional teaching (P<0.001). A lot of the students accepted the PBL in the course. Conclusion PBL can improved the teaching quality of the course of Assessment & Evaluation of Physical Therapy.
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@#To introduce a rehabilitation program for total hip replacement (THR), including muscle strength training; rehabilitation for scar and adhesion, scoliosis, hip control, etc. The principle and the cautions were discussed.
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@#Objective To investigate whether the curative effect of Botulinum Toxic A(BTX-A) block increased and prolonged when the dose calculated according to certain formula.Methods 15 children with cerebral palsy(CP) were appointed as the trial group and the dose of BTX-A was calculated according to the designed formula.The other 58 CP children were appointed as the control group and the BTX-A dose was determined by routine method.Results After treatment,the motor function of the children in trial group was superior to that in the control group(P<0.05) and the duration of therapeutic effect of the trial group was significantly longer than the control group(P<0.001).Conclusion BTX-A dose calculated according to the formula can increase effect and prolong the duration.
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@#Objective To explore the associated factors influencing the prognosis of upper limb function and ability of activities daily living(ADL)in stroke patients with left side hemiplegia.Methods 64 stroke patients with left side hemiplegia were treated regularly last for 1 month.At admission,the assessment procedure for cognitive function were performed with scales of Mini-Mental State Examination(MMSE),Loewenstein Occupational Therapy Cognitive Assessment(LOTCA),Motor Impersistence(MI),Schenkenberg Line Bisection Test.Brunnstrom stage,Modified Barthel Index(MBI),Ueda,Bin Hemiplegic Finger Function Assessment Scale,Upper Limb Function Assessment Scale were graded for the upper limb function and ADL ability before and after training.The multinominal logistic regression analysis was used to analyze the relationship between those factors and the upper limb function and ADL ability.Results The extent of resumption of upper limb function of patients was positively correlated with the ability of formal operational thinking(P<0.01)in LOTCA score before training.However,the extent of resumption of hand was negatively correlated with MI score before training(P<0.01).The extent of resumption of the hand practicability was positively correlated with the ability of operational thinking and score of ADL in LOTCA before training(P<0.01).The extent of the resumption of ADL was positively correlated with the ability score of operational thinking in LOTCA and diseased region.It was negatively correlated with the score of Schenkenberg line bisection(P<0.01).Conclusion The ability of operational thinking in LOTCA before training and the scores of Schenkenberg line bisection,ADL and MI are helpful in prognosis for the upper limb function in stroke patients with left side hemiplegia.
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@#Objective To investigate the optimal dose of botulinum toxic A(BTX-A)for releasing spasticity of cerebral palsy(CP)and related factors.Methods 39 children with CP was treated by BTX-A injected in local muscles to release the spasticity.Results After treatment,23 children had good curative effect.In them,15 cases were male,8 cases were female,the mean age was 60.7±26.9 months(range 33 to 145 months).There was no correlation between the optimal unit dose of BTX-A and those including sex,age,body weight,diagnosis type,degree of Gross Motor Function Classification System(GMFCS),etiological factor and the injections.There was a linear positive correlation between the optimal unit dose of BTX-A and the score of Modified Ashworth Scale(MAS).Conclusion BTX-A can release the spasticity of CP children,the injecting dose is correlated with MAS score.
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Objective To explore the correlation between the time course of disease and bone metabolism changes in patients with spinal cord injury. Methods Data on serum osteocalcin(SO)measured by radioimmunoassay(RIA)from a database on 167 patients with spinal cord injury(SCI)were analyzed retrospectively.The patients were divided into four groups according to the time post-injury:group A(＜3 months post-injury,n=44),group B(3-6 months post-injury,n=42),group C(7-12 months post-injury,n=37)and group D(＞12 months post-injury,n=44). Results The mean SO value in all 4 groups of patients was significantly higher than normal.The mean SO value of group B was significantly higher than that of group A,but not significantly different from that of group C.The mean SO value of group D was significantly lower than that of group C,but not significantly different from that of group A.Conclusion Serum osteocalcin is elevated in the early stages of SCI,and its subsequent de-cline is closely correlated with the time post-injury.
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@#Objective To explore the effect of body-weight support treadmill training(BWSTT)on lower extremity muscle atrophy and ambulatory capacity in complete spinal cord injured(SCI)patients.Methods 20 patients with complete SCI at the thoracic level were divided into control and BWSTT group.They all received comprehensive rehabilitation,and patients in BWSTT group also received BWSTT for 3 months when the physical condition was permitted.They were assessed before and after treatment with measurement of thigh girth,ambulatory capacity measure of Functional Independence Measure(FIM),10 meters ambulatory velocity and activity of daily living(ADL)evaluation.Patients in BWSTT group also received middle thigh MRI examination before and after BWSTT.Results The muscles at the mid-thigh of the BWSTT group looked larger after BWSTT than before.The scores of FIM ambulatory function,the 10 miters ambulatory velocity of BWSTT group improved significantly when compared with that of the control group(P<0.05).The thigh girth and the scores of ADL were no different between these two groups before and after treatment(P<0.05).Conclusion BWSTT may ameliorate lower extremities skeletal muscle atrophy and improve ambulatory capacity for SCI patients.
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@#Objective To investigate the effect of long leg orthosis on lower limb function rehabilitation of hemiplegics.Methods38 patients with severe hemiplegia were randomized into the orthosis group(21 cases)and control group(17 cases).All patients were received rehabilitation training,but the patients in the orthosis group wearing long leg orthosis while training.They were assessed with Fugl-Meyer scale for lower limb,Berg Balance Scale,Holden functional walking scale,Modified Barthel Index before and 1 month after training.ResultsThe scores of Berg Balance Scale,Holden Functional Walking Scale and Modified Barthel Index in the orthosis group were better than those of the control group(P<0.01)1 month after training,whereas no significant difference was found in score of Fugl-Mayer Assessment(P>0.05).ConclusionIt's better for those patients with severe hemiplegia wearing long leg orthosis while training.
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@# Skeletal muscle contractile properties are determined by their myosin heavy chain (MHC) expression profiles partly. Spinal cord injury induced the adaptation change in MHC isoform mRNAs and protein expression of skeletal muscle below the injured level, leading to the increased expression of fast and decreased expression of slow MHC isoforms. The adaptations in the MHC-mRNAs preceded the changes in proteins. The degree and velocity of MHC isoform adaptation were dependent on differenrt muscle and animal species. Short-term training could not induce the significant change of the transformation of MHC isoform, whereas long-term stepping training which emphasized load bearing could attenuate the MHC shift from slow toward faster isoforms.
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@# Skeletal muscle contractile properties are determined by their myosin heavy chain (MHC) expression profiles partly. Spinal cord injury induced the adaptation change in MHC isoform mRNAs and protein expression of skeletal muscle below the injured level, leading to the increased expression of fast and decreased expression of slow MHC isoforms. The adaptations in the MHC-mRNAs preceded the changes in proteins. The degree and velocity of MHC isoform adaptation were dependent on differenrt muscle and animal species. Short-term training could not induce the significant change of the transformation of MHC isoform, whereas long-term stepping training which emphasized load bearing could attenuate the MHC shift from slow toward faster isoforms.
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@#Objective To observe the effect of low frequency vibration (LFV) on bone metabolism, bone mass density (BMD), bone histomorphometric and biomechanical characterization in rats with secondary osteoporosis (OP) after spinal cord injury (SCI).MethodsSCI model was established with 50 SD rats by transecting spinal cord completely at the level of tenth thoracic vertebra, and the animals were randomly divided into 5 groups: SCI 6-week control group, SCI 12-week control group, vibration 6-week (Vi 6w) group, vibration 12-week (Vi 12w) group and vibration 6-12 week (Vi 6-12w) group. All rats of vibration groups accepted LFV (frequency=20 Hz, acceleration=0.15 g) with 10 minutes once, twice per day, and 6 days per week. The LFV was given from the forth day postoperation to the end of the sixth week in Vi 6w group, and to the end of twelfth week in Vi 12w group, while from the seventh week postoperation to the end of twelfth week in Vi 6-12w group. All animals were sacrificed when LFV test finishied. The serum alkaline phosphatase (ALP), bone glaprotein (BGP) and serum calcium (Ca2+)/BMD of femur and the fifth lumbar vertebra (L5)/bone histomorphometric characterization of tibia/bone biomechanical characterization of femur and L5 were measured.ResultsCompared with control groups, the serum Ca2+ and BMD of promixal femur improved significantly in rats of Vi 6w group ( P<0.05), while the maximal load of L5 increased significantly in rats of Vi 12 group ( P<0.05). There were no changes in rats of Vi 6-12w group ( P>0.05).ConclusionThe early treatment of LFV may improve the secondary OP of rats with SCI, but the effect is different in different sites of rats' body. The late treatment of LFV can't improve the secondary OP, but may keep rats with SCI from deteriorating.
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@# Objective To explore the effect of low frequency vibration (LFV) on osteogenesis of bone marrow stromal cells (BMSCs) and OPG mRNA,RANKL mRNA expression.MethodsBMSCs from 10-week-old female SD rats were cultured and randomly divided into 2 groups:control group and vibration group.The BMSCs of vibration group was given LVF with 20 Hz,0.25 g,2 times/d,10 min/time for 7 days.The LFV was given from the eleventh day after BMSCs cultured.The osteogenesis and OPG mRNA,RANKL mRNA of all BMSCs in two group were tested at the end of LFV.ResultsCompared to the control groups,the BMSCs growth and proliferation improved in vibration group,but the alkaline phosphatase (ALP)activity and the number of mineral nodule did not changed significantly.The OPG mRNA elevated in vibration group,while the RANKL mRNA showed no change.ConclusionThe LFV may increase the growth and proliferation of BMSCs,which is attributed to the elevated OPG gene expression.The osteogenesis improved no significance,which may be associated with the too short vibration time.
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@#ObjectiveTo study the validity of Motor Status Score (MSS) and Fugl-Meyer Assessment Scale (FMA).MethodsThe validity of MSS and FMA was studied in 22 patients with brain injury and stroke.ResultsIt showed a strong positive correlation between MSS and FMA, and the correlation coefficient was 0.961 ( P<0.01).ConclusionMSS has a highly valid to the motor function of upper limbs after brain injury and can be used as a index for evaluation of rehabilitation of upper limbs.