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@#Objective To explore the risk of venous thromboembolism (VTE), especially lower-extremity deep vein thrombosis (DVT) and pulmonary embolism (PE), for stroke patients in rehabilitating, and the functional outcome. Methods A total of 3 557 stroke patients in the neurological rehabilitation center of Beijing Bo'ai Hospital for stroke rehabilitation from January, 2015 to October, 2020 were reviewed through the electronic medical record system. Demographic characteristics, stroke characteristics (type and location), laboratory data (D-dimer polymer and arterial partial pressure of oxygen), motor function (Brunnstrom stage, Fugl-Meyer Assessment of motor and balance, modified Ashworth Scale score of triceps crus, and Holden Walking Ability Classification), activities of daily living (Barthel Index), and anticoagulant/antiplatelet treatment data were collected and analyzed. Results The incidence of DVT and PE was 28.5% and 1.29%, respectively. Most were found 30 days later after onset. The incidence of PE was higher after ischemic stroke (χ2 = 12.49, P < 0.001) rather than hemorrhagic stroke. The patients with hemispheric stroke, severe lower-extremity paralysis, and poor activities of daily living were more prone to complications associated with VTE. After rehabilitation, the function of stroke patients with PE could be improved (|t| > 4.302, P < 0.001). Conclusion The risk of DVT and PE in patients during stroke convalescence may not be negligible, and those with older age, previous history of thrombosis, severe stroke, and severe limb paralysis may be stratified in high-risk. Following anticoagulation treatment, early individualized comprehensive rehabilitation can be done for patients with PE to improve their function and activities of daily living.
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Objective:To analyze the role of patient support system in multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment adherence and outcome, and provide evidence for deepening the patient-centered support system.Methods:Based on the stakeholder analysis, definite stakeholders (administrators from the Department of Medical Insurance, and those from the provincial CDC), expectant stakeholders (administrators from regional CDC, health workers from primary CDCs, medical workers from designated MDR/RR-TB hospitals and MDR/RR-TB patients), and latent stakeholders (MDR/RR-TB patient families and their neighbors or colleagues) were selected using a purposive sampling. These stakeholders were subject to a semi-structured interview on patient support. The inclusion of participants ceased after reaching code or thematic saturation and meaning saturation, while thematic framework analysis was applied in interview data.Results:The 25 interviewees included could be categorized into three groups of stakeholders, i. e., 4 definite stakeholders, 19 expectant stakeholders and 2 latent stakeholders. Three themes summarized in this regard were definite stakeholders providing policy support to advance these patients′ access to standardized diagnosis and treatment services; diagnosis and treatment and management support of expectant stakeholders of these patients to encourage their compliance to treatment and enable their access to high quality medical care; and support from latent stakeholders as a critical guarantee for the patients to welcome a desirable treatment outcome. Psychological support provided under MDR/RR-TB basic care program in some provinces contributed positively to raising patients′ compliance. Economic support, treatment support from family menmbers ccould help the patients to welcome desirable outcomes.Conclusions:MDR/RR-TB patient-centered support system operating in the Yangtze River delta provide the patients with MDR/RR-TB diagnostic and treatment services of some accessibility. Given the progress, there are still shortcomings for the respective stakeholders to enhance their attention and collaboration to improve the access and equity to medical service.
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Objective@#To evaluate whether midlife consumption of sugar-sweetened beverages (SSBs), including juices and soft drinks, were associated with late-life cognitive impairment in Chinese adults.@*Methods@#Follow up was conducted for participants from Singapore Chinese Health Study, a population-based prospective cohort, for 16-23 (mean 20) years. The information about their SSBs consumption were collected at baseline survey from 1993 to 1998 by using a validated food frequency questionnaire and their cognition status were evaluated by using a Singapore-modified Mini-Mental State Examination Scale in the 3rd follow-up visit during 2014- 2016. Multivariable logistic regression models were used to estimate the ORs and 95%CIs.@*Results@#A total of 16 948 participants were included in the analysis and 2 443 of them were identified as cognitive impairment using education-specific cutoffs. Sex, age, ancestral home, education level, physical activity level, total diet fiber intake level, BMI, alcohol drinking were significantly associated with cognitive impairment (P<0.05). After adjusted the above variables, potential dietary variables and disease status, no significant association was observed between SSBs consumption and cognitive impairment (P>0.05). Compared with those who never or hardly ever drank soft drinks, no significant differences in cognitive impairment risk were observed for those who drank soft drinks 2 or more times a week (OR=0.91, 95%CI: 0.77-1.08), those who drank 1 time a week (OR=1.00, 95%CI:0.82-1.23) and those who drank 1-3 times a month (OR=0.94, 95%CI: 0.80-1.09) (trend P=0.306). Compared with those who never or hardly ever drank juices, no significant differences in cognitive impairment risk were observed for those who drank juices 2 or more times a week (OR=1.03, 95%CI:0.88-1.20), those who drank 1 time a week (OR=0.96, 95%CI: 0.82-1.12) and those who drank 1-3 times a month (OR=0.94, 95%CI: 0.82-1.08) (trend P=0.930). No significant interactions were found with age, sex, and BMI status.@*Conclusion@#SSBs consumption in midlife was not significantly associated with risk of late-life cognitive impairment in Singaporean Chinese adults with relatively low consumption levels. Further researches are needed to verify the results.
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Objective:To study the expressione of autophagy-related protein Beclin-1 and LC3 in cortex and hippocampus of rats after cerebral ischemia reperfusion injury and the efficacy of Edaravone.Methods:Sprague Dawley rats were randomly divided into sham group,model group and Edaravone group.The cerebral ischemia reperfusion model was induced via Zea Longa with blocking the middle cerebral artery of 2 h and reperfusing of 24 h.Animals assigned to sham group were only separated left common carotid artery.Edaravone was injected intraperitoneally at a dose of 1 0 mg/kg at 15 min before reperfusion.The condition of nerve injury of rats was conducted by Neurobehavioral score.The degree of brain injury and success of model were determined based on 2,3,5-triphenyltetrazolium chloride(TTC)staining.The changes of neuron stained by hematoxylin and eosin (HE) in cortex and hippocampus were observed.The expression of Beclin-1 and LC3 was measured by immunohistochemistry.Results:After cerebral ischemia reperfusion the neurobehavioral score of edaravone group was(2.00± 0.67),which was obcviously less than(2.50± 0.53) of model group(P＜0.05).The infraction focus and the neuron injury in cortex and hippocampus neurons were also observed in model group,and the edaravone group reduced above expression.The positive rate of Beclin-1 of each group in cortex were (1 1.08± 0.85)％,(33.42± 1.57)％ and (25.61± 1.39)％,there was significant difference between model group with sham group and edaravone group (P＜0.05).The positive rate of Beclin-1 of each group in hippocampus were (10.34± 0.21)％,(31.82± 1.73)％ and (22.74± 1.26)％,there was significant difference between model group with sham group and edaravone group(P ＜ 0.05).The positive rate of LC3 of each group in cortex were (15.33± 0.47)％,(39.72± 1.73)％ and (28.53± 1.61)％,there was significant difference between model group with sham group and edaravone group(P＜0.05).The positive rate of LC3 of each group in hippocampus were (13.74± 0.37)％,(32.53± 1.43)％ and(25.38± 1.23)％,there was significant difference between model group with sham group and edaravone group (P＜0.05).Conclusion:The expression of Beclin-1 and LC3 was increased after cerebral ischemia reperfusion.Edaravone may reduce autophagy and brain injury through downregulation the expression of Beclin-1 and LC3.
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Objective To observe the effect of rhythmic auditory stimulation (RAS) on gait of stroke hemiplegic patients. Methods From April, 2014 to April, 2015, eleven stroke hemiplegic patients were divided into RAS group (n=6) and control group (n=5) randomly. Both groups accepted routine rehabilitation, and the RAS group accepted RAS walking exercise, while the control group accepted verbal in-structed walking exercise. They were tested with Brunnstrom's Stage and gait analysis before and three weeks after training. Results There was no significant increase in Brunnstrom's Stage (Z0.05) in both groups after training. The RAS group increased in stride length, velocity and cadence (t>4.829, P0.05). Conclusion Walking exercise under RAS facilitates to improve gait in stroke hemiplegic patients.
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Objective To explore the effect of exercise training on learning and memory ability in rats with focal cerebral ischemia, and to analyze the changes of brain tissue structure of rats after exercise training through diffusion tensor imaging (DTI). Methods Twenty-four SPF male Sprague-Dawley rats were randomly divided into sham operation group (n=8), natural recovery group (n=8) and exercise training group (n=8). The left middle cerebral artery occlusion (MCAO) model was established. The exercise training group received running wheel training 24 hours after modeling, for 14 days. All groups were tested by the Morris water maze 15 days after modeling. The latency in the navigation experiment, as well as the first latency, boundary swimming time ratio, the boundary swimming distance ratio, the average speed and the swimming path in the space exploration experiment were recorded. Four rats with similar Longa scores in each group received rou-tine magnetic resonance imaging and DTI scanning, the fractional anisotropy (FA), axial diffusivity (λ‖), and radial diffusivity (λ⊥) of isch-emic cortex and hippocampal lesion and contralateral side were measured. Results In the navigation experiment, the latency of three groups showed a downward trend along with training days (P0.05), while it was shorter in the exercise train-ing group than in the natural recovery group in the same time (P2.627, P2.521, P0.05). The swimming paths in the exercise training group and the sham operation group were better than that of the natural recovery group. The FA and rFA in the left cortical area were higher in the sham operation group than in the exercise training group and the natural recovery group (P0.05). There was no significant difference in the FA in the right cortical area among three groups (F=0.532, P=0.607). Theλ⊥,λ‖, rλ‖and rλ⊥in the left cortical area were lower in the sham opera-tion group than in the natural recovery group (P0.05). There was no significant difference in theλ⊥andλ‖in the right cortical area among three groups (F0.05). There was no significant difference in the FA,λ⊥,λ‖and rFA, rλ⊥and rλ‖in the bilateral hippo-campal interest area among three groups (F0.05). The rFA, rλ‖, rλ⊥and leftλ⊥ were correlated with the latency in the space ex-ploration experiment in the Morris water maze test (P<0.05), in which the correlation coefficient of rλ⊥was the highest (r=0.761, P<0.01). Conclusion Proper exercise training can improve the learning and memory ability of rats with focal cerebral ischemia, and can promote the repair of nerve fiber damage and reduce the vascular edema. In addition, the rFA, rλ‖, rλ⊥andλ⊥of ischemic cortex may be predictors of cognitive function recovery in rats after focal cerebral ischemia, especially rλ⊥.
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Objective To explore the effects of early exercise on motor function and the mechanism in rats after focal cerebral ischemia. Methods 21 Sprague-Dawley male rats were divided into control group (n=7), natural recovery group (n=7) and exercise training group (n=7), and the latter 2 groups were modeled with middle cerebral artery occlusion. The exercise training group received wheel running exercise 24 hours after modeling for 14 days. They were assessed with Rogers score and beam balance test 21 days after modeling. 4 rats in each group received routine MRI and diffusion tensor imaging (DTI) scanning. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of ischemic (L) and contralateral side (R) were measured, and the rate of them (L/R, r) was calculated. Results There was significant difference in Rogers score among the groups (Z=-0.786, P0.05). Beam balance score of the natural recovery group was significantly different from the control group and the exercise training group (F=38.11, P0.05). The LFA of the natural recovery group was significantly different from the control group (P0.05);while the rFA of the natural recovery group was significantly different from the control group and the exercise training group (F=19.30, P0.05). LFA and rFA strongly correlated with all the behavior scores (r=-0.90--0.70, P0.05). DTT showed that the direction and density of neural fibers were significantly asymmetrical in the natural re-covery group and the exercise training group, and more symmetrical in the exercise training group. Conclusion Early exercise can promote the neural functional recovery in rats after focal cerebral ischemia, which may associate with the improve of conduction of fibers.
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BACKGROUND:Periprosthetic joint infection is a complication that is difficult to deal with after joint arthroplasty. Early diagnosis is the key to treatment. To find a fast response, high-sensitivity and high-specificity molecular biomarker can significantly optimize the diagnosis process of periprosthetic joint infection. OBJECTIVE:To monitor blood procalcitonin, interleukin-6 and lipopolysaccharide binding protein levels, to compare with blood leukocyte count and C-reactive protein levels, to identify above indexes, and to distinguish sensitivity and specificity of periprosthetic joint infection. METHODS: A total of 81 patients with pain after arthroplasty who were treated in Affiliated Hospital of Jining Medical Colege from January 2008 to December 2013 were enroled in this study. The repair surgery of al patients was divided into two stages. In the first stage, complete debridement and the instalation of temporary occupancy device were conducted. After 3 months averagely, two-phase reconstruction was performed. At 1 day before surgery, venous blood was colected. Calcitonin, interleukin 6, lipopolysaccharide binding protein, leukocyte count and C- reactive protein levels were detected. During the operation, synovial membrane and sample of false envelope around the prosthesis were colected. Bacterial and histological examinations were performed. The sensitivity and specificity were calculated using receiver operating characteristic curve. RESULTS AND CONCLUSION: One-way analysis of variance results showed that the receiver operating characteristic curve of lipopolysaccharide binding protein was bigger, 0.962; 95 confidence interval 0.924-1.000. Diagnostic value was optimal, and the critical value was 23.5 μg/L. These data suggested that when lipopolysaccharide binding protein exceeded 23.5 μg/L before surgery, periprosthetic joint infection would be identified. The receiver operating characteristic curve of C-reactive protein was 0.871. The receiver operating characteristic curve of leukocytes was close to 0.5. The diagnostic value of leukocyte count on periprosthetic joint infection was not great. These findings indicate that lipopolysaccharide binding protein has good application prospect in the diagnosis of periprosthetic joint infection after joint replacement, and shows high positive predictive rate and negative predictive rate of periprosthetic joint infection.
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Objective To evaluate the biomechanical effect of horizontal, vertical, and cruciate suture repairs and partial meniscectomy on contact mechanics. Methods Control group (complete meniscus), buckethandletear group and suture repaired group were recorded. The contact map of the control group was firstly recorded; simulated bucket handle medial meniscal tears were then created. Tears were treated with 1 of 3 suture repair techniques or partial meniscectomy. The 24 samples were treated randomly and thus there were 6 samples evaluated for every operation method. Instantaneous contact area (CA), mean contact pressure (MCP), and peak contact pressure (PCP) measurements were recorded with a pressure sensing system. CA, MCP, and PCP for intact stifles (control), stifles with simulated tears, and stifles after treatment were recorded and compared using 1-way repeated measures ANOVA. Results Stifleswithbuckethandletearshadsignificantlydecreased CA, increased MCP and increased PCP when compared with control group. All meniscal repair techniques reestablished normal contact mechanics. When comparing meniscal repair and partial meniscectomy, stifles with partial meniscectomy had lower CA, higher MCP and PCP than stifles undergoing repair (P = 0.851 and 0.987, respectively). Conclusions Contact mechanics obtained from each repair technique were mechanically superior to partial meniscectomy. Performing meniscal repair instead of partial meniscectomy with select meniscal tears may mitigate the development of degenerative joint disease.
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BACKGROUND:Failure of anterior cruciate ligament reconstruction can be caused by multiple factors, which requires a revision surgery. However, there are few studies about the revision of anterior cruciate ligament. OBJECTIVE:To investigate the primary cause, indication, methods and effectiveness of revision after the failure of anterior cruciate ligament reconstruction. METHODS: Thirty patients with instability undergoing anterior cruciate ligament reconstructions were subjected to revision under arthroscopy. After revision, a systemic analysis was performed based on KT-2000 examination, the International Knee Documentation Committee (IKDC) scale, Lysholm and Tegner scores. RESULTS AND CONCLUSION:Of the 30 cases, 9 cases were reconstructed with bone-patelar tendon-bone autograft, 14 cases with hamstring tendon autograft, 7 cases with hamstring tendon alograft. Twelve cases had a femoral tunnel in the front of the predicted one, 1 case had knee stiffness, 8 cases had a tibial tunnel in the front of the predicted one, and 8 cases had both the femoral and tibial tunnels in the front of the predicted ones. One case had a malposited interference screw which reconstructed with bone-patelar tendon-bone autograft; one case complicated by posteromedial corner injury was not reconstructed. The reconstructed anterior cruciate ligament was absolutely ruptured and absorbed in 12 cases, and 18 cases had obviously loosen but stil partly linked reconstructed ligament. None had severe incompletion of spongy bone. Al cases received primary revision. Ten cases reconstructed with ipsilateral hamstring tendon, 14 cases reconstructed with contralateral hamstring tendon, and 6 cases with LARS ligament. The mean side-to-side difference of KT-2000 examination at 90° and 30°, the mean IKDC, Tegner and Lysholm scores were significantly improved after revision. There were many reasons leading to failure of anterior cruciate ligament reconstruction, such as malposition of the bone tunnel, invalid fixation, adhesion, compound ligament injuries, and ankylosis. The functional results and objective stability could be obtained through revision folowing anterior cruciate ligament reconstruction.
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Objective To explore.the effect of operative treatment for more than 70-year-old patients with osteoporotic hip fracture,and analyze the clinical feature,perioperative management and choices of operative treatment.Methods One hundred and fifty-nine patients of more than 70-year-old with osteoporotic hip fracture were operated from June 2007 to October 2010.Fracture type:38 cases with intertrochanteric fracture while femoral neck fracture in 121 cases.Results One hundred and thirty-five cases were followed up after operation ranging from 3 to 43 months.There were 2 cases by proximal femur nail internal fixation,13 cases by proximal femur locked plate internal fixation,15 cases by dynamic hip screwinternal fixation,48 cases by bipolar femoral head arthroplasty and 57 cases by total hip arthroplasty.The Harris scores of various surgical method above respectively were 100.0％ (2/2),76.9％ ( 10/13 ),80.0％(12/15),89.6％ (43/48),96.5％ (55/57).Conclusions The operation plays an important role in the treatment of elderly osteoporotic hip fracture,having so many advantages as earlier mobilization,less complications and better life quality.But it is important to pay attention to perioperative management and choose reasonable surgical approach according to classification of fracture.